Birth Flashcards
1
Q
what happens during birth?
A
- Release of oxytocin -> triggers uterine contractions -> push baby out
- No such thing as a “typical” birth – lots of variability
2
Q
stages of labour
A
- 1: uterine muscle opens the cervix to ~4in.
- 2: contractions push the head, then body, through the birth canal
- 3: contractions push out placenta, fetal membranes, and remainder of umbilical cord (“afterbirth”)
3
Q
birth complications
A
- Infant/mother mortality
- Anoxia: supply of oxygen from umbilical cord is cut off before baby can breathe independently
- Breech: baby’s position is feet/butt first
- Pre-term birth: born before 36/37 weeks
4
Q
Cesarean Section
A
- Surgery to deliver baby
- Typically used in cases where vaginal delivery may be a risk to infant
- Complications in labour, infant health at risk, infant too large, mother has infection, etc.
- Around 26% of births in Canada -> rates increasing
5
Q
outcomes of vaginal vs. cesarean delivery
A
- Correlational studies comparing outcomes of vaginal vs. C-section delivery:
- Risks of C-sections: bleeding, infection, difficulties breastfeeding, postpartum depression, negative feelings about childbirth
- Risks of vaginal delivery: incontinence (urinary, fecal, flatus)
6
Q
Term Breech Trial: basics
A
- 1st randomized trial of C-section vs. Vaginal delivery and related outcomes
- Focused on breech delivery
- Complete breech (feet down); frank breech (bottom down, feet up)
- Most infants in breech position are delivered through C-section
- Different outcomes for infants delivered vaginal vs. C-section
7
Q
Term Breech Trial: subjects
A
women with frank/breech presentations at term (some recruited before birth, some recruited at time of birth)
8
Q
Term Breech Trial: conditions & analysis
A
- Randomly assigned to either planned C-section or planned vaginal delivery
- Data analyzed according to this “intent to treat” model, even if it didn’t actually work out like that (“once randomized, always analyzed” -> C-section group will be analyzed as such –and vice versa– even if they didn’t get it) -> reduces risk of false positives
9
Q
Term Breech Trial: results (initial study)
A
- At birth, greater risk of infant death for vaginal vs. Cesarian (1.3% vs. 0.3%)
- Created controversy -> hospitals decreased performance of vaginal births as a result
- Upon closer inspection, turns out only 3 actually died due to delivery method (same as Cesarean)
10
Q
Term Breech Trial Follow Up (3 months): findings
A
- No difference: adjustment to motherhood, need for medical intervention after hospital discharge, sex relations, pain, depression
- Mothers with c-sections: more pain in abdomen (vs. Vaginal delivery -> more pain in genital area)
- Mothers with c-sections: less urinary incontinence
11
Q
Term Breech Trial: conclusions and limitations
A
- Conclusions: no major differences in negative outcomes (at 3 months) associated with C-section vs. Vaginal
- Limitations: Can results of breech deliveries be generalized to other births?