Childbirth (also called labor, birth, partus or parturition) is the culmination of a human pregnancy or gestation period with the expulsion of one or more newborn infants from a woman's uterus. The process of normal human childbirth is categorized in three stages of labour: the shortening and dilation of the cervix, descent and birth of the infant, and birth of the placenta.^[1] In many cases, with increasing frequency, childbirth is achieved through caesarean section, the removal of the neonate through a surgical incision in the abdomen, rather than through vaginal birth.^[2] In the U.S. and Canada it represents nearly 1 in 3 (31.8%) and 1 in 4 (22.5%) of all childbirths, respectively.^[3][4] Some women take epidurals just before childbirth to avoid any pain.^[5]

Signs[link]

Natural childbirth at home.

Labor is sometimes accompanied by intense and prolonged pain. Pain levels reported by laboring women vary widely. Pain levels appear to be influenced by fear and anxiety levels. Some other factors may include experience with prior childbirth, age, ethnicity, preparation, physical environment and immobility.^{[citation needed]}

Psychological[link]

Childbirth can be an intense event and strong emotions, both positive and negative, can be brought to the surface.

Between 70% and 80% of mothers in the United States report some feelings of sadness or "baby blues" after childbirth.^{[citation needed]} Postpartum depression may develop in some women; about 10% of mothers in the United States are diagnosed with this condition. Abnormal and persistent fear of childbirth is known as tokophobia.

Preventive group therapy has proven effective as a prophylactic treatment for postpartum depression.^[6]

Childbirth is stressful for the infant. In addition to the normal stress of leaving the protected uterine environment, additional stresses associated with breech birth, such as asphyxiation, may affect the infant's brain.^{[citation needed]}

Normal human birth[link]

Vaginal birth[link]

Because humans are bipedal with an erect stance and have, in relation to the size of the pelvis, the biggest head of any mammalian species, human fetuses and human female pelvises are adapted to make birth possible.

The erect posture causes the weight of the abdominal contents to thrust on the pelvic floor, a complex structure which must not only support this weight but allow three channels to pass through it: the urethra, the vagina and the rectum. The head and shoulders require a specific sequence of maneuvers to occur for the bony head and shoulders to pass through the bony ring of the pelvis.

Six phases:

1. Engagement of the fetal head in the transverse position. The baby's head is facing across the pelvis at one or other of the mother's hips.
2. Descent and flexion of the fetal head.
3. Internal rotation. The fetal head rotates 90 degrees to the occipito-anterior position so that the baby's face is towards the mother's rectum.
4. Delivery by extension. The fetal head passes out of the birth canal. Its head is tilted forwards so that the crown of its head leads the way through the vagina.
5. Restitution. The fetal head turns through 45 degrees to restore its normal relationship with the shoulders, which are still at an angle.
6. External rotation. The shoulders repeat the corkscrew movements of the head, which can be seen in the final movements of the fetal head.

The fetal head may temporarily change shape substantially (becoming more elongated) as it moves through the birth canal. This change in the shape of the fetal head is called molding and is much more prominent in women having their first vaginal delivery.^[7]

Latent phase[link]

The latent phase of labor, also called prodromal labor, and the contractions may be an intensification of the Braxton Hicks contractions that may start around 26 weeks gestation. Cervical effacement occurs during the closing weeks of pregnancy and is usually complete or near complete, by the end of the latent phase. Cervical effacement or cervical dilation is the thinning and stretching of the cervix. The degree of cervical effacement may be felt during a vaginal examination but is not necessary. A 'long' cervix implies that not much has been taken into the lower segment, and vice versa for a 'short' cervix. Latent phase ends with the onset of active first stage; when the cervix is about 4 cm dilated.

First stage: dilation[link]

There are several factors that midwives and physicians use to assess the laboring mother's progress, and these are defined by the Bishop Score. The Bishop score is also used as a means to predict whether the mother is likely to spontaneously progress into second stage (delivery).

The first stage of labor starts classically when the effaced (thinned) cervix is 3 cm dilated. There is a variation in this point as some women may or may not have active contractions prior to reaching this point. The onset of actual labor is defined when the cervix begins to progressively dilate. Rupture of the membranes or a bloody show may or may not occur at or around this stage.

Uterine muscles form opposing spirals from the top of the upper segment of the uterus to its junction with the lower segment. During effacement, the cervix becomes incorporated into the lower segment of the uterus. During a contraction, these muscles contract causing shortening of the upper segment and drawing upwards of the lower segment, in a gradual expulsive motion. The presenting fetal part then is permitted to descend. Full dilation is reached when the cervix has widened enough to allow passage of the baby's head, around 10 cm dilation for a term baby.

