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Childbirth

Childbirth is an amazing process of giving birth and this process can vary quite extensively from person to person and even from birth to birth.

Childbirth can also be termed as Labour, Delivery, Birth, Partus, and even Partiurition.

Sometimes the progression of Childbirth will go along with normal expectations, and in some cases, they should be thrown out the window.

An Interesting fact is that at any given time almost 3.25% of the female population is pregnant.

On average there are 12,000 new births everyday in the World.

2 Main Types of Deliveries:

1.)  Vaginal birth

–  This the most often form of delivery and progression follows several stages or transformation of the cervix with dilation and effacement.
–  Vaginal delivery has been in style  for thousands of years and the process, can be, in most cases rather simple while in other circumstances can be quite difficult and complex.
–  The pelvic anatomy of humans are uniquely structured to allow for birth through the Vagina.
–  The pelvic floor is important and allows for the weight and controls the passage of the Uterus, vagina, and the rectum.

2.)  Caesarean Section

–  Caesarean Section is occasionally required or chosen depending on the circumstance, where a surgical incision in the abdomen allows for delivery of the fetus.
–  Can be chosen or done emergent due to complications/symptoms

Common Symptoms of Childbirth

–  Symptoms vary from person to person
–  Strong contractile waves (Contractions)
–  Abdominal pain
–  Abdominal discomfort
–  Anxiety
–  Restlessness
–  Back pain
–  Back Labour
–  Loss of mucus plug

What is the Latent phase?

–  Also referred to as Prodromal labor
–  Lasts several days to a few hours prior to birth
–  Contractions become increasingly intense

What are Braxton Hicks Contractions?

–  They often occur in this stage of birth
–  False contractions
–  Seen in 2nd and 3rd trimesters
–  Can be the Uterus preparing for eventual childbirth

Cervical Effacement

–  This is an important progressive effect during this stage
–  This is when the contour of the cervix changes from a bottleshaped area impossible for birth
–  A smoother and flatter cervix thins making the passage of the fetus much more plausible
–  When cervix is dilated about 3cm – latent phase ends.

Onset of Labour is a complex system and is different to everyone.

–  There are various definitions about onset or the beginning of the Childbirth process.

Below are a few examples:

1.)   Regular uterine contractions every six minutes with Cervical dilation or Cervical Effacement.

2.)  Regular contractions less than 10 minutes apart and progressive Cervical dilation or Cervical Effacement

3.)  Regular contractions with 3 that are painful uterine contractions during a t10 minute period lasting longer than 45 seconds

4.)  The breaking of the amniotic sac (mucus plug), or contractions or cramps that have a consistent pattern

5.)  Other

Labor Contractions Have Similar Characteristics

–  Regular and Predictable –  (Having them every 8 minutes)
–  Become progressively closer –  (They were every 10 minutes – now they are every 7)
–  They last longer  –   (Were 10 seconds in length – now they last 45 seconds)
–  Become much stronger and/or more painful
–  They may be felt in the back and then in the stomach
–  Moving, changing positions, and changing activity doesn’t slow or stop contractions
–  Membranes may rupture or bloody show may be seen  (not always seen)

3 Main Stages of Labor and Childbirth

1.) First Stage of Labor:  Dilation

–  Vaginal examination is often necessary during this stage
–  Bishop Score is a predictive score to determine when the second stage begins
–  It also helps determine if induction of labor is required
–  First stage begins when dilation of cervix has reached 3 cm
–  Uterine muscles begin working
–  Contractions allow uterine muscles causing the uterus to shorten
–  The cervix gradually dilates – from 3cm to 10 cm.
–  When 10 cm is reached then the Baby’s head can can pass through the cervix
–  This stage can last from “on average” 8 hours for first time vaginal deliveries and 4 hours for someone who has previously given birth

The stoppage of this Stage:

–  When cervix dilation no longer continues at 1.2cm per hour for 2 hours
–  “Failure to Progress” possibility is then evaluated
–  Adequate time must be done to evaluate this period
–  Cesarean or C-section may be an option

