Maternity Care (US Navy, 1963)
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Maternity Care (US Navy, 1963)


[Music] [Narrator:] When you are in your ninth month,
it’s only natural to prepare for your eventual trip to the hospital and to wonder a little more about your baby. Many questions come to mind. Will he be a boy or girl? Will he be handsome? What to name him? But perhaps most persistent, will be the question about your baby’s birth. Will he arrive on time? At your first visit to the doctor, you were told your due date, but at best this was only a rough estimate. Actually, only one baby out of every 10 is born on the due date. If he comes any time within two weeks, before or after this date, he will be on time. Or, as your doctor says, a full-term baby. You may also be wondering how you know when you’re in labor. Don’t worry, almost all women know instinctively when labor begins. But, just to reassure you, let’s see what happens when labor begins. Your uterus is an organ, which consists essentially of layers of muscles, except for its mouth, the cervix, which contains mostly fibrous tissue. These muscles, from time to time, tighten or contract for a few seconds, then relax. This happens at irregular intervals throughout your pregnancy. Each contraction is so mild that you’re usually unaware of its occurrence. But during the last three or four weeks of your pregnancy, this muscular activity increases and you may become aware of it, since there is some discomfort associated with it. Each contraction still lasts but a few seconds, and may not recur for hours or even days. On occasion, the tightness or firmness of these muscular contractions may even be felt through the abdominal wall. This muscular activity serves a very useful purpose. It helps to soften the cervix, and to strengthen these muscles for their work during labor. Sometimes these contractions may recur frequently enough with discomfort to be mistaken for the beginning of labor, a condition referred to as false labor. In false labor, the intervals between contractions; that is, the period the muscles are relaxed, are irregular in duration. By making a graph of the muscular activity of false labor in this manner, you can get a clearer picture of its characteristics. These peaks represent two conditions. Their height is the intensity or strength of the muscular contraction. Their width tells how long the contraction lasts. These plateaus represent the intervals between contractions. That is, the period the muscles are relaxed. Note that neither the plateaus nor the peaks show any uniform pattern. And as time passes, the contractions in false labor show no tendency to increase in frequency, duration, or intensity. And may, after a few hours, cease completely, not to reappear for hours or even days. In true labor, on the other hand, the muscular contractions follow a much more uniform, or regular pattern. They occur at regular intervals. Furthermore, as time passes, the contractions get stronger; that is, you feel them more. They last longer. And they occur more frequently in a rhythmical pattern. For example, the intervals between the contractions may start at 20 or 15 minutes. Then, decrease to 10 minutes. The important thing to remember is this: when you have three or four contractions, occurring at regular intervals, and each contraction lasts 30 seconds or more, it’s time to go to the hospital. Sometimes before true labor begins, your uterus, here shown exposed, undergoes certain changes. Its cervix, normally tightly closed during pregnancy, may discharge a plug of mucus slightly tinged with blood, an event referred to as pink show, and an indication that labor is about to begin. Also, the membrane surrounding your baby may occasionally rupture to release its fluid, either slowly like this, or with a gush. This too heralds the approach of labor. Finally, when the muscular contractions of your uterus begin to alter the cervical opening, your doctor knows with certainty that you are in true labor. With first baby, the change noted first is a shortening of the opening. Eventually, each contraction causes the opening to become a little wider. With true labor, the feeling of tightness and discomfort is usually felt first in the lower back and then radiates toward the front of your abdomen. But whether or not this useful sign appears, it is important to remember that the contractions in true labor always have a definite rhythm. And they always gradually increase in frequency, intensity, and duration. So, when you notice your contractions are occurring at regular intervals, and that they have reached a point where each contraction lasts at least 30 seconds, it’s time to call your husband, a friend, or a taxi to drive you to the hospital. Follow the same course of action if your membranes should rupture, regardless of whether or not you are having regular contractions. At the hospital, your presence sets into motion a plan of action especially designed for pregnant women… a plan that’s been carried out many, many times before, and by well-trained teams of experts. As you’re led into the next room, and prepared to be examined, the nurse calls for a doctor. And while awaiting his arrival, she locates your prenatal records, which reports everything significant about your pregnancy and the general condition of your