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Birth

Birth

In humans, the process of delivering a child from the uterus, usually by passage through the birth canal at the end of pregnancy, normally after a gestation period of about 267 days; also called parturition, or labor.

Childbearing is often viewed as the transition to adult female sexuality . Birth labor is divided into several stages. During the latent phase (Stage 0), which lasts from several hours to as long as three days, uterine contractions (either regular or irregular) are present, but the cervix has not dilated more than three or four centimeters. The mucus plug may be passed at this stage. The first stage of labor begins with uterine contractions accompanied by mild pain at intervals of about 10 to 20 minutes and sensations of discomfort in the small of the back which eventually become stronger and spread to the entire abdominal area. The cervix, or neck of the uterus, dilates rapidly from three or four centimeters until its opening is large enough to allow the passage of the child (10 centimeters). By the end of the first stage (although sometimes much earlier), the sac containing the amniotic fluid which surrounds the child breaks. The first stage can take up to 12 hours with first-time mothers, although it may be very rapid in women who have had several children. It can last many hours in obstructed labor, where the baby is unusually large or badly angled.

The second stage of labor begins with the complete dilation and effacement (thinning) of the cervix and ends when the baby is born. At this stage, the contractions are

increasingly frequent and intense, ultimately recurring at intervals of two to three minutes and lasting about a minute. The mother begins contracting her abdominal muscles voluntarily ("bearing down"), and the baby is expelled, usually head first, by a combination of this voluntary contraction and the involuntary contractions of the uterine muscles. The physician aids in the delivery by guiding the infant's head and shoulders out of the birth canal. About 2 to 3 percent of babies are born feet first (breech babies). Obstetrical forceps may be applied during the second stage of labor to speed delivery in order to ease either maternal exhaustion or infant distress. Other medical techniques utilized include the episiotomy, a surgical incision along the back of the vagina to enlarge the opening. (This procedure is now performed less frequently than it was in the past.)

When the baby is born, mucus and blood are removed from the nose and mouth by means of suctioning. The umbilical cord is clamped and cut, and the child is given to the mother to hold. The infant's physical condition is then assessed by the Apgar score , which evaluates the overall level of health based on heart rate, skin color, muscular activity and respiratory effort, and response to stimuli. During the third stage of labor, which occurs within the first hour after the child is born, placental material, or afterbirth, is expelled through the birth canal by strong uterine contractions called after-birth pains. These contractions also help the uterus to return to its normal size. The doctor examines the placenta and amniotic sac to confirm that all tissue has been expelled from the uterus, as serious complications may result if fragments remain inside, especially hemorrhaging. If parts of the placenta or sac are missing, the doctor removes them by hand. Finally, the episiotomy (if one has been performed) is sutured with absorbable stitches. The total duration of labor averages about 13 hours for first deliveries and about eight hours for subsequent deliveries, although there are large individual variances from these figures.

The pain of the birth process can be relieved by drugs, but many of these drugs also have the effect of slowing uterine contractions or depressing the respiratory system of the child. Drugs are either not usedor used with special carein the case of twins or premature infants. Moderate doses of narcotic analgesics may be given to the mother, which are metabolized quickly and nearly absent by the time of delivery. Local anesthetics similar to Novocaine may be administered to provide pain relief in the cervical and vaginal areas, offering more localized relief with fewer side effects than narcotics. Methods of childbirth have been developed in which the use of drugs is kept to a minimum.

The natural childbirth movement begun by Fernand Lamaze, which advocates birth without drugs or medical intervention, departed from the practices of the 1940s and 1950s, when the administration of drugs and medical procedures such as episiotomies were standard obstetrical procedure. Natural childbirth methods use nonmedical relaxation techniques for pain control and allow for more active participation in labor by the mother and a lay coach, usually the husband. They typically include prenatal classes for the mother and coach. Women who use the Lamaze method are taught to perform three activities simultaneously during contractions: breathing in a special pattern, chanting a nonsense or meaningless phrase coordinated with the rhythm of her breathing, and staring intently at an object.

The home delivery movement, which became popular in the United States during the 1970s, gave way to the establishment of birthing centers (in or affiliated with hospitals) staffed by nurse-midwives and obstetricians in an attempt to duplicate the family-centered, drug-free experience of home birth but without the risks posed by the absence of medical professionals. The natural childbirth movement has also focused on easing the birth experience for the infant. In Birth Without Violence, the physician Frederick Leboyer described modern hospital birth as "torture of the innocent" and proposed measures to make the transition to life outside the womb a more gentle one for the newborn. These measures include dim lights and a quiet atmosphere in the delivery room, postponing cutting of the umbilical cord, and bathing the infant in lukewarm water. Psychologists Otto Rank and R.D. Laing have elaborated on the idea of birth trauma as a factor in adult mental and emotional problems, and Leonard Orr developed rebirthing in the 1970s as a holistic healing technique for eliminating negative beliefs that influence an adult's behavior and attitudes.

Occasionally, complicating factors that can affect the mother, the child, or both are encountered in the birth process. These factors include, for example, poor health, anatomical abnormalities, prematurity, and unusual orientation of the child in the uterus, such as breech presentation, in which the child moves through the birth canal head last, and (rarely) transverse presentation, in which the child is positioned sideways. In some women, the pelvic space is too small for spontaneous birth of a baby, and the delivery of the child is accomplished through a surgical opening made in the mother's abdominal wall and uterus, in a procedure called a cesarean section. For a healthy mother and child, the risks of childbirth are extremely low. Premature labor, which occurs in about one pregnancy out of 20, is the primary danger to mother and child during the last trimester of pregnancy and the major cause of newborn death. About 40 to 50 percent of mothersespecially first-time mothersexperience mild post-partum depression , thought to be caused by a combination of biochemical factors and adjustment to the pressures and demands of parenthood. A smaller percentage between 5 and 10 percentbecome severely depressed. Postpartum depression usually lasts up to 90 days.

Abnormalities present at the time of birth, known as birth defects or congenital defects, occur in one of every 14 babies born in the United States. More than 3,000 birth defects have been identified, ranging from minor dark sports or a birthmarks to serious disfigurements or limited lifespans. Congenital heart defects occur to one of every 125 to 150 infants born in the U.S., making heart defects among the most common birth defects and the leading cause of birth defect-related deaths. Down syndrome is the most frequently occurring chromosomal abnormality, occurring to one of every 800 to 1,000 infants born in the United States. Annually, care of children with birth defects in the U.S. costs billions of dollars.

Birth defects have two causes: heredity and environment . Environment includes maternal illness, such as German measles. Other environmental factors include: alcohol and drugs, consumed during the pregnancy, and exposure to certain medicines or chemicals. Heavy alcohol consumption during pregnancy can trigger fetal alcohol syndrome in newborns, characterized by underweight, small eyes, a short upturned nose with a broad bridge, and often a degree of mental retardation . Thalidomide, prescribed in the 1950s as a mild sedative, led to the birth of 7,000 severely deformed babies, suffering from a condition called phocomelia, characterized by extremely short limbs that were often without fingers or toes.

For some diseases, like spina bifida, the causes are unknown but believed to be a combination of heredity and environment. Spina bifida, a neural tube defect, is the most frequently occurring permanently disabling birth defect in the United States, affecting one out of every 1,000 newborns. In spina bifida, the spine fails to close properly during the first month of pregnancy. In worst cases, the spinal cord protrudes through the back. A large percentage of children born with spina bifida have hydrocephalus, an accumulation of fluid in the brain which requires a surgical procedures called "shunting" to relieve the fluid build up and redirect it into the abdominal area. Sophisticated medical techniques allow most children with spina bifida to live well into adulthood. Based on research, the U.S. Public Health Service recommends that women of childbearing age in the U.S. consume 0.4 mg of folic acid daily to reduce the risk of having a pregnancy with spinal bifida or the other two neural two defects: anencephaly or encephalocele. Amniocentesis or ultrasound testing can diagnose spina bifida before birth.

