The Baby’s ArrivalBeginning of labor

Ch. 6 Page 179

Cervix Contractions Fetal monitoringDilateEffacement LighteningBreech birth

Transition Bloody showBraxton Hicks Crowning Premature Episiotomy

ForcepsCord blood Stem cells Cesarean birth

The BeginningLightening- when the baby’s head moves lower

in the uterus, allowing for more room in the upper area of the woman’s torso.When? Days or weeks before delivery for the first

pregnancy. Days or hours before additional births.

Bloody show- when the mucus plug in the uterus dissolves. The mucus plug prevents bacteria from moving

into the cervix in the uterus during pregnancy.This will result in a few drops of blood or a pink

vaginal discharge.

Early signs of LaborWater break- This is a discharge of fluid from the

woman’s vagina. It signals that the amniotic sac has torn, allowing amniotic fluid to leave the sac. It is important to note the time and an approximate

amount of fluid lost. Delivery should occur 24-48 hours after to avoid

infection.

Contractions- spasms of the uterine muscles that push the baby’s head down into the birth canal. The beginning contractions are sort and may have a lot

of time between them. As the contractions get stronger, the time between will shorten.

These contractions are painful but bearable. Once they end, no lingering pain will be felt.

http://www.babycenter.com/stages-of-labor

Signs of Labor Premature Labor- labor that begins when the baby is at 20-37 weeks.

They will be about 10 minutes apart and dull back pain may be felt. Medication can be given to stop labor for a short period (Tocolytic) Corticosteroids are also given to speed the development of fetal lungs.

False Labor- Braxton Hicks contractions can begin any time during pregnancy but will be erratic and infrequent. During the last few weeks of pregnancy they may become more pronounced.

3 signs the labor may be false: irregular and not rhythmic, don’t become stronger over time, end with light exercise. If unsure, call the doctor or birthing center.

Inducing Labor- Commonly, doctors will puncture the amniotic sac to trigger labor. Other times, medication may be given to start the process. (Cytotic) After 42 weeks of pregnancy When water break doesn’t start contractions Does not significantly change length or severity of contractions.

3 STAGES of LABOR Stage 1 Uterine muscles slowly soften and thin the cervix. (1

minute long & 5+ minutes apart) Cervix starts to open (dilate) and Birth canal shortens as it widens

(effacement) Concludes in TRANSITION- where the cervix is at 10 cm and the birth

canal is paper thin. http://www.youtube.com/watch?v=PVZwZOpxVSo

Stage 2 Begins with CROWNING. (head can be seen) Mother pushes with contractions to expel the baby through the birth canal. Head is delivered first, face down. Respiratory is suctioned to allow for unobstructed breathing. Baby’s head is rotated to allow for shoulders to deliver more easily.

Stage 3 Mother may have time to rest before the final stage begins. An additional urge to push may allow for the delivery of the support system, often referred to as afterbirth. The contractions will help the placenta dislodge from the uterine wall.

Other factors in deliveryRelaxin- hormone that allows for ligaments and

connective tissue to stretch so that the pelvic bones can stretch apart

Episiotomy- a surgically made cut that allows for additional stretching during delivery. Use has gone down as research suggests that women have less problems with a tear than with a cut.(1/3;1/5)

Forceps- sometimes used to help doctor get a better grip on fetus to guide movement through birth canal. http://www.youtube.com/watch?v=KYtd1mgBO1Q

Other factors in deliveryCord detachment- Traditionally done in the first

minute but research shows benefits to waiting an additional minute. http://www.youtube.com/watch?v=Rd8hqa4mWIo

Cord blood-The remaining blood that is left in the umbilical cord and placenta after delivery. http://www.nationalcordbloodprogram.org/qa/

Stem cells- Are capable of producing all types of blood cells. Can be used by the child or other family members if medical problems become an issue. http://stemcells.nih.gov/info/basics/pages/basics1.aspx

Cesarean Birth C-section

Reasons 1970-1:20 to 1:4 today Lack of progress during labor Baby distress Breech baby Multiple babies

Process Epidural- mother stays awake/General anesthesia- mother put to sleep IV and catheter are inserted Mother’s arms strapped down/ surgical area shaved and sterilized Incision is made between pubic bones and baby and placenta are

delivered

Differences for baby Reduces stress on baby during delivery Head stays rounded

Differences for mother Blood clot risk/ heavier blood loss Illness from anesthesia Lifting restrictions/ slower recovery time

Premature Birth

5% - 6% of births are premature (before 37 week)

Lower birth rate Higher incidence of problems

N-ICU Neonate Intensive Care Unit

Baby may start life in an incubatorAllows for complete control of baby’s environmentProtects baby from risk of infectionsConstant monitoring of organ functions

The Baby’s ArrivalThe Newborn

Ch. 6 Page 190

Neonate Fontanels Lango VernixMilia

Arrival Lungs must be drained of amniotic fluid

Circulatory system oxygen from lungs instead of cord.

