{"id":169,"date":"2014-09-18T15:49:51","date_gmt":"2014-09-18T15:49:51","guid":{"rendered":"https:\/\/courses.candelalearning.com\/lifespandevelopment1x1\/?post_type=chapter&#038;p=169"},"modified":"2024-04-29T23:14:59","modified_gmt":"2024-04-29T23:14:59","slug":"childbirth","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/chapter\/childbirth\/","title":{"raw":"Childbirth","rendered":"Childbirth"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Outcomes<\/h3>\r\n<ul>\r\n \t<li>Describe various approaches to childbirth<\/li>\r\n \t<li>Describe\u00a0a normal delivery, including the stages of childbirth<\/li>\r\n<\/ul>\r\n<\/div>\r\n<h2>Approaches to Childbirth<\/h2>\r\n[caption id=\"attachment_3824\" align=\"alignright\" width=\"379\"]<a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/21172937\/160804-F-II211-1032.jpeg\"><img class=\"wp-image-3824\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/21172937\/160804-F-II211-1032-300x220.jpeg\" alt=\"Couple practicing swaddling a baby with a doll.\" width=\"379\" height=\"278\" \/><\/a> <strong>Figure 1<\/strong>. This couple prepares for their baby by attending a class where they learn useful skills related to childbirth and infant care, including swaddling.[\/caption]\r\n\r\nPrepared childbirth refers to being not only physically in good condition to help provide a healthy environment for the baby to develop, but also helping a couple to prepare to accept their new roles as parents and to get information and training that will assist them for delivery and life with the baby as much as possible. The more a couple can learn about childbirth and the newborn, the better prepared they will be for the adjustment they must make to a new life. Nothing can prepare a couple for this completely. Once a couple finds that they are to have a child, they begin to conjure up images of what they think the experience will involve. Once the child is born, they must reconcile those images with reality (Galinsky, 1987). Knowing more of what to expect does help them in forming more realistic images thus making the adjustment easier.\u00a0Let's explore some of the methods of prepared childbirth.\r\n<h3>HypnoBirthing<\/h3>\r\nGrantley\u00a0Dick-Read was an English obstetrician and pioneer of prepared childbirth in the 1930s. In his book <em>Childbirth\u00a0Without\u00a0Fear<\/em>, he suggests that the fear of childbirth increases tension and makes the process of childbearing more painful. He believed that if mothers were educated, the fear and tension would be reduced and the need for medication could frequently be eliminated. The Dick-Read method emphasized the use of relaxation and proper breathing with contractions as well as family support and education. Today this method is known as the Mongan Method or HypnoBirthing. Women using this method report feeling like they are lost in a daydream, but focused and in control.\r\n<h3>The Lamaze Method<\/h3>\r\nThis method originated in Russia and was brought to the United States in the 1950s by\u00a0Fernand\u00a0Lamaze. The emphasis of this method is on teaching the woman to be in control in the process of delivery. It includes learning muscle relaxation, breathing through contractions, having a focal point (usually a picture to look at) during contractions and having a support person who goes through the training process with the mother and serves as a coach during delivery. The Lamaze Method is still the most commonly taught method in the U.S. today.\r\n<h3>The Bradley Method<\/h3>\r\nThis method originated in the late 1940\u2019s and helps women deliver\u00a0naturally, with few or no drugs. There are a series of courses that emphasize excellent\u00a0nutrition\u00a0and\u00a0exercise,\u00a0relaxation techniques\u00a0to manage pain, and the involvement of the partner as a coach. Parents-to-be are taught to be knowledgeable consumers of birth services and to take responsibility in making informed decisions regarding procedures, attendants and the birthplace. In turn, this will lead to\u00a0keeping mothers healthy and low-risk in order to avoid\u00a0complications\u00a0that may lead to medical intervention.\r\n<h3>Nurse Midwives<\/h3>\r\nHistorically in the United States, most babies were born under the care of lay midwives.\u00a0In\u00a0the 1920s, middle-class women were increasingly using doctors to assist with childbirth but rural women were still being assisted by lay midwives.\u00a0The nursing profession began educating nurse-midwives to assist these women.\u00a0Nurse-midwives continued to assist most rural women with delivery until the 1970s and 1980s when their growth is thought to have posed a threat to the medical profession (Weitz, 2007). Women who are at low risk for birth complications can successfully deliver under the care of nurse-midwives. Some hospitals give privileges to nurse-midwives to deliver there. They may also deliver babies at home or in birthing centers.