Top

Day 5 Notes: Birth

June 20, 2013 by  

Labor & delivery

Birth

Delivery is good description of the birthing process. Think UPS, a long journey and fragile cargo.

Let’s try to make an outline:

  •  Prenatal Development
    • Prenatal Vulnerabilities
      • teratogen = causes prenatal damage
    • Teratogens
      • Environmental factor
      • Interfere with development
      • Medication & drugs
      • Substance
      • Disease
    • Harm depends on:
      • Interaction w other factors
      • Age of prenatal organism
      • Genetic predisposition
      • Dose
      • Sensitive period
        • Especially vulnerable
      • Critical period
        • Damage has big impact
        • Can be used interchangeably
  • Critical Periods
    • 1. Implantation
      • 10 to14 days after conception
      • Have common blood supply
      • Whatever’s in mom’s blood crosses
    • 2. Week 3.5 to 4.5
      • Closure of the neural tube
      • Central nervous system vulnerable throughout pregnancy
    • 3. Central nervous system
      • Vulnerable throughout pregnancy
  • Major Teratogens
    • Folate Deficiency
      • Lack of folic acid
      • Neural tube defects
      • Slow growth rate
      • Premature
    • Poisons
    • Radiation
    • Mercury
    • Lead
    • PCBs (polychlorinated biphenyl)
      • Coolants
    • Bacterial & Parasitic Diseases
      • Toxoplasmosis
      • Cats
    • Viruses
      • Acquired immune deficiency syndrome (AIDS)
      • Rubella (German measles)
      • Varicella (chickenpox)
        • Highly infectious disease
          • 95% of Americans have had it
          • 90% of pregnant women immune
          • 1 out of 2,000 develop during pregnancy
        • A. If in pregnancy (week 1-20)
          • 2% chance of defects
          • Congenital varicella syndrome
          • Scars
          • Malformed and paralyzed limbs
        • B. Newborn period
          • 5 days before to 2 after birth
          • About 25 % newborns become infected
          • About 30% of infected babies will die if not treated
  • Parental Use Of:
    • Over The Counter Drugs
      • Aspirin
        • If used repeatedly
        • Death near birth
        • Low birth weight
        • Poor motor development
        • Lower IQ
      • Caffeine
        • 3 cups of coffee day
        • Low birth weight
        • Prematurity
        • Miscarriage
        • Newborn withdrawal symptoms
      • Smoking during pregnancy
        • Impaired breathing w. sleep
        • Cancer later in childhood
        • Infant death
        • Low birth weight
        • Prematurity
        • Miscarriage
      • Alcohol
        • Infant brains are especially sensitive to alcohol
        • Suppress release of glutamate
          • brain’s main excitatory
          • neurons receive less excitation and undergo apoptosis
        • Breaks down more slowly
          • levels remain high longer
          • immature liver
        • Worse if born to alcoholic mom
          • drink 4-5+ drinks/day
        • No amount of alcohol is safe
      • Fetal alcohol syndrome
        • Best known non-genetic cause of mental retardation (brain damage)
        • (3 in 1,000)
        • Impaired motor coordination
        • Facial abnormalities
        • Heat defects
        • ADHD
    • Prescription Drugs
      • Thalidomide
        • Anti-nausea & sedative
        • Used in 1960’s
        • Severe limb deformations
        • Sensitive period: Week 4-6
      • Phenytoin (or Dilantin)
        • Anti-convulsive (anti-seizure)
        • Used to treat epilepsy
        • 10% chance of birth defects
        • If taken in the first trimester
      • Antidepressant drugs
        • heart problems
    • Psychoactive Drugs
      • Cocaine
        • Impacts
          • Mother’s egg
          • Father’s sperm
          • Prenatal environment
        • Deformed heart, genital, kidney
        • Brain hemorrhages & seizures
        • Born drug-addicted
