BirthBirthLABOUR: LABOUR: Complex mix of fetal signals and Complex mix of fetal signals and

endocrine mechanisms in the mother. endocrine mechanisms in the mother. Fetus secretes surfactant protein which Fetus secretes surfactant protein which

seems to alter maternal hormones. seems to alter maternal hormones. Also, the agents (progesterone, nitric Also, the agents (progesterone, nitric

oxide, and others) that keep the uterine oxide, and others) that keep the uterine muscle quiet, decrease, and the uterus muscle quiet, decrease, and the uterus starts to contract. starts to contract. sometimes timing is off sometimes timing is off premature labour premature labour

BIRTHBIRTH

LABOUR:LABOUR: Surfactin signals mom’s hypothalamus: Surfactin signals mom’s hypothalamus:

produced when fetal lungs ready to breathe produced when fetal lungs ready to breathe

BIRTHBIRTH

LABOUR (Cont’d):LABOUR (Cont’d): Hypothalamus stimulates pituitaryHypothalamus stimulates pituitary Pituitary secretes oxytocinPituitary secretes oxytocin Oxytocin makes uterus contract: labour Oxytocin makes uterus contract: labour

beginsbegins

BIRTHBIRTH

Other mechanisms involved in the start of labour:Other mechanisms involved in the start of labour:CRH: corticotropin-releasing hormone: released CRH: corticotropin-releasing hormone: released by the placenta. Amounts correlate with date of by the placenta. Amounts correlate with date of labour (early, on time or post-dates) by the 16labour (early, on time or post-dates) by the 16 thth--2020thth weeks gestation weeks gestationCRH seems to trigger fetal production of cortisol. CRH seems to trigger fetal production of cortisol. Cortisol clears fluid from infant’s lungs and Cortisol clears fluid from infant’s lungs and stimulates more CRH production.stimulates more CRH production.

This, in turn, stimulates placental estrogen This, in turn, stimulates placental estrogen production, necessary for starting labour.production, necessary for starting labour.

BIRTHBIRTH

SOME POSSIBLE SIGNS OF LABOUR:SOME POSSIBLE SIGNS OF LABOUR: Mucus plug falls out from cervixMucus plug falls out from cervix Amniotic fluid leaks or gushes outAmniotic fluid leaks or gushes out Contractions - but … Braxton Hicks: False Contractions - but … Braxton Hicks: False

LabourLabour

WHAT IS LABOUR?

BIRTHBIRTH

STAGES OF LABOUR:STAGES OF LABOUR: ““False” labour: Braxton-Hicks contractionsFalse” labour: Braxton-Hicks contractions First stage:First stage:

early first stage: longest (hours or days), mild early first stage: longest (hours or days), mild contractions, 10-30” duration @ 20, 15, 10, 5’ contractions, 10-30” duration @ 20, 15, 10, 5’ intervalsintervals

late first stage: 60-90” duration @ 3, 2, 1’late first stage: 60-90” duration @ 3, 2, 1’ transition: shortest, (15-30’) most intense, transition: shortest, (15-30’) most intense,

random pattern of contractions.random pattern of contractions. All along, cervix dilating and effacing All along, cervix dilating and effacing

(thinning)(thinning)

BIRTHBIRTH

STAGES OF LABOUR (Cont’d):STAGES OF LABOUR (Cont’d): Second stage:Second stage:

cervix fully dilated (10 cm)cervix fully dilated (10 cm) baby moves down birth canalbaby moves down birth canal crowningcrowning duration: primiparas about 1 hr., multiparas duration: primiparas about 1 hr., multiparas

fasterfaster head first, rotationhead first, rotation shoulders, one at a timeshoulders, one at a time rest of baby slithers outrest of baby slithers out

BIRTHBIRTH

STAGES OF LABOUR (Cont’d):STAGES OF LABOUR (Cont’d): Third stage:Third stage:

after 10-15’ intervalafter 10-15’ interval expulsion of placentaexpulsion of placenta

During interval between stages 2 and 3:During interval between stages 2 and 3: lungs start to work graduallylungs start to work gradually cord delivers last of maternal blood to infantcord delivers last of maternal blood to infant heart valves closeheart valves close cord must not be cut until white and not cord must not be cut until white and not

pulsingpulsing

BIRTHBIRTH

Birth:Birth: empowering experience for motherempowering experience for mother

Super-orgasm (Kitzinger)Super-orgasm (Kitzinger) Gentle pushing, breathing baby outGentle pushing, breathing baby out Mouth open leads to open introitusMouth open leads to open introitus

BIRTHBIRTH

POSITIONS FOR LABOURPOSITIONS FOR LABOUR Not on her backNot on her back!!! Lithotomy Position!!! Lithotomy Position

Weight of uterus and its content on abdominal Weight of uterus and its content on abdominal aorta: can cause reduced blood flow to fetusaorta: can cause reduced blood flow to fetus

Slows down labourSlows down labour Importance of gravity’s helpImportance of gravity’s help

BIRTHBIRTH

POSITIONS FOR BIRTHPOSITIONS FOR BIRTH Standard: lithotomy – one of the worst. Standard: lithotomy – one of the worst.

Better:Better: sitting up reclinedsitting up reclined lying on her sidelying on her side on hands and kneeson hands and knees

Unmedicated, undisturbed birth best. 90-Unmedicated, undisturbed birth best. 90-95% births do not need intervention.95% births do not need intervention.

BIRTHBIRTH

RISKS OF INDUCING LABOUR:RISKS OF INDUCING LABOUR: Contractions too hard, lead to more Contractions too hard, lead to more

analgesics and anestheticsanalgesics and anesthetics Hard contractions can also lead to uterine Hard contractions can also lead to uterine

rupture and to brain damage (pressure on rupture and to brain damage (pressure on the skull)the skull)

If lungs not ready, leads to respiratory If lungs not ready, leads to respiratory distress (formerly called hyaline distress (formerly called hyaline membrane) due to lack of surfactinmembrane) due to lack of surfactin

BIRTHBIRTH

POSSIBLE COMPLICATIONS (5-10%)POSSIBLE COMPLICATIONS (5-10%)

inefficient placenta, affects fetal inefficient placenta, affects fetal growth, life threatening for fetusgrowth, life threatening for fetus

placenta previaplacenta previa

Placenta praeviaClassification and external resources

Diagram showing placenta praevia.

ICD-10 044, P02.0ICD-9 641.0, 641.1MeSH D010923

BIRTHBIRTH

POSSIBLE COMPLICATIONS (5-10%)POSSIBLE COMPLICATIONS (5-10%) abruptio placentaabruptio placenta transverse presentationtransverse presentation breech presentation (feet or buttocks)breech presentation (feet or buttocks) prolapsed cordprolapsed cord cord pinched or wrapped around neckcord pinched or wrapped around neck

BIRTHBIRTH

POSSIBLE COMPLICATIONS (5-10%) POSSIBLE COMPLICATIONS (5-10%) (Cont’d):(Cont’d):small pelvic diametersmall pelvic diametermultiple birthsmultiple birthstoxemia: elevated BP, fluid retention, can toxemia: elevated BP, fluid retention, can lead to eclampsia (possibly fatal)lead to eclampsia (possibly fatal)maternal asthmamaternal asthma

BIRTHBIRTH

POSSIBLE COMPLICATIONS (5-10%) POSSIBLE COMPLICATIONS (5-10%) (Cont’d):(Cont’d):All carry risk of hypoxia or anoxiaAll carry risk of hypoxia or anoxiaHypoxia:Hypoxia:

reduced oxygenreduced oxygenAnoxia:Anoxia:

NO oxygenNO oxygenConsequences: Consequences:

brain damagebrain damage detectable or subclinicaldetectable or subclinical

BIRTHBIRTH

POSSIBLE IATROGENIC EFFECTS OF POSSIBLE IATROGENIC EFFECTS OF INTERVENTION:INTERVENTION:

Common interventions:Common interventions:Induction of labour (pitocin), use of pitocin Induction of labour (pitocin), use of pitocin to re-start or accelerate labour: can cause to re-start or accelerate labour: can cause too strong contractions, pain, uterine too strong contractions, pain, uterine rupture. Due date myth.rupture. Due date myth.Episiotomy (infections, painful sex, painful Episiotomy (infections, painful sex, painful sitting)sitting)

EPISIOTOMY

BIRTHBIRTH

POSSIBLE IATROGENIC EFFECTS OF POSSIBLE IATROGENIC EFFECTS OF INTERVENTION:INTERVENTION:

Common interventions (Cont’d):Common interventions (Cont’d):C-section: major abdominal surgery; C-section: major abdominal surgery; possible lack of adrenaline/noradrenaline in possible lack of adrenaline/noradrenaline in baby. N. American C-sec rates too high baby. N. American C-sec rates too high Psychosocial factors:Psychosocial factors:

vagina preservationvagina preservationno pain or awarenessno pain or awarenessset the dateset the date

BIRTHBIRTH

POSSIBLE IATROGENIC EFFECTS OF POSSIBLE IATROGENIC EFFECTS OF INTERVENTION:INTERVENTION:

Common interventions (Cont’d):Common interventions (Cont’d):Medical factors:Medical factors:

ultrasoundsultrasoundsfetal monitorsfetal monitorshigher maternal agehigher maternal agetummy tuck combined with C-sectiontummy tuck combined with C-section

Pain medication (analgesics and Pain medication (analgesics and anesthetics): can slow down labour and anesthetics): can slow down labour and decrease oxygen delivery to babydecrease oxygen delivery to baby

BIRTHBIRTH

POSSIBLE IATROGENIC EFFECTS OF POSSIBLE IATROGENIC EFFECTS OF INTERVENTION:INTERVENTION:

Common interventions (Cont’d):Common interventions (Cont’d):Fetal monitor: external or internalFetal monitor: external or internal

External: curtails movement, mother on her External: curtails movement, mother on her backback

Internal: possible damage to baby, also Internal: possible damage to baby, also curtails mother’s movementcurtails mother’s movement

ForcepsForcepsAll interventions potentially All interventions potentially iatrogeniciatrogenic: : damage caused by medical treatment.damage caused by medical treatment.

BIRTHBIRTH

EFFECTS OF ANESTHETICS AND EFFECTS OF ANESTHETICS AND ANALGESICS:ANALGESICS:slow down labour (leading to pitocin use)slow down labour (leading to pitocin use)sluggish babysluggish babymother zonked, weakmother zonked, weakcan interfere with bondingcan interfere with bondingcan interfere with lactationcan interfere with lactationcan interfere with rooming-incan interfere with rooming-in

BIRTHBIRTH

SOME POST-NATAL EFFECTS OF SOME POST-NATAL EFFECTS OF

HYPOXIAHYPOXIA Increased SIDSIncreased SIDS Increased risk of respiratory illnessesIncreased risk of respiratory illnesses Weaker sucking reflexWeaker sucking reflex Weaker head-turning reflexWeaker head-turning reflex Increased hyperactivityIncreased hyperactivity Increased difficulty in reading and mathIncreased difficulty in reading and math

BIRTHBIRTH

BIRTH HORMONES (INFANT)BIRTH HORMONES (INFANT) Adrenaline and noradrenalineAdrenaline and noradrenaline

open airways, lungsopen airways, lungs enhance cell metabolismenhance cell metabolism more blood to brainmore blood to brain alertnessalertness

Not released in C-sectionNot released in C-section

BIRTHBIRTH

BIRTH HORMONES (INFANT)BIRTH HORMONES (INFANT) Could be interfered with when Could be interfered with when

administering drugs to mother during labouradministering drugs to mother during labour No thorough longitudinal study but 80% No thorough longitudinal study but 80%

increased risk of asthma by age 8increased risk of asthma by age 8 Silver nitrate, drops in baby’s eyes in case Silver nitrate, drops in baby’s eyes in case

of maternal gonorrhea (blindness) but…of maternal gonorrhea (blindness) but… Interferes with bonding, can be delayed an Interferes with bonding, can be delayed an

hourhour

BIRTHBIRTH

In some cultures, intercourse used to start or In some cultures, intercourse used to start or accelerate labour.accelerate labour.

How soon can have sex post-partum? Six weeks How soon can have sex post-partum? Six weeks or when ready. Effect of episiotomy, C-section.or when ready. Effect of episiotomy, C-section.

Moms who breastfeed tend to return to sex Moms who breastfeed tend to return to sex earlier. Results depending on sampling and earlier. Results depending on sampling and methodology. In both parents testosterone methodology. In both parents testosterone decreases, prolactin increases.decreases, prolactin increases.

Tiredness, lack of sleep, overwhelmedTiredness, lack of sleep, overwhelmed Change in roles, decrease of “romanticism”.Change in roles, decrease of “romanticism”.