The Birth Process

Mamie Guidera, CNM, MSNCarol O’Donoghue, CNM, MSN, MPH

Normal Labor and birth: Objectives

IntroductionsPhysiologic labor and birth: the basics

Phases of labor Birth video The P’s: Power, passageway, passenger, etc.

Briefs: American birth & (some of the) influences:

Where births take placeCultural expectations of pain managementA word on Fetal Monitoring

Here’s the truth: Childbirth is not only a physiologic phenomenon, but a cultural/sociological experience. So before you walk onto the Labor Floor, ask yourself:

o Where/how did you first learn about how a baby is born? What do you know about your own birth?

o Who (family member, friends, healthcare provider) or what (your medical training, book, television show, movie) has influenced your perception of labor? What birth stories come to your mind first?

o Is there such a thing as “good” pain? If you are an athlete, have you ever sought out physical discomfort? Why?

o Have you ever been in pain? How did you deal with it?

o What do you think is the role of the healthcare provider in birth?

Birth in the United States

Site of birth Hospital Birth Center Home

Model of birth Medical Model Midwifery Model

Stages of Labor

First stage: early, active, transition Dilatation

Second stage Pushing and birth

Third stage Delivery of placenta

Fourth stage Postpartum

True vs False Labor:

Williams Obstetrics (22nd edition)

True Labor: Contractions occur at

regular intervals Intensity gradually

increases Discomfort is in the

back and abdomen. Cervix dilates. Discomfort is not

stopped by sedation

Contractions are irregular

Intensity remains the same

No cervical dilatation

Discomfort relieved by sedation

The Ps of Labor

Woman/Fetus Power Passageway Passenger Position Psyche

Providers/Support Persons: Patience Persistence Practice/ Pain Relief Psyche

The PassagePelvic Bones and Pelvimetry

The PassagePelvic Bones and Pelvimetry

Passenger: Attitude

Passenger: Presentation

Passenger: Presentation

Birth

Perineal management (keep your hands off

Mirror

Ask mother to feel the baby’s head

Stay focused on woman, not tasks