The duration of labour varies widely, but active phase averages some 20 hours^[8] for women giving birth to their first child ("primiparae") and 8 hours^{[citation needed]} for women who have already given birth ("multiparae"). Active phase arrest is defined as in a primigravid woman as the failure of the cervix to dilate at a rate of 1.2 cm/hr over a period of at least two hours. This definition is based on Friedman's Curve, which plots the typical rate of cervical dilation and fetal descent during active labor.^[9] Some practitioners may diagnose "Failure to Progress", and consequently, perform a Cesarean.^[10]

Sequence of cervix dilation during labor

Second stage: fetal expulsion[link]

This stage begins when the cervix is fully dilated, and ends when the baby is born. As pressure on the cervix increases, the Ferguson reflex increases uterine contractions so that the second stage can go ahead^{[citation needed]}. At the beginning of the normal second stage, the head is fully engaged in the pelvis; the widest diameter of the head has passed below the level of the pelvic inlet. The fetal head then continues descent into the pelvis, below the pubic arch and out through the vaginal introitus. This is assisted by the additional maternal efforts of "bearing down" or pushing. The fetal head is seen to 'crown' as the labia part. At this point, the woman may feel a burning or stinging sensation.

Complete expulsion of the baby signals the successful completion of the second stage of labor.

A newborn baby with umbilical cord ready to be clamped

The second stage of birth will vary by factors including parity, fetal size, anesthesia, the presence of infection. Longer labors are associated with declining rates of spontaneous vaginal delivery and increasing rates of infection, perineal laceration, obstetric hemorrhage, as well as need for intensive care of the neonate ^[11]

Third stage: umbilical cord closure and placental expulsion[link]

Breastfeeding during and after the third stage, the placenta is visible in the bowl to the right.

The period from just after the fetus is expelled until just after the placenta is expelled is called the third stage of labor.

The umbilical cord is routinely clamped and cut in this stage, but it would normally close naturally even if not clamped. A 2008 Cochrane Review looked into the timing of clamping the umbilical cord. It found that the time of clamping made no difference to the mother, but did have effects for the baby. If the cord is clamped after 1–3 minutes, the infant receives increased amounts of haemoglobin in their first months of life, but may have an increased risk of needing phototherapy to treat jaundice. Sometimes a newborn’s liver is slow to break down all of the red cells they had in the womb, particularly if they are left with more fetal blood from delayed cord clamping and phototherapy helps to speed the breakdown.^[12]

Placental expulsion begins as a physiological separation from the wall of the uterus. The period from just after the fetus is expelled until just after the placenta is expelled is called the third stage of labor. The average time from delivery of the baby until complete expulsion of the placenta is estimated to be 10–12 minutes dependent on whether active or expectant management is employed^[13]

Placental expulsion can be managed actively, by giving a uterotonic such as oxytocin along with appropriate cord traction and fundal massage to assist in delivering the placenta by a skilled birth attendant. Alternatively, it can be managed expectantly, allowing the placenta to be expelled without medical assistance. In a joint statement, World Health Organization, the International Federation of Gynaecologists and Obstetricians and the International Confederations of Midwives recommend active management of the third stage in all vaginal deliveries.^[14][15] This is a strong recommendation of the World Health Organization backed by moderate base evidence citing reduced risk of postpartum bleeding (i.e.: obstetric hemorrhage).

In as many as 3% of all vaginal deliveries, the duration of the third stage is longer than 30 minutes and raises concern for retained placenta.^[16]

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 its membranes are easily broken and wiped away. With the advent of modern interventive obstetrics, artificial rupture of the membranes has become common, so babies are rarely born in the caul.

Fourth stage[link]

The "fourth stage of labor" is a term used in two different senses:

• It can refer to the immediate puerperium,^[17] or the hours immediately after delivery of the placenta.^[18]

• It can be used in a more metaphorical sense to describe the weeks following delivery.^[19]

Afterwards[link]

Many cultures feature initiation rites for newborns, such as circumcision, naming ceremonies, baptism, and others.

Mothers are often allowed a period where they are relieved of their normal duties to recover from childbirth. The length of this period varies. In many countries, taking time off from work to care for a newborn is called "maternity leave" or "parental leave" and can vary from a few days to several months.

