Editing Midwifery (section)

==== Labor and delivery ====
[[File:Cephalicpre.JPG|thumb|An illustration of normal head-first presentation.  The membranes have ruptured and the cervix is fully dilated.]]
[[File:Geburt 01.jpg|thumb|Newborn rests as caregiver checks breath sounds.]]
{{Main|Childbirth}}

Midwives are qualified to assist with a normal vaginal delivery while more complicated deliveries are handled by a health care provider who has had further training.  Childbirth is divided into four stages.

:'''First stage of labor''' The first stage of labour involves the opening of the cervix.<ref name=":0">{{Cite web|url=https://www.thewomens.org.au/health-information/pregnancy-and-birth/labour-birth/stages-of-labour/|title=Stages of Labour|website=The women's: The Royal Women's Hospital|access-date=17 May 2016|archive-date=3 June 2016|archive-url=https://web.archive.org/web/20160603220548/https://www.thewomens.org.au/health-information/pregnancy-and-birth/labour-birth/stages-of-labour/|url-status=live}}</ref> In the early parts of this stage the cervix will become soft and thin thus preparing for the delivery of the baby.<ref name=":0" /> The first stage of labour is complete when the cervix has dilated the full 10cm.<ref name=":0" /> During the first stage of labor the mother begins to feel strong and regular contractions that come every 5 to 20 minutes and last 30 to 60 seconds.  Contractions gradually become stronger, more frequent, and longer lasting.

:'''Second stage of labor''' During the second stage the baby begins to move down the birth canal.  As the baby moves to the opening of the vagina it "crowns", meaning the top of the head can be seen at the vaginal entrance. At one time an "episiotomy", (an incision in the tissue at the opening of the vagina) was done routinely because it was believed that it prevented excessive tearing and healed more readily than a natural tear.<ref name="Mayo Clinic" />  However, more recent research shows that a surgical incision may be more extensive than a natural tear, and is more likely to contribute to later incontinence and pain during sex than a natural tear would have.<ref name="Mayo Clinic">{{cite web | url=http://www.mayoclinic.org/episiotomy/ART-20047282?p=1 | title=Labor and delivery, postpartum care | publisher=Mayo Clinic | date=30 July 2015 | access-date=15 August 2015 | author=Mayo Clinic staff | archive-date=27 July 2015 | archive-url=https://web.archive.org/web/20150727152444/http://www.mayoclinic.org/episiotomy/ART-20047282?p=1 | url-status=live }}</ref>

:The midwife assists the baby as needed and when fully emerged, cuts the umbilical cord.  If desired, either of the baby's parents may cut the cord.  In the past the cord was cut shortly after birth, but there is growing evidence that delayed cord clamping may benefit the infant.<ref name="MedlinePlus4">{{cite web | url=http://consumer.healthday.com/women-s-health-information-34/birth-health-news-61/delaying-umbilical-cord-clamping-might-boost-child-development-699710.html | title=Delaying Umbilical Cord Clamping Might Boost Child Development | last=Mozes | first=Alan | date=26 May 2015 | access-date=18 October 2015 | archive-date=16 September 2015 | archive-url=https://web.archive.org/web/20150916002348/http://consumer.healthday.com/women-s-health-information-34/birth-health-news-61/delaying-umbilical-cord-clamping-might-boost-child-development-699710.html | url-status=dead }}</ref>

:'''Third stage of labor'''  The third stage of labour is where the mother must deliver the [[placenta]].<ref name=":0" /> In order for the mother to do this they may need to push. Just like the contractions in the first stage of labour they may experience one or two of these.<ref name=":0" /> The midwife may assist the mother in delivering the placenta by gently pulling on the umbilical cord.<ref name=":0" />

:'''Fourth stage of labor'''  The fourth stage of labor is the period beginning immediately after the birth and extending for about six weeks.  The [[World Health Organization]] describes this period as the most critical and yet the most neglected phase in the lives of mothers and babies.<ref name="World Health Organization">{{cite web | url=https://www.who.int/maternal_child_adolescent/documents/postnatal-care-recommendations/en/ | archive-url=https://web.archive.org/web/20140307050915/http://www.who.int/maternal_child_adolescent/documents/postnatal-care-recommendations/en/ | url-status=dead | archive-date=March 7, 2014 | title=WHO recommendations on postnatal care of the mother and newborn | publisher=WHO | access-date=22 December 2014 | author=WHO}}</ref>  Until recently babies were routinely removed from their mothers following birth, however beginning around 2000, some authorities began to suggest that early skin-to-skin contact (placing the naked baby on the mother's chest) is of benefit to both mother and infant. As of 2014, early skin-to-skin contact is endorsed by all major organizations that are responsible for the well-being of infants.<ref name="Medscape">{{cite web | url=http://www.medscape.com/viewarticle/806325_9 | title=Uninterrupted Skin-to-Skin Contact Immediately After Birth | publisher=Medscape | access-date=21 December 2014 | author=Phillips, Raylene | archive-date=3 April 2015 | archive-url=https://web.archive.org/web/20150403065140/http://www.medscape.com/viewarticle/806325_9 | url-status=live }}</ref>  Thus, to help establish bonding and successful breastfeeding, the midwife carries out immediate mother and infant assessments as the infant lies on the mother's chest and removes the infant for further observations only after they have had their first breastfeed.

Following the birth, if the mother had an [[episiotomy]] or a tearing of the [[perineum]], it is sutured. The midwife does regular assessments for uterine contraction, [[fundal height]],<ref name="Maternal-Newborn Care">{{cite web | url=http://www.atitesting.com/ati_next_gen/skillsmodules/content/maternal-newborn/equipment/postpart_assessment.html | title=Postpartum Assessment | publisher=ATI Nursing Education | access-date=24 December 2014 | archive-url=https://web.archive.org/web/20141224072821/http://www.atitesting.com/ati_next_gen/skillsmodules/content/maternal-newborn/equipment/postpart_assessment.html | archive-date=2014-12-24 | url-status=dead }}</ref> and vaginal bleeding.<ref name="Labor and Delivery:  Postpartum Care">{{cite web | url=http://www.mayoclinic.org/healthy-living/labor-and-delivery/in-depth/postpartum-care/art-20047233 | title=Postpartum care: What to expect after a vaginal delivery | publisher=Mayo Clinic | access-date=23 December 2014 | author=Mayo clinic staff | archive-date=21 December 2014 | archive-url=https://web.archive.org/web/20141221202550/http://www.mayoclinic.org/healthy-living/labor-and-delivery/in-depth/postpartum-care/art-20047233 | url-status=live }}</ref>  Throughout labor and delivery the mother's [[vital signs]] (temperature, blood pressure, and pulse) are closely monitored and her fluid intake and output are measured. The midwife also monitors the baby's pulse rate, palpates the mother's abdomen to monitor the baby's position, and does vaginal examinations as indicated.  If the birth deviates from the norm at any stage, the midwife requests assistance from the multi-disciplinary team.