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Labour is a physiological process during which the foetus, membranes, umbilical cord and placenta are expelled from the uterus. After the birth of the placenta and membranes, childbirth ends and the postpartum period begins. The course and outcome of labour and delivery is influenced by many factors, originating from mother and foetus but also by the attending care provider(s). Care during childbirth should find a good balance between too little, too late and too much, too soon. Barrier-free collaboration of all care providers involved in maternity care is required in order to provide good-quality, woman-centred birth care. Adverse perinatal and/or maternal outcome, including a negative birth experience, may have lifelong consequences. In this chapter the mechanisms of normal and abnormal labour, delivery and puerperium are described as well as the relevant factors contributing to a normal or abnormal course of delivery and its consequences.
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Vertex or occiput position
When the foetal head is flexed (chin on chest) the occipital fontanel is the presenting part
A special type of protein composed of an assembly of six connexins. A connexon of one cell is joined to that of an adjacent cell to form an intercellular channel consisting of 12 connexin subunits. Clusters of intercellular channels are known as a gap junction because of the minute extracellular ‘gap’ that separates the apposed plasma membranes. Each intercellular channel provides an axial channel that interconnects the cytoplasm of the apposed cell directly and permits the passage of ion and other small molecules between adjacent cells
A subunit of connexon, a protein that forms a gap junction, a channel that permits ions and small molecules to move between adjacent cells. The connexins are important to intercellular communication
An organized collection of protein channels in cell membranes that allows ions and small molecules to pass between adjacent cells
The posterior parietal bone is lower than the anterior parietal bone and the sagittal suture is near the symphysis
The anterior parietal bone is lower than the posterior parietal bone and the sagittal suture is closer to the sacrum
Support throughout the whole process of labour and delivery provided either by hospital staff (such as nurses or midwives), or women who had no personal relationship to the labouring woman (such as doulas). Continuous support may include emotional support (continuous presence, reassurance and praise) and information about labour progress. It may also include advice about coping techniques, comfort measures (touching, massage, warm baths/showers, encouraging mobility, promoting adequate fluid intake and output) and speaking up when needed on behalf of the woman. (Cochrane Review ‘Continuous support for women during childbirth’)
Agreement to a medical intervention or action based on full knowledge of the intervention or action and its possible risks and benefits
The process in which clinicians and patients are both involved in the making of decisions regarding treatments and care plans, based on clinical evidence that balances risks and expected outcomes with patient preferences and values
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- Delivery and puerperium
RM, PhD Esteriek de Miranda
MSc, PhD Corine J.M. Verhoeven
MSc, MD, PhD Petra C.A.M. Bakker
RM, MSc Marianne Prins
- Bohn Stafleu van Loghum