Array ( [0] => {{short description|Expulsion of a fetus from the pregnant mother's uterus}} [1] => {{about|birth in humans|birth in non-human mammals and other animals|Birth|the band Childbirth|Childbirth (band)}} [2] => {{Use dmy dates|date=April 2023}} [3] => {{EngvarB|date=April 2023}} [4] => {{Infobox medical condition (new) [5] => | name = Childbirth [6] => | synonyms = Labour and delivery, partus, giving birth, parturition, birth, confinement{{cite encyclopedia|url=https://en.oxforddictionaries.com/definition/confinement|title=confinement – Definition of confinement in English by Oxford Dictionaries|dictionary=Oxford Dictionaries – English|access-date=23 November 2018|archive-date=23 November 2018|archive-url=https://web.archive.org/web/20181123154402/https://en.oxforddictionaries.com/definition/confinement|url-status=dead}}{{cite encyclopedia|url=https://dictionary.cambridge.org/dictionary/english/confinement|title=Confinement – meaning in the Cambridge English Dictionary|dictionary=Cambridge Dictionary}} [7] => | image = Postpartum baby2.jpg [8] => | caption = Mother and [[neonate|newborn baby]] shown with [[vernix caseosa]] covering [9] => | field = [[Obstetrics]], [[midwifery]] [10] => | symptoms = [11] => | complications = [[Obstructed labour]], [[postpartum bleeding]], [[eclampsia]], [[postpartum infection]], [[birth asphyxia]], [[Kangaroo care|neonatal hypothermia]]{{cite journal | vauthors = Lunze K, Bloom DE, Jamison DT, Hamer DH | title = The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival | journal = BMC Medicine | volume = 11 | issue = 1 | pages = 24 | date = January 2013 | pmid = 23369256 | pmc = 3606398 | doi = 10.1186/1741-7015-11-24 | doi-access = free }} [12] => | onset = [13] => | duration = [14] => | types = [[Vaginal delivery]], [[C-section]] [15] => | causes = [[Pregnancy]] [16] => | risks = [17] => | diagnosis = [18] => | differential = [19] => | prevention = [[Birth control]], [[elective abortion]] [20] => | treatment = [21] => | medication = [22] => | prognosis = [23] => | frequency = 135 million (2015){{cite web|title=The World Factbook|url=https://www.cia.gov/the-world-factbook/countries/world/|website=www.cia.gov|access-date=30 July 2016|date=11 July 2016|archive-date=26 January 2021|archive-url=https://web.archive.org/web/20210126032610/https://www.cia.gov/the-world-factbook/countries/world/|url-status=live}} [24] => | deaths = 500,000 [[maternal deaths]] a year [25] => | alt = [26] => }} [27] => [28] => '''Childbirth''', also known as '''labour''', '''parturition''' and '''delivery''', is the completion of [[pregnancy]] where one or more [[babies]] exits the internal environment of the [[mother]] via [[vaginal delivery]] or [[caesarean section]].{{cite book|last1=Martin|first1=Elizabeth| name-list-style = vanc |title=Concise Colour Medical l.p.Dictionary|publisher=Oxford University Press|isbn=978-0-19-968799-2|page=375|url=https://books.google.com/books?id=2_EkBwAAQBAJ&pg=PA375|language=en|url-status=live|archive-url=https://web.archive.org/web/20170911003120/https://books.google.com/books?id=2_EkBwAAQBAJ&pg=PA375|archive-date=11 September 2017|year=2015}} In 2019, there were about 140.11 million human [[birth]]s globally.{{Cite web |title=Number of births and deaths per year |url=https://ourworldindata.org/grapher/births-and-deaths-projected-to-2100 |access-date=24 June 2022 |website=Our World in Data |archive-date=14 June 2022 |archive-url=https://web.archive.org/web/20220614104952/https://ourworldindata.org/grapher/births-and-deaths-projected-to-2100 |url-status=live }} In the [[Developed country|developed countries]], most deliveries occur in [[hospital]]s,{{cite book|last1=Co-Operation|first1=Organisation for Economic|last2=Development|title=Doing better for children|date=2009|publisher=OECD|location=Paris|isbn=978-92-64-05934-4|page=105|url=https://books.google.com/books?id=0Q_WAgAAQBAJ&pg=PA105|url-status=live|archive-url=https://web.archive.org/web/20170911003120/https://books.google.com/books?id=0Q_WAgAAQBAJ&pg=PA105|archive-date=11 September 2017}}{{Cite journal |last1=Olsen |first1=Ole |last2=Clausen |first2=Jette A. |date=2023-03-08 |title=Planned hospital birth compared with planned home birth for pregnant women at low risk of complications |journal=The Cochrane Database of Systematic Reviews |volume=2023 |issue=3 |pages=CD000352 |doi=10.1002/14651858.CD000352.pub3 |issn=1469-493X |pmc=9994459 |pmid=36884026 }} while in the [[Developing country|developing countries]] most are [[home birth]]s.{{cite book|last1=Fossard|first1=Esta de|last2=Bailey|first2=Michael| name-list-style = vanc |title=Communication for Behavior Change: Volume lll: Using Entertainment–Education for Distance Education|date=2016|publisher=Sage Publications India|isbn=978-93-5150-758-1|url=https://books.google.com/books?id=PWElDAAAQBAJ&pg=PT138|access-date=31 July 2016|url-status=live|archive-url=https://web.archive.org/web/20170911003120/https://books.google.com/books?id=PWElDAAAQBAJ&pg=PT138|archive-date=11 September 2017}} [29] => [30] => [31] => The most common childbirth method worldwide is vaginal delivery.{{cite journal | vauthors = Memon HU, Handa VL | title = Vaginal childbirth and pelvic floor disorders | journal = Women's Health | volume = 9 | issue = 3 | pages = 265–77; quiz 276–77 | date = May 2013 | pmid = 23638782 | pmc = 3877300 | doi = 10.2217/whe.13.17 }} It involves four [[stages of labour]]: the [[cervical effacement|shortening]] and [[Cervical dilation|opening of the cervix]] during the first stage, descent and birth of the baby during the second, the delivery of the [[placenta]] during the third, and the recovery of the mother and infant during the fourth stage, which is referred to as the [[Postpartum period|postpartum]]. The first stage is characterised by abdominal cramping or also back pain in the case of back labour,{{Cite web |title=What Are the Different Types of Contractions? |url=https://www.parents.com/pregnancy/giving-birth/signs-of-labor/what-are-contractions/ |access-date=2024-03-16 |website=Parents |language=en}} that typically lasts half a minute and occurs every 10 to 30 minutes.{{cite encyclopedia |title= Birth |url= http://www.encyclopedia.com/topic/birth.aspx#5 |encyclopedia= [[Columbia Encyclopedia|The Columbia Electronic Encyclopedia]] |edition= 6 |publisher= [[Columbia University Press]] |year= 2016 |access-date= 30 July 2016 |via= Encyclopedia.com |url-status= live |archive-url= https://web.archive.org/web/20160306205819/http://www.encyclopedia.com/topic/birth.aspx#5 |archive-date= 6 March 2016 }} Contractions gradually become stronger and closer together.{{cite web|title=Pregnancy Labor and Birth|url=http://www.womenshealth.gov/pregnancy/childbirth-beyond/labor-birth.html|website=Women's Health|access-date=31 July 2016|date=27 September 2010|url-status=live|archive-url=https://web.archive.org/web/20160728000124/http://www.womenshealth.gov/pregnancy//childbirth-beyond/labor-birth.html|archive-date=28 July 2016|quote=The first stage begins with the onset of labour and ends when the cervix is fully opened. It is the longest stage of labour, usually lasting about 12 to 19 hours
..
The second stage involves pushing and delivery of your baby. It usually lasts 20 minutes to two hours.}} Since the pain of childbirth correlates with contractions, the pain becomes more frequent and strong as the labour progresses. The second stage ends when the infant is fully expelled. The third stage is the delivery of the [[placenta]].{{cite journal | vauthors = McDonald SJ, Middleton P, Dowswell T, Morris PS | title = Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes | journal = The Cochrane Database of Systematic Reviews | volume = 7 | issue = 7 | pages = CD004074 | date = July 2013 | pmid = 23843134 | pmc = 6544813 | doi = 10.1002/14651858.CD004074.pub3 }} The fourth stage of labour involves the recovery of the mother, [[delayed cord clamping|delayed clamping of the umbilical cord]], and monitoring of the [[neonate]].{{Cite web |title=Stages of Labor |url=https://www.bidmc.org/centers-and-departments/obstetrics-and-gynecology/programs-and-services/pregnancy/labor-and-delivery/stages-of-labor |access-date=30 June 2022 |website=www.bidmc.org |language=en-us |archive-date=27 May 2022 |archive-url=https://web.archive.org/web/20220527022112/https://www.bidmc.org/centers-and-departments/obstetrics-and-gynecology/programs-and-services/pregnancy/labor-and-delivery/stages-of-labor |url-status=live }} {{As of|2014|post=,}} all major health organisations advise that immediately following a [[Live birth (human)|live birth]], regardless of the delivery method, that the infant be placed on the mother's chest (termed [[skin-to-skin contact]]), and to delay neonate procedures for at least one to two hours or until the baby has had its first [[breastfeeding]].{{cite web | url=http://www.medscape.com/viewarticle/806325_9 | title=Uninterrupted Skin-to-Skin Contact Immediately After Birth |website=Medscape | access-date=21 December 2014 |last=Phillips |first=Raylene | url-status=live | archive-url=https://web.archive.org/web/20150403065140/http://www.medscape.com/viewarticle/806325_9 | archive-date=3 April 2015 }}{{cite web | url=http://www.euro.who.int/__data/assets/pdf_file/0013/131521/E79235.pdf | title=Essential Antenatal, Perinatal and Postpartum Care | publisher=WHO | work=Promoting Effective Perinatal Care | access-date=21 December 2014 | url-status=live | archive-url=https://web.archive.org/web/20150924034812/http://www.euro.who.int/__data/assets/pdf_file/0013/131521/E79235.pdf | archive-date=24 September 2015 }}{{cite web |url=http://www.nice.org.uk/guidance/cg190/evidence/cg190-intrapartum-care-full-guideline3 |title=Care of healthy women and their babies during childbirth |publisher=National Institute for Health and Care Excellence |work=National Collaborating Centre for Women's and Children's Health |date=December 2014 |access-date=21 December 2014 |url-status=dead |archive-url=https://web.archive.org/web/20150212090530/http://www.nice.org.uk/guidance/cg190/evidence/cg190-intrapartum-care-full-guideline3 |archive-date=12 February 2015 }} [32] => [33] => [34] => Vaginal delivery is generally recommended as a first option. Cesarean section can lead to increased risk of complications and a significantly slower recovery. There are also many natural benefits of a vaginal delivery in both mother and baby. Various methods may help with pain, such as [[relaxation techniques]], [[opioids]], and [[spinal block]]s. It is best practice to limit the amount of interventions that occur during labour and delivery such as an elective cesarean section, however in some cases a scheduled cesarean section must be planned for a successful delivery and recovery of the mother. An emergency cesarean section may be recommended if unexpected complications occur or little to no progression through the birthing canal is observed in a vaginal delivery. [35] => [36] => [37] => Each year, complications from pregnancy and childbirth result in about 500,000 [[maternal deaths|birthing deaths]], seven million women have serious long-term problems, and 50 million women giving birth have negative health outcomes following delivery, most of which occur in the [[developing world]]. Complications in the mother include [[obstructed labour]], [[postpartum bleeding]], [[eclampsia]], and [[postpartum infection]].{{cite book|title=Education material for teachers of midwifery: midwifery education modules|date=2008|publisher=World Health Organisation|location=Geneva [Switzerland]|isbn=978-92-4-154666-9|edition=2nd|url=http://whqlibdoc.who.int/publications/2008/9789241546669_4_eng.pdf?ua=1|page=3|url-status=live|archive-url=https://web.archive.org/web/20150221002801/http://whqlibdoc.who.int/publications/2008/9789241546669_4_eng.pdf?ua=1|archive-date=21 February 2015}} Complications in the baby include [[birth asphyxia|lack of oxygen at birth]] (birth asphyxia), [[Birth trauma (physical)|birth trauma]], and [[Premature birth|prematurity]].{{cite book |last1=Martin |first1=Richard J. |last2=Fanaroff |first2=Avroy A. |last3=Walsh |first3=Michele C.| name-list-style = vanc |title=Fanaroff and Martin's Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant|publisher=Elsevier Health Sciences|isbn=978-0-323-29537-6|page=116|url=https://books.google.com/books?id=AnVYBAAAQBAJ&pg=PA116|language=en|url-status=live|archive-url=https://web.archive.org/web/20170911003120/https://books.google.com/books?id=AnVYBAAAQBAJ&pg=PA116|archive-date=11 September 2017|date=2014}}{{cite web | url=https://www.who.int/mediacentre/factsheets/fs333/en/ | title=Newborns: reducing mortality | publisher=World Health Organization | access-date=1 February 2017 | author=World Health Organization | url-status=live | archive-url=https://web.archive.org/web/20170403211834/http://www.who.int/mediacentre/factsheets/fs333/en/ | archive-date=3 April 2017 }} [38] => {{TOC limit}} [39] => [40] => ==Signs and symptoms== [41] => The most prominent sign of labour is strong repetitive [[uterine contractions]]. Pain in contractions has been described as feeling similar to very strong [[menstrual cramps]]. Crowning may be experienced as an intense stretching and burning. The [[Lamaze]] method of childbirth teaches that making noises such as moaning, groaning, grunting, repeating words over and over, and any sound that one's body may wish to naturally make may help to relieve pain and help labour to progress. According to Lamaze, "While the media would have you believe that all birthing women scream, in reality, it's not the most common noise." They say that screaming may be a sign that the labouring woman is beginning to panic and the support team should help her back to regulated breathing.{{cite web |title=Making Noise in Labor and Birth |url=https://www.lamaze.org/Giving-Birth-with-Confidence/GBWC-Post/making-noise-in-labor-and-birth |website=Lamaze International |access-date=16 March 2023 |archive-date=16 March 2023 |archive-url=https://web.archive.org/web/20230316235819/https://www.lamaze.org/Giving-Birth-with-Confidence/GBWC-Post/making-noise-in-labor-and-birth |url-status=live }} [42] => [43] => [[Back labour]] is a complication that occurs during childbirth when a fetus exhibits posterior presentation (i.e. when the fetus is facing the mother’s navel), instead of the typical anterior presentation.{{Cite web |title=What is back labor? Signs, pain relief, and more |url=https://www.babycenter.com/pregnancy/your-body/back-labor_1451580 |access-date=2024-03-17 |website=BabyCenter |language=en}} This leads to more intense contractions, and causes pain in the lower back that persists between contractions as the fetus’ occiput exerts pressure on the mother’s sacrum.{{Cite web|date=2020-04-27 |title=Back Labor |url=https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/back-labor/ |access-date=2024-03-17 |website=American Pregnancy Association |language=en-US}} [44] => [45] => Another prominent sign of labour is the [[rupture of membranes]], commonly known as "water breaking". During pregnancy, a baby is surrounded and cushioned by a fluid-filled sac. Usually the sac ruptures at the beginning of or during labour. It may cause a gush of fluid or leak in an intermittent or constant flow of small amounts from a woman's vagina. The fluid is clear or pale yellow. If the amniotic sac has not yet broken during labour the health care provider may break it in a technique called an [[amniotomy]]. In an amniotomy a thin plastic hook is used to make a small opening in the sac, causing the water to break.{{cite web |title=Labor and delivery, postpartum care |url=https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/water-breaking/art-20044142 |website=Mayo Clinic |access-date=16 March 2023 |archive-date=2 January 2018 |archive-url=https://web.archive.org/web/20180102225815/https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/water-breaking/art-20044142 |url-status=live }} If the sac breaks before labour starts, it's called a [[prelabor rupture of membranes]]. Contractions will typically start within 24 hours after the water breaks. If not, the care provider will generally begin [[labour induction]] within 24 to 48 hours. If the baby is preterm (less than 37 weeks of pregnancy), the healthcare provider may use a medication to delay delivery.{{cite web |title=Water Breaking |url=https://my.clevelandclinic.org/health/symptoms/24382-water-breaking |website=Cleveland Clinic |access-date=16 March 2023 |archive-date=17 March 2023 |archive-url=https://web.archive.org/web/20230317034514/https://my.clevelandclinic.org/health/symptoms/24382-water-breaking |url-status=live }} [46] => [47] => === Labour pain === [48] => There is currently no definitive scientific explanation for why labour hurts. According to studies, during pregancy, the [[myometrium]] (the muscle part of the uterus) is greatly denervated.{{Cite journal |last=Tingåker |first=Berith K |last2=Johansson |first2=Olle |last3=Cluff |first3=Ann Hjelm |last4=Ekman-Ordeberg |first4=Gunvor |date=March 2006 |title=Unaltered innervation of the human cervix uteri in contrast to the corpus during pregnancy and labor as revealed by PGP 9.5 immunohistochemistry |url=https://linkinghub.elsevier.com/retrieve/pii/S0301211505003945 |journal=European Journal of Obstetrics & Gynecology and Reproductive Biology |language=en |volume=125 |issue=1 |pages=66–71 |doi=10.1016/j.ejogrb.2005.07.020}} Stretch receptors in the uterus disappear during pregnancy, and stretch receptors in the cervix disappear at the onset of labour.{{Cite journal |last=Tingåker |first=Berith K |last2=Irestedt |first2=Lars |date=June 2010 |title=Changes in uterine innervation in pregnancy and during labour: |url=http://journals.lww.com/00001503-201006000-00003 |journal=Current Opinion in Anesthesiology |language=en |volume=23 |issue=3 |pages=300–303 |doi=10.1097/ACO.0b013e328337c881 |issn=0952-7907}} Consequently, the reason for labour pain has only been theorized, not ascertained. One theory is that the pain results from the buildup of chemicals released during physical exertion. The second leading theory is that the pain results from the vasoconstriction of uterine blood vessels in the myometrium; each contraction squeezes the blood vessels, reducing blood flow and causing some [[Hypoxia (medicine)|hypoxia]]. [49] => [50] => === Psychological === [51] => [52] => During the later stages of gestation, there is an increase in abundance of [[oxytocin]], a hormone that is known to evoke feelings of contentment, reductions in anxiety, and feelings of calmness and security around the mate.{{Cite journal|vauthors = Meyer D |year=2007 |title=Selective serotonin reuptake inhibitors and their effects on relationship satisfaction |journal= [[The Family Journal]] |volume=15 |issue=4 |pages=392–97 |doi=10.1177/1066480707305470|s2cid=144945177 |doi-access=free }} Oxytocin is further released during labour when the fetus stimulates the cervix and vagina, and it is believed that it plays a major role in the bonding of a mother to her infant and in the establishment of maternal behaviour. Studies show that the father of the child also has an increase in oxytocin levels following contact with the infant and parents with higher oxytocin levels showed more responsiveness and synchrony in their interactions with their infant. The act of [[breastfeeding|nursing]] a child also causes a release of oxytocin to help the baby get milk more easily from the nipple.{{cite web |url= http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/oxytocin.html |title= Oxytocin | vauthors = Bowen R |date= 12 July 2010 |work= Hypertexts for Biomedical Sciences |access-date= 18 August 2013 |url-status= live |archive-url= https://web.archive.org/web/20140829220747/http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/oxytocin.html |archive-date= 29 August 2014 }}{{cite journal |title=Oxytocin and early parent-infant interactions: A systematic review |journal=International Journal of Nursing Sciences |year=2019 |pmid=31728399 |last1=Scatliffe |first1=N. |last2=Casavant |first2=S. |last3=Vittner |first3=D. |last4=Cong |first4=X. |volume=6 |issue=4 |pages=445–453 |doi=10.1016/j.ijnss.2019.09.009 |pmc=6838998 }} [53] => [54] => == Vaginal birth == [55] => {{Further|Vaginal delivery}} [56] => [[File:2920 Stages of Childbirth-en.svg|thumb|upright=1.6|Sequence of images showing the stages of ordinary childbirth]] [57] => [58] => '''Station''' refers to the relationship of the fetal presenting part to the level of the [[ischial spine]]s. When the presenting part is at the ischial spines the station is 0 (synonymous with engagement). If the presenting fetal part is above the spines, the distance is measured and described as minus stations, which range from −1 to −4 [[centimetre|cm]]. If the presenting part is below the ischial spines, the distance is stated as plus stations ( +1 to +4 cm). At +3 and +4 the presenting part is at the perineum and can be seen.{{cite book| vauthors = Pillitteri A |title=Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family|chapter-url=https://books.google.com/books?id=apeLf0mPx1QC&pg=PA350|access-date=18 August 2013|year=2010|publisher=Lippincott Williams & Wilkins|location=Hagerstown, Maryland|isbn=978-1-58255-999-5|page=350|chapter=Chapter 15: Nursing Care of a Family During Labor and Birth|url-status=live|archive-url=https://web.archive.org/web/20140628043145/http://books.google.com/books?id=apeLf0mPx1QC&pg=PA350|archive-date=28 June 2014}} [59] => [60] => The fetal head may temporarily change shape (becoming more elongated or cone shaped) as it moves through the birth canal. This change in the shape of the fetal head is called ''molding'' and is much more prominent in women having their first vaginal delivery.{{cite web |title=Baby's head shape: Cause for concern? |url=https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/healthy-baby/art-20045964 |publisher=Mayo Clinic |access-date=9 July 2023 |date=10 March 2022}} [61] => [62] => '''Cervical ripening''' is the physical and chemical changes in the cervix to prepare it for the stretching that will take place as the fetus moves out of the uterus and into the birth canal. A scoring system called a [[Bishop score]] can be used to judge the degree of cervical ripening to predict the timing of labour and delivery of the infant or for women at risk for preterm labour. It is also used to judge when a woman will respond to [[induction of labour]] for a postdate pregnancy or other medical reasons. There are several methods of inducing cervical ripening which will allow the uterine contractions to effectively dilate the cervix.{{cite journal|first=Aaron E|last=Goldberg|name-list-style=vanc|title=Cervical Ripening|url=https://emedicine.medscape.com/article/263311-overview|website=Medscape|access-date=10 May 2018|date=2 March 2018|archive-date=7 August 2020|archive-url=https://web.archive.org/web/20200807104204/https://emedicine.medscape.com/article/263311-overview|url-status=live}} [63] => [64] => Vaginal delivery involves four stages of labour: the [[cervical effacement|shortening]] and [[Cervical dilation|opening of the cervix]] during the first stage, descent and birth of the baby during the second, the delivery of the [[placenta]] during the third, and the 4th stage of recovery which lasts until two hours after the delivery. The first stage is characterised by abdominal cramping or back pain that typically lasts around half a minute and occurs every 10 to 30 minutes. The contractions (and pain) gradually becomes stronger and closer together. The second stage ends when the infant is fully expelled. In the third stage, the delivery of the placenta. The fourth stage of labour involves recovery, the uterus beginning to contract to pre-pregnancy state, [[delayed cord clamping|delayed clamping of the umbilical cord]], and monitoring of the neonatal tone and vitals. {{As of|2014|post=,}} all major health organisations advise that immediately following a [[Live birth (human)|live birth]], regardless of the delivery method, that the infant be placed on the mother's chest, termed [[skin-to-skin contact]], and delaying routine procedures for at least one to two hours or until the baby has had its first breastfeeding. [65] => [66] => ===Onset of labour=== [67] => [[File:2919 Hormones Initiating Labor-02.jpg|thumb|upright=1.3|The hormones initiating labour]] [68] => Definitions of the onset of labour include: [69] => * Regular uterine contractions at least every six minutes with evidence of change in [[cervical dilation]] or [[cervical effacement]] between consecutive digital examinations.{{cite journal | vauthors = Kupferminc M, Lessing JB, Yaron Y, Peyser MR | title = Nifedipine versus ritodrine for suppression of preterm labour | journal = British Journal of Obstetrics and Gynaecology | volume = 100 | issue = 12 | pages = 1090–94 | date = December 1993 | pmid = 8297841 | doi = 10.1111/j.1471-0528.1993.tb15171.x | s2cid = 24521943 }} [70] => * Regular contractions occurring less than 10 minutes apart and progressive cervical dilation or cervical effacement.{{cite journal | vauthors = Jokic M, Guillois B, Cauquelin B, Giroux JD, Bessis JL, Morello R, Levy G, Ballet JJ | title = Fetal distress increases interleukin-6 and interleukin-8 and decreases tumour necrosis factor-alpha cord blood levels in noninfected full-term neonates | journal = BJOG | volume = 107 | issue = 3 | pages = 420–25 | date = March 2000 | pmid = 10740342 | doi = 10.1111/j.1471-0528.2000.tb13241.x | doi-access = free }} [71] => * At least three painful regular uterine contractions during a 10-minute period, each lasting more than 45 seconds.{{cite journal | vauthors = Lyrenäs S, Clason I, Ulmsten U | title = In vivo controlled release of PGE2 from a vaginal insert (0.8 mm, 10 mg) during induction of labour | journal = BJOG | volume = 108 | issue = 2 | pages = 169–78 | date = February 2001 | pmid = 11236117 | doi = 10.1111/j.1471-0528.2001.00039.x | s2cid = 45247771 }} [72] => [73] => Many women are known to experience what has been termed the "nesting instinct". Women report a spurt of energy shortly before going into labour. Common signs that labour is about to begin may include what is known as ''lightening'', which is the process of the baby moving down from the rib cage with the head of the baby engaging deep in the pelvis. The pregnant woman may then find breathing easier, since her lungs have more room for expansion, but pressure on her bladder may cause more frequent need to void (urinate). Lightening may occur a few weeks or a few hours before labour begins, or even not until labour has begun.{{cite web|title=Labor and delivery, postpartum care|url=https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/signs-of-labor/art-20046184|website=Mayo Clinic|access-date=7 May 2018|archive-date=7 May 2018|archive-url=https://web.archive.org/web/20180507222539/https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/signs-of-labor/art-20046184|url-status=live}} Some women also experience an increase in vaginal discharge several days before labour begins when the "mucus plug", a thick plug of [[mucus]] that blocks the opening to the uterus, is pushed out into the vagina. The mucus plug may become dislodged days before labour begins or not until the start of labour. [74] => [75] => While inside the uterus the baby is enclosed in a fluid-filled membrane called the [[amniotic sac]]. Shortly before, at the beginning of, or during labour the [[rupture of membranes|sac ruptures]]. Once the sac ruptures, termed "the water breaks", the baby is at risk for infection and the mother's medical team will assess the need to [[Labor induction|induce labour]] if it has not started within the time they believe to be safe for the infant. [76] => [77] => ===Stages of labour=== [78] => ====First stage==== [79] => The first stage of labour is divided into latent and active phases, where the latent phase is sometimes included in the definition of labour,{{cite journal | vauthors = Giacalone PL, Vignal J, Daures JP, Boulot P, Hedon B, Laffargue F | title = A randomised evaluation of two techniques of management of the third stage of labour in women at low risk of postpartum haemorrhage | journal = BJOG | volume = 107 | issue = 3 | pages = 396–400 | date = March 2000 | pmid = 10740337 | doi = 10.1111/j.1471-0528.2000.tb13236.x | doi-access = free }} and sometimes not.{{cite journal | vauthors = Hantoushzadeh S, Alhusseini N, Lebaschi AH | title = The effects of acupuncture during labour on nulliparous women: a randomised controlled trial | journal = The Australian & New Zealand Journal of Obstetrics & Gynaecology | volume = 47 | issue = 1 | pages = 26–30 | date = February 2007 | pmid = 17261096 | doi = 10.1111/j.1479-828X.2006.00674.x | s2cid = 23495692 }} [80] => [81] => The '''latent phase''' is generally defined as beginning at the point at which the woman perceives regular [[uterine contraction]]s.{{cite web |title= Latent phase of labor |url= http://www.uptodate.com/contents/latent-phase-of-labor | vauthors = Satin AJ |work= [[UpToDate]] |publisher= Wolters Kluwer |date= 1 July 2013 |url-status= live |archive-url= https://web.archive.org/web/20160303224621/http://www.uptodate.com/contents/latent-phase-of-labor |archive-date= 3 March 2016 }}{{subscription required}} In contrast, [[Braxton Hicks contractions]], which are contractions that may start around 26 weeks gestation and are sometimes called "false labour", are infrequent, irregular, and involve only mild cramping.{{cite book | vauthors = Murray LJ, Hennen L, Scott J |title=The BabyCenter Essential Guide to Pregnancy and Birth: Expert Advice and Real-World Wisdom from the Top Pregnancy and Parenting Resource|publisher=Rodale Books|location=Emmaus, Pennsylvania|year=2005|isbn=978-1-59486-211-3|url=https://archive.org/details/babycenteressentmurr| url-access = registration |pages= [https://archive.org/details/babycenteressentmurr/page/294 294]–295 |access-date=18 August 2013}} Braxton Hicks contractions are the uterine muscles preparing to deliver the infant. [82] => [83] => [[Cervical effacement]], which is the thinning and stretching of the [[cervix]], and [[cervical dilation]] occur during the closing weeks of [[pregnancy]]. Effacement is usually complete or near-complete and dilation is about 5 cm by the end of the latent phase.{{cite web | url=http://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/multimedia/cervical-effacement-and-dilation/img-20006991 | title=Cervical effacement and dilation | publisher=Mayo Clinic | access-date=31 January 2017 | author=Mayo clinic staff | url-status=live | archive-url=https://web.archive.org/web/20161204112729/http://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/multimedia/cervical-effacement-and-dilation/img-20006991 | archive-date=4 December 2016 }} The degree of cervical effacement and dilation may be felt during a vaginal examination. [84] => [85] => [[File:Bumm 158 lg.jpg|thumb|Engagement of the fetal head]] [86] => The '''active phase''' of labour has geographically differing definitions. The World Health Organization describes the active first stage as "a period of time characterised by regular painful uterine contractions, a substantial degree of cervical effacement and more rapid cervical dilatation from 5 cm until full dilatation for first and subsequent labours”.{{cite web|title=WHO recommendations Intrapartum care for a positive childbirth experience (Recommendation 5)|url=http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1|website=World Health Organization|access-date=6 May 2018|archive-date=29 March 2018|archive-url=https://web.archive.org/web/20180329081924/http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1|url-status=live}} In the US, the definition of active labour was changed from 3 to 4 cm, to 5 cm of [[cervical dilation]] for multiparous women, mothers who had given birth previously, and at 6 cm for nulliparous women, those who had not given birth before.[http://www.acog.org/About_ACOG/ACOG_Departments/Patient_Safety_and_Quality_Improvement/~/media/Departments/Patient%20Safety%20and%20Quality%20Improvement/201213IssuesandRationale-Labor.pdf Obstetric Data Definitions Issues and Rationale for Change] {{webarchive|url=https://web.archive.org/web/20131106064308/http://www.acog.org/About_ACOG/ACOG_Departments/Patient_Safety_and_Quality_Improvement/~/media/Departments/Patient%20Safety%20and%20Quality%20Improvement/201213IssuesandRationale-Labor.pdf |date=6 November 2013 }}, 2012 by [[American Congress of Obstetricians and Gynecologists|ACOG]]. This was done in an effort to increase the rates of vaginal delivery.{{cite journal | vauthors = Boyle A, Reddy UM, Landy HJ, Huang CC, Driggers RW, Laughon SK | title = Primary cesarean delivery in the United States | journal = Obstetrics and Gynecology | volume = 122 | issue = 1 | pages = 33–40 | date = July 2013 | pmid = 23743454 | pmc = 3713634 | doi = 10.1097/AOG.0b013e3182952242 }} [87] => [88] => Health care providers may assess the mother's progress in labour by performing a cervical exam to evaluate the cervical dilation, effacement, and station. These factors form the [[Bishop score]]. The Bishop score can also be used as a means to predict the success of an [[induction of labour]]. [89] => [90] => During effacement, the cervix becomes incorporated into the lower segment of the uterus. During a contraction, uterine muscles contract causing shortening of the upper segment and drawing upwards of the lower segment, in a gradual expulsive motion.{{Cite web|title=Birth (Parturition) {{!}} Boundless Anatomy and Physiology|url=https://courses.lumenlearning.com/boundless-ap/chapter/birth-parturition/|access-date=26 February 2021|website=courses.lumenlearning.com|archive-date=11 August 2021|archive-url=https://web.archive.org/web/20210811012109/https://courses.lumenlearning.com/boundless-ap/chapter/birth-parturition/|url-status=live}} The presenting fetal part then is permitted to descend. Full dilation is reached when the cervix has widened enough to allow passage of the baby's head, around 10 cm dilation for a term baby. [91] => [92] => A standard duration of the latent first stage has not been established and can vary widely from one woman to another. However, the duration of active first stage (from 5 cm until full cervical dilatation) usually does not extend beyond 12 hours in the first labour("primiparae"), and usually does not extend beyond 10 hours in subsequent labours ("multiparae").{{cite web|title=WHO recommendations Intrapartum care for a positive childbirth experience (item #3.2.2.)|url=http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1|website=World Health Organization|access-date=6 May 2018|archive-date=29 March 2018|archive-url=https://web.archive.org/web/20180329081924/http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1|url-status=live}} [93] => [94] => '''Dystocia of labour''', also called "dysfunctional labour" or "failure to progress", is difficult labour or abnormally slow progress of labour, involving progressive cervical dilatation or lack of descent of the fetus. Friedman's Curve, developed in 1955, was for many years used to determine labour dystocia. However, more recent medical research suggests that the Friedman curve may not be currently{{when|date=March 2021}} applicable.{{cite journal | vauthors = Zhang J, Troendle JF, Yancey MK | title = Reassessing the labor curve in nulliparous women | journal = American Journal of Obstetrics and Gynecology | volume = 187 | issue = 4 | pages = 824–28 | date = October 2002 | pmid = 12388957 | doi = 10.1067/mob.2002.127142 | url = http://www.medscape.com/viewarticle/450311 | archive-url = https://web.archive.org/web/20160118084934/http://www.medscape.com/viewarticle/450311 | url-status = live | archive-date = 18 January 2016 }}{{cite web|title=Abnormal Labour|url=https://emedicine.medscape.com/article/273053-overview?pa=OT1PplDgX0%2FNFOi%2FLF24oxYPYIAGpQD5H4mEGMOCY3eJ3kdH%2F0UTMSMuoAql%2BvPUyo8%2Bbpl4R6EomboZA%2BCKsLOwhd8Mdk7tVO%2FdkscsGC4%3D|website=Medscape|access-date=14 May 2018|archive-date=8 December 2019|archive-url=https://web.archive.org/web/20191208132244/https://emedicine.medscape.com/article/273053-overview?pa=OT1PplDgX0%2FNFOi%2FLF24oxYPYIAGpQD5H4mEGMOCY3eJ3kdH%2F0UTMSMuoAql%2BvPUyo8%2Bbpl4R6EomboZA%2BCKsLOwhd8Mdk7tVO%2FdkscsGC4%3D|url-status=live}} [95] => [96] => ==== Second stage: fetal expulsion ==== [97] => [98] => The expulsion stage begins when the cervix is fully dilated, and ends when the baby is born. As pressure on the cervix increases, a sensation of pelvic pressure is experienced, and, with it, an urge to begin pushing. At the beginning of the normal second stage, the head is fully engaged in the pelvis; the widest diameter of the head has passed below the level of the [[pelvic inlet]]. The fetal head then continues descent into the pelvis, below the pubic arch and out through the [[Human vagina#Vaginal opening and hymen|vaginal opening]]. This is assisted by the additional maternal efforts of pushing, or bearing down, similar to [[defecation]]. The appearance of the fetal head at the vaginal opening is termed '''crowning'''. At this point, the mother will feel an intense burning or stinging sensation. [99] => [100] => When the [[amniotic sac]] has not [[Rupture of the membranes|ruptured]] during labour or pushing, the infant can be born with the membranes intact. This is referred to as "delivery en [[caul]]". [101] => [102] => Complete expulsion of the baby signals the successful completion of the second stage of labour. Some babies, especially preterm infants, are born covered with a waxy or cheese-like white substance called [[vernix]]. It is thought to have some protective roles during fetal development and for a few hours after birth. [103] => [104] => The second stage varies from one woman to another. In first labours, birth is usually completed within three hours whereas in subsequent [105] => labours, birth is usually completed within two hours.{{cite web|title=WHO recommendations Intrapartum care for a positive childbirth experience (item #33)|url=http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1|website=World Health Organization|access-date=6 May 2018|archive-date=29 March 2018|archive-url=https://web.archive.org/web/20180329081924/http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1|url-status=live}} Second-stage labours longer than three hours are associated with declining rates of spontaneous vaginal delivery and increasing rates of infection, [[perineal tear]]s, and obstetric haemorrhage, as well as the need for intensive care of the neonate.{{cite journal | vauthors = Rouse DJ, Weiner SJ, Bloom SL, Varner MW, Spong CY, Ramin SM, Caritis SN, Peaceman AM, Sorokin Y, Sciscione A, Carpenter MW, Mercer BM, Thorp JM, Malone FD, Harper M, Iams JD, Anderson GD | title = Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes | journal = American Journal of Obstetrics and Gynecology | volume = 201 | issue = 4 | pages = 357.e1–7 | date = October 2009 | pmid = 19788967 | pmc = 2768280 | doi = 10.1016/j.ajog.2009.08.003 | author18 = Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network | display-authors= 4 }} [106] => [107] => ==== Third stage: placental expulsion ==== [108] => {{Further|Umbilical cord|Placental expulsion}} [109] => The period from just after the fetus is expelled until just after the placenta is expelled is called the ''third stage of labour'' or the ''involution stage''. [[Placental expulsion]] begins as a physiological separation from the wall of the uterus. The average time from delivery of the baby until complete expulsion of the placenta is estimated to be 10–12 minutes dependent on whether active or expectant management is employed.{{cite journal | vauthors = Jangsten E, Mattsson LÅ, Lyckestam I, Hellström AL, Berg M | title = A comparison of active management and expectant management of the third stage of labour: a Swedish randomised controlled trial | journal = BJOG | volume = 118 | issue = 3 | pages = 362–69 | date = February 2011 | pmid = 21134105 | doi = 10.1111/j.1471-0528.2010.02800.x | display-authors= 4 | doi-access = free }} In as many as 3% of all vaginal deliveries, the duration of the third stage is longer than 30 minutes and raises concern for [[retained placenta]].{{cite journal | vauthors = Weeks AD | title = The retained placenta | journal = Best Practice & Research. Clinical Obstetrics & Gynaecology | volume = 22 | issue = 6 | pages = 1103–17 | date = December 2008 | pmid = 18793876 | doi = 10.1016/j.bpobgyn.2008.07.005 }} [110] => [111] => Placental expulsion can be managed actively or it can be managed expectantly, allowing the placenta to be expelled without medical assistance. Active management is the administration of a [[uterotonic]] drug within one minute of fetal delivery, controlled traction of the umbilical cord and [[Uterus#Structure|fundal]] massage after delivery of the placenta, followed by performance of uterine massage every 15 minutes for two hours.{{cite journal | vauthors = Ball H |title= Active management of the third state of labour is rare in some developing countries |url= http://www.guttmacher.org/pubs/journals/3510509.html |journal= International Perspectives on Sexual and Reproductive Health |volume= 35 |issue= 2 |date= June 2009 |url-status= live |archive-url= https://web.archive.org/web/20160304053957/http://www.guttmacher.org/pubs/journals/3510509.html |archive-date= 4 March 2016 }} In a joint statement, [[World Health Organization]], the [[International Federation of Gynaecology and Obstetrics]] and the [[International Confederation of Midwives]] recommend active management of the third stage of labour in all vaginal deliveries to help to prevent [[Postpartum bleeding|postpartum haemorrhage]].