\r\n<h3>Home Birth<\/h3>\r\nBecause one out of every 20 births involves a complication, most medical professionals recommend that delivery take place in a hospital. However,\u00a0some couples choose to have their baby at home. About 1 percent of births occur outside of a hospital in the United States. Two-thirds of these are home births and more than half of these are assisted by midwives. In the United States, women who\u00a0have had previous children, who are over 25 and who are white are most likely to not give birth in a hospital (MacDorman et al.,\u00a02010).\r\n<h3>Birthing Centers<\/h3>\r\nA birthing center presents a more home-like environment than a\u00a0hospital labor ward, typically with more options during labor: food\/drink, music, and the attendance of family and friends if desired. Other characteristics can also include non-institutional furniture such as queen-sized beds, large enough for both mother and father and perhaps birthing tubs or showers for\u00a0water births. The decor is meant to emphasize the normality of birth. In a birth center, women are free to act more spontaneously during their birth, such as squatting, walking or performing other\u00a0postures that assist in labor. Active birth is encouraged. The\u00a0length of stay\u00a0after a birth is shorter at a birth center; sometimes just 6 hours after birth the mother and infant can go home. One-third of out-of-hospital births occur in freestanding clinics, birthing centers, or in\u00a0physicians\u00a0offices or other locations.\r\n<h3>Water Birth<\/h3>\r\nLaboring and\/or giving birth in a warm tub of water can help a woman relax. The buoyancy of the water can help alleviate discomfort and pressure for the mother. Many hospitals have birthing tubs that allow women to labor in them. However, only some hospitals allow for the birth to take place in the water. Some believe that water birth gives a more calm and tranquil transition for the baby from the womb. Water births are more common to occur at home or in birthing centers.\r\n<div class=\"textbox examples\">\r\n<h3>watch it<\/h3>\r\nWatch this family's approach to childbirth by having a water birth in their home with a midwife and a doula. Note that there is no audio in the video, only background music.\r\n\r\n<iframe src=\"https:\/\/www.youtube.com\/embed\/wczscWXk8e4?start=223\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe>\r\n\r\nNot many pregnancies or births go exactly as planned, as seen in the following story of this mother who had to quickly deliver her baby at 30 weeks.\r\n\r\nhttps:\/\/www.youtube.com\/watch?time_continue=88&amp;v=jzBQQXy5XRE\r\n\r\nYou can <a href=\"https:\/\/oerfiles.s3-us-west-2.amazonaws.com\/Lifespan+Development\/Transcriptions\/MyHighRiskBirthStory_transcript.txt\" target=\"_blank\" rel=\"noopener\">view the transcript for \"My High-Risk Birth Story | CBC Parents\" here (opens in new window)<\/a>.\r\n\r\n<\/div>\r\n<h3>Hospital Birth<\/h3>\r\nMost births in the U.S. occur in hospitals. Mothers have the choice to have a medicated or unmedicated delivery. Some women do fine with \"natural methods\" of\u00a0pain relief\u00a0alone. Many women blend \"natural methods\" with\u00a0medications\u00a0and medical interventions that relieve pain. Building a positive outlook on childbirth and managing\u00a0fear\u00a0may also help some women cope with the pain. Labor pain is not like pain due to illness or injury. Instead, it is caused by contractions of the uterus that are pushing the baby down and out of the birth canal. In other words, labor pain has a purpose.\r\n\r\nThe most common pain relief method used during labor and delivery is an epidural. An epidural is a procedure that involves placing a tube into the lower back, into a small space outside the\u00a0spinal cord. Small doses of medicine can be given through the tube as needed throughout labor.\u00a0With an epidural, pain relief starts 10 to 20 minutes after the medicine has been given. The degree of numbness felt can be adjusted.\u00a0An epidural can prolong the first and second stages of labor. If given late in labor or if too much medicine is used, it might be hard to push when the time comes.\r\n<div class=\"textbox examples\">\r\n<h3>watch it<\/h3>\r\nWhat are the advantages and disadvantages of receiving an epidural? Watch this video to see how the procedure is done.\r\n\r\n<iframe src=\"\/\/plugin.3playmedia.com\/show?mf=3935257&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=2tw-SXI3wKU&amp;video_target=tpm-plugin-pb3x9zy4-2tw-SXI3wKU\" width=\"800px\" height=\"520px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe>\r\n\r\nYou can <a href=\"https:\/\/oerfiles.s3-us-west-2.amazonaws.com\/Lifespan+Development\/Transcriptions\/EpiduralAnaesthesia_transcript.txt\" target=\"_blank\" rel=\"noopener\">view the transcript for \"Epidural Anaesthesia\" here (opens in new window)<\/a>.