Lecture 5 - The Birth Experience

Question 1

What can be observed when approaching labor?

Answer 1

• engagement - baby’s head moves into pelvic area
• “bloody show” - pug of mucus is dislodged from cervix
• water breaking - rupture of the amniotic membranes

Question 2

Labor

Answer 2

• approx 266-280 days after conception
• release of corticoptropin releasing hormone -> oxytoxin -> triggers contractions

Question 3

What is the gestation and growth hypothesis?

Answer 3

• point when the mother’s body is no longer able to support fetus/energy demands not being met, baby releases CRH

Question 4

Braxton Hicks

Answer 4

• type of contraction often mistaken for labor contractions
• do not alter cervix in any way
• way for uterus to prepare for giving birth

Question 5

Stage 1

Answer 5

• labor is established, contractions begin
• effacement - shortening of the uterus, causes the dilation of the cervix

Question 6

Augmentation

Answer 6

• can be given during stage 1
  -pitocin - synthetic oxytocin that speeds up contractions and dilation
• may reduce baby’s O2 supply
• cascade of interventions = pitocin -> decrease O2 -> fetal distress -> c-section

Question 7

transition

Answer 7

• urge to start pushing
• discouraged bc can cause inflammation of uterus and slow labor

Question 8

Effect of contractions on infant

Answer 8

• temporarily reduces size of head - causes plates to overlap at fissures
• stimulate hormones that allow baby to adapt to withstand periods of O2 dep
• forces amniotic fluid out of lungs
• forces blood from placenta to fetus

Question 9

Stage 2

Answer 9

• delivery
• approx 45 min to 2 hours
• head moves through cervix w/ each contraction
• crowning - crown of head shows
• contractions stronger and longer but less frequent

Question 10

Episiotomy

Answer 10

• surgical incision of perineum, requires sutures
• perineal tears - typically minor

Question 11

Stage 3

Answer 11

• cutting umbilical cord
• delivery of placenta and other membranes

Question 12

Active or passive delivery of placenta

Answer 12

• active = drug or fundal massage, usually preferred to avoid postpartum hemorrhage
• passive = delivered on its own

Question 13

What is a birth plan, and what are some things it could include?

Answer 13

• written outline of wishes for labor and delivery
• birth attendants
• comfort measures
• birth positions
• anesthesia options
• newborn care

Question 14

Place of birth

Answer 14

• 99% of U.S. deliveries in hospitals, about 50% worldwide
• also can give birth in freestanding birth center or at home

Question 15

What are some examples of birth attendants?

Answer 15

• obstetricians - trained surgeons, specialist in handling all stages of pregnancy and birth
• midwife - have medical training (usually nurses), present during entire labor and delivery process
• doula - do not have medical training, physical/emotional/educational support, advocate

Question 16

What is the doula effect?

Answer 16

shorter and less painful labor and delivery
- relax pt by decreasing levels of adrenaline

Question 17

Natural vs Prepared childbirth

Answer 17

• Natural - no external pain management, relaxation techniques, hypnosis, water birth
• prepared - intentional education and preparation of mother, Lamaze breathing technique, Bradley method

Question 18

What pain management is offered for birth?

Answer 18

• analgesic drugs - DULL the perception of pain, opioids for EX
• anesthesia - numbs pain completely, epidurals for EX

Question 19

What is one caution of anesthesia during birth?

Answer 19

• could slow labor as a form of augmentation, could lead to c-section
• could affect baby, making them sluggish

Question 20

What are the different forms of assisted birth?

Answer 20

• both are used to guide head down birth control
• forceps - tongs? are used on either side @ temples of the baby’s head, increase risk of vaginal and perineal damage
• vacuum extractor - suction is placed on crown of head, not typically used before 34 weeks bc scalp is too weak

Question 21

Cesarean Section

Answer 21

• surgical removal, usually is done when baby is at high risk or is distressed
• high infection rate
• longer hospital stays and recovery time

Question 22

What are the potential risks of surgical intervention?

Answer 22

• deter release of stress-related hormones
• less likely to have skin to skin contact (helps body regulate HR and RR)
• low APGAR scores (color, muscle tone, pain response)
• breathing problems
• difficulties breastfeeding (latching on)