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118 Cards in this Set
- Front
- Back
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What does daily folic acid in multivitamin reduce?
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Reduces the development of neural tube defects in infants
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What is the recommended weight gain of a pregnant woman?
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At least 25 pounds
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What are some sources of weight gain in pregnant women?
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• maternal fat
• breast and uterine growth • placenta • amniotic fluid • Increased maternal blood volume • Fetus is, on average, 7.5 pounds at birth |
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What are some physiological changes in pregnant women?
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• Increased blood volume
• Increased cardiac output/volume of blood • Increased heart rate • Kidneys increase in size and increase their filtration rate by 50% • Increased respiratory rate with increased ratio of O2/CO2, which facilitates transfer of O2 to and removal of CO2 from fetal blood through the placenta |
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What is toxemia?
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Toxemia develops in last two months of pregnancy in 6-7% of pregnancies in the USA
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What is Preeclamsia
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Preeclampsia = early toxemia
-weight gain -edema -high blood pressure -proteinuria |
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What is eclampsia?
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Eclampsia is severe toxemia
-weight gain -edema -high blood pressure -proteinuria -convulsions -coma -death |
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How often does gestational diabetes mellitus occur?
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occurs in less than 1% of pregnancies
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How does does gestational diabetes mellitus occur?
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As some pregnant women gain weight, their tissues develop resistance to the action of
insulin which results in a significant rise in maternal and fetal glucose levels |
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What happens to the fetus as a result of higher glucose levels from mother?
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Higher glucose levels in fetus cause them to grow unusually large (macrosomia) which
makes it difficult or impossible to be delivered vaginally |
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What is an ectotopic pregnancy?
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• Implantation in the oviduct because scarring in oviduct interferes with preembryos ability to travel to the uterus
• Implanted embryo is not able to develop into a viable fetus, puts mother’s health and life in danger, and requires surgical removal of developing embryo and placenta |
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What is the most common cause of oviduct scarring?
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sexually transmitted infections like chlamydia and gonorrhea
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What does implantation induce the corpus luteum to do?
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corpus luteum is induced to continue functioning and produce generous amounts of progesterone and estrogen during the first trimester to help maintain the development of the placenta
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What do the steroids from the corpus luteum support?
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Supports maternal appetite, fat deposition, and breast enlargement
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When does secretion of hCG begin and what does it help maintain?
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Cells of the cytotrophoblast begins as soon as 2 days after implantation, hCG contributes to the persistence of the corpus luteum through the first trimester
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When does the placenta begin to stimulate itself with hCG and the three different estrogens? What is the purpose of this?
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After the 5th week of pregnancy, purpose of this is to provide hormonal support to the mother throughout the entire pregnancy
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True or false, secretion of estrogens by placenta do not require intermediate steps in fetal adrenal gland and fetal liver
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False
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What does the placenta use from the mother to make progesterone? Who is the progesterone supplied to?
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The placenta uses cholesterol from the mother to make progesterone to supply both the mother and the fetus
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How is estriol made in the fetus?
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Progesterone produced by the placenta which goes into the fetal blood reaches the fetal adrenal glands (called fetal zone), where it is converted
to the weak androgen, DHEA which is then converted in the fetal liver to 16-OH DHEA-sulfate and is transferred back to placenta where it is converted to estriol. |
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What hormones do the pituitary gland and placenta both produce?
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• Prolactin
• Corticotropin • Thyrotropin • Endorphins • Oxytocin |
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What secretes human placental lactogen? What does it do?
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Secreted by the placenta and has effects similar to growth hormone and prolactin
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When is human placental lactogen especially high? What does this cause?
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Especially high in maternal blood late in pregnancy, causes a slight increase in maternal and fetal blood glucose
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What does human placental lactogen do that is similar to progesterone and estrogen?
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Helps prime mammary glands for milk production.
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What does relaxin do? When is it secreted?
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-Relaxin relaxes connective tissue connecting the two pubic bones so that fetus can pass through birth canal more easily at delivery.
-Relaxin is secreted by the corpus luteum and the placenta and levels rise steadily during pregnancy -Relaxin also prepares the cervix to soften and dilate before and during labor |
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What happens to relaxin, corticotropin releasing hormone, cortisol, estrogen/progesterone ratio, prostaglandins, and oxytoxcin as human labor/birth initiation occurs?
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All increase
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What does increased corticotropin releasing hormone during human labor/birth initiation cause?
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Increased CRH production from placenta (“placental clock”) results in:
• ↑ cortisol production (positive feedback loop) • ↑ maturation of fetal organs in preparation for birth • ↑ prostaglandin production (positive feedback loop) • ↑ estrogen/progesterone ratio |
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What does increased cortisol during human labor/birth initiation cause?
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• Increased cortisol from the fetal adrenal glands causes a positive feedback loop with the CRH (corticotropin releasing hormone) produced by the
placenta which stimulates fetal pituitary gland to produce ACTH to stimulate fetal adrenal gland to produce more cortisol. • Cortisol released from fetal adrenal glands appears to contribute to the initiation of labor. |
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What does increased estrogen/progesterone ratio cause during human labor/birth initiation?
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• CRH also acts directly in fetal zone of fetal adrenal gland to induce DHEA production
which leads to more estrogen production by the placenta (Fig 10-16). • Increase in estrogen/progesterone ratio in last 5 weeks of pregnancy may help initiate labor. • Increased estrogen supports increased uterine contractility. |
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What does increased prostaglandins cause during human/labor birth initiation?
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• Prostaglandins increase during last month of pregnancy and directly stimulate uterine
(myometrium) contraction. • CRH stimulates production of prostaglandins from the fetal membranes. • High levels of prostaglandins have a positive feedback loop with CRH production by the placenta. • ↑ estrogen/progesterone ratio stimulates prostaglandin production. |
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What does increased oxytocin cause during human/labor birth initiation?
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• Oxytocin has a strong stimulatory effect on uterine
contractions. • Secreted by posterior pituitary gland and probably by the placenta. • ↑ estrogen/progesterone ratio appears ↑ oxytocin secretion and ↑ oxytocin receptors in uterus. • Uterine contractions then stimulate more oxytocin production. • Oxytocin also appears to stimulate increased prostaglandin production from uterus. |
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What is the fetal ejection reflex?
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Fetal ejection reflex: stimulation of oxytocin release by mechanical stimulation of the uterus, cervix, or vagina, resulting in further uterine
contractions. |
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How can labor be induced? How are these hormones administered?
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• Labor can be induced by administration of exogenous oxytocin (pitocin) and/or
prostaglandins. • Pitocin is given intraveneously. • Prostaglandins can be given intravenously, orally, or as a vaginal suppository. |
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What are some reasons for giving pitocin (oxytocin)?
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• Women is post-term and labor is not spontaneously progressing.
• Need to deliver a baby before term because of possible risks to fetus and/or mother. • Pitocin (exogenous oxytocin) is also commonly given to women already in labor, but whose labor is not progressing fast enough. |
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What is parturition?
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Childbirth
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Is birth that occurs up to two weeks before or two weeks after the 40 week date considered to be within a normal time?
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Yes
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True or false, females tend to be born a few days earlier than male babies
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True
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What kind of women tend to deliver their babies earlier?
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Women with shorter follicular phases and women who exercise throughout pregnancy
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When is the yearly birth peak in North America? Why is this?
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• In North America there is a birth peak in the Fall which corresponds to high conception rates in the winter and low conception rates during the hottest months of the year.
• During warmest months, the males have a lower sperm count and lower testosterone. |
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When do women usually feel their fetus drop into their pelvic cavity?
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2-3 weeks before delivery
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What are Braxton-Hicks contractions?
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In the last weeks of pregnancy, women may feel Braxton-Hicks contractions which are mild, irregular uterine contractions, but not labor
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What is stage 1 of labor?
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cervical effacement and dilation
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What is stage 2 of labor?
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fetus leaves uterus and passes through cervix and vagina resulting in the delivery of the fetus
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What is stage 3 of labor?
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Delivery of the placenta
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What is a primiparous woman?
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A woman who is giving birth for the first time ~ 8-14 hours
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What is a multiparous woman?
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-A woman who has had previous children ~ 4-9 hours
-Length can be up to 24 hours or even longer and be considered within normal limits. |
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What are the differences between the female and male pelvic structure?
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Females have
• larger, more oval pelvic inlet • wider pubic symphysis • wider pubic arch (>90º) • outward turning of the ischial tuberosities • (last three features produce a larger pelvic outlet) |
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what is cervical effacement?
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Cervical effacement is thinning of the normally thick walls of the cervix and retraction of the cervix upward
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What causes cervical effacement?
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Uterine contractions must occur at regular intervals and become strong enough to cause cervical effacement
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How long and how often do contractions last/occur?
