The Birth Process

Peter James B. Abad, RN MS Genetic Counseling Student December 2011

Labor
A series of events by which uterine contractions and abdominal pressure expel the fetus and placenta from a woman s body.
(Pillitteri, 2010).

Theories of Labor Onset

Uterine muscle stretching, which results in release of prostaglandins Pressure on the cervix, which stimulates the release of oxytocin from the posterior pituitary gland. Oxytocin stimulation Change in ratio of estrogen and progesterone Placental age, which triggers contractions at a set point. Rising fetal cortisol levels, which reduces progesterone formation and increases prostaglandin formation Fetal membrane production of prostaglandin, which stimulates contractions.

Preliminary Signs of Labor

Lightening Increase in level of activity Slight loss of weight Braxton Hicks Contractions Ripening of the cervix

True vs False Labor

(Williams Obstetrics 22nd Ed)
True Labor: Contractions occur at regular intervals Intensity gradually increases Discomfort is in the back and abdomen. Cervix dilates. Discomfort is not stopped by sedation

False Labor: Contractions are irregular Intensity remains the same No cervical dilatation Discomfort relieved by sedation

Components of Labor
4 P s of Labor Passage Passenger Powers Psychological Outlook

Passage
Refers to the route a fetus must travel from the uterus to the cervix and vagina to the eternal perineum.

Passenger
The passenger is the fetus Whether a fetal skull can pass depends on both its structure (bones, fontanelles and suture lines) and its alignment with the pelvis.

 Molding
A change in the shape of the fetal skull produced by the force of uterine contractions pressing the vertex of the head against the not-yet dilated cervix.

Fetal Presentation and Position Attitude- describes the degree of flexion a fetus assumes during labor or the relation of the fetal parts to each other.

Engagement Refers to the settling of the presenting part of a fetus far enough into the pelvis to be at the level of the ischial spines, a midpoint of the pelvis.

Station Refers to the relationship of the presenting part of a fetus to the level of the ischial spine.

Fetal Lie Is the relationship between the long axis of the fetal body and the long axis of the woman s body.

Fetal Presentation
Cephalic Presentation
Fetal head is the body part that will first contact the cervix

Breech Presentation
Either the buttocks or the feet are the first body parts that will contact the cervix.

Shoulder Presentation
Transverse lie. A fetus lies horizontally in the pelvis so that the longest axis is perpendicular to that of the mother.

Fetal Position
Position is the relationship of the presenting part to a specific quadrant of a woman s pelvis.

Mechanisms of Labor
Descent
Is the downward movement of the biparietal diameter of the fetal head to within the pelvic inlet.

Mechanisms of Labor
Flexion
Head bends forward onto the chest, making the smallest anteroposterior diameter present to the birth canal.

Mechanisms of Labor
Internal Rotation
This movements brings the shoulders into the optimal position to enter the inlet, putting the widest diameter of the shoulders in line with the wide transverse diameter of the inlet.

Mechanisms of Labor
Extension
As the occiput is born, the back of the neck stops beneath the pubic arch and acts as a pivot for the rest of the head. The head extends, and the foremost parts of the head are born.

Mechanisms of Labor
External Rotation
The head rotates back to the diagonal or transverse position of the early part of labor. This brings the shoulders into an anteroposterior position which is best for entering the outlet.

Mechanisms of Labor
Expulsion
Once the shoulder is born, the rest of the baby is born easily and smoothly because of its small size.

Powers of Labor
Uterine contractions
Rhythmicity and progressive lengthening and intensity

Cervical changes
Effacement- shortening and thinning of the cervical canal. Dilatation- refers to the enlargement or widening of the cervical canal from an opening few mm to 10 cm to permit passage of the fetus.

Psyche
Woman s psychological outlook Self-esteem issues/concerns Support system Knowledge, perceptions and beliefs Health care provider

Stages of Labor
First Stage
Longest stage; 12-14 hours Regular and increasingly frequent uterine contractions cause the cervix to dilate in preparation for delivery.

Second Stage
Lasts an hour or two; contractions are stronger and closer together Starts when the baby s begins to move through the cervix into the vaginal canal.

Third Stage
10-60 minutes after delivery of baby Placenta is delivered.

Method of Childbirth
Vaginal delivery
Usual method of childbirth

Cesarean Delivery
Surgical removal of the baby from the uterus through an incision in the mother s abdomen. Indications:
Labor progresses too slowly When the fetus seems to be in trouble When the mother is bleeding vaginally

Vaginal Childbirth Methods

(from http://www.givingbirthnaturally.com/vaginal-childbirth.html)

Hypnobirthing
is a natural childbirth method that is rooted in the belief that a Fear-Tension-Pain cycle creates pain during childbirth. By eliminating fear and tension, the laboring mother experiences no pain. One of its distinguishing tenets is that pain is not an intrinsic characteristic of labor and can be completely eliminated.