2.)  Second Stage of Labor: Expulsion

–  Begins with the complete dilation of cervix
–  Continues through the birthing of the baby
–  Following dilation – the baby then progress to the pelvis region
–  The pelvic brim and the baby’s head passing is an important aspect
–  This is typically the narrowest part of the pelvis
–  Next the head will pass the pubic arch and introitus
–  Bearing down and pushing are essential during this part
–  “Crown” occurs when labia part and a burning or stinging feeling may be felt by the
mother at this point.
–  Often the baby is then completely birthed

3.)  Third Stage of Labor: Placenta

–  12-30 minutes following birth of the baby the placenta will be expelled

Expectant management

–  No medical assistance is required
–  Breastfeeding helps this process
–  Massaging of top of uterus helps this process
–  Uterine contractions occur

Active management

–  Medical requirement is used or is necessary
–  Oytocic agents used to cause uterine contraction
–  Cord reactions helps expel the placenta

Blood loss

–  Uterine will contract after placenta is expelled
–  This will help dramatically prevent excess blood loss
–  Blood loss is often closely monitor and most cases is not a concern

Look at some of the many Complications During Childbirth:

1.)  Breech Birth.

–  The baby is in a breech presentation when the baby enters the birth canal with the feet or buttocks pointing first.
–  Typical finding for a “normal birth” is when the baby is in a head first presentation.
–  Overall occurs generally between 5-10% of births when at term.

2.)  Difficulty of descent of fetal head

–  Often seen with difficulty through the pelvic brim

3.)  Shoulder Dystocia

–  Occurs once the head is delivered a problem with the shoulder is seen
–  The anterior portion of the shoulder can not continue further during the delivery.
–  Several options or maneuvers are available.
–  Complications include hypoxia, hemorrhage, and possible paralysis

4.)  Cephalo-pelvic disproportion (CPD)

–  When the pelvis is unable to expand enough to all the baby to progress in labour
–  A small pelvis is often the cause, but a large fetus may also be a risk factor.
–  Pelvic fracture and a disease like rickets may lead to this condition

5.)  Child Swelling

6.)  Hypoxia – difficulty breathing

7.)  others

Maternal Complications

1.)  Episiotomy 

–  A surgical incision during childbirth to assist in delivery
–  This procedure was once the standard of practice in Europe, Australia, and the United States.
–  Is now only used when required
–  Latin America allows this procedure 90% of the time.
–  Increased complications arise when normal births use Episiotomy

2.)  Vaginal Injury

–  Tearing
–  Nerve Damage
–  Pain
–  Stool incontinence
–  Urine incontinence
–  Sexual dysfunction

3.)  Hysterectomy

–  May be required in some cases of emergency

4.)  Infection

5.)  Excess bleeding or Hemorrhage

–  Heavy blood loss is the #1 cause of maternal death world wide
–  Shock often follows loss of large amount of blood
–  Blood transfusions may be required

6.)  Others

Importance of C-section

–  When complications arise due to breech, c-section is often a logical choice.
–  Several risks are associated with a surgery
–  Risks include – internal injury, hysterectomy required, infertility, injury to baby, bleeding, others

Time immediately following Birth

–  Breastfeeding and comfort of mother and child are often seen
–  Rest is important following birth
–  Proper nutrition is important

Pain Control during Birth

–  Non-medical and Medical options

Non-Medical treatments include:

–  Psychological preparations done prior to childbirth
–  Water Therapy
–  Massages
–  Meditation
–  Hypnosis
–  Family support
–  Friend support
–  Doula who is an assistant for this process
–  Sterile water
–  others

Medical pain control

Very Early stage of Childbirth

  –  Pethidine [Demerol]
  –  Fentanyl
  –  Pethidine with Promethazine

Epidural blocks

–  Generally safe
–  Medicine can cross the placenta

Nitrous Oxide –   prescribed in Europe

Statics given by:  CIA World Factbook (https://www.cia.gov/library/publications/the-world-factbook/geos/us.html)