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Contractions last for 30-60 seconds and occur every 5-20 minutes
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What is a bloody show?
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At around the initiation of effacement, a cervical mucus plug may become dislodged along with a small amount of blood, this is referred as a bloody show
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As effacement progresses, an enzyme weakens the amniotic sac and the sac may break releasing the ________ _________
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Amniotic fluid
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When are women instructed to come into the hospital?
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When contraction intervals become five minutes or less
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What happens during Stage 1 of labor: cervical effacement?
Purpose? Intensity? Length of contractions? Interval of contractions? Duration of effacement? |
• Purpose: to soften and thin out cervix
• Intensity of uterine contractions are usually mild • Length of contractions: 30-60 seconds • Interval of contractions: 5-20 minutes • Duration of effacement: variable depending on person |
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What happens during Stage 1 of labor: dilation?
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• Pre-labor cervical os is 0.3 cm, while fully dilated cervix can be 10 cm in diameter just before going into the 2nd stage of labor
• As dilation increases, contractions tend to be progressively more painful |
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What happens during Stage 1: early dilation?
Purpose? Intensity? Length of contraction? Interval of contraction? Duration? |
• Purpose: open cervix from 0 to 7 cm
• Intensity: stronger than effacement and gradually more painful • Length of contractions: ≤60 seconds • Interval of contractions: 1-3 minutes • Duration: 5-9 hours (primiparous); 2-5 hours (multiparous) |
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What happens during the final phase of stage 1 labor: transition dilation contractions?
Purpose? Intensity? Length of contractions? Interval of contractions? Duration? |
• Purpose: complete opening of cervix from 7 to 10 cm
• Intensity: progressively stronger and more painful contractions • Length of contractions: 60-90 seconds • Interval of contractions: 1 minute • Duration: relatively short |
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What occurs during stage 2 of labor?
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• Full cervical dilation to 10 cm and full effacement
• Fetus passes through cervix & vagina • Uterine contractions move fetus through birth canal |
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What happens during stage 2 of labor: movement of fetus out of uterus through cervix and vagina?
Purpose? Intensity? Length of contractions? Interval of contractions? Duration? |
• Purpose: move fetus out of uterus through cervix and into vagina
• Intensity: less strong than during transition phase • Length of contractions: around 60 seconds • Interval of contractions: 1-3 minutes • Duration: 30 minutes to 2 hours (longer with first baby) |
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When is an episiotomy usually performed?
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Stage 2 of labor
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What is an epidural block injection?
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• Epidural block injection: pain medicine (typically an opiate) is injected into outside
membranes outside the dura of the spinal cord • Epidural injections numb sensations in the body below the site of the injection |
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What is a pudendal block?
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analgesic is injected around
the pudendal nerve on each side of vagina |
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What are some medications used during labor?
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Intravenous and oral analgesics,
tranquilizers, and anxiolytics |
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What is intravenous pitocin?
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Exogenous oxytocin given to induce or augment uterine contractions
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What is the largest diameter of a newborn? What is the average circumference?
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The head, average circumference is 13 inches
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What is crowning?
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When the top of the head appears just before delivery
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What is the ductus arteriosus?
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bypasses fetal lungs
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what happens with the first breath the infant takes?
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the patent ductus arteriosus closes so that infant blood from right side of heart is pushed through the lungs to be oxygenated
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What is the foramen ovale?
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allows mixing of blood between right and left heart chambers in the fetus
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What is the ductus venosus?
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shunts blood around fetal liver
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What happens to the ductus venosus and the foramen ovale when the newborn takes his/her first breath of oxygen?
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they both close
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What happens to the umbilical cord after delivery?
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It is cut and clamped
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Why are antibacterial drops put into the infants' eyes?
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To prevent gonorrhea and chlamydia
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When can circumcision be done?
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within first 48 hours of life on males
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What happens during Stage 3 of labor: delivery of placenta?
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• 15 to 30 minutes after delivery of the infant, the placenta is delivered
• Hematopoietic stem cells can be harvested from cord blood from placenta • Uterine bleeding typically occurs immediately after delivery of placenta • Breast feeding/nippling stimulates release of oxytocin which can decrease the post-delivery uterine bleeding |
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What is a typical fetal position?
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Cephalic presentation with the head facing down in the pelvic cavity
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What is the breech position?
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fetus has head up and feet, buttock, or knees extending downward
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What is transverse position?
