Chapter 4- Birth And The Newborn Baby Flashcards Preview

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Flashcards in Chapter 4- Birth And The Newborn Baby Deck (123):

During stage one of childbirth, the longest lasting stage which lasts an average of 12 to 14 hours with the first birth and 4 to 6 hours with later births, this occurs, as uterine contractions gradually become more frequent and powerful, they cause the cervix to open (dilate) and thin (efface) forming a clear channel from the uterus into the birth canal or vagina

Dilation and effacement of the cervix


This is the climax of stage one in which the frequency and strength of contractions are at their peak and the cervix opens completely, this brief phase is called



Stage two, delivery of the baby, lasts about ___ minutes for a first baby and ___ minutes in later births

50, 20


In which stage of labor does the mother feel a natural urge to squeeze and push with her abdominal muscles?

Stage two, delivery of the baby


In which stage of labor does the baby head crown, the vaginal opening stretches around the entire head

Stage two


During which stage of labour do contractions cause the cervix to open and dilate

Stage one


Which stage of birth last about 15 minutes for a first baby?

Stage two, delivery of the baby


In this stage of labor, the baby is born

Stage two


During this stage, the placenta separates from the wall of the uterus and the placenta is delivered

Stage 3, birth of the placenta


This stage of labor brings labor to an end

Stage 3, delivery of the placenta


This stage of labor last 12 to 14 hours with a first birth

Stage one, dilation and effacement of the cervix


How long and heavy is the average newborn baby?

20 inches long and 7 1/2 pounds in weight


Why is the newborns head large in comparison to the trunk and legs?

Babies have well-developed brains which means that they can learn quickly in the first few months of life but cannot get around on their own


List the five characteristics assessed by the Apgar scale

Heart rate, respiratory effort, reflex irritability (sneezing, coughing, grimacing), muscle tone, color

Babies are given a rating add one minute and again at five minutes after birth.


On the Apgar scale, a score of ___ or better indicates that the infant is in good physical condition; a score between ___ and ___ indicates that the baby requires special assistance; a score of ___ or below indicates a dire emergency

7; 4 and 6; 3


True or false: in many village and tribal cultures, expectant mothers know very little about the childbirth process

False, expectant mothers are well acquainted with the child birth process


Explain how childbirth practices have changed over time in Western societies

Before the late 1800s, birth usually took place at home and was a family centered event. The industrial revolution brought greater crowding to cities, along with new health problems and as a result, childbirth moved from home to hospital, where the health of mothers and babies could be protected. Once doctors assumed responsibility for childbirth, women's knowledge of it declined, and relatives and friends no longer participated.

By the 1950s and 1960s, woman had begun to question the medical procedures that had come to be used routinely during labor and delivery, many felt that routine use of strong drugs and delivery instruments had rob them of a precious experience and was often neither necessary nor safe, and a natural childbirth movement arose in Europe and spread to North America to make hospital birth as comfortable and rewarding for mothers as possible


What is the goal of natural childbirth?

Reducing pain and medical intervention and making childbirth as rewarding an experience as possible


List and briefly describe three features of a typical natural childbirth program

The expectant mother and a companion participate in three activities:

Classes: learn about the anatomy and physiology of labor and delivery which reduces a mothers fear

Relaxation and breathing techniques: during these classes, relaxation and breathing exercises are taught to help counteract the pain of uterine contractions

Labor coach: the companion learns how to help the expectant mother during childbirth by reminding her to relax and breathe, massaging her back, supporting her body, and offering encouragement and affection


Do mothers who go through natural childbirth have more or less favorable attitudes toward the child birth experience than those who do not?

They have more favorable attitudes toward the child birth experience because they feel more in control and they also feel less pain


What are the benefits of social support during childbirth?

