Birth

Question 1

what happens during birth?

Answer 1

• Release of oxytocin -> triggers uterine contractions -> push baby out
• No such thing as a “typical” birth – lots of variability

Question 2

stages of labour

Answer 2

• 1: uterine muscle opens the cervix to ~4in.
• 2: contractions push the head, then body, through the birth canal
• 3: contractions push out placenta, fetal membranes, and remainder of umbilical cord (“afterbirth”)

Question 3

birth complications

Answer 3

• Infant/mother mortality
• Anoxia: supply of oxygen from umbilical cord is cut off before baby can breathe independently
• Breech: baby’s position is feet/butt first
• Pre-term birth: born before 36/37 weeks

Question 4

Cesarean Section

Answer 4

• Surgery to deliver baby
• Typically used in cases where vaginal delivery may be a risk to infant
• • Complications in labour, infant health at risk, infant too large, mother has infection, etc.
• Around 26% of births in Canada -> rates increasing

Question 5

outcomes of vaginal vs. cesarean delivery

Answer 5

• Correlational studies comparing outcomes of vaginal vs. C-section delivery:
• Risks of C-sections: bleeding, infection, difficulties breastfeeding, postpartum depression, negative feelings about childbirth
• Risks of vaginal delivery: incontinence (urinary, fecal, flatus)

Question 6

Term Breech Trial: basics

Answer 6

• 1st randomized trial of C-section vs. Vaginal delivery and related outcomes
• Focused on breech delivery
• • Complete breech (feet down); frank breech (bottom down, feet up)
• • Most infants in breech position are delivered through C-section
• • Different outcomes for infants delivered vaginal vs. C-section

Question 7

Term Breech Trial: subjects

Answer 7

women with frank/breech presentations at term (some recruited before birth, some recruited at time of birth)

Question 8

Term Breech Trial: conditions & analysis

Answer 8

• Randomly assigned to either planned C-section or planned vaginal delivery
• Data analyzed according to this “intent to treat” model, even if it didn’t actually work out like that (“once randomized, always analyzed” -> C-section group will be analyzed as such –and vice versa– even if they didn’t get it) -> reduces risk of false positives

Question 9

Term Breech Trial: results (initial study)

Answer 9

• At birth, greater risk of infant death for vaginal vs. Cesarian (1.3% vs. 0.3%)
• Created controversy -> hospitals decreased performance of vaginal births as a result
• Upon closer inspection, turns out only 3 actually died due to delivery method (same as Cesarean)

Question 10

Term Breech Trial Follow Up (3 months): findings

Answer 10

• No difference: adjustment to motherhood, need for medical intervention after hospital discharge, sex relations, pain, depression
• Mothers with c-sections: more pain in abdomen (vs. Vaginal delivery -> more pain in genital area)
• Mothers with c-sections: less urinary incontinence

Question 11

Term Breech Trial: conclusions and limitations

Answer 11

• Conclusions: no major differences in negative outcomes (at 3 months) associated with C-section vs. Vaginal
• Limitations: Can results of breech deliveries be generalized to other births?