CST 11

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CST 11 LABOR AND DELIVERY OUTCOME 2e
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DUE DATE...
By taking the first day of the womans last
menstrual cycle and adding 280 days, you can
calculate when baby is due to be born.
As the mother nears full term, several things
happen
Baby loses the lanugo covering (much vernix
remains) and reaches an average size of 20 inches
in length and 7 pounds. Eye color is slate-blue
or black, and will not be fixed until after
exposure to light for some time.
Baby drops down several inches in the abdomen.
This is called lightening. and The head becomes
engaged. This means it presses firmly against
the cervix. The birth is close at hand.
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PARTURITION...
This is the correct term for the process of
childbirththe emergence of a child from its
mothers uterus. It starts with a signal from
the pituitary gland. The hormone oxytocin is
secreted into the bloodstream of the mother, and
the process begins. (pitocin and syntocinon are
common synthetic forms of this hormone, used to
induce labor) There are 3 stages of childbirth

1. LABOR
2. BIRTH OF THE BABY
3. BIRTH OF THE PLACENTA

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• 3 signals indicate that labor has begun
• Contractions begin
• Mucous plug is dispelled
• Amniotic sac breaks

Labor
SIGNAL THREE Before labor begins, or in the
early stages, the amniotic sac ruptures under
pressure and fluid trickles or gushes out.
Sometimes the sac must be broken manually.
SIGNAL ONE Initial uterine contractions are
short and mild, but frequency, intensity,
duration increase. During transition stage, the
cervix completes dilation and stretches over
baby's head. The entire process usually lasts
from 4-18 hours
SIGNAL TWO The mucous plug falls out as cervix
dilates it is accompanied by a tinge of blood,
and is referred to as bloody show
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DILATION EFFACEMENT
Prior to the beginning of labor, the thick
cartilage walls of the cervix begin to thin out
and lengthen. This process is called effacement.
The cervix must be completely effaced in order
to fully dilate.
The purpose of labor is for the muscles to
contract, pulling open the cervix. It must open
(or dilate) to 10 cm. (approximately 4 inches) to
allow for the birth of the baby. This is hard and
painful work for the mother.
LABOR
The red arrows point to the cervical area and
various stages in becoming fully effaced and
dilated.
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LABOR
Aptly named, labor is hard work.
Contractions/dilation can be very painful. There
are several methods that can help the mother
manage the pain.
Although medications can control pain, there is
risk that the baby will be affected and become
groggy.
A regional anesthetic can be injected through the
vagina into a nerve to relieve pain, but an
epidural block is now the method of preference.
An injection into the spinal column blocks pain.
The mother remains awake.
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LABOR
During labor the mother will need to attempt to
control this pushing movement. A slow expulsion
of the baby from the vagina causes less damage to
sensitive skin.
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EPISIOTOMY
An episiotomy is an incision through the skin
and muscles in the perineum, made during a
vaginal delivery. This procedure is performed in
2/3 of US births, and allows extra room for baby
to pass out of the birth canal. The incision
prevents tearing. It stitches easier and heals
faster than a tear.
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DELIVERY
73 of births in Canada are vaginal deliveries.
During delivery most remaining vernix caseosa is
rubbed off.
A cephalic birth position is one that is
head-first!
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DURING DELIVERY OF THE BABY
The mother may stand with her legs apart, squat,
lean over, recline backward or lie down with legs
supported to facilitate the delivery.
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DELIVERY
The "sutures" or anatomical lines where the bony
plates of the skull join together can be easily
felt in the newborn infant. The diamond shaped
spaces on the top, top back, and sides of the
skull are often referred to as the "soft spot" in
young infantscorrectly known as fontanelles
(fontanels).
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DELIVERY OF THE BABY
The fontanelles actually allow the skull to
change to a new shape, so it can emerge through
the small cervical opening. This is called
molding of the head. This change in the shape
of the skull will go back to its original
appearance in a few hours up to a few days.
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POST-DELIVERY OF THE BABY
Immediately following delivery, if not during, a
bulb syringe is used to suction mucous from the
throat and nasal passages. Its important that
those first breaths be deep and clear. Healthy,
loud cries assure that!
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POST-DELIVERY OF THE BABY
The umbilical cord is connected at babys navel.
The cord must be clamped and cut. (or tied off)
Then another small plastic clamp is used, placed
close to babys tummy.
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DELIVERY OF THE PLACENTA
Stage 3 of childbirth follows delivery of the
babyit is the delivery of the afterbirth.
After the placenta is delivered, it should be
inspected for size, shape, consistency, and
completeness. A one minute, thorough examination
to detect normalcy or abnormalities may be
critical in the management of mother and baby.
An abnormal placenta may be one of the first
indications that mother or baby has a problem.
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SPECIAL DELIVERIES...
A suctioning method or vacuum is sometimes used
to assist in difficult deliveries. It can turn
the baby to a better position or perhaps just
quicken the descent down the birth canal.
A breech birth position is sometimes more
difficult. It means that the baby is in the
birth canal feet or buttocks first.
An instrument called a forceps is sometimes used
during delivery also. The cushioned tongs are
used to hold, guide, or pull baby through the
birth canal to hasten delivery.
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SPECIAL DELIVERIES...
CAESARIAN SECTION
Also known as C-section 1. fetus is delivered
through a horizontal incision in abdominal and
uterine walls 2. advisable when fetus in
improperly aligned (such as a sideways position
called transverse position), multiple fetuses,
fetal distress, mother is worn out, or mother
has a transferable genital condition or
infection.
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IDENTIFICATION
Soon after birth, information will be gathered
for babys official birth certificate. This
becomes a matter of permanent public record
make sure it is correct, including spellings!
Its time to name the baby! Identification wrist
or ankle bands are secured, as well as foot
prints.
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• The hormone oxytocin that started the process of
  childbirth has several other effects on the body.
  
• Research indicates that it plays a major role in
  establishing maternal behaviors in the mother.
• Stimulates the muscles of the cervix, vagina, and
  uterus, helping them contract after delivery
• Works in conjunction with a second hormone
  secretion from the pituitary gland, prolactin, to
  make and secrete milk from the mammary gland of
  the breast. This process is called lactation.

LACTATION
The first secretion from the breast is called
colostrum. It is sticky, and a milky-yellow
color. It not only provides baby with perfect
nutrition and is easily digestible, but also
contains immunities from the mother.