Sickle-cell anemia, Tay-Sachs, color blindness, deafness, and extra digits on the hand or feet are hereditary birth defects passed on through generations by abnormal genes. Birth defects may not impact each generation, but the abnormal gene is passed on.

Further Reading

Hotchner, Tracy. Pregnancy and Childbirth: The Complete Guide for a New Life. 2nd ed. New York: Avon, 1990.

Martin, Margaret. The Illustrated Book of Pregnancy and Childbirth. New York: Facts on File, 1991.

Nathaniels, Peter. Life Before Birth and a Time to Be Born. Ithaca, NY: Promethean Press, 1992.

See also Fetal alcohol effect and syndrome

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birth

birth Although childbirth is a universal fact of human physiology, where, how, with whom, and even when a woman gives birth are often culturally determined.

Anthropological awareness of the social nature of human birth owes much to the pioneering work of Wenda Trevathan, an evolutionary anthropologist who studied the differences between human and higher primate birth. Because higher primates walk on all fours, their pelvis is wide enough to allow the direct descent of the fetal head, making for easy labours and uncomplicated births. When humans began to walk on two feet, the upright stance they had to adopt made the pelvis narrower, so that the baby has to rotate as it descends in order to pass through. Non-human primate babies can climb onto their mothers' backs and cling immediately after birth, but the larger brains of human infants made it necessary for them to be born earlier in their developmental cycle, ensuring that human babies would be relatively helpless at birth and require immediate nurturing. These factors encouraged the evolution of birth as a highly social process; women give birth alone and unaided in only a very few societies.

For these reasons, Trevathan postulated that midwifery evolved along with human birth. The presence of other women would have enhanced the success of the birth process as these women acquired skills such as turning the baby in utero to ensure the optimal position for birth, assisting rotation of the head and shoulders at birth, massaging the mother's uterus and administering herbs to stop postpartum bleeding, and facilitating breastfeeding. Trevathan suggests that more mothers and babies would have survived in societies that developed midwifery traditions early on, giving such societies a distinct evolutionary advantage.

Both ancient and contemporary figurines and paintings from indigenous cultures all over the world show women giving birth upright: kneeling, sitting on a low stool or chair, or standing with women behind or on either side of them to hold and support them with a midwife kneeling in front with her hands out, waiting to catch the baby. This upright position, with its physiological advantages of facilitating fetal rotation and descent and the mother's ability to push effectively, was pervasive in birth until the advent of Western obstetrics. Its replacement by the flat-on-the-back position common in Western-style hospitals demonstrates the extensive cultural restructuring that has been applied to birth in industrialized countries.

The social nature of birth and its importance for survival ensure that this biological and intensely personal process will carry a heavy cultural overlay. In 1908, Arnold van Gennep noted that cultures ritualize important life transitions — of which birth is a prime example. Anthropologist and childbirth educator Sheila Kitzinger has noted that birth practices point ‘as sharply as an arrowhead’ to the core values and beliefs of the culture, telling the observer a great deal about the way that culture views the world and women's place in it. Where women's status is high, a rich set of nurturant traditions tends to develop around birth; where it is low, the opposite may occur. For example, in the highly patriarchal Islamic society of Bangladesh, in which the status of women is low, childbirth (like menstruation) has traditionally been regarded as highly polluting. It was believed that women should give birth on dirty linens, attended only by female relatives. An indigenous midwifery tradition never developed, and rates of infant mortality and puerperal infections are high. In contrast, in the matrilineal societies of Polynesia, where the status of women is high, pregnant women are pampered and nurtured. Skilled midwives administer frequent full-body massages during pregnancy and have a rich repertoire of techniques for assisting women during labour and birth.