Having a Doula or a trained lay attendant, helps mothers have fewer birth complications and labors that are several hour shorter. These women also interacted more positively with their babies after delivery

Support during labor also has the benefit of mothers less often having instrument assisted or cesarean deliveries or needing medication to control pain. Their babies Apgar scores are higher, and they are more likely to be breast-feeding at a two month follow-up


Name the childbirth position favored by research findings, and the benefits of using this position

The sitting position

Labor is shortened because pushing is easier and more effective, the baby benefits from a richer supply of oxygen because blood flow to the placenta is increased. Because the mother can see the delivery, she can track the effectiveness of each contraction in pushing the baby out of the birth canal. Helps to ensure that the babies head and shoulders emerge slowly, which reduces the chances of tearing the mothers tissues and the need for an episiotomy. Less likely to use pain relieving medication


True or false: most doctors discourage the water birth method, as it increases the risk of anoxia

False, as long as water birth is carefully managed by health professionals, it poses no additional risk of infection or safety to mothers are babies. The water burger supports her weight, relaxes her, and provides her with the freedom to move into any position she finds most comfortable


You or false: more than 10% of American women choose to give birth at home

False, the number of women choosing to have their babies at home is less than 1%


Homebirth are typically handled by certified _________, who have degrees in nursing and additional training in childbirth management



Electronic instruments that track the babies heart rate during labor. An abnormal heartbeat pattern may indicate that the baby is in distress due to lack of oxygen and needs to be delivered immediately

Fetal monitors


What are four reasons that fetal monitoring is a controversial procedure?

In healthy pregnancies, it does not reduce he already low rates of infant brain damage and death

Most infants have some heartbeat irregularities during labor and many babies may be identified as being in danger when they are not

Link to an increase in the number of instrument and cesarean deliveries

Some women complain that the devices are uncomfortable and interfere with the normal course of labor


True or false: some form of medication is used in more than 80% of US births



_________ are drugs given in mild doses to relieve pain during labor, while _________ are a stronger type of painkiller that blocks sensation

Analgesic; anesthetic


This is the most common approach to controlling pain during labor, in which a regional pain-relieving drug is delivered continuously through a catheter into a small space in the lower spine. Limits pain reduction to the pelvic region

Epidural analgesia


What are two problems associated with routine use of labor and delivery medication

Epidural analgesia weakens uterine contractions and as a result, labor is prolonged and the chances of cesarean delivery increase

Because drugs rapidly cross the placenta, exposed newborns tend to have lower Apgar scores, to be sleepy and withdrawn, to suck poorly during feedings, and to be irritable when awake


My Baby Dino so aww sum

Yup very tw rue


Metal clamps placed around the babies head to pull the infant from the birth canal. Have been used since the 16th century to speed up delivery



Consists of a plastic cup placed on the babies head attached to a suction tube

Vacuum extractor


In what circumstance is delivery with forceps or a vacuum extractor appropriate?

If the mother's pushing during the second stage of labor does not move the baby through the birth canal in a reasonable period of time


What are the risks associated with instrument delivery using forceps and vacuum extraction?

Forceps: greatly increases the risk of brain damage. Low-forceps delivery when the baby is most of the way through the vagina, is associated with risk of injury to the babies head and the mothers tissues

Vacuum extractors: less likely to tear the mothers tissues but cup suction does cause bleeding beneath the baby's skin and on the outside of the skull. Can cause more serious complications, including bleeding within the eye and beneath the school which can cause brain damage in 5% of cases


Labor that is started artificially, usually by breaking the amnion, or bag of waters, and giving the mother synthetic oxytocin, a hormone that stimulates contractions

Induced labor


Describe two ways that an induced labor differs from a naturally occurring labor

With induced labor, contractions are longer, harder, and closer together, increasing the possibility of inadequate oxygen supply to the baby. Mothers often find it more difficult to stay in control of an induced labor, even when they have been coached in natural childbirth and as a result labor and delivery medication is likely to be used in larger amounts, and the chances of instrument delivery are slightly greater


A surgical birth; the doctor makes an incision in the mothers abdomen and lifts the baby out of the uterus

Cesarean delivery


In what circumstances is a cesarean delivery warranted?

Medical emergencies, such as Rh incompatibility, premature separation of the placenta from the uterus, or serious maternal illness or infection. Also justified when babies are in breech position, turned so that the buttocks or feet would be delivered first


A natural labor after a cesarean is associated with slightly ________ rates of rapture of the uterus and infant death



A general term for a variety of impairments in muscle coordination caused by brain damage before, during, or just after birth. The disorder can range from very mild tremors to severe crippling and mental retardation

Cerebral palsy


In adequate oxygen supply during the birth process



Placenta ________ refers to a premature separation of the placenta, whereas placenta _________ refers to a detachment of the placenta resulting from implantation of the blastocyst so low in the uterus that the placenta covers the cervical opening

