Natural Vaginal Child Birth Delivery:Childbirth, labour, delivery, birth, partus, or parturition is the culmination of a period of pregnancy with the expulsion of one or more newborn infants from a woman's uterus. The process of normal childbirth is categorized in three stages of labour: the shortening and dilation of the cervix, descent and birth of the infant, and the expulsion of the placenta.Each year about 0.5 million women die due to pregnancy and childbirth, 7 million have serious long term complications, and 50 million have negative outcomes following delivery.Most of these issues occur in the developing world.
The fetus undergoes a series of changes in position, attitude, and presentation during labor. This process is essential for the accomplishment of a vaginal delivery. The presence of a fetal malpresentation or an abnormality of the maternal pelvis can significantly impede the likelihood of a vaginal delivery. The contractile aspect of the uterus is another essential aspect of this process. This combination of factors has been classically described as the passenger (the fetus), the passage (the maternal pelvis) and the powers (the uterine contractions). This chapter addresses the impact of the fetus and the maternal pelvis on the labor process.
Child Birth: Stations of Presentation.Station:-
It is the relation of lowermost bony part of the vertex to the ischial spine. or
It is the location of the baby on its descent down into the birth canal.
Negative numbers:- mean the baby is not engaged.
Ppositive numbers:- mean the baby is engaged.
landmark:- is ischial spines which is midway ( ) pelvic inlet and outlet.
* If the baby's head is even with the ischial spines, the station is 0.
* If the baby's head is 1cm above the spines, the station is -1 (2cm above -2 etc).
* If the baby's head is 1cm below the spines (on the way out!), the station is +1 (2cm below +2 etc).
Importance:- Determine whether your baby is close to being born or not.
Childbirth Stations of Presentation.
Description: This 3D medical animation shows the birth stations of presentation using the -5 to +5 positions. From an anterior (front) view, the baby is shown within the mother's pelvis, descending from -5 vertex station point by point to the +5 station.
A vaginal delivery is the birth of offspring (babies in humans) in mammals through the vagina. It is the natural method of birth for all mammals except monotremes, which lay eggs into the external environment. The average length of a hospital stay for a normal vaginal delivery is 36–48 hours or with an episiotomy (a surgical cut to widen the vaginal canal) 48–60 hours, whereas a C-section is 72–108 hours. Different types of vaginal deliveries have different terms:
- A spontaneous vaginal delivery (SVD) occurs when a pregnant female goes into labor without the use of drugs or techniques to induce labor, and delivers her baby in the normal manner, without forceps, vacuum extraction, or a cesarean section.
- An assisted vaginal delivery (AVD) occurs when a pregnant female goes into labor (with or without the use of drugs or techniques to induce labor), and requires the use of special instruments such as forceps or a vacuum extractor to deliver her baby vaginally.
- An instrumental vaginal delivery (IVD) is another term for an assisted vaginal delivery.
- An induced vaginal delivery (also IVD) is a term for a delivery involving labor induction, where drugs or manual techniques are used to initiate the process of labor. Use of the term "IVD" in this context is less common than for instrumental vaginal delivery.
- A normal vaginal delivery (NVD) is a term for a vaginal delivery, whether or not assisted or induced, usually used in statistics or studies to contrast with a delivery by cesarean section.
Vaginal Childbirth (Birth) video
Labor and Vaginal Birth (Childbirth) video
Shoulder dystocia is a specific case of obstructed labour whereby after the delivery of the head, the anterior shoulder of the infantcannot pass below, or requires significant manipulation to pass below, the pubic symphysis. It is diagnosed when the shoulders fail to deliver shortly after the fetal head. Shoulder dystocia is an obstetric emergency, and fetal demise can occur if the infant is not delivered, due to compression of the umbilical cord within the birth canal.
