Normal Delivery / Vaginal Delivery – Stages, Tips & Complications
Vaginal delivery, also known as normal delivery, is the process of birthing a baby through the vaginal canal. According to the National Institutes of Health, most women possess the physical well-being to opt for vaginal childbirth, although some may encounter complications necessitating surgical intervention, such as a cesarean section (C-section). The journey of a normal vaginal birth commences with labor, a unique experience for every woman. Many mothers-to-be opt for childbirth classes to equip themselves for the incredible journey of giving birth. Depending on your health, your baby’s well-being, and the policies of your chosen delivery center, you may be offered pain-relief medications to ease any discomfort leading up to the delivery.
Did You Know?
Vaginal delivery is recommended for its substantial health benefits for both mothers and infants. According to the American College of Obstetricians and Gynecologists, women who give birth vaginally typically enjoy faster recovery times, experience fewer infections, and spend less time in the hospital compared to those who undergo cesarean section deliveries. Furthermore, