Chapter 4 - Birth and Newborn Baby Flashcards Preview

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Stage 1: Dilation and Effacement of the Cervix

Dilation and effacement of the cervix: widening and thinning of the cervix during the first stage of labour This stage lasts an average of 12 to 14 hours with the first birth and 4 to 6 with later births


Stage 1: Dilation and Effacement of the Cervix Contractions

Uterine contractions gradually become more frequent and powerful, causing the cervix to widen and thin Contractions start out about 10 to 20 minutes apart and initially last about 15 to 20 seconds They get gradually closer together, occurring every 2 to 3 minutes, lasting up to 60 seconds, and are much stronger at this point


Stage 1: Dilation and Effacement of the Cervix Transition

Transition: climax of the first stage of labour, in which the frequency and strength of contractions are at their peak and the cervix opens completely It’s important to keep Mom as relaxed as possible here; if she pushes too soon, she may bruise the cervix and slow the progress of labour


Stage 2: Delivery of the Baby Before Crowning

This stage lasts about 50 minutes for a first baby and 20 minutes in later births Strong contractions continue, and Mom begins to push with each contraction, forcing the baby out and down


Stage 2: Delivery of the Baby Crowning

Crowning: we say the baby is crowning when the vaginal opening has stretched around the entire head


Stage 2: Delivery of the Baby After Crowning

After crowning, the baby’s head, then upper body, trunk, and finally legs, emerge Baby is wet with amniotic fluid, and still attached to the umbilical cord Once the cord stops pulsing, it’s clamped and cut


Stage 3: Birth of the Placenta

This stage lasts only about 5 to 10 minutes The placenta separates from the wall of the uterus and is delivered


The Baby’s Adaptation to Labour and Delivery

During labour, Baby produces high levels of stress hormones o This sends a rich supply of blood to the brain and heart, preventing the periods of oxygen deprivation during the contractions from causing damage o Causes the lungs to absorb any remaining fluid and expand the bronchial tubes, which helps Baby breathe effectively after birth o Arouses Baby into alertness


The Newborn Baby’s Appearance

The average newborn o Is 20 inches long o Weighs about 7.5 lbs o Has a large head in comparison to the trunk and legs o Has short, bowed, legs o Is likely to have a flattened nose and a misshapen head, if birth proceeded naturally


Apgar Scale

A rating used to assess the newborn baby’s physical condition immediately after birth and five minutes later. 7 or higher is good physical condition. 4-6 means the baby needs assistance. 3 or below is serious danger and needs emergency care. o 77% of newborns receive a score of 8-10, o 17% score 3-7 o 6% score 0-2 Criteria: heart rate, respiratory effort, reflex irritability, muscle tone, colour


Natural, or prepared, childbirth

Natural, or prepared, childbirth - an approach designed to reduce pain and medical intervention and to make childbirth a rewarding experience for parents Most natural childbirth programmes draw on methods developed by Grantly Dick-Read and Fernand Lamaze, both of whom believed that childbirth had become more painful for women due to the fear and tension we’d been taught to experience Mother who use natural child birth feel more in control, more positive and use less pain medication.


Natural, or Prepared, Childbirth Typically, Mom and a companion participate in…

o Classes, in which they learn about the anatomy and physiology of labour and delivery o Relaxation and breathing techniques aimed at counteracting the pain of uterine contractions o Labour coach, in which Mom’s companion learns how to help Mom during childbirth by reminding her to relax and breathe, massaging her back, supporting her body, and offering encouragement and affection


Natural, or Prepared, Childbirth Social Support

The social support that is a routine part of natural childbirth appears to make a large difference. Doula = birthing support person Mothers with more social support o interact more positively with their babies o are less likely to need a cesarean delivery o have babies with higher Apgar scores


Natural, or Prepared, Childbirth upright, sitting position

During natural childbirth at a birth centre or home, Mom may give birth in an upright, sitting position The upright position makes pushing easier and more effective, shortening the duration Blood flow to the placenta is increased, providing Baby with a richer oxygen supply Permits for partner to sit behind and suport Mom’s ability to see the delivery can help her to tract the effectiveness of each contraction of pushing Baby out of the birth canal