\r\n\r\n<\/div>\r\nAnother form of pharmacologic pain relief available for laboring mothers is inhaled nitrous oxide. This is typically a 50\/50 mixture of nitrous oxide with air that is an inhaled analgesic and anesthetic. Nitrous oxide has been used for pain management in childbirth since the late 1800\u2019s. The use of inhaled analgesia is commonly used in the UK, Finland, Australia, Singapore, and New Zealand, and is gaining in popularity in the United States.[footnote]Giving Birth Naturally: Natural Childbirth Techniques. American Pregnancy Association. Retrieved from\u00a0http:\/\/americanpregnancy.org\/labor-and-birth\/natural-childbirth-techniques\/[\/footnote]\r\n<div class=\"textbox exercises\">\r\n<h3>Making A Birth Plan<\/h3>\r\nAs you can see, women have many choices when it comes to the approach they want to take in preparing for childbirth. What decisions would you make?\u00a0<a href=\"https:\/\/americanpregnancy.org\/labor-and-birth\/birth-plan\/\" target=\"_blank\" rel=\"noopener\">Learn how to create a birth plan<\/a>.\r\n\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/bc03bdd6-c5e3-4ec8-93e9-b51d58b39771\r\n\r\n<\/div>\r\n<h2>The Process of Delivery<\/h2>\r\n[caption id=\"attachment_759\" align=\"aligncenter\" width=\"499\"]<img class=\"wp-image-759\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/1496\/2016\/03\/15231141\/2920_Stages_of_Childbirth-02.jpg\" alt=\"Diagram showing the three stages of childbirth: dilation, birth, and the afterbirth delivery. Stage 1: Dilation. The amniotic fluid is within the uterus, the cervix goes from undiluted to fully dilated at over 10 centimeters in diameter. Stage 2: Birth. First, the presentation of the head. Then, the rotation and delivery of anterior shoulder. Then the delivery of posterior shoulder. Then the delivery of the lower body and umbilical cord. Stage 3: Afterbirth delivery. The placenta detaches and exists through the vagina.\" width=\"499\" height=\"780\" \/> <strong>Figure 2<\/strong>. The stages of childbirth.[\/caption]\r\n\r\n<strong>The first stage<\/strong> of labor is typically the longest. The First Stage\u00a0of labor begins with uterine contractions that may initially last about 30 seconds and be spaced 15 to 20 minutes apart. These increase in duration and frequency to more than a minute in length and about 3 to 4 minutes apart. Typically, doctors advise that they should be called when contractions are coming about every 5 minutes. Some women experience false labor or\u00a0Braxton-Hicks\u00a0contractions, especially with the first child. These may come and go. They tend to diminish when the mother begins walking around. Real labor pains tend to increase with walking.\r\n\r\nDuring this stage, the cervix or opening to the uterus dilates to 10 centimeters or just\u00a0under\u00a04 inches.\u00a0This may take around 12-16 hours for first children or about 6-9 hours for women who have previously given birth. It takes one woman in 9 over 24 hours to dilate completely. Labor may also begin with a discharge of blood or amniotic fluid. If the amniotic sack breaks, which happens for one out of eight pregnancies, labor will be induced if necessary to reduce the risk of infection.\r\n\r\n<strong>The second stage<\/strong>\u00a0involves the passage of the baby through the birth canal. This stage takes about 10-40 minutes. Contractions usually come about every 2-3 minutes. The mother pushes and relaxes as directed by the medical staff. Normally the head is delivered first. The baby is then rotated so that one shoulder can come through and then the other shoulder. The rest of the baby quickly passes through. The baby's mouth and nose are suctioned out. The umbilical cord is clamped and cut.\r\n\r\n<strong>The third stage\u00a0<\/strong>is generally less painful, at least when compared to the other stages. During this stage, the placenta or afterbirth is delivered. This typically occurs within 20 minutes after the delivery of the baby.\u00a0If tearing of the vagina occurred during birth, the tear may be stitched at this time.\r\n<h2>Cesarean Section<\/h2>\r\n<b>Cesarean section<\/b>, also known as\u00a0<b>C-section<\/b>, or\u00a0<b>cesarean delivery<\/b>, is the use of\u00a0surgery\u00a0to\u00a0deliver babies.\u00a0<sup id=\"cite_ref-NIH2010_2-0\" class=\"reference\"><\/sup>A cesarean section is often necessary when a\u00a0vaginal delivery\u00a0would put the baby or mother at risk.<sup id=\"cite_ref-NIH2010_2-1\" class=\"reference\"><\/sup>\u00a0This may include\u00a0obstructed labor,\u00a0twin pregnancy,\u00a0high blood pressure\u00a0in the mother,\u00a0breech birth, or problems with the\u00a0placenta\u00a0or\u00a0umbilical cord.<sup id=\"cite_ref-NIH2010_2-2\" class=\"reference\"><\/sup><sup id=\"cite_ref-ACOG2014_3-0\" class=\"reference\"><\/sup>\u00a0Cesarean delivery may be performed based upon the shape of the mother's\u00a0<a title=\"Pelvis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pelvis\" target=\"_blank\" rel=\"noopener\">pelvis<\/a>\u00a0or history of a previous C-section.