Labor, Delivery, Post-partum & Newborns
RECAP
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Labor is the process that moves baby out of the Mom. It occurs via
involuntary contractions which are the rhythmic movement of muscles in
the uterus that push the baby against the cervix causing it to open.
The baby then makes its way out of the Mom by traveling through the
birth canal or vagina.
The labor contractions alternate with periods of rest for the Mom’s body.
First two things that usually occur during labor are:
1. the loss of the mucus plug
2. the rupture of the amniotic sac or the
breaking of Mom’s water.
Stages of Labor
Labor is divided into 3 stages.
Stage One: Dialation, or the
opening of the cervix, to a full 4 inches. This stage last 12 – 24 hours.
Contractions are 15 – 20 mins. apart and last less than 1 minute
Stage Two
Delivery of the baby occurs!
Baby starts to emerge through cervix and birth canal. This stage ends at
birth-when baby is fully clear from mom. This stage last about 1 ½ hours.
Contractions are 1 minute in duration occurring every minute.
Baby should exit head first, if not this is considered a breech birth. 1 out of 25
deliveries is breech. Breech babies may be manually turned, delivered breech
(extremely risky!)
or delivered via
Cesarian section.
Episiotomies (surgical cut & repair by stitches after delivery) may be necessary
to prevent tearing of the vaginal walls during delivery.
Stage two-continued
The umbilical cord will stop functioning after delivery.
Doctor or Dad
will cut the
umbilical cord.
Delivery Aids and Tools may be necessary. Forceps and vacuum extractors
help pull the baby out.
The hormones Oxytocin and Pitocin are used to start and speed up contractions.
Stage Three
Expulsion of the afterbirth
The afterbirth (placenta, cord and other membranes) must be checked to
make sure all was
Expelled. Cord
blood may be
obtained and
saved for future
use.
Vernix Caseosa
The baby is wiped clean after delivery. The vernix is a natural protective skin
grease – similar to a wetsuit! It protects from heat loss before and during birth
and too much water absorption during pregnancy.
Bonding
Bonding between parents and child begins to occur right after birth. Mom and
Dad fall in love with the infant and infant begins to identify Mom and Dad.
Bonding!!
For Baby bonding results in:
• increased chances of survival for the infant
• improvements in weight gain
• less crying
• increased language and mental development.
For parents, bonding results in:
• less child abuse
• faster recovery time for Mom
• more self-confidence
• less post-partum depression
Birth Plans
Birth Plans should be made before delivery by the parents and doctor.
Birth Plans include:
1. Where the birth will occur? Choices are at home with a certified nurse
midwife or at the hospital with a doctor. In the hospital it can be: in the delivery
room or in a birthing room.
Birthing room
Birthing rooms are a good compromise between a technological, depersonalized
hospital birth (which cannot offer the emotional experience of a home birth) and
a birth at home (which cannot offer the medical backup of a hospital).
Delivery room
#2 Who will be there?
Side note: a Doula is a trained person that assists with physical, emotional
and educational support. She is also there to help calm the “laboring
Mom.” She is part of the birthing team She is similar to a midwife but
does not participate in the delivery (down there!)
#3 Labor Style
Natural childbirth
– Developed by Dr. Rick Read in 1930s
– Delivery without drugs
– Based on educating the Mom so she knows what to expect,
therefore reducing her fear factor and so pain is manageable.
– Mom is trained on how to breathe and relax during delivery
#3 Labor Style
Lamaze-developed by Dr. Fernand Lamaze
Women have been conditioned to fear childbirth. So Lamaze method educates to
reduce fear.
• Mom is taught to focus on one other thing in the room and to breath in
patterns so as to keep her mind off the pain
• The Dad attends the Lamaze lessons with Mom and is the Coach
• The Mom receives medication when necessary
# 3 Labor Style
Leboyer Method-Shhhhhh!!!!!
• Developed by Dr. Fredrick Leboyer
• The focus is on the comfort of the baby and the safety of the mom and
baby
• This method believes delivery is painful for the baby as well.
• Low lights are used in the delivery room
• The room is quiet, soft voices, soothing music
• The cord is cut only after it stops functioning
• Baby is given a warm water bath after he has had time to bond, cuddle
and suckle at Mom’s breast
#3 Labor Style
Water Birth
• Uses a large bathtub for mom to sit in. It is filled with warm water and
soft lighting.
#4 Pain Management
• Analgesia to reduce anxiety and pain (Demerol)
• Local anesthetic: a shot to numb the vaginal area
• Regional block: epidural, pain medication inserted into
spine, mom maintains sensations but has no pain
• General: Mom is put out like a light!
# 5 Induction or Not?
Will Induction be used if necessary?
• Hormones can be used to start and speed up labor.
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The manual breaking the amniotic sack or water will also start the onset
of labor.
#6 Equipment
What equipment will be used?
• Can parents provide and use special music?
• Will a vaginal mirror be used so mom can watch the birth process?
• Use of a video camera?
• Use of delivery tools can be discussed before birth too.
#7 Tear or Cut
• Episiotomy vs. natural tearing?
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#8 Who will cut the umbilical cord?
• Will it be saved?
• Will cord blood only be saved?
# 9 Length of Stay
• Mom often stays less than 24 hours in the hospital after delivery.
• Health insurance and postpartum condition of mom will determine the
length of stay.
Cesarian Section Delivery
• If a C-Section is planned will Mom be awake or totally knocked-out?
• Who else will be present?
• Will a mirror be used for Mom’s viewing pleasure?
• Downsides: higher infection rate, longer recovery time, greater stress b/c
it is surgery.
Medical Care and Testing of Newborns
A Neonate is a baby from birth (when the baby is clear of the mother’s body) to
one month old. The newborn is exposed to light, sound, breathing on their own,
securing food on their own, and gravity too.
A Pediatrician is the doctor who cares for infants and children. The delivery
staff cares for the child and mom too. Babies and parents are banded at the
same time at birth for identification and security purposes.
Good prenatal care gives the baby the best chance for a healthy start. All
newborns need medical attention; sick newborns need extra medical care.
ICN is the Intensive Care Nursery. NICU, in the ICN, are the neonatal
intensive care units. A NICU is a heated, completely enclosed bed, equipped
with oxygen, monitors for breathing and heart rate.
The Brazelton Neonatal Behavioral Assessment Scale (NBAS) is an
assessment test that determines the newborns responsiveness to its physical and
social environment. It identifies problems in neurological functioning and predicts
future development. Scoring takes about 30 minutes and occurs in the following
four areas:
 Interaction with the environment - alertness
 Motor processes – general activity level and reflexes
 Control of physical state – self-quieting behaviors
 Responses to stress – startle reaction and trembling
The pediatrician will test for Anemia (low blood oxygen); Phenylketonuria
(PKU), a disease that can cause mental retardation unless treated by diet; and
Jaundice, an immature liver disorder, that can be treated by the use of special
lights.
Breast Milk contains the right proportions of proteins, carbs, fats, vitamins,
minerals and water. It also carries the necessary immunities the baby will need
to stay healthy. It easy to digest, it is always sterile, ready to serve, the right
serving size and rate of flow for the infant.
The mom benefits from breast feeding in the following ways:
 it contracts her uterus
 reduces her bleeding
 helps her bones
 saves money
 it is easy to prepare
 it is easy to freeze for later use
Formula feeding requires a little more effort. Use only commercially prepared
formulas, sterilized bottles and nipples. Formula comes in ready to serve,
condensed-just add water; and dry powder that must be reconstituted with
water. Never save unfinished formula for later use. Most formulas are cow’s
milk-based, some are soy based for infants with digestive problems.
Babies should be fed every 3-4 hours; they will usually let you know when they
are hungry.
Babies must be burped because they swallow air during crying and feeding.
Burp them twice, midway through and after feeding.