Placenta abruptio, placenta previa


True or false: the vast majority of children who experience anoxia display lifelong impairments in cognitive and linguistic skills

False, the greater the oxygen deprivation, the poor children's cognitive and language skills will be in early and middle childhood. Although affects of even mild to moderate anoxia often persist, many children improve over time


Infants born more than six weeks early are at risk for this, a condition in which the babies lungs are so poorly developed that the air sacs collapse, causing serious breathing difficulties

Respiratory distress syndrome. Today mechanical respirators keep many such infants alive but many suffered permanent brain damage and their delicate lungs are harmed by the treatment itself


Babies are considered premature if they are born ___ weeks or more before the end of a full 38 week pregnancy or if they weigh less than ____ pounds

Three weeks; 5 1/2 pounds


True or false: birthweight is the best available predictor of infant survival and healthy development



List the problems associated with low birth weight that persist through childhood and adolescence and into adulthood

Brain structural abnormalities, frequent illness, inattention, overactivity, sensory impairments, poor motor coordination, language delays, low intelligence test scores, deficits in school learning, and emotional and behavioral problems.


What population is the rate of premature birth highest and why

Poverty-stricken women because they are more likely to be under nourished, under stress, and exposed to other harmful environmental influences. They often do not receive the prenatal care necessary to protect their vulnerable babies


These infants are born several weeks or more before their due date. Although they are small, their weight may still be appropriate, based on time spent in the uterus

Preterm infants


These infants are below their expected wait considering the length of the pregnancy. Some are actually full-term and others are preterm babies who are especially underweight

Small-for-date infants


Do preterm or small for date infants usually have more serious problems?

Small-for-date infants usually have more serious problems, such as they are more likely to die, catch infections, and show evidence of brain damage. They are smaller in stature, have lower intelligence test scores, are less attentive, achieve more poorly in school, and are socially immature


How do the characteristics of preterm infants affect the behavior of parents?

Preterm babies are very small, sleepy and unresponsive, and suck poorly and when they are awake they are usually irritable

The appearance and behavior of preterm babies can lead parents to be less sensitive and responsive in caring for them. They are less often held close, attached, and talked to gently. At times, mothers of these infants resort to interfering pokes and verbal commands, in an effort to obtain a higher level of response from the baby.


What are interventions for preterm infants?

Cared for in a special plexi gas in the closed bed called and I select. Temperatures carefully controlled and to help protect the baby from infection, air is filtered before it enters the Isolette. When a preterm infant is fed through a stomach tube, breeze with the aid of a respirator, and receive medication through an intravenous needle, that isolate can be very isolating indeed


In developing countries where hospitalization is not always possible, this type of care is the most readily available intervention for promoting the survival and recovery of preterm babies. It involves placing the infant in a vertical position between the mothers breasts or next to the fathers chest so the parents body functions as a human incubator

Kangaroo care

Fosters improve oxygenation of the babies body, temperature regulation, sleep, breast-feeding, alertness, and infant survival. Provides the baby with gentle stimulation of all sensory modalities. Mothers and fathers practicing kangaroo care feel more confident about caring for their fragile babies, interact more sensitively and affectionately, and feel more attached to them


True or false: research suggests that all preterm children, regardless of family characteristics, require continuous, high-quality interventions well into the school years in order to maintain developmental gains

False, for parents with the economic and personal resources to care for a preterm infant, just a few sessions of coaching in recognizing and responding to the baby's needs are linked to better outcomes for the baby. Whereas infants living in stressed, low income households need long-term intensive intervention


The number of deaths in the first year of life per 1000 live births-is an index used around the world to assess the overall health of a nation's children

Infant mortality


True or false: African-American and Native American infants are more than twice as likely as white infants to die in the first year of life



The rate of death within the first month of life

Neonatal mortality


List the two leading causes of neonatal mortality

Serious physical defects, most of which cannot be prevented. Low birth weight


What are the factors largely responsible for the relatively high rates of infant mortality in the United States?

Widespread poverty and weak healthcare programs for mothers and young children


What are factors linked to lower infant mortality rates?

Government sponsored health care benefits, prenatal visits, professional health visits to the home to provide counseling about infant care and to arrange continuing medical services, paid employment leave


In the Kauai longitudinal Study, what factors predicted long term difficulties following birth trauma and what factors predicted favorable outcomes?

Likelihood of long-term difficulties increased if birth trauma was severe. But I'm on mildly to moderately stress children, that was going up instable families did almost is well on measures of intelligence and psychological adjustment as those with no birth problems. Those exposed to poverty, family disorganization, and mentally ill parents often develop serious learning difficulties, behavior problems, and emotional disturbance


True or False: the Kauai Study tells us that as long as birth injuries are not overwhelming, a supportive home can restore children's growth



True or false: fathers provide their infants with as much stimulation and affection as mothers do



True or false: the parent-infant relationship requires close physical contact in the hours immediately following birth

False, current evidence shows that the human parent-infant relationship does not depend on a precise, early. Of togetherness for bonding, or feelings of affection and concern for the infant


Hospitals can offer this, in which the infant stays in the mother's hospital room all or most of the time

Rooming in


And inborn, automatic response to a particular form of stimulation. The newborns most obvious organized patterns of behavior



With this reflex, the infant quickly close his eyelids to protect them from strong stimulation

Eye blink


This reflex help the infant find the nipple



This reflects permits feeding



This reflex helps infant survive if dropped into the water



This reflects in human evolutionary past, may have helped infant cling to mother



This reflex prepares infant for voluntary grasping. Spontaneous grasp of adults finger

Palmar grasp


This reflects may prepare infant for voluntary reaching. Infantilize in a fencing position, one arm is extended in front of eyes on side to his head is turned other arm is flexed

Tonic neck


This reflex prepares infant for voluntary walking



This reflex cause the toes to fan out and curl when the sole of the infants foot is stroked



Briefly explain the adaptive value of newborn reflexes

Some reflexes have survival value. For instants the rooting reflex helps a breast-fed baby find the mothers nipple and the only display it when hungry and touched by another person. The swimming reflex helps them to survive in water. The moral reflex would have help infants cling to their mothers when they were carried about all day.


Explain how some reflexes form the basis for complex motor skills that will develop later

The tonic neck reflex may prepare the baby for voluntary reaching, being in the fencing position mean courage them to combine vision with our movements and eventually reach for objects.

Certain reflexes such as the Palmer grasp, swimming, and stepping drop out early, but the motor functions involved are renewed later. Stepping reflex helps to prepare the baby for walking


When do most newborn reflexes disappear?

Most newborn reflexes disappear during the first six months. Researchers believe that this is due to a gradual increase in voluntary control over behavior at the cerebral cortex develops


Explain the importance of assessing newborn reflexes

He flexes can reveal the health of the babies nervous system. Week or absent reflexes, overly rigid or exaggerated reflexes, and reflexes that persist beyond the point in development when they should normally disappear can signal brain damage


Degrees of sleep and wakefulness that newborn infants move in and out of throughout the day and night

States of arousal


During this state, the infant is at full rest and shows little or no body activity. The eyelids are closed, no I movements occur, the face is relaxed, and breathing is slow and regular

Regular or NREM sleep


During this infant state of arousal, gentle limb movements, occasional stirring, and facial grimacing occur. Although the eyelids are closed, occasional rapid eye movement can be seen beneath them. Breathing is irregular

Irregular or REM sleep


During this infant state of arousal, the infant is either falling asleep or waking up. Body is less active than in irregular sleep but more active than in regular sleep. The eyes open and close; when open, they have a glazed look. Breathing is even but somewhat faster than in regular sleep



During this infant state of arousal, the infants body is relatively inactive, with eyes open and attentive. Breathing is even

Quiet alertness


During this infant state of arousal, the infant shows frequent bursts of uncoordinated bodily activity. Breathing is very irregular. Face may be relaxed or tense and wrinkled. Crying may occur

Waking activity and crying


Why do infants spend so much time in REM sleep?

Researchers believe that the stimulation of REM sleep is vital for growth of the central nervous system. Young infants seem to have a special need for the stimulation because they spend so little time in an alert state, when they can get input from the environment.

The rapid eye movement protect the health of the eye, eye movements cause the vitreous to circulate, thereby delivering oxygen to parts of the eye that do not have their own blood supply


What is the most effective way to soothe a crying baby when feeding and diaper changing to not work?

Lifting the baby to the shoulder and rocking or walking, is most effective


How do the cries of brain-damaged babies and those who have experienced prenatal and birth complications differ from those of healthy infants, and how might this difference affect parental responding?

Their cries are often shrill, piercing, and shorter in duration than the cries of healthy infants

Parents may become frustrated, resentful, and angry. Preterm and I'll babies are more likely to be abused by highly stressed parents


Persistent crying, or _______, is a fairly common problem in newborns characterized by intense crying and difficulty calming down, which generally subsides between __ to __ months of age. Describe an intervention aimed at reducing this condition.

Colic; three and six months

Nurses made periodic home visits, providing parents with help in identifying their babies early warning signs of becoming overly aroused, and using effective soothing techniques, and in modifying light, noise, and activity in the home to promote predictable sleep-wake cycles


The unexpected death usually during the night, of an infant younger than one year of age that remains unexplained after through investigation

Sudden infant death syndrome SIDS


True or false: in industrialized countries, SIDS is the leading cause of infant mortality between one week and 12 months of age



What are the risk factors associated with S I DS?

Prematurity, low birth weight, poor Apgar scores, limp muscle tone, abnormal heart rate, abnormal respiration, disturbances in sleep-wake cycles, respiratory infection, impaired brain functioning, maternal cigarette smoking, prenatal drug abuse, sleeping on the stomach, being wrapped very warmly, living in poverty


List three ways to reduce the incidence of SIDS

Quitting smoking and drug taking, changing the infant sleeping position so they are laying on their back, and removing a few bedclothes can reduce the incidence of SIDS. Using a pacifier, sleeping babies who suck arouse more easily in response to breathing and heart rate irregularities


True or false: infants are born with a poorly developed sense of touch and, consequently, they are not sensitive to pain

False, sensitivity to touch is well developed at birth and are quite sensitive to pain


True are false: infants not only have taste preferences, but they are also capable of communicating these preferences to adults through facial expressions

True, like adults, they relax their facial muscles in response to sweetness, purse their lips when the taste sour, and show a distinct archlike mouth opening when it is bitter


True or false: certain odour preferences are innate

True, certain odour preferences are present at birth.


Explain the survival value of a newborn sense of smell

The odor of human milk is more attractive to newborns and newborns attraction to the odours of their mother and of breast milk helps them locate an appropriate food source and, in the process, distinguish their caregiver from other people


At birth, do infants prefer pure tones or complex sounds?

They prefer a complex sounds, such as noises and voices


True or false: infants can discriminate almost all of the speech sounds of any human language

True, they can detect the sounds of any human language. They have a better ability to perceive sounds not found in their own language then adults


Describe the newborns visual acuity

Vision is the least developed of the newborns senses. Visual structures in both the eye and the brain are not fully formed at birth. Newborn babies cannot focus their eyes well and their visual acuity, or fineness of discrimination, is limited. Infants perceive objects at a distance of 20 feet about as clearly as adults do at 600 feet. Newborn baby see unclearly across a wide range of distances. The parents face looks like a blurry image but they can detect human faces


True or false: infants have well-developed color vision at birth, and they are immediately capable of discriminating colors

False, newborn babies are not yet good at discriminating colors. It will take about four months for color vision to become adultlike


This scale evaluates the babies reflex is, muscle tone, state changes, responsiveness to physical and social stimuli, and other reactions

Neonatal behavioral assessment scale NBAS


What is the neonatal intensive care unit network neurobehavioral scale NNNS, specifically designed to evaluate?

Specially designed for use with newborns at risk for developmental problems because of low birth weight, preterm delivery, prenatal substance exposure, or other conditions. Scores are used to recommend appropriate interventions and to guide parents in meeting their babies unique needs


Since the NBAS is given to infants all around the world, researchers have been able to learn a great deal about individual and cultural differences in newborn behavior and the ways in which various childrearing practices affect infant behavior. Briefly discussed these findings

NBAS scores of Asian and native-American babies reveal that they are less irritable than Caucasian infants. Mothers in these cultures often encourage their babies calm dispositions through holding and nursing at the first signs of discomfort. Maternal care quickly changes the poor NBAS scores of under nourished infants in Zambia, Africa. The Zambian mother carries her baby about on her hip all day, providing a rich variety of sensory stimulation. The once unresponsive newborn becomes an alert, contented one week old


Why is a single NBAS score not a good predictor of later development, and what should be used in place of a single score?

