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Labor and Breastfeeding Notes
Labor and Breastfeeding Notes
Labor and Breastfeeding
Placental Stage
Critical stage post-labor due to risks of hemorrhaging and infection if the placenta is not fully delivered.
Preparing for Labor: Relaxin
Before dilation, the body releases relaxin, a hormone that loosens the ligaments in the pelvic region.
Relaxin prevents hip fractures or pelvic cracks during natural childbirth by allowing the bones to shift slightly.
Dislocated pelvis during childbirth is a painful and serious condition, often inadequately treated.
Relaxin release increases during the third trimester, especially in the last month.
Narrow or small pelvis can prevent pregnancy or necessitate a cesarean section.
Historically, "birthing hips" referred to women with a wider pelvis, naturally suited for pregnancy and delivery.
Dilation Stage
Initiated when the fetus becomes too large and pushes against the cervix.
Head-first delivery (ideal) causes the head to push on the cervix.
Any part of the fetus pushing on the cervix can initiate dilation.
The pressure sends a nerve impulse to the hypothalamus, which releases oxytocin.
Oxytocin causes the uterus to contract, pushing the fetus against the cervix, creating a positive feedback loop.
Contractions become closer and more intense until the cervix dilates from the size of a Cheerio to the size of a bagel.
Full dilation is about 10 centimeters, or five fingers.
Dilation can last from 2 to 20 hours or longer, and the process varies among women.
Cervical mucus plug prevents bacteria and infection during pregnancy; dislodging it often signals the start of labor.
Amniotic sac pops, releasing amniotic fluid; amount varies among women.
Excessive amniotic fluid can cause breathing difficulties for the mother.
Hormones and Contractions
Oxytocin acts on the uterus, causing contractions.
Prostaglandins, released by the placenta, work with oxytocin to speed up dilation.
Cervical mucus plug prevents infection by blocking openings.
Amniotic sac rupture leads to the release of amniotic fluid.
Vaginal Canal Dilation
The relaxin hormone loosens the vaginal canal, allowing some expansion, but less than the cervix.
Contractions
Contractions become more intense due to the positive feedback loop of oxytocin and the effect of prostaglandins.
Expulsion Stage
Follows full dilation (10 centimeters).
Medical term for when the baby's head is visible through the cervix, the term is crowning.
Characterized by forceful contractions that push the baby through the cervix and birth canal.
Pain Management: Epidurals
Certain medications like morphine are unsafe as they slow down the labor process.
Epidural anesthesia involves injecting into the spine to block sensory pain receptors, reducing pain from the waist down.
Epidurals can be used for lower abdominal surgeries, such as colon surgery.
Risks of epidurals include back pain, paralysis, or loss of feeling in the feet.
Alberta statistics indicate that 1 in 100 women experience long-term issues from epidurals.
Anesthesia has advanced significantly, but epidural procedures carry potential risks.
Forceps and Vacuum Assistance
Forceps: Rarely used due to the risk of crushing the skull and causing brain damage.
Vacuum: A vacuum hose is attached to the baby's head, and the baby is delivered with suction assistance.
Vacuum-assisted births can cause a bruise on the baby's head.
Episiotomy
Episiotomy: A controlled cut made in the perineum to enlarge the vaginal opening.
Used when the baby needs to be delivered quickly or if there's a risk of severe tearing.
Less common now but was standard practice until the late 1970s.
Hospital Practices
Past practices (1960s-1970s) included routine enemas, shaving of the pelvic region, and episiotomies.
Current practices have changed, with enemas and episiotomies no longer being routine.
Pain management has improved, but early methods like knocking women out during dilation are no longer used.
Placental Stage
Involves delivery of the placenta and remaining umbilical cord.
Delayed cord cutting allows for additional nutrients and oxygen transfer to the baby.
Placenta should be delivered within 10-15 minutes, up to half an hour.
The expelled placenta is referred to as the afterbirth.
Failure to deliver the placenta fully can lead to hemorrhaging and infection.
Placenta Examination
The placenta is inspected to ensure all parts are intact.
Amniotic sac is examined.
The mother is at risk if parts of the placenta remain and could lead to issues like postpartum hemorrhage and infections.
Water Births
Water births are practiced in some cultures.
A sterile environment is essential to prevent infection.
Water births are believed to promote relaxation, facilitating easier labor.
Cesarean Section
Reasons for cesarean sections include:
Large baby size.
High blood pressure in the mother.
Small pelvis.
STI transmission.
Breech or transverse baby position.
Umbilical cord issues.
The main umbilical cord issues might include cases where the umbilical cord is wrapped around the neck of the fetus.
Cesarean Section Procedure
Involves cutting through the abdominal wall and uterus.
The baby is delivered, and the umbilical cord is clamped and cut.
Oxytocin and prophylactic antibiotics are administered to the mother.
The uterus is externalized for easy visualization and repair.
Major abdominal surgery with a significant healing process.
Multiple cesarean sections can increase risk.
Patient Advocacy
All patients have the right to ask about procedures, alternatives, and seek second opinions.
Pre-surgical clinics provide opportunities to ask questions and receive education.
Positive Feedback Loops
Oxytocin and prostaglandin are positive feedback loops.
Breastfeeding
Prolactin is needed for breast milk letdown but can be negatively impacted during pregnancy.
Progesterone and estrogen suppress prolactin production during pregnancy.
Lactation during pregnancy is possible if the mother was already lactating.
High-risk pregnancies may require stopping breastfeeding to conserve energy and prevent early labor.
Breastfeeding Process
Progesterone and estrogen levels decrease after delivery, allowing prolactin to be produced.
Breastfeeding is not instantaneous and requires training and support.
Nerve stimulation from the baby triggers the hypothalamus to release milk.
Pavlovian response: The body associates the baby's cry with hunger, leading to milk letdown.
Involuntary process affected by stress, hormones, and structural issues.
Nipple cream can moisturize nipples to prevent cracking and infections.
Breast milk production varies among women.
Breastfeeding in impoverished countries may be the only source of nutrition for the child.
Cesarean sections may delay breast milk production due to shock to the system and energy diversion for recovery.
Teratogens
Teratogens: Substances exposed to during pregnancy that cause structural abnormalities, especially during the embryo stage.
In Alberta, 2-3% of children are born with birth defects due to teratogen exposure.
Impact lessens as exposure occurs later in pregnancy.
Examples:
Cigarettes: Lead to low birth rates, premature miscarriage, and ectopic pregnancy.
Alcohol: Causes fetal alcohol syndrome, with the highest risk between weeks 7 and 12 of pregnancy.
Cocaine.
Accutane.
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