Stages of Childbirth

Labor
• Labor – the process of giving birth
• Not everyone woman will experience all signs,
but when they occur, they are a clue labor is
near
 Signs of Labor
• Experience lightening (baby drops lower into
the pelvis)
– Can occur a few weeks before labor or it may not
happen until just before labor
• Few weeks before birth, the cervix (lower part
of the uterus) becomes thinner – effacement
• Opening of cervix begins to widen – dilate
 Signs of Labor
• May notice a pinkish discharge from vagina –
show
– Results from a loosening of the mucus plug that
sealed the cervix during pregnancy
• Amniotic sac ruptures when labor begins –
breaking of the waters
• Labor begins – contractions – a tightening of
the uterus muscles, followed by relaxation of
the muscles
 False Labor Real Labor
• Contractions are • Contractions may be
irregular irregular at first, but
then occur at regular
intervals

• Contractions do not • As real labor

become stronger or progresses,
more frequent contractions intensify &
come closer together
 False Labor Real Labor
• The contractions • Contractions usually not
generally stop if the affected by change in
woman walks around or position
shifts position

• Contractions most often

• Woman feels pain in
start in the lower back
the lower abdomen
& spread to the lower
abdomen
 The Stages of Labor
• First Stage
– Contractions cause the cervix to dilate
• Second Stage
– The baby is born
• Third Stage
– The placenta is expelled from the mother’s body
 First Stage
• Begins with early labor
– contractions are usually mild
– may last 30-40 second
– occur every 20-30 minutes
– Irregular at the beginning
– Gradually, grow stronger, last longer & occur more
often
– Last about 8-12 hours
– No need to rush to hospital
– Rest or engage in light activity
 First Stage
• Active labor
– Starts when the cervix has dilated to 3 cm
– Last about 3-5 hours
– Contractions become stronger & more frequent
– Mommy-to-be advised to go to hospital when
contractions are five minutes apart or less
• Sooner if she lives further away
 First Stage
• Active Labor
– Admitted to hospital or birthing center
– Hospital gown
– Id band attached to wrist
– Mother – brief medical history, signs forms &
gives urine sample
– Pelvic exam (one of many) check degree of
dilation & position of baby
– Mommy-to-be pulse & blood pressure checked
– Fetal monitor – keep track of baby’s heart rate &
watch for signs of stress
 First Stage
• Transition
– 30 minutes to 2 hours
– Often the most demanding part of labor
– Contractions – intensify
– Last 60-90 seconds, occur every 30 seconds
– Begging cervix is dilated about 7 cm, during it
dilates to 10 cm]
 At your table…….
• List how mommies to be can reduce the
discomforts of labor.
 Bell Work
• What is the difference between real and false
labor?
• How many labor stages are there?
– Describe each.
 Reducing Discomforts
• Support of loved ones helps make the
experience less stressful
• Being well-rested – tolerance & endurance
during labor
• Having eaten (light snacks and ice chips)
• Knowing what to expect reduces anxiety &
fear = can reduce pain
• Using techniques taught in child-birth class
 Reducing Discomforts
• Medications
– Systemic drug – helps relieve pain, tension or
nausea, injected into muscle or vein
– Local anesthetic – anesthetic is a medication that
causes loss of sensation. Local is given by injection
& numbs a small area
– Regional anesthetic – numbs large area (epidural)
most common type
– General anesthetic – produces unconsciousness
 Second Stage
• Cervix – fully dilated
• Delivery of baby begins!!
• Mommy – bear down with her abdominal
muscles & push baby out of the uterus &
through the vagina
– 20 minutes – 2 hours
– Contractions – 45-90 seconds, 3-5 minutes
• Typical birth – baby travels down the birth
canal head first and facing the mother’s back
 Second Stage
• Baby’s skull – flexibly joined plates of bone
• As the head begins to emerge, the baby turns
face upward
• Episiotomy – surgical cut at the vaginal opening,
helping the baby’s head pass through vaginal
opening
• Head fully emerged – baby’s mouth & nose are
