I’M GOING INTO LABOR!!!
(What do I do now?)
Labor
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Labor is the energy and effort used to push the
baby out of the womb.
Dilation is when the cervix dilates from 0 – 10 cm.
Effacement is the thinning of the cervix.
Average length of labor for a first baby is 12 – 20
hours.
Reliable Indicators that labor has begun
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The Show: Spotting of blood because of the mucus
plug coming out when the cervix begins to dilate.
Water Breaks: Rupture of amniotic sac causing fluid
leaks through cervix.
Contractions: Muscle contractions at regular
intervals than cannot be “walked off.”
Contractions
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Contractions are the rhythmic tightening and
relaxing motions of the muscles of the uterus.
Braxton-Hicks Contractions are called “false labor.”
They can occur throughout the pregnancy and
typically involve the back, not the uterus. They are
not regular and can go away with exercise.
Induced Labor
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A doctor causes labor to begin by injecting pitocin
that begins contractions
A doctor ruptures the amniotic sac to begin
contractions.
First Stage of Labor
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Contractions begin
Cervix dilates to 7
Average length is two to
ten hours
Longest Stage
Contractions grow
stronger, longer, and
more frequent
Fetal monitor attached
Transition
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Regular, powerful,
contractions every two to
three minutes that last up
to 60 to 90 seconds
Last about 90 minutes
Baby’s head enters birth
canal
Cervix dilates to 10
Epidural
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Injection in back next to spinal canal.
Numbs the lower half of the body
Given when mother is partially dilated
 Usually
to about 4 cm
 Depends on the anestheseologist
External/Internal Monitoring
Positions for Giving Birth
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Lie on back
Squatting
Lie on side
Sitting
Kneeling
In water
Purpose of contractions during the 1st stage of
Labor – to dilate the cervix
Second Stage of Labor
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The second stage of labor is the birth of the baby
Crowning is when the head of the baby can be
seen.
Sometimes forceps or a vacuum is used if progress is
not being made and the baby is in the birth canal
too long.
Fontanelles are the soft spot on the baby’s head.
The purpose of contractions during the 2nd stage of
labor – to push the baby out of mom’s body.
Episiotomy
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An episiotomy is a surgical cut in the perineum to
enlarge the vaginal opening to make birth easier
and prevent tearing.
The cut is stitched back together after delivery.
Third Stage of Labor
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The third stage of labor is the delivery of the
placenta.
The placenta detaches from the uterine wall as the
uterus shrinks.
The placenta is expelled typically within 20 minutes.
Who does what?
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Obstetrician – concerned with pregnancy and childbirth
OBGYN – Obstetrician/gynecologist – specializes in
pregnancy, childbirth and other female concerns
Mid-Wife - A midwife is a health care professional who provides an array
of health care services for women that can include medical histories and
gynecological examinations, contraceptive counseling, prescriptions, and
labor and delivery care. Providing expert care during labor, delivery, and
after birth is a specialty of midwives that makes them unique.
Labor and Delivery Nurse - They care for women during labor and
childbirth, monitoring the baby and the mother, coaching mothers and
assisting doctors. As a Labor and Delivery Nurse, you’ll prepare women,
and their families, for the stages of giving birth and help patients with
breastfeeding after the baby is born.
Delivery Options
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Vaginal Delivery – Baby is delivered vaginally
through the birth canal. Preferred because it helps
the baby expel the amniotic fluid and gain strength
Cesarean Section Delivery - a surgical procedure in
which one or more incisions are made through a
mother's abdomen and uterus.
Birthing Room – used for regular, vaginal deliveries
Operating room – used for cesarean deliveries
Anesthesia & Complications
Breech Delivery
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A breech delivery is when a baby is born feet or
butt first.
A feet first delivery is especially worrisome due to
broken bones or displaced joints.
Breech delivery is a concern because the cord and
head must come at the same time pinching off the
oxygen supply as the baby descends through the
birth canal.
Many breech babies use cesarean delivery.
Other Deliveries
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Normal – head down
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Posterior – face up
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Transverse – shoulder first
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Fetus doesn’t drop – C-section
Cesarean Delivery Used When:
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The labor is long and difficult and the life or the
baby or mother is threatened.
The fetal monitor shows a drop in heart rate.
Placenta Previa—placenta is covering the opening
to the cervix.
The woman’s bone structure is too small to allow
vaginal delivery.
The Apgar Rating
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The Apgar rating is used
to determine if
emergency steps need
to be taken with a
newborn.
The rating goes from 0
to 10 with a score of 7
or higher indicating a
healthy newborn.
Colostrum
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Colostrum is a yellow fluid rich in nutrients and
antibodies produced by the breast in the first few
days after childbirth.
Colostrum protects the newborn from infections.
Mothers are encouraged to give the new baby the
colostrum.
Sitz Bath
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Soaking the perineum for short periods of time
after childbirth.
Keeps area clean to prevent infection of episiotomy.
Problems of Premature Infants
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Low birth weight
Underdeveloped lungs
Infections
Slow development later
in life
Little or no sucking reflex