Labor, Birth

25 pounds.

Of which: 11 fat, 3 urterine and breast growth, 2 placenta, 1 amniotic fluid, 1 increase in blood volume and the fetus is 7 pounds

Circulatory:
- increased blood volume
- increased cardiac output
- increased heart rate

Kidneys increase in size and iltration rate > 50%

Increased respiratory rate

Ratio O2/CO2 towards O2 which facillitates the diffusion to fetus.

- Toxemia
- Diabetes Mellitus
- Ectopic pregnancy

Develops in last 2 months of pregnancy in 6-7%

2 kinds:

1. preeclamsia, symptoms:
= weigh gain
= enema
= high BP
= proteinuria

Eclampsia: severe toxemia
Above symptoms with coma, conculsions and possibly death

<1%

Weight gain -> insulin resistant -> rise in glucose levels of fetus and mother

Due to the high glucose levels: rapid growth in fetus that can make it too large for delivery

-> increased chance to C-section.

Implantation in oviduct instead of uterus because of scarring oviducts that interferes with transportation.

Not viable. Surgery to remove.

Causes: STIs (chlymidia + gonorrhea)

- pro/est: maintain development of
- steroids: supports maternal appetiti, fat deposition and breast enlargement

Cytotrophoblasts secrete hCG 2 days after implantation.

hCG, produced 2 days after implantation, contributes to maintenance of the corpus luteum.

- hCG (cytotro. and thus later placenta) from d. 12 onwards

Stimulates:
- week 5: progesterone and estrogen (3 kinds) secretion.

- human placental lactogen (hPL): similar to prolactin and slightly increase blood glucose and helps prima glands for milk production.

Other hormones: (similar to pituitary hormones)
- prolactin
- corticotropin
- thyrotropin
- endorphins
- oxytocin

Progesterone produced by placenta -> fetal zone of fetal adrenal glands -> DHEA -> fetal liver -> 16-OH-DHEA-sullfate -> placenta -> estriol

Relaxin (level rises steadily) relaxes the connective tissue between bones.

Moreover, relaxin also prepares the cerxic to soften and dilate.

> relaxin
> CRH
> cortisol
> pro/est ratio
> prostaglandins
> oxytocin

Increase CRH (placenta)-> Increase cortisol (fetal adrenal glands, POSTIVE FEEDBACK)->

1. maturation of fetal organs
2. increase prostaglandin production
3. increase est/pro ratio

- postive feedback loop with CRH
- produce ACTH from pituitary -> more cortisol
- contributes to initiation of labor.

- last 5 weeks; initiation of labor?
- increased estrogen: support for uterine contractions
- stimulate prstaglandin production

- produced from fetal membranes

- increase uterine contraction

- postive feedback loop with CRH

- stimulatory effect on uterine contraction

- secreted: fetal p. pituitary and placenta

- est/pro >

- feedbackloop with contractions

- increase prostaglandin production

- ACTH -> cortisol: postive feedback

- stimulates DHEA -> estradiol production

-postive feedback loop with prostaglandins

Oxitocin (form of pinocin) and/or prostaglandins

- post-term: labor is not progressing or not spontaneous occuring

- preterm: possible risks.

38 weeks, 40 weeks.

+- 2 weeks is considered normal

- females earlier than males

- shorter follicular cylces -> earlier

- exercizing women -> earlier.

Peak during fall (babies made in winter) and low in spring.

Other way around in Europe =)

Why? Men during warmest months lower sperm count?

Sometimes 2-3 weeks and women can feel it

Contractioins in the final weeks (esp. the last one) of pregnany that are mild and irregulare urterine contractions but not labor.

Stage 1 of labor: cervical dilation and effacement

Stage 2 of labor: Fetus passes through cervix and vagina

Stage 3: delivery of fetus

Stage 4: delivery of placenta

Primi: longer, 8-14 hours

Multi: 4-9 hours

Normal: within 24 hours

Female:

- more ovale
- wider pubic sumphesis
- wider pubic arch
- outward turning of ischial tuberosities

=> Larger pelvic outlet.

Thinning of the cervical wall and the retraction of the cervix upwards

after initial uterine contractions which are not strong enough.. (30-60 s. 5-20 m)

The 1m interval contractions, more intense -> effacement.

