Baby delivery details

Delivery includes the placenta, umbilical cord and membranes, and this takes between five and thirty minutes. After birth, the umbilical cord moves away from the vulva and is an indication of the final detachment of the placenta; the cord comes out of the uterine cavity after the placenta. This natural movement of the umbilical cord proportional to the decrease of the placenta is known as Ahlfeld’s sign.

The detachment of the placenta occurs by two possible mechanisms. The first detachment occurs in the center of the utero-placental junction, a mechanism known as Baudelocque-Schultze mechanism and usually happens in about 95 percent of cases. Less common is when the placenta is torn at the side of the utero-placental junction, known as the Baudelocque-Duncan mechanism.

Uterine contractions continue during the descent of the placenta, which help to compress the vessels of the myometrium terminals that lose their usefulness after birth, a process known as the bonds in obstetrics.

Many experts deem the childbirth period ends with delivery, but others consider a fourth term –the immediate recovery and the two hours following delivery. During this period, called early puerperium, the mother and child should be together to promote the initiation of breastfeeding, child safety and tranquility. In this sense, the term “rooming” is used to describe the baby’s stay in the same room as her mother, whether in the hospital or other place of rest.

Mechanism of delivery

For the mechanics of delivery, the fetus of smaller diameter passes through the larger diameter of the maternal pelvis. To not be embedded at some point during his path to outside of the uterus, the baby goes through a series of natural movements that constitute the mechanism of labor.

Descent: occurs by the action of gravity, once the cervix is dilated, and by the powerful uterine contractions and maternal abdominal muscles. The descent tends to be slowly progressive, based on the maternal pelvic structure.

Flexion: the fetal head is flexed so that the fetal chin touches its chest, finding the first point of resistance of the pelvic floor.

Embeddedness: the diameter of the fetal head that goes from the opposite parietal bone, called the biparietal diameter, reaches the brim of the pelvis at the level of the ischial spines. It usually occurs in the late phase of pregnancy, right at the start of labour.

Internal Rotation: This occurs in the narrow middle of the pelvis, when the fetus, by continuing its descent, makes a rotation of 90 degrees counterclockwise to clockwise, so as to adapt to the rhomboid configuration of the pelvic floor muscles between the levator ani and the ilio-coccygeal. Thus, the baby’s face is directed toward the rectum of the mother.

Extension: the head of the fetus extends through the birth canal, so that it first moves against the vulvar orifice. The head is below the pubic symphysis and the most relaxed perineum.

External rotation: once the head is out, there is a 45 degree turn to restore its original position, before the internal rotation, and it remains in normal position in relation to the shoulders.

Removal: the pubic shoulder tends to come out first, followed by perineal shoulder. The rest of the body comes out with a slight maternal drive.

These movements are all due to the relationship between the bony head and shoulders of the fetus and the pelvic girdle feeding.

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