For most pregnant women, delivering their baby through the birth canal is the culmination of their 9-month journey. While vaginal delivery is a natural process, it still takes immense physical effort and the experience is unique for every woman. This guide covers what to expect during a vaginal birth, including the stages of labour, pain management options, and potential interventions if needed.
How Labour Begins
Labour starts when regular contractions begin dilating and thinning out the cervix to prepare it for delivery. For first-time mothers, early labour contractions may go on for many hours before becoming more frequent and intense. It’s usually fine to remain home during this early phase. More established labour involves contractions coming every 5 minutes and lasting over 1 minute, signalling that it’s time to head to the delivery location.
The amniotic sac surrounding the baby often ruptures sometime during labour, in what’s commonly called the water breaking. If it doesn’t break on its own, the doctor may pierce the membrane during a vaginal exam. Losing the amniotic cushion can help intensify contractions.
The Three Stages of Labour
Labour is divided into three stages:
First Stage: The cervix dilates from 0 to 10 cm wide. Contractions become stronger and more regular to assist dilation. For first-time mothers, active labour may take 12+ hours, while subsequent deliveries are often much faster.
Second Stage: The mother pushes to deliver the baby. Pushing begins when the cervix is fully open. She will feel overwhelming pressure with each contraction. The baby moves down and their head begins crowning. After the head delivers, the shoulders and body follow. This stage may take 2-3 hours for new mothers.
Third Stage: The placenta detaches from the uterine wall and is expelled through the vagina. Mild contractions help this process occur shortly after birth. Options are letting it deliver naturally or getting an injection to accelerate placental delivery.
Pain Management Choices
Labour contractions can be extremely painful. There are a variety of options to provide relief:
- Breathing Techniques: Methods like the Lamaze technique use certain breathing patterns to focus through contractions. They are usually combined with massage and other natural methods.
- Nitrous Oxide: Also called laughing gas, this provides mild pain relief through a mask during contractions. Some disadvantages are that it takes time to work and may cause nausea or dizziness.
- Opioids: Injections of medications like diamorphine or pethidine offer moderate pain relief. Side effects on mum and baby must be carefully managed.
- Epidural: This injected anaesthetic offers the most complete pain relief. A catheter in the back delivers continuous numbing medication to the spinal cord. While very effective, it may make pushing more difficult and increases interventions.
- Local Anaesthesia: Numbing shots can be administered in the vaginal area during delivery, like if an episiotomy is needed. This provides targeted, short-term relief.
Positions and Pushing Techniques
There are several positions women can try during the pushing stage to make use of gravity and alignment to aid delivery. Changing positions every so often helps keep energy levels up and labour progressing. Some options are:
Upright: Standing, squatting, kneeling on all fours – vertical positions use the power of gravity to bring the baby down. Handles or a partner’s shoulders can provide support. Squatting opens the pelvis an extra 10-15% compared to lying down.
Sitting: Sitting upright, resting back on the bed with knees pulled up, using a birthing seat or special stool provides an intermediate option between lying down and standing. Pillows offer extra back support.
Lying Down: Traditional flat on back or propped up positions are the most common. They provide the most access for monitoring and procedures. But gravity doesn’t assist. Side-lying positions can also be an option.
Water Birth: Immersion in a birthing pool eases buoyancy during contractions. Warm water can reduce pain and relaxation. Some maternity units offer pools and guidelines on water birth eligibility.
Pushing techniques focus on working with the body. Holding breath and forceful pushing is discouraged. Instead, breathing rhythmically and pushing in time with contractions saves energy. Additional guidance from midwives on when and how to push prevents exhaustion and tearing. Partners can provide physical and emotional support.
When Interventions May Occur
While most vaginal deliveries proceed naturally, medical interventions are sometimes required for health and safety reasons. Some situations where assistance may be offered include:
- Labour stalling because the baby is improperly positioned
- Baby showing signs of distress such as abnormal heart rate
- Mother unable to push effectively due to exhaustion or inadequate contractions
- Complications from health conditions like high blood pressure
Two options doctors may use are:
Forceps or Vacuum Extraction: Metal forceps or a vacuum cup applied to the baby’s head can help guide them out of the birth canal. Additional anaesthesia is administered first for comfort.
Episiotomy: A small incision made in the vaginal opening can provide more space for delivery. It may be done to prevent severe tearing during interventions. Stitches repair the cut afterwards.
Is a Home Birth Right for You?
Women with low-risk, healthy pregnancies may choose to deliver at home attended by a midwife rather than going to a hospital. Benefits include greater comfort in familiar surroundings and avoiding medical interventions. However, if complications occur, immediate access to emergency hospital care saves precious minutes. Mothers with high-risk conditions like gestational diabetes are better suited for a hospital birth in case neonatal care is needed. An attendee midwife can advise if home birth is appropriate based on your health profile.
If pregnancy continues past 42 weeks with no signs of labour, induction may be recommended. This artificially starts contractions using mechanical or chemical methods:
Sweeping Membranes: The midwife massages the cervix to separate the amniotic sac. This releases hormones to promote labour.
Ripening Cervix: Prostaglandin tablets or gels soften the cervix so it begins dilating. Contractions often follow.
Breaking Waters: Rupturing the amniotic sac releases chemicals that stimulate uterine contractions. This may be combined with oxytocin.
Oxytocin Drip: The synthetic hormone causes the uterus to contract more frequently and strongly. Given through an IV, dosage can be adjusted until active labour begins.
Induced labour may be more intense with stronger, more painful contractions. Using multiple methods together increases effectiveness. Close foetal monitoring ensures the baby tolerates induction. IV fluids and nutrition are given since eating is often restricted. Labour still progresses through the same stages as natural labour.
Caring for Baby Immediately After Birth
In the first minutes after delivery, caring for both mother and baby is vital:
Clearing Airways: Gently wiping away mucus from the baby’s mouth and nose helps initial breathing and crying to occur.
Clamping Cord: The umbilical cord is clamped in two places and then cut to detach baby from placenta. Delayed clamping allows continued blood flow from placenta to newborn.
Drying and Warming: Rubbing the baby with towels stimulates circulation and dries amniotic fluid. The baby is then placed skin-to-skin on the mother’s chest covered in a blanket.
Vitamin K Shot: An injection of vitamin K is given to prevent potential bleeding problems.
Apgar Evaluation: At 1 and 5 minutes after birth, Apgar scores assess baby’s heart rate, breathing, muscle tone, reflexes and skin color. This validates their transition to life outside the womb.
Footprints: Inked footprints serve as medical identification and a keepsake for parents. Other measurements like weight and length are also taken.
After stabilisation, baby can remain skin-to-skin for an hour or longer to encourage bonding, regulate temperature and initiate breastfeeding. This early contact benefits both newborn and mother.
Welcoming Baby into the World
However labour and delivery unfold, the euphoria of meeting your newborn makes all the effort worthwhile. While birth plans often change, knowledge of the process allows mothers to feel empowered making decisions. With an open mind and trust in the support team, the voyage of bringing life into the world can be an awe-inspiring experience, whatever twists and turns it may take.