Dilates till 10 cm

Around initiation of effacement, the mucus plug of the cervix is released leading to small amount of blood.

Enzymes release weaken a site of the amniotic membrane -> ruptures.
During effacement progress

- provides a barrier (prevent infections)
- cushun function (decreases chance for cephalohematoma)

initial: 0.3 cm

contraction 1-3 min: progresses and dilates to 10 cm

the more it progresses, the more painful.

During the final stage of effacement/dilation the cervix dilates the last 7-10 cm.

Very painfol and strong.

- 10 cm dilation
- fetus passes through cervix and vagina
- uterine contractions -> assist movement through birth canal.
- episotomy

A small cut in the perineal skin to 'prevent' tearing?

Studies show:

- longer healing process
- interferes with bonding
- women who underwent episotomy have more and deeper tears that take longer to heal.

- Epidural block injection
- Pudendal block
- Intravenus or oral analgesics, tranuilizers, anxiolytics
- intravenous pitocin (> uterine contractions)

Typically an optiate that is injected outside dura of spinal cord.

Numb sensations in body below injections

administered around the pudal nerve on each side of vagina

Fetal head = largest diameter (33 cm). This is to some extend compensated by the presence of fonanels: "soft spots" on the newborns brains where bones have not fused yet.

Face down. cephalic

Then rotates so t hat shoulders appear up-and-down position.

- forceps: When not progressing in 2nd stage (eg abnormal fetal position). Two curved steel blades. Rotated and pulled.

- Vacuum pump: fetus pulled out.

normal: face down = cephalic presentation

Difficult positions:
- breech: head up and feet, buttock or knees extending down
- transverse: sideways or transversely in pelvis
-

- forceps/vacuum
- midwife external rotation pressure
- midwife internal pressur
- moxibustion with stimulatin if acupoint BL 67

After birth: placenta

15-30 min after
Uterine bleeding occurs after which can be relieved by oxytocin release upon breast feeding

fetal distress, difficulty, breech/transversal

(liability claim avoidance)

General or local (spinal) anasthesia or acupunture.
Abdominal incision (below navel), through skin, muscle layer (pushed aside), and infant removed.

- recovery longer
- interferese with mom-kid bonding immediatly after birth

Nope, in antropological studies with over 70 cultures: none.
Most of them had midwives, and men did not deliver or were present.

1900 Germany by 'twilight sleep' during labor and delivery.

Horizonal position easier for medication + restrainment easier.

Because of the medications: not able to push -> forceps

During the unconcious deliveries: more space fir forceps to be delivered.

pre-1900: less than 5%
Most home births by midwifes.
Hospital births had higher mortality rate (infections)

1970: 99%

- use of gravity (in contractions, effacement, decrease likelihood of c section)

- increase surface of peritonal opening

- decrease pressue on aorta (> blood supply to fetus < chance to fetal stress)

> c sections, but not amount of cerebral palsy

No improvement in outcome of healthy mom's baby.

Continuous monitoring: prevents mother from walking during labor -> not use gravity -> increases lenght of labour and doubles c sections

SOLUTION: flexible monitoring

increases uterine contractions..

But also increases painfulness, and therefore increases the demand for pain medication.

Numb pain of uterine contractions.

- decrease endogenous endorphin production
- decreases sense to push
- decreases sense of involvement and control
- decreases oxytocin and increases csection + oxitocin normally helps with bond formation.

- decrease beta-endorphins
- increase in post partem depression

1970: 5%
Now: 25-30%

- increase illness and mortality

- more fluid in babies lungs

- lower levels of (nor)epi, beta-endorphins

Female supportive person who works with and for the mom to confort, reduce axiety, allows empowerment etc

Stress: increases cortisol, which increases sym. activity and decreases para. This leads to a decrease in contractions, and thus a prolonged delivery with a larger chance for c sections.

Also depression can work on immunology this way.

Overall beneficial:

reduces length, oxcytocin use, pain medication, forceps and c-section.

If absent: reduces growtih and increases infant death.

Relatively stressful environment prepares child:

- (nor)epi produced: 1. stimulate cardiovascular system. 2. facillitates adjustment to aerobic environment.

-> beta-endorphins are produced in infant and mother: facillitates bonding