Brigitte Jordan's comparative study of birthing systems in Holland, Sweden, the US, and Mexico's Yucatan was the first to demonstrate this wide variation in the definition, the locus, the attendants, and the artifacts of childbirth; it sparked general interest in the anthropology of birth. Jordan's work on American birth was expanded by anthropologists Emily Martin and Robbie Davis-Floyd. They have suggested that American hospital birth, like much of American society, is organized around models of factory production and the technological control of natural processes. In many American hospitals, over 80% of women have their labours artificially speeded up or induced, are routinely hooked up to the electronic fetal monitor, often for long periods, have IVs inserted into their arms to provide the fluids that they are not allowed to drink, and lie flat with their feet in stirrups to give birth. While such technological interventions can sometimes be lifesaving, their routine overuse often generates problems. (The degree of overuse of birth technologies in the US is highlighted by the much lower rates of most such interventions in Great Britain, where a vocal, active, and influential consumer movement arguing for evidence-based care has had a significant impact on obstetrical policies.) Such routine procedures have been interpreted by Davis-Floyd as rituals that symbolically enact and display the core values of the American technocracy, which centre around the supervaluation of technology in many aspects of American life.

The prestige of Western ‘high technologies’ has induced many developing countries to stamp out viable indigenous midwifery systems and import the Western model even when it is ill-suited to the local situation. Western style hospitals built in the Third World may lack the most basic supplies but are often stocked with several expensive machines that few know how to use or repair. The medically trained personnel who staff these hospitals often have little understanding of or respect for local birth traditions, with the result that local women often avoid such hospitals whenever possible. From Northern India to the Yucatan, indigenous women echo each other's concerns: ‘They expose you,’ ‘they shave you,’ ‘they cut you,’ ‘they leave you alone and ignore you, but won't let your family come in’. Ironically, none of the rules and procedures these women find so alarming are essential to good obstetric care; rather, they reflect the importation of the mechanistic Western model and its culturally insensitive imposition on indigenous groups.

In an effort to counteract this trend and build a bridge between technology and tradition, the World Health Organization and UNICEF have been promoting programs to ‘upgrade’ the skills of traditional midwives. Anthropological studies have shown, however, that because the medically trained personnel in these programmes tend to place a higher value on the Western techomedical approach, they generally fail to take advantage of the knowledge and skills developed by community midwives within the context of their own cultural traditions.

In 1978, Brigitte Jordan called for the ‘mutual accommodation’ of indigenous and Western birthing systems. In northern Brazil, an obstetrician, Dr Galba Araujo, demonstrated one form this ‘mutual accommodation’ might take: he oversaw the building of rural community clinics staffed by local midwives (who received culturally sensitive training that honoured their skills while imparting useful biomedical information), and linked them to one city hospital through a government funded ambulance system. (Lack of transportation to a hospital in emergencies is a significant cause of maternal death in the developing world.)

In the US, obstetricians solidified their control over birth during the first half of the twentieth century and nearly eliminated midwifery by the 1950s. Since then the demands of many women for natural childbirth, coupled with scientific research into the dangers of interventionist hospital birth and the benefits of planned, midwife attended births at home or in freestanding birth centres, have generated a midwifery renaissance. Indeed, in the four countries in which infant perinatal mortality statistics are the lowest in the world — Japan, Holland, Sweden, and Denmark — over 70% of births are attended by midwives who serve as the woman's primary caregiver.