        • Crack worst:
          • low birth weight
        • CNS damage
        • “Crack baby”
      • Marijuana
        • Low birth weight
        • Mixed finding
    • Semi-Teratogen
      • Contributing factors
      • # of previous births
      • RH incompatibility
      • Emotional Stress
      • Maternal age
      • Nutrition
  • Stages of Childbirth
    • Pre-Stage
      • Lightening
      • Fetus “drops” into pelvis
      • Bloody show
        • Small amount of bloody-mucus
      • Water breaks
        • Membrane of amniotic sac
        • Amniotic fluid
        • Feels like pop, trickle or gush
        • 400 ml (14 ounces)
    • Stage 1
      • Dilation & Cervical Effacement
        • 1st child 12-14 hours
        • 2nd child+ 4-6 hours
      • Cervix dilation & effacement
        • Starting at 3-4 cm
        • Full dilation = 10 cm
        • Fetus head = ~10 cm
      • Contraction
        • Uterine muscles
        • Upper to lower uterus
        • Shorten upper segment
        • Draw lower segment upward
    • Stage 2
      • Cervix is fully dilated
      • Ends when the baby is born
      • Timing
        • 1st child 50 minutes
        • 2nd child+ 20 minutes
      • Cervix pressure increases
      • Ferguson reflex
      • Increased uterine contractions
      • Head is fully engaged in pelvis
      • Head goes below pubic arch
      • Mother “bears down” or pushing
      • Head is down but sideways
      • Head turns face down
      • Baby moves
        • down under pelvis bone
        • then up
      • Crowning
        • Intense stretching & burning
        • See the head
      • Helping you out
        • Forceps
        • Vacuum
    • Stage 3
      • After birth before placenta
      • 10-12 minutes
      • 30+ minutes, worry
      • Separates from uterine wall
      • Clamp umbilical cord
        • 1-5 minutes
        • Shorter decreases anemia risk
        • Longer increases jaundice risk
        • Cutting is painless (no nerves)
      • Active management
        • Uterotonic drug
        • 1 min after delivery
        • Prevents postpartum hemorrhage
    • Stage 4
      • Birth to 6 weeks old
      • Postpartum period
      • AKA, puerperium
  • Initiation Rites
    • Naming ceremonies
    • Eat the placenta
    • Maternal leave
    • Circumcision
    • Baptism
  • Expectations
  • Reality
    • Misshaped head
    • Wrinkled
    • Purple
    • Needy
    • Molding
      • As through birth canal
      • Head becomes more elongated
      • Worse in 1st child
  • Birthing Options
    • Unassisted Birth
      • No professionals present
    • Partner, mother, grandparents
    • Mother & Partner Birth
    • Solo Birth
  • Delivery
    • Vertex Delivery
    • Six phases of head-first delivery
      • 1. Head facing sideways
      • 2. Descent & flexing of head
      • 3. Head rotation 90-degrees
        • Face mother’s rectum
      • 4. Head extends out birth canal
        • Head tilts forward
        • Crown of head leads way
      • 5. Restitution
        • Head turn 45-degrees
        • Restore relationship w shoulders (which are angled)
      • 6. External rotation
        • Shoulders follow head; corkscrew movement
    • Water Birth
      • Reduce need for analgesia
      • Warm water tubs
      • Available in hospitals & birthing centers
  • Delivery en caul
    • Born with amniotic sac in tact
    • Membranes are easily broken
    • Wiped away
    • Rare
    • Doctor breaks sac before birth
  • Induction
    • Distance from hospital
    • Oxytocin: induce uterine contractions
  • Vaginal Birth
    • Large head compared to pelvis
    • Not always possible
  • Cesarean section
    • Indicated if:
      • maternal HIV/AIDS
      • medical conditions
      • fetal abnormality
      • breech position
      • fetal distress

 

 

 

Comments

Feel free to leave a comment...
and oh, if you want a pic to show with your comment, go get a gravatar!





Bottom