<sup id=\"cite_ref-NIH2010_2-3\" class=\"reference\"><\/sup><sup id=\"cite_ref-ACOG2014_3-1\" class=\"reference\"><\/sup>\u00a0A trial of\u00a0vaginal birth after C-section\u00a0may be possible.\u00a0<sup id=\"cite_ref-NIH2010_2-4\" class=\"reference\"><\/sup>The\u00a0World Health Organization\u00a0recommends that cesarean sections be performed only when medically necessary.<sup id=\"cite_ref-ACOG2014_3-2\" class=\"reference\"><\/sup><sup id=\"cite_ref-WHO2015_4-0\" class=\"reference\"><\/sup>\u00a0Some C-sections are performed\u00a0without a medical reason, upon request\u00a0by someone, usually the mother.\r\n<div class=\"textbox examples\">\r\n<h3>Watch it: Vaginal and Cesarean Birth<\/h3>\r\n<ul>\r\n \t<li><a href=\"https:\/\/www.youtube.com\/watch?v=ZDP_ewMDxCo&amp;feature=player_embedded\" target=\"_blank\" rel=\"noopener\">Watch an animation of labor and vaginal birth.<\/a><\/li>\r\n \t<li><a href=\"https:\/\/www.youtube.com\/watch?v=xyN48VnRYUY\" target=\"_blank\" rel=\"noopener\">Watch an animation of a\u00a0cesarean birth.<\/a><\/li>\r\n<\/ul>\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/0e214fc6-0e8d-43cf-9bf8-02e6f574a81c\r\n\r\n<\/div>\r\n<div class=\"textbox key-takeaways\">\r\n<h3>glossary<\/h3>\r\n[glossary-page]\r\n[glossary-term]cesarean section:[\/glossary-term]\r\n[glossary-definition]is the use of surgery to deliver babies through the mother's abdomen and uterus[\/glossary-definition]\r\n[\/glossary-page]\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Outcomes<\/h3>\n<ul>\n<li>Describe various approaches to childbirth<\/li>\n<li>Describe\u00a0a normal delivery, including the stages of childbirth<\/li>\n<\/ul>\n<\/div>\n<h2>Approaches to Childbirth<\/h2>\n<div id=\"attachment_3824\" style=\"width: 389px\" class=\"wp-caption alignright\"><a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/21172937\/160804-F-II211-1032.jpeg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3824\" class=\"wp-image-3824\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/21172937\/160804-F-II211-1032-300x220.jpeg\" alt=\"Couple practicing swaddling a baby with a doll.\" width=\"379\" height=\"278\" \/><\/a><\/p>\n<p id=\"caption-attachment-3824\" class=\"wp-caption-text\"><strong>Figure 1<\/strong>. This couple prepares for their baby by attending a class where they learn useful skills related to childbirth and infant care, including swaddling.<\/p>\n<\/div>\n<p>Prepared childbirth refers to being not only physically in good condition to help provide a healthy environment for the baby to develop, but also helping a couple to prepare to accept their new roles as parents and to get information and training that will assist them for delivery and life with the baby as much as possible. The more a couple can learn about childbirth and the newborn, the better prepared they will be for the adjustment they must make to a new life. Nothing can prepare a couple for this completely. Once a couple finds that they are to have a child, they begin to conjure up images of what they think the experience will involve. Once the child is born, they must reconcile those images with reality (Galinsky, 1987). Knowing more of what to expect does help them in forming more realistic images thus making the adjustment easier.\u00a0Let&#8217;s explore some of the methods of prepared childbirth.<\/p>\n<h3>HypnoBirthing<\/h3>\n<p>Grantley\u00a0Dick-Read was an English obstetrician and pioneer of prepared childbirth in the 1930s. In his book <em>Childbirth\u00a0Without\u00a0Fear<\/em>, he suggests that the fear of childbirth increases tension and makes the process of childbearing more painful. He believed that if mothers were educated, the fear and tension would be reduced and the need for medication could frequently be eliminated. The Dick-Read method emphasized the use of relaxation and proper breathing with contractions as well as family support and education. Today this method is known as the Mongan Method or HypnoBirthing. Women using this method report feeling like they are lost in a daydream, but focused and in control.<\/p>\n<h3>The Lamaze Method<\/h3>\n<p>This method originated in Russia and was brought to the United States in the 1950s by\u00a0Fernand\u00a0Lamaze. The emphasis of this method is on teaching the woman to be in control in the process of delivery. It includes learning muscle relaxation, breathing through contractions, having a focal point (usually a picture to look at) during contractions and having a support person who goes through the training process with the mother and serves as a coach during delivery. The Lamaze Method is still the most commonly taught method in the U.S. today.