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Fetus is positioned sideways or transveresly in pelvis
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When is forceps delivery and vacuum extraction necessary?
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• Used when infant is not progressing in the second stage of labor due to abnormal
fetal position or other reasons • Forceps delivery: Two curved steel blades are placed around the infants head and are gently rotated and pulled to facilitate delivery • Vacuum delivery: suction cup is attached to fetus head and fetus is pulled out |
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What is a cesarean section and when is it used?
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• Done when fetus is in distress, difficulty with vaginal delivery, breech or other
abnormal position, or maternal preference • Mother receives spinal anesthesia, general anesthesia, or acupuncture • Abdominal incision is made below the navel in the midline and the incision continues through the uterine wall and the infant is removed • Recovery time for mother is much longer than after a vaginal delivery |
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History of Birthing
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• In anthropological studies of over 70 cultures around the world, there are NO examples where women deliver on their backs, rather they deliver while
awake in an upright position • In ALL these cultures, women midwives deliver babies and in the majority of the cultures men are not present at the deliveries |
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More History of Birthing
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In the 1800s in Europe and the
USA, male physicians started taking over the job of delivering babies as women midwives became more and more marginalized |
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More History of Birthing (2)
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• The increase in the importance of medical
licensing in the USA and Europe in the 1800s also contributed to the reduction of the midwife activities • Midwife training at that time was a decentralized system of female mentors and students • Students received comprehensive training from their mentor midwife, however, the midwives did not have a system of formal licensing |
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More History of Birthing (3)
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Literature was disseminated by the male dominated
medical establishment that portrayed midwives as unscientific and untrained, even though at these times studies showed that mothers and infants had a higher morbidity and mortality rate when they were delivered in hospitals by male physicians compared to at home by female midwives |
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Medical interventions for a "painless" delivery
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In Germany around 1900 system was developed to put women into ‘twilight sleep’ during labor & delivery
–morphine injection for pain in labor – scopolamine for an amnesiac effect to allow mother to disassociate from the labor & birth pain – chloroform or ether to put mom to sleep during the delivery |
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Medical interventions for a "painless" delivery continued..
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• In the ‘twilight sleep’ on the morphine, scopalamine, chloroform, and/or ether the
women would often thrash and move around even though they were unconsciousness • Along with anesthesia, the horizontal position for women to lay on their backs was adopted so women’s arms could be more easily restrained and tied down and their legs could be strapped to the stirrups |
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Development of forceps delivery & episiotomy
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Women would deliver unconscious because of
anesthesia and were not be able to push the baby out so the use of forceps deliver was very common. To facilitate inserting forceps into vagina and around the babies head, the practice of episiotomy was developed. An episiotomy is a scissors cut of perineum. Perineum is the space between vulva and anus. Episiotomy cuts gave more room for the forceps to be inserted into the vagina around the babies head. After delivery episiotomy cut needs to closed with suture |
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Anesthetics for Mothers at
Delivery |
• Mothers who received anesthesia were unconsciousness at delivery
• Newborn baby was taken away into a nursery with other newborns and it would be often several hours after delivery before the mom and newborn would see each other |
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Pre-1900 in USA, what percentage of babies were delivered in hospitals?
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Less than 5%, studies conducted from the 1890s to the present showed that birth in hospitals attended by
physicians were NO safer than births at home by a mid-wife In fact, studies around 1900 and in the early 1900s showed that there was an increased maternal and infant death rate in hospital births compared to home-births by midwives. Part of the reason for the increased maternal and infant death rate in hospitals were all the infectious diseases that were passed from patient to doctor or nurse to patient |
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Location of delivery
Pre-1900s? 1936? 1970? |
In the USA, hospital deliveries steadily have
increased: • Pre-1900, 5% of babies delivered in hospitals • by 1936, 75% of babies delivered in hospitals • by 1970, 99% of babies delivered in hospitals Attempts to create home environment in hospital: • 1970s: Family-centered care in delivery room • 1980s: rooming in of infants with mom in hospital |
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What are some advantages of labor and deliver in an upright/crouched position?
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• Utilizes the benefits of gravity to ↑ strength of uterine
contractions and → ↓ length of labor → ↓ likelihood of C-section • Increases surface area of pelvic opening/birth canal by 33-38% • ↓ pressure on mothers aorta (largest artery) which increases blood supply to the fetus → ↓ likelihood of fetal stress |
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In the 1800s, how did male obstetricians in Europe change labor delivery?