Management of shoulder dystocia has become a focus point for many obstetrical nursing units in North America. Courses encourage nursing units to do routine drills to prevent delays in delivery which adversely affect both mother and fetus. A common treatment mnemonic is ALARMER
- Ask for help. This involves preparing for the help of an obstetrician, for anesthesia, and for pediatrics for subsequent resuscitation of the infant that may be needed if the methods below fail.
- Leg hyperflexion (McRoberts' maneuver)
- Anterior shoulder disimpaction (pressure)
- Rubin maneuver
- Manual delivery of posterior arm
- Roll over on all fours
The advantage of proceeding in the order of ALARMER is that it goes from least to most invasive, thereby reducing harm to the mother in the event that the infant delivers with one of the earlier maneuvers. In the event that these maneuvers are unsuccessful, a skilled obstetrician may attempt some of the additional procedures listed above. Intentional clavicular fracture is a final attempt at nonoperative vaginal delivery prior to Zavanelli's maneuver or symphysiotomy, both of which are considered extraordinary treatment measures.
Shoulder Dystocia Injury: 3D Medical Animation
An episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician during second stage of labor to quickly enlarge the opening for the baby to pass through. The incision, which can be done at a 90 degree angle from the vulva towards the anus or at an angle from the posterior end of the vulva (medio-lateral episiotomy), is performed under local anesthetic (pudendal anesthesia), and is suturedclosed after delivery. It is one of the most common medical procedures performed on women, and although its routine use in childbirth has steadily declined in recent decades, it is still widely practiced in many parts of the world including Latin America,Poland, Bulgaria, India and Qatar.Episiotomy can be avoided by 'birth canal widening' performed before the start of labour and achieving a 10 cm opening to the birth canal so the baby's head can pass through easily. This can be achieved safely and painlessly by antenatal perineal massage since 1984 which does not cause a wound which can become infected. Cochrane Collaborate Report a report produced by the collaboration of specialists of 120 countries, have since 2006 advised that women should be informed about the benefits of Antenatal Perineal massage or Birth Canal Widening, as episiotomy can be avoided. The risk of losing greater than 1 liter of blood during childbirth, which is called Post Partum Haemorrhage (PPH), increases with all doctor induced intervention, including episiotomy, forceps and Caesarean section. So, by avoiding the surgeon's knife, the risk of death from PPH decreases.
Episiotomy is done as prophylaxis against soft-tissue tearing which would involve the anal sphincter and rectum. Vaginal tears can occur during childbirth, most often at the vaginal opening as the baby's head passes through, especially if the baby descends quickly. Tears can involve the perineal skin or extend to the muscles and the anal sphincter and anus. The midwife or obstetrician may decide to make a surgical cut to the perineum with scissors or a scalpel to make the baby's birth easier and prevent severe tears that can be difficult to repair. The cut is repaired with stitches (sutures). Some childbirth facilities have a policy of routine episiotomy.
Though indications on the need for episiotomy vary, and may even be controversial (see discussion below), where the technique is applied, there are two main variations. Both are depicted in the above image. In one variation, the midline episiotomy, the line of incision is central over the anus. This technique bifurcates the perineal body, which is essential for the integrity of the pelvic floor. Precipitous birth can also sever—and more severely sever—the perineal body, leading to long-term complications such as incontinence. Therefore, the oblique technique is often applied (also pictured above). In the oblique technique, the perineal body is avoided, cutting only the vagina epithelium, skin, and muscles (transversalius and bulbospongiosus). This technique aids in avoiding trauma to the perineal body by either surgical or traumatic means.
In 2009, a Cochrane meta-analysis based on studies with over 5,000 women concluded that: "Restrictive episiotomy policies appear to have a number of benefits compared to policies based on routine episiotomy. There is less posterior perineal trauma, less suturing and fewer complications, no difference for most pain measures and severe vaginal or perineal trauma, but there was an increased risk of anterior perineal trauma with restrictive episiotomy". The authors were unable to find quality studies that compared mediolateral versus midline episiotomy.
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