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Birth. LABOUR: Complex mix of fetal signals and endocrine mechanisms in the mother. Fetus secretes surfactant protein which seems to alter maternal hormones.

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birth
Birth

LABOUR:

  • Complex mix of fetal signals and endocrine mechanisms in the mother.
  • Fetus secretes surfactant protein which seems to alter maternal hormones.
  • Also, the agents (progesterone, nitric oxide, and others) that keep the uterine muscle quiet, decrease, and the uterus starts to contract.
    • sometimes timing is off  premature labour
birth1
BIRTH

LABOUR:

  • Surfactin signals mom’s hypothalamus: produced when fetal lungs ready to breathe
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BIRTH

LABOUR (Cont’d):

  • Hypothalamus stimulates pituitary
  • Pituitary secretes oxytocin
  • Oxytocin makes uterus contract: labour begins
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BIRTH

Other mechanisms involved in the start of labour:

  • CRH: corticotropin-releasing hormone: released by the placenta. Amounts correlate with date of labour (early, on time or post-dates) by the 16th-20th weeks gestation
  • CRH seems to trigger fetal production of cortisol. Cortisol clears fluid from infant’s lungs and stimulates more CRH production.

This, in turn, stimulates placental estrogen production, necessary for starting labour.

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BIRTH

SOME POSSIBLE SIGNS OF LABOUR:

  • Mucus plug falls out from cervix
  • Amniotic fluid leaks or gushes out
  • Contractions - but … Braxton Hicks: False Labour
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BIRTH

STAGES OF LABOUR:

  • “False” labour: Braxton-Hicks contractions
  • First stage:
    • early first stage: longest (hours or days), mild contractions, 10-30” duration @ 20, 15, 10, 5’ intervals
    • late first stage: 60-90” duration @ 3, 2, 1’
    • transition: shortest, (15-30’) most intense, random pattern of contractions.
  • All along, cervix dilating and effacing (thinning)
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BIRTH

STAGES OF LABOUR (Cont’d):

  • Second stage:
    • cervix fully dilated (10 cm)
    • baby moves down birth canal
    • crowning
    • duration: primiparas about 1 hr., multiparas faster
    • head first, rotation
    • shoulders, one at a time
    • rest of baby slithers out
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BIRTH

STAGES OF LABOUR (Cont’d):

  • Third stage:
    • after 10-15’ interval
    • expulsion of placenta
  • During interval between stages 2 and 3:
    • lungs start to work gradually
    • cord delivers last of maternal blood to infant
    • heart valves close
    • cord must not be cut until white and not pulsing
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BIRTH
  • Birth:
    • empowering experience for mother
  • Super-orgasm (Kitzinger)
  • Gentle pushing, breathing baby out
  • Mouth open leads to open introitus
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BIRTH

POSITIONS FOR LABOUR

  • Not on her back!!! Lithotomy Position
    • Weight of uterus and its content on abdominal aorta: can cause reduced blood flow to fetus
    • Slows down labour
    • Importance of gravity’s help
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BIRTH

POSITIONS FOR BIRTH

  • Standard: lithotomy – one of the worst. Better:
    • sitting up reclined
    • lying on her side
    • on hands and knees
  • Unmedicated, undisturbed birth best. 90-95% births do not need intervention.
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BIRTH

RISKS OF INDUCING LABOUR:

  • Contractions too hard, lead to more analgesics and anesthetics
  • Hard contractions can also lead to uterine rupture and to brain damage (pressure on the skull)
  • If lungs not ready, leads to respiratory distress (formerly called hyaline membrane) due to lack of surfactin
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Placenta praevia

Classification and external resources

BIRTH

POSSIBLE COMPLICATIONS (5-10%)

  • inefficient placenta, affects fetal growth, life threatening for fetus
  • placenta previa

Diagram showing placenta praevia.

ICD-10 044, P02.0

ICD-9 641.0, 641.1

MeSH D010923

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BIRTH

POSSIBLE COMPLICATIONS (5-10%)

  • abruptio placenta
  • transverse presentation
  • breech presentation (feet or buttocks)
  • prolapsed cord
  • cord pinched or wrapped around neck
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BIRTH

POSSIBLE COMPLICATIONS (5-10%) (Cont’d):

  • small pelvic diameter
  • multiple births
  • toxemia: elevated BP, fluid retention, can lead to eclampsia (possibly fatal)
  • maternal asthma
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BIRTH

POSSIBLE COMPLICATIONS (5-10%) (Cont’d):

  • All carry risk of hypoxia or anoxia
  • Hypoxia:
    • reduced oxygen
  • Anoxia:
    • NO oxygen
  • Consequences:
    • brain damage
    • detectable or subclinical
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BIRTH

POSSIBLE IATROGENIC EFFECTS OF INTERVENTION:

Common interventions:

  • Induction of labour (pitocin), use of pitocin to re-start or accelerate labour: can cause too strong contractions, pain, uterine rupture. Due date myth.
  • Episiotomy (infections, painful sex, painful sitting)
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BIRTH

POSSIBLE IATROGENIC EFFECTS OF INTERVENTION:

Common interventions (Cont’d):

  • C-section: major abdominal surgery; possible lack of adrenaline/noradrenaline in baby. N. American C-sec rates too high
  • Psychosocial factors:
    • vagina preservation
    • no pain or awareness
    • set the date
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BIRTH

POSSIBLE IATROGENIC EFFECTS OF INTERVENTION:

Common interventions (Cont’d):

  • Medical factors:
    • ultrasounds
    • fetal monitors
    • higher maternal age
    • tummy tuck combined with C-section
  • Pain medication (analgesics and anesthetics): can slow down labour and decrease oxygen delivery to baby
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BIRTH

POSSIBLE IATROGENIC EFFECTS OF INTERVENTION:

Common interventions (Cont’d):

  • Fetal monitor: external or internal
    • External: curtails movement, mother on her back
    • Internal: possible damage to baby, also curtails mother’s movement
    • Forceps
  • All interventions potentially iatrogenic: damage caused by medical treatment.
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BIRTH

EFFECTS OF ANESTHETICS AND ANALGESICS:

  • slow down labour (leading to pitocin use)
  • sluggish baby
  • mother zonked, weak
  • can interfere with bonding
  • can interfere with lactation
  • can interfere with rooming-in
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BIRTH

SOME POST-NATAL EFFECTS OF

HYPOXIA

  • Increased SIDS
  • Increased risk of respiratory illnesses
  • Weaker sucking reflex
  • Weaker head-turning reflex
  • Increased hyperactivity
  • Increased difficulty in reading and math
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BIRTH

BIRTH HORMONES (INFANT)

  • Adrenaline and noradrenaline
    • open airways, lungs
    • enhance cell metabolism
    • more blood to brain
    • alertness
  • Not released in C-section
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BIRTH

BIRTH HORMONES (INFANT)

  • Could be interfered with when administering drugs to mother during labour
  • No thorough longitudinal study but 80% increased risk of asthma by age 8
  • Silver nitrate, drops in baby’s eyes in case of maternal gonorrhea (blindness) but…
  • Interferes with bonding, can be delayed an hour
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BIRTH
  • In some cultures, intercourse used to start or accelerate labour.
  • How soon can have sex post-partum? Six weeks or when ready. Effect of episiotomy, C-section.
  • Moms who breastfeed tend to return to sex earlier. Results depending on sampling and methodology. In both parents testosterone decreases, prolactin increases.
  • Tiredness, lack of sleep, overwhelmed
  • Change in roles, decrease of “romanticism”.