Sponge baths are recommended until the navel area heals. Always gather all
supplies before bathing the baby, as you can’t leave the baby alone to retrieve a
missing item.
Sudden Infant Death Syndrome (SIDS) is when an otherwise healthy baby
dies without warning while sleeping. SIDS is more common in African-American
male children, low birth weight babies, children of smokers and children born to
very young mothers.
When preparing the baby for bed: do not overdress the baby before sleeping and
place the baby on his back to sleep. Remove all toys, blankets, pillows and loose
bedding in the crib.
The Newborn Baby
I. First Checks:
1. The Apgar Score assesses:
appearance - color of the child,
pulse - heart rate,
grimace – reflex irritability (coughing, sneezing, crying)
activity – muscle tone
respiration - breathing, crying
The Apgar is done at one minute and five minutes after birth. The rating is 0, 1,
or 2 for each measure. The scores are then combined. This creates a top score
of 10. A score below 7 means the baby needs help establishing breathing. A
very low rating (below 4) will merit immediate medical intervention. A score less
than 10 is not necessarily reason for alarm because few babies achieve perfect
score (10), even after 5 minutes.
2. Next, the baby is then weighed; head circumference and length are measured
and recorded.
3. Then a physical exam is given.
 Facial features are checked for indicators of Fetal Alcohol Syndrome
(FAS) or Down’s syndrome.
 The mouth is checked for cleft palate and cleft lip.
 The hips are checked for dislocation.
 The feet are checked for Club Feet. Club Feet are abnormally bent feet
and ankles.
 The anus is checked for an Imperforate Anus (closed anus).
 The genitals are checked to make sure they are fully and correctly formed
(CAH - middle sex or non-descended testicles).
 The spine is checked for swelling or an ulcer (open wound). Spina bifida
is when a bony part of the spine fails to develop exposing and leaving the
spinal cord unprotected.

The navel is checked for swelling that could indicate a hernia, or failure
of the abdominal wall to fully develop.
4. Reflexes are instinctive to newborns and are checked in the delivery room.
The strongest reflex is Rooting/Sucking.
Rooting Reflex
 Stimulus: cheeks or skin around the mouth is touched
 Reflex: head turns in direction of touch and mouth searches for food.
Palmar Reflex
 Stimulus: palm of hand is stroked
 Reflex: baby grasps finger or object touching the palm
Plantar Reflex
 Stimulus: ball of foot is stroked horizontally
 Reflex: toes curl around or down around object
Babinski Reflex
 Stimulus: outside sole of foot is stroked from heel to toe
 Reflex: babies spread their toes-fan toes outward
Moro Reflex
 Stimulus: loud noise bright light, change in body position, cough, or
sneeze
 Reflex: baby arches his back, flings legs and arms out; rapidly flexes
(curls inward) limbs toward body
Tonic Reflex
 Stimulus: head turned to one side
 Reflex: extends arms and legs on that side, flexes (curls inward)
opposite limbs
II. What does a newborn look like?
Baby’s head is large, often misshapen (depending upon the delivery method) and
out of proportion to the rest of the body.
Fontanelles, soft spots, are present where the scalp bones have not yet joined
together. It is normal to see them pulsing. Closure occurs by 18 months.
Skin is covered with a white, waterproof waxy-like coating known as the vernix.
The umbilical cord stump will be painted with iodine, which is purple/black in
color. It will have a clip on the end of it. Some hospitals have electronic
monitors in the clip to prevent baby theft. The cord will shrivel and fall off within
7 – 10 days. Do not get the cord wet nor pull the cord off.
The Meconium plug is the first bowel movement. It will be black, sticky and
somewhat tar-like. Then subsequent bowel movements should be
greenish/yellow and somewhat runny.
It is normal for babies to lose some weight the first few days of life. The baby
will usually regain the weight within 2 weeks.
Children that do continue to lose weight or lose a higher percentage of body
weight are diagnosed with Failure to Thrive Syndrome. Medical attention is
necessary.