Pathways To Pregnancy And Parturition 2nd Edition Pdf Free Download
Sasha Stolt
In uncomplicated term pregnancies, labor usually begins within 2 weeks (before or after) of the estimated date of delivery. In a first pregnancy, labor lasts 12 to 18 hours on average; subsequent labors are often shorter, averaging 6 to 8 hours.
pathways to pregnancy and parturition 2nd edition pdf free download
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(See also Introduction to Intrapartum Complications Introduction to Intrapartum Complications Abnormalities and complications of labor and delivery should be diagnosed and managed as early as possible. In pregnancy, intrapartum complications may be caused by known risk factors that precede... read more .)
Labor is the physical efforts of expulsion of the fetus and the placenta from the uterus during birth (parturition). Toward the end of the third trimester, estrogen causes receptors on the uterine wall to develop and bind the hormone oxytocin. At this time, the baby reorients, facing forward and down with the back or crown of the head engaging the cervix (uterine opening). This causes the cervix to stretch and nerve impulses are sent to the hypothalamus, which signals for the release of oxytocin from the posterior pituitary. The oxytocin causes the smooth muscle in the uterine wall to contract. At the same time, the placenta releases prostaglandins into the uterus, increasing the contractions. A positive feedback relay occurs between the uterus, hypothalamus, and the posterior pituitary to assure an adequate supply of oxytocin. As more smooth muscle cells are recruited, the contractions increase in intensity and force.
The prevention of a pregnancy comes under the terms contraception or birth control. Strictly speaking, contraception refers to preventing the sperm and egg from joining. Both terms are, however, frequently used interchangeably.
Termination of an existing pregnancy can be spontaneous or voluntary. Spontaneous termination is a miscarriage and usually occurs very early in the pregnancy, usually within the first few weeks. This occurs when the fetus cannot develop properly and the gestation is naturally terminated. Voluntary termination of a pregnancy is an abortion. Laws regulating abortion vary between states and tend to view fetal viability as the criteria for allowing or preventing the procedure.
Human pregnancy begins with fertilization of an egg and proceeds through the three trimesters of gestation. The labor process has three stages (contractions, delivery of the fetus, expulsion of the placenta), each propelled by hormones. The first trimester lays down the basic structures of the body, including the limb buds, heart, eyes, and the liver. The second trimester continues the development of all of the organs and systems. The third trimester exhibits the greatest growth of the fetus and culminates in labor and delivery. Prevention of a pregnancy can be accomplished through a variety of methods including barriers, hormones, or other means. Assisted reproductive technologies may help individuals who have infertility problems.
There are two options or pathways for applying to become a MassHealth doula provider: The Formal Training Pathway and the Experience Pathway. Every individual doula applicant must apply through one of these pathways. Please review this entire section before downloading application forms.
MassHealth pays for the following services provided by MassHealth doula providers per MassHealth member per perinatal period (the perinatal period is defined as the period encompassing pregnancy and labor and delivery, through 12 months following delivery, inclusive of all pregnancy outcomes):
The United States has one of the highest rates of maternal mortality among high-income countries, with nearly 17.4 deaths for every 100,000 live births, despite significantly higher spending on maternity care.1 Further, risks for maternal mortality are disproportionately higher among Black women, who have a pregnancy-related mortality ratio more than double that of white women, regardless of educational level (see exhibit). Similarly elevated risks of maternal mortality are also reported for Indigenous women.2
Transformation of the maternity care system will require new models of health care delivery developed with input from community stakeholders and designed to reduce racial health inequities.3 Such models are being examined not only for their overall effectiveness and cost-savings potential but specifically for their likelihood to improve maternity care for people of color and those with low income. The need for new approaches has perhaps never been greater: as the coronavirus pandemic continues to rage in the U.S., evidence shows that Black, Hispanic, and Indigenous women are being disproportionately affected by COVID-19 during pregnancy.4
What They Are and What They Do: Community-based doulas are trusted individuals, often from local communities, who are trained to provide psychosocial, emotional, and educational support during pregnancy, childbirth, and the postpartum period.6 They are particularly critical in labor and delivery, serving as patient advocates, and providing comfort and coaching. Community-based doula programs build on the strong relationship doulas establish with mothers throughout pregnancy, birth, and the postpartum period to promote ongoing care and support.7
Evidence of Effectiveness: Preliminary, observational studies on the impact of group prenatal care demonstrate reduced rates of preterm birth (upwards of 41%), neonatal intensive care unit (NICU) admissions, low birthweight, and emergency department use during pregnancy, as well as increases in breastfeeding, patient and physician satisfaction, and parental knowledge of childbirth and child-rearing.31 A study of a group prenatal care program for pregnant Medicaid beneficiaries in South Carolina found the model was cost-effective; by preventing premature births, group prenatal care resulted in cost savings of $2.3 million for the state. However, some studies, particularly randomized clinical trials, found no differences in health outcomes like preterm births between women in group versus individual prenatal care.32 Whether group prenatal care programs were able to successfully move online during the COVID-19 pandemic, and the impact of that transition, remains an open question.