Natural, or Prepared, Childbirth Water births

Water births have become more popular Warm water supports Mom’s weight, relaxes her, and provides her with the freedom to shift positions as she needs Associated with a shorter labour, a lower episiotomy rate, and a greater likelihood of a medication-free delivery than are other methods


Home Delivery

Home deliveries are common in some industrialized nations, but only about 1% of North American mothers choose this method Some home births are attended by doctors, but most are attended by certified nurse-midwives, who have degrees in nursing and additional training in childbirth For healthy women who are assisted by a well-trained doctor or midwife, home births appear to be as safe as hospital birth If attendants are not well-trained or Mom is at risk for complications, hospitals are safer


Medical Interventions

Medical interventions are used sometimes in both industrialized and nonindustrialized cultures In North America, medical interventions are very common o This is partially because there are more multiple births and high-risk deliveries in the past (because of less miscarages) o But even births without risk factors are often highly medicalized here Types of medical interventions • Fetal monitoring – electrical insterments that track babys heart rate. • Labor and delivery medications • Instrument delivery – forceps, vacuum extractor - not used frequently anymore – risk of brain damage, head and eye bleeding • Induced labor – started artificially – synthetic oxytocin starts the contractions – number of ID has doubled (likely do to convenience) – it is done if baby or mothers health is threatened – contractions are longer, harder, and closer together (mother feels less control and more meds are used) – risk on inadequate oxygen to baby – higher chances of instrument delivery - • Caesarean delivery


Common delivery medications

analgesics anesthetics


Epidural analgesia

is the most common method used during labour, in which a regional pain-relieving drug is delivered via catheter into a small space in the lower spine Whereas older spinal block procedures numbed the entire lower half of the body, this newer technique affects the pelvic region only, so Mom can still feel contractions and can still push


issues with the use of delivery medication

Epidural analgesia does weaken uterine contractions, so labour is prolonged Drugs cross the placenta, so exposed newborns tend to have lower Apgar scores, to be sleepy and withdrawn, to suck poorly during feedings, and to be irritable when awake There is controversy over whether or not there are long-term negative effects


Cesarean delivery

a surgical delivery in which the doctor makes an incision in the mother’s abdomen and lifts the baby out of the uterus This accounts for about 19% of births in Canada Once a cesarean has been performed, later vaginal births are discouraged o A natural labour after a cesarean is associated with slightly increased rates of rupture of the uterus and infant death, particularly if labour is induced Note that recovery time following a cesarean is longer than after natural childbirth Also note that pain medication is necessary during a cesarean, and will affect Baby as well


Cesarean delivery is commonly performed when

There is an Rh incompatibility There is premature separation of the placenta from the uterus Mom has an illness, such as herpes simplex 2, which can infect Baby during vaginal delivery Breech position – baby turned so that the buttock or feet would be delivered first – bad because: possibility of pinched umbilical cord which would deprive the baby of oxygen o This position can increase the risk of oxygen deprivation and of head injuries


Birth complications are more likely when Mom is …

Is in poor health Doesn’t receive good medical care Has a history of pregnancy problems


Cerebral palsy

Variety of impairments in muscle coordination caused by brain damage before, during, or right after birth


Some examples of birth complications are…

Inadequate oxygen A pregnancy that ends too early or too late A baby who is born underweight


Some potential causes of anoxia are

• Placenta abruptio(n), premature separation of the placenta • Placenta previa, a condition caused by implantation of the blastocyst so low in the uterus that the placenta covers the cervical opening; part of the placenta may detach during the third trimester as the cervix begins to dilate and efface


Respiratory distress syndrome

a disorder of preterm infants in which the lungs are so immature that the air sacs collapse, causing serious breathing difficulties



Inadequate oxygen supply


Oxygen Deprivation

Oxygen deprivation can also occur if Baby fails to start breathing within a few minutes after birth Cell death can occur for several hours after oxygen deprivation has occurred Researchers are experimenting with technology to cool the brain by several degrees for a few days after birth for anoxic newborns, as a way to reduce brain damage


Long term consequences of Oxygen Deprivation

Anoxia during labour and delivery is associated with poorer cognitive and language skills in early and middle childhood Many children improve over time, with the severity of the effects depending on the severity of the deprivation