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In the 1800s, male obstetricians in Europe developed the method for women to deliver on their backs because women were given morphine, scopolamine,
chloroform, and ether to be rendered unconscious. The horizontal position also made it easier for the women’s legs to be positioned in the stirrups and have their arms restrained. This also gave the male physician control over the laboring mother. Standard Western obstetrical practice: mother often goes through late stage labor & delivery on her back. |
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What are the consequences of delivering on one's back rather than an upright position?
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• Less comfortable for mothers
• ↓ benefits of gravity for labor → ↓ strength of uterine contractions → ↑ length of labor → ↑ likelihood of C-section • ↓ benefits of gravity for labor → ↓ opening of pelvic cavity/birth canal • ↑ pressure on mothers aorta (largest artery) which may reduce blood supply to the fetus → ↑ likelihood of fetal stress → ↑ likelihood of C-section |
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Rupture of membranes to progress labor: What are advantages and disadvantages?
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Advantages:
↓ total length of labor by 40-120 minutes Disadvantages: • 24 hour time clock starts because bacteria can invade and infect uterus and fetus, so if delivery does not occur within 24 hours a cesearian-section must be done • Intact membranes which contain amniotic fluid function as a barrier that provides a cushion during labor as the baby descends through the birth canal • Ruptured membranes lack protective barrier and increase chance that a baby will have a cephalohematoma (hemorrhage between scalp and bones of skull) • Mothers’ report that after membranes are ruptured, they feel like they loose control • If labor progresses too quickly → severe pain → epidural for pain → ↓ uterine contractions → labor does not progress → C-section • If labor does not progress → pitocin (oxytocin) is given → if labor does not progress → Csection |
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What are the benefits of having intact membranes during labor?
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• Intact membranes are a barrier that provide protection against invasion by bacterial infections
• Intact membranes are a barrier that provides a cushion during labor as the baby descends through the birth canal and reduces the likelihood of developing a cephalohematoma |
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Continuous Fetal Monitoring
of Fetal Heart Rate: |
Continuous heart monitoring of infant if achieved by screwing a small monitor into the fetal scalp.
When continuous fetal monitoring was instituted in USA → doubled the cesarian section rate, but resulted in no reduction in the incidence of cerebral palsy. Nine separate studies throughout world have not shown any improvement in outcome for the baby with continuous fetal heart monitoring in healthy women. Prevents mom from walking during labor → ↓ beneficial effects of gravity on labor → ↑ length of labor → ↑ rate of C-section (2X) |
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Continuous Fetal Monitoring
of Fetal Heart Rate: continued.. |
Most experts recommend that continuous monitoring offers no advantage to healthy pregnant women with no pregnancy
complications and with normal growth and development of fetus. However, in spite of this data, the policy continues to be the common use of fetal monitoring throughout the USA to reduce the threat of lawsuit in case there is any problem with the baby |
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Flexible monitoring of fetal heart rate:
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• Check fetal heart rate with
stethoscope every 10-15 minutes • Short monitor strip given every 30 minutes |
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What is oxytocin (pitocin) and what does it do?
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• Oxytocin is natural hormone that ↑ strength and ↑ frequency of uterine contractions
• When oxytocin (pitocin) is given → ↑ pain of contractions → ↑ likelihood of taking pain medicines (e.g., epidural infusion) • Pain may be so bad from the pitocin that the pitocin needs to be discontinued and in some cases, a counteracting medicine is given |
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What is the purpose of an epidural?
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↓ mothers own endogenous production of endorphins
↓ mothers ability to feel the natural urge to push in labor ↓ mothers sense of control over labor ↓ mothers sense of accomplishment of delivering her baby ↓ mothers production of oxytocin & ↓ mothers ability to push → ↑ C-section rate ↓ mothers production of oxytocin → may ↓ the mothers feelings of attachment to newborn baby |
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Epidural Analgesia continued..
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1/3 of mothers who receive epidural early in labor develop a fever as high as 103 – 104:
→ at delivery many of their infants also have fever and since it is not known whether the fever is from the epidural or infection the infant must receive a septic work-up which involves a blood culture, spinal tap and three days of intravenous antibiotics waiting for the culture results → interferes with the maternal-infant bonding in the early hours and days of life |
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How is a breech position dealt with?
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Standard approach in western obstetrics is to schedule a csection for fetuses in breech position.
