The Birth Process. Mamie Guidera, CNM, MSN Carol O’Donoghue, CNM, MSN, MPH. Normal Labor and birth: Objectives . Introductions Physiologic labor and birth: the basics Phases of labor Birth video The P’s: Power, passageway, passenger, etc. Briefs:
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Mamie Guidera, CNM, MSN
Carol O’Donoghue, CNM, MSN, MPH
Here’s the truth: Childbirth is not only a physiologic phenomenon, but a cultural/sociological experience. So before you walk onto the Labor Floor, ask yourself:
Length of first stage labor in healthy nulliparous and multiparous childbearing womenadapted from Albers L. (2007)bold = nullips, italics = multips
What are the signs and symptoms of impending labor?
Fetal station and part
Importance of cervical status
Stripping of membranes
Artificial rupture of membranes
What are the characteristics of each?
What are frequent maternal behaviors?
Practice/ Pain Relief
Health care provider
…let’s talk about this…
Woman giving birth
Beliefs, values, culture
From 10 cm to birth of baby
Pushing or expulsion
(keep your hands off
Ask mother to feel the baby’s head
Stay focused on woman, not tasks
Causes release of potassium, bradykinin, histamin, serotonin
Impulses follow sensory-nerve fibers from paracervical and hypogastric plexus to lumbar sympathetic chain
Enter dorsal horn of spinal cord at T10-12, L1
Birth Ball, toilet
Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C. Continuous Emotional Support During Labor in a US Hospital: A Randomized Controlled Trial. JAMA, May 1991; 265: 2197 - 2201.
Hodnett, ED et al (2007). Continuous support for women during childbirth (Review). Cochrane Database of Systematic Reviews 2007, Issue 3. Art No.: CD 003766.
Pathways of Placement of Anesthetics for Labor Pain
Eltzschig H et al. N Engl J Med 2003;348:319-332
Lieberman & O’Donoghue, Am J Obstet Gynecol 2002, 186(5):S31-S68.
Leighton& Halpern Am J Obstet Gynecol 2002, 186(5):S69-77.
Gabbe (2002), 4th Ed.
Gabbe (2002), 4th Edition; Williams (2005), 22nd Edition
Williams Obstetrics (2005), 22nd Edition
Gabbe (2002), 4th Ed.; Williams (2005), 22nd Edition
ACOG Practice Bulletin 70 (2005); Williams (2005), 22nd Ed.
http://www.ahrq.gov/clinic/uspstf/uspsiefm.htm Accessed 6/30/08
Don’t just stand there.