LABOR • As the unborn baby becomes developed enough to exist independently, the muscles of the mother’s uterus push to expel the fetus from her body. This process is called “labor”.
The distance a fetus must travel during labor and delivery is only approximately 4 inches. • It is, however, a very difficult journey for both the mother and the baby.
Molding • Molding is the shaping of the fetal head to adjust itself to the size of the birth canal.
Indications that labor is starting: • “Show” or spotting (blood-tinged mucus discharge that might appear when the mucus plug which seals the cervix dislodges) • Show is a very early sign that labor is starting. • Show may occur several days before the birth actually occurs. http://www.pennmedicine.org/encyclopedia/em_DisplayAnimation.aspx?gcid=000108&ptid=17 • Water breaks (amniotic sac bursts and fluid drains) • Labor is called “dry labor” after the sac bursts (because baby is in a dry environment). • When “dry labor” begins early in the labor process, the total length of labor is usually shorter than when the water does not break until later in the contractions phase. http://visualhealthsolutions.com/asset-vpl_0545_001.html • Contractions or cramps • Contractions get progressively stronger, longer, and closer together. • Contractions occur at more regular intervals as time progresses. http://video.about.com/pregnancy/Understand-Labor-Pains.htm
Three Stages of Labor • Contractions or dilation stage • Birth or expulsion stage • Placenta expelled or afterbirth stage
Contractions or Dilation—Stage 1 • Stage #1 is the longest of the three stages. • The contractions steadily get stronger (more painful), longer (lasting about 60 seconds), closer together (5 to 6 minutes apart), and more regular (evenly spaced). • Stage #1 lasts several hours (an average of 6-18 hours for first babies and 2-5 hours for later babies).
(Stage #1 continued) • The contractions cause the cervix to efface and dilate. • Cervix = the lower, narrow end of the uterus • Dilate = to widen • Effacement = thinning • The cervix must dilate to 10 centimeters (4 inches) to allow the baby to pass through. http://www.pennmedicine.org/encyclopedia/em_DisplayAnimation.aspx?gcid=000027&ptid=17 http://www.pennmedicine.org/encyclopedia/em_DisplayAnimation.aspx?gcid=000044&ptid=17 http://www.youtube.com/watch?v=Npno6EoCcPs
(Stage #1 continued) • The mother should go to the hospital when contractions are 5 to 10 minutes apart. • Contractions are timed from the beginning of one contraction to the beginning of the next. • Relaxation makes stage #1 less difficult. • Stage #1 ends with a period called “transition”. • The cervix is fully dilated and the baby’s head slips out of the uterus into the birth canal. • The contractions are very strong, they last longer (up to 90 seconds), and they occur more frequently (2 to 3 minutes apart).
Birth or Expulsion—Stage 2 • Stage #2 typically lasts 1 to 2 hours for the first child, but might last only 15 to 30 minutes for later babies. • The contractions during stage #2 work to push the baby down through the pelvis and out of the vagina, or birth canal. • http://www.pennmedicine.org/encyclopedia/em_DisplayAnimation.aspx?gcid=000138&ptid=17 • http://www.youtube.com/watch?v=0Z3AvcihoRg
(Stage #2 continued) • Occasionally forceps (or a vacuum extractor) must be used to control the movement of the baby’s head down the birth canal (helping the baby emerge more slowly or more quickly). • Forceps = Specialized tongs made from bands of surgical steel that are molded to fit the shape of a baby’s head. http://www.youtube.com/watch?v=zibRN-INd0k
(Stage #2 continued) • An episiotomy is performed if necessary. • An episiotomy is a small incision to enlarge the birth opening (a.) to prevent tearing of the mother’s tissue as the head emerges and (b.) to reduce pressure on the baby’s head. http://www.medicanalife.com/Episiotomy_v51 http://www.muschealth.com/video/Default.aspx?videoId=10092&cId=34&type=rel(Note: scroll to episiotomy animation)
Vacuum extractor = A device that uses suction to help the doctor move the baby down the birth canal as the mother pushes. http://www.muschealth.com/video/Default.aspx?videoId=10092&cId=34&type=rel (Note: scroll to assisted delivery animation)
(Stage #2—continued) • http://www.muschealth.com/video/Default.aspx?videoId=10092&cId=34&type=rel (Note: scroll to delivery animation) • http://www.youtube.com/watch?v=B84MewU8h7Y
Placenta is Expelled or Afterbirth—Stage 3 • Stage #3 lasts from 10 to 30 minutes. • This stage involves little or no pain or discomfort. • The contractions help the placenta separate from the wall of the uterus.
(Stage #3 continued) • The uterus continues to contract and mother pushes to expel the placenta. http://www.pennmedicine.org/encyclopedia/em_DisplayAnimation.aspx?gcid=000100&ptid=17 • The placenta is examined to be certain that no parts of it remain in the uterus (which could result in bleeding, infection, and serious illness).
Labor animation—stages 1, 2, and 3 • http://www.babycenter.com/2_inside-pregnancy-labor-and-birth_3658872.bc
The Newborn at Birth • The newborn is held with the head slightly lower than the feet and the nose and throat are gently suctioned (to drain and remove any remaining fluids from the airways, which would cause the baby to choke as he/she takes his/her first breath).
(The Newborn at Birth continued) • If necessary, the baby is stimulated (irritated by tickling, rubbing, patting, etc.) to initiate breathing. (Note: Crying causes the baby to suck in air and inflate the lungs.)
(The Newborn at Birth continued) • The umbilical cord is clamped, tied, and cut. (There are no nerves in the umbilical cord, so neither baby nor mother experience pain.) • Antibiotic solution is placed in the baby’s eyes to prevent infections. • The baby is placed in a warm, sterile (germ free) bassinet (incubator) for approximately 2 hours to assist with body temperature regulation.