Limbs are thin & facial features flat- (swollen or puffy face)

Cone shaped head-fontanels allow skull bones to move Head is ¼ of babies total weight

Eyes are almost adult size Babies of color usually have brown eyes Caucasian babies usually have blue-gray eyes Eye color becomes permanent in 3-6 months

Temperature regulation must be helped in the first 24 hours. Knit cap & swaddled in blanket Warming lamp

Skin Lungo-(la-NEW-go) fine hair covering skin falls out in the first few days Vernix- (VIRN-ix) white paste protects skin in fluid helps with delivery Milia- (MILL-ee-ah) baby acne caused by mother’s hormones-goes away in a

week

Apgar Scalerating the newborn

Pulse

Respiration

Reflex

Muscle Tone

Skin

Neonate Testing & Procedures Suctioning

Usually done during the birthing process 5-10% need additional respiration

Cord Clamping- Within the first minute or after pulsing stops

Vitamin K Injection -Helps with blood clotting

PKU test -Heel stick blood test

Silver Nitrate or Antibiotic Eye Ointment Prevention of blindness due to exposure to gonorrhea

Hep B Vaccine (only given if there is a risk of STI)

Bath (Now done later) Waiting allows vernix to help moisturize sensitive skin Waiting prevents a drop in body temperature

Circumcision- Removing the foreskin of penis Considered a cosmetic procedure- not medically necessary Some religions require it.

BondingBonding is an important human instinct that gives

babies a sense of security and self-esteem.

Bonding helps parents feel connected to the newborn. This starts with the first time the baby’s heart beat is heard or the first ultrasound.

Sometimes, the bonding is immediate and other times it takes longer. Studies show that about 20% of parents feel no real emotional attachment in the hours after delivery.

The more time and physical contact that is gained, the better chance there is for the bonding to occur.

Bonding TechniquesSkin to skin contact during delivery

Voice recognition

Touch and stroking

Face shape & feature recognition

Breast feeding/nursing

The Baby’s ArrivalThe Postnatal Period

Ch. 6 Page 195

Bonding ColostrumNeonatal periodJaundice BulirubinLactation

Lactation consultant Rooming-in Legal Documents

Postnatal period Postpartum depression

Breast Feeding vs.

Bottle Feeding

Feeding choicesBreast vs Bottle

Breast feeding begins immediately Promotes uterine contractions and slows bleeding Satisfies babies desire to natural suck for comfort Stimulates breast to produce milk

Colostrum- Early breast milk High calorie High protein Transfers antibodies Inexpensive

Bottle feeding can be done at any time by both parents Provides a constant source of nourishment Allows father to share in the process Convenient but expensive

When it’s time to go home Usually mother and baby go home 12 hours after delivery.

Rooming in option allows for constant interaction Partial rooming in allows mother time to rest after delivery. C-sections and complications delay release from hospital. http://www.youtube.com/watch?v=PkX286L5a_0

Jaundice -50% of newborns slight yellow discoloration of skin or eyes Caused by reduced liver function

Bilirubin cannot be removed efficiently Phototherapy is used to treat. (ultraviolet light)

Left untreated, will cause damage to the nervous system.

Learning how to feed and care for baby Lactation coach teaches techniques to help trouble shoot. Proper techniques for hygiene care.

Legal Documents Birth Certificate Social Security Number

Premature BabiesBorn before 37th week

Weighs under 5 pounds

High risk birth- pregnancy complications

Medical complications/birth defects

http://www.youtube.com/watch?v=5Kt06hg2_L4

Choosing a hospital with a NICU

Babies born between 23-26 weeks have the highest risk of complications

Babies born between 28-30 weeks have a better chance of survival

Postnatal Care of Mother Physical Needs

Rest Rest when baby sleeps Accept or request help with household chores

Exercise Wait for physicians approval Start slow and easy (stretching and walking)

Good nutrition Breast-feeding will require an additional 300 nutrient dense calories Additional fluid intake helps with lactation and weight loss

Medical checkups Postnatal visit 4-6 weeks after birth

Check for uterus size and condition Allows mothers to ask any questions or voice concerns

Postnatal Care of MotherEmotional Needs

Feelings of confusion and overwhelmMood swings

Baby BluesPostpartum Depressionhttp://www.youtube.com/watch?v=yH3WMQO-ooU