{{cite journal | vauthors = Stanton C, Armbruster D, Knight R, Ariawan I, Gbangbade S, Getachew A, Portillo JA, Jarquin D, Marin F, Mfinanga S, Vallecillo J, Johnson H, Sintasath D | title = Use of active management of the third stage of labour in seven developing countries | journal = Bulletin of the World Health Organization | volume = 87 | issue = 3 | pages = 207–15 | date = March 2009 | pmid = 19377717 | pmc = 2654655 | doi = 10.2471/BLT.08.052597 | display-authors= 4 }}{{cite journal | title = Joint statement: management of the third stage of labour to prevent post-partum haemorrhage | journal = Journal of Midwifery & Women's Health | volume = 49 | issue = 1 | pages = 76–77 | year = 2004 | pmid = 14710151 | doi = 10.1016/j.jmwh.2003.11.005 | author-link1 = International Confederation of Midwives | author-link2 = International Federation of Gynaecology and Obstetrics | author1 = International Confederation of Midwives | author2 = International Federation of Gynaecologists Obstetricians }}{{Cite report|title= WHO recommendations for the prevention of postpartum haemorrhage |year= 2007 |url= http://whqlibdoc.who.int/hq/2007/WHO_MPS_07.06_eng.pdf |archive-url= https://web.archive.org/web/20090705031910/http://whqlibdoc.who.int/hq/2007/WHO_MPS_07.06_eng.pdf |archive-date= 5 July 2009 | vauthors = Mathai M, Gülmezoglu AM, Hill S |publisher= [[World Health Organization]], Department of Making Pregnancy Safer |location= Geneva}} [112] => [113] => Delaying the clamping of the [[umbilical cord]] for at least one minute or until it ceases to pulsate, which may take several minutes, improves outcomes as long as there is the ability to treat [[jaundice]] if it occurs. For many years it was believed that late cord cutting led to a mother's risk of experiencing significant bleeding after giving birth, called [[postpartum bleeding]]. However a recent review found that delayed cord cutting in healthy full-term infants resulted in early [[haemoglobin]] concentration and higher birthweight and increased iron reserves up to six months after birth with no change in the rate of postpartum bleeding.{{cite journal | vauthors = McDonald SJ, Middleton P, Dowswell T, Morris PS | title = Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes | journal = The Cochrane Database of Systematic Reviews | volume = 7 | issue = 7 | pages = CD004074 | date = July 2013 | pmid = 23843134 | doi = 10.1002/14651858.CD004074.pub3 | editor1-last = McDonald | editor1-first = Susan J | pmc = 6544813 }}{{Cite news |last1=Campbell |first1=Denis |name-list-style=vanc |title=Hospitals warned to delay cutting umbilical cords after birth |url=https://www.theguardian.com/society/2013/jul/11/hospitals-nhs-umbilical-cords-babies-delay-cutting |newspaper=The Guardian |access-date=11 June 2018 |date=10 July 2013 |archive-date=12 June 2018 |archive-url=https://web.archive.org/web/20180612145023/https://www.theguardian.com/society/2013/jul/11/hospitals-nhs-umbilical-cords-babies-delay-cutting |url-status=live }} [114] => [115] => ==== Fourth stage: postpartum ==== [116] => {{Further|Postpartum period|Puerperal disorder}} [117] => [[File:Geburt 01.jpg|thumb|Newborn rests as caregiver checks breath sounds.]] [118] => The fourth stage of labour is the period beginning immediately after childbirth, and extends for about six weeks. The terms ''[[postpartum]]'' and ''postnatal'' are often used for this period.{{cite journal | vauthors = Gjerdingen DK, Froberg DG | title = The fourth stage of labor: the health of birth mothers and adoptive mothers at six-weeks postpartum | journal = Family Medicine | volume = 23 | issue = 1 | pages = 29–35 | date = January 1991 | pmid = 2001778 }} The woman's body, including hormone levels and uterus size, return to a non-pregnant state and the newborn adjusts to life outside the mother's body. The [[World Health Organization]] (WHO) describes the postnatal period as the most critical and yet the most neglected phase in the lives of mothers and babies; most deaths occur during the postnatal period.{{cite web | url=https://www.who.int/maternal_child_adolescent/documents/postnatal-care-recommendations/en/ | title=WHO recommendations on postnatal care of the mother and newborn | publisher=World Health Organization | date=2013 | access-date=22 December 2014 | author=WHO | url-status=dead | archive-url=https://web.archive.org/web/20141222172315/http://www.who.int/maternal_child_adolescent/documents/postnatal-care-recommendations/en/ | archive-date=22 December 2014 }} [119] => [120] => Following the birth, if the mother had an [[episiotomy]] or a tearing of the [[perineum]], it is stitched. This is also an optimal time for uptake of [[long-acting reversible contraception]] (LARC), such as the [[contraceptive implant]] or [[intrauterine device]] (IUD), both of which can be inserted immediately after delivery while the woman is still in the delivery room.{{Cite journal|last1=Whitaker|first1=Amy K.|last2=Chen|first2=Beatrice A.|publication-date=January 2018|title=Society of Family Planning Guidelines: Postplacental insertion of intrauterine devices|journal=Contraception|volume=97|issue=1|pages=2–13|doi=10.1016/j.contraception.2017.09.014|issn=0010-7824|date=5 October 2017|pmid=28987293|doi-access=free}}{{Cite web|url=https://www.acog.org/en/Clinical/Clinical%20Guidance/Committee%20Opinion/Articles/2016/08/Immediate%20Postpartum%20Long-Acting%20Reversible%20Contraception|title=Immediate Postpartum Long-Acting Reversible Contraception|website=www.acog.org|language=en|access-date=20 April 2020|archive-date=22 July 2020|archive-url=https://web.archive.org/web/20200722134522/https://www.acog.org/en/Clinical/Clinical%20Guidance/Committee%20Opinion/Articles/2016/08/Immediate%20Postpartum%20Long-Acting%20Reversible%20Contraception|url-status=live}} The mother has regular assessments for uterine contraction and [[fundal height]],{{cite web | url=http://www.atitesting.com/ati_next_gen/skillsmodules/content/maternal-newborn/equipment/postpart_assessment.html | title=Postpartum Assessment | publisher=ATI Nursing Education | access-date=24 December 2014 | url-status=dead | archive-url=https://web.archive.org/web/20141224072821/http://www.atitesting.com/ati_next_gen/skillsmodules/content/maternal-newborn/equipment/postpart_assessment.html | archive-date=24 December 2014 | df=dmy-all }} vaginal bleeding, heart rate and blood pressure, and temperature, for the first 24 hours after birth. Some women may experience an uncontrolled episode of shivering or [[postpartum chills]] following the birth. The first passing of urine should be documented within six hours. Afterpains (pains similar to menstrual cramps), contractions of the uterus to prevent excessive blood flow, continue for several days. Vaginal discharge, termed "lochia", can be expected to continue for several weeks; initially bright red, it gradually becomes pink, changing to brown, and finally to yellow or white.{{cite web | url=http://www.mayoclinic.org/healthy-living/labor-and-delivery/in-depth/postpartum-care/art-20047233 | title=Postpartum care: What to expect after a vaginal delivery | publisher=Mayo Clinic | access-date=23 December 2014 | author=Mayo clinic staff | url-status=live | archive-url=https://web.archive.org/web/20141221202550/http://www.mayoclinic.org/healthy-living/labor-and-delivery/in-depth/postpartum-care/art-20047233 | archive-date=21 December 2014 }} [121] => [122] => At one time babies born in hospitals were removed from their mothers shortly after birth and brought to the mother only at feeding times.{{cite web |title=Rooming-in: An Essential Evolution in American Maternity Care |url=https://www.nichq.org/insight/rooming-essential-evolution-american-maternity-care |website=NICHO |access-date=7 June 2022 |archive-date=28 May 2022 |archive-url=https://web.archive.org/web/20220528034609/https://nichq.org/insight/rooming-essential-evolution-american-maternity-care |url-status=live }} Mothers were told that their newborns would be safer in the nursery and that the separation would offer the mothers more time to rest. As attitudes began to change, some hospitals offered a "rooming in" option wherein after a period of routine hospital procedures and observation, the infant could be allowed to share the mother's room. As of 2020, [[rooming-in]] has increasingly become standard practice in maternity wards."Rooming-in: An Essential Evolution in American Maternity Care", By Jennifer Usianov. ''National Institute for Childre's Health Quality''. {https://www.nichq.org/insight/rooming-essential-evolution-american-maternity-care}{{Dead link|date=June 2023 |bot=InternetArchiveBot |fix-attempted=yes }} Retrieved 1 November 2021. [123] => [124] => ===Early skin-to-skin contact=== [125] => [[File:La méthode kangourou Bébé Prématuré Laquinitinie Douala.jpg|thumb|[[Kangaroo care]] by father in [[Cameroon]]]] [126] => [127] => [[Skin-to-skin contact]] (SSC), sometimes also called [[kangaroo care]], is a technique of newborn care where babies are kept chest-to-chest and skin-to-skin with a parent, typically their mother or possibly the father. This means without the shirt or undergarments on the chest of both the baby and parent. A 2011 medical review found that early skin-to-skin contact resulted in a decrease in infant crying, improved cardio-respiratory stability and blood glucose levels, and improved breastfeeding duration.{{cite web | url=http://apps.who.int/rhl/archives/hscom2/en/index.html | title=Early skin-to-skin contact for mothers and their healthy newborn infants | work=The WHO Reproductive Health Library | publisher=WHO | date=4 January 2008 | access-date=23 December 2014 | vauthors = Saloojee H | url-status=dead | archive-url= https://web.archive.org/web/20141221025957/http://apps.who.int/rhl/archives/hscom2/en/index.html | archive-date=21 December 2014 }}{{cite journal | vauthors = Crenshaw J | title = Care practice #6: no separation of mother and baby, with unlimited opportunities for breastfeeding | journal = The Journal of Perinatal Education | volume = 16 | issue = 3 | pages = 39–43 | date = 2007 | pmid = 18566647 | pmc = 1948089 | doi = 10.1624/105812407X217147 }} A 2016 [[Cochrane review]] also found that SSC at birth promotes the likelihood and effectiveness of breastfeeding.{{cite journal | vauthors = Moore ER, Bergman N, Anderson GC, Medley N | title = Early skin-to-skin contact for mothers and their healthy newborn infants | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD003519 | date = November 2016 | issue = 11 | pmid = 27885658 | pmc = 3979156 | doi = 10.1002/14651858.CD003519.pub4 }} [128] => [129] => As of 2014, early postpartum SSC is endorsed by all major organisations that are responsible for the well-being of infants, including the [[American Academy of Pediatrics]]. The [[World Health Organization]] (WHO) states that "the process of [130] => childbirth is not finished until the baby has safely transferred from placental to mammary nutrition." It is advised that the newborn be placed skin-to-skin with the mother following vaginal birth, or as soon as the mother is alert and responsive after a Caesarean section, postponing any routine procedures for at least one to two hours. The baby's father or other support person may also choose to hold the baby SSC until the mother recovers from the anaesthetic.{{cite web|title=Fathers and skin-to-skin contact|url=http://www.kangaroomothercare.com/fathers-skin-to-skin.aspx|publisher=Kangaroo Mother Care|access-date=30 April 2013|archive-date=26 April 2013|archive-url=https://web.archive.org/web/20130426093714/http://www.kangaroomothercare.com/fathers-skin-to-skin.aspx|url-status=dead}} [131] => [132] => The WHO suggests that any initial observations of the infant can be done while the infant remains close to the mother, saying that even a brief separation before the baby has had its first feed can disturb the bonding process. They further advise frequent skin-to-skin contact as much as possible during the first days after delivery, especially if it were interrupted for some reason after the delivery. [133] => [134] => [[La Leche League]] advises women to have a delivery team which includes a support person who will advocate to assure that: [135] => :* The mother and her baby are not separated unnecessarily [136] => :*The baby will receive only her milk [137] => :*The baby will receive no supplementation without a medical reason [138] => :* All testing, bathing or other procedures are done in the parent's room{{cite web |title=Birth and Breastfeeding |url=https://www.llli.org/breastfeeding-info/birth-and-breastfeeding/ |website=La Leche League |access-date=27 April 2022 |archive-date=17 May 2022 |archive-url=https://web.archive.org/web/20220517052016/https://www.llli.org/breastfeeding-info/birth-and-breastfeeding/ |url-status=live }} [139] => [140] => It has long been known that a mother's level of the hormone [[oxytocin]] elevates in a mother when she interacts with her infant. In 2019, a large review of the effects of oxytocin found that the oxytocin level in fathers that engage in SSC is increased as well. Two studies found that "when the infant is clothed only in a diaper and placed in between the mother or father's breasts, chest-to-chest [elevated paternal oxytocin levels were] shown to reduce stress and anxiety in parents after interaction."{{cite journal |title=Oxytocin and early parent-infant interactions: A systematic review |year=2019 |pmc=6838998 |last1=Scatliffe |first1=N. |last2=Casavant |first2=S. |last3=Vittner |first3=D. |last4=Cong |first4=X. |journal=International Journal of Nursing Sciences |volume=6 |issue=4 |pages=445–453 |doi=10.1016/j.ijnss.2019.09.009 |pmid=31728399 }} [141] => [142] => ===Discharge=== [143] => [144] => For births that occur in hospitals the WHO recommends a hospital stay of at least 24 hours following an uncomplicated vaginal delivery and 96 hours for a Cesarean section. Looking at length of stay (in 2016) for an uncomplicated delivery around the world shows an average of less than 1 day in Egypt to 6 days in (pre-war) Ukraine. Averages for Australia are 2.8 days and 1.5 days in the UK.{{cite web |last1=Harrington |first1=Rebecca |title=American women giving birth leave the hospital as quickly as women in Haiti and Kenya |url=https://www.businessinsider.com/length-hospital-time-after-giving-birth-2016-3 |website=Insider |access-date=20 March 2022 |archive-date=21 May 2022 |archive-url=https://web.archive.org/web/20220521024824/https://www.businessinsider.com/length-hospital-time-after-giving-birth-2016-3 |url-status=live }} While this number is low, two-thirds of women in the UK have midwife-assisted births and in some cases the mother may choose a hospital setting for birth to be closer to the wide range of assistance available for an emergency situation. However, women with midwife care may leave the hospital shortly after birth and her midwife will continue her care at her home.{{cite web |title=Where to give birth: the options |url=https://www.nhs.uk/pregnancy/labour-and-birth/preparing-for-the-birth/where-to-give-birth-the-options/ |website=NHS |date=December 2020 |access-date=20 May 2022 |archive-date=14 February 2022 |archive-url=https://web.archive.org/web/20220214201435/https://www.nhs.uk/pregnancy/labour-and-birth/preparing-for-the-birth/where-to-give-birth-the-options/ |url-status=live }} [145] => In the U.S. the average length of stay has gradually dropped from 4.1 days in 1970 to a current stay of 2 days. The CDC attributed the drop to the rise in health care costs, saying people could not afford to stay in the hospital any longer. To keep it from dropping any lower, in 1996 congress passed the [[Newborns' and Mothers' Health Protection Act]] that requires insurers to cover at least 48 hours for uncomplicated delivery. [146] => [147] => ==Labour induction and caesarean section== [148] => {{Main|Caesarean section|labour induction|delivery after previous caesarean section}} [149] => [150] => In many cases and with increasing frequency, childbirth is achieved through [[labour induction]] or [[caesarean section]], also called a C-section. Labour induction is the process or treatment that stimulates childbirth and delivery. Inducing labour can be accomplished with pharmaceutical or non-pharmaceutical methods. Inductions are most often performed either with [[prostaglandin]] drug treatment alone, or with a combination of prostaglandin and intravenous [[oxytocin]] treatment.{{cite journal | vauthors = Mozurkewich EL, Chilimigras JL, Berman DR, Perni UC, Romero VC, King VJ, Keeton KL | title = Methods of induction of labour: a systematic review | journal = BMC Pregnancy and Childbirth | volume = 11 | pages = 84 | date = October 2011 | pmid = 22032440 | pmc = 3224350 | doi = 10.1186/1471-2393-11-84 | doi-access = free }} [151] => Caesarean section is the removal of the [[neonate]] through a surgical incision in the abdomen, rather than through vaginal birth. During the procedure the patient is usually numbed with an epidural or a spinal block, but general anaesthesia can be used as well. A cut is made in the patient's abdomen and then in the uterus to remove the baby.{{cite web |title= Rates for total cesarean section, primary cesarean section, and vaginal birth after cesarean (VBAC), United States, 1989–2010 |url= http://www.childbirthconnection.org/pdfs/cesarean-section-trends.pdf |series= Relentless Rise in Cesarian Rate |work= [[Childbirth Connection]] website |date= August 2012 |publisher= |author= |access-date= 29 August 2013 |url-status= dead |archive-url= https://web.archive.org/web/20130217122109/http://www.childbirthconnection.org/pdfs/cesarean-section-trends.pdf |archive-date= 17 February 2013 }} Before the 1970s, once a patient delivered one baby via C-section, it was recommended that all of her future babies be delivered by C-section, but that recommendation has changed. Unless there is some other indication, mothers can attempt a trial of labour and most are able to have a vaginal birth after C-section (VBAC).{{Cite journal |last1=Trojano |first1=Giuseppe |last2=Damiani |first2=Gianluca Raffaello |last3=Olivieri |first3=Claudiana |last4=Villa |first4=Mario |last5=Malvasi |first5=Antonio |last6=Alfonso |first6=Raffaello |last7=Loverro |first7=Matteo |last8=Cicinelli |first8=Ettore |date=6 September 2019 |title=VBAC: antenatal predictors of success |journal=Acta Bio-Medica: Atenei Parmensis |volume=90 |issue=3 |pages=300–309 |doi=10.23750/abm.v90i3.7623 |issn=2531-6745 |pmc=7233729 |pmid=31580319}} Induced births and elective cesarean before 39 weeks can be harmful to the neonate as well as harmful or without benefit to the mother. Therefore, many guidelines recommend against non-medically required induced births and elective cesarean before 39 weeks.{{Cite web |title=Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age |edition=1st |website=Patient Safety Council |publisher=[[March of Dimes]] |vauthors=Main E, Oshiro B, Chagolla B, Bingham D, Dang-Kilduff L, Kowalewski L |date=July 2010 |access-date=29 August 2013 |url=http://www.patientsafetycouncil.org/uploads/MOD_39_Weeks_Toolkit.pdf |archive-url= https://web.archive.org/web/20121120003529/http://www.patientsafetycouncil.org/uploads/MOD_39_Weeks_Toolkit.pdf |archive-date=20 November 2012 }} [152] => [153] => ===Labour induction=== [154] => [155] => The 2012 rate of labour induction in the United States was 23.3%, and had more than doubled from 1990 to 2010.{{cite web|title=Recent Declines in Induction of Labor by Gestational Age|url=https://www.cdc.gov/nchs/data/databriefs/db155.htm|website=Centers for Disease Control and Prevention|access-date=9 May 2018|archive-date=10 May 2018|archive-url=https://web.archive.org/web/20180510050622/https://www.cdc.gov/nchs/data/databriefs/db155.htm|url-status=live}}{{cite journal | vauthors = Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, Kirmeyer S, Osterman MJ | title = Births: final data for 2007 | journal = National Vital Statistics Reports | volume = 58 | issue = 24 | pages = 1–85 | date = August 2010 | pmid = 21254725 | url = https://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_24.pdf |url-status= live |archive-url= https://web.archive.org/web/20130821102537/http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf |archive-date= 21 August 2013 }} By 2022 it had climbed to 32%.