Station[link]

Refers to the relationship of the fetal presenting part to the level of the ischial spines. When the presenting part is at the ichial spines the station is 0 (synonymous with engagement). If the presenting fetal part is above the spines, the distance is measured and described as minus stations, which range from -1 to -4 cm. If the presenting part is below the ischial spines, the distance is stated as plus stations ( +1 to +4 cm). At +3 and +4 the presenting part is at the perineum and can be seen.^[20]

Management[link]

Eating or drinking during labor is an area of ongoing debate. While some have argued that eating in labor has no harmful effects on outcomes,^[21] others continue to have concern regarding the increased possibility of an aspiration event (choking on recently eaten foods) in the event of an emergency delivery due to the increased relaxation of the esophagus in pregnancy, upward pressure of the uterus on the stomach, and the possibility of general anesthetic in the event of an emergency cesarean.^[22]

Pain control[link]

Non pharmaceutical

Some women prefer to avoid analgesic medication during childbirth. They can still try to alleviate labor pain using psychological preparation, education, massage, acupuncture, TENS unit use, hypnosis, or water therapy in a tub or shower. Some women like to have someone to support them during labor and birth, such as the father of the baby, a family member, a close friend, a partner, or a doula. The human body also has a chemical response to pain, by releasing endorphins. Endorphins are present before, during, and immediately after childbirth.^[23] Some homebirth advocates believe that this hormone can induce feelings of pleasure and euphoria during childbirth,^[24] reducing the risk of maternal depression some weeks later.^[23]

Water birth is an option chosen by some women for pain relief during labor and childbirth, and some studies have shown waterbirth in an uncomplicated pregnancy to reduce the need for analgesia, without evidence of increased risk to mother or newborn.^[25] Hot water tubs are available in many hospitals and birthing centres.

Meditation and mind medicine techniques are also used for pain control during labour and delivery. These techniques are used in conjunction with progressive muscle relaxation and many other forms of relaxation for the mind and body to aid in pain control for women during childbirth. One such technique is the use of hypnosis in childbirth. There are a number of organizations that teach women and their partners to use a variety of techniques to assist with labor comfort, without the use of pharmaceuticals

A new mode of analgesia is sterile water injection placed just underneath the skin in the most painful spots during labor. A control trial in Iran of 0.5mL injections was conducted with normal saline which revealed a statistical superiority with water over saline.^[26]

Pharmaceutical

Different measures for pain control have varying degrees of success and side effects to the woman and her baby. In some countries of Europe, doctors commonly prescribe inhaled nitrous oxide gas for pain control, especially as 50% nitrous oxide, 50% oxygen, known as Entonox; in the UK, midwives may use this gas without a doctor's prescription. Pethidine (with or without promethazine) may be used early in labour, as well as other opioids such as fentanyl, but if given too close to birth there is a risk of respiratory depression in the infant.

Popular medical pain control in hospitals include the regional anesthetics epidural blocks, and spinal anaesthesia. Epidural analgesia is a generally safe and effective method of relieving pain in labour, but is associated with longer labour, more operative intervention (particularly instrument delivery), and increases in cost.^[27] Generally, pain and cortisol increased throughout labor in women without EDA. Pain and stress hormones rise throughout labor for women without epidurals, while pain, fear, and stress hormones decrease upon administration of epidural analgesia, but may rise again later.^[28] Medicine administered via epidural can cross the placenta and enter the bloodstream of the fetus.^[29] Epidural analgesia has no statistically significant impact on the risk of caesarean section, and does not appear to have an immediate effect on neonatal status as determined by Apgar scores.^[30]

Augmentation[link]

Augmentation is the process of facilitating further labour. Oxytocin has been used to increase the rate of vaginal delivery in those with a slow progress of labor.^[31]

Instrumental delivery[link]

Obstetric forceps or ventouse may be used to facilitate childbirth.

Multiple births[link]

In cases of a cephalic presenting twin (first baby head down), twins can often delivered vaginally. In some cases twin delivery is done in a larger delivery room or in an operating theatre, in the event of complication e.g.

• Both twins born vaginally - this can occur both presented head first or where one comes head first and the other is breech and/or helped by a forceps/ventouse delivery
• One twin born vaginally and the other by caesarean section.
• If the twins are joined at any part of the body - called conjoined twins, delivery is mostly by caesarean section.

Support[link]

Baby on warming tray attended to by her father.