Deep in the evolutionary past, our ancestors came to understand the benefits of women helping other women to give birth. Today, the most successful birthing systems combine midwifery care with solid scientific research on the physiology of birth. Contemporary midwives work in all settings, from hospital to home, and support women to avoid unnecessary interventions, to give birth in upright positions, to breastfeed, and to enjoy uninterrupted contact with their babies after birth. It has been repeatedly demonstrated that midwifery care results in fewer interventions, less iatrogenic damage to mothers and babies, improved outcomes (both psychological and physical), and lower costs. It is to be hoped that in short order the world will pass through the current phase of high-technology interventions in normal birth and come full spiral, uniting evolutionary understandings with contemporary science through midwives' skilled, nurturant, and woman-centered care.

Robbie Davis-Floyd

Bibliography

Davis-Floyd, R. E. (1992). Birth as an American rite of passage. University of California Press, Berkeley and London
Davis-Floyd, R. E. and and Sargent, C. (1997). Childbirth and authoritative knowledge: cross-cultural perspectives. University of California Press, Berkeley, California.
Jordan, Brigitte (1993; orig. pub. 1978). Birth in four cultures: a cross-cultural investigation of childbirth in Yucatan, Holland, Sweden and the United States, (4th edn) Waveland Press, Prospect Heights, Ohio.


See also labour; pregnancy.

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Birth

46. Birth

See also 281. MOTHER ; 327. PREGNANCY

amniomancy
a form of divination by examining the embryonic sac or amniotic fluid.
autogeny, autogony
the spontaneous generation of an organism in an inorganic fluid medium. autogenous, autogenic, autogonic, autogonous, adj. autogenously, autogonously, adv.
digoneutism
the ability to produce two broods in a year. digoneutic , adj.
epigenesis
the theory that embryonic development is totally controlled by the cells environment. Cf. syngenesis. epigenesist , n. epigenetic , adj.
epimorphosis
development of an organism or form of animal life in which body segmentation is complete before hatching. epimorphic , adj.
fetation, foetation
the development of a fetus; gestation.
geniture
Obsolete, birth; the process of generation.
gestation
1. the process of carrying in the womb.
2. fetation; the process of development of the fetus in the womb.
gravidity
pregnancy. gravid , adj.
hysterology
scientific study of the uterus.
Lamaze technique
psychoprophylaxis.
maieusiophobia
tocophobia.
midwifery
the prineiples and practice of a midwife. Cf. tocology.
multiparity
the condition or process of producing more than one offspring at one birth. multiparous , adj.
nativity
1. the time, place, and circumstances of a persons birth.
2. the configuration of the planets at the time of a persons birth and a representation, as a chart, of that configuration.
nulliparity
the condition in a woman of never having given birth. nullipara , n. nulliparous , adj.
obstetrics
the branch of medicine that deals with prenatal and postnatal care and with the delivery of a child. obstetrician , n. obstetric, obstetrical, adj.
omphalomancy
a form of divination in which the number of knots in a newborns umbilical cord are counted to foretell the number of children the mother will have later.
omphalotomy
the surgical process of dividing the umbilical cord.
oviparism
the bearing of offspring by laying eggs that mature outside of the body. oviparity , n. oviparous , adj.
ovoviviparism
the bearing of offspring by producing eggs that mature within the body, with the young born alive. ovoviviparity , n. ovoviviparous , adj.
oxytocic
a substance or drug that induces or stimulates childbirth. oxytocic , adj.
palingenesis
1. partial or complete regeneration.
2. the doctrine that a soul passes through several bodies in a series of rebirths. Also palingenesia, palingenesy. palingenetic , adj.
parity
the state, quality, or fact of having given birth to or having borne offspring.
parturiency
the state or condition of bringing forth young or being about to begin parturition. parturient , adj.
parturition
childbirth; the act or process of giving birth. parturient , adj.
primigravida
a woman who is pregnant for the first time.
primipara
a woman who has given birth to one child or who is giving birth for the first time. primiparity , n. primiparous , adj.
psychoprophylaxis
a method of preparing women for childbirth without anesthetic, by means of education, psychological and physical conditioning, and breathing exercises. Also called Lamaze technique. psychoprophylactic , adj.
puerperium
the state or condition of a woman during and immediately following childbirth. puerperal , adj.
recrudescence
the process of renewal or rebirth. recrudescent , adj.
regeneracy
the act or quality of being renewed, reformed, or reborn, especially in a spiritual rebirth. regenerate , adj.
regenesis
the act or process of renewal or rebirth.
secundigravida
a woman who is pregnant for the second time.
spermicide
a substance or preparation used for killing sperm, used in contraception. spermicidal , adj.
superfetation
a conception occurring after the onset of a pregnancy from an earlier conception.
syngenesis
the theory that the form and development of the embryo are the result of the combined influence of sperm and egg. Cf. epigenesis. syngenetic , adj.
thoracopagus
a fetal abnormality, consisting of twins joined at the thorax.
tocology, tokology
the science of obstetrics or midwifery. tocologist, tokologist, n. tocological, tokological, adj.
tocophobia, tokophobia
an abnormal fear of childbirth. Also called maieusiophobia.
unigravida
primigravida.
uterogestation
the process of gestation taking place in the womb from conception to birth.
vasectomy
surgical excision of part of the vas deferens, the duet which carries sperm from the testes, performed as a form of male contraception.
viviparism
the bearing of living offspring, characteristic of almost all mammals, many reptiles, and some fishes. viviparity , n. viviparous , adj.