{{cite news |title=The U.S. rate of C-section births continues to climb |url=https://www.washingtonpost.com/health/2022/07/26/us-rate-c-section-births-continues-climb/ |newspaper=The Washington Post |access-date=26 November 2022}} [156] => The [[American Congress of Obstetricians and Gynecologists]] (ACOG) guidelines recommend a full evaluation of the maternal-fetal status, the status of the cervix, and at least a 39 completed weeks (full term) of gestation for optimal health of the newborn when considering elective induction of labour. Per these guidelines, indications for induction may include: [157] => * [[Abruptio placentae]] [158] => * [[Chorioamnionitis]] [159] => * Fetal compromise such as isoimmunisation leading to [[haemolytic disease of the newborn]] or [[oligohydramnios]] [160] => * Fetal demise [161] => * [[Gestational hypertension]] [162] => * Maternal conditions such as [[gestational diabetes]] or [[chronic kidney disease]] [163] => * [[Preeclampsia]] or [[eclampsia]] [164] => * [[Premature rupture of membranes]] [165] => * Post-term pregnancy [166] => [167] => Induction is also considered for logistical reasons, such as the distance from hospital or psychosocial conditions, but in these instances gestational age confirmation must be done, and the maturity of the fetal lung must be confirmed by testing. The ACOG also note that contraindications for induced labour are the same as for spontaneous vaginal delivery, including [[vasa previa]], complete [[placenta praevia]], [[umbilical cord prolapse]] or active [[genital herpes simplex]] infection, in which cases a cesarean section is the safest delivery method.{{cite web |title= Oxytocin for Induction |work= Optimizing Protocols in Obstetrics |series= Series 1 |date= December 2011 |author= ACOG District II Patient Safety and Quality Improvement Committee |publisher= [[American College of Obstetricians and Gynecologists|American Congress of Obstetricians and Gynecologists]] (ACOG) |url= https://www.acog.org/About_ACOG/ACOG_Districts/District_II/~/media/Districts/District%20II/PDFs/OxytocinForInduction.pdf |access-date= 29 August 2013 |url-status= dead |archive-url= https://web.archive.org/web/20130621001053/https://www.acog.org/About_ACOG/ACOG_Districts/District_II/~/media/Districts/District%20II/PDFs/OxytocinForInduction.pdf |archive-date= 21 June 2013 }} [168] => [169] => ===Cesarean section=== [170] => [171] => The WHO recommends a C-section rate of between 10 and 15% because C-sections rates higher than 10% are not associated with a decrease in morbidity and mortality.{{Cite journal |date=January 2015 |title=WHO Statement on caesarean section rates |url=http://dx.doi.org/10.1016/j.rhm.2015.07.007 |journal=Reproductive Health Matters |volume=23 |issue=45 |pages=149–150 |doi=10.1016/j.rhm.2015.07.007 |pmid=26278843 |issn=0968-8080|last1=World Health Organization Human Reproduction Programme |first1=10 April 2015 |hdl=11343/249912 |s2cid=40829330 |hdl-access=free }} In 2018, a group of medical professionals called the rates of increase around the world "alarming". In a ''Lancet'' report, C-sections were found to have more than tripled from about 6% of all births to 21%. In a statement by the maternal and child health organisation, the [[March of Dimes]], the increase is largely due to an increase of elective C-sections rather than when it is really necessary or indicated.{{cite web |title=Rate Of C-Sections Is Rising At An 'Alarming' Rate, Report Says |url=https://www.npr.org/sections/goatsandsoda/2018/10/12/656198429/rate-of-c-sections-is-rising-at-an-alarming-rate |website=NPR |access-date=16 March 2023 |archive-date=16 March 2023 |archive-url=https://web.archive.org/web/20230316180601/https://www.npr.org/sections/goatsandsoda/2018/10/12/656198429/rate-of-c-sections-is-rising-at-an-alarming-rate |url-status=live }} [172] => [173] => Looking at the C-section rates between 1976 and 1996, one large study done in the U.S. found that the proportion of pregnancies delivered by C section increased from 6.7% in 1976 to 14.2% in 1996, with maternal choice the most frequent reason given.{{cite journal |title=Indications for caesarean section in a consultant obstetric unit over three decades |url=https://www.tandfonline.com/doi/abs/10.1080/0144361031000098316 |journal=Journal of Obstetrics and Gynaecology |year=2003 |doi=10.1080/0144361031000098316 |access-date=16 March 2023 |last1=MacKenzie |first1=I. Z. |last2=Cooke |first2=Inez B |last3=Annan |first3=B. |volume=23 |issue=3 |pages=233–238 |pmid=12850849 |s2cid=25452611 |archive-date=16 March 2023 |archive-url=https://web.archive.org/web/20230316163728/https://www.tandfonline.com/doi/abs/10.1080/0144361031000098316 |url-status=live }} By 2018 the rate had climbed to one-third of all births.{{cite journal |title=Cesarean Delivery Rates and Costs of Childbirth in a State Medicaid Program After Implementation of a Blended Payment Policy |url=https://pubmed.ncbi.nlm.nih.gov/29912840/ |journal=Medical Care |year=2018 |pmid=29912840 |access-date=17 March 2023 |last1=Kozhimannil |first1=K. B. |last2=Graves |first2=A. J. |last3=Ecklund |first3=A. M. |last4=Shah |first4=N. |last5=Aggarwal |first5=R. |last6=Snowden |first6=J. M. |volume=56 |issue=8 |pages=658–664 |doi=10.1097/MLR.0000000000000937 |s2cid=49305610 |archive-date=17 March 2023 |archive-url=https://web.archive.org/web/20230317150724/https://pubmed.ncbi.nlm.nih.gov/29912840/ |url-status=live }} [174] => [175] => ==Management== [176] => [[File:Share of births attended by skilled health staff, OWID.svg|thumb|upright=1.8|Share of births attended by skilled health staff{{cite web |title=Share of births attended by skilled health staff |url=https://ourworldindata.org/grapher/births-attended-by-health-staff-sdgs |website=Our World in Data |access-date=5 March 2020 |archive-date=17 March 2020 |archive-url=https://web.archive.org/web/20200317143050/https://ourworldindata.org/grapher/births-attended-by-health-staff-sdgs |url-status=live }}]] [177] => [178] => Obstetric care frequently subjects women to institutional routines, which may have adverse effects on the progress of labour. Supportive care during labour may involve emotional support, comfort measures, and information and advocacy which may promote the physical process of labour as well as women's feelings of control and competence, thus reducing the need for obstetric intervention. The continuous support may be provided either by hospital staff such as nurses or midwives, [[doula]]s, or by companions of the woman's choice from her social network. There is increasing evidence to show that the participation of the child's father in the birth leads to a better birth and also post-birth outcomes, providing the father does not exhibit excessive anxiety.{{cite web |date=6 February 2007 |title=Men At Birth – Should Your Bloke Be There? |url=http://www.bellybelly.com.au/birth/men-at-birth |url-status=live |archive-url=https://web.archive.org/web/20130601041645/http://www.bellybelly.com.au/birth/men-at-birth |archive-date=1 June 2013 |access-date=23 August 2013 |work=BellyBelly.com.au |vauthors=Vernon D}} [179] => [180] => Continuous labour support may help women to give birth spontaneously, that is, without caesarean or vacuum or forceps, with slightly shorter labours, and to have more positive feelings regarding their experience of giving birth. Continuous labour support may also reduce women's use of pain medication during labour and reduce the risk of babies having low five-minute Apgar scores.{{cite journal |last1=Bohren |first1=MA |last2=Hofmeyr |first2=GJ |last3=Sakala |first3=C |last4=Fukuzawa |first4=RK |last5=Cuthbert |first5=A |date=6 July 2017 |title=Continuous support for women during childbirth. |journal=The Cochrane Database of Systematic Reviews |volume=7 |issue=8 |pages=CD003766 |doi=10.1002/14651858.CD003766.pub6 |pmc=6483123 |pmid=28681500}} [181] => [182] => ===Preparation=== [183] => Eating or drinking during labour is an area of ongoing debate. While some have argued that eating in labour has no harmful effects on outcomes,{{cite journal | vauthors = Tranmer JE, Hodnett ED, Hannah ME, Stevens BJ | title = The effect of unrestricted oral carbohydrate intake on labor progress | journal = Journal of Obstetric, Gynecologic, and Neonatal Nursing | volume = 34 | issue = 3 | pages = 319–28 | year = 2005 | pmid = 15890830 | doi = 10.1177/0884217505276155 }} others continue to have concern regarding the increased possibility of an aspiration event (choking on recently eaten foods) in the event of an emergency delivery due to the increased relaxation of the oesophagus in pregnancy, upward pressure of the uterus on the stomach, and the possibility of general anaesthetic in the event of an emergency cesarean.{{cite journal | vauthors = O'Sullivan G, Scrutton M | title = NPO during labor. Is there any scientific validation? | journal = Anesthesiology Clinics of North America | volume = 21 | issue = 1 | pages = 87–98 | date = March 2003 | pmid = 12698834 | doi = 10.1016/S0889-8537(02)00029-9 }} A 2013 [[Cochrane review]] found that with good obstetrical anaesthesia there is no change in harms from allowing eating and drinking during labour in those who are unlikely to need surgery. They additionally acknowledge that not eating does not mean there is an empty stomach or that its contents are not as acidic. They therefore conclude that "women should be free to eat and drink in labour, or not, as they wish."{{cite journal | vauthors = Singata M, Tranmer J, Gyte GM | title = Restricting oral fluid and food intake during labour | journal = The Cochrane Database of Systematic Reviews | volume = 8 | issue = 8 | pages = CD003930 | date = August 2013 | pmid = 23966209 | doi = 10.1002/14651858.CD003930.pub3 | editor1-last = Singata | access-date = 22 August 2013 | url = http://summaries.cochrane.org/CD003930/eating-and-drinking-in-labour | editor1-first = Mandisa | others = Pregnancy and Childbirth Group | pmc = 4175539 | archive-date = 7 July 2014 | archive-url = https://web.archive.org/web/20140707225132/http://summaries.cochrane.org/CD003930/eating-and-drinking-in-labour | url-status = live }} [184] => [185] => At one time shaving of the [[perineum|area around the vagina]], was common practice due to the belief that hair removal reduced the risk of infection, made an [[episiotomy]] (a surgical cut to enlarge the vaginal entrance) easier, and helped with instrumental deliveries. It is currently less common, though it is still a routine procedure in some countries even though a systematic review found no evidence to recommend shaving.{{cite journal | vauthors = Basevi V, Lavender T | title = Routine perineal shaving on admission in labour | journal = The Cochrane Database of Systematic Reviews | issue = 11 | pages = CD001236 | date = November 2014 | volume = 2014 | pmid = 25398160 | doi = 10.1002/14651858.CD001236.pub2 | pmc = 7076285 }} Side effects appear later, including irritation, redness, and multiple superficial scratches from the razor. Another effort to prevent infection has been the use of the antiseptic [[chlorhexidine]] or [[providone-iodine solution]] in the vagina. Evidence of benefit with chlorhexidine is lacking.{{cite journal | vauthors = Lumbiganon P, Thinkhamrop J, Thinkhamrop B, Tolosa JE | title = Vaginal chlorhexidine during labour for preventing maternal and neonatal infections (excluding Group B Streptococcal and HIV) | journal = The Cochrane Database of Systematic Reviews | volume = 9 | issue = 9 | pages = CD004070 | date = September 2014 | pmid = 25218725 | doi = 10.1002/14651858.CD004070.pub3 | pmc = 7104295 }} A decreased risk is found with providone-iodine when a cesarean section is to be performed.{{Cite journal|last1=Haas|first1=David M.|last2=Morgan|first2=Sarah|last3=Contreras|first3=Karenrose|last4=Kimball|first4=Savannah|date=26 April 2020|title=Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections|journal=The Cochrane Database of Systematic Reviews|volume=2020| issue=4 |pages=CD007892|doi=10.1002/14651858.CD007892.pub7|issn=1469-493X|pmc=7195184|pmid=32335895}} [186] => [187] => ===Forceps or vacuum assisted delivery=== [188] => {{main|Obstetrical forceps}} [189] => [190] => An assisted delivery is used in about 1 in 8 births, and may be needed if either mother or infant appears to be at risk during a vaginal delivery. The methods used are termed [[obstetrical forceps]] extraction and [[vacuum extraction]], also called ventouse extraction. Done properly, they are both safe with some preference for forceps rather than vacuum, and both are seen as preferable to an unexpected C-section. While considered safe, some risks for the mother include vaginal tearing, including a higher chance of having a more major vaginal tear that involves the muscle or wall of the anus or rectum. For women undergoing operative vaginal delivery with vacuum extraction or forceps, there is strong evidence that [[prophylactic antibiotics]] help to reduce the risk of infection.{{cite journal |last1=Liabsuetrakul |first1=T |last2=Choobun |first2=T |last3=Peeyananjarassri |first3=K |last4=Islam |first4=QM |title=Antibiotic prophylaxis for operative vaginal delivery. |journal=The Cochrane Database of Systematic Reviews |date=26 March 2020 |volume=2020 |issue=3 |pages=CD004455 |doi=10.1002/14651858.CD004455.pub5 |pmid=32215906|pmc=7096725 }} There is a higher risk of blood clots forming in the legs or pelvis – anti-clot stockings or medication may be ordered to avoid clots. [[Urinary incontinence]] is not unusual after childbirth but it is more common after an instrument delivery. Certain exercises and physiotherapy will help the condition to improve.{{cite web |title=Forceps or vacuum delivery |url=https://www.nhs.uk/conditions/pregnancy-and-baby/ventouse-forceps-delivery/ |website=NHS |access-date=15 November 2020 |archive-date=16 November 2020 |archive-url=https://web.archive.org/web/20201116173331/https://www.nhs.uk/conditions/pregnancy-and-baby/ventouse-forceps-delivery/ |url-status=live }} [191] => [192] => ===Pain control=== [193] => {{Main|Pain management during childbirth}} [194] => [195] => ====Non-pharmaceutical==== [196] => Some women prefer to avoid [[analgesic]] medication during childbirth. Psychological preparation may be beneficial. Relaxation techniques, immersion in water, massage, and [[acupuncture]] may provide pain relief. Acupuncture and relaxation were found to decrease the number of caesarean sections required.{{cite journal | vauthors = Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP | title = Pain management for women in labour: an overview of systematic reviews | journal = The Cochrane Database of Systematic Reviews | volume = 3 | issue = 3 | pages = CD009234 | date = March 2012 | pmid = 22419342 | doi = 10.1002/14651858.CD009234.pub2 | pmc = 7132546 }} Immersion in water has been found to relieve pain during the first stage of labour, reduce the need for anaesthesia, and shorten the duration of labour.{{cite journal | title = Immersion in water during labor and delivery | journal = Pediatrics | volume = 133 | issue = 4 | pages = 758–61 | date = April 2014 | pmid = 24652300 | doi = 10.1542/peds.2013-3794 | author1 = American Academy of Pediatrics Committee on Fetus Newborn | author2 = American College of Obstetricians Gynecologists Committee on Obstetric Practice | doi-access = free | hdl = 11573/1473752 | hdl-access = free }} Additionally, [[water birth]] is associated with a decreased risk of postpartum hemorrhaging, low Apgar scores, neonatal infections, requirement for neonatal resuscitation, and neonatal admission to intensive care. However, there is a higher chance of cord avulsion.{{cite journal |last1=McKinney |first1=Jordan |last2=Vilchez |first2=Gustavo |last3=Jowers |first3=Alicia |last4=Atchoo |first4=Amanda |last5=Lin |first5=Lifeng |last6=Kaunitz |first6=Andrew |last7=Lewis |first7=Kendall |last8=Sanchez-Ramos |first8=Luis |title=Water birth: a systematic review and meta-analysis of maternal and neonatal outcomes |journal=American Journal of Obstetrics and Gynecology |date=March 2024 |volume=230 |issue=3 |pages=S961–S979.e33 |doi=10.1016/j.ajog.2023.08.034 |pmid=38462266 |url=https://www.sciencedirect.com/science/article/pii/S000293782300604X |access-date=14 March 2024}} [197] => [198] => Most women like to have someone to support them during labour and birth; such as a midwife, nurse, or [[doula]]; or a lay person such as the father of the baby, a family member, or a close friend. Studies have found that continuous support during labour and delivery reduce the need for medication and a caesarean or operative vaginal delivery, and result in an improved [[Apgar score]] for the infant.{{cite journal | vauthors = Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A | title = Continuous support for women during childbirth | journal = The Cochrane Database of Systematic Reviews | volume = 7 | pages = CD003766 | date = July 2017 | issue = 8 | pmid = 28681500 |pmc=6483123 | doi = 10.1002/14651858.CD003766.pub6 }}{{cite journal | vauthors = Caughey AB, Cahill AG, Guise JM, Rouse DJ | title = Safe prevention of the primary cesarean delivery | journal = American Journal of Obstetrics and Gynecology | volume = 210 | issue = 3 | pages = 179–93 | date = March 2014 | pmid = 24565430 | doi = 10.1016/j.ajog.2014.01.026 }} [199] => [200] => ====Pharmaceutical==== [201] => Different measures for pain control have varying degrees of success and side effects to the woman and her baby. In some countries of Europe, doctors commonly prescribe inhaled [[nitrous oxide]] gas for pain control, especially as 53% nitrous oxide, 47% oxygen, known as [[Entonox]]; in the UK, midwives may use this gas without a doctor's prescription.{{Cite web|url=http://www.nnuh.nhs.uk/publication/download/medicine-administration-for-midwives-mid21v6-1/|title=Medicine Administration for Midwives|last=Lancashire|first=Liz|date=9 July 2018|website=Norfolk and Norwich University Hospitals|access-date=16 June 2019|archive-date=16 June 2019|archive-url=https://web.archive.org/web/20190616201305/http://www.nnuh.nhs.uk/publication/download/medicine-administration-for-midwives-mid21v6-1/|url-status=dead}} [[Opioid]]s such as [[fentanyl]] may be used, but if given too close to birth there is a risk of respiratory depression in the infant.{{update after|2021|3|16}}{{Cite journal|last1=Kumar|first1=Manoj|last2=Paes|first2=Bosco|date=July 2003|title=Epidural Opioid Analgesia and Neonatal Respiratory Depression|journal=Journal of Perinatology|language=en|volume=23|issue=5|pages=425–27|doi=10.1038/sj.jp.7210905|pmid=12847541|issn=1476-5543|url=https://rdcu.be/dFdEd}} [202] => [203] => Popular medical pain control in hospitals include the regional anaesthetics [[epidural]]s (EDA), and [[spinal anaesthesia]]. Epidural analgesia is a generally safe and effective method of relieving pain in labour, but has been associated with longer labour, more operative intervention (particularly instrument delivery), and increases in cost.{{cite journal | vauthors = Thorp JA, Breedlove G | title = Epidural analgesia in labor: an evaluation of risks and benefits | journal = Birth | volume = 23 | issue = 2 | pages = 63–83 | date = June 1996 | pmid = 8826170 | doi = 10.1111/j.1523-536X.1996.tb00833.x }} However, a more recent (2017) Cochrane review suggests that the new epidural techniques have no effect on labour time and the use of instruments or the need for C-section deliveries. Generally, pain and stress hormones rise throughout labour for women without epidurals, while pain, fear, and stress hormones decrease upon administration of epidural analgesia, but rise again later.{{cite journal | vauthors = Alehagen S, Wijma B, Lundberg U, Wijma K | title = Fear, pain and stress hormones during childbirth | journal = Journal of Psychosomatic Obstetrics and Gynaecology | volume = 26 | issue = 3 | pages = 153–65 | date = September 2005 | pmid = 16295513 | doi = 10.1080/01443610400023072 | s2cid = 44646591 }} [204] => Medicine administered via epidural can cross the placenta and enter the bloodstream of the fetus.{{cite journal | vauthors = Loftus JR, Hill H, Cohen SE | title = Placental transfer and neonatal effects of epidural sufentanil and fentanyl administered with bupivacaine during labor | journal = Anesthesiology | volume = 83 | issue = 2 | pages = 300–08 | date = August 1995 | pmid = 7631952 | doi = 10.1097/00000542-199508000-00010 | doi-access = free }} Epidural analgesia has no statistically significant impact on the risk of caesarean section, and does not appear to have an immediate effect on neonatal status as determined by Apgar scores.{{cite journal | vauthors = Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A | title = Epidural versus non-epidural or no analgesia for pain management in labour | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | pages = CD000331 | date = May 2018 | issue = 5 | pmid = 29781504 | pmc = 6494646 | doi = 10.1002/14651858.CD000331.pub4 }} [205] => [206] => ===Augmentation=== [207] => [[File:106 Pregnancy-Positive Feedback.jpg|thumb|Oxytocin facilitates labour and will follow a [[positive feedback]] loop.]] [208] => Augmentation is the process of stimulating the uterus to increase the intensity and duration of contractions after labour has begun. Several methods of augmentation are commonly been used to treat slow progress of labour (dystocia) when uterine contractions are assessed to be too weak. [[Oxytocin]] is the most common method used to increase the rate of vaginal delivery.