BIRTH

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BIRTH
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Recognition of Labor

• Contractions are
• regular in frequency
• intermittent in character
• at intervals of 10 minutes or less
• each lasts 30 seconds or longer

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Bloody Show

• Small amount of bloody discharge from the vagina
• This is the operculum releasing due to dilation
  of the cervix

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What is False Labor?

• signs of what appears to be uterine contractions
  getting stronger
• may be painful
• and may be at or near the EDD

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How can you tell?
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Palpation of the Cervix
Assessing effacement and dilation
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Palpation of the Cervix

• Ascertain the specific amount of dilation
• ripeness of the cervix
• full dilation (10 cm) and effacement
• If done too frequently
• can cause infection
• introduces bacteria into an otherwise clean
  environment

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Uterine Contractions

• Uterine muscle fibers are unique, unlike any
  other muscle in the body
• Regular muscle fibers
• get shorter during contraction and return to
  their normal length after the contraction
• The purpose of the uterine contraction however
  necessitates a different action
• the baby has to be pushed out

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Uterine Contractions

• So instead
• After the uterus contracts, the muscle fibers
  stay shortened during the relaxation phase
• Pressure is maintained on the cervix
• Dilation takes place slowly but progressively

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Uterine Contractions

• This process is called retraction
• Progressively reduces the capacity of the uterus
• eventually pushes the baby out

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Uterine Contractions

•  
• The cervix (the lowest part of the lower pole)
  does not contract
• primarily a fibrous connective tissue (not
  muscle)
• The contractions of the upper pole causes
  retraction of the tissues of the lower pole
• stretch and thin out effacement dilation

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Effacement Dilation

• As the cervix thins, the internal os is retracted
  up the sides of the uterus
• The external os is loosened and begins to dilate
  allowing the operculum to dislodge Bloody
  Show

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Dilation and the Forewaters

• Thinning of the cervix and dilation of the
  external os allows the amniotic fluid in front of
  the babys head to protrude
• This is known as the forewaters or the
  Hydrostatic Dilator

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Dilation and the Forewaters
Hydrostatic Dilator fluid trapped between the
head and the sides of the birth canal
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Hydrostatic Dilator

• Function
• protects the babys head during the dilation
  process
• does not let the head push directly on the cervix

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Stages of Labor

• Labor is a process

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Stage 1

• Begins with the onset of regular contractions
• Ends with the full dilation of the cervix

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Stage 1

• Takes about 8-10 hours (multiparous) or 12-24
  hours (primigravida)  

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Transition Second Phase of Stage 1

• This is the most physically and emotionally
  taxing phase of labor
• Cervix is opening from 8-10 centimeters
• Uterus is contracting strongly
• May enter an emotionally vulnerable state of
  exhaustion and exhilaration

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Stage 2

• Begins with full dilation of the cervix
• Ends with the birth of the baby
• Generally takes from 10-60 minutes
• (1 hour)

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Contractions become more powerful

• Urge to bear down or push
• She may want to hold her breath through the
  contractions
• She may become nauseated and vomit
• She may feel like she has to have a bowel
  movement
• May inhibit her pushing

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Stage 2 Mechanisms of Birth

• AKA Cardinal Movements

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Mechanisms of Birth

•  
• The baby has to make its way down and out of the
  birth canal by fitting its head and body through
  narrow passages
• The baby must twist and turn along the path of
  escape
• known as the Cardinal Movements

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Obstetrics Illustrated (1998)

•  
• I Flexion
• II Descent
• III Internal Rotation
• IV Delivery of the Head
• V Restitution
• VI External Rotation

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Stage 3

• Stage 3
• Begins with the birth of the baby
• Ends with the birth of the placenta
• Generally takes about 5-50 mins.
• (1 hour)

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Placental Birth
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Placental Birth

• After delivery of the baby
• the uterus and vagina become loose and slackened
• soft to external palpation
• The site of the placental attachment is harder
  and firmer and may be palpable

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NOTE

• The placenta is usually attached to the anterior
  superior portion of the fundus of the uterus
• This will depend on
• the shape of the uterus and
• the position of the uterus at the time of
  implantation
• Normally the uterus is slightly anti-flexed
  and the blastocyst falls onto the anterior
  superior wall

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Placental Birth

• Normally
• the placenta will dislodge from the uterine wall
  with
• uterine contractions or
• massage of the uterus

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Signs of Placental Detachment

• The fundus becomes narrow, hard and ballotable
• Slight bleeding occurs again (bleeding has
  stopped from the birth)
• The cord becomes longer

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Credes Method

• Apply gentle pressure on the fundus while pulling
  on the cord gently
• the cord will usually lengthen out of the vagina
  with this process
• Releasing pressure on the fundus will then show
  one of two things
• either the cord retracts back into the vagina
  indicating it has not detached or
• it will remain lengthened out of the vagina
  indicating it has detached

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Note

• It is not a good idea to pull or tug on the cord
  to remove the placenta
• tearing of the placenta from the fundus (prior to
  cessation of uterine arterial flow to the
  placenta) could cause severe bleeding and
  possibly death

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Blood Loss

• Blood loss should be noted
• normally 250 ml (cup) will be lost during the
  placental delivery
• Any excessive bleeding should be taken as a sign
  of retention of placental parts until otherwise
  determined

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After Care Stage 4
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Stage 4

• Begins with the birth of the placenta
• Ends with the recovery of the new mother
• Lasts for about 4 6 hours
• Consists of close observation
• monitoring vital signs excessive uterine bleeding

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After the placenta is delivered

• The vagina and labia are inspected for tears or
  other general injuries
• provide the appropriate care
• may include suturing tears and episiotomies
• The placenta must also be inspected for
  appearance and completeness
• suspicion of any missing pieces necessitates
  inspection of the uterus

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Placental Types

• Disperse Magistral
• Battledore Fenestrate
• Circumvallate Duplex
• Succenturiate Vellamentosa
• Bipartite/Tripartite
• some are at higher risks for retention of
  placental parts
• fenestrate may look like a retained placenta even
  if it is not (false finding)

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Retention of Placental Parts

• Retention of part or all of the placenta
• usually causes bleeding
• may be severe enough to cause death
• There are cases when it does not immediately
  cause a problem
• If parts are retained for a period of time,
  eventually infection or immune reaction

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Retention of Placental Parts

• Management
• DC (dilatation and curettage) needs to be
  performed
• remove the offending parts