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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
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
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
stage 1
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
stage 14
Stage 1
  • 10 cm = full dilation
  • effacement ranges from 0 - 100% (thinned to the point of disappearing)
  • “transitional phase” is often difficult
stage 2
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
stage 26
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
stage 3
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
medicalization of birthing episiotomies
Medicalization of birthing:Episiotomies
  • estimated that rate should not be above 30%
  • many performed without a woman’s consent
  • fetal monitoring
medicalization of birthing cesarean sections
Medicalization of birthing: cesarean sections
  • rate from 1975-2000: 20%
  • prior to 1970s, rate was 5%
  • defensive medicine?
c sections
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
medicalization cont d induction of labor
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
induction
Induction
  • increased risk for use of pain medication, episiotomy, operative vaginal delivery, c-section
  • fetal risks > suffocation, physical injury
midwifery
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)
midwifery cont d
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
lactation
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:
let down reflex
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
let down reflex17
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
benefits of breastfeeding for infant
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
breastmilk vs formula
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)
breastmilk vs formula20
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)
breastmilk vs formula21
Breastmilk vs. formula
  • lactose promotes calcium absorption
  • both may contain environmental contaminants
  • viruses (HepB, HIV) can be transmitted thru breastmilk
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