Stages of Labor

First Stage of Labor Begins at the onset of labor and ends when the cervix is 100 percent effaced and completely dilated to 10 centimeters. Average length ranges for a first-time mother is from ten-to-fourteen hours and shorter for subsequent births. Second Stage of Labor Begins when the cervix is completely effaced and dilated and ends with the birth of the baby. Average length for a first time mother ranges from 1 to-2 hours and shorter for subsequent births. Third Stage of Labor y y Begins with the birth of the baby and ends with the delivery of the placenta. Average length for all vaginal deliveries ranges from five-to-fifteen minutes.

Types of Placental Separation y y Schultz. The presenting part is the fetal side which is shiny. Duncan. The presenting part is the maternal side which is called dirty because it is raw and red.

Fourth Stage of Labor y Begins with delivery of the placenta and ends one-to-two hours after delivery. The nurse should assess the fundus, blood pressure and pulse rate, the lochia which should be moderate in flow, and the perineum. If the flow of the lochia is heavy the mother should be checked for lacerations and rechecked for retained placental fragments.

Cardinal Movements
Labor is a physical and emotional event for the laboring woman. For the infant, however, there are many positional changes that assist the baby in the passage through the birth canal. Because of the resistance met by the baby, positional changes are specific, deliberate and precise as they allow the smallest diameter of the baby to pass through a corresponding diameter of the woman's pelvic structure. Neither care providers nor the laboring woman is directly responsible for these position changes. The baby is the one responsible for these position changes - the cardinal movements. Descent The baby's head moves deep into the pelvic cavity. This movement, commonly called lightening, is preceded by Engagement or the entering of the biparietal diameter (measuring ear tip to ear tip across the top of the baby's head) into the pelvic inlet. The baby's head becomes markedly molded when these distances are closely the same. When the occiput is at the level of the ischial

spines, it can be assumed that the biparietal diameter is engaged and then descends into the pelvic inlet. Flexion This movement occurs during descent and is brought about by the resistance felt by the baby's head against the soft tissues of the pelvis. The resistance brings about a flexion in the baby's head so that the chin meets the chest. The smallest diameter of the baby's head (or suboccipitobregmatic plane) presents into the pelvis. Internal rotation As the head reaches the pelvic floor, it typically rotates to accommodate for the change in diameters of the pelvis. At the pelvic inlet, the diameter of the pelvis is widest from right to left. At the pelvic outlet, the diameter is widest from front to back. So the baby must move from a sideways position to one where the sagittal suture is in the anteroposterior diameter of the outlet (where the face of the baby is against the back of the laboring woman and the back of the baby's head is against the front of the pelvis). If anterior rotation does not occur, the occiput (or head) rotates to the occipitoposterior position. The ocipitoposterior position is also called persistent occipitoposterior and is the common cause for true back labor. Extension After internal rotation is complete and the head passes through the pelvis at the nape of the neck, a rest occurs as the neck is under the pubic arch. Extension occurs as the head, face and chin are born. External rotation After the head of the baby is born, there is a slight pause in the action of labor. During this pause, the baby must rotate so that his/her face moves from face-down to facing either of the laboring woman's inner thighs. This movement, also called restitution, is necessary as the shoulders must fit around and under the pubic arch. It is at this point that shoulder dystocia may be identified. Shoulder dystocia occurs when the baby's shoulders are halted at the pelvic outlet due to inadequate space through which to pass. Mother's birthing babies who are identified as macrosomatic (in excess of 9.9 lbs.) are more likely to experience shoulder dystocia. Additionally, 15-30% of macrosomatic babies experiencing shoulder dystocia sustain some injury to the brachial plexus. Most of these injuries (80%) resolve by the baby's first birthday. Commonly, the McRobert's technique is used to resolve shoulder dystocia. This technique involves a sharp flexing of the maternal thighs against the maternal abdomen to reduce the angle between the sacrum and the spine. Expulsion Almost immediately after external rotation, the anterior shoulder moves out from under the pubic bone (or symphisis pubis). The perineum becomes distended by the posterior shoulder which is then also born. The rest of the baby's body is then born, with an upward motion of the baby's body by the care provider. Postpartum is the period beginning immediately after the birth of a child and extending for about six weeks. It is the time after birth, a time in which the mother's body, including hormone levels and uterus size, returns to a non-pregnant state. Lochia is post-partum vaginal discharge, containing blood, mucus, and placental tissue.

Cesarean Birth Delivery

A cesarean section can be done in a life threatening situation to save either the mother or the baby. This surgical birth is done by making an incision in the abdomen to allow the baby to be born through the abdomen. This type of birth is done by a surgical incision in the abdomen and uterus to allow a baby or babies to be born safely when a vaginal birth is not the safest.

Courteney Cox Reveals Postpartum Depression

By Stephen M. Silverman
Despite what she describes as a delayed case of postpartum depression after the June 13, 2004, birth of her and husband David Arquette's daughter Coco, Courteney Cox says she'd like to have another child. "I went through a really hard time not right after the baby, but when (Coco) turned 6 months," Cox, 41, tells USA Today. "I couldn't sleep. My heart was racing. And I got really depressed. I went to the doctor and found out my hormones had been pummeled." Taking the steroid hormone progesterone helped Cox get through her difficulties, as did support from such close friends as Jennifer Aniston, who lives nearby in Malibu, and Brooke Shields, who famously suffered and conquered her own bouts with postpartum depression. Having now shed her vulnerable feelings of what she terms "smallness" and dealt with such strange suicidal urges as driving off a cliff, she says Cox reveals that she and Arquette are hoping for a sibling for their daughter, whose expanding vocabulary now includes the words "lion," "flower" and "bellybutton." As Cox tells the newspaper: "I look at Coco and say, 'I'm blessed. Why mess with this? Should I take any chances?' But we've got to try for a boy. We've got to have a little (boy) Arquette in the family."

REACTION: Postpartum Depression may be present in any woman after giving birth, may they be a celebrity or just a normal housewife. Causes of Postpartum Depression or sometimes called postpartum blues is still not well understood these days, it varies from patient to patient, in the case of the actress Courteney Cox Arquette, her hormone were the main reason, as we all know hormones play a big part on the moods and thinking of a lot of women. But there are studies that hormones and postpartum depression doesn t really correlate, all mothers experience these hormonal changes, yet only about 10 15% suffer PPD. This does not mean, however, that hormones do not play a role in PPD. For example, in women with a history of PPD, a hormone treatment simulating pregnancy and parturition caused these women to suffer mood symptoms. The same treatment, however, did not cause mood symptoms in women with no history of PPD. One interpretation of these results is that there is a subgroup of women who are vulnerable to hormone changes during pregnancy. We still don t have a concrete reason why and how Postpartum Depression happens in a mother, they need a good support system and counseling to let them know and remind them that having a child is the greatest gift God has given them.