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Birth

Birth

Birth, or parturition (pronounced pahr-chuh-RIH-shuhn), in mammals is the process during which a fully developed fetus emerges from the mother's uterus (or womb) by the force of strong, rhythmic muscle contractions. The birth of live offspring is a reproductive feature shared by mammals, some fishes, and certain invertebrates (such as scorpions), as well as some reptiles and amphibians. Animals that give birth to live offspring are called viviparous (pronounced vie-VIP-uh-rus, meaning "live birth").

In contrast to viviparous animals, other animals such as birds and frogs give birth to eggs; these animals are called oviparous (meaning "egg birth"). Still other animals, such as some fish and reptiles, are ovoviviparous, meaning that the young develop in eggs within the mother's body and hatch either before or immediately after emerging from the mother.

Viviparous animals

In viviparous animals, fertilization of the mother's egg with the father's sperm takes place inside the mother's body. Nutrients are passed from the mother to the developing fetus. In certain mammals, such as humans, this transfer of nutrients occurs through an organ called the placenta, which is formed from the embryo and the mother's uterus.

Words to Know

Amniotic fluid: The fluid in which the fetus is suspended while in the uterus.

Amniotic sac: A thin membrane forming a sac that contains the amniotic fluid.

Cervix: The narrow, bottom end of the uterus; the opening of the uterus.

Fetus: An unborn mammal at the later stages of development. A human embryo is considered a fetus after eight weeks.

Gestation: The period of carrying young in the uterus before birth.

Labor: The strong, rhythmic contractions of the uterus that result in birth.

Placenta: An organ that develops in certain mammals during gestation through which a fetus receives nourishment from the mother.

Umbilical cord: The cord in most mammals that connects the fetus to the placenta.

Uterus (womb): A muscular organ inside the female mammal in which a baby develops.

Viviparous: Animals that give birth to live offspring.

The carrying of young in the uterus is called gestation (pronounced jes-TAY-shun). The length of time between fertilization and birth in viviparous animals is called the gestation period. The gestation period varies, depending on species. In humans, it is about nine months. Elephants have one of the longest gestation periods of all animals, lasting 22 months.

The birth process

The process of birth in humans normally begins at the end of the gestation period with the release of several hormones that stimulate the mother's uterus to contract. Contractions signal the first stage of labor. In order for the fetus to leave the uterus and enter the birth canal (comprised of the cervix and vagina), it must pass all the way through the cervix, the opening of the uterus.