{{cite journal | vauthors = Wei SQ, Luo ZC, Xu H, Fraser WD | s2cid = 29571476 | title = The effect of early oxytocin augmentation in labor: a meta-analysis | journal = Obstetrics and Gynecology | volume = 114 | issue = 3 | pages = 641–49 | date = September 2009 | pmid = 19701046 | doi = 10.1097/AOG.0b013e3181b11cb8 }} The World Health Organization recommends its use either alone or with [[amniotomy]] (rupture of the amniotic membrane) but advises that it must be used only after it has been correctly confirmed that labour is not proceeding properly if harm is to be avoided. The WHO does not recommend the use of [[antispasmodic]] agents for prevention of delay in labour.{{cite web|title=Recommendations for Augmentation of Labour|url=http://apps.who.int/iris/bitstream/handle/10665/174001/WHO_RHR_15.05_eng.pdf?sequence=1|website=World Health Organization|access-date=9 May 2018|archive-date=8 May 2018|archive-url=https://web.archive.org/web/20180508131859/http://apps.who.int/iris/bitstream/handle/10665/174001/WHO_RHR_15.05_eng.pdf?sequence=1|url-status=live}} [209] => [210] => ===Episiotomy=== [211] => {{Further|Episiotomy}} [212] => [213] => For years an [[episiotomy]] was thought to help prevent more extensive vaginal tears and heal better than a natural tear. [[Perineal tear]]s can occur at the vaginal opening as the baby's head passes through, especially if the baby descends quickly. Tears can involve the [[perineum|perineal skin]] or extend to the muscles and the anal sphincter and anus. Once common, they are now recognised as generally not needed. When needed, the midwife or obstetrician makes a surgical cut in the perineum to prevent severe tears that can be difficult to repair. A 2017 Cochrane review compared episiotomy as needed (restrictive) with routine episiotomy to determine the possible benefits and harms for mother and baby. The review found that restrictive episiotomy policies appeared to give a number of benefits compared with using routine episiotomy. Women experienced less severe perineal trauma, less posterior perineal trauma, less suturing and fewer healing complications at seven days with no difference in occurrence of pain, urinary incontinence, painful sex or severe vaginal/perineal trauma after birth.{{cite journal | vauthors = Jiang H, Qian X, Carroli G, Garner P | title = Selective versus routine use of episiotomy for vaginal birth | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | pages = CD000081 | date = February 2017 | issue = 2 | pmid = 28176333 | pmc = 5449575 | doi = 10.1002/14651858.CD000081.pub3 }} [214] => [215] => ===Multiple births=== [216] => {{Main|Multiple birth}} [217] => In cases of a [[cephalic presentation|head first-presenting]] first twin, twins can often be delivered vaginally. In some cases twin delivery is done in a larger delivery room or in an operating theatre, in the event of complication e.g. [218] => * Both twins born vaginally – this can occur both presented head first or where one comes head first and the other is breech and/or helped by a forceps/ventouse delivery [219] => * One twin born vaginally and the other by caesarean section. [220] => * If the twins are joined at any part of the body – called [[conjoined twins]], delivery is mostly by caesarean section. [221] => [222] => ===Fetal monitoring=== [223] => [224] => For external [[monitoring (medicine)|monitoring]] of the fetus during childbirth, a simple [[Pinard horn|pinard stethoscope]] or [[doppler fetal monitor]] ("''[[doptone]]''") can be used. [225] => A method of external (noninvasive) fetal [[monitoring (medicine)|monitoring]] (EFM) during childbirth is [[cardiotocography]] (CTG), using a ''cardiotocograph'' that consists of two sensors: The ''heart'' (cardio) sensor is an [[ultrasonic sensor]], similar to a [[Doppler fetal monitor]], that continuously emits ultrasound and detects motion of the fetal heart by the characteristic of the reflected sound. The pressure-sensitive ''contraction'' transducer, called a ''tocodynamometer'' (toco) has a flat area that is fixated to the skin by a band around the belly. The pressure required to flatten a section of the wall correlates with the internal pressure, thereby providing an estimate of contraction.{{cite book |title= The Medical Equipment Dictionary | vauthors = Hammond P, Johnson A | veditors = Brown M |publisher= Chapman & Hall |location= London |isbn= 978-0-412-28290-4 |chapter-url= http://home.btconnect.com/MalcolmBrown/entries/TOCODYNAMOMETER.html |chapter= Tocodynamometer |access-date= 23 August 2013 |year= 1986 |url-status= live |archive-url= https://web.archive.org/web/20160304044244/http://home.btconnect.com/MalcolmBrown/entries/TOCODYNAMOMETER.html |archive-date= 4 March 2016 }} Online version accessed. [226] => Monitoring with a cardiotocograph can either be intermittent or continuous.{{cite journal|title=Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour|url=http://www.cochrane.org/CD006066/PREG_continuous-cardiotocography-ctg-form-electronic-fetal-monitoring-efm-fetal-assessment-during-labour|journal=Cochrane Database of Systematic Reviews|volume=2|pages=CD006066|access-date=6 May 2018|doi=10.1002/14651858.CD006066.pub3|pmid=28157275|pmc=6464257|year=2017|last1=Alfirevic|first1=Zarko|last2=Gyte|first2=Gillian ML|last3=Cuthbert|first3=Anna|last4=Devane|first4=Declan|issue=5|archive-date=7 May 2018|archive-url=https://web.archive.org/web/20180507221407/http://www.cochrane.org/CD006066/PREG_continuous-cardiotocography-ctg-form-electronic-fetal-monitoring-efm-fetal-assessment-during-labour|url-status=live}} The [[World Health Organization]] (WHO) advises that for healthy women undergoing spontaneous labour continuous cardiotocography is not recommended for assessment of fetal well-being. The WHO states: "In countries and settings where continuous CTG is used defensively to protect against litigation, all stakeholders should be made aware that this practice is not evidence-based and does not improve birth outcomes."{{cite web|title=WHO recommendations Intrapartum care for a positive childbirth experience (Recommendation 17)|url=http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1|website=World Health Organization|access-date=7 May 2018|archive-date=29 March 2018|archive-url=https://web.archive.org/web/20180329081924/http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1|url-status=live}} [227] => [228] => A mother's water has to break before internal (invasive) monitoring can be used. More invasive monitoring can involve a [[fetal scalp electrode]] to give an additional measure of fetal heart activity, and/or [[intrauterine pressure catheter]] (IUPC). It can also involve [[fetal scalp pH testing]].{{medical citation needed|date=March 2021}} [229] => [230] => ==Complications== [231] => {{See also|Neonatal death|maternal death|}} [232] => [233] => [[File:Share of women that are expected to die from pregnancy-related causes, OWID.svg|thumb|Share of women that are expected to die from pregnancy-related causes]] [234] => [235] => There was a 44% decline in the maternal death rate between 1990 and 2015. However, 830 women died every day in 2015 from causes related to pregnancy or childbirth and for every woman who dies, 20 or 30 encounter injuries, infections or disabilities. Most of these deaths and injuries are preventable.{{cite web|title=Maternal health|url=http://www.unfpa.org/maternal-health|website=United Nations Population Fund|access-date=24 April 2018|archive-date=29 November 2020|archive-url=https://web.archive.org/web/20201129122355/https://www.unfpa.org/maternal-health|url-status=live}}{{cite book |vauthors= Van Lerberghe W, De Brouwere V |chapter= Of Blind Alleys and Things That Have Worked: History's Lessons on Reducing Maternal Mortality |veditors= De Brouwere V, Van Lerberghe W |title= Safe Motherhood Strategies: A Review of the Evidence |location= Antwerp |publisher= ITG Press |year= 2001 |isbn= 978-90-76070-19-3 |chapter-url= http://dspace.itg.be/bitstream/10390/1515/1/shsop17.pdf#page=15 |series= Studies in Health Services Organisation and Policy |volume= 17 |pages= 7–33 |quote= Where nothing effective is done to avert maternal death, "natural" mortality is probably of the order of magnitude of 1,500/100,000. |access-date= 29 August 2013 |archive-date= 28 August 2021 |archive-url= https://web.archive.org/web/20210828031201/http://dspace.itg.be/bitstream/handle/10390/1515/shsop17.pdf;jsessionid=01CB3701C881CA8BEF7ACD2A307311D7?sequence=1#page=15 |url-status= dead }} [236] => [237] => ===Maternal mortality and adverse health consequences=== [238] => In 2008, noting that each year more than 100,000 women die of complications of pregnancy and childbirth and at least seven million experience serious health problems while 50 million more have adverse health consequences after childbirth, the [[World Health Organization]] (WHO) has urged midwife training to strengthen maternal and newborn health services. To support the upgrading of midwifery skills the WHO established a midwife training program, Action for Safe Motherhood. [239] => [240] => The rising maternal death rate in the US is of concern. In 1990 the US ranked 12th of the 14 developed countries that were analysed. However, since that time the rates of every country have steadily continued to improve while the US rate has spiked dramatically. While every other developed nation of the 14 analysed in 1990 shows a 2017 death rate of less than 10 deaths per every 100,000 live births, the US rate has risen to 26.4. By comparison, the United Kingdom ranks second highest at 9.2 and Finland is the safest at 3.8.{{cite web|title=U.S. Has The Worst Rate Of Maternal Deaths In The Developed World|url=https://www.npr.org/2017/05/12/528098789/u-s-has-the-worst-rate-of-maternal-deaths-in-the-developed-world|website=NPR|date=12 May 2017|access-date=25 April 2018|last1=Propublica|first1=Nina Martin|last2=Montagne|first2=Renee|archive-date=24 April 2018|archive-url=https://web.archive.org/web/20180424221005/https://www.npr.org/2017/05/12/528098789/u-s-has-the-worst-rate-of-maternal-deaths-in-the-developed-world|url-status=live}} [241] => [242] => In 2022, the WHO reported that the US had the highest maternal death rate of any developed nation while other nations continued to experience declines. The death rate of black women has also continued to climb with a 2020 CDC report showing the maternal death rate at 55.3 deaths per 100,000 live births – 2.9 times the rate for white women.{{cite web |last1=Howard |first1=Jacqueline |title=US sees continued rise in maternal deaths – and ongoing inequities, CDC report shows |url=https://www.cnn.com/2022/02/23/health/maternal-deaths-increase-us-report/index.html |website=CNN |date=23 February 2022 |access-date=13 February 2023 |archive-date=14 February 2023 |archive-url=https://web.archive.org/web/20230214021006/https://www.cnn.com/2022/02/23/health/maternal-deaths-increase-us-report/index.html |url-status=live }} In 2023, a study reported that deaths among Native American women were even higher, at 3.5 times the rate for White women. The report attributed the high rate in part to the fact that Native American women are cared for under a poorly funded Federal Health Care System that is so stretched that the average monthly visit lasts only from three to seven minutes. Such a short visit allows neither time for performing an adequate health assessment nor time for the patient to discuss any problems she may be experiencing.{{cite web |title=Sharp rise in deaths among pregnant women and new mothers |url=https://video.azpbs.org/video/at-risk-1676327693/ |website=PBS Newshour |access-date=13 February 2023 |archive-date=14 February 2023 |archive-url=https://web.archive.org/web/20230214030105/https://video.azpbs.org/video/at-risk-1676327693/ |url-status=live }} [243] => [244] => ===Infant mortality=== [245] => Compared to other developed nations, the United States also has high infant mortality rates. The [[Trust for America's Health]] reports that as of 2011, about one-third of American births have some complications; many are directly related to the mother's health including increasing rates of obesity, type 2 diabetes, and physical inactivity. The U.S. Centers for Disease Control and Prevention (CDC) has led an initiative to improve woman's health previous to conception in an effort to improve both neonatal and maternal death rates.{{cite web |title= Healthy Women, Healthy Babies: How health reform can improve the health of women and babies in America |url= http://healthyamericans.org/assets/files/TFAH%202011HealthyBabiesBrief.pdf | vauthors = Levi J, Kohn D, Johnson K |publisher= [[Trust for America's Health]] |location= Washington, D.C. |date= June 2011 |access-date= 29 August 2013 |url-status= live |archive-url= https://web.archive.org/web/20120624230140/http://healthyamericans.org/assets/files/TFAH%202011HealthyBabiesBrief.pdf |archive-date= 24 June 2012 }} [246] => [247] => Looking at 168 countries around the world, a 2015 [[Save the Children]]'s report found that each day about 8,000 newborns die during the first month of life. Worldwide, more than 1 million babies die during their first day even though simple measures such as antibiotics, hand-held breathing masks and other simple interventions could prevent the deaths of 70% of infants. The United States had the highest first-day infant death rate of all the industrialised nations in the world. In the US, each year about 11,300 newborns die within 24 hours of their birth, 50% more first-day deaths than all other industrialised countries combined.{{cite web |last1=Castillo |first1=Michelle |title=U.S. has highest first-day infant mortality out of industrialized world, group reports |url=https://www.cbsnews.com/news/us-has-highest-first-day-infant-mortality-out-of-industrialized-world-group-reports/ |website=CBS News |date=7 May 2013 |access-date=14 February 2023 |archive-date=14 February 2023 |archive-url=https://web.archive.org/web/20230214164007/https://www.cbsnews.com/news/us-has-highest-first-day-infant-mortality-out-of-industrialized-world-group-reports/ |url-status=live }} [248] => [249] => ===Labour and delivery complications=== [250] => {{Main|Obstetric labour complication}} [251] => [252] => ====Obstructed labour==== [253] => [254] => {{Main|Obstructed labour}} [255] => The second stage of labour may be delayed or lengthy due to poor or uncoordinated uterine action, an abnormal uterine position such as [[breech birth|breech]] or [[shoulder dystocia]], and cephalopelvic disproportion (a small pelvis or large infant). Prolonged labour may result in maternal exhaustion, fetal distress, and other complications including [[obstetric fistula]].{{cite book|title=Education material for teachers of midwifery: midwifery education modules|date=2008|publisher=World Health Organisation|location=Geneva |isbn=978-9241546669|pages=38–44|edition=2nd|url=http://whqlibdoc.who.int/publications/2008/9789241546669_4_eng.pdf?ua=1|url-status=live|archive-url=https://web.archive.org/web/20150221002801/http://whqlibdoc.who.int/publications/2008/9789241546669_4_eng.pdf?ua=1|archive-date=21 February 2015}} [256] => [257] => ====Eclampsia==== [258] => {{Main|Eclampsia}} [259] => [260] => [[Eclampsia]] is the onset of seizures (convulsions) in a woman with [[pre-eclampsia]]. Pre-eclampsia is a disorder of pregnancy in which there is high blood pressure and either large amounts of protein in the urine or other organ dysfunction. Pre-eclampsia is routinely screened for during prenatal care. Onset may be before, during, or rarely, after delivery. Around 1% of women with eclampsia die.{{medical citation needed|date=March 2021}} [261] => [262] => ===Maternal complications=== [263] => {{Main|Puerperal disorder}} [264] => A puerperal disorder or postpartum disorder is a complication which presents primarily during the puerperium, or postpartum period. The postpartum period can be divided into three distinct stages; the initial or acute phase, six to 12 hours after childbirth; subacute postpartum period, which lasts two to six weeks, and the delayed postpartum period, which can last up to six months. In the subacute postpartum period, 87% to 94% of women report at least one health problem.{{cite journal | vauthors = Glazener CM, Abdalla M, Stroud P, Naji S, Templeton A, Russell IT | title = Postnatal maternal morbidity: extent, causes, prevention and treatment | journal = British Journal of Obstetrics and Gynaecology | volume = 102 | issue = 4 | pages = 282–87 | date = April 1995 | pmid = 7612509 | doi = 10.1111/j.1471-0528.1995.tb09132.x | s2cid = 38872754 }}{{cite journal | vauthors = Thompson JF, Roberts CL, Currie M, Ellwood DA | title = Prevalence and persistence of health problems after childbirth: associations with parity and method of birth | journal = Birth | volume = 29 | issue = 2 | pages = 83–94 | date = June 2002 | pmid = 12051189 | doi = 10.1046/j.1523-536X.2002.00167.x }} Long-term health problems (persisting after the delayed postpartum period) are reported by 31% of women.{{cite journal | vauthors = Borders N | title = After the afterbirth: a critical review of postpartum health relative to method of delivery | journal = Journal of Midwifery & Women's Health | volume = 51 | issue = 4 | pages = 242–48 | date = 2006 | pmid = 16814217 | doi = 10.1016/j.jmwh.2005.10.014 }} [265] => [266] => ====Postpartum bleeding==== [267] => [268] => {{Main|Postpartum bleeding}} [269] => [270] => According to the WHO, haemorrhage is the leading cause of maternal death worldwide accounting for approximately 27.1% of maternal deaths.{{Cite journal |last1=Say |first1=Lale |last2=Chou |first2=Doris |last3=Gemmill |first3=Alison |last4=Tunçalp |first4=Özge |last5=Moller |first5=Ann-Beth |last6=Daniels |first6=Jane |last7=Gülmezoglu |first7=A. Metin |last8=Temmerman |first8=Marleen |last9=Alkema |first9=Leontine |date=1 June 2014 |title=Global causes of maternal death: a WHO systematic analysis |journal=The Lancet Global Health |language=English |volume=2 |issue=6 |pages=e323–e333 |doi=10.1016/S2214-109X(14)70227-X |issn=2214-109X |pmid=25103301|s2cid=8706769 |doi-access=free |hdl=1854/LU-5796925 |hdl-access=free }} Within maternal deaths due to haemorrhage, two-thirds are caused by postpartum haemorrhage. The causes of postpartum haemorrhage can be separated into four main categories: Tone, Trauma, Tissue, and Thrombin. Tone represents [[uterine atony]], the failure of the uterus to contract adequately following delivery. Trauma includes lacerations or uterine rupture. Tissue includes conditions that can lead to a retained placenta. [[Thrombin]], which is a molecule used in the human body's blood clotting system, represents all coagulopathies.{{Cite journal |last1=Bienstock |first1=Jessica L. |last2=Eke |first2=Ahizechukwu C. |last3=Hueppchen |first3=Nancy A. |date=29 April 2021 |title=Postpartum Hemorrhage |journal=The New England Journal of Medicine |volume=384 |issue=17 |pages=1635–1645 |doi=10.1056/NEJMra1513247 |issn=1533-4406 |pmid=33913640 |pmc=10181876 |s2cid=233447661 }} [271] => [272] => ====Postpartum infections==== [273] => {{Main|Postpartum infections}} [274] => Postpartum infections, also historically known as childbed fever and medically as puerperal fever, are any bacterial infections of the reproductive tract following childbirth or miscarriage. Signs and symptoms usually include a fever greater than 38.0 °C (100.4 °F), chills, lower abdominal pain, and possibly bad-smelling vaginal discharge. The infection usually occurs after the first 24 hours and within the first ten days following delivery. Infection remains a major cause of maternal deaths and morbidity in the developing world. The work of [[Ignaz Semmelweis]] was seminal in the pathophysiology and treatment of childbed fever and his work saved many lives.{{cite journal |title=Medicine in stamps-Ignaz Semmelweis and Puerperal Fever |journal=Journal of the Turkish German Gynecological Association |year=2013 |pmid=24592068 |last1=Ataman |first1=A. D. |last2=Vatanoğlu-Lutz |first2=E. E. |last3=Yıldırım |first3=G. |volume=14 |issue=1 |pages=35–39 |doi=10.5152/jtgga.2013.08 |pmc=3881728 }} [275] => [276] => ====Psychological complications==== [277] => {{Main|Psychiatric disorders of childbirth|Postpartum psychosis|Postpartum depression|Childbirth-related posttraumatic stress disorder|Maternity blues}} [278] => [279] => Childbirth can be an intense event and strong emotions, both positive and negative, can be brought to the surface. Abnormal and persistent fear of childbirth is known as [[tokophobia]]. The prevalence of fear of childbirth around the world ranges between 4–25%, with 3–7% of pregnant women having clinical fear of childbirth.