Vaginal Childbirth Methods

(from http://www.givingbirthnaturally.com/vaginal-childbirth.html)

The Bradly Method

also termed "husband-coached childbirth" teaches women to focus on and manage pain during labor. Classes focus not just on childbirth, but also on healthy pregnancy habits, postpartum care and breastfeeding.

Vaginal Childbirth Methods

(from http://www.givingbirthnaturally.com/vaginal-childbirth.html)

Lamaze
is the most widely-known of all the childbirth methods. It is most widely recognized for its breathing techniques. However, Lamaze has undergone several significant changes over the years and breathing techniques are no longer the foundation of this method. Teachings vary widely from instructor to instructor as the certification process focuses on the educator developing their own individualized curriculum rather than emphasizing a standard curriculum.

Water birth
Maya was born in water, using a deep relaxation birthing method of HypnoBirthing. My early labor was very easy, so much so that it was difficult to distinguish it as labor at all. As my surges progressed and strengthened I opened and relaxed and my labor progressed quickly. The environment was incredibly calming and reassuring - quite a contrast from the hospital birth of my first daughter. The water supported and relaxed my body and tissues, and Maya was born easily and gently after only approximately 2 hours of (noticeable) labor. Given a typical, healthy pregnancy with no special circumstances, I would now never birth my baby any other way.

Heres the truth: Childbirth is not only a physiologic phenomenon, but a cultural/sociological experience. So before you walk onto the Labor Floor, ask yourself:

o Where/how did you first learn about how a baby is born? What do you know about your own birth? o Who (family member, friends, healthcare provider) or what (your medical training, book, television show, movie) has influenced your perception of labor? What birth stories come to your mind first? o Is there such a thing as good pain? If you are an athlete, have you ever sought out physical discomfort? Why? o Have you ever been in pain? How did you deal with it? o What do you think is the role of the healthcare provider in birth?

Traditional Birth Practices and Beliefs

Traditional Birth Practices in the Philippines

Prenatal Care

The woman was the first person to know she was pregnant by finding out that she missed her periods and was feeling nauseated followed by vomiting. The husband and then the close relatives were the next to know. No prenatal care, except by a hilot, a medicine man or woman who inherited the skill to deliver babies from special spirits. The significant other was not present when she met with the hilot at her home. The hilot gave the pregnant woman a special drink to ease the labor, which was made from mixtures of burned seeds of jackfruit and water. This formula had to be consumed before the delivery.

There were no nutritional restrictions, except to not eat too much sugar so that the baby would not be too big and make the delivery harder. Do not crossover fence, the baby will have the cord go over his/her neck and choke. Do not go out at night, this will weaken the baby. Do not wear black clothes; this is bad luck for the baby. Do not eat mangos; this will cause a baby girl to have hair on her face. The hilot would give the mother a big bottle of drink made from wine-marinated roots or herbs. It is called panigan and should be taken before eating to make the fetus healthy.

Labor and Delivery

The baby was delivered at home The significant other could be present, but most did not want to see the birthing process. Other family members were expected to wait outside and not distract the mother There was no medication used to relieve the pain With the thin bamboo that was sharpened and then boiled, the hilot would cut the umbilical cord and the placenta. hilot would bathe the baby and then she wrapped the umbilical cord, coconut oil and tobacco in a piece of cloth for seven days. After that, the hilot told the family to burn the package in a pot filled with charcoal inside the house so the smoke would fill the entire house. This ritual was to make the house a good environment for the baby The hilot would throw the placenta in the river. They believe this takes the bad luck away from the baby It was desired that the first baby be a boy so the child could help take care of the parent's property. Boys are expected to carry familys last name

Post Partum The hilot would teach the mother to bind her hips tightly to bring all the muscles used in the birthing process back to normal again. The tear on her vagina would also go back together and return to its prepregnancy state For 12 days, the hilot would come everyday to massage the mothers body and hips, and after the 12 days were up, she would shower the mother with warm water that was previously boiled with guava and orange leaves. This recipe was used to make the skin feel good. The hilot believed that the skin lost its elasticity during birth. After delivery, the mother would be on bed rest for 12 days, with the head of the bed slightly elevated by wood or bricks, so the blood would not go up to her head. After 6 days she might be allowed to shower

Mother could breastfeed, but other activities were restricted so she would not experience increased bleeding She had to eat a special soup made from chicken and leaves called marungai, so that she would produce plenty of milk for the baby One of the women interviewed thinks having ten (10) kids is ideal. Children were expected to help with the family business or farm at that time Questions about health of the mother and children should be addressed to the hilot Babies usually did not have a special name, except they were usually named after saints since Filipinos are strongly influenced by the Catholic religion

Thank you!