health. Also, she obtains for the doctor some other important current information, such as your blood pressure, your baby’s heartbeat, and the frequency and duration of your contractions. All of this information is important to the doctor. It not only helps him determine the condition of your labor, but how well you and your baby are reacting to it. Before admitting you for treatment, he’ll make an examination to check the condition of the opening of your cervix. This not only confirms whether you are really in labor, but more importantly, how far your labor has progressed. Thus, he is able to decide whether to have you taken to the labor room, or the delivery room, and even sometimes sent back home to await the start of labor. Normally, if you’ve come in as instructed, you will first be taken to the labor room. After a shower and a change to hospital gown, you’ll be prepped. That is to say, your pubic area will be carefully shaved and washed, to prevent anything contaminated from entering the birth canal and possibly infecting you, or your baby. Then, you’ll be given an enema and asked to empty your bladder. These actions lessen your discomfort during contractions and provide more room within your pelvic region for the expansion of the birth canal, so your baby will pass through more easily. Immediately following the prepping and enema, the doctor will examine you again. This time the examination is concerned with making sure you have no respiratory infection, or other condition that might prohibit the use of certain drugs to ease your discomfort during labor and delivery. At the completion of this examination, he will give specific instructions to the nurse as to the kind, amount, and frequency of medication you are to be given. Also, how frequently you’re to have your temperature, pulse, and respiration checked, as well as your blood pressure, fetal heartbeats, and contractions. Your contractions during this period, the early part of the first stage of labor, are usually never too uncomfortable. By lying on your side and breathing slowly and evenly, instead of holding your breath, you’ll find that any discomfort that you may experience is lessened appreciably. Between contractions, there is of course, no discomfort. At the proper time you will be given the medication prescribed by the doctor. This medication is intended only to ease your discomfort, not to eliminate it completely. It may include both oral and injected medication. The injected medication is administered only after your labor is well-established. If given too soon, it may slow down, or stop your labor. And if given an amount large enough to eliminate your discomfort completely, it may prove harmful to your baby. Once you have received medication, the bed guards are raised to prevent you from accidentally falling while asleep. Also, during this stage of labor, you may be left alone for short periods. But don’t fret, for just outside your room will be doctors, nurses, and aides, immediately within call whenever you need attention. But they’ll know when to look in on you again. For, from this large blackboard, each doctor can quickly learn the condition and progress of his patient in labor. Here are posted the changing bits of significant information obtained from the various examinations and checks made on each woman in labor. This helps assure every patient receiving the necessary supervision and personal attention she needs when she needs it. Throughout the first stage of labor, your doctor will make periodic examinations of the opening of your cervix. To understand better why he does this, let’s look at your cervix as it appears at the start of labor. And let’s show it exposed, so you can see what happens to it during the first stage. The cervix shortens gradually as its walls are pulled by the muscular contractions of the uterus. This continues until its edges become almost paper-thin. Then, the opening begins to expand. By checking the size and thickness of this opening from time to time, your doctor can tell how fast it’s expanding. And approximately when the opening is likely to be wide enough for your baby to pass into the vagina or birth canal. When this happens, the first stage of your labor will be over. But more important, it will alert your doctor to have someone stay with you throughout the remainder of your labor. How long your first stage of labor will last depends upon many factors. Suffice it to say, the time varies considerably among different women. But for each woman, it is shorter after her first delivery. An important thing to remember about the first stage is that the contractions you will experience are completely involuntary. You cannot change their intensity or frequency. So, when you have a contraction, roll on your side and remember to just keep breathing slowly and evenly. Don’t hold your breath! And don’t push or bear down with your abdominal muscles. You will tire yourself needlessly, and have no effect on shortening the first stage of your labor. And between contractions, concentrate on relaxing and resting. It helps to imagine how it feels to have your arms and legs go limp. The size of your cervical opening is posted on the board. Normally, the opening measures about 10 centimeters, or 4 inches when fully dilated, which marks the end of the first stage of labor. You’ll know when this