Chapter 1. Birth

Synopsis

Human Development Video Activity

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You must read each slide, and complete any questions on the slide, in sequence.

amniotic sac

A membrane that contains the amniotic fluid, in which the unborn baby develops and grows. The fluid within the sac protects the fetus from impact by absorbing shock, maintains a consistent temperature, and provides a means for the fetus to breathe.

birth canal

The passage, that includes the uterus, the cervix, and the vagina, through which a baby is delivered when born vaginally.

cervix

Organ that lies between the uterus and the vagina. It contains a canal that can dilate different amounts allowing sperm, menstrual flow, and a fetus to pass.

cesarean section (c-section)

A surgical procedure for delivering a baby non-vaginally that requires incisions in the mother’s abdomen and uterus through which the fetus can be retrieved.

contractions

The periodic cramping of the muscles of the uterus that serves to push the baby through the birth canal.

crowning

The point in vaginal childbirth when the top of the baby’s head is visible outside the mother's vagina.

placenta

The vascular organ that builds up on the mother’s uterine wall to surround and nourish the embryo and fetus during pregnancy.

transition

The last part of the first stage of labor when the cervix is close to or fully dilated. It is the shift to the second stage of labor and is a time of very strong contractions and sometimes shaking or shivering. While intense, it is generally the shortest phase of labor.

umbilical cord

A tube that connects the fetus’s abdomen to the placenta. The umbilical cord delivers oxygen-rich blood and nutrients to the fetus and takes away waste and deoxygenated blood from the fetus.

uterus

The female organ in which the fetus develops and grows until birth. Often also called the womb.

A young mother resting with her newborn in a hospital bed

Birth

Author

Catherine Robertson, Grossmont College
S. Stavros Valenti, Hofstra University

Synopsis

This activity focuses on the biology of birth and the experience that most mothers go through in having a baby. You will see video clips and illustrations depicting the various stages leading up to a healthy, vaginal birth. You will also explore some medical interventions in the birth process as well as the growing trend to personalize the birthing experience for both mother and child.

REFERENCES

Centers for Disease Control and Prevention. (2000). Trends in the attendant, place, and timing of births and in the use of obstetric interventions in the United States, 1989–1997. Mortality and Morbidity Weekly Report, 49.

Centers for Disease Control and Prevention. (1999). Achievements in public health, 1900–1999: Healthier mothers and babies. Mortality and Morbidity Weekly Report, 48.

Troyer, L., & Parisi, V. (1994). Management of labor. In J. Scott, P. Di Saia, C. Hammond, & W. Spellacy. (Eds.), Danforth obstetrics and gynecology. Philadelphia: Lippincott.

It's Time!

A mother with a large pregnant belly lying in a bed in a hospital setting

With so little space to move about, the baby shifts position in the weeks leading up to labor. Usually, the baby ends up with its head lodged in the birth canal approximately 266 days after conception. At this time, labor is triggered as an outpouring of hormones from the baby’s brain passes through the baby’s bloodstream and into the mother’s. As the mother’s uterus and surrounding uterine muscles begin contractions, birth draws near. Labor averages about 18 hours for a first baby and six hours for subsequent babies.

In this activity, you will watch mothers and fathers go through the process of childbirth.

Overview of a Healthy Birth

A full term fetus in the uterus with labels pointing to the uterus, umbilical cord, amniotic sac, birth canal, cervix, and placenta

One of the first signs of labor is a leakage of fluid that occurs when the amniotic sac tears during early contractions. The mother may also notice a pinkish residue, referred to as the “bloody show,” that occurs when the mucous plug of the cervix loosens. Regular, strong muscle contractions will increase in intensity and occur at shorter intervals signaling that labor is progressing. At this point, it is time to go to the hospital or birthing center where mother and baby can be monitored.

Through childbirth classes, Vanessa has prepared for the three stages of the birth process.

Stage 1: The first stage of labor begins with contractions of the uterus and dilation of the opening of the cervix to 10 centimeters (about four inches).

Stage 2: The second stage of labor begins when the baby’s head moves through the cervix and into the birth canal. This stage ends with the delivery of the baby.

Stage 3: The third stage of labor is when the mother’s body expels the placenta and the remainder of the umbilical cord, which was cut when the baby was delivered.

In the next few screens, you will follow Vanessa on her journey through the stages of the birth process.

