Notes on the Psychology of Childbirth

Special Topics in Biological and Cognitive Psychology: Psychology of Childbirth

Psyc 207 | Prof. Kalina Christoff

Learning Objectives
  • Understand the pros and cons of membrane sweeping and their statistical cancellation.
  • Learn common methods for inducing labor.
  • Identify the underestimation of risks in labor intervention and overestimation of risks from inaction.
  • Understand the role of the umbilical cord post-birth.
  • Explore the historical and current status of cord clamping/cutting.
  • Gain insights into active management of the third stage of labor.
  • Overall focus on Medical Knowledge (Part 1).
Membrane Sweeping (Membrane Stripping / Stretch and Sweep)
Rationale
  • Presumed to release endogenous prostaglandins from membranes and cervix, aiding labor initiation.
  • Prostaglandins are hormone-like lipid compounds playing a crucial role in labor.
Pros and Cons of Membrane Sweeping
Pros
  • May decrease pregnancy length by an average of 1-4 days.
  • Can reduce the rate of formal medical induction.
    • To avoid one formal medical induction, membrane sweeping must be performed in 8 women.
Cons
  • Painful procedure: average pain rating is 7 out of 10.
  • Possible complications include:
    • Bleeding or irregular contractions.
    • Leads to rupture of the amniotic sac in 1 out of 10 women, resulting in formal induction within 24 hours based on current medical guidelines.
    • Can be performed without consent during vaginal/cervical exams.
Statistics on Gestational Age and Delivery
  • Approximately 35% of women give birth on their due date, while:
    • 78% of nulliparous women are overdue.
    • 87% of multiparous women are overdue.
  • Currently, 20-30% of women have labor induced.
Common Methods for Inducing Labor
1. Artificial Oxytocin (Pitocin)
  • Currently the most recommended and frequently used method.
    • Involves continuous oxytocin administration throughout labor and post-delivery.
2. Prostaglandins (and Vaginal Misoprostol)
  • More effective than oxytocin for achieving vaginal delivery within 24 hours.
  • Higher likelihood of causing uterine hyperstimulation than oxytocin.
3. Mechanical Methods (Balloon Catheters, Amniotomy, etc.)
  • Reduced rates of uterine hyperstimulation compared to prostaglandins.
  • Associated with increased maternal and neonatal infections compared to prostaglandins and artificial oxytocin.
Induction after 41 Weeks
  • Induction is often considered after 41 weeks due to increased stillbirth risk.
    • The risk is small but escalates weekly between 36-43 weeks.
    • Approximately 500 unnecessary inductions are performed to prevent one stillbirth (Kotaska, 2011).