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
irregular
• Contractions may be
irregular at first, but
then occur at regular
intervals
• Contractions do not
become stronger or
more frequent
• As real labor
progresses, contractions
intensify & come closer
together
False Labor
• The contractions
generally stop if the
woman walks around or
shifts position
Real Labor
• Contractions usually not
affected by change in
position
• Contractions most often
• Woman feels pain in the
start in the lower back
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
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•
•
•
•
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
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•
•
•
•
•
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
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•
•
•
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
activity
Some movements
of limbs
Active motion
Responsiveness
No response to
stimulation
Grimace
Cough or sneeze
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,
not blue
Completely pink
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. 