Download Birth - Psychology

Birth
LABOUR:
 Complex mix of fetal signals and
endocrine mechanisms in the mother.
 Fetus secretes surfactant protein which
seems to alter maternal hormones.
 Also, the agents (progesterone, nitric
oxide, and others) that keep the uterine
muscle quiet, decrease, and the uterus
starts to contract.

sometimes timing is off  premature labour
BIRTH
LABOUR:
 Surfactin signals mom’s hypothalamus:
produced when fetal lungs ready to breathe
BIRTH
LABOUR (Cont’d):
 Hypothalamus stimulates pituitary
 Pituitary secretes oxytocin
 Oxytocin makes uterus contract: labour
begins
BIRTH
Other mechanisms involved in the start of labour:
CRH: corticotropin-releasing hormone: released
by the placenta. Amounts correlate with date of
labour (early, on time or post-dates) by the 16th20th weeks gestation
CRH seems to trigger fetal production of cortisol.
Cortisol clears fluid from infant’s lungs and
stimulates more CRH production.
This, in turn, stimulates placental estrogen
production, necessary for starting labour.
BIRTH
SOME POSSIBLE SIGNS OF LABOUR:
 Mucus plug falls out from cervix
 Amniotic fluid leaks or gushes out
 Contractions - but … Braxton Hicks: False
Labour
WHAT IS LABOUR?
BIRTH
STAGES OF LABOUR:
 “False” labour: Braxton-Hicks contractions
 First stage:



early first stage: longest (hours or days), mild
contractions, 10-30” duration @ 20, 15, 10, 5’
intervals
late first stage: 60-90” duration @ 3, 2, 1’
transition: shortest, (15-30’) most intense,
random pattern of contractions.
 All
along, cervix dilating and effacing
(thinning)
BIRTH
STAGES OF LABOUR (Cont’d):
 Second stage:







cervix fully dilated (10 cm)
baby moves down birth canal
crowning
duration: primiparas about 1 hr., multiparas
faster
head first, rotation
shoulders, one at a time
rest of baby slithers out
BIRTH
STAGES OF LABOUR (Cont’d):
 Third stage:


after 10-15’ interval
expulsion of placenta
 During




interval between stages 2 and 3:
lungs start to work gradually
cord delivers last of maternal blood to infant
heart valves close
cord must not be cut until white and not
pulsing
BIRTH
 Birth:

empowering experience for mother
 Super-orgasm
(Kitzinger)
 Gentle pushing, breathing baby out
 Mouth open leads to open introitus
BIRTH
POSITIONS FOR LABOUR
 Not on her back!!! Lithotomy Position



Weight of uterus and its content on abdominal
aorta: can cause reduced blood flow to fetus
Slows down labour
Importance of gravity’s help
BIRTH
POSITIONS FOR BIRTH
 Standard: lithotomy – one of the worst.
Better:



sitting up reclined
lying on her side
on hands and knees
 Unmedicated,
undisturbed birth best. 9095% births do not need intervention.
BIRTH
RISKS OF INDUCING LABOUR:
 Contractions too hard, lead to more
analgesics and anesthetics
 Hard contractions can also lead to uterine
rupture and to brain damage (pressure on
the skull)
 If lungs not ready, leads to respiratory
distress (formerly called hyaline
membrane) due to lack of surfactin
BIRTH
Placenta praevia
Classification and external resources
POSSIBLE COMPLICATIONS
(5-10%)

inefficient placenta,
affects fetal growth, life
threatening for fetus
 placenta previa
Diagram showing placenta praevia.
ICD-10
ICD-9
MeSH
044, P02.0
641.0, 641.1
D010923
BIRTH
POSSIBLE COMPLICATIONS (5-10%)
 abruptio placenta
 transverse presentation
 breech presentation (feet or buttocks)
 prolapsed cord
 cord pinched or wrapped around neck
BIRTH
POSSIBLE COMPLICATIONS (5-10%)
(Cont’d):
small pelvic diameter
multiple births
toxemia: elevated BP, fluid retention, can
lead to eclampsia (possibly fatal)
maternal asthma
BIRTH
POSSIBLE COMPLICATIONS (5-10%)
(Cont’d):
All carry risk of hypoxia or anoxia
Hypoxia:

reduced oxygen
Anoxia:

NO oxygen
Consequences:


brain damage
detectable or subclinical
BIRTH
POSSIBLE IATROGENIC EFFECTS OF
INTERVENTION:
Common interventions:
Induction of labour (pitocin), use of pitocin
to re-start or accelerate labour: can cause
too strong contractions, pain, uterine
rupture. Due date myth.
Episiotomy (infections, painful sex, painful
sitting)
EPISIOTOMY
BIRTH
POSSIBLE IATROGENIC EFFECTS OF
INTERVENTION:
Common interventions (Cont’d):
C-section: major abdominal surgery;
possible lack of adrenaline/noradrenaline in
baby. N. American C-sec rates too high
Psychosocial factors:
vagina preservation
no pain or awareness
set the date

BIRTH
POSSIBLE IATROGENIC EFFECTS OF
INTERVENTION:
Common interventions (Cont’d):
Medical factors:
ultrasounds
fetal monitors
higher maternal age
tummy tuck combined with C-section

Pain
medication (analgesics and
anesthetics): can slow down labour and
decrease oxygen delivery to baby
BIRTH
POSSIBLE IATROGENIC EFFECTS OF
INTERVENTION:
Common interventions (Cont’d):
Fetal monitor: external or internal



All
External: curtails movement, mother on her
back
Internal: possible damage to baby, also
curtails mother’s movement
Forceps
interventions potentially iatrogenic:
damage caused by medical treatment.
BIRTH
EFFECTS OF ANESTHETICS AND
ANALGESICS:
slow down labour (leading to pitocin use)
sluggish baby
mother zonked, weak
can interfere with bonding
can interfere with lactation
can interfere with rooming-in
BIRTH
SOME POST-NATAL EFFECTS OF
HYPOXIA
 Increased SIDS
 Increased risk of respiratory illnesses
 Weaker sucking reflex
 Weaker head-turning reflex
 Increased hyperactivity
 Increased difficulty in reading and math
BIRTH
BIRTH HORMONES (INFANT)
 Adrenaline and noradrenaline




open airways, lungs
enhance cell metabolism
more blood to brain
alertness
 Not
released in C-section
BIRTH
BIRTH HORMONES (INFANT)
 Could be interfered with when
administering drugs to mother during
labour
 No thorough longitudinal study but 80%
increased risk of asthma by age 8
 Silver nitrate, drops in baby’s eyes in case
of maternal gonorrhea (blindness) but…
 Interferes with bonding, can be delayed an
hour
BIRTH





In some cultures, intercourse used to start or
accelerate labour.
How soon can have sex post-partum? Six weeks
or when ready. Effect of episiotomy, C-section.
Moms who breastfeed tend to return to sex
earlier. Results depending on sampling and
methodology. In both parents testosterone
decreases, prolactin increases.
Tiredness, lack of sleep, overwhelmed
Change in roles, decrease of “romanticism”.