moment arrives, because you’ll find yourself bearing down instinctively, just as you do when having a bowel movement. You’ll notice, too, that you are breathing harder and grunting, and thinking that you need to move your bowels. You may at this time receive some additional medication to ease the increased discomfort, which results from your vagina being stretched as each contraction slowly pushes your baby through it. Also, during this second stage of labor, the progress of your baby’s movement and condition, as well as your own, will be checked much more frequently. From now on, someone will stay with you constantly. Since the second stage, unlike the first, can be shortened appreciably by your bearing-down efforts. You’ll be instructed on how to breathe and use your muscles to make them more effective. So that when the next contraction begins, you’ll flex your thighs against your abdomen, grasp your legs below the knees, and holding your breath, push downward with your abdominal muscles as strongly as you can, as if you were straining at stool. The longer you hold your breath and push, the better. This, of course, is very tiring work. So, when the contraction ends, you’ll lower your legs and rest. You’ll probably find it more comfortable to take short, shallow breaths. Every change in your condition and progress of labor will be carefully watched. And your doctor will look in on you more frequently to check physically on how far your baby has descended into your vagina. As soon as his findings lead him to believe you’re your baby is about 15 or 20 minutes from being born, you’ll be taken to the delivery room. Everything in this room is there to make the delivery of your baby as safe and comfortable as it can possibly be. This is evident in the precautions taken to prevent contamination and possible infection, and in the care with which the medication for anesthesia is selected and prepared. This medication is but one of a large variety of anesthetics. Each one has certain advantages and disadvantages for different deliveries. Some act quickly, others slowly. Some last a long time, others briefly. And some have little or no effects upon your baby, while others, under certain circumstances can make it dangerously difficult for the baby to breathe. Therefore, the final choice of which anesthetic to use must be left with your doctor. Only he can judge wisely which one will best suit your labor and afford the maximum comfort to you, and the greatest safety to your baby. The anesthetic selected for this patient is the type used in a procedure called saddle block. The saddle block technique is one which allows you to remain fully conscious. It involves inserting a needle near the nerves in your back, then injecting the anesthetic, which blocks all sensation from your pelvic area. And as you can see, there’s very little, if any pain felt, when it is given. You will now rest for a few minutes to allow the anesthetic to take effect. And during this period, the doctor checks your fetal heartbeat, blood pressure, and level of anesthesia, so he’ll know when to have your legs secured in padded supports which hold them raised in the delivery position. A section of the delivery table is now dropped and rolled back to make your birth canal more accessible. Following this, your perineal area is swabbed with an antiseptic solution. Your wrists are secured in bracelets to keep your hands from unintentionally contaminating the perineal area or the sterile drapes which are placed around it and over your legs. During your labor, you may be given oxygen to help sustain your baby until he is able to breathe on his own. As you can see, it takes real team effort and expertness to prepare you for the safest and most comfortable delivery you could possibly wish. No longer do you feel pain. The involuntary urge to bear down with your contractions no longer occurs. So, when your doctor tells you to, you’ll bear down, and only then. The muscular contractions of the uterus and abdomen push your baby against the vaginal opening, stretching the surrounding tissues. If it appears that these tissues may tear, your doctor makes a short, straight incision through them. You feel no pain when this is done. The resulting incision can be repaired much better and will heal faster than an accidental, jagged tear. Also, it makes it easier for your baby to be born. This instrument, called forceps, further aids delivery of your baby. Watch how carefully the doctor inserts each blade, so it is positioned alongside the baby’s head. When the two handles are held close together, the doctor is able to pull and guide the baby’s head out of the birth canal. Thereby shortening the second stage of labor. The use of forceps causes no harm to the baby or the mother. And because of its proved contribution to the baby’s safety, and the mother’s comfort, some doctors use it for almost all of their deliveries. Once the head is delivered, the doctor clears its mouth and nose of mucus. He does this so that when the chest is born, and the baby is able to take his first breath, the mucus won’t clog his airway. The whitish patch on the baby’s head is some of the cheesy material called vernix caseosa, that covers the entire baby, and protected its skin while floating in the watery fluid within the uterus. If the rest of the baby doesn’t deliver