Signs of labor
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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

  • 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


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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


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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


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Stage 1

  • 10 cm = full dilation

  • effacement ranges from 0 - 100% (thinned to the point of disappearing)

  • “transitional phase” is often difficult


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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


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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


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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


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Medicalization of birthing:Episiotomies

  • estimated that rate should not be above 30%

  • many performed without a woman’s consent

  • fetal monitoring


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Medicalization of birthing: cesarean sections

  • rate from 1975-2000: 20%

  • prior to 1970s, rate was 5%

  • defensive medicine?


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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


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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


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Induction

  • increased risk for use of pain medication, episiotomy, operative vaginal delivery, c-section

  • fetal risks > suffocation, physical injury


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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)


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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


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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:


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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


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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


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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


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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)


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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)


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Breastmilk vs. formula

  • lactose promotes calcium absorption

  • both may contain environmental contaminants

  • viruses (HepB, HIV) can be transmitted thru breastmilk


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