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Signs of Labor

Signs of Labor. regular, persistent contractions (vs. Braxton Hicks contractions) due to oxytocin release from pituitary loss of mucus plug (cervical dilation) rupture of amniotic membranes procession through stages 1, 2 and 3. Labor. What induces labor? Possible role of fetal adrenal gland

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Signs of Labor

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  1. Signs of Labor • regular, persistent contractions (vs. Braxton Hicks contractions) due to oxytocin release from pituitary • loss of mucus plug (cervical dilation) • rupture of amniotic membranes • procession through stages 1, 2 and 3

  2. Labor • What induces labor? • Possible role of fetal adrenal gland • Stress > cortisol release from fetal adrenal > placenta releases prostaglandins > uterine contractions • Contractions > oxytocin release from pituitary

  3. Stage 1 • longest (8 to 12 hours for first delivery) • involves effacement and dilation of cervix • caused by hormonal changes and force of myometrial contractions • as muscles of uterus shorten, pressure is applied to baby

  4. Stage 1 • 10 cm = full dilation • effacement ranges from 0 - 100% (thinned to the point of disappearing) • “transitional phase” is often difficult

  5. Stage 2 • fetal membranes often break at this point • mother feels urge to bear down • lasts from 1 to 2 hours; often painful • mother pushes, adding force of abdominal muscles to that caused by uterine muscles

  6. Stage 2 • baby moves toward vaginal opening • “crowning” occurs when head is visible • episiotomy may be performed (80%) • after head is born, only a few pushes are required for rest of body to exit

  7. Stage 3 • once baby is delivered, uterine cavity shrinks • placenta detaches • uterine contractions force placenta out within 15 minutes • uterine massage can facilitate placenta delivery

  8. Medicalization of birthing:Episiotomies • estimated that rate should not be above 30% • many performed without a woman’s consent • fetal monitoring

  9. Medicalization of birthing: cesarean sections • rate from 1975-2000: 20% • prior to 1970s, rate was 5% • defensive medicine?

  10. C-sections • necessary when baby is in breech position or fetal distress is indicated • risks > fetal injury, maternal blood loss, infection, blood clots from bed rest

  11. Medicalization, cont’d.: induction of labor • occurs in 10-15% of all hospital deliveries • involves prostaglandins applied to cervix and/or infusion of pitocin • often causes more intense, painful contractions

  12. Induction • increased risk for use of pain medication, episiotomy, operative vaginal delivery, c-section • fetal risks > suffocation, physical injury

  13. Midwifery • alternative care givers who offer a less invasive pregnancy experience • certified nurse midwives > attend graduate programs; usually practice in conjunction with univ. or med. school • licensed nurse-midwives • not nurses; practice in private homes or hospital birthing centers • trained through formal schooling and apprenticeships • must pass state board exams (avail. in 17 states)

  14. Midwifery, cont’d. • lay midwives: • trained through schooling and apprenticeships • practice in states without licensing opportunities • can’t charge fees in some states • deliveries with midwives: • less medication, fewer interventions required • no diff. in duration of labor, perineal lesions, maternal blood loss • no diff. in birthweight, gestational age • vaginal birth rates higher

  15. Lactation • pregnancy hormones caused growth of breasts • prior to birth, glands produce colostrum • after birth, prolactin stimulates milk production • when infant suckles, letdown reflex occurs:

  16. Let-down reflex • sensory receptors in nipples stimulated • nerve impulse travels to brain • causes pituitary to release hormones oxytocin & prolactin • oxytocin causes myoepithelial cells surrounding alveoli to contract

  17. Let-down reflex • prolactin causes milk synthesis • can be interfered with by stressors (blood vessel constriction) • can become conditioned reflex • prolactin causes shutdown of reproductive system

  18. Benefits of breastfeeding for infant • Colostrum: • produced 2-5 days postpartum • high in protein; low in fat, carbs • contains intact cells (macrophages, lymphocytes) • antibodies (nonspecific IgAs) • Mature milk: • water, protein, fat, lactose • vitamins, minerals, salts, hormones

  19. Breastmilk vs. formula • Cow’s milk-based formula has 3X greater protein levels • primary proteins: • in formula > casein (causes curdling) • in breastmilk > whey (easily digested) • amino acid taurine nearly absent in cow’s milk (now supplemented)

  20. Breastmilk vs. formula • same levels of fat (50%) but types differ: • breastmilk has more cholesterol (protective?) • lipase present in breastmilk • sucrose added to formula to match high levels of sugar (lactose) in breast milk • bifidus factor present in higher levels in breast milk (promotes growth of “good” bacteria)

  21. Breastmilk vs. formula • lactose promotes calcium absorption • both may contain environmental contaminants • viruses (HepB, HIV) can be transmitted thru breastmilk

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