itself, the doctor grasps its head, and carefully pulls and guides its body out of the birth canal. He also holds your baby with his head down to help drain the mucus, and as necessary, continue to aspirate his mouth and nose, until he breathes satisfactory and lets out with a lusty cry. Now, mother, you can get your first real look at your baby. From your expression, she’s exactly what you wanted. The second stage of your labor is now over. The next step is to clamp and cut the umbilical cord. This is a relatively simple and completely painless procedure for both your baby and you. As a further protection to your baby, she is placed in this heated bassinet, with her head at the lower end of the bassinet’s sloping mattress, to further the drainage of any remaining mucus. She’s certainly a vigorous, healthy-looking baby, as most newborns are. As a precaution against blindness due to infection, the infant’s eyes are treated with a special medication. This procedure is required by most state laws to be performed on all newborns. Let’s watch another delivery, in which a different anesthetic technique is used to assist the mother during birth. Notice the appearance and sleepiness of this baby. It takes quite a bit of time for the doctor to arouse him and get him breathing satisfactorily on his own. This occurs more frequently when the mother is unconscious or sleepy from receiving general anesthesia, or for that matter, too much medication of any kind. Although this anesthetic technique is sometimes necessary for certain types of deliveries, many doctors prefer, whenever possible, to have mothers conscious and cooperative when they deliver their babies. It not only helps the baby to start breathing on his own faster, thereby lessening the likelihood of complications, but in addition, it gives each mother the opportunity to enjoy more fully the miracle of birth. Here’s another delivery, in which the anesthesia used, is again different. What kind of anesthetic you will receive, or how it will be given, must of necessity be finally decided by your doctor on the basis of the conditions of your labor and delivery. The technique being used here is known as a pudendal block. Its effect is to block all sensation of pain from the region of your birth canal. When the anesthetic is injected, the mother feels no pain, and she remains fully conscious and cooperative throughout the delivery. With this type of anesthesia, the use of forceps and the performance of an episiotomy are painless experiences to the mother, who, however, still feels her contractions, and automatically bears down with them. This slight discomfort, of necessity present when you’re conscious and cooperative, is amply justified in order to achieve the safest delivery possible for your baby, who will be born, awake, vigorous and eager to breathe, a condition that occurs more frequently when you are awake and cooperative. To have all babies be born in this condition is your doctor’s aim. And to achieve it, your help is needed. So, when you can, don’t insist on more medication than you need to control the discomforts of labor and the pain of delivery. Your baby will benefit and so will you. Let’s return to our first mother and follow the remainder of her delivery. After a few more contractions, with an assist from her and her doctor, the placenta, or after birth, is delivered. Your doctor examines the placenta carefully to make sure it’s complete. He doesn’t want any of it left behind to possibly cause you trouble later on. Your labor is all over now. You know you should feel tired, but you don’t. Apparently, the sheer joy of giving birth causes your fatigue to fade away. You know you will always recognize your own baby, especially after seeing him being born. But hospitals want to make sure you do. That’s why you will be banded with an identification bracelet and your thumb print will be placed on your baby’s birth record. Your baby too will be similarly banded. And, in some hospitals, as a further precaution against possible mix-up, his footprints will also be transferred to his birth record. A few sutures, skillfully placed, soon restore your cut tissues to their original position. When the procedure is finished you’ll hardly know anything had been done to them. It’s time now, Mother, to get some well-earned rest. But, before you do, you’ll want another look at your creation. At times such as this, surely you will sense a spark of the eternal beauty of birth and the joy of living. [Music]

8 Comments

  • tasha b

    So much unnecessary intervention… Glad we finally are starting to realize that women's bodies were literally built to give birth and doctors don't need to step in unless it's warranted

  • JESUS LOVES HIS PEOPLE!

    Thank GOD for JESUS! He went through this for us! Mary had no bed with rails. No medication. No doctor or aides. But our Saviour came just the same. In a stable and was laid in a manger! THANK YOU JESUS! πŸ’“

  • Purple Chicken Farm

    I feel really sorry for my grandmothers right now. Holy crap. They tout this as "safe and comfortable". Yeah…being literally tied to a bed flat on your back during labor is soooo comfortable! Yikes! Is there any interventions they're missing? For being such a "miracle", they sure managed to eff it all up! Wow!

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