What They Are and What They Do: The pregnancy medical home (PMH) provides comprehensive perinatal health care. PMHs provide early prenatal care in the first trimester, expand patient access through increased office hours, and engage patients in shared decision-making.36 Teams are financially incentivized for achieving specific milestones toward these goals and for meeting program requirements, such as screening for risk, collaborating with a care coordinator, and using data and analytics to monitor their own performance.
The pregnancy and birth care options available in Victoria vary according to where you live, the models of care available at the services in your area, your medical history and risk factors such as weight, age and experience during previous pregnancies.
Carers during pregnancy, labour and birth may include midwives, your general practitioner, an obstetrician or a combination of all three. It is a good idea to talk to healthcare professionals, family and friends about your options, and what to expect from the different types of pregnancy care available.
Midwives have special training and skills in caring for women during pregnancy, labour and birth. They also care for newborn babies in the days and weeks after birth, including helping the mother with breastfeeding. Midwives can be men or women.
Obstetricians provide some of the care at a public hospital antenatal clinic. You may see an obstetrician if they are on duty at the time of your appointment, depending on the hospital and your level of risk. You are more likely to see an obstetrician if your pregnancy is, or becomes, complicated, or if you choose to see an obstetrician as a private patient.
General practitioners (or GPs) are medical doctors with specialist training in general practice. If they want to care for women during pregnancy and birth they usually complete further training, such as a Diploma in Obstetrics and Gynaecology or other courses.
Ideally you will have received care from your doctor prior to conception in order to optimise your health in preparation for pregnancy and to reduce any preventable risks. It is also very important for you and your baby to be looked after from the start of your pregnancy until after the birth. Care should include:
It is important that you make informed decisions about your pregnancy and birth care. When making these decisions, speak with your obstetrician, midwife or GP. Some options might not be available to you because of:
During your pregnancy, you will have time to explore all your options with the help of your carers. You can change your mind if you find the choice you have made is not right for you and there are other care options available.
Your care during pregnancy (antenatal care) can be provided by a midwife, hospital doctor, GP or obstetrician or a combination of these. The type of antenatal care you receive will depend on your health, your risk of complications, where you live and the type of care you choose.
Midwifery care is delivered via a public hospital midwives clinic. You may see the same midwife or group of midwives throughout your pregnancy and your baby will be delivered by whichever midwives and doctors are on duty in the birthing unit. Many hospitals can offer home visits with a midwife if you go home early (usually within 48 hours after the birth).
This model of care is where a small group of public hospital midwives care for you during your pregnancy, labour and birth, and postnatal period. Under this model of care, the bulk of your care is given by one or two midwives called a primary midwife.
This option is similar to midwifery group practice, only it involves a larger team of up to eight midwives who care for you during pregnancy, labour and birth, and postnatal period. This model is often only available in metropolitan areas.
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