{{cite journal | vauthors = Jaju S, Al Kharusi L, Gowri V | title = Antenatal prevalence of fear associated with childbirth and depressed mood in primigravid women | journal = Indian Journal of Psychiatry | volume = 57 | issue = 2 | pages = 158–61 | date = 2015 | pmid = 26124521 | pmc = 4462784 | doi = 10.4103/0019-5545.158152 | doi-access = free }}{{cite journal | vauthors = Lukasse M, Schei B, Ryding EL | title = Prevalence and associated factors of fear of childbirth in six European countries | journal = Sexual & Reproductive Healthcare | volume = 5 | issue = 3 | pages = 99–106 | date = October 2014 | pmid = 25200969 | doi = 10.1016/j.srhc.2014.06.007 | hdl = 10642/2246 | hdl-access = free }} [280] => Although pain may be seen as a self-evident and indisputable fact, in reality pain is only one sensation of childbirth. There are many other sensations such as bliss, joy and satisfaction which can be more powerful than pain. Previous studies have indicated that negative expectations can actually increase sensitivity to pain through the process of nocebo hyperalgesia. While positive expectations can reduce pain through placebo analgesia.{{cite journal |last1=Carlino |first1=Elisa |last2=Frisaldi |first2=Elisa |last3=Benedetti |first3=Fabrizio |title=Pain and the Context |journal=Nature Reviews Rheumatology |date=June 2014 |volume=10 |issue=6 |pages=348–355 |doi=10.1038/nrrheum.2014.17 |pmid=24567065 |url=https://rdcu.be/dFdFi}} [281] => [282] => Most new mothers may experience mild feelings of unhappiness and worry after giving birth. Babies require a lot of care, so it is normal for mothers to be worried about, or tired from, providing that care. The feelings, often termed the [[Maternity blues|"baby blues"]], affect up to 80% of mothers. They are somewhat mild, last a week or two, and usually go away on their own.{{cite web|title=Postpartum Depression Facts|url=https://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml|website=National Institute of Mental Health|access-date=4 May 2018|archive-date=21 June 2017|archive-url=https://web.archive.org/web/20170621200731/https://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml|url-status=live}} [283] => [284] => [[Postpartum depression]] is different from the "baby blues". With postpartum depression, feelings of sadness and anxiety can be extreme and might interfere with a woman's ability to care for herself or her family. Because of the severity of the symptoms, postpartum depression usually requires treatment. The condition, which occurs in nearly 15% of births, may begin shortly before or any time after childbirth, but commonly begins between a week and a month after delivery. [285] => [286] => [[Childbirth-related posttraumatic stress disorder]] is a psychological disorder that can develop in women who have recently given birth.{{cite journal | vauthors = Lapp LK, Agbokou C, Peretti CS, Ferreri F | title = Management of post traumatic stress disorder after childbirth: a review | journal = Journal of Psychosomatic Obstetrics and Gynaecology | volume = 31 | issue = 3 | pages = 113–22 | date = September 2010 | pmid = 20653342 | doi = 10.3109/0167482X.2010.503330 | s2cid = 23594561 }}{{cite journal | vauthors = Condon J | title = Women's mental health: a "wish-list" for the DSM V | journal = Archives of Women's Mental Health | volume = 13 | issue = 1 | pages = 5–10 | date = February 2010 | pmid = 20127444 | doi = 10.1007/s00737-009-0114-1 | s2cid = 1102994 }}{{cite book | last = Martin | first = Colin | name-list-style = vanc | title = Perinatal Mental Health: a Clinical Guide | publisher = M & K Pub | location = Cumbria England | year = 2012 | isbn = 978-1907830495 | page = 26}} Causes include issues such as an emergency C-section, preterm labour, inadequate care during labour, [287] => lack of social support following childbirth, and others. Examples of symptoms include [[intrusive thoughts|intrusive symptoms]], [[Flashback (psychology)|flashbacks]] and [[nightmare]]s, as well as symptoms of [[avoidance coping|avoidance]] (including [[amnesia]] for the whole or parts of the event), problems in developing a [[Maternal bond|mother-child attachment]], and others similar to those commonly experienced in [[posttraumatic stress disorder]] (PTSD). Many women who are experiencing symptoms of PTSD after childbirth are misdiagnosed with postpartum depression or [[adjustment disorder]]s. These diagnoses can lead to inadequate treatment.{{cite journal | vauthors = Alder J, Stadlmayr W, Tschudin S, Bitzer J | title = Post-traumatic symptoms after childbirth: what should we offer? | journal = Journal of Psychosomatic Obstetrics and Gynaecology | volume = 27 | issue = 2 | pages = 107–12 | date = June 2006 | pmid = 16808085 | doi = 10.1080/01674820600714632 | s2cid = 21859634 }} [288] => [289] => [[Postpartum psychosis]] is a rare [[Emergency psychiatry|psychiatric emergency]] in which symptoms of high mood and racing thoughts ([[mania]]), depression, severe confusion, loss of inhibition, paranoia, hallucinations and delusions set in, beginning suddenly in the first two weeks after childbirth. The symptoms vary and can change quickly.{{cite journal | vauthors = Jones I, Chandra PS, Dazzan P, Howard LM | title = Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period | journal = Lancet | volume = 384 | issue = 9956 | pages = 1789–99 | date = November 2014 | pmid = 25455249 | doi = 10.1016/S0140-6736(14)61278-2 | s2cid = 44481055 }} It usually requires hospitalisation. The most severe symptoms last from two to 12 weeks, and recovery takes six months to a year. [290] => [291] => ===Fetal complications=== [292] => [[File:Bumm 84 lg.jpg|thumb|Mechanical fetal injury may be caused by improper rotation of the fetus.]] [293] => Five causes make up about 80% of newborn deaths globally: prematurity, low-birth-weight, infections, lack of oxygen at birth, and trauma during birth. [294] => [295] => ====Stillbirth==== [296] => {{Main|Stillbirth}} [297] => Stillbirth is typically defined as [[fetus|fetal]] death at or after 20 to 28 weeks of pregnancy.{{cite web|title=Stillbirth: Overview|url=https://www.nichd.nih.gov/health/topics/stillbirth/Pages/default.aspx|website=NICHD|access-date=4 October 2016|date=23 September 2014|url-status=live|archive-url=https://web.archive.org/web/20161005085055/https://www.nichd.nih.gov/health/topics/stillbirth/Pages/default.aspx|archive-date=5 October 2016}}{{Cite web |title=Stillbirths |url=https://www.who.int/maternal_child_adolescent/epidemiology/stillbirth/en/ |url-status=dead |archive-url=https://web.archive.org/web/20161002035346/http://www.who.int/maternal_child_adolescent/epidemiology/stillbirth/en/ |archive-date=2 October 2016 |access-date=29 September 2016 |website=World Health Organization |language=en-GB}} It results in a baby born without [[vital signs|signs of life]]. [298] => [299] => Worldwide prevention of most stillbirths is possible with improved health systems.{{cite journal|title=Ending preventable stillbirths An Executive Summary for The Lancet's Series|journal=The Lancet|date=Jan 2016|url=http://www.thelancet.com/pb/assets/raw/Lancet/stories/series/stillbirths2016-exec-summ.pdf|access-date=31 January 2020|archive-url=https://web.archive.org/web/20180712154237/http://www.thelancet.com/pb/assets/raw/Lancet/stories/series/stillbirths2016-exec-summ.pdf|archive-date=12 July 2018|url-status=dead}} About half of stillbirths occur during childbirth, and stillbirth is more common in the [[developing world|developing]] than [[developed world]]. Otherwise depending on how far along the pregnancy is, [[induction of labor|medications may be used to start labour]] or a type of surgery known as [[dilation and evacuation]] may be carried out.{{cite web|title=How do health care providers manage stillbirth?|url=https://www.nichd.nih.gov/health/topics/stillbirth/topicinfo/Pages/managed.aspx|website=NICHD|access-date=4 October 2016|date=23 September 2014|url-status=live|archive-url=https://web.archive.org/web/20161005133645/https://www.nichd.nih.gov/health/topics/stillbirth/topicinfo/Pages/managed.aspx|archive-date=5 October 2016}} Following a stillbirth, women are at higher risk of another one; however, most subsequent pregnancies do not have similar problems.{{cite web|title=Stillbirth: Other FAQs|url=https://www.nichd.nih.gov/health/topics/stillbirth/topicinfo/Pages/questions.aspx|website=NICHD|access-date=4 October 2016|date=23 September 2014|url-status=live|archive-url=https://web.archive.org/web/20161005133552/https://www.nichd.nih.gov/health/topics/stillbirth/topicinfo/Pages/questions.aspx|archive-date=5 October 2016}} [300] => [301] => Worldwide in 2019 there were about 2 million stillbirths that occurred after 28 weeks of pregnancy, this equates to 1 in 72 total births or one every 16 seconds.{{Cite web |title=Stillbirths and stillbirth rates |url=https://data.unicef.org/topic/child-survival/stillbirths/ |access-date=24 June 2022 |website=UNICEF DATA |language=en-US |archive-date=9 September 2021 |archive-url=https://web.archive.org/web/20210909023831/https://data.unicef.org/topic/child-survival/stillbirths/ |url-status=live }} Still births are more common in [[South Asia]] and [[Sub-Saharan Africa]]. Stillbirth rates have declined, though more slowly since the 2000s.{{Cite journal|last1=Draper|first1=Elizabeth S.|last2=Manktelow|first2=Bradley N.|last3=Smith|first3=Lucy|last4=Rubayet|first4=Sayed|last5=Hirst|first5=Jane|last6=Neuman|first6=Melissa|last7=King|first7=Carina|last8=Osrin|first8=David|last9=Prost|first9=Audrey|date=6 February 2016|title=Stillbirths: rates, risk factors, and acceleration towards 2030|journal=The Lancet|language=en|volume=387|issue=10018|pages=587–603|doi=10.1016/S0140-6736(15)00837-5|issn=0140-6736|pmid=26794078|doi-access=free}} [302] => [303] => ====Preterm birth==== [304] => {{Main|Preterm birth}} [305] => Preterm birth is the birth of an infant at fewer than 37 weeks [[Gestational age (obstetrics)|gestational age]]. Globally, about 15 million infants were born [[preterm|before 37 weeks of gestation]].{{cite web |date=November 2015 |title=Preterm birth Fact sheet N°363 |url=https://www.who.int/mediacentre/factsheets/fs363/en/ |url-status=live |archive-url=https://web.archive.org/web/20150307050438/http://www.who.int/mediacentre/factsheets/fs363/en/ |archive-date=7 March 2015 |access-date=30 July 2016 |website=WHO}} Premature birth is the leading cause of death in children under five years of age though many that survive experience disabilities including learning defects and visual and hearing problems. Causes for early birth may be unknown or may be related to certain chronic conditions such as diabetes, infections, and other known causes. The World Health Organization has developed guidelines with recommendations to improve the chances of survival and health outcomes for preterm infants.{{cite web|title=Preterm Birth|url=https://www.who.int/en/news-room/fact-sheets/detail/preterm-birth|website=World Health Organization|access-date=26 April 2018|archive-date=7 March 2015|archive-url=https://web.archive.org/web/20150307050438/http://www.who.int/mediacentre/factsheets/fs363/en/|url-status=live}}{{Cite journal |last1=Tsatsaris |first1=Vassilis |last2=Cabrol |first2=Dominique |last3=Carbonne |first3=Bruno |date=2004 |title=Pharmacokinetics of tocolytic agents |url=https://pubmed.ncbi.nlm.nih.gov/15509182 |journal=Clinical Pharmacokinetics |volume=43 |issue=13 |pages=833–844 |doi=10.2165/00003088-200443130-00001 |issn=0312-5963 |pmid=15509182 |s2cid=43377674 |access-date=12 September 2022 |archive-date=12 September 2022 |archive-url=https://web.archive.org/web/20220912174616/https://pubmed.ncbi.nlm.nih.gov/15509182/ |url-status=live }} [306] => [307] => If a pregnant woman enters preterm labour, delivery can be delayed by giving medications called [[tocolytics]]. Tocolytics delay labour by inhibiting contractions of the uterine muscles that progress labour. The most widely used tocolytics include beta agonists, calcium channel blockers, and magnesium sulfate. The goal of administering tocolytics is not to delay delivery to the point that the child can be delivered at term, but instead to postponing delivery long enough for the administration of [[glucocorticoids]] which can help the fetal lungs to mature enough to reduce morbidity and mortality from [[Hyaline membrane disease|infant respiratory distress syndrome]]. [308] => [309] => ==== Post-term birth ==== [310] => {{Main|Postterm pregnancy}} [311] => The term postterm pregnancy is used to describe a condition in which a woman has not yet delivered her baby after 42 weeks of [[gestation]], two weeks beyond the usual 40-week duration of pregnancy.{{cite web |url=http://www.merck.com/mmpe/sec19/ch272/ch272f.html |title=Postmature Infant |access-date=6 October 2008 |last=Kendig |first=James W |date=March 2007 |work=The Merck Manuals Online Medical Library |archive-date=20 August 2012 |archive-url=https://web.archive.org/web/20120820014059/http://www.merckmanuals.com/professional/sec19/ch272/ch272f.html |url-status=live }} Postmature births carry risks for both the mother and the baby, including [[meconium aspiration syndrome]], fetal malnutrition, and [[stillbirths]].{{cite journal |last1=Muglu |first1=J |last2=Rather |first2=H |last3=Arroyo-Manzano |first3=D |last4=Bhattacharya |first4=S |last5=Balchin |first5=I |last6=Khalil |first6=A |last7=Thilaganathan |first7=B |last8=Khan |first8=KS |last9=Zamora |first9=J |last10=Thangaratinam |first10=S |title=Risks of stillbirth and neonatal death with advancing gestation at term: A systematic review and meta-analysis of cohort studies of 15 million pregnancies. |journal=PLOS Medicine |date=July 2019 |volume=16 |issue=7 |pages=e1002838 |doi=10.1371/journal.pmed.1002838 |pmid=31265456|pmc=6605635 |doi-access=free }} The [[placenta]], which supplies the baby with oxygen and nutrients, begins to age and will eventually fail after the 42nd week of gestation. Induced labour is indicated for postterm pregnancy.{{Cite journal |date=August 2014 |title=Practice Bulletin No. 146: Management of Late-Term and Postterm Pregnancies |url=https://journals.lww.com/greenjournal/Abstract/2014/08000/Practice_Bulletin_No__146__Management_of_Late_Term.34.aspx |journal=Obstetrics & Gynecology |language=en-US |volume=124 |issue=2 PART 1 |pages=390–396 |doi=10.1097/01.AOG.0000452744.06088.48 |pmid=25050770 |s2cid=7149045 |issn=0029-7844 |access-date=12 September 2022 |archive-date=11 September 2022 |archive-url=https://web.archive.org/web/20220911182548/https://journals.lww.com/greenjournal/Abstract/2014/08000/Practice_Bulletin_No__146__Management_of_Late_Term.34.aspx |url-status=live }}{{Cite journal |last=Neff |first=Matthew J. |date=1 December 2004 |title=ACOG Releases Guidelines on Management of Post-term Pregnancy |url=https://www.aafp.org/pubs/afp/issues/2004/1201/p2221.html |journal=American Family Physician |language=en-US |volume=70 |issue=11 |pages=2221–2225 |access-date=12 September 2022 |archive-date=11 September 2022 |archive-url=https://web.archive.org/web/20220911182540/https://www.aafp.org/pubs/afp/issues/2004/1201/p2221.html |url-status=live }}{{Cite journal |last1=Wang |first1=Mary |last2=Fontaine |first2=Patricia |date=1 August 2014 |title=Common Questions About Late-Term and Postterm Pregnancy |url=https://www.aafp.org/pubs/afp/issues/2014/0801/p160.html |journal=American Family Physician |language=en-US |volume=90 |issue=3 |pages=160–165 |pmid=25077721 |access-date=12 September 2022 |archive-date=11 September 2022 |archive-url=https://web.archive.org/web/20220911182537/https://www.aafp.org/pubs/afp/issues/2014/0801/p160.html |url-status=live }} [312] => [313] => ====Neonatal infection==== [314] => {{Main|Neonatal infection}} [315] => [[File:Neonatal infections and other (perinatal) conditions world map - DALY - WHO2004.svg|thumb|[[Disability-adjusted life year]] for neonatal infections and other (perinatal) conditions per 100,000 inhabitants in 2004. Excludes [[preterm birth|prematurity]] and low birth weight, [[birth asphyxia]] and [[birth trauma (physical)|birth trauma]] which have their own maps/data.{{cite web |title= Mortality and Burden of Disease Estimates for WHO Member States in 2004 |url= https://www.who.int/entity/healthinfo/global_burden_disease/gbddeathdalycountryestimates2004.xls |format= xls |publisher= Department of Measurement and Health Information, World Health Organization |date= February 2009 |access-date= 4 October 2020 |archive-date= 28 August 2021 |archive-url= https://web.archive.org/web/20210828123901/https://www.who.int/healthinfo/global_burden_disease/gbddeathdalycountryestimates2004.xls |url-status= live }}{{Div col|small=yes|colwidth=10em}} [316] => {{legend|#b3b3b3|no data}} [317] => {{legend|#ffff65|less than 150}} [318] => {{legend|#fff200|150–300}} [319] => {{legend|#ffdc00|300–450}} [320] => {{legend|#ffc600|450–600}} [321] => {{legend|#ffb000|600–750}} [322] => {{legend|#ff9a00|750–900}} [323] => {{legend|#ff8400|900–1050}} [324] => {{legend|#ff6e00|1050–1200}} [325] => {{legend|#ff5800|1200–1350}} [326] => {{legend|#ff4200|1350–1500}} [327] => {{legend|#ff2c00|1500–1850}} [328] => {{legend|#cb0000|more than 1850}} [329] => {{div col end}}]] [330] => [331] => Newborns are prone to infection in the first month of life. The [[pathogenic bacterium]] ''[[Streptococcus agalactiae]]'' (a group B streptococcus) is most often the cause of these occasionally fatal infections. The baby contracts the infection [[Vertical transmission|from the mother]] during labour. In 2014 it was estimated that about one in 2000 newborn babies had a group B streptococcuss infection within the first week of life, usually evident as [[respiratory disease]], general [[sepsis]], or [[meningitis]].{{cite journal | vauthors = Ohlsson A, Shah VS | title = Intrapartum antibiotics for known maternal Group B streptococcal colonization | journal = The Cochrane Database of Systematic Reviews | issue = 6 | pages = CD007467 | date = June 2014 | volume = 2016 | pmid = 24915629 | doi = 10.1002/14651858.CD007467.pub4 | s2cid = 205189572 }} [332] => [333] => Untreated [[sexually transmitted infections]] (STIs) are associated with [[birth defect]]s, and infections in newborn babies, particularly in the areas where rates of infection remain high. The majority of STIs have no symptoms or only mild symptoms that may not be recognised. Mortality rates resulting from some infections may be high, for example the overall perinatal mortality rate associated with untreated syphilis is 30%.{{cite web |title= Sexually transmitted infections (STIs) |url=https://www.who.int/mediacentre/factsheets/fs110/en/ |volume= Fact sheet 110 |date= May 2013 |access-date= 30 August 2013 |publisher= World Health Organization |url-status= live |archive-url= https://web.archive.org/web/20141125133056/http://www.who.int/mediacentre/factsheets/fs110/en/ |archive-date= 25 November 2014 }} [334] => [335] => ====Perinatal asphyxia==== [336] => {{Main|Perinatal asphyxia}} [337] => [338] => [[Perinatal asphyxia]] is the medical condition resulting from [[Hypoxia (medical)|deprivation of oxygen]] to a newborn infant that lasts long enough during the birth process to cause physical harm. Hypoxic damage can also occur to most of the infant's organs ([[heart]], [[lung]]s, [[liver]], [[Gut (zoology)|gut]], [[kidneys]]), but [[brain damage]] is of most concern and perhaps the least likely to quickly or completely heal.{{cite journal | vauthors = van Handel M, Swaab H, de Vries LS, Jongmans MJ | title = Long-term cognitive and behavioral consequences of neonatal encephalopathy following perinatal asphyxia: a review | journal = European Journal of Pediatrics | volume = 166 | issue = 7 | pages = 645–54 | date = July 2007 | pmid = 17426984 | pmc = 1914268 | doi = 10.1007/s00431-007-0437-8 }} Oxygen deprivation can lead to permanent disabilities in the child, such as [[cerebral palsy]].{{Citation |last1=Marret |first1=Stéphane |title=Chapter 16 - Pathophysiology of cerebral palsy |date=1 January 2013 |url=https://www.sciencedirect.com/science/article/pii/B9780444528919000166 |journal=Handbook of Clinical Neurology |volume=111 |pages=169–176 |editor-last=Dulac |editor-first=Olivier |series=Pediatric Neurology Part I |publisher=Elsevier |language=en |access-date=28 July 2022 |last2=Vanhulle |first2=Catherine |last3=Laquerriere |first3=Annie |doi=10.1016/B978-0-444-52891-9.00016-6 |pmid=23622161 |isbn=9780444528919 |editor2-last=Lassonde |editor2-first=Maryse |editor3-last=Sarnat |editor3-first=Harvey B.}} [339] => [340] => ====Mechanical fetal injury==== [341] => {{Main|Birth trauma (physical)}} [342] => Risk factors for fetal birth injury include [[fetal macrosomia]] (big baby), [[maternal obesity]], the need for instrumental delivery, and an inexperienced attendant. Specific situations that can contribute to birth injury include breech presentation and [[shoulder dystocia]]. Most fetal birth injuries resolve without long term harm, but [[brachial plexus injury]] may lead to [[Erb's palsy]] or [[Klumpke's paralysis]].