There is increasing evidence to show that the participation of the woman's partner in the birth leads to better birth and also post-birth outcomes, providing the partner does not exhibit excessive anxiety.^[32] Research also shows that when a laboring woman was supported by a female helper such as a family member or doula during labor, she had less need for chemical pain relief, the likelihood of caesarean section was reduced, use of forceps and other instrumental deliveries were reduced, there was a reduction in the length of labor, and the baby had a higher Apgar score (Dellman 2004, Vernon 2006). However, little research has been conducted to date about the conflicts between partners, professionals, and the mother.

Monitoring[link]

A method of monitoring a childbirth is cardiotocography, which consists of two sensors: The heart (cardio) sensor is a ultrasonic sensor, similar to a Doppler fetal monitor, that continuously emits ultrasound and detects motion of the fetal heart by the characteristic of the reflected sound. The pressure-sensitive contraction transducer, called a tocodynamometer (toco) has a flat area that is fixated to the skin by a band around the belly. The pressure required to flatten a section of the wall correlates with the internal pressure, thereby providing an estimate of it.^[33]

Collecting stem cells[link]

It is possible to collect two types of stem cells during childbirth: amniotic stem cells or umbilical cord blood stem cells. To collect amniotic stem cells, it is necessary to do amniocentesis before or during the birth. Amniotic stem cells are multipotent and very active, useful for both autologous or donor use. There are private banks in US; the first is Biocell Center in Boston.^[34][35][36]

Umbilical cord blood stem cells are also active, but less multipotent than amniotic stem cells. There are a lot of banks of cord blood, both private and public and for autologous or eterologous use.

Complications[link]

Disability-adjusted life year for maternal conditions per 100,000 inhabitants in 2002.^[37]

  no data

  less than 100

  100-400

  400-800

  800-1200

  1200-1600

  1600-2000

  2000-2400

  2400-2800

  2800-3200

  3200-3600

  3600-4000

  more than 4000

Disability-adjusted life year for perinatal conditions per 100,000 inhabitants in 2002.^[37]

  no data

  less than 100

  100-400

  400-800

  800-1200

  1200-1600

  1600-2000

  2000-2400

  2400-2800

  2800-3200

  3200-3600

  3600-4000

  more than 4000

Childbirth is an inherently dangerous and risky activity, subject to many complications. The "natural" mortality rate of childbirth—where nothing is done to avert maternal death—has been estimated at 1500 deaths per 100,000 births.^[38] (See main article: neonatal death, maternal death). Modern medicine has greatly alleviated the risk of childbirth. In modern Western countries, such as the United States and Sweden, the current maternal mortality rate is around 10 deaths per 100,000 births.^[39]

Birthing complications may be maternal or fetal, and long term or short term.

Labor complications[link]

The second stage of labor may be delayed or lengthy due to:

• malpresentation (breech birth (i.e. buttocks or feet first), face, brow, or other)
• failure of descent of the fetal head through the pelvic brim or the interspinous diameter
• poor uterine contraction strength
• active phase arrest
• cephalo-pelvic disproportion (CPD)
• shoulder dystocia

Secondary changes may be observed: swelling of the tissues, maternal exhaustion, fetal heart rate abnormalities. Left untreated, severe complications include death of mother and/or baby, and genitovaginal fistula.

Dystocia (obstructed labour)[link]

Dystocia is an abnormal or difficult childbirth or labour. Approximately one fifth of human labours have dystocia. Dystocia may arise due to incoordinate uterine activity, abnormal fetal lie or presentation, absolute or relative cephalopelvic disproportion, or (rarely) a massive fetal tumor such as a sacrococcygeal teratoma. Oxytocin is commonly used to treat incoordinate uterine activity, but pregnancies complicated by dystocia often end with assisted deliveries, including forceps, ventouse or, commonly, caesarean section. Recognized complications of dystocia include fetal death, respiratory depression, Hypoxic Ischaemic Encephalopathy (HIE), and brachial nerve damage. A prolonged interval between pregnancies, primigravid birth, and multiple birth have also been associated with increased risk for labour dystocia.^[40]

Shoulder dystocia is a dystocia in which the anterior shoulder of the infant cannot pass below the pubic symphysis or requires significant manipulation to pass below it. It can also be described as delivery requiring additional manoeuvres after gentle downward traction on the head has failed to deliver the shoulders.

A prolonged second stage of labour is another type of dystocia whereby the fetus has not been delivered within three hours in a nulliparous woman, or two hours in multiparous woman, after her cervix has become fully dilated.

Synonyms for dystocia include difficult labour, abnormal labour, difficult childbirth, abnormal childbirth, and dysfunctional labour.