suctioned (mucus)
• Baby is still attached to umbilical cord – therefore
someone must cut it
 Second Stage
• Baby is born!!!!
• Parents are elated to welcome baby
• Some will laugh, cry tears of joy & relief
 Third Stage
• Final stage
• Placenta is delivered
• Mommy experiences mild contractions
– Which separate the placenta from the uterine wall
and move it into the vagina – the pushes it out
• 10-30 minutes
• Menstrual-like flow begins
– Continues for at several days to six weeks
 At your table….
• What is a cesarean delivery?
• When is one necessary?
 Cesarean Delivery
• Sometimes called a C-section
• Procedure in which a doctor delivers the baby
through a surgical opening in the mother’s
abdomen
 Cesarean Delivery
• May be necessary:
– Mother’s pelvis is too small to deliver baby
– Fetus is in the breech position (feet or buttocks
closest to the cervix)
– Mother is carrying multiples
– Mother has preexisting medical condition that makes
birth unsafe
– Placenta covers the opening of the uterus
– Long labor threatens mommy and/or baby
– Fetal monitor shows baby’s heart rate dropping
dangerously low
 Cesarean Delivery
• Most conditions are known in advance
• Many are scheduled to take place prior to
labor
• Most cases – mothers are given an epidural.
She is alert and awake, but does not feel any
discomfort
• Birth coach can be present
 Newborns
• Newborn’s skin is covered with vernix – a
greasy white material.
– Keeps the skin from getting waterlogged by
amniotic fluid
 Newborns
• Head may look pointed or lopsided because of
being squeezed on its way through the birth
canal.
– It will take on a rounded shape within a few days
 Newborns
• Skin of most newborns looks blotchy at first
– Face may be covered with pimple-like bumps
called milia
– Most skin conditions clear up within the first few
weeks
 Newborns
• Jaundice – occurs when a baby’s liver is not
yet able to break down a substance called
bilirubin.
– Skin has yellowish tint
– Treated with ultraviolet light (hospital or special
equipment at home
– Fairly common
 Newborns
• At first baby’s eye may appear crossed –
newborns cannot focus
– Drops are given at birth to prevent infection
sometimes cause the eyes to swell
• Light skin babies – almost always have blue
eyes at birth
• Darker skin babies – often have more brown
eyes
– Individual eye color develops over several weeks
 Bonding
• Holding baby immediately after delivery
• Attachment begins!!!
 Postnatal Care
• Both mommy & baby need it
• Apgar Scale
– System used to rate an infant’s physical condition
minutes after delivery to detect any problems that
require immediate emergency treatment
– Scores are recorded at 1 & 5 minute(s) of life
– Newborns who score a total of seven or more
point are in good to excellent condition
 Routine Newborn Care
• Baby is given a vitamin K injection and a
hepatitis B vaccine
• Baby is weighed, measured and washed
• Before baby leave the delivery room, an ID
band that matches the mothers is placed on
baby’s ankle or wrist
• Footprints are recorded
• About 10% of all pregnancies is the US result
in premature birth (before 37 weeks)
– Before prenatal development is complete
– Ex. Breathing problems due to lungs are immature
• Low birth weight – less than 5.5 lbs
• Both require special attention – Neonatal
Intensive Care Unit
– Constant monitoring & attention
– Most are placed in incubator – an enclosed crib in
which temperature, humidity & oxygen levels are
carefully controlled
 Rooming In
• Practice of allowing the baby to be cared for in
the mother’s room rather than in the hospital
nursery.
• Allows mommy and baby to spend more time
together
•
 Breast Feeding
• Takes a few days for milk to come in
• However, she will produce Colostrum – a
yellow fluid rich in nutrients and antibodies
that protect newborns from infection
 Birth Certificate
• Order one. (Hospitals will fill out paper work
or send for you to fill it out)
• Keep in a safe place
• A child cannot get a SSN without one
How many centimeters should a
pregnant woman dilate for
delivery?
 1. Draw what you think is 10
centimeters.