During the first stage of labor, which can last 12 hours or more, the contractions of the uterus move the fetus toward the cervix, causing the cervix to dilate (widen). With dilation, the cervix opens to accommodate the passage of the baby's head. The amniotic sac also usually ruptures, releasing amniotic fluid that streams out of the vagina. (The amniotic sac is a membrane filled with fluid in which the fetus floats while developing in the uterus.)

During the second stage of labor, lasting anywhere from 30 minutes to 2 hours, the mother uses her abdominal muscles to help push the fetus through and out of the birth canal. In a normal delivery, the baby's head appears first (called crowning) and the rest of the body follows. The umbilical cord that connects the fetus to the placenta is tied and cut. The place on the baby's abdomen where the umbilical cord is attached is the navel, or belly button. The baby is now separated from the mother and must breathe air through its own lungs.

In the third stage of labor, usually lasting from a few minutes to a half hour, contractions cause the placenta and fetal membranes to separate from the wall of the uterus and be expelled from the vagina. The placenta and fetal membranes together are called the afterbirth.

[See also Embryo and embryonic development; Fertilization; Hormones; Reproduction; Reproductive system ]

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birth

birth or labor, delivery of the fetus by the viviparous mammal. Birth is also known as parturition. Human birth normally occurs about 280 days after onset of the last menstrual period before conception.

The Stages of Labor

Onset of labor, the first stage, is heralded by contractions of the uterus felt as cramplike pains in the abdomen or lower back that recur at intervals of 10 to 30 minutes and last about 40 seconds; they increase in frequency until they occur at about 2-minute intervals. With each contraction the cervix, or neck of the uterus, dilates until it becomes wide enough, about 4 in. (10 cm), to permit emergence of the baby.

In the second stage of labor the baby passes through the birth canal, most commonly head first, and is born. The effectiveness of uterine contractions in this stage is enhanced by the bearing-down abdominal contractions of the mother.

The third stage of labor, which occurs about 15 to 30 minutes after the child is born, is characterized by the separation of the placenta from the uterine wall and its expulsion. The total time of labor averages 13 to 14 hours in women pregnant for the first time and 8 to 9 hours in women who have previously borne children.

Methods of Analgesia

The pain of childbirth can be relieved with a variety of analgesic and sedative drugs, including morphine, barbiturates, and chloroform. However, many drugs that relieve pain also slow the uterine contractions or dangerously depress the baby's respiratory system. Spinal anesthetics, injected directly into the spinal cord, while not dangerous to the child, are difficult to administer accurately and are therefore potentially dangerous to the mother. Hypnosis has also been used experimentally.

Natural Childbirth

In recent years so-called natural childbirth has come into wide use; the advantages are that the child is born undrugged and the mother can be conscious at the moment of birth. Natural childbirth emphasizes the ability of many women to give birth with a minimal amount of pain-killing drugs or none at all. The Dick-Read method, formulated by the British obstetrician of that name, emphasizes maternal understanding of the birth process as an aid to relaxation, and exercises to strengthen muscles and encourage proper breathing. The Lamaze method, or psychoprophylaxis, is of Russian origin; it uses breathing exercises as a conditioned response to uterine contractions.

Complications of Childbirth

Birth often cannot proceed normally because of a defect of the cervix or weak uterine contractions; breech births, in which the feet or buttocks emerge first, and transverse births, in which the child is positioned across the uterus, usually require obstetrical intervention, such as forceps delivery, manually turning the baby, or performing a cesarean section. About 10% of pregnancies terminate in deliveries that are too early, producing (after at least 200 days of gestation) premature infants requiring special care. Birth of a fetus prior to about 200 days of gestation is termed a miscarriage; birth within the first three months, an abortion. Stillbirth is the delivery of a dead child.