<\/p>\n<h3>The Bradley Method<\/h3>\n<p>This method originated in the late 1940\u2019s and helps women deliver\u00a0naturally, with few or no drugs. There are a series of courses that emphasize excellent\u00a0nutrition\u00a0and\u00a0exercise,\u00a0relaxation techniques\u00a0to manage pain, and the involvement of the partner as a coach. Parents-to-be are taught to be knowledgeable consumers of birth services and to take responsibility in making informed decisions regarding procedures, attendants and the birthplace. In turn, this will lead to\u00a0keeping mothers healthy and low-risk in order to avoid\u00a0complications\u00a0that may lead to medical intervention.<\/p>\n<h3>Nurse Midwives<\/h3>\n<p>Historically in the United States, most babies were born under the care of lay midwives.\u00a0In\u00a0the 1920s, middle-class women were increasingly using doctors to assist with childbirth but rural women were still being assisted by lay midwives.\u00a0The nursing profession began educating nurse-midwives to assist these women.\u00a0Nurse-midwives continued to assist most rural women with delivery until the 1970s and 1980s when their growth is thought to have posed a threat to the medical profession (Weitz, 2007). Women who are at low risk for birth complications can successfully deliver under the care of nurse-midwives. Some hospitals give privileges to nurse-midwives to deliver there. They may also deliver babies at home or in birthing centers.<\/p>\n<h3>Home Birth<\/h3>\n<p>Because one out of every 20 births involves a complication, most medical professionals recommend that delivery take place in a hospital. However,\u00a0some couples choose to have their baby at home. About 1 percent of births occur outside of a hospital in the United States. Two-thirds of these are home births and more than half of these are assisted by midwives. In the United States, women who\u00a0have had previous children, who are over 25 and who are white are most likely to not give birth in a hospital (MacDorman et al.,\u00a02010).<\/p>\n<h3>Birthing Centers<\/h3>\n<p>A birthing center presents a more home-like environment than a\u00a0hospital labor ward, typically with more options during labor: food\/drink, music, and the attendance of family and friends if desired. Other characteristics can also include non-institutional furniture such as queen-sized beds, large enough for both mother and father and perhaps birthing tubs or showers for\u00a0water births. The decor is meant to emphasize the normality of birth. In a birth center, women are free to act more spontaneously during their birth, such as squatting, walking or performing other\u00a0postures that assist in labor. Active birth is encouraged. The\u00a0length of stay\u00a0after a birth is shorter at a birth center; sometimes just 6 hours after birth the mother and infant can go home. One-third of out-of-hospital births occur in freestanding clinics, birthing centers, or in\u00a0physicians\u00a0offices or other locations.<\/p>\n<h3>Water Birth<\/h3>\n<p>Laboring and\/or giving birth in a warm tub of water can help a woman relax. The buoyancy of the water can help alleviate discomfort and pressure for the mother. Many hospitals have birthing tubs that allow women to labor in them. However, only some hospitals allow for the birth to take place in the water. Some believe that water birth gives a more calm and tranquil transition for the baby from the womb. Water births are more common to occur at home or in birthing centers.<\/p>\n<div class=\"textbox examples\">\n<h3>watch it<\/h3>\n<p>Watch this family&#8217;s approach to childbirth by having a water birth in their home with a midwife and a doula. Note that there is no audio in the video, only background music.<\/p>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/wczscWXk8e4?start=223\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Not many pregnancies or births go exactly as planned, as seen in the following story of this mother who had to quickly deliver her baby at 30 weeks.<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"My High-Risk Birth Story | CBC Parents\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/jzBQQXy5XRE?start=88&#38;feature=oembed\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>You can <a href=\"https:\/\/oerfiles.s3-us-west-2.amazonaws.com\/Lifespan+Development\/Transcriptions\/MyHighRiskBirthStory_transcript.txt\" target=\"_blank\" rel=\"noopener\">view the transcript for &#8220;My High-Risk Birth Story | CBC Parents&#8221; here (opens in new window)<\/a>.<\/p>\n<\/div>\n<h3>Hospital Birth<\/h3>\n<p>Most births in the U.S. occur in hospitals. Mothers have the choice to have a medicated or unmedicated delivery. Some women do fine with &#8220;natural methods&#8221; of\u00a0pain relief\u00a0alone. Many women blend &#8220;natural methods&#8221; with\u00a0medications\u00a0and medical interventions that relieve pain. Building a positive outlook on childbirth and managing\u00a0fear\u00a0may also help some women cope with the pain. Labor pain is not like pain due to illness or injury. Instead, it is caused by contractions of the uterus that are pushing the baby down and out of the birth canal. In other words, labor pain has a purpose.