Maternal complications[link]

Vaginal birth injury with visible tears or episiotomies are common. Internal tissue tearing as well as nerve damage to the pelvic structures lead in a proportion of women to problems with prolapse, incontinence of stool or urine and sexual dysfunction. Fifteen percent of women become incontinent, to some degree, of stool or urine after normal delivery, this number rising considerably after these women reach menopause. Vaginal birth injury is a necessary, but not sufficient, cause of all non hysterectomy related prolapse in later life. Risk factors for significant vaginal birth injury include:

• A baby weighing more than 9 pounds.
• The use of forceps or vacuum for delivery. These markers are more likely to be signals for other abnormalities as forceps or vacuum are not used in normal deliveries.
• The need to repair large tears after delivery.

Pelvic girdle pain. Hormones and enzymes work together to produce ligamentous relaxation and widening of the symphysis pubis during the last trimester of pregnancy. Most girdle pain occurs before birthing, and is known as diastasis of the pubic symphysis. Predisposing factors for girdle pain include maternal obesity.

Infection remains a major cause of maternal mortality and morbidity in the developing world. The work of Ignaz Semmelweis was seminal in the pathophysiology and treatment of puerperal fever and saved many lives.

Hemorrhage, or heavy blood loss, is still the leading cause of death of birthing mothers in the world today, especially in the developing world. Heavy blood loss leads to hypovolemic shock, insufficient perfusion of vital organs and death if not rapidly treated. Blood transfusion may be life saving. Rare sequelae include Hypopituitarism Sheehan's syndrome.

The maternal mortality rate (MMR) varies from 9 per 100,000 live births in the US and Europe to 900 per 100,000 live births in Sub-Saharan Africa.^[41] Every year, more than half a million women die in pregnancy or childbirth.^[42]

Fetal complications[link]

Mechanical fetal injury[link]

Risk factors for fetal birth injury include fetal macrosomia (big baby), maternal obesity, the need for instrumental delivery, and an inexperienced attendant. Specific situations that can contribute to birth injury include breech presentation and shoulder dystocia. Most fetal birth injuries resolve without long term harm, but brachial plexus injury may lead to Erb's palsy or Klumpke's paralysis.^[43]

Neonatal infection[link]

Disability-adjusted life year for neonatal infections and other (perinatal) conditions per 100,000 inhabitants in 2004. Excludes prematurity and low birth weight, birth asphyxia and birth trauma which have their own maps/data.^[44]

  no data

  less than 150

  150-300

  300-450

  450-600

  600-750

  750-900

  900-1050

  1050-1200

  1200-1350

  1350-1500

  1500-1850

  more than 1850

Neonates are prone to infection in the first month of life. Some organisms such as S. agalactiae (Group B Streptococcus) or (GBS) are more prone to cause these occasionally fatal infections. Risk factors for GBS infection include:

• prematurity (birth prior to 37 weeks gestation)
• a sibling who has had a GBS infection
• prolonged labour or rupture of membranes

Untreated sexually transmitted infections are associated with congenital and perinatal infections in neonates, particularly in the areas where rates of infection remain high. The overall perinatal mortality rate associated with untreated syphilis, for example, approached 40%.^[45]

Neonatal death[link]

Infant deaths (neonatal deaths from birth to 28 days, or perinatal deaths if including fetal deaths at 28 weeks gestation and later) are around 1% in modernized countries.

The most important factors affecting mortality in childbirth are adequate nutrition and access to quality medical care ("access" is affected both by the cost of available care, and distance from health services).^{[citation needed]}

A 1983-1989 study by the Texas Department of State Health Services highlighted the differences in neonatal mortality (NMR) between high risk and low risk pregnancies. NMR was 0.57% for doctor-attended high risk births, and 0.19% for low risk births attended by non-nurse midwives. Conversely, some studies demonstrate a higher perinatal mortality rate with assisted home births.^[46] Around 80% of pregnancies are low-risk. Factors that may make a birth high risk include prematurity, high blood pressure, gestational diabetes and a previous cesarean section.

Intrapartum asphyxia[link]

Intrapartum asphyxia is the impairment of the delivery of oxygen to the brain and vital tissues during the progress of labour. This may exist in a pregnancy already impaired by maternal or fetal disease, or may rarely arise de novo in labour. This can be termed fetal distress, but this term may be emotive and misleading. True intrapartum asphyxia is not as common as previously believed, and is usually accompanied by multiple other symptoms during the immediate period after delivery. Monitoring might show up problems during birthing, but the interpretation and use of monitoring devices is complex and prone to misinterpretation. Intrapartum asphyxia can cause long-term impairment, particularly when this results in tissue damage through encephalopathy.^[47]

Professions associated with childbirth[link]

Model of pelvis used in the beginning of the 20th century to teach technical procedures for a successful childbirth. Museum of the History of Medicine, Porto Alegre, Brazil

Different categories of birth attendants may provide support and care during pregnancy and childbirth, although there are important differences across categories based on professional training and skills, practice regulations, as well as nature of care delivered.

“Childbirth educators” are instructors who aim to educate pregnant women and their partners about the nature of pregnancy, labour signs and stages, techniques for giving birth, breastfeeding and newborn baby care. In the United States and elsewhere, classes for training as a childbirth educator can be found in hospital settings or through many independent certifying organizations such as Birthing From Within, BirthWorks, The Bradley Method, CAPPA, HypBirth, HypnoBabies, HypnoBirthing, ICTC, ICEA, Lamaze, etc. Each organization teaches its own curriculum and each emphasizes different techniques. Information about each can be obtained through their individual websites.

Doulas are assistants who support mothers during pregnancy, labour, birth, and postpartum. They are not medical attendants; rather, they provide emotional support and non-medical pain relief for women during labour. Like childbirth educators and other assistive personnel, certification to become a doula is not compulsory, thus, anyone can call themself a doula or a childbirth educator.

Midwives are autonomous practitioners who provide basic and emergency health care before, during and after pregnancy and childbirth, generally to women with low-risk pregnancies. Midwives are trained to assist during labour and birth, either through direct-entry or nurse-midwifery education programs. Jurisdictions where midwifery is a regulated profession will typically have a registering and disciplinary body for quality control, such as the College of Midwives of British Columbia (CMBC) in Canada^[48] or the Nursing and Midwifery Council (NMC) in the United Kingdom.^[49]

In jurisdictions where midwifery is not a regulated profession, traditional or lay midwives may assist women during childbirth, although they do not typically receive formal health care education and training.

Medical doctors who practice obstetrics include categorically specialized obstetricians; family practitioners and general practitioners whose training, skills and practices include obstetrics; and in some contexts general surgeons. These physicians and surgeons variously provide care across the whole spectrum of normal and abnormal births and pathological labour conditions. Categorically specialized obstetricians are qualified surgeons, so they can undertake surgical procedures relating to childbirth. Some family practitioners or general practitioners also perform obstetrical surgery. Obstetrical procedures include cesarean sections, episiotomies, and assisted delivery. Categorical specialists in obstetrics are commonly dually trained in obstetrics and gynecology (OB/GYN), and may provide other medical and surgical gynecological care, and may incorporate more general, well-woman, primary care elements in their practices. Maternal-fetal medicine specialists are obstetrician/gynecologists subspecialized in managing and treating high-risk pregnancy and delivery.

Obstetric nurses assist midwives, doctors, women, and babies prior to, during, and after the birth process, in the hospital system. Some midwives are also obstetric nurses. Obstetric nurses hold various certifications and typically undergo additional obstetric training in addition to standard nursing training.

Facilities[link]

Following are facilities that are particularly intended to house women during childbirth:

• A labor ward, also called a delivery ward or delivery unit, is generally a department of a hospital that focuses on providing health care to women and their children during childbirth. It is generally closely linked to the hospital's neonatal intensive care unit and/or obstetric surgery unit if present. A maternity ward or maternity unit may include facilities both for childbirth and for postpartum rest and observation of mothers in normal as well as complicated cases.
• A birthing center generally presents a more home-like environment than a hospital labor ward.

In addition, it is possible to have a home birth.

Society and culture[link]

Childbirth routinely occurs in hospitals in much of Western society. Before the 20th century and in some countries to the present day it has more typically occurred at home.^[50]

In Western and other cultures, age is reckoned from the date of birth, and sometimes the birthday is celebrated annually. East Asian age reckoning starts newborns at "1", incrementing each Lunar New Year.

Some families view the placenta as a special part of birth, since it has been the child's life support for so many months.The placenta may be eaten by the newborn's family, ceremonially or otherwise (for nutrition; the great majority of animals in fact do this naturally).^[51] Most recently there is a category of birth professionals available who will encapsulate placenta for use as placenta medicine by postpartum mothers.

The exact location in which childbirth takes place is an important factor in determining nationality, in particular for birth aboard aircraft and ships.