Complications of childbirth affecting the newborn include infant blindness attributable to gonorrhea infection, now largely eliminated by routine administration of silver nitrate to the eyes; retrolental fibroplasia, a type of blindness common for some years in premature infants that was found to result from administration of high concentrations of oxygen and is now largely avoided; and erythroblastosis fetalis, or Rh disease, which can often be prevented. Puerperal fever, an infection of the mother's genital tract once common following labor and delivery, has now also been largely eliminated by preventive hygiene, especially in labor, and by antibiotic therapy.

See pregnancy; obstetrics.

Bibliography

See D. Caton, What a Blessing She Had Chloroform (1999).

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Birth

BIRTH

Birth is the prototype for all discontinuities in the relation between a mind and its objects. Otto Rank's The Myth of the Birth of the Hero (1909) introduced this theme into psychoanalytic literature.

In the same year Freud took an interest in dreams of birth in an addendum to The Interpretation of Dreams (1900a). Birth, as a passage from intra-uterine life to extra-uterine life became for him "the first experience of anxiety, and thus the source and prototype of the affect of anxiety" (SE, 5: 525, note 2). He returns to this theme in Introductory Lectures on Psychoanalysis (1916-17a [1915-17]), in which he speaks of the "separation"(SE, 15: 397) of birth.

This is the theme that Wilfred Bion developed in Caesura (1975) when he made birth the paradigm for all psychic discontinuity, which means that experiences lived through before the caesura must be capable of being retranscribed in a psychically assimilable form after the caesura. Taking a more genetic point of view, other authors have applied the term "psychic birth" to the moment when children become conscious of their individuation and the separation between them and their libidinal objects (Mahler, Margaret, 1975; Tustin, Frances, 1981).

Didier Houzel

See also: Constitution; Dream symbolism; Infant development; Infant observation; Infant observation (therapeutic); Infantile psychosis; Intergenerational; Maternal; Memoirs of the future; Myth of the Birth of the Hero, The ; Narcissistic elation; Parenthood; Postnatal/postpartum depression; Premature-Prematurity; Primary love; Reversal into the opposite; Seduction; Sexual theories of children; Social feeling (individual psychology); Trauma of Birth, The .

Bibliography

Bion, Wifred R. (1975). The grid and Caesura. Rio de Janeiro: Imago.

Freud, Sigmund. (1900a). The interpretation of dreams. Part I. SE, 4, 1-338.

. (1900a). The interpretation of dreams. Part II. SE, 5 : 339-625.

. (1916-17a [1915-17]). Introductory lectures on psycho-analysis. Parts I and II. SE, Part I, 15 ; Part II, 16.

Mahler, Margaret, Pine, Fred, and Bergman, Anni. (1975). The psychological birth of the human infant. New York: Basic Books.

Tustin, Frances. (1981). Autistic states in children. London: Routledge.

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birth

birth / bər[unvoicedth]/ • n. the emergence of a baby or other young from the body of its mother; the start of life as a physically separate being: he was blind from birth despite a difficult birth he's fit and healthy. ∎  a baby born: the overall rate of incidence of Down syndrome is one in every 800 live births. ∎  the beginning or coming into existence of something: the birth of democracy. ∎  origin, descent, or ancestry: the mother is American by birth. ∎  high or noble descent: she was proud of her beauty and her birth. • v. [tr.] inf. give birth to (a baby or other young): she had carried him and birthed him [intr.] in spring the cows birthed. PHRASES: give birth bear a child or young: she's due to give birth in March she gave birth to a son.

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birth

birth XII. — ON. byrð birth, descent, corr. to Goth.(ga)baurps, f. Gmc. *bur- *ber- BEAR2; see -TH1.
Hence birthday XIV; cf. OE. ġebyrddæġ.

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birth

birth (berth) n. (in obstetrics) see labour.

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birth

birth See parturition.

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birth

birthberth, birth, dearth, earth, firth, girth, mirth, Perth, worth •stillbirth • childbirth • afterbirth •Edgeworth • Hepworth • Ellsworth •Whitworth • halfpennyworth •Bosworth • jobsworth • Iorwerth

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