Parturition, commonly known as childbirth or labor, is a natural and complex process through which a pregnant mammal gives birth to her offspring. This transformative event marks the culmination of the pregnancy journey, as the developing fetus is ready to transition from the safety of the mother's womb to the outside world. It is a remarkable phenomenon that involves intricate hormonal, physiological, and behavioral changes in both the mother and the fetus. In this essay, we will delve into the fascinating process of parturition, exploring its stages, hormonal influences, and the significance of this event in the continuation of species. Parturition is a highly regulated process orchestrated by the intricate interplay of hormones. During pregnancy, the uterus provides a nurturing environment for the developing fetus, surrounded by the amniotic fluid. As the pregnancy reaches full term, the fetus secretes a hormone called cortisol, which stimulates the placenta to produce another hormone called prostaglandins. Prostaglandins play a crucial role in softening and thinning the cervix, the lower part of the uterus, preparing it for dilation. Additionally, the secretion of oxytocin, commonly referred to as the "love hormone" due to its role in bonding and social behavior, increases in response to fetal cortisol levels. Oxytocin triggers uterine contractions, initiating the labor process. Parturition can be divided into three distinct stages: the latent phase, the active phase, and the placental phase. The latent phase is often the longest and least intense, characterized by irregular contractions that help in the gradual dilation and effacement of the cervix. During this phase, the expectant mother may experience a release of the mucus plug, known as the "show," indicating the progress of the cervical changes. The active phase marks the onset of more intense and regular contractions. Oxytocin levels surge, and the contractions become stronger, more prolonged, and closer together. This stage leads to rapid cervical dilation and the eventual transition of the fetus into the birth canal. As the contractions intensify, the mother may experience increased discomfort and a strong urge to bear down and push. The amniotic sac may rupture, leading to the release of amniotic fluid, commonly referred to as the "breaking of water." This rupture also serves to facilitate the descent of the fetus. The fetus's position and presentation are essential during childbirth. Ideally, the baby's head presents first as it is the largest and most efficient part to pass through the birth canal. In some cases, the baby may present in a breech position (feet or buttocks first) or in other less common positions, requiring additional medical attention and possibly a cesarean section. During the active phase, the mother's body releases endorphins, which act as natural painkillers and help the mother cope with the increasing intensity of contractions.

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PARTURITION
BY:RAJKUMAR JAIN, FOUNDER
EDUSKILLS BY RK
COURSE:B.Sc(H) ZOOLOGY
“Every woman is special when she becomes a
wife but she is a God when she becomes a
MOTHER.”

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LEARNING OBJECTIVES
• Parturition and Timing of birth
• Stages of birth and labor
• Aspects of pre-mature, multiple &difficult births

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• The internal relationship between mother and foetus
terminates in childbirth, or parturition.
• Process of bringing forth a child from the
uterus, ending pregnancy.
• Parturition means “giving birth to young one.”
• Parturition is the expelling of the fully formed
young one from the mother’s uterus after the
gestation period.

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Step 1: Determine the first day of your last menstrual period.
Step 2: Next, count back 3 calendar months from that date.
Step 3: Lastly, add 1 year and 7 days to that date.
• Avg. length of pregnancy in humans is 9
months.
• The due date (or term) can be calculated in 3 easy steps:
• For example: Your menstrual period began on 9 September 2010. Counting back 3 calendar months
would be 9 June 2010. Adding 1 year and 7 days would bring you to 16 June 2011, as your estimated
due date.
• This method is called Naegele’s Rule (German obstetrician) and is based on a normal
28-day menstrual cycle. Hence, one has to adjust dates as per longer or shorter
menstrual cycles.