Because newborn behavior and parenting styles combine to shape development, changes in scores over the first week or two of life rather than a single score provide the best estimate of the babies ability to recover from the stress of birth. The tests recovery curves predict intelligence and absence of emotional and behavioral problems with moderate success well into the preschool years


How are NBAS interventions beneficial for the early parent-infant relationship?

Helps parents get to know their newborns to discussion or demonstration of the capacities these instruments assess. Parents interact more effectively with their babies. Helps the parent-infant relationship get off to a good start


Discuss several changes in the family system following the birth of a new baby

The mother needs to recover from childbirth and adjust to massive hormone shifts in her body. If she is breast-feeding, energies must be devoted to working out this intimate relationship. The father must become a part of this new threesome while supporting the mother in her recovery and at times he may feel ambivalent about the baby, who constantly demands and gets the mothers attention


True or false: for most new parents the arrival of the baby causes significant marital strain

False. The arrival of the baby is often associated with mild declines in a relationship satisfaction and communication quality, but does not cost significant marital strain


Describe changes in the division of labor in the home following childbirth

In dual earner marriages, the larger the difference between men's and women's caregiving responsibilities, the greater the decline in marital satisfaction after childbirth, especially for women. In contrast, sharing caregiving predicts greater parental happiness and sensitivity to the baby. For employed lower SES women who endorse traditional gender roles, when their husbands help extensively with childcare, these mothers tend to report more distress, perhaps because they feel disappointed at being unable to fulfill their desire to do most of the caregiving


In what ways does postponing childbearing until the late 20s or 30s ease the transition to parenthood?

Permits couples to pursue occupational goals and gain life experiences. Under the circumstances, men are more enthusiastic about becoming fathers and therefore more willing to participate. And women whose careers are well underway and whose marriages are happy or more likely to encourage their husbands to share housework and child care, which fosters father's involvement


Explain how a second birth affects the family system

Mothers of second children report just as much stress as first time others. Requires that fathers take an even more active role in parenting. Well functioning families with a newborn second child typically pull back from the traditional division of responsibilities that occurred after the first birth. Both parents must help their firstborn child adjust


Describe how the mothers depressed mood affects her newborn infant in the first months of life

Infants of depressed mothers sleep poorly, are less attentive to their surroundings, and have elevated levels of the stress hormone cortisol. Also show mental and emotional symptoms such as delays in development, an irritable mood, and attachment difficulties


Describe parenting practices associated with persistent maternal depression, and note how these parenting behaviors impact the development of the child

Depressed parents view their infants more negatively than independent observers do and they use inconsistent discipline.

Children who experience these maladaptive parenting practices often have serious adjustment problems and may withdraw into a depressive mood themselves, become impulsive and aggressive, and may engage in violent antisocial behavior


True or false, persistent paternal depression is a strong predictor of child behavior problems



Briefly summarize interventions for postpartum depression

Therapy and antidepressant medication


True or false, planned birth and adoptions by single 30 to 45-year-old women are increasing

True. These mothers are generally financially secure, have readily available social support from family members and friends, and adapt to parenthood with relative ease


The majority of nonmarital births are planned/unplanned and to women in their ____

Unplanned, women in their 30s


Describe common stressors associated with being a single mother

They have incomes below the poverty line and experience a stressful transition to parenthood. Cohabitating relationships are less socially excepted bowl and involve less commitment and cooperation, and are far more likely to break up. Single mothers often lack emotional and parenting support


Discuss how interventions for low-risk parents differ from interventions for high-risk parents

Low-risk: counselor-lead groups focusing on couple and adjustment and parenting skills are highly effective

High-risk: need more intensive interventions. Programs in which a professional intervenor visits the home and focuses on enhancing social support and parenting have resulted in improved parent-infant interaction and benefits for children's cognitive and social development into middle childhood. Also require tangible support such as money, food, transportation, and affordable childcare to ease stress and allow them to engage in effective parenting


What are three signs that indicate labor is near?

False labor or prelabor contractions felt in the upper part of the uterus as it contracts. Remains brief and unpredictable for several weeks

Two weeks before birth, lightening occurs. The babies head drops low into the uterus because the cervix softens and can no longer support the baby's weight as easily

The bloody show. As the cervix begins to open, the plug of mucus that sealed it during pregnancy is released, producing a reddish discharge