<\/p>\n<p>The most common pain relief method used during labor and delivery is an epidural. An epidural is a procedure that involves placing a tube into the lower back, into a small space outside the\u00a0spinal cord. Small doses of medicine can be given through the tube as needed throughout labor.\u00a0With an epidural, pain relief starts 10 to 20 minutes after the medicine has been given. The degree of numbness felt can be adjusted.\u00a0An epidural can prolong the first and second stages of labor. If given late in labor or if too much medicine is used, it might be hard to push when the time comes.<\/p>\n<div class=\"textbox examples\">\n<h3>watch it<\/h3>\n<p>What are the advantages and disadvantages of receiving an epidural? Watch this video to see how the procedure is done.<\/p>\n<p><iframe loading=\"lazy\" src=\"\/\/plugin.3playmedia.com\/show?mf=3935257&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=2tw-SXI3wKU&amp;video_target=tpm-plugin-pb3x9zy4-2tw-SXI3wKU\" width=\"800px\" height=\"520px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe><\/p>\n<p>You can <a href=\"https:\/\/oerfiles.s3-us-west-2.amazonaws.com\/Lifespan+Development\/Transcriptions\/EpiduralAnaesthesia_transcript.txt\" target=\"_blank\" rel=\"noopener\">view the transcript for &#8220;Epidural Anaesthesia&#8221; here (opens in new window)<\/a>.<\/p>\n<\/div>\n<p>Another form of pharmacologic pain relief available for laboring mothers is inhaled nitrous oxide. This is typically a 50\/50 mixture of nitrous oxide with air that is an inhaled analgesic and anesthetic. Nitrous oxide has been used for pain management in childbirth since the late 1800\u2019s. The use of inhaled analgesia is commonly used in the UK, Finland, Australia, Singapore, and New Zealand, and is gaining in popularity in the United States.<a class=\"footnote\" title=\"Giving Birth Naturally: Natural Childbirth Techniques. American Pregnancy Association. Retrieved from\u00a0http:\/\/americanpregnancy.org\/labor-and-birth\/natural-childbirth-techniques\/\" id=\"return-footnote-169-1\" href=\"#footnote-169-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/p>\n<div class=\"textbox exercises\">\n<h3>Making A Birth Plan<\/h3>\n<p>As you can see, women have many choices when it comes to the approach they want to take in preparing for childbirth. What decisions would you make?\u00a0<a href=\"https:\/\/americanpregnancy.org\/labor-and-birth\/birth-plan\/\" target=\"_blank\" rel=\"noopener\">Learn how to create a birth plan<\/a>.<\/p>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_bc03bdd6-c5e3-4ec8-93e9-b51d58b39771\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/bc03bdd6-c5e3-4ec8-93e9-b51d58b39771?iframe_resize_id=assessment_practice_id_bc03bdd6-c5e3-4ec8-93e9-b51d58b39771\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<h2>The Process of Delivery<\/h2>\n<div id=\"attachment_759\" style=\"width: 509px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-759\" class=\"wp-image-759\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/1496\/2016\/03\/15231141\/2920_Stages_of_Childbirth-02.jpg\" alt=\"Diagram showing the three stages of childbirth: dilation, birth, and the afterbirth delivery. Stage 1: Dilation. The amniotic fluid is within the uterus, the cervix goes from undiluted to fully dilated at over 10 centimeters in diameter. Stage 2: Birth. First, the presentation of the head. Then, the rotation and delivery of anterior shoulder. Then the delivery of posterior shoulder. Then the delivery of the lower body and umbilical cord. Stage 3: Afterbirth delivery. The placenta detaches and exists through the vagina.\" width=\"499\" height=\"780\" \/><\/p>\n<p id=\"caption-attachment-759\" class=\"wp-caption-text\"><strong>Figure 2<\/strong>. The stages of childbirth.<\/p>\n<\/div>\n<p><strong>The first stage<\/strong> of labor is typically the longest. The First Stage\u00a0of labor begins with uterine contractions that may initially last about 30 seconds and be spaced 15 to 20 minutes apart. These increase in duration and frequency to more than a minute in length and about 3 to 4 minutes apart. Typically, doctors advise that they should be called when contractions are coming about every 5 minutes. Some women experience false labor or\u00a0Braxton-Hicks\u00a0contractions, especially with the first child. These may come and go. They tend to diminish when the mother begins walking around. Real labor pains tend to increase with walking.<\/p>\n<p>During this stage, the cervix or opening to the uterus dilates to 10 centimeters or just\u00a0under\u00a04 inches.\u00a0This may take around 12-16 hours for first children or about 6-9 hours for women who have previously given birth. It takes one woman in 9 over 24 hours to dilate completely. Labor may also begin with a discharge of blood or amniotic fluid. If the amniotic sack breaks, which happens for one out of eight pregnancies, labor will be induced if necessary to reduce the risk of infection.