However, methods can be applied to turn the fetus around into the head down (cephalic) position: – External cephalic version applied by midwives – Internal cephalic version applied by midwives – Moxibustion with stimulation of acupoint BL 67 by using the heat generated by burning Chinese herbal preparations containing Artemisia vulgaris (mugwort). Acupoint BL 67 is on the outside corner of the fifth toe. (JAMA. 1998; 280: 1580-1584) |
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What was the percentage of people who got C-sections in 1970?
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5%
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What is the percentage of people who get C-sections today?
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25-30%
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Some history on Cesarion Section
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Between 1970 – 2000 there has been an increased
awareness and interest in natural childbirth rate yet the c-section rate has increased from 5% to 25% over this period. The main reason for this change is the number of lawsuits filed against obstetricians for children with neurological problems who were delivered vaginally. This has resulted in a very low threshold for c-section. * While the C-section rate increased from 5%-25% between 1970-2000, the rate of cerebral palsy in children was unchanged |
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What are some negative side effects of a Cesarion Section?
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C-sections actually increase illness and mortality among both mothers and their
babies C-section is a major abdominal surgery which is very painful and requires weeks for the mother to fully recover → uncomfortable for the mother and also interferes with her ability to bond with her baby |
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Women with low levels of Vitamin D (increase/decrease) the likelihood they will have a C-section.
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Increase
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What is the purpose of an episiotomy?
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First developed to facilitate forceps delivery
Later became routine for NSVD (normal spontaneous vaginal deliveries)…..the rationale was that with a vaginal delivery there may be a spontaneous tear and if you already cut a small tear in the perineum before delivery it will reduce the size of the delivery induced tear |
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What are some cons of an episiotomy?
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promote more extensive, large tears in the vaginal opening at the site where the episiotomy was placed.
Takes a longer time to heal than the small tears that can occur with a vaginal delivery. Associated with prolonged discomfort and can be disabling for several weeks after delivery interferes with the mothers ability to bond with and care for her newborn baby |
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Episiotomy information
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Large multi-decade study following 1000s of women showed that episiotomy increased the rate of urinary
incontinence in women later in life When these study results came out, Sweden reduced rate of episiotomies from 90% to 5% in a short period of time However, in USA, the rate was reduced much less than in Sweden |
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What is the psycho-physioloical state of women in pregancy and peri-natal period?
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psychoneurophysiology:
depression → ↓ immune system |
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How can stress and anxiety affect labor?
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↑ production of stress hormones/ ↑ sympathetic
nervous system & ↓ parasympathetic nervous system → ↓ uterine contractions → ↓ progression of labor → ↑ likelihood of c-section |
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What must women feel to reduce anxiety in labor and delivery?
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In control, respected, and supported
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What are some stress/anxiety reduction techniques that may facilitate labor and decrease of c-section rate?
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Exercise
Hatha Yoga Tai Chi Massage/acupressure Relaxation techniques to release tension Breathing Visualization Meditation/self-hypnosis |
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What is a doula?
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Doula is labor support person who is with the mother from when labor begins and stays
with the mother until after the baby is delivered. Doula does not deliver baby. Doula supports mom & works with midwife or obstetrician. Doula works with mom, dad, and midwife or obstetrician to develop a BIRTH PLAN. |
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What can a doula do during pregancy for a mom?
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Mother meets doula during pregnancy and may teach
mom about: Physical exercises Massage/acupressure Relaxation techniques to release tension in mother Breathing Visualization Meditation/self-hypnosis Labor positions Birthing positions |
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How does a doula help a mother during labor and delivery?
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In labor & delivery women are in a dependent & psychologically open state.
Benefit from a nurturing female caregiver with experience in childbirth. Calm, nurturing, accepting, holding, loving: “MOTHERING THE MOTHER” Provides quiet reassurance & supports the mothers natural ability to proceed with labor. Mother is validated as a person, mother, & future care-giver. |
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More on Doula support..
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Provides emotional & physical support without interruption throughout labor/delivery.
Feeling of security with and support from another woman enhances the mother’s ability to develop and explore her own capabilities as a mother in a way that empowers her as a mother and allows her to adapt and respond to the power of the birthing process. Enables mother to be in control of her own labor & delivery (in contrast to the labor “coaches” or obstetricians who take over the control of labor) |
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Some data gathered from seven randomized trials on doula supported deliveries.
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↓ length of labor by 25%
↓ exogenous oxytocin use by 40% ↓ pain medication by 60% ↓ forceps use by 40% ↓ C-section rate by 50% |
