Chapter 6: The Baby’s Arrival

1. Chapter 6:The Baby’s Arrival Section 1: The Birth Process

2. Objectives • Recognize the ways in which labor may begin • Outline the 3 stages of labor • Describe a newborn’s physical changes and appearance at birth

3. The Beginning of Labor • Many changes within the last days • Different for each woman • One of the first signs is lightening • the baby “dropping”

4. Definite Signs • Show, bloody show– “losing the mucus plug” • Cervix: lower part of uterus • Sealed with mucus throughout pregnancy • Prevents bacteria & infection • Before labor, mucus starts to liquefy • Woman may notice a few drops of blood

5. Definite Signs • Water breaking • Range from trickle to gush • The membrane holding the amniotic fluid has broken • For many: doesn’t happen until she is at the hospital • When it breaks woman should note details and tell doctor

6. Contractions • Only clear sign that labor is underway • Tightening and releasing of the uterine muscle • Follow a characteristic pattern • Over time they get longer, stronger, and closer together

7. Fetal Monitoring Device • Used during labor to record infant’s heart rate & contractions • Medical staff determines the degree of stress on the fetus

8. Stages of Labor • Progresses through 3 stages: • Contractions open the cervix • Baby is born • Placenta is expelled

9. First Stage • During each contraction, the muscles shorten and thicken • Pulling open the cervix • Slowly thinning and opening until it is wide enough for the baby • Cervix dilates (widens) • 4 in or 10 cm • Cervix becomes thinner • ¾ in  sheet of paper • “Effacement”

10. First Stage: Contractions • Longer= 60 seconds • Stronger • Closer together 5-6 min • Needs increasing support from partner • Should be at the hospital by this time

11. Positioning • Baby should be head down • If not= breech positioning • Doctor evaluates to determine vaginal delivery or cesarean birth

12. 1st stage: The Mother • Needs to stay relaxed • Fear & tension cause muscles to tighten • Can slow down labor • Make it more uncomfortable • Childbirth classes can help with breathing & relaxation techniques • Find a comfortable position

13. End of 1st Stage • Contractions are 90 seconds and 2-3 minute apart • Fully dilated • This time is called “Transition” • Most difficult part of labor to cope with

14. Health Tip • If the mother finds the 1st stage difficult and very long • May choose to use medication • Dull pain or completely numb an area • Benefits & risks are involved • Possible side effects

15. 2nd Stage • Cervix is completely dilated • Baby’s head has entered the vagina • Contractions no longer stretch cervix they push the baby down • May only last several minutes and up to several hours

16. The Pelvis • How does a baby fit through a small opening? • The bones of pelvis are connected by ligaments which stretch • Pregnancy hormones help to stretch

17. 2nd Stage: The Baby • Body is specially adapted for birth • Skull is soft and flexible • Becomes longer and narrower than normal • 5 Bones of skull can overlap to fit through the pelvis and vagina • If baby is not fitting properly, several procedures may occur

18. 2nd Stage: Possible Procedures • Episiotomy: widening the vaginal opening with a surgical incision • Many doctors and midwives try to avoid this if possible • Women need to be able to relax all muscles to allow for stretching • Doctors may need to use forceps • Specialized tongs that are molded to fit the shape of the baby’s head

19. End of the 2nd Stage • Women can give birth in a variety of positions • Most common: semisitting position with legs apart and knees bent • Usually a special delivery bed is used • As the baby moves down the birth canal, the head appears first, then one shoulder, and then the other, then: • The baby is born!

20. 3rd Stage of Labor • Uterus gives birth to the placenta • May be as brief as 2 minutes or may last up to half an hour • After a period of rest, mother may feel more contractions • Help the placenta separate from wall of uterus • Placenta is soft and comes away easily • Once placenta is delivered, the process is complete!

21. Cesarean Birth • Not all births progress through the 3 stages • Cesarean birth: delivery of a baby through a surgical incision in the mother’s abdomen • Mother may remain awake, father may be present • If known beforehand, special childbirth class may be recommended • After surgery, mother and baby usually stay for 4 days

23. Cultural Exchange • Julius Caesar’s doctor realized Julius’ mother was dying during childbirth • Performed a radical surgery • Now called Caesarean Section!

24. Past Vs. Present • Past: if a woman had a C-section generally would always have C-sections • Due to scar • Concern would rupture the uterine wall • Present: improvement in surgery increases safety • Incision is made very low • Receives little stress during contractions • Physicians will encourage vaginal births for the 2nd child unless medical reasons prohibit

25. Birth video- diagram • Video

26. Newborn at Birth • First several hours, the baby goes through amazing changes • Throughout pregnancy the baby’s lungs are filled with fluid • Oxygen through blood in umbilical cord • Pressure through birth canal expels the fluid • When baby is delivered the lungs expand and the baby takes first breath

27. Breathing at Birth • Breathing reflex continues on own • May need help from doctor or nurse • Suctioned out • Rub baby’s back • Baby takes in oxygen from air & circulatory system changes • A valve in the heart closes and becomes permanently sealed • Blood now circulates to and from the lungs, rather than bypassing the lungs

28. Umbilical Cord • No longer needed • Within a few minutes, the cord stops pulsing and begins to shrink • The cord is clamped, tied, and cut off

29. How Does the Newborn Look? • Head: wobbly & large • Accounts for ¼ of the body length • May be lopsided or pointed • Temporary • 2 fontanels: open spaces where the bones of baby’s skull have not permanently joined

30. Fontanels • “Soft spots” • Largest is just above the baby’s forehead • Second is toward the back • Spaces allow for the bones to move together • 6-18 months the bone covers the spaces completely

31. Other Features • Fat cheeks • Short, flat nose • Receding chin • These features make the baby’s face well adapted for sucking • Nose & chin are out of the way • Eyes are near adult sized • Dark graying-blue • Permanent eye color within several months

32. Skin coloring • At time of birth • Dusky color • After breathing skin color improves • Circulatory system takes time to adjust • Fingers and toes may remain bluish, cooler • Baby needs to stay warm • Wrapping in blanket • Cap on head

33. Hair & skin • Soft, fine hair may cover babies skin • Baby is covered in vernix • Rich, creamy substance • Protects skin from amniotic fluid • At birth, some may be left in the skin folds • Tiny white bumps • “Milia” plugged oil ducts • Disappears after week or two

34. Kangaroo Care • Research into immediate skin-to-skin contact • Mother & baby • Debate between benefits & risks • Kangaroo Care