See also[link]

Wikinews has related news: 17-pound baby born in Russia

Wikimedia Commons has media related to: Childbirth

• Advanced maternal age, an increase in age at first birth
• Amniotic stem cells
• Asynclitic birth, an abnormal birth position
• Bradley method of natural childbirth
• Coffin birth
• Health care provider
• Homebirth
• Lamaze
• Naegele's Rule to calculate the due date for a pregnancy
• Natalism
• Natural childbirth
• Obstetrical Dilemma
• Partogram
• Postpartum depression (PPD)
• Postnatal
• Pre- and perinatal psychology
• Pre-labor
• Traditional birth attendant
• Unassisted childbirth
• Vernix caseosa
• Waterbirth

References[link]

External links[link]

• csections.org - a balanced view of caesareans - a possible outcome of your birth
• Child's growth after birth
• Medical Video showing Childbirth from the American Medical Video Journal
• Childbirth (Parto) - Spanish

Ina May Gaskin at Nambassa 3 day Music & Alternatives festival, New Zealand 1981.

Ina May Gaskin, CPM, has been described as "the mother of authentic midwifery."^[1]

Family[link]

Gaskin was born to an Iowa Protestant family (Methodist on one side, Presbyterian on the other). Her father, Talford Middleton, was raised on a large Iowa farm, which was lost to a bank not long after his father’s accidental death in 1926. Her mother, Ruth Stinson Middleton, was a home economics teacher, who taught in various small towns within a forty-mile radius of Marshalltown, Iowa. Both parents were college graduates, who placed a great importance on higher education.

Her maternal grandparents ran a Presbyterian orphanage in Farmington, Missouri, a small town in the Ozarks. Her grandmother, Ina May Beard Stinson, directed the orphanage for many years after her pastor husband’s death. She was an avid member of the Woman's Christian Temperance Union and a great admirer of Elizabeth Cady Stanton, Susan B. Anthony, and Jane Addams. Gaskin’s paternal grandparents were all farmers. Adam Leslie Middleton, her grandfather, traveled and worked with farmers from Iowa, Illinois, Minnesota, South Dakota, Nebraska, and Kansas in cooperative grain marketing, organizing communities, as well as larger outlets in Chicago and other large cities, to establish local cooperative grain elevators. His work as an organizer took him to Canada to work with wheat growers, and to Washington, D. C., on the invitation of the Secretary of Agriculture under President Warren G. Harding, Henry C. Wallace, father of Henry A. Wallace, President Franklin Delano Roosevelt’s Secretary of Agriculture.

The Farm Midwifery Center[link]

In 1971 Gaskin, with her husband Stephen, founded a commune called The Farm in Summertown Tennessee. There, she and the midwives of the Farm created The Farm Midwifery Center, one of the first out-of-hospital birth centers in the United States.^[2] Standards of birthing at the Farm are modeled to the recommendations of the American College of Obstetricians and Gynecologists. Family members and friends are commonly in attendance and are encouraged to take an active role in the birth. The Farm Midwifery Center has been able to maintain extremely low rates of medical intervention with consistently good birth outcomes for nearly four decades^[3]

Significance of her work[link]

According to Carol Lorente (1995), the work of Gaskin and the midwives might not have had the impact it did, if it hadn't been for the publication of her book Spiritual Midwifery (1977):

"Considered a seminal work, it presented pregnancy, childbirth and breastfeeding from a fresh, natural and spiritual perspective, rather than the standard clinical viewpoint. In homebirth and midwifery circles, it made her a household name, and a widely respected teacher and writer."^[4]

Gaskin has been credited with the emergence and popularization of direct-entry midwifery (i.e. not training as a nurse first) in the United States since the early 1970s. Between 1977 and 2000, she published the quarterly magazine Birth Gazette. Ina May’s Guide to Childbirth, her second book about birth and midwifery, was published by Bantam/Dell in 2003. Her books have been published in several languages, including German, Italian, Hungarian, Slovenian, Spanish, and Japanese.

Since the early 1980s, she has been an internationally-known speaker on maternity care independently and for the Midwives Alliance of North America (MANA),^[1] lecturing throughout the world to midwives, physicians, doulas, expectant parents and health policy-makers. She has spoken at medical and midwifery schools in several countries and at both the Starwood Festival and the WinterStar Symposium, discussing the history and importance of midwifery.