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One more example….. Franz Naegele’s Rule

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Other ways of calculating due date:
Estimate your delivery date by using the steps 1&2 and the chart:
1) Locate the first day of last menstrual period
2) Next, note the date directly below. This is the estimated date of delivery

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PREPARATION FOR LABOR
1) 2-3 weeks before labor, women may have some sensation of decreased abdominal distention
produced by the movement of foetus down into the pelvic cavity. This is called “LIGHTENING.”
2) This means that the baby has “dropped.”
3) Lightening occurs about 2 weeks before birth in primiparous woman but may not occur until
labor in multiparous woman.
4) Allows the woman to breathe easily because of less pressure in diaphragm.
5) The women may also urinate more frequently as the foetus is pressing on her bladder.
6) A few hours to a week before labor begins the head of the foetus moves down into the pelvic girdle.
This is called “Engagement of the presenting part.”

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HUMAN PELVIC STRUCTURE
MALE AND FEMALE

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Take birthing classes: what will happen during
labor. Answers your questions about the process.
Take breastfeeding classes: proper latch
training, hold baby during feeding
Take parenting classes: to keep baby safe, dress
and how to tell baby has medical emergency
Visit the hospital: comfort, baby delivery space, help
plan birth process.
Pack your bag: loose and comfortable clothes, breast
pads, nipple cream, water bottle, camera, medications,
blankets, healthy food etc.
CONTD…..

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BIRTH PROCESS
• The birth process can be divided into three stages viz., (1) cervical effacement and
dilation, (2) expulsion of the foetus, and (3) expulsion of the placenta.
• The length of each stage varies among individuals and in same individual between first
and subsequent births..
• Time period of labor and birth in primiparous women: 8-14 hrs.
• Time period of labor and birth in multiparous women: 4-9 hrs.

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STAGE 1: CERVICAL EFFACEMENT AND DILATION
Cervix effacement aka “ripening of cervix” is when the cervix softens, thins and shortens.
The opening of the cervical canal before labor is small normally obliterated and plugged with
mucus.
The first stage of labor is marked by the onset of regular uterine contractions
open or dilate the cervix from 0.2cm to 7-10cm
push the baby’s head against the opening of cervix and progressively dilates it.
The result of effacement contractions is
cervical effacement, which means a thinning
of the normally thick walls of the cervix and
retraction of the cervical tissue upward into
the uterus, making it easier for the foetus to
pass into the birth canal (cervical and vaginal
canals).

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During pregnancy the cervix is blocked by a mucous plug. At, or immediately
before the beginning of effacement contractions, mucus is dislodged along with a
small amount of blood, and this bloody show (pinkish in colour) exits through the
vagina.
Also at this time, or in the first stage, an enzyme weakens the amnion. A small tear then
appears in the amniotic sac (actually made up of chorion on the outside and amnion on the
inside), and clear amniotic fluid trickles or gushes from the sac and is expelled through the
vagina.
This bursting of the amniotic sac (breaking of the bag of waters) and the bloody show are
sure signs that true labor is commencing.
The final phase of stage 1 labor, during which the cervix
dilates from about 7 to 10 cm in diameter, is called transition
dilation. This phase lasts about 20 min–1 h and tends to be
shorter in multiparous women. Transition is characterised
by very intense transition contractions that last longer (60–
90s) than those in earlier stages of dilation.

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FALSE LABOR???
It included Braxton-Hicks contractions i.e “false labor”
• Occurs after 20
weeks.
• Painless
• Irregular&Infrequent
• Don’t get stronger
• Lessen with change of position
• Cervix dosent dilate
• Interval b/w contractions
doesn’t get shorter

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WHAT HAPPENS DURING TRANSITION?
Foetus descends into the pelvic basin, puts pressure on the pelvic floor. This causes an
urge in pregnant woman to push during these contractions, but she is advised not to do
so. [REASON: It will tire the mother but not the move the foetus and cause edema
{puffiness caused by excess fluid trapped in the body’s tissues.} of the cervical
tissues.]
Pressure on the pelvic floor creates a pushing urge, which women report feeling like an
urge to defecate.
Transition is most difficult part of labor, not only because of severity of contractions but
because a woman may experience intense pain, nausea, vomiting, trembling, leg
cramps, discouragement and restlessness.
During transition, condition of foetus is monitored for signs of fatal distress. Heart
functions are monitored by placing wire leads either on mother’s abdomen or foetus’s
scalp through cervical opening.

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STAGE 2: EXPULSION OF THE FOETUS
Begins when the cervix is dilated maximally and ends with the delivery
of the infant.
Intensity of transition is less than the stage 1. Each contraction lasts upto 60s, with 1-3
min treat intervals between contractions.
During this stage of labor, the physician may perform an “episiotomy” to prevent
tearing of the perineal tissues as the baby emerges.
To do this, a local anesthetic is injected into the perineum (the region between the anus and the
vagina) and a small incision is made in the perineal skin. This incision later will be sutured with
absorbable material.
At this stage the woman is encouraged to push which causes the top of head to appear
(crowning). This signifies the baby is about to be born.

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• Once the head is out, any mucus or amniotic fluid in the baby’s nose or mouth is
removed with a suction device.
• The infant then slides out takes his or her first breath, and usually emits an exhilarating cry.
• The infant then rotates so the shoulders emerge in the up-and-down position (facing the mother’s
side) that is the largest dimension of the birth canal.
• The umbilical cord is then clamped in two places about 3in from the baby’s abdomen and is cut
between the clamps.
• There are no nerve endings in the cord, and neither the mother nor the infant feels the procedure.
• Drops of penicillin or silver nitrate are then placed in the infant’s eyes to prevent bacterial infection.
• This is required by law in all states because of the risk that the infant could be blinded by bacteria if the
mother is infected.

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STAGE 3: EXPULSION OF THE PLACENTA
• Last stage of delivery
• Last about 5-30mins, placenta afterbirth is expelled
e next few contractions push the placenta which has been detached from the uter
• Normally 8 oz (~240ml) of blood is lost during delivery. OMG!!!!!
• Usually the uterus will be massaged through the abdominal wall to encourage contraction,
which inhibits uterine blood flow. If uterine hemorrhage (excessive bleeding) persists,
oxytocin or a chemical that constricts blood vessels is administered to contract the uterus
and inhibit bleeding.

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WHAT HAPPENS TO PLACENTA
AFTER EXPULSION?
In some societies, expelled placenta is treated with reverence and is buried
ceremoniously.
Hospitals in the U.S typically discard it unless it needs to be examined for medical
reasons.
Placenta and umbilical cord have valuable pool of stem cells. HSC (Hematopoietic
stem cells) found in the cord blood cells have the potential to proliferate and
differentiate into RBCs, WBCs and Platelets.
Cord blood can be transplanted into leukaemia and lymphoma cancer patients, where
it can restore bone marrow destroyed by radiation and chemotherapy.

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PRETERM BIRTHS
Preterm infant- born before 37 weeks.
Characteristics of such infants: low body weight (less than 2.5kg), disability like mental
retardation, blindness, deafness & learning disabilities. Eg., infants born weighing less
than 5.5 lbs are four times less likely to graduate from high school by age 19.
The normal weight of a foetus 1 month before the due date is about 2.5kg, compared with
the average weight of 3.4kg at birth. Many of the foetus’s organs mature in the last weeks
of pregnancy, so an infant born before the ned of the full term pregnancy is also often
called premature; if length of the gestation exceeds 39 weeks, the infant is posterm, or
post-mature.

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Multiple pregnancies also lead to preterm birth.
Chronic health conditions, such as diabetes or infections.
Drug or alcohol abuse.
Preeclampsia (high blood pressure during pregnancy)
Problems with uterus or cervix.
Too less time {less than 18 months} between pregnancies.
Vaginal bleeding or infections during pregnancies.
Preterm separation of placenta.
Causes of preterm births

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SOLUTION TO PRETERM BIRTHS
Avoid tobacco, alcohol or drugs when you are pregnant.
Take a healthy balanced diet.
Reduce your stress levels.
Wait for at least 18 months in between two pregnancies.
Treatment with a vaginal progesterone gel has also been shown to reduce the
risk of preterm deliveries in women with short cervix. (progesterone inhibits
uterine contractility, and the ratio of progesterone to estriol decreases in
the moth- er’s blood prior to normal labor.)

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MULTIPLE BIRTHS
The odds for having twins are about 1 in 71; for triplets 1 in 6400; quadruplets, 1 in 512,000.
Heredity can influence the odds of having fraternal twins.
Fraternal twins occur more commonly in women who have a family history of twins.
Delivery of multiple foetuses occur about 22 days earlier, on average, than single births.
Presence of twins can be detected by ultrasounds or detection of two heartbeats.
INTERESTING FACT: There are records of the second twin being delivered up to 56 days after
the first! A few of these cases in which a twin is born many days after its sibling may be due to
superfetation, i.e. fertilization of a newly ovulated egg occurs while a previous foetus is
developing in the uterus. This would have to occur before the fourth month of pregnancy,
because after that time the amniotic sac obliterates the uterine lumen and would not allow
sperm passage. There is, however, no direct proof that superfetation occurs in humans.
CAUSES: More than one egg is fertilised.
PREVENTION: IVF with single embryo transfer.

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DIFFICULT BIRTHS
In most of the births, the foetus position
is normal i.e head-down position.
However, in 3-4% of births, the foetus, is
in breech presentation, at the beginning
of labor, which means that the feet,
buttocks or knees rest against the
cervix.
Breech deliveries often occur with no
difficulties, however unfortunately, the
labor phase is longer and the
gynaecologist has to perform a
cesarean delivery.
In 1 out of 200 births, the foetus is in
transverse presentation i.e the
shoulders and arms emerging first. Such
cases also need caesarean deliveries.

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When foetus doesn’t emerge easily, physician can insert an
instrument (forceps) into the birth canal and around the head to
effect a forceps delivery.
Medical reasons for using forceps are: (1) acute distress of the
foetus, such as irregular or weak heartbeat and lack of oxygen
caused by premature separation of the placenta, compression
of the umbilical cord, or excessive pressure on the foetal head;
(2) illnesses of the mother, such as heart problems,
tuberculosis, or toxemia; (3) a previous cesarean section, as the
wall of the uterus might tear; (4) presentation of the foetus in a
breech position; and (5) an abnormally slow labor.

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FORCEP DELIVERY

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VACCUM EXTRACTION
It is used if labor is lasting too long without progressing, if the foetus is
in danger, or if the mother should not push because of cardiovascular
or neurological problems.
In this method, a metal cup is placed on top of the foetus’s head,
negative pressure is applied to this cup, and the cup is firmly attached.
The foetus is then pulled out.
Vacuum extraction is less likely to cause damage to the mother’s
perineal tissue than with the use of forceps, but is more likely to cause
foetal scalp injury. About 1 in 20 babies born in the United States are
delivered vaginally with the assistance of for- ceps or vacuum
extraction.

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Vacuum Extraction Delivery

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CESAREAN DELIVERY
Latin caedere, meaning “to cut”; also known as cesarean sections, or C-sections. Apparently, the name of this
operation had its origin in an order by Emperor Julius Caesar of such an operation to be done on dying
pregnant women in hopes of saving the unborn children.
Lasts upto 20-90 mins.
Cesarean delivery is performed when the foetus is in a transverse presentation or less commonly in a breech
presentation, when the pelvis of the woman is too small, the foetus is too large, or when the foetus shows
signs of distress, such as abnormalities in heart function.
Cesarean delivery is performed if the umbilical cord gets compressed between the head and the wall of the
birth canal, if the placenta is coming out before the foetus (placenta previa), or if the placenta prematurely
separates from the uterus.
Some of the reasons given for the increase in cesarean deliveries include: (1) the assumption that once a
woman has a cesarean, she can never deliver a future child vaginally (this is not true in many cases);
(2) using a cesarean delivery for a breech birth (this often is not necessary); (3) the increased use of
foetal monitoring to detect foetal problems during labor; (4) the increasing rate of multiple
pregnancies and pregnancies of older women; (5) the rising obesity rate of US women and associated
risk of pregnancy complications in women with excess body weight; and (6) doctors’ fear of liability
lawsuits and reduced physician time required for a cesarean versus a vaginal birth.

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THANK
YOU