<\/p>\n<p><strong>The second stage<\/strong>\u00a0involves the passage of the baby through the birth canal. This stage takes about 10-40 minutes. Contractions usually come about every 2-3 minutes. The mother pushes and relaxes as directed by the medical staff. Normally the head is delivered first. The baby is then rotated so that one shoulder can come through and then the other shoulder. The rest of the baby quickly passes through. The baby&#8217;s mouth and nose are suctioned out. The umbilical cord is clamped and cut.<\/p>\n<p><strong>The third stage\u00a0<\/strong>is generally less painful, at least when compared to the other stages. During this stage, the placenta or afterbirth is delivered. This typically occurs within 20 minutes after the delivery of the baby.\u00a0If tearing of the vagina occurred during birth, the tear may be stitched at this time.<\/p>\n<h2>Cesarean Section<\/h2>\n<p><b>Cesarean section<\/b>, also known as\u00a0<b>C-section<\/b>, or\u00a0<b>cesarean delivery<\/b>, is the use of\u00a0surgery\u00a0to\u00a0deliver babies.\u00a0<sup id=\"cite_ref-NIH2010_2-0\" class=\"reference\"><\/sup>A cesarean section is often necessary when a\u00a0vaginal delivery\u00a0would put the baby or mother at risk.<sup id=\"cite_ref-NIH2010_2-1\" class=\"reference\"><\/sup>\u00a0This may include\u00a0obstructed labor,\u00a0twin pregnancy,\u00a0high blood pressure\u00a0in the mother,\u00a0breech birth, or problems with the\u00a0placenta\u00a0or\u00a0umbilical cord.<sup id=\"cite_ref-NIH2010_2-2\" class=\"reference\"><\/sup><sup id=\"cite_ref-ACOG2014_3-0\" class=\"reference\"><\/sup>\u00a0Cesarean delivery may be performed based upon the shape of the mother&#8217;s\u00a0<a title=\"Pelvis\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pelvis\" target=\"_blank\" rel=\"noopener\">pelvis<\/a>\u00a0or history of a previous C-section.<sup id=\"cite_ref-NIH2010_2-3\" class=\"reference\"><\/sup><sup id=\"cite_ref-ACOG2014_3-1\" class=\"reference\"><\/sup>\u00a0A trial of\u00a0vaginal birth after C-section\u00a0may be possible.\u00a0<sup id=\"cite_ref-NIH2010_2-4\" class=\"reference\"><\/sup>The\u00a0World Health Organization\u00a0recommends that cesarean sections be performed only when medically necessary.<sup id=\"cite_ref-ACOG2014_3-2\" class=\"reference\"><\/sup><sup id=\"cite_ref-WHO2015_4-0\" class=\"reference\"><\/sup>\u00a0Some C-sections are performed\u00a0without a medical reason, upon request\u00a0by someone, usually the mother.<\/p>\n<div class=\"textbox examples\">\n<h3>Watch it: Vaginal and Cesarean Birth<\/h3>\n<ul>\n<li><a href=\"https:\/\/www.youtube.com\/watch?v=ZDP_ewMDxCo&amp;feature=player_embedded\" target=\"_blank\" rel=\"noopener\">Watch an animation of labor and vaginal birth.<\/a><\/li>\n<li><a href=\"https:\/\/www.youtube.com\/watch?v=xyN48VnRYUY\" target=\"_blank\" rel=\"noopener\">Watch an animation of a\u00a0cesarean birth.<\/a><\/li>\n<\/ul>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_0e214fc6-0e8d-43cf-9bf8-02e6f574a81c\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/0e214fc6-0e8d-43cf-9bf8-02e6f574a81c?iframe_resize_id=assessment_practice_id_0e214fc6-0e8d-43cf-9bf8-02e6f574a81c\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox key-takeaways\">\n<h3>glossary<\/h3>\n<div class=\"titlepage\">\n<dl>\n<dt>cesarean section:<\/dt>\n<dd>is the use of surgery to deliver babies through the mother&#8217;s abdomen and uterus<\/dd>\n<\/dl>\n<\/div>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-169\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Julie Lazzara for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Psyc 200 Lifespan Psychology. <strong>Authored by<\/strong>: Laura Overstreet. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"http:\/\/opencourselibrary.org\/econ-201\/\">http:\/\/opencourselibrary.org\/econ-201\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li><strong>Authored by<\/strong>: OpenStax College. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Childbirth#\/media\/File:2920_Stages_of_Childbirth-02.jpg\">https:\/\/en.wikipedia.org\/wiki\/Childbirth#\/media\/File:2920_Stages_of_Childbirth-02.jpg<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em>. <strong>License Terms<\/strong>: Download for free at http:\/\/cnx.org\/contents\/FPtK1zmh@6.27:zMTtFGyH@4\/Introduction<\/li><li>Bradley Method of natural childbirth. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bradley_method_of_natural_childbirth\">https:\/\/en.wikipedia.org\/wiki\/Bradley_method_of_natural_childbirth<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Caesarean section. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Caesarean_section\">https:\/\/en.wikipedia.org\/wiki\/Caesarean_section<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">All rights reserved content<\/div><ul class=\"citation-list\"><li>My High-Risk Birth Story. <strong>Provided by<\/strong>: CBC Parents. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?time_continue=88&#038;v=jzBQQXy5XRE\">https:\/\/www.youtube.com\/watch?time_continue=88&#038;v=jzBQQXy5XRE<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><li>Home Birth Water Birth with Doula and Midwife. <strong>Provided by<\/strong>: Yema Mamas. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=wczscWXk8e4\">https:\/\/www.youtube.com\/watch?v=wczscWXk8e4<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><li>Epidural Anaesthesia. <strong>Authored by<\/strong>: LHSCCanada. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=2tw-SXI3wKU\">https:\/\/www.youtube.com\/watch?v=2tw-SXI3wKU<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">Public domain content<\/div><ul class=\"citation-list\"><li>Couple in baby class. <strong>Authored by<\/strong>: Senior Airman Krystal Ardrey. <strong>Provided by<\/strong>: U.S. Air Force. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.airforcemedicine.af.mil\/News\/Photos\/igphoto\/2001602805\/\">https:\/\/www.airforcemedicine.af.mil\/News\/Photos\/igphoto\/2001602805\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/pdm\">Public Domain: No Known Copyright<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-169-1\">Giving Birth Naturally: Natural Childbirth Techniques. American Pregnancy Association. Retrieved from\u00a0http:\/\/americanpregnancy.org\/labor-and-birth\/natural-childbirth-techniques\/ <a href=\"#return-footnote-169-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":74,"menu_order":12,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Psyc 200 Lifespan Psychology\",\"author\":\"Laura Overstreet\",\"organization\":\"\",\"url\":\"http:\/\/opencourselibrary.org\/econ-201\/\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"\",\"author\":\"OpenStax College\",\"organization\":\"\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Childbirth#\/media\/File:2920_Stages_of_Childbirth-02.jpg\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"Download for free at http:\/\/cnx.org\/contents\/FPtK1zmh@6.27:zMTtFGyH@4\/Introduction\"},{\"type\":\"cc\",\"description\":\"Bradley Method of natural childbirth\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Bradley_method_of_natural_childbirth\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Caesarean section\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Caesarean_section\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"original\",\"description\":\"Modification, adaptation, and original content\",\"author\":\"Julie Lazzara for Lumen Learning\",\"organization\":\"Lumen Learning\",\"url\":\"\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"},{\"type\":\"pd\",\"description\":\"Couple in baby class\",\"author\":\"Senior Airman Krystal Ardrey\",\"organization\":\"U.S. Air Force\",\"url\":\"https:\/\/www.airforcemedicine.af.mil\/News\/Photos\/igphoto\/2001602805\/\",\"project\":\"\",\"license\":\"pd\",\"license_terms\":\"\"},{\"type\":\"copyrighted_video\",\"description\":\"My High-Risk Birth Story\",\"author\":\"\",\"organization\":\"CBC Parents\",\"url\":\"https:\/\/www.youtube.com\/watch?time_continue=88&v=jzBQQXy5XRE\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube License\"},{\"type\":\"copyrighted_video\",\"description\":\"Home Birth Water Birth with Doula and Midwife\",\"author\":\"\",\"organization\":\"Yema Mamas\",\"url\":\"https:\/\/www.youtube.com\/watch?v=wczscWXk8e4\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube License\"},{\"type\":\"copyrighted_video\",\"description\":\"Epidural Anaesthesia\",\"author\":\"LHSCCanada\",\"organization\":\"\",\"url\":\"https:\/\/www.youtube.com\/watch?v=2tw-SXI3wKU\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube License\"}]","CANDELA_OUTCOMES_GUID":"3121881b-2d56-41f5-8f7a-162f6507117f, 91998b66-5e72-41c2-8841-975d37214bc4, 7fb82763-3da9-40bd-ad17-63316d2222e6","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-169","chapter","type-chapter","status-publish","hentry"],"part":156,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/pressbooks\/v2\/chapters\/169","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/wp\/v2\/users\/74"}],"version-history":[{"count":51,"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/pressbooks\/v2\/chapters\/169\/revisions"}],"predecessor-version":[{"id":7749,"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/pressbooks\/v2\/chapters\/169\/revisions\/7749"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/pressbooks\/v2\/parts\/156"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/pressbooks\/v2\/chapters\/169\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/wp\/v2\/media?parent=169"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/pressbooks\/v2\/chapter-type?post=169"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/wp\/v2\/contributor?post=169"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/wp-json\/wp\/v2\/license?post=169"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}