Thesis on "Birth Stages in the First"

Thesis 7 pages (1812 words) Sources: 0

[EXCERPT] . . . .

Birth Stages

In the first stage, uterine contractions are 15 to 20 minutes apart at the beginning and last up to a minute. These contractions cause the woman's cervix which is the opening into the birth canal to stretch and open. As the first stage progresses, the contractions come closer together, appearing every two to five minutes. Their intensity increases too and by the end of the first birth stage, contractions dilate the cervix to an opening of abour 4 inches, so that the baby can move from the uterus to the birth canal. For a woman having her first child, the first stage lasts an average of 12 to 24 hours and it is the longest of the three stages. And for later births, the first stage lasts an average of 8 hours.

The second birth stage begins when the baby's head starts to move through the cervix and the birth canal. In this stage, it terminates when the baby completely emerges from the mother's body. For a first birth, this stage lasts approximately 90 minutes, and for later births the second stage averages 45 minutes in length. With each contraction, the mother bears down hard to push the baby out of her body. By the time the baby's head is out of the mother's body, the contractions come almost every minute and last for about a minute.

Afterbirth is the third stage at which time the placenta, umbilical cord, and other membranes are detached and expelled. This final stage is the shortest of the three birth stages, lasting only minutes.

Birth Strategies

Natural childbirth is the method that aims to reduce the mother's pain by decreasing her fear through education about childbirth and by teaching her to use breathing methods and relaxation techniques during delivery. This approach was developed in 1914 by English obstetrician Grantley Dick-Read. French obstetrician Ferdinand Larnaze developed a method similar to natural childbirth that is known as prepared childbirth, or the Lamaze method. It includes a special breathing technique to control pushing in the final stages of labor, as well as more detailed education about anatomy and physiology than Dick- Read's approach provides. The pregnant woman's partner usually serves as a coach, who attends childbirth classes with her and helps her with her breathing and relaxalion during delivery.

Another form of birth strategy is the waterbirth method which involves giving birth in a tub of warm water. In this method, some women go through labor in the water and get out for delivery while others remain in the water for delivery. The rationale for waterbirth is that the baby has been in an amniotic sac for many months and that delivery in a similar environment is likely to be less stressful for the baby and the mother. Mothers get into the warm water when contractions become closer together and more intense. Getting into the water too soon can cause labor to slow or stop. Massage is increasingly used as a procedure prior to and during delivery and researchers have found that massage can reduce pain and anxiety during labor.

Acupuncture, the insertion of very fine needles into specific locations in the body, is used as a standard procedure to reduce the pain of childbirth in China, although it only recently has begun to be used in the United States for this purpose. Hypnosis, the induction of a psychological state of altered attention and awareness in which the individual is unusually responsively to suggestions, is also increasingly being used during childbirth. Music therapy during childbirth, which involves the use of music to reduce stress and manage pain, is increasingly being used.

In a cesarean delivery, the baby is removed from the mother's uterus through an incision made in her abdomen. Cesarean deliveries are safer than breech deliveries. Cesarean deliveries also are performed if the baby is lying crosswise in the uterus, if the baby's head is too large to pass through the mother's pelvis, if the baby develops complications, or if the mother is bleeding vaginally.

Fetus to Infant Transition

During each conraction, when the placenta and umbilical cord are compressed as the uterine muscles draw together, the supply of oxygen to the fetus is decreased. If the delivery takes too long, the baby can develop anoxia, a condition in which the fetus or newborn has an insufficient supply of oxygen which can cause brain damage and the baby has considerable capacity to withstand the stress of birth. Large quantities of adrenaline and noradrenaline, hormones that protect the fetus in the event of oxygen deficiency, are secreted in stressful circumstances. These hormones increase the heart's pumping activity, speed up heart rate, channel blood flow to the brain, and raise the blood-sugar level. Never again in life will such large amounts of these honnones be secreted. This circumstance underscores how stressful it is to be born and also how well prepared and adapted the fetus is for birth.

At the time of birth, the baby is covered with what is called vernix caseosa, a protective skin grease. This vernix consists of fatty secretions and dead cells, thought to help proteel the baby's skin against heat loss before and during birth. Immediately after birth, thc umbilical card is cut. Before birth, oxygen came from the mother via the umbilical cord, but now the baby is self-sufficient and can breathe on its own. Now 25 million little air sacs in the lungs must be filled with air. These first breaths may be the hardest ones an individual takes.

Measures of Neonatal Health and Responsiveness

At birth, the infant is subjected to rapid and profound physiological changes. Survival depends on a prompt and orderly conversion to air breathing. For efficient interchange of oxygen and carbon dioxide, the fluid-filled alveoli of the lungs must expand with air, the air must be exchanged by appropriate respiratory motion, and perfusion must be established. Apgar is widely used to assess the health of newborns at one and five minutes after birth and to identify those neonates who require resuscitation as well as to assess the effectiveness of any resuscitative meassures. Each of the five easily identifiable characteristics - heart rate, respiratory effort, muscle tone, reflex irritability, and color - is assessed and assigned a value of 0 to 2.

The total score, based on the sum of the five components, is determined 1 and 5 minutes after delivery. The 1 minute Apgar score reflect the need for immediate resuscitation. The 5-minute score and particularly the change in score between 1 and 5 minutes is a useful index of the effectiveness of resuscitative efforts. The 5-minute Apgar score also has prognostic significance for neonatal survival for the reason that survival is related closely to the condition of the infant in the delivery room. A total score of 7 to 10 indicates that the newborn's condition is good. A score of 5 indicates there may be developmental difficulties. A score of 3 or below signals an emergency and indicates that the baby might not survive. The Apgar Scale is especially good at assessing the newborn's ability to respond to the stress of delivery and the new environment and also identifies high-risk infants who need resuscitation.

The Brazelton Neonatal Behavioral Assessment Scale (NBAS) is performed within 24 to 36 hours after birth and used as a sensitive index of neurological competence in the weeks or months after birth and as a measure in many studies of infant development. It assesses the newborn's neurological development, reflexes, and reactions to people. In this measurement, the newborn is an active participant, and the score is based on the newborn's best performance in reflexes such as sneezing, blinking, and rooting, are assessed along with reactions to circumstances, such as the infant's reaction to a rattle.

A very low NBAS score can indicate brain damage, or stress to the brain that may heal in time. The Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) provides a more comprehensive analysis of the newborn's behavior, neurological and stress responses, and regulatory capacities. It is especially useful for evaluating preterm infants and substance-exposed infants.

Preterm Born / Low Birth Weight Children

Children who were born low in birth weight are more likely than their normal birth weight counterparts to have a learning disability, attention deficit and hyperactivity disorder, or breathing problems such as asthma. Approximately 50% of all low birth weight children are enrolled in special education programs. Not all of these adverse consequences can be attributed solely to being born low in birth weight. Some of the less severe but more common developmental and physical delays occur because many low birth weight children come from disadvantaged environments.

Bonding special component of the parent-infant relationship is bonding, the formation of a connection, especially a physical bond between parents and the newborn in the period shortly after birth. Sometimes hospitals seem determined to deter bonding. Drugs given to the mother to make her delivery less painful can make the mothet drowsy, interfering with her ability… READ MORE

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