Birth and Postpartum Period

Overview of the Lifespan

Periods of Life

  • Prenatal Period: Conception to birth (9-month period)

  • Infancy: First 2 years of life (first month is neonatal)

  • Childhood: 2 to 10-12 years old

    • Early: up to age 5-6

  • Adolescence: 10-12 to 18-22 years old

  • Early Adulthood: Late teens or early 20s to 45 years old

  • Middle & Late Adulthood:

    • Middle: 45-60 years old

    • Late: 60 to death

The Birth Process

Hormonal Changes in Late Pregnancy

  • Placenta secretes Corticotropin-Releasing Hormone (CRH) to trigger hormone release

  • Oxytocin: Released by the pituitary gland to induce and speed up contractions, facilitating labor.

Labor: The Process of Birth Begins

  • High oxytocin levels lead to periodic uterine contractions.

  • Administration of Oxytocin: Commonly given in synthetic form (Pitocin) to manage labor.

  • Positive feedback loop: contractions lead to more oxytocin release through the posterior pituitary gland.

Braxton Hicks Contractions

  • Mild, irregular contractions occurring in the 2nd or 3rd trimester (~4 months).

  • Feel like mild menstrual cramps and do not indicate labor.

  • Usually stop with rest or change of position.

The Birth Process: Stages

Stage 1: Dilation

  • Longest stage, lasting 16 to 24 hours for firstborn children.

  • Regular and intense contractions cause cervix to dilate.

    • Beginning labor: contractions every 15-20 min

    • End of labor: contractions every 2-5 min

  • Cervical Dilation: Fully dilated cervix measures 10 cm (4 in).

Stage 2: Expulsion

  • Lasts approximately 45 to 60 minutes.

  • Begins when baby’s head moves through the cervix towards the birth canal.

  • Ends when the baby completely emerges from the mother’s body.

Stage 3: After Birth

  • Shortest stage, usually only lasting a few minutes.

  • Umbilical cord and placenta are expelled from the mother’s body.

Transition from Fetus to Neonate

  • Umbilical cord is cut.

  • Skin-to-skin contact (Kangaroo Mother Care) provides several benefits:

    • Stabilizes baby’s heart rate

    • Encourages exclusive breastfeeding

    • Supports growth and reduces risks of neonatal complications.

The Apgar Scale

APGAR Score

  • Points Breakdown:

    • Appearance: 0 (cyanotic/pale) to 2 (normal color)

    • Pulse: 0 (absent) to 2 (normal >100 bpm)

    • Grimace: 0 (no response) to 2 (strong cry)

    • Activity: 0 (floppy) to 2 (well flexed)

    • Respiration: 0 (apneic) to 2 (strong cry)

  • Total score ranges from 0 to 10.

Deprivation of Oxygen

  • Risks during labor may include lack of oxygen to the fetus, which can occur through:

    • Umbilical cord wrapping around the neck.

    • Cord pinching during prolonged contractions.

  • Anoxia can produce brain damage if restrictions last for a few minutes.

Newborn Screening Program

  • Newborn Blood Spot Screening: Collected via heel poke for early condition detection.

    • Optimal screening window: 24-48 hours after birth.

    • Conditions screened include metabolic, endocrine conditions, cystic fibrosis, sickle cell disease, immunodeficiency, spinal muscular atrophy.

Approaches to Childbirth

Vaginal Delivery

  • Birth through the vagina.

  • Natural Childbirth: No drugs for pain relief.

  • Alternative techniques include:

    • Massage, water birth, acupuncture.

Caesarean Delivery

  • Baby is surgically removed through an abdominal incision.

  • Types: Scheduled vs emergency.

  • Statistics (2016): Caesarean births account for 27.9% of deliveries.

Factors Contributing to Caesarean Birth Rate

  • Labor dystocia, abnormal fetal heart tracing, fetal malpresentation, multiple fetuses, suspected fetal macrosomia, maternal & obstetrician preference, and overestimation of risks with labor post-cesarean.

Pain & Childbirth

Epidural Analgesia

  • Pain relief via catheter inserted around spinal cord, numbing from the waist down.

  • Administered ~10 minutes and starts to work in about 15 minutes.

  • Can slow labor by 20-30 minutes and often requires women to stay in bed.

Risks of Epidural

  • Potential drop in mother’s blood pressure, inability to feel contractions and push.

  • Less common risks include severe headache and post-delivery complications.

  • Epidural rate (vaginal delivery) in Canada was 59.3% in 2017-2018.

Decision to Opt for Epidural

  • Depends on pain tolerance, personal preferences for natural childbirth, exhaustion during labor, and potential need for a c-section.

  • Alternatives include massage, imagery, focused breathing, nitrous oxide.

The Postpartum Period

Physical Adjustments

  • Lack of sleep and hormonal changes after childbirth, with a significant drop in estrogen and progesterone.

  • Involution: Uterus returning to its pre-pregnancy size.

Emotional & Psychological Aspects

  • Postpartum Blues: Affects 70-80% of new mothers; characterized by mood swings, anxiety, and trouble sleeping.

  • Postpartum Depression (PPD): Reported in 7.5% of women, with more intense and prolonged symptoms affecting maternal care.

Symptoms of PPD

  • Include excessive crying, withdrawal from social interactions, changes in appetite, sleep disturbances, intense fatigue, loss of interest in previously enjoyed activities, and thoughts of self-harm.

Risk Factors for PPD

  • Higher likelihood in low and middle-income countries, personal history of mood/anxiety disorders, poor social support, difficult infant temperament, marital difficulties, and negative life events.