Labor & Delivery

Cepeda, Elaine F.

LABOR
The most important thing she'd learned over the years was that there was no way to be a perfect mother and a million ways to be a good one. -- Jill Churchill

Labor
It is defined as the onset of regular contractions and cervical change.

Signs of Labor
Lightening: occurs when the babys head drops
down into the pelvis

Bloody show: a blood-tinged or brownish

discharge from the cervix is the released mucus plug that has sealed off the womb from infection

Signs of Labor (cont.)

Diarrhea Ruptured membranes: fluid gushing or
leaking from the vagina means the membranes of the amniotic sac that surrounded and protected the baby have ruptured

Contractions: called as Braxton-Hicks

contractions

Signs of Labor
Lightening Bloody show Diarrhea Ruptured membrane Contractions

Stages of Labor

Stage 1 Stage 2 Stage 3

Stage 1
The first stage of labor is divided into 3 phases:
Latent Active Transition

Stages 2 & 3

Preterm Labor
Premature or pre-term labor is having regular contractions that causes cervix to begin to open before the mother reaches 37 weeks of pregnancy.

Causes of spontaneous preterm birth

Infection Having a problem with the placenta such as placenta previa or placental abruption Having an excessively large uterus Having structural abnormalities of the uterus or cervix. Having abdominal surgery during pregnancy

Risk Factors
Previously had a preterm delivery Are pregnant with twins or other multiples Are younger than 17 or older than 35 Are African American Were underweight before you got pregnant or don't gain enough weight during your pregnancy Have had vaginal bleeding in the first or second trimester. Had moderate to severe anemia early in your pregnancy Smoke, abuse alcohol, or use drugs (especially cocaine) during pregnancy Gave birth in the last 18 months (particularly if you became pregnant within six months of giving birth) Have had no prenatal care or got a late start on prenatal care Are pregnant with a single baby that's the result of fertility treatments Have low socioeconomic status

Pain Treatments
Non-drug options Medications Analgesics Anesthesia

Medications
Analgesics relieve pain without the total
loss of feeling or muscle movement. o Spinal block is a single injection into the spinal
fluid that relieves pain quickly.

o Epidural block continuously administers pain

medication to the area around the spinal cord and spinal nerves through a catheter inserted in the epidural space

Medications
Anesthetics block all feeling, including
pain. They also block muscle movement. General anesthetics causes loss of consciousness.

DELIVERY
Think of stretch marks as pregnancy service stripes. -- Joyce Armor

What to expect during delivery

Pain at the episiotomy site Sore breasts Hemorrhoids Constipation Hot and cold flashes Urinary or fecal incontinence After pains Vaginal discharge

Types of Delivery
Vaginal delivery Cesarean delivery

Vaginal Delivery
Spontaneous
This implies that the birth occurred without the need for forceps, vacuum, or any other instrumentation. It does not imply that every part of the birth was without medical care or intervention.

Non-spontaneous
Episiotomy Amniotomy Induced Labor Fetal Monitoring Vacuum extraction

Non-spontaneous
Episiotomy A surgical incision made in the perineum. Two types of incisions:
o Midline: made directly back towards the anus o Medio-lateral: slants away from the anus

Amniotomy Breaking the bag of water It is usually done to:

o Induce or augment labor o Place an internal monitor to assess the uterine contraction pattern o Place an internal monitor on the babys scalp to assess the infants wellbeing o Check for meconium

Non-spontaenous (cont.)
Induced Labor Means that labor needs to be started for a number of reasons It is most often used for pregnancies with medical problems or other complications Medical reasons for inducing labor include:
o o o o o Diabetes High blood pressure Ruptured membranes Small baby Past-due pregnancy

Non-spontaneous (cont.)
Fetal monitoring Vacuum extraction

Absolute contraindications
Complete placenta previa Herpes simplex virus with active genital lesions or prodromal symptoms Previous classic uterine incision or extensive transfundal uterine surgery Untreated HIV infection

Cesarian Section
This is also called as C-section. A surgical procedure performed if a vaginal delivery is not possible During this procedure, the baby is delivered through surgical incisions made in the abdomen and the uterus.

Reasons for C-section

Planned cesarean:
o Cephalopelvic disproportions (CPD) o Previous cesarian birth o Multiple pregnancy o Placenta previa o Transverse lie o Breech presentation

Reasons for C-section (cont.)

Unplanned cesarean:
o Failure to labor to progress o Cord compression o Prolapsed cord o Abruptio placentae

Procedure
Administration of anesthesia Abdomen will be cleaned with antiseptic Oxygen mask will be placed over the mouth and nose

Removal of the baby through the incisions

Three- to fourinch incision in the uterus

Incision through the skin and the wall of the abdomen

Cutting of the umbilical cord

Removal of placenta

Closing of the incisions

Risk of Cesarean delivery

Infection Loss of blood or need for a blood transfusion A blood clot that may break off and enter the bloodstream Injury to the bowel or bladder A cut that might weaken the uterine wall Abnormalities of the placenta in subsequent pregnancies Difficulty becoming pregnant Risks from general anesthesia Fetal injury

Can a mother have a baby vaginally after cesarean?

The chances of vaginal birth after cesarean (VBAC) are greatly increased:
A low transverse incision was made in the uterus during cesarean The pelvis is not too small to accommodate a normal-sized baby Mother is not having a multiple pregnancy First cesarean was performed for breech presentation of the baby

References
Normal Labor and Delivery process. Webmd. http://www.webmd.com/baby/guide/normal-labor-and-deliveryprocess. 07-12-13 Spontaneous Vaginal Delivery. Healthline. http://www.healthline.com/health/pregnancy/spontaneousvaginal-delivery. 15-03-12. 07-12-13 Spontaneous Vaginal Delivery. American Family Physician. http://www.aafp.org/afp/2008/0801/p336.html. 07-12-13 Types of Delivery. Cleaveland Clinic. http://my.clevelandclinic.org/healthy_living/pregnancy/hic_assist ed_delivery_methods.aspx. 23-07-12. 07-12-13