Crowning is when the top of the infants head is first
observed
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3 June 2009
Once the arm is born,
the whole infant usually slips right out.
Labor consists of three stages: Dilation of the cervix (by far
the longest portion), delivery of the infant, and delivery of the
placenta.
I DILATION OF THE CERVIX:
The opening of the cervix (the cervical os) is tightly closed and
sealed during pregnancy. The initial stage of labor opens
(dilates) the cervix until it is large enough for the fetus' head (the
largest presenting part) to pass through, usually 10 centimeters or
"four fingers". The first sign of dilation is the discharge of
the mucus plug from the cervical os, termed the "show." It is
often tinged with blood. Contractions will usually be noticed at
this time.
The safe manner to determine the stage of dilation is with rectal
palpation with a gloved hand. Dilation of the cervix takes 10-20
hours. Dilation is aided by the fetus' skull wedging it open,
hence the 'conehead' appearance of occipitally born infants.
The urge to push should be
resisted during this first stage so that the cervix is not torn.
The amniotic membrane may break releasing the amniotic fluid ("the
waters") during this time. It is best if they break just before
the next stage of labor so that they act as a lubricant.
II. DELIVERY OF THE INFANT:
Once the cervix is fully dilated, the fetus begins to move down the
birth canal, again, using its 'pointy little head' as a wedge.
This process usually takes 1 to 2 hours. The perineum membrane
which surrounds the opening of the vagina needs to be fgiven time to
dilate to prevent tearing. Massage will help. Here
is
a
cartoon diagraming the stations of
presentation (progress of the
fetus through the birth
canal).
The sign of imminent birth is the appearance of the top of the fetus'
head, termed "crowning." The head will retract and appear a
number of times, each time showing more of the head.
The most challenging stage of the birth is the delivery of the head
because it is the largest presenting part. Once the head in born,
the most strenuous part of labor is over. Good
view
of
head (and hand) being born
After the head is born, a few more contractions will cause a shoulder
to appear, and arm to flip out, and get ready to catch because the body
and legs are easily delivered compared to the head and shoulders.
III. DELIVERY OF THE PLACENTA
AND ASSOCIATED MEMBRANES After the infant is delivered, it should be placed at the
mother's breast. The umbilicus should not be cut until the blood
has drained from the
placenta into the infant. The stimulation of the infant at breast
will trigger the release of oxytocin from the posterior
pituitary. This will strengthen uterine contractions, assisting
with moving blood out of the placenta, and the expulsion of the
placenta: The
placenta
should be closely examined to ensure that it is entire,
and that no fragments remain in the uterus where they could cause
bleeding and infection.
Here is the Apgar scale to evaluate newborns. They should be
7 or above by 10 minutes after birth:
A WOMAN'S EXTERNAL ANATOMY OF THE VULVA
Here is an explicit (and sometimes humerous) video from the Discovery
Channel discussing the components of
the vulva (woman's external genetalia) (With Roumanian subtitles!): Women's
sexual
organs
(Discovery Channel video)
0:00-1:00 Intro
1:00 program begins
2:05 language
2:23 vulva
3:00 mons veneris (mons pubis)
3:27 urethreal meatus
3:40 labia majora and minora
4:00