{{cite book| title=Gray's Anatomy | veditors = Warwick R, Williams PL | edition=35th British| publisher= Longman |location=London|year=1973 |page=1046 |isbn=978-0443010118 | title-link=Gray's Anatomy }} [343] => [344] => == History == [345] => {{See also|Natural childbirth#History|Men's role in childbirth#History}} [346] => [347] => === Role of males === [348] => Historically, women have been attended and supported by other women during labour and birth. Midwife training in European cities began in the 1400s, but rural women were usually assisted by female family or friends.Hutter Epstein, M.D., Randi (2011). ''Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank''. New York: W.W. Norton & Company, Inc. However, it was not simply a ladies' social bonding event as some historians have portrayed – fear and pain often filled the atmosphere, as death during childbirth was a common occurrence.{{cite journal | first = Nancy Schrom | last = Dye | name-list-style = vanc | date =Autumn 1980 | title = History of Childbirth in America | journal = Signs: Journal of Women in Culture and Society | publisher = The University of Chicago Press | volume = 6 | issue = 1 | pages = 97–108 | jstor = 3173968 | doi=10.1086/493779 | pmid = 21213655 | s2cid = 144068193 }} In the United States before the 1950s, a father would not be in the birthing room. It did not matter if it was a [[home birth]]; the father would be waiting downstairs or in another room in the home. If it was in a hospital, then the father would wait in the waiting room.{{cite book | last = Leavitt | first = Judith W. | date = 1988 | title = Brought to Bed: Childbearing in America, 1750–1950 | publisher = University of Oxford | pages = 90–91 | isbn = 978-0-19-505690-7 }} Fathers were only permitted in the room if the life of the mother or baby was severely at-risk. In 1522, a German physician was sentenced to death for sneaking into a delivery room dressed as a woman. [349] => [350] => The majority of guidebooks related to pregnancy and childbirth were written by men who had never been involved in the birthing process.{{according to whom|date=March 2021}} A Greek physician, [[Soranus of Ephesus]], wrote a book about obstetrics and gynaecology in the second century, which was referenced for the next thousand years. The book contained endless home remedies for pregnancy and childbirth, many of which would be considered heinous by modern women and medical professionals. [351] => [352] => Both preterm and full term infants benefit from skin to skin contact, sometimes called [[kangaroo care]], immediately following birth and for the first few weeks of life. Some fathers have begun to hold their newborns skin to skin; the new baby is familiar with the father's voice and it is believed that contact with the father helps the infant to stabilise and promotes father to infant bonding. Looking at recent studies, a 2019 review found that the level of [[oxytocin]] was found to increase not only in mothers who had experienced early skin to skin attachment with their infants but in the fathers as well, suggesting a [[neurobiological]] connection. If the infant's mother had a caesarean birth, the father can hold their baby in skin-to-skin contact while the mother recovers from the anaesthetic. [353] => [354] => === Hospitals === [355] => Historically, most women gave birth at home without emergency medical care available. In the early days of hospitalisation for childbirth, a 17th-century maternity ward in Paris was incredibly congested, with up to five pregnant women sharing one bed. At this hospital, one in five women died during the birthing process. At the onset of the [[Industrial Revolution]], giving birth at home became more difficult due to congested living spaces and dirty living conditions. That drove urban and lower-class women to newly available hospitals, while wealthy and middle-class women continued to labour at home.{{cite book|last= Cassidy|first= Tina|name-list-style= vanc|title= Birth|publisher= Atlantic Monthly Press|location= New York|year= 2006|pages= [https://archive.org/details/birthsurprisingh00cass/page/54 54–55]|isbn= 978-0-87113-938-2|url= https://archive.org/details/birthsurprisingh00cass/page/54}} Consequently, wealthier women experienced lower maternal mortality rates than those of a lower social class.{{cite journal | vauthors = Loudon I | title = Maternal mortality in the past and its relevance to developing countries today | journal = The American Journal of Clinical Nutrition | volume = 72 | issue = 1 Suppl | pages = 241S–246S | date = July 2000 | pmid = 10871589 | doi = 10.1093/ajcn/72.1.241S | doi-access = free }} Throughout the 1900s, there was an increasing availability of hospitals, and more women began going into the hospital for labour and delivery. In the United States, 5% of women gave birth in hospitals in 1900. By 1930, 50% of all women and 75% of urban-dwelling women delivered in hospitals. By 1960, this number increased to 96%. By the 1970s, home birth rates fell to approximately 1%.A natural process? Women, men and the medicalisation of childbirth". ''broughttolife.sciencemuseum.org.uk''. Retrieved 3 December 2018. In the United States, the middle classes were especially receptive to the medicalisation of childbirth, which promised a safer and less painful labour.{{cite journal |year = 2005 |title = Consumer Risk Perceptions in a Community of Reflexive Doubt |journal = Journal of Consumer Research|volume = 32|pages = 235–48 |doi = 10.1086/432233 | vauthors = Thompson CJ | issue = 2}} [356] => [357] => Accompanied by the shift from home to hospital was the shift from midwife to physician. Male physicians began to replace female midwives in Europe and the United States in the 1700s. The rise in status and popularity of this new position was accompanied by a drop in status for midwives. By the 1800s, affluent families were primarily calling male doctors to assist with their deliveries, and female midwives were seen as a resource for women who could not afford better care. That completely removed women from assisting in labour, as only men were eligible to become doctors at the time. Additionally, it privatised the birthing process as family members and friends were often banned from the delivery room.{{citation needed|date=March 2021}} [358] => [359] => There was opposition to the change from both progressive feminists and religious conservatives. The feminists were concerned about job security for a role that had traditionally been held by women. The conservatives argued that it was immoral for a woman to be exposed in such a way in front of a man. For that reason, many male obstetricians performed deliveries in dark rooms or with their patient fully covered with a drape.{{citation needed|date=March 2021}} [360] => [361] => ====Baby Friendly Hospitals==== [362] => [363] => In 1991 the WHO launched a global program, the [[Baby Friendly Hospital Initiative]] (BFHI), that encourages birthing centers and hospitals to institute procedures that encourage mother/baby bonding and breastfeeding. The [[Johns Hopkins Hospital]] describes the process of receiving the Baby Friendly designation: [364] => {{blockquote|It involves changing long-standing policies, protocols and behaviors. The Baby-Friendly Hospital Initiative includes a very rigorous credentialing process that includes a two-day site visit, where assessors evaluate policies, community partnerships and education plans, as well as interview patients, physicians and staff members.{{cite web |title=The Baby-Friendly Hospital Initiative |url=https://www.hopkinsmedicine.org/gynecology_obstetrics/specialty_areas/birthing-services/johns-hopkins-hospital/baby-friendly.html#:~:text=The%20Baby-Friendly%20Hospital%20Initiative%20%28BFHI%29%2C%20a%20global%20program,of%20care%20for%20infant%20feeding%20and%20mother-baby%20bonding. |website=Johns Hopkins Medicine |access-date=January 9, 2022 |archive-date=9 January 2022 |archive-url=https://web.archive.org/web/20220109222941/https://www.hopkinsmedicine.org/gynecology_obstetrics/specialty_areas/birthing-services/johns-hopkins-hospital/baby-friendly.html#:~:text=The%20Baby-Friendly%20Hospital%20Initiative%20%28BFHI%29%2C%20a%20global%20program,of%20care%20for%20infant%20feeding%20and%20mother-baby%20bonding. |url-status=live }}}} [365] => [366] => Every major health organisation, such as the [[Centers for Disease Control and Prevention|CDC]], supports the BFHI. As of 2019, 28% of hospitals in the US have been accredited by the WHO.{{cite web |title=The CDC Guide to Breastfeeding Interventions |url=https://www.cdc.gov/breastfeeding/pdf/bf_guide_1.pdf |website=CDC |access-date=9 January 2022 |archive-date=21 January 2022 |archive-url=https://web.archive.org/web/20220121014658/https://www.cdc.gov/breastfeeding/pdf/bf_guide_1.pdf |url-status=live }} [367] => [368] => === Medication === [369] => The use of pain medication in labour has been a controversial issue for hundreds of years. A Scottish woman was burned at the stake in 1591 for requesting pain relief in the delivery of twins. Medication became more acceptable in 1852, when Queen Victoria used chloroform as pain relief during labour. The use of [[morphine]] and [[scopolamine]], also known as "[[twilight sleep]]", was first used in Germany and popularised by German physicians Bernard Kronig and Karl Gauss. This concoction offered minor pain relief but mostly allowed women to completely forget the entire delivery process. Under twilight sleep, mothers were often blindfolded and restrained as they experienced the immense pain of childbirth. The cocktail came with severe side effects, such as decreased uterine contractions and altered mental state. Additionally, babies delivered with the use of childbirth drugs often experienced temporarily-ceased breathing. The feminist movement in the United States openly and actively supported the use of twilight sleep, which was introduced to the country in 1914. Some physicians, many of whom had been using painkillers for the past fifty years, including opium, cocaine, and quinine, embraced the new drug. Others were hesitant. [370] => [371] => === Caesarean sections === [372] => [373] => There are many conflicting stories of the first successful [[cesarean section]] (or C-section) in which both mother and baby survived. It is, however, known that the procedure had been attempted for hundreds of years before it became accepted in the beginning of the twentieth century. While forceps have gone through periods of high popularity, today they are only used in approximately 10% of deliveries. The c-section has become the more popular solution for difficult deliveries. In 2005, one-third of babies were born via C-section. Historically, surgical delivery was a last-resort method of extracting a baby from its deceased or dying mother but today [[caesarean delivery on maternal request]] is a medically unnecessary caesarean section, where the infant is born by a caesarean section requested by the parent even though there is not a medical [[Indication (medicine)|indication]] to have the surgery.{{cite journal|year=2006|title=State-of-the-Science Conference Statement. Cesarean Delivery on Maternal Request|url=http://consensus.nih.gov/2006/CesareanStatement_Final053106.pdf|journal=Obstetrics & Gynecology |volume=107|issue=6|pages=1386–97|doi=10.1097/00006250-200606000-00027|pmid=16738168|author=NIH|url-status=dead|archive-url=https://web.archive.org/web/20170118080344/https://consensus.nih.gov/2006/CesareanStatement_Final053106.pdf|archive-date=18 January 2017|access-date=30 December 2008}} [374] => [375] => === Natural childbirth === [376] => {{main|Natural childbirth}} [377] => The reemergence of "natural childbirth" began in Europe and was adopted by some in the US as early as the late 1940s. Early supporters believed that the drugs used during deliveries interfered with "happy childbirth" and could negatively impact the newborn's "emotional wellbeing". By the 1970s, the call for natural childbirth was spread nationwide, in conjunction with [[Second-wave feminism|the second-wave of the feminist movement]]. While it is still most common for American women to deliver in the hospital, supporters of natural birth still widely exist, especially in the UK where midwife-assisted [[home birth]]s have gained popularity. [378] => [379] => == Epidemiology == [380] => {{main|Maternal mortality}} [381] => [[File:810 women die every day from preventable causes related to pregnancy and childbirth, 94% occur in low and lower middle-income countries.png|thumb|330x330px|810 women die every day from preventable causes related to pregnancy and childbirth. 94% occur in low and lower middle-income countries.]] [382] => The [[United Nations Population Fund]] estimated that 303,000 women died of pregnancy or childbirth related causes in 2015.{{cite web|title=Maternal health|url=http://www.unfpa.org/maternal-health|access-date=29 January 2017|publisher=United Nations Population Fund|archive-date=29 November 2020|archive-url=https://web.archive.org/web/20201129122355/https://www.unfpa.org/maternal-health|url-status=live}} These causes range from [[Postpartum bleeding|severe bleeding]] to [[Obstructed labour#Prognosis|obstructed labour]],{{cite journal|date=January 2015|title=Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013|journal=Lancet|volume=385|issue=9963|pages=117–71|doi=10.1016/S0140-6736(14)61682-2|pmc=4340604|pmid=25530442 |last1=Murray |first1=Christopher JL |last2=Lopez |first2=Alan D |last3=Vos |first3=Theo|collaboration=GBD 2013 Mortality and Causes of Death Collaborators }} for which there are highly effective interventions. As women have gained access to [[family planning]] and skilled [[birth attendant]]s with backup emergency obstetric care, the global maternal mortality ratio has fallen from 385 maternal deaths per 100,000 live births in 1990 to 216 deaths per 100,000 live births in 2015, and it was reported in 2017 that many countries had halved their maternal death rates in the last 10 years. [383] => [384] => Outcomes for mothers in childbirth were especially poor before [[antibiotics]] were discovered in the 1930s, because of high rates of [[Postpartum infections|puerperal fever]]. Until [[Germ theory of disease|germ theory]] was accepted in the mid-1800s, it was assumed that puerperal fever was caused by a variety of sources, including the leakage of breast milk into the body and anxiety. Later, it was discovered that puerperal fever was transmitted by the dirty hands and tools of doctors. [385] => [386] => Home births facilitated by trained midwives produced the best outcomes from 1880 to 1930 in the US and Europe, whereas physician-facilitated hospital births produced the worst. The change in trend of maternal mortality can be attributed with the widespread use of antibiotics along with the progression of medical technology, more extensive physician training, and less medical interference with normal deliveries. [387] => [388] => Since the US began recording childbirth statistics in 1915, the US has had historically poor maternal mortality rates in comparison to other developed countries. Britain started recording maternal mortality data from 1880 onward. [389] => [390] => ==Society and culture== [391] => [[File:Miniature Naissance Louis VIII.jpg|thumb|right|210px|Medieval woman, having given birth, enjoying her [[lying-in]] ([[postpartum confinement]]). France, 14th century.]]Distress levels vary widely during pregnancy as well as during labour and delivery. They appear to be influenced by fear and anxiety levels, experience with prior childbirth, cultural ideas of childbirth pain, mobility during labour, and the support received during labour.{{cite journal |vauthors=Weber SE |date=January 1996 |title=Cultural aspects of pain in childbearing women |journal=Journal of Obstetric, Gynecologic, and Neonatal Nursing |volume=25 |issue=1 |pages=67–72 |doi=10.1111/j.1552-6909.1996.tb02515.x |pmid=8627405|doi-access=free }}{{cite journal |display-authors=4 |vauthors=Callister LC, Khalaf I, Semenic S, Kartchner R, Vehvilainen-Julkunen K |date=December 2003 |title=The pain of childbirth: perceptions of culturally diverse women |journal=Pain Management Nursing |volume=4 |issue=4 |pages=145–54 |doi=10.1016/S1524-9042(03)00028-6 |pmid=14663792}} [392] => [[File:Lurestan Fibula (4484325444).jpg|thumbnail|A [[Luristan bronze]] [[Fibula (brooch)|fibula]] showing a woman giving birth between two [[antelopes]], ornamented with [[flowers]]. From Iran, 1000 to 650 BC, at the [[Louvre museum]].]] [393] => Personal expectations, the amount of support from caregivers, quality of the caregiver-patient relationship, and involvement in decision-making are more important in the mother's overall satisfaction with the birthing experience than are other factors such as age, [[socioeconomic status]], ethnicity, preparation, physical environment, pain, immobility, or medical interventions.{{cite journal |vauthors=Hodnett ED |date=May 2002 |title=Pain and women's satisfaction with the experience of childbirth: a systematic review |journal=American Journal of Obstetrics and Gynecology |volume=186 |issue=5 Suppl Nature |pages=S160-72 |doi=10.1016/S0002-9378(02)70189-0 |pmid=12011880 |s2cid=33672391}} [394] => [395] => ===Costs=== [396] => [[File:Cost of Childbirth.jpg|thumb|400px|alt=Cost of Childbirth in several countries in 2012.|Cost of childbirth in several countries in 2012{{Cite news|url=https://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html|title=American Way of Birth, Costliest in the World |url-status=live|archive-url=https://web.archive.org/web/20170101175649/http://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html?pagewanted=all|archive-date=1 January 2017|newspaper=The New York Times|date=30 June 2013|last1=Rosenthal|first1=Elisabeth| name-list-style = vanc }}]] [397] => [398] => According to a 2013 analysis commissioned by ''The New York Times'' and performed by Truven Healthcare Analytics, the cost of childbirth varies dramatically by country. In the United States the average amount actually paid by insurance companies or other payers in 2012 averaged $9,775 for an uncomplicated conventional delivery and $15,041 for a caesarean birth. A 2013 study found varying costs by facility for childbirth expenses in [[California]], varying from $3,296 to $37,227 for a vaginal birth and from $8,312 to $70,908 for a caesarean birth.{{cite journal | vauthors = Hsia RY, Akosa Antwi Y, Weber E | title = Analysis of variation in charges and prices paid for vaginal and caesarean section births: a cross-sectional study | journal = BMJ Open | volume = 4 | issue = 1 | pages = e004017 | date = January 2014 | pmid = 24435892 | pmc = 3902513 | doi = 10.1136/bmjopen-2013-004017 }} {{open access}} [399] => [400] => Reporting on costs in 2023, ''Forbes'' gave an average cost of $18,865 ($14,768 for vaginal and [401] => $26,280 for cesarean) which included pregnancy, delivery and postpartum care. However, many factors determined the costs, including where the woman lived, the type of birth, and whether or not they had insurance. Even with insurance, average out of the pocket expenses for a vaginal delivery were $2,655 and $3,214 for a cesarean birth. Variables which determined charges included length of hospital stay, which averaged 48 hours for vaginal birth and 96 hours for a cesarean. There could be charges for any complications before or after the birth, for example an induced labour costs more than a spontaneous birth. Babies that had a difficult birth may need special tests and monitoring, adding to the costs of childbirth.{{cite web |last1=Rivelli |first1=Elizabeth |title=How Much Does It Cost To Have A Baby? 2023 Averages |url=https://www.forbes.com/advisor/health-insurance/average-childbirth-cost/#:~:text=Giving%20birth%20costs%20%2418%2C865%20on%20average%2C%20including%20pregnancy%2C,insurance%3F%20You%20can%20expect%20a%20hefty%20hospital%20bill. |website=Forbes |access-date=10 March 2023 |archive-date=10 March 2023 |archive-url=https://web.archive.org/web/20230310134058/https://www.forbes.com/advisor/health-insurance/average-childbirth-cost/#:~:text=Giving%20birth%20costs%20%2418%2C865%20on%20average%2C%20including%20pregnancy%2C,insurance%3F%20You%20can%20expect%20a%20hefty%20hospital%20bill. |url-status=live }} [402] => [403] => Beginning in 2014, the [[National Institute for Health and Care Excellence]] began recommending that many women give birth at home under the care of a midwife rather than an obstetrician, citing lower expenses and better healthcare outcomes.