1.3 Second stage of labor

In the second stage of labour, the baby is expelled from the womb through the birth canal by both the uterine contractions and by powerful abdominal contractions ("bearing down"). The baby is most commonly born head-first. In some cases the baby is breech meaning either the feet or buttocks are descending first. With properly trained staff and the right circumstances, even babies in the " breechBreech birth is a birth in which the fetus's bottom is facing toward the cervix and the vaginal opening, rather than its head, which is the ideal, and usual position for a baby. About three percent of human births are breech births. Labour and vaginal del" position can be delivered vaginally.

There are several types of breech presentations the most common is where the baby's buttocks are delivered first and the legs are folded onto the baby's body with the knees bent and feet near the buttocks (full breech). Others include Frank breech, much like full breech but the babies legs are extended toward his ears, and footling or incomplete breech, in which one or both legs are extended and the foot or feet are the presenting part. Another rare presentation is a transverse lie. This is where the baby is sideways in the womb and a hand or elbow has entered the birth canal first. A vaginal birth should not be attempted, although in rare cases the arm can be pushed back up and the baby can be coaxed into the proper position.

Normally, the second stage of labour would take about 40 minutes for a woman who has never given birth before, and 20 minutes for one who has previously given birth to one or more spontaneous deliveries. Problems may be encountered at this stage due to reasons such as inadequate maternal effort or maternal exhaustion, the front of the baby's head is facing forwards instead of backwards, or simply because the baby's head does not fit properly into the mother's pelvis.

Immediately after birth, the child undergoes extensive physiological modifications as it acclimatizes to independent breathing. Several cardiac structures start regressing immediately after birth, such as the ductus arteriosus and the foramen ovale.

The medical condition of the child is assessed with the Apgar score, based on five parameters. A "good start" refers to higher scores, while a child doing poorly with have low scores that do not improve rapidly over time.

1.4 Third stage

The last stage of labour occurs in the fifteen minutes to one hour after the baby is born. In this stage, the uterus expels the placenta (afterbirth) and the mother normally should not lose more than 500ml of blood. It is essential that the whole placenta is expelled, so the midwife will examine the placenta to ensure that it is intact. Remaining parts can cause postnatal haemorrhage or infection.

1.5 After the birth

Usually soon after birth the parents assign the infant its given names. They may have two sets of names in mind, one for if it is a boy, and one for if it is a girl.

Often people visit and bring a gift for the baby.

Many cultures feature initiation rites for newborns, such as circumcision or baptism, amongst others.

1.6 Variations

When the amniotic sac has not ruptured during labour or pushing, the infant can be born with the membranes intact. This is referred to as "being born in the caul." The caul is harmless and easily wiped away by the doctor or person assisting with the childbirth. In medieval times, a caul was seen as a sign of good fortune for the baby, in some cultures was seen as protection against drowning, and the caul was often impressed onto paper and stored away as an heirloom for the child. With the advent of modern interventive obstetrics, premature artificial rupture of the membranes has become common and it is rare for infants to be born in the caul in Western births.

1.7 Pain control

Due to the relatively large size of the human skull and the shape of the human pelvis forced by the erect posture, childbirth is more difficult and painful for human mothers than other mammals. Many methods are available to reduce the pain of labour, including psychological preparation, emotional support, epidural analgesia, spinal anaesthesia, nitrous oxide, opioids, and natural childbirth methods such as the Lamaze technique or Bradley Method. Each method has its own advantages and disadvantages.

1.8 Complications

Complications occasionally arise during childbirth; these generally require management by an obstetrician.

Non-progression of labor (longterm contractions without adequate cervical dilation) is generally treated with cervical prostaglandin gel or intravenous synthetic oxytocin preparations. If this is ineffective, Caesarean section may be necessary.

Fetal distress is the development of signs of distress by the child. These may include rising or decreasing heartbeat (monitored on cardiotocography/CTG), shedding of meconium in the amniotic fluid, and other signs.

Non-progression of expulsion (the head or presenting parts are not delivered despite adequate contractions): this can require interventions such as vacuum extraction , forceps extraction and Caesarian section.

In the past, a great many women died during or shortly after childbirth (see puerperal fever) but modern medical techniques available in industrialized countries have greatly reduced this total.

Unanticipated heavy bleeding during or after childbirth is potentially lethal in places without immediate access to high level emergency care. Heavy blood loss leads to hypovolemic shock, insufficient perfusion of vital organs and death if not rapidly treated by stemming the blood loss and blood transfusion. Hypopituitarism after obstetric hypovolemic shock is termed Sheehan's syndrome.

2 Social aspects

In modern times, participation of the father during childbirth is now the norm. However, before the 1960s, in most cultures the father was forbidden to enter childbirth area, as were other men with the exception of the doctor.

The exception to this rule were Poleshuks from Polesie. In this culture the wife gave birth sitting on her husband's knees.

The recent social development of requiring signed consent, permitting fathers into the birth area, and leaving the mother with less impairment from drugs and physical restraint, has lead to a considerable increase in parental control over all aspects the birth process. In recent years, many believe all of these social changes have allowed reductions in circumcision rates, along with drops in other interventions, such as episiotomy.

Often times families view the placenta as a special part of birth, since it has been the child's life support for so many months. Many parents like to see and touch this mysterious organ. In some cultures, there is a custom to dig a hole and plant a tree along with the placenta on the child's first birthday -- in some populations, it is ceremonially eaten by the newborn's family.

The eldest American woman known to give birth was Arceli Keh, aged 63. In November 2004 Aleta St. James, a 56 year old single mother gave birth to twins conceived through in vitro fertilization; days later, it was announced that Frances Harris, a 59 year old great-grandmother who had had a tubal ligation thirty years ago had become pregnant with twins due in December.

3 Legal aspects

In some legal jurisdictions, the place of childbirth decides the nationality of a child (under the doctrine of Jus soli)

4 External links

• Emergency Child Birth - Provides video clip and colour photos (real) of child birth, and also emergency measures
• How you came into the world and grew inside a womb: from cells and embryo to baby - Has colour photos (real) and explanations
• AP story on pregnancies in the elderly

Human development Obstetrics

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