Question

You work in a "planning" clinic and follow a young couple who are planning to have a first child soon. Unfortunately the couple experiences some difficulties: Your interventions have borne fruit. The woman finally got pregnant and the pregnancy went well. However, the delivery was very difficult and ended in a emergency cesarean section. Although the child and the mother are now in good health health, you need to find out what restricted the baby's expulsion from the uterus. Here is the information you have: - Stretching of the cervix was incomplete during childbirth - Uterine contractions were weak and irregular during childbirth - The placenta was normal - Breastfeeding is normal - The myometrium has no visible lesions - The woman does not present any worrying deficiency Using their information, come up with a hypothesis that can explain the woman's inability to give birth naturally. (i. Explain in detail the physiological processes behind childbirth and breastfeeding, taking care to name all the systems involved as well as their respective roles) (ii. Highlight the commonalities between the processes of these two phenomena and explain why, in view of the information you own, they may or may not explain difficult childbirth) (iii. Establish precisely the part (s) of the birthing phenomenon altered according to the information you have by referring to the physiological processes explained in i.) (iv. Comment on the woman's ability to give birth naturally for a future pregnancy)

Answer 1

Ans i) Physiological process behind child birth- physiological process in child birth comprises of

• Uterine contraction
• Retraction
• Effacement of the cervix

PHYSIOLOGY OF UTERINE CONTRACTION IN LABOUR

The pacemaker to generate uterine contraction is Situated near of tubal ostia and wave of contraction spread to lower uterine segment.

Fundal dominance- In good and normal contraction there is fundal dominance with gradual diminishing contractions towards the lower segment.

Polarity of uterus : When upper segment contracts, retracts and pushes the fetus down the lower uterine segment and cervix dilates in response by stretching effect by presenting part.

Signs of good uterine contraction:

1. Good synchronization of contraction waves from both sides of uterus.
2. Regular pattern of contractions
3. Good relaxation in between the contractions
4. Intra amniotic pressure during relaxation is 8mm rising beyond 20mm during contraction

CHARACTERSTICS OF CONTARCTION

INTENSITY : The intensity of uterine contraction means degree of uterine systole. intensity Increases with progress of labour and its Maximum during 2nd stage of labour

DURATION : Duration of each contraction initially last for 10-15 seconds gradually increases upto 40-45 sec.

FREQUENCY : in the early stage of labour, contractions come at the interval of 10-15 min and increases to maximum in 2nd stage of labour.

TONUS : intra uterine pressure in between the contractions

Uterine Retraction: It is a unique chracterstic of uterine muscle in which there is Permanent shortening of uterine muscle following contraction hence leading to desend of fetus and labour progress with each contraction. Uterine retraction leads to;

• Formation of lower uterine segment.
• Maintain advancement of presenting part made during contractions.
• Reduce the surface are of uterus leading to placental separation.
• Achieving heamostasis after separation of placenta by trapping the blood vessels.

Physiology of breast feeding-

Mammogenesis-Development of breasts to a functional state under the effect of hormone estrogen, progesterone in puberty and prolactin during pregnancy and child birth.

Lactogenesis-Synthesis and secretion of milk from the breast alveoli . Following delivery of placenta the rapid drop in progesterone and increased presence of prolactin, cortisol, and insulin are resbonsible for this stage of lactation

Galactokinesis-Ejection of milk from the breast. Oxytocin hormone released from posterior lobe of the pituatory gland is responsible for this phase  nipple stimulation or sensory stimulation by the baby leads to ejection of milk from the alveoli gland.

Galactopoiesis-Maintenance of lactation. Prolactin hormone is responsible for this phase of lactation.As long as suckling continues this hormone prodeuction is maintained in the mother's body.

Ans ii)

The commonalities between the processes of these two phenomena are they both are governed by hormones production (estrogen, progestrone, prolactin, oxytocin).Possible causes of difficult birth can be:-

Uterine contractions were weak and irregular during childbirth- this can be due to lower level of oxytocin and prostaglandin in the blood stream leading to reduced or diminished uterine contraction.

Stretching of the cervix was incomplete during childbirth- The desent of fetal presenting part was not proper leading to incomplete dilatation of cervix. which again is due to poor uterine contaction and retraction

Ans iii) The birthing phenomenon altered according to the information

• Emergence of multiple pace maker foci leading to less efficient contractions and hence causing primary dysfunction labour.
• Lack of fundal dominance and the reverse polarity leads to spastic lower uterine segment. Here pacemaker does not work in rhythm.
• If the intensity diminishes, duration is shortened and interval between the contraction increases it leads to hypotonic uterine dysfunction.

Ans iv ) The woman's ability to give birth naturally for a future pregnancy- The woman should be able to give birth naturally in future pregnancy by judicious observation of labour progress and timely intervention with uterine stimulants for induction and maintainance of labour.