{{cite book |author=National Collaborating Centre for Women's and Children's Health |title=Intrapartum Care: Care of Healthy Women and Their Babies During Childbirth |location=London |publisher=RCOG |year=2007 |series=NICE Clinical Guidelines, No. 55 |url=https://www.ncbi.nlm.nih.gov/books/NBK49388/ |pmid=21250397 |isbn=9781904752363 |access-date=22 October 2019 |archive-date=15 July 2020 |archive-url=https://web.archive.org/web/20200715213338/https://www.ncbi.nlm.nih.gov/books/NBK49388/ |url-status=live }}{{page needed|date=October 2019}}{{cite web |title=Recommendations: Intrapartum care for healthy women and babies |url=https://www.nice.org.uk/guidance/cg190/chapter/Recommendations#place-of-birth |website=National Institute for Health and Care Excellence |date=3 December 2014 |access-date=6 December 2020 |archive-date=2 December 2020 |archive-url=https://web.archive.org/web/20201202225019/https://www.nice.org.uk/guidance/cg190/chapter/Recommendations#place-of-birth |url-status=live }} The median cost associated with home birth was estimated to be about $1,500 vs. about $2,500 in hospital.{{Cite news|url=https://www.nytimes.com/2014/12/04/world/british-regulator-urges-home-births-over-hospitals-for-uncomplicated-pregnancies.html|title=British Regulator Urges Home Births Over Hospitals for Uncomplicated Pregnancies - NYTimes.com|url-status=live|archive-url=https://web.archive.org/web/20170328080317/https://www.nytimes.com/2014/12/04/world/british-regulator-urges-home-births-over-hospitals-for-uncomplicated-pregnancies.html?_r=0|archive-date=28 March 2017|newspaper=The New York Times|date=3 December 2014|last1=Bennhold|first1=Katrin|last2=Louis|first2=Catherine Saint | name-list-style = vanc }} [404] => [405] => === Location === [406] => {{further|Home birth}} [407] => Childbirth routinely occurs in hospitals in many [[developed countries]]. Before the 20th century and in some countries to the present day, such as [[Netherlands|the Netherlands]], it has more typically occurred at home.{{cite book |title= Encyclopedia of Social History |volume= V. 780 |series= Garland Reference Library of Social Sciences |publisher= Taylor & Francis | veditors = Stearns PN |isbn= 978-0-8153-0342-8 |location= London |page= 144 |url= https://books.google.com/books?id=kkIeyCEedrsC&pg=PA144 |year= 1993 |url-status= live |archive-url= https://web.archive.org/web/20160102154830/https://books.google.com/books?id=kkIeyCEedrsC&pg=PA144 |archive-date= 2 January 2016 }} [408] => [409] => In rural and [[remote communities]] of many countries, hospitalised childbirth may not be readily available or the best option. Maternal evacuation is the predominant risk management method for assisting mothers in these communities.{{Cite book|title=Indigenous experiences of pregnancy and birth| first1 = Hannah Neufeld | last1 = Tait | first2 = Jaime | last2 = Cidro | name-list-style = vanc |isbn=978-1772581355|oclc=1012401274|year= 2018| publisher = Demeter Press }} Maternal evacuation is the process of relocating pregnant women in remote communities to deliver their babies in a nearby urban hospital setting. This practice is common in Indigenous [[Inuit]] and Northern Manitoban communities in [[Canada]] as well as [[Aboriginal Australians|Australian aboriginal]] communities. There has been research considering the negative effects of maternal evacuation due to a lack of social support provided to these women. These negative effects include an increase in maternal newborn complications and postpartum depression, and decreased breastfeeding rates. [410] => [411] => The [[locus in quo|exact location]] in which childbirth takes place is an important factor in determining nationality, in particular for [[birth aboard aircraft and ships]]. [412] => [413] => ===Facilities=== [414] => Facilities for childbirth include: [415] => * A ''labour ward'', also called a ''delivery ward'' or ''labour and delivery'', is generally a [[Hospital department|department of a hospital]] that focuses on providing [[health care]] to women and their children during childbirth. It is generally closely linked to the hospital's [[neonatal intensive care unit]] and/or [[obstetric surgery]] unit if present. A ''maternity ward'' or ''maternity unit'' may include facilities both for childbirth and for [[postpartum]] rest and observation of mothers in normal as well as complicated cases. [416] => * A [[maternity hospital]] is a hospital that specialises in caring for women while they are pregnant and during childbirth and provide care for newborn babies, [417] => * A [[birthing center]] generally presents a simulated home-like environment. Birthing centers may be located on hospital grounds or "free standing" (that is, not affiliated with a hospital). [418] => * A [[home birth]] is usually accomplished with the assist of a midwife. Some women choose to give birth at home without any professionals present, termed an [[unassisted childbirth]]. [419] => [420] => ===Associated occupations=== [421] => [[File:Modelo-de-quadril.jpg|thumb|Model of pelvis used in the beginning of the 19th century to teach technical procedures for a successful childbirth. Museum of the History of Medicine, [[Porto Alegre]], Brazil]] [422] => [423] => Different categories of [[birth attendant]]s may provide support and care during pregnancy and childbirth, although there are important differences across categories based on professional training and skills, practice regulations, and the nature of care delivered. Many of these occupations are highly professionalised, but other roles exist on a less formal basis. [424] => [425] => "Childbirth educators" are instructors who aim to teach pregnant women and their partners about the nature of pregnancy, labour signs and stages, techniques for giving birth, breastfeeding and newborn baby care. Training for this role can be found in hospital settings or through independent certifying organisations. Each organisation teaches its own curriculum and each emphasises different techniques. The [[Lamaze technique]] is one well-known example. [426] => [427] => [[Doula]]s are 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 women during labour. Like childbirth educators and other [[unlicensed assistive personnel]], certification to become a doula is not compulsory, thus, anyone can call themself a doula or a childbirth educator.{{citation needed|date=March 2021}} [428] => [429] => [[Nanny#Types|Confinement nannies]] are individuals who are employed to provide assistance and stay with the mothers at their home after childbirth. They are usually experienced mothers who took courses on how to take care of mothers and newborn babies.{{citation needed|date=March 2021}} [430] => [431] => [[Midwifery|Midwives]] are autonomous practitioners who provide basic and emergency health care before, during and after pregnancy and childbirth, generally to women with low-risk pregnancies. Midwives are trained to assist during labour and birth, either through direct-entry or nurse-midwifery education programs. Jurisdictions where midwifery is a regulated profession will typically have a registering and disciplinary body for quality control, such as the American Midwifery Certification Board in the United States,{{cite web |url=http://www.amcbmidwife.org/about-amcb |title=About AMCB |access-date=20 February 2014 |url-status=live |archive-url=https://web.archive.org/web/20140223000426/http://www.amcbmidwife.org/about-amcb |archive-date=23 February 2014 }} the College of Midwives of British Columbia in Canada{{cite web |url= http://www.cmbc.bc.ca/ |work= College of Midwives of British Columbia website |title= Welcome to the College of Midwives of British Columbia |access-date= 30 August 2013 |author= |publisher= |url-status= live |archive-url= https://web.archive.org/web/20130917090243/http://www.cmbc.bc.ca/ |archive-date= 17 September 2013 }}{{cite web |title= Health Professions Act |work= Statues and Regulations of British Columbia internet version |volume= Chapter 183 |publisher= Queens Printer |location= Vancouver, British Columbia, Canada |orig-year= Revised Statues of British Columbia 1996 |date= 21 August 2013 |url= http://www.bclaws.ca/EPLibraries/bclaws_new/document/ID/freeside/00_96183_01 |access-date= 30 August 2013 |author= Province of British Columbia |url-status= live |archive-url= https://web.archive.org/web/20130825071500/http://www.bclaws.ca/EPLibraries/bclaws_new/document/ID/freeside/00_96183_01 |archive-date= 25 August 2013 }} or the [[Nursing and Midwifery Council]] in the United Kingdom.{{cite web |title= Our role |work= Nursing & Midwifery Council website |url= http://www.nmc-uk.org/About-us/Our-role/ |orig-year= Created 2010-02-24 |date= 31 August 2011 |access-date= 30 August 2013 |author= |publisher= |location= London, England |url-status= live |archive-url= https://web.archive.org/web/20130905035801/http://www.nmc-uk.org/About-us/Our-role/ |archive-date= 5 September 2013 }}{{cite web |title= The Nursing and Midwifery Order 2001 |url= http://www.legislation.gov.uk/uksi/2002/253/contents/made |year= 2002 |volume= No. 253 |publisher= [[Office of Public Sector Information|Her Majesty's Stationery Office]], [[The National Archives (United Kingdom)|The National Archives]], [[Ministry of Justice (United Kingdom)|Ministry of Justice]], [[Government of the United Kingdom|Her Majesty's Government]] |location= London, England |url-status= live |archive-url= https://web.archive.org/web/20130808173537/http://www.legislation.gov.uk/uksi/2002/253/contents/made |archive-date= 8 August 2013 }} [432] => [433] => In the past, midwifery played a crucial role in childbirth throughout most indigenous societies. Although western civilisations attempted to assimilate their birthing technologies into certain indigenous societies, like [[Turtle Islands, Tawi-Tawi|Turtle Island]], and get rid of the midwifery, the National Aboriginal Council of Midwives brought back the cultural ideas and midwifery that were once associated with indigenous birthing.{{Cite book|title=Natal signs: cultural representations of pregnancy, birth and parenting | last = Burton | first = Nadya | name-list-style = vanc |date=2015|publisher=Demeter Press|isbn=978-1926452326|oclc=949328683}} [434] => [435] => In jurisdictions where midwifery is not a regulated profession, [[traditional birth attendant]]s, also known as traditional or lay midwives, may assist women during childbirth, although they do not typically receive formal health care education and training. [436] => [437] => [[Doctor of Medicine|Medical doctors]] who practise in the field of childbirth include categorically specialised [[obstetrics|obstetricians]], [[family medicine|family practitioners]] and [[general practice|general practitioners]] whose training, skills and practices include obstetrics, and in some contexts [[general surgeon]]s. These physicians and surgeons variously provide care across the whole spectrum of normal and abnormal births and pathological labour conditions. Categorically specialised obstetricians are qualified [[surgeon]]s, so they can undertake surgical procedures relating to childbirth. Some family practitioners or general practitioners also perform obstetrical surgery. Obstetrical procedures include [[cesarean section]]s, [[episiotomy|episiotomies]], and assisted delivery. Categorical specialists in obstetrics are commonly trained in both [[obstetrics and gynaecology]] (OB/GYN), and may provide other medical and surgical gynaecological care, and may incorporate more general, well-woman, [[primary care]] elements in their practices. [[Maternal–fetal medicine]] specialists are obstetrician/gynecologists subspecialised in managing and treating high-risk pregnancy and delivery. [438] => [439] => [[Anaesthetists]] or [[anaesthetists]] are medical doctors who specialise in pain relief and the use of drugs to facilitate surgery and other painful procedures. They may contribute to the care of a woman in labour by performing an [[epidural]] or by providing [[anaesthesia]] (often [[spinal anaesthesia]]) for Cesarean section or [[forceps delivery]]. They are experts in [[pain management during childbirth]]. [440] => [441] => [[Obstetrics gynecology nursing|Obstetric nurses]] assist midwives, doctors, women, and babies before, during, and after the birth process, in the hospital system. They hold various [[Nursing board certification|nursing certifications]] and typically undergo additional obstetric training in addition to standard [[Nursing school|nursing training]]. [442] => [443] => [[Paramedic]]s are healthcare providers that are able to provide emergency care to both the mother and infant during and after delivery using a wide range of medications and tools on an ambulance. They are capable of delivering babies but can do very little for infants that become "stuck" and are unable to be delivered vaginally. [444] => [445] => [[Lactation consultant]]s assist the mother and newborn to [[breastfeed]] successfully. A [[health visitor]] comes to see the mother and baby at home, usually within 24 hours of discharge, and checks the infant's [[adaptation to extrauterine life]] and the mother's [[postpartum physiological changes]]. [446] => [447] => === Non-western communities === [448] => Cultural values, assumptions, and practices of pregnancy and childbirth vary across cultures. For example, some [[Maya peoples#Guatemala|Maya]] women who work in agricultural fields of some rural communities will usually continue to work in a similar function to how they normally would throughout pregnancy, in some cases working until labour begins.{{Cite book|title=Developing destinies: a Mayan midwife and town|last=Barbara|first=Rogoff | name-list-style = vanc |date=2011|publisher=Oxford University Press|isbn=978-0-19-531990-3|oclc=779676136}}{{page needed|date=October 2019}} [449] => [450] => Comfort and proximity to extended family and social support systems may be a childbirth priority of many communities in developing countries, such as the Chillihuani in Peru and the Mayan town of San Pedro La Laguna.{{Cite book|title=Growing up in a culture of respect child rearing in highland Peru|last=Inge|first=Bolin | name-list-style = vanc |date=2006|publisher=University of Texas Press|oclc=748863692}}{{page needed|date=October 2019}} Home births can help women in these cultures feel more comfortable as they are in their own home with their family around them helping out in different ways. Traditionally, it has been rare in these cultures for the mother to lie down during childbirth, opting instead for standing, kneeling, or walking around prior to and during birthing. [451] => [452] => Some communities rely heavily on religion for their birthing practices. It is believed that if certain acts are carried out, then it will allow the child for a healthier and happier future. One example of this is the belief in the Chillihuani that if a knife or scissors are used for cutting the [[umbilical cord]], it will cause for the child to go through clothes very quickly. To prevent this, a jagged ceramic tile is used to cut the umbilical cord. In Mayan societies, ceremonial gifts are presented to the mother throughout pregnancy and childbirth to help her into the beginning of her child's life. [453] => [454] => Ceremonies and customs can vary greatly between countries. See; [455] => {{columns-list|colwidth=15em| [456] => * [[Childbirth in Benin]] [457] => * [[Childbirth in Ghana]] [458] => * [[Childbirth in Haiti]] [459] => * [[Childbirth in India]] [460] => * [[Childbirth in Iraq]] [461] => * [[Childbirth in Japan]] [462] => * [[Childbirth in Mexico]] [463] => * [[Childbirth in Nepal]] [464] => * [[Childbirth in Sri Lanka]] [465] => * [[Childbirth in Thailand]] [466] => * [[Childbirth in Trinidad and Tobago]] [467] => * [[Childbirth in Zambia]] [468] => }} [469] => [470] => ===Collecting stem cells=== [471] => It is currently possible to collect two types of [[stem cells]] during childbirth: [[amniotic stem cells]] and umbilical [[cord blood]] stem cells. They are being studied as possible treatments of a number of conditions.{{cite journal | vauthors = Dziadosz M, Basch RS, Young BK | title = Human amniotic fluid: a source of stem cells for possible therapeutic use | journal = American Journal of Obstetrics and Gynecology | volume = 214 | issue = 3 | pages = 321–27 | date = March 2016 | pmid = 26767797 | doi = 10.1016/j.ajog.2015.12.061 }} [472] => [473] => === Placentophagy === [474] => Some animal mothers are known to eat their afterbirth, called [[placentophagy]]. In some cultures the placenta may be consumed as a nutritional boost, but it may also be seen as a special part of birth and eaten by the newborn's family ceremonially.{{cite book|title=Having a Great Birth in Australia: Twenty Stories of Triumph, Power, Love and Delight from the Women and Men who Brought New Life Into the World|publisher=[[Australian College of Midwives]]|year=2005|isbn=978-0-9751674-3-4| veditors = Vernon DM |editor-link=David Vernon (writer)|location=Canberra, Australia|page=56|title-link=Having a Great Birth in Australia}} In the developed world the placenta may be eaten believing that it reduces postpartum bleeding, increases milk supply, provides micronutrients such as iron, and improves mood and boosts energy. The CDC advises against this practice, saying it has not been shown to promote health but has been shown to possibly transmit disease organisms that were passed from the placenta into the mother's breastmilk and then infecting the baby.{{cite web |title=Labor and delivery, postpartum care |url=https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/expert-answers/eating-the-placenta/faq-20380880 |website=Mayo Clinic |access-date=29 June 2022 |archive-date=29 June 2022 |archive-url=https://web.archive.org/web/20220629155636/https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/expert-answers/eating-the-placenta/faq-20380880 |url-status=live }} [475] => [476] => == See also == [477] => {{columns-list|colwidth=30em| [478] => * [[Abuse during childbirth]] [479] => * [[Advanced maternal age]], when a woman is of an older age at reproduction [480] => * [[Antinatalism]] [481] => * [[Asynclitic birth]], an abnormal birth position [482] => * [[Birth defect]] [483] => * [[Childbirth positions]] [484] => * [[Coffin birth]] [485] => * [[Ferguson reflex]] [486] => * [[Maternal health]] [487] => * [[Multiple birth]] [488] => * [[Obstetrical bleeding]] [489] => * [[Naegele's rule]], to calculate the due date for a pregnancy [490] => * [[Natalism]] [491] => * [[Obstetrical Dilemma]] [492] => * [[Perineal massage]] [493] => * [[Pre- and perinatal psychology]] [494] => * [[Reproductive Health Supplies Coalition]] [495] => * [[Unassisted childbirth]] [496] => * [[Vernix caseosa]] [497] => [498] => '''Natural birth topics:''' [499] => * [[Bradley method of natural childbirth]] [500] => * [[Lamaze]] [501] => * [[Natural childbirth]] [502] => * [[Water birth]] [503] => }} [504] => [505] => == References == [506] => {{Reflist}} [507] => [508] => == External links == [509] => {{Sister project links}} [510] => [511] => * [https://players.brightcove.net/3850378299001/SyAEZ6ptl_default/index.html?videoId=4703722752001 Spontaneous Vaginal Delivery], Video by Merck Manual Professional Edition [512] => * [https://opqic.org/maternal-morbidity-mortality-in-the-media/ Maternal Morbidity/Mortality in the Media] {{Webarchive|url=https://web.archive.org/web/20220727193827/https://opqic.org/maternal-morbidity-mortality-in-the-media/ |date=27 July 2022 }} [513] => [514] => {{Medical resources [515] => | ICD11 = {{ICD11|JB2|973282267}} [516] => | ICD10 = {{ICD10|O80-O84}} [517] => }} [518] => [519] => {{Women's health|state=collapsed}} [520] => {{Human development}} [521] => {{Reproductive health}} [522] => {{Pregnancy}} [523] => {{Pathology of pregnancy, childbirth and the puerperium}} [524] => {{Infants and their care}} [525] => {{Authority control}} [526] => [527] => [[Category:Childbirth| ]] [528] => [[Category:Midwifery]] [529] => [[Category:Wikipedia medicine articles ready to translate]] [] => )
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Childbirth

Childbirth is the process by which a baby is born. It typically includes three stages: labor, delivery of the baby, and the delivery of the placenta.

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It typically includes three stages: labor, delivery of the baby, and the delivery of the placenta. Labor involves contractions of the uterus, which help the baby move through the birth canal. Delivery can occur through various methods, including vaginal birth, assisted delivery, or cesarean section. The placenta, which enables nutrients and oxygen to reach the baby during pregnancy, is expelled shortly after birth. The experience of childbirth can vary greatly, and factors such as medical interventions, pain management, and cultural practices can influence the process. Childbirth has important social, emotional, and health implications for both the mother and the baby, and is a significant event in human reproduction.

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