ZV

5_Birth and Postpartum Period

University of Lethbridge KNES 3630: FIAT LUX

  • Instructor: Kelsey Kendellen, PhD

Lecture Objectives

  • Describe the three stages of the birth process.

  • Differentiate between natural & Caesarean delivery.

  • Explain the Apgar Scale.

  • Discuss the adjustments that occur in the 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 or newborn)

  • 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

Labor: The Process of Birth Begins

  • Hormonal Triggers in Late Pregnancy:

    • Placenta secretes Corticotropin-Releasing Hormone (CHR).

    • CHR triggers release of various hormones including oxytocin.

    • Oxytocin: hormone that initiates and speeds up contractions.

    • High levels of oxytocin lead to periodic contractions in the uterus.

  • Administration of Oxytocin:

    • Synthetic form: Pitocin, commonly used for inducing labor.

    • Creates a positive feedback loop to release more oxytocin leading to stronger contractions.

Braxton Hicks Contractions

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

  • Feel similar to mild menstrual cramps.

  • They do not indicate actual labor but prepare the body for it.

The Birth Process: Stages

Stage 1: Dilation

  • Longest stage, lasting 16 to 24 hours typically for firstborns.

  • Regular and intense uterine contractions dilate the cervix.

  • Beginning contractions: 15-20 minutes apart. Near end: 2-5 minutes apart.

  • Cervical Effacement and Dilation:

    • Fully dilated cervix: 10 cm or 4 in.

Stage 2: Expulsion

  • Lasts about 45 to 60 minutes.

  • Begins when the baby's head begins to move through the cervix toward the birth canal.

  • Ends when the baby is born.

Stage 3: After Birth

  • Shortest stage, typically lasts only minutes.

  • Child's umbilical cord and placenta are expelled from the mother.

Birth: Transition from Fetus to Neonate

  • Immediate Post-delivery Actions:

    • Umbilical cord is cut.

    • Skin-to-skin contact (Kangaroo Mother Care) offers various benefits: stabilizing heart rate, promoting breastfeeding, and reducing risks of neonatal issues.

The Apgar Scale

APGAR Score Components

  • Appearance:

    • 0: Cyanotic/Pale

    • 1: Peripheral Pink

    • 2: Normal color

  • Pulse:

    • 0: No pulse

    • 1: <100 bpm

    • 2: >100 bpm

  • Grimace:

    • 0: No response

    • 1: Grimace or weak cry when stimulated

    • 2: Strong cry when stimulated

  • Activity:

    • 0: Floppy

    • 1: Some flexion

    • 2: Well flexed (jugular tone)

  • Respiration:

    • 0: Apneic

    • 1: Slow, irregular

    • 2: Strong cry

Deprivation of Oxygen

  • Common issues during labor include:

    • Umbilical cord may be pinched or wrapped around the neck leading to anoxia (restriction of oxygen).

Newborn Screening Program

  • Newborn Blood Spot Screening:

    • Blood collected from a heel poke to screen for 22 treatable conditions within 24-48 hours after birth.

Approaches to Childbirth

Vaginal Delivery

  • Birth through the vagina.

  • Natural childbirth: No drugs given for pain relief. Alternative techniques include massage, water birth, acupuncture, and HypnoBirthing.

Caesarean Delivery

  • Baby removed from uterus through incision in mother’s abdomen.

  • Two types: scheduled versus emergency.

  • Statistics:

    • Caesarean births: 27.9% in Canada (2016).

    • Increasing rate of repeat Caesareans.

Factors Contributing to Caesarean Birth Rate

  • Labor dystocia, abnormal fetal heart tracing, malpresentation, and multiple fetuses.

  • Increased maternal preference and decreased risks for maternal trauma also play roles.

Pain & Childbirth

Epidural

  • A common method for pain management during labor by administering medicine through a catheter placed around the spinal cord.

  • Provides numbness from the waist down.

  • Risks: lower blood pressure, inability to feel contractions, possible headaches.

  • Epidural rates in Canada: 59.3% for vaginal delivery (2017-2018).

The Postpartum Period

  • Period after childbirth characterized by hormonal changes and physical adjustments.

  • Involution: Process of the uterus returning to its prepregnant size post-birth.

Postpartum: Physical & Emotional Changes

  • Postpartum Blues:

    • Affects 70-80% of new mothers; mood swings and sleep troubles for 2-3 days to two weeks.

  • Postpartum Depression (PPD):

    • 7.5% of women report depressive symptoms; lasts longer and is more intense.

PPD Symptoms and Risk Factors

Symptoms Include:

  • Crying excessively, withdrawing from social interactions, appetite changes, fatigue, loss of interest in previously enjoyed activities, and severe anxiety.

Risk Factors:

  • Low-income background, history of mood disorders, poor support, difficult infant temperament, marital difficulties, and negative life events.