2. Actually draw 10 centimeters.

 Review
• Identify the six nutrients that should be included in a
pregnant woman’s diet?
• How much weight should a pregnant woman gain?
• Identify three hazards that pregnant women should
avoid.
• Describe the three stages of labor.
• Know the difference between false and true labor
• What are two signs that labor is beginning?
• What does it mean by the baby being breeched?
• When would a c-section be necessary?
 Common Signs that Labor is Near
• Lightening = the baby "drops" or engages into the
pelvis
– May occur two to four weeks prior to labor for first-time
mothers and often not until labor begins if you have
previously had children
• Your abdomen usually appears lower and more
protruding.
• You may experience a greater ease in breathing,
relief from heartburn and an ability to eat larger
portions.
 First Stage = LABOR
• Contractions = tightening and relaxing of the
muscles of the uterus.

• Contractions help dilate (widen) the cervix

and push the baby from the uterus through
the vagina.
 Admission Procedures
• Admission
• Changes into hospital gown
• ID band on wrist
• Pelvic exam
• Fetal monitor = register mother’s contractions
and baby’s heartbeat
• Given bed in labor room or birthing room
 Active Labor
• Contractions grow more intense
– 3-4 minutes apart and last 40-60 seconds
• This hard work gets results, dilating the cervix
up to about 7 cm.
• Walk around, relax in rocking chair, etc.
• Coach should encourage, etc.
 Transition
• Moves childbirth from labor to the stage of
pushing and delivery
• Total time = 90 minutes, compared to 14
hours of early and active labor
• Contractions are regular, extremely powerful
= 60 to 90 seconds, every 2-3 minutes
• Cervix dilates fully to 10 cm.
 Transition
• Most difficult part of labor
• Medications are generally given at this time
• Nauseous, drowsy, feverish, then chilled
• Feels as if baby is pressing down
• Emotions are increasing
• Coach should be comforting, etc.
 Second Stage = Pushing and Delivery

• If no medication yet, probably needs it now

• Fully dilated
• 2 hours = first birth and 1 hour = 2nd and 3rd
births
 Preparing for Delivery
• Moved from labor room to delivery room or
preparing birthing room
• Woman’s pelvic and vaginal area is scrubbed
and then painted with an antiseptic solution
• Body is covered with sterile cloth
• Coach is prepped
 Delivery
• Contractions = strong, every minute or two,
lasting just as long
• Burning or stinging in birth canal
• Forceful pushing pushes baby down birth
• Canal, facing backwards with the head down
• Crowning = head begins to emerge
 Episiotomy

As the baby emerges, there's a chance that

skin between the vagina and anus will be
stretched to the breaking point. To prevent
uncontrolled tearing, many physicians
routinely make the minor incision
 Delivery
• Nurse suctions mucous from baby’s mouth and
nose
• Head expands birth canal so the rest of the body
can pass
• Body’s baby rotates to one side, guided by doctor
enabling shoulders to come out one at a time
• Fathers can receive child
• Umbilical cord is clamped
 Bonding
• Routine tests and procedures
• Baby is laid in mom’s arms with dad close by
• Parents talk to and caress baby
• Infant sees their faces, hears their voices
which creates a physical closeness and
bonding takes place
 Complications
• Not all births proceed normally
• If woman cannot push the baby out herself,
forceps or vacuum extractor are used
• Breech delivery = baby is born feet or buttocks
first, which may lead to a cesarean section
Cesarean Section
 Cesarean Section
• Long, difficult labor threatens to injure mom
or baby
• Baby’s heart rate is dropping
• Woman experiences placenta previa where
the placenta covers the opening of the uterus
and prevents vaginal delivery
• Woman’s pelvis is too small or she has
multiple birth
 Third Stage = Delivery of Placenta
• Occupied with baby, mom may barely notice
this stage, which is the delivery of the placenta
• Nurse may massage abdomen to assist the
process = 10-30 min
• If an episiotomy was performed, it is now
repaired
• Uterus shrinks, bloody discharge may still occur
up to 6 weeks.
• http://www.webmd.com/content/tools/1/slid
e_fetal_pos
 Caring for the Newborn
• Neonate = a newborn baby in the first month of
life
• Doctors/Nurses put drops into neonate’s eyes to
prevent possible infection and given a vitamin K
injection
• Checked for proper development, weighed,
measured and washed
• ID band is placed on baby
• Infant’s footprints
 Neonatal Checkup
The Apgar Scale: 7+ pts = good condition
0 Points 1 Points 2 Points
Heart Rate Absent Under 100 Over 100

Breathing Absent Slow; irregular Good; crying

Muscle Tone Limp; no or weak Some movements Active motion

activity of limbs

Responsiveness No response to Grimace Cough or sneeze

stimulation
Skin Color: Dark Grayish or pale Strong body color; Strong body color;
but grayisg limbs pink lips, palms,
soles
Skin Color: White Blue or pale Body limbs pink, Completely pink
not blue
 Neonatal Checkup
• Neonatal Behavioral Assessment Scale
– Takes 25 minutes to administer
– Tests baby’s ability to maintain a deep sleep when
disturbed by a light, rattle and bell
 Premature Infants
• 10% of babies are premature
– 3 weeks or more before their due date
– Low birth weight
– Undeveloped lungs, infection
– May be placed in an isolette
 Circumcision
• Surgical procedure where part of the foreskin
is cut away from the tip of the penis
• 2nd day after birth
• Religions rights/traditions
• Medical experts debate health advantages
• Easier to clean, prevents infection
• Parents’ decision
 Birth Certificate
• Indicates birth is recorded
• Hospital does paperwork of registering the
birth with the county or community’s office of
vital statistics, office issues certificate
• Kept in safe place for child’s proof of identity
• Cannot get social security number without a
birth certificate
 Birth Certificates
• Proves:
– Legal Age = Vote, serve in military, get a driver’s
license, get married or sign a contract

– Citizenship = Vote or obtain passport

– Relationships = identify parents, guardians and

heirs
 Name Activity
• Choose three boy and three girl first and
middle names that you think are good, solid
names that you would consider naming a child
in the future. 