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Childbirth (also called labour, birth, partus or parturition) is the culmination of a human pregnancy with the emergence of a newborn infant from its mother's uterus. A woman is considered to be in labour when she begins experiencing regular, strong uterine contractions, accompanied by changes of her cervix — primarily effacement and dilation. While childbirth is widely experienced as painful, some women do report painless labours. When the baby is born its birth weight is determined. The natural birth
First stage: contractions A typical human childbirth will begin with the onset of contractions of the uterus. The frequency and duration of these contractions varies with the individual. The onset of labour may be sudden or gradual, and is defined as regular uterine activity in the presence of cervical dilatation. During a contraction the long muscles of the uterus contract, starting at the top of the uterus and working their way down to the bottom. At the end of the contraction, the muscles relax to a state shorter than at the beginning of the contraction. This draws the cervix up over the baby's head. Each contraction dilates the cervix until it becomes completely dilated, often referred to as 10+ cm (4") in diameter. A gradual onset with slow cervical change towards 3 cm (just over 1 inch) dilation is referred to as the "latent phase". A woman is said to be in "active labour" when contractions have become regular in frequency (3-4 in 10 minutes) and about 60 seconds in duration. The now powerful contractions are accompanied by cervical effacement and dilation greater than 3 cm. The labour may begin with a rupture of the amniotic sac, the paired amnion and chorion ("breaking of the water"). The contractions will accelerate in frequency and strengthen. In the "transition phase" from 8 cm–10 cm (3 or 4 inches) of dilation, the contractions often come every two minutes are typically lasting 70–90 seconds. Transition is often regarded as the most challenging and intense for the mother. It is also the shortest phase. During this stage, the expectant mother typically goes through several emotional phases. At first, the mother may be excited and nervous. Then, as the contractions become stronger, demanding more energy from the mother, mothers generally become more serious and focused. However, as the cervix finishes its dilation, some mothers experience confusion or bouts of self-doubt or giving up. The duration of labour varies widely, but averages some 13 hours for women giving birth to their first child ("primiparae") and 8 hours for women who have already given birth. If there is a significant medical risk to continuing the pregnancy, induction may be necessary. As this carries some risk, it is only done if the child or the mother are in danger from prolonged pregnancy. Forty-two weeks' gestation without spontaneous labour is often said to be an indication for induction although evidence does not show improved outcomes when labour is induced for post-term pregnancies. Inducing labour increases the risk of cesarean section and uterine rupture in mothers that have had a previous cesarean section. no it does not Second stage: delivery
Third stage: placenta
After the birth Medical professionals typically recommend breastfeeding of the first milk, colostrum, to reduce postpartum bleeding/hemorrhage in the mother, and to pass immunities and other benefits to the baby. Parents usually bestow the infant its given names soon after birth. Often people visit and bring a gift for the baby. Many cultures feature initiation rites for newborns, such as naming ceremonies, baptism, and others. Mothers are often allowed a babymoon period where they are relieved of their normal duties to recover from childbirth and establish breastfeeding with their babies. Length of this period varies. In China this is 30 days and is referred to as "doing the month" (see Postpartum period). Variations When the amniotic sac has not ruptured during labour or pushing, the infant can be born with the membranes intact. This is referred to as "being born in the caul." The caul is harmless and its membranes are easily broken and wiped away by the doctor or midwife assisting with the childbirth. In medieval times, and in some cultures still today, a caul was seen as a sign of good fortune for the baby, in some cultures was seen as protection against drowning. The caul was often impressed onto paper and stored away as an heirloom for the child. With the advent of modern interventive obstetrics, premature artificial rupture of the membranes has become common, so babies are rarely born in the caul. Pain The amounts of pain experienced by women during childbirth varies. For some women, the pain is intense and agonizing; for other women there is little to no pain. Many factors affect pain perception; fear, number of previous births, fetal presentation, cultural ideas of childbirth, birthing position, support given during labor, beta-endorphin levels, and a woman's natural pain threshold. Uterine contractions are always intense during childbirth, some women report these sensations as painful though the degree of pain varies from individual to individual and there are even some women who find them pleasurable. Non-medical pain control Some women believe that reliance on analgesic medication is unnatural, or worry that it may harm the child, but are still very concerned about labour pain. To alleviate pain, they may undergo psychological preparation, education, massage, hypnosis, water therapy in a tub or shower. Some women like to have someone to support them during labour and birth; often female family members such as her mother, a sister, the father of the baby, a close friend, a partner or a trained professional doula. Some women deliver in a squatting or crawling position in order to more effectively push during the second stage and so that gravity can aid the descent of the baby through the birth canal. The human body also has its own method of pain control for labour and childbirth in the form of beta-endorphins. As a naturally occurring opiate, beta-endorphin has properties similar to pethidine, morphine, and heroin, and has been shown to work on the same receptors of the brain. Like oxytocin, beta-endorphin is secreted from the pituitary gland, and high levels are present during sex, pregnancy, birth, and breastfeeding. This hormone can induce feelings of pleasure and euphoria during childbirth. Water births are being increasingly chosen by many women as an option for pain relief during labour and childbirth, and waterbirth has been proven in many trials to be not only a safe option for mother and baby, but in many cases show a reduction in the need for further analgesia, and a higher rate of birth 'without injuries' **** Many hospitals and birthing centres now offer women the option of waterbirth, either via custom-made 'birthing pools' or large bath tubs, and have policies to safeguard their use. Medical pain control In Europe, doctors commonly prescribe inhaled nitrous oxide gas for pain control; in the UK, midwives may use this gas without a doctor's prescription. Pethidine (with or without promethazine) may be used early in labour, as well as other opioids, but if given too close to birth there is a risk of respiratory depression in the infant. Popular medical pain control in hospitals include the regional anesthetics epidural blocks, and spinal anaesthesia. Doctors favor the epidural block because medication does not enter the mother's circulatory system, thus it does not cross the placenta and enter the bloodstream of the fetus. Studies however suggest that epidural use can lengthen the labour, and may compromise breastfeeding success **. Different measures for pain control have varying degrees of success and side effects to mother and baby. Administration must be carefully timed. For example, an epidural block given too early in labour can stop or slow labour, and given too late in labour can hinder maternal efforts to push out the baby. These risks should be balanced against the fact that childbirth can be extremely painful, and anesthetics are an effective and usually safe pain treatment. Complications and risks of birth Problems that occur during childbirth are called complications. They can affect the mother or the baby. Sometimes they cause injury or even death. Doctors and midwives are trained to deal with these problems should they occur. Infant deaths (neonatal deaths from birth to 28 days, or perinatal deaths if including fetal deaths at 28 weeks gestation and later) are around 1% in modernized countries. The risk of maternal death during childbirth in developed nations is comparatively low; only about 1 in 1800 mothers die in childbirth (only 1 in 3700 in North America). In the Third World, it is a much riskier proposition: neonatal deaths rates in Sub-Saharan Africa and South Asia are more than 3.7% Heavy blood loss leads to hypovolemic shock, insufficient perfusion of vital organs and death if not rapidly treated by stemming the blood loss (medically with ergometrine and pitocin or surgically) and blood transfusion. Hypopituitarism after obstetric hypovolemic shock is termed Sheehan's syndrome. Professions associated with childbirth Midwives are experts in normal birth. Midwives believe that childbirth is a normal process that is best accomplished with as little interference as possible. Midwives are trained to assist at births, either through direct-entry or nurse-midwifery programs. Lay midwives typically train in apprenticeship programs with experienced midwives. Obstetricians are experts in dealing with abnormal births and pathological labour conditions, though they sometimes attend normal births as a precautionary measure. Obstetricians in most countries are trained as surgeons, so they can undertake surgical procedures relating to childbirth. Such procedures include caesarean sections, episiotomies, or emergency hysterectomies. Obstetricians' tendency to intervene surgically to overcome complications has led to criticism that they perform surgery too readily. In the United States, obstetric malpractice settlements are typically very large, so obstetricians argue that they are forced to intervene aggressively to limit their liability. In the United States, a doctor who specializes in caring for women with pregnancy complications is often referred to as a maternal-fetal medicine sub-specialist. Obstetric nurses assist doctors, mothers, and babies prior to, during, and after the birth process. Some midwives are also obstetric nurses. Obstetric nurses hold various certifications and typically undergo additional obstetric training in addition to standard nursing training Doulas are trained assistants who support mothers during pregnancy, labour, birth, and postpartum. They are not medical attendants; rather, they provide emotional support and non-medical pain relief for mothers during labour. Social aspects In most cultures, childbirth is considered to be the beginning of a person's life, and a person's age is defined relative to it. Some families view the placenta as a special part of birth, since it has been the child's life support for so many months. Some parents like to see and touch this mysterious organ. In some cultures, parents plant a tree along with the placenta on the child's first birthday. The placenta may be eaten by the newborn's family, ceremonially or otherwise Legal aspects In some legal jurisdictions, the place of childbirth decides the nationality of a child (under th nicetitties e doctrine of Jus soli). Psychological aspects Childbirth can be a stressful event. As with any stressful event, strong emotions can be brought to the surface. Medicating the mother against her labor pain is a widespread practice in hospitals. Intravenously-administered drugs — although not, as discussed above, epidurals — may reach the infant's bloodstream through the umbilical cord, with uncertain effects. Some women report symptoms compatible with post-traumatic stress disorder (PTSD) after birth. Between 70 and 80% of mothers in the United States report some feelings of sadness or "baby blues" after childbirth. Postpartum depression may develop in some women; about 10% of mothers in the United States are diagnosed with PPD. Abnormal and persistent fear of childbirth is known as Tokophobia. Preventative group therapy has proven effective as a prophylactic treatment for postpartum depression. There are some who argue that childbirth is stressful for the infant. Stresses associated with breech birth, such as asphyxiation, may affect the infant's brain. It is not known how the birth experience affects the development of personality in the infant. It was once thought that newborns do not have the capacity to feel pain or fear, and now some parents are choosing alternative birth settings (other than the hospital) in an attempt to create a more comfortable environment not only for the newborn, but the birthing mother and other family members. Partner and other support There is increasing evidence to show that the participation of the woman's partner in the birth leads to better birth and also post-birth outcomes, providing the partner does not exhibit excessive anxiety. Research also shows that when a labouring woman was supported by a female helper such as a family member or doula during labour, she had less need for chemical pain relief, the likelihood of caesarean section was reduced, use of forceps and other instrumental deliveries were reduced and there was a reduction in the length of labour and the baby had a higher Apgar score (Dellman 2004, Vernon 2006). Well known authors on childbirth See also | |||||||||||||
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