She is the founder of the Safe Motherhood Quilt Project, a national effort developed to draw public attention to the current maternal death rates, and to honor those women who have died of pregnancy-related causes during the past twenty years.^[5]

She has appeared in such prominent films as Ricki Lake's movies Orgasmic Birth (2009) (directed by Debra Pascali-Bonaro) and The Business of Being Born (2008) (directed by Abby Epstein). She also appears in With Women: A Documentary About Women, Midwives and Birth (2006).^[6]

Outcomes[link]

A study of home births assisted by the midwives of The Farm, (Durand, (1992)) looked at the outcomes of 1707 women who received care in rural Tennessee between 1971 and 1989. These births were compared to outcomes of over 14,000 physician-attended hospital births in 1980. Comparing perinatal deaths, labor complications, and use of assisted delivery, the study found that "under certain circumstances, home births attended by lay midwives can be accomplished as safely as, and with less intervention than, physician-attended hospital deliveries."^[7]

The Gaskin Maneuver[link]

The Gaskin Maneuver, also called all fours, is a technique to reduce shoulder dystocia. Gaskin claims to have introduced it in 1976 after learning it from a Belizean woman who had, in turn, learned the maneuver in Guatemala, where it originated. In this maneuver, the mother supports herself on her hands and knees to resolve shoulder dystocia.^[8] Switching to a hands and knees position causes the shape of the pelvis to change, thereby allowing the trapped shoulder to free itself and the baby to be born. Since this maneuver requires a significant movement from the standard lithotomy position, it can be substantially more difficult to perform while under epidural anesthesia, but still possible,^[9] and can be performed by an experienced delivery room-team.^[10]

Recognition[link]

Ina May Gaskin has lectured and continues to lecture at midwifery conferences and medical schools all over the world. On June 14th, 2008, she led a workshop called 'A Guide to Natural Childbirth' at the New York Open Center^[11] in Manhattan. She served as President of Midwives' Alliance of North America from 1996 to 2002. She received the ASPO/Lamaze Irwin Chabon Award (1997), and the Tennessee Perinatal Association Recognition Award. She was featured in Salon magazine’s “Brilliant Careers” in 1999.^[1] In 2003, she was made a Visiting Fellow of Morse College, Yale University.^[12] Ina May was awarded the title "Honorary Doctor" in recognition of her work demonstrating the effectiveness and safety of midwifery by the Thames Valley University, London, England, on November 24, 2009.^[13] On September 29, 2011, Ina May Gaskin was announced as a co-winner of the 2011 Right Livelihood Award, sometimes also called "the Alternative Nobel Prize".^[3][14]

Bibliography[link]

Books[link]

• 1987 - Babies, Breastfeeding & Bonding (Bergin & Garvey Publishers) ISBN 0-89789-134-1
• 2002 - Spiritual Midwifery (The Book Publishing Company) ISBN 1-57067-104-4 (1st edition 1977)
• 2003 - Ina May's Guide to Childbirth (Bantam) ISBN 0-553-38115-6
• 2009 - Ina May's Guide to Breastfeeding (Bantam, US) ISBN 978-0-553-38429-1 (Pinter & Martin, UK) ISBN 978-1-905177-33-2
• 2010 - Birth Matters: A Midwife's Manifesta (Seven Stories Press, US) ISBN 978-1-58322-927-9 (Pinter & Martin, UK) ISBN 978-1-905177-58-5

Articles[link]

• All-Fours Maneuver for Reducing Shoulder Dystocia During Labor, The Journal of Reproductive Medicine, May, 1998.
• Induced and Seduced: The Dangers of Cytotec. in Mothering, July-August, 2001. Retrieved: 2006-08-26.
• The Undervalued Art of Vaginal Breech Birth: a Skill Every Birth Attendant Should Learn in Mothering, July-August, 2004. Retrieved: 2006-08-26. {Broken Link}
• A Summary of Articles Published in English about Misoprostol (Cytotec) for Cervical Ripening or Induction of Labor, 2005-09-05 Retrieved: 2010-01-22.

Filmography[link]

• With Women: A Documentary About Women, Midwives and Birth (2006)
• The Business of Being Born (2008)
• Orgasmic Birth: The Best-Kept Secret (2009)

Notes and references[link]

External links[link]

• Ina May Gaskin Official website
• Safe Motherhood Quilt Project
• Farm Midwifery Workshops
• The Farm Midwives Website
• Ina May Gaskin IMDB
• Profile by Viv Groskop, The Guardian, September 2009
• "Ina May Gaskin and the Battle for at-Home Births" feature by Samantha M. Shapiro in The New York Times Magazine May 23, 2012