Читать книгу Child Development From Infancy to Adolescence - Laura E. Levine - Страница 239

Earlier in the pregnancy the woman may have felt some tightening of the uterine muscles called Braxton Hicks contractions which can begin as early as the 6th week of pregnancy but aren’t noticeable until midpregnancy. They usually are infrequent, painless, and sporadic (Cunningham, Leveno et al., 2014), but as the woman gets closer to her due date, contractions begin to soften and thin out the cervix (the narrow lower end of the uterus) to prepare it for true labor. Labor is divided into three stages: early and active labor, pushing, and delivering the placenta. So much happens during the first stage that it is further divided into three phases: early labor, active labor, and transition. Details about what happens in each stage is provided in Table 4.2, and Figure 4.7 illustrates how the process unfolds.

Early labor: The first phase in the first stage of labor in which contractions are usually not painful but the cervix begins to thin out and dilate.

Active labor: The second phase in the first stage of labor in which contractions become longer, stronger, and more frequent and the cervix dilates to 4 centimeters.

Transition: The third phase in the first stage of labor in which contractions come in rapid succession and last up to 90 seconds each, with little or no pause between them, and which ends when the cervix has dilated 10 centimeters.

Table 4.2

Sources: ACOG (2007); Cunningham, Leveno, et al. (2014).

Description

Figure 4.7 Stages of labor.

As shown in Figure 4.7, most babies enter the birth canal head first, with the back of their head toward the front of their mother’s stomach. Labor can be slower and more difficult if the baby is in an abnormal position, such as facing upward or positioned so the baby’s feet or bottom come out first. In that case, the doctor may try to rotate the baby into a better position, but sometimes an abnormal position necessitates a surgical delivery (Center of Excellence for Medical Multimedia, n.d.).

In recent years, there has been an increase in Western countries in the number of labors that are medically induced using medications or by purposely rupturing the amniotic sac. Sometimes labor is induced before a woman’s due date for the convenience of the family or a physician, but it also is used when a pregnancy is past its due date or there is a risk of the baby becoming too large. However, there is debate within the medical community about when induction is a safer alternative than letting a late pregnancy continue (Ault, 2016). Although the risks associated with any induction are relatively small, it can increase the chances of infection or of the uterus rupturing (Mayo Clinic, 2017a). A decision about if or when to induce labor should be an informed one, based on discussion between the woman and her physician.

Just born. This baby is immediately put onto the mother’s stomach after birth so she can touch and hold her baby right away.

BSIP / Contributor via Getty Images