Stage 1: Contractions Begin

^{Vanessa started having contractions after midnight. A full 24 hours later, she was still in Stage 1. Here, she talks about the process of labor, receives an epidural injection to help her with the pain, and endures contractions.}

A new mother may not recognize the very first contractions. Many women report that early contractions feel like the beginning of a painful bowel movement, impending nausea, or menstrual cramping. She probably will not be aware of the baby’s specific movements as it has been moving around fairly steadily for the past week or two getting into position for delivery.

Early contractions usually last anywhere from 15 to 60 seconds, and they are spaced about 15 to 20 minutes apart. As labor progresses, contractions grow more intense, last longer, and occur more frequently. By the end of the first stage of labor, the contractions are only two to five minutes apart.

A full term fetus in the uterus with labels pointing to the uterus, umbilical cord, amniotic sac, birth canal, cervix, and placenta. The cervix is starting to dilate.

^{The cervix dilates to let the baby' head enter the birth canal.}

Transition from Stage 1 to Stage 2

A full term fetus in the uterus with labels pointing to the uterus, umbilical cord, amniotic sac, birth canal, cervix, and placenta. The cervix has reached its full dilation as the body prepares to move the baby through the birth canal.

^{Transition from Stage 1 to Stage 2: The mother's body prepares to move the baby through the birth canal.}

The first stage of labor may last 12 to 24 hours. It ends when the cervix has dilated to at least four centimeters. There is a transition between the first and second stage of the birth process. Transition is a time of very intense labor. Contractions are extremely strong and frequent. Hormonal changes in the mother’s body may cause nausea, shivering, shaking in the outer limbs, fatigue, and/or hot flashes or cold flushes. Stress levels may rise, which in turn, may cause her to become very irritable. The cervix continues to dilate to close to its full 10 centimeters as the body prepares to move the baby through the birth canal. Fortunately, this painful phase is short-lived and ends with the baby beginning its journey to meet the outside world.

Stage 2: Crowning and Delivery of the Baby

^{After hours in labor, Vanessa and her husband are finally able to see their new arrival.}

Stage 2 of labor begins when the baby’s head moves through the cervix and into the birth canal. Contractions are now fairly constant in that they occur about one minute apart and last about one minute. This stage, which averages about 90 minutes, is a critical time when the mother must bear down and help to push the baby outside of her body. If all goes well, the baby’s head will emerge first as it does for 95% of newborns. Just before the actual birth, observers will be able to see the head crowning, or showing at the opening of the vagina.

After three hard final pushes, Vanessa’s little girl has arrived. Her name is Jaclyn, and she weighs 7 pounds, 8 ounces. As soon as she comes out, little Jaclyn is placed on her mother’s belly. With instructions from the physician, the father cuts the umbilical cord. The nurse then puts Jaclyn in the warming tray, wipes her off, and clamps her umbilical cord. After a few minutes in the warming unit, Jaclyn is weighed. When she is sufficiently warm, Jaclyn is given back to her mother. At this point, Jaclyn is welcomed by family and friends.

1.1 Stage 2: Crowning and Delivery of the Baby (continued)

A full term fetus in the uterus with labels pointing to the uterus, umbilical cord, amniotic sac, birth canal, cervix, and placenta. In the first image, the crown of the baby’s head is visible at the opening of the vagina. In the second image, the shoulders are visible, and the doctor gets involved in effort to guide the baby safely out.

^{Stage 2, Crowning: The baby's head is visible at the opening of the vagina.}

^{Stage 2, The Final Step: First the head appears. Then, the shoulders appear. Finally, the baby emerges completely.}

Stage 3: Expelling the Afterbirth

The fetus needs support structures, such as the amniotic sac, the placenta, and the umbilical cord, for nourishment and protection while in the mother’s uterus. Once the baby is born, these structures are no longer necessary, and they are expelled from the mother’s body as afterbirth during Stage 3.

The placenta and umbilical cord being expelled as afterbirth

^{Stage 3: The placenta, the amniotic sac and the umbilical cord are expelled as afterbirth.}

Medical Intervention: When Nature Needs a Helping Hand

A mother-to-be is lying in an operating room with a sheet blocking her view of her abdomen. Doctors and nurses are in scrubs prepared to perform a cesarean section.

^{A mother-to-be on the operating table getting ready for her cesarean section}

Sometimes, a mother needs medical intervention to help her to deliver her baby. There are several common procedures that can assist the process of childbirth.

The most common intervention is medication to ease labor pains. Physicians give minimal doses because these medications may also affect the fetus.

A doctor may decide that labor should be induced for the safety of the mother or the child. Labor can be induced either by rupturing the amniotic membranes or by injecting the mother with oxytocin, a hormone that will initiate contractions.

To avoid tears in the mother’s vaginal wall during delivery of a large baby, the physician may perform an episiotomy, a minor incision that widens the vaginal opening and lets the baby’s head and body emerge more easily.

When complications arise during the course of a vaginal delivery, medical personnel may recommend a cesarean section (c-section), a surgical procedure in which the infant is removed through an incision in the wall of the mother’s uterus. Many babies and mothers whose lives would have been at risk during a vaginal delivery have been saved by this procedure.

Personalizing Childbirth

A hospital birth room that contains a tub, a mat, a comfortable bed, and a big, inflated ball which are all items that serve to make a mother who is going through labor more comfortable.

^{A modern labor room showing some options for personalizing the birthing process}

A century ago, most women gave birth at home. In the U.S. today, the vast majority of births take place in a hospital. With this attention to the medical needs of and potential risks to mother and baby, the mortality rate associated with childbirth has dropped significantly in the past century. While no one wants those mortality rates to rise again, some critics question whether medical intervention during childbirth occurs too readily. Analysts within the medical field have argued that medical procedures, such as cesarean sections, induced labor, and episiotomies, may be performed too frequently. Possibly inspired by criticism of the traditional hospital birthing model as being sterile and impersonal and/or by the increasing availability of more home-like birthing alternatives, a growing trend to personalize childbirth has evolved over the last 30 years.

The use of midwives to help in the labor and delivery of low-risk pregnancies has increased during these three decades. Birth support programs have become readily available to help to prepare parents for the challenges of pregnancy, labor, and delivery. These programs provide training in everything from nutrition and healthy practices for a pregnant woman to breathing and relaxation techniques to help the mother deal with the pain of labor to responsibilities and assignments for the birth coach, a vital member of the birth team. More than 50 percent of the hospital rooms used for childbirth have been converted into home-like labor rooms, where family members can gather to await the birth of the baby. The growing number of options for families reflects the overwhelming movement toward designing, customizing, and personalizing the birthing process.

Assessment: Check Your Understanding

A pregnant woman in labor in a tub while her husband comforts her

Question 1.1

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Good job! Although the length of contractions can vary, they are typically 15 to 20 minutes apart at the beginning of labor.

Sorry. Although the length of contractions can vary, they are typically 15 to 20 minutes apart at the beginning of labor.

Assessment: Check Your Understanding

Question 1.2

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Good job! Good job! The actual delivery of the child occurs at the end of the second stage of labor.

Sorry. The actual delivery of the child occurs at the end of the second stage of labor.

Assessment: Check Your Understanding

Question 1.3

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Good job! The amniotic sac ruptures before or during Stage 1 labor. By Stage 3, when the afterbirth is expelled, the fluid from the ruptured amniotic sac has already leaked out.

Sorry. The amniotic sac ruptures before or during Stage 1 labor. By Stage 3, when the afterbirth is expelled, the fluid from the ruptured amniotic sac has already leaked out.

Assessment: Check Your Understanding

Question 1.4

Select each label for appropriate position on the diagram showing the baby in the mother’s uterus at the beginning of the birth process.

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B avA+5+Ez0mwyURL+kx9GsWkkNzsOU0uEl7oB+EqjiTE+DCYO3yrPW+uYFYFZmbhiXkl1uYlaitWeBE7dMOWb/qDsUVd5z5FALkIXafrGVgCqxW1kdBqD67e7VPA=
C G3DYg40nTqRWpoKcmXGBq0DqW6Dm2u6hOjzQhozCuOH0koXMEtOPbAro6PDNfG8wx6W0IVww5TIlcrThm4Dyeqy7bcLB+1h1KJEEGxqaTmafPFDVJMrCcFIqJJ8=
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Please review your answers in the list above.

Assessment: Check Your Understanding

Question 1.5

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Refer back to screen 9. Be sure to support you opinion with specific examples while explaining why you believe these details are or are not helpful. Take into account what role you might play in a delivery (as a coach, as a family member, as a mother, as a close friend, etc.) and how some of these trends may or may not make your job easier.

Congratulations! You have completed this activity.Total Score: x out of x points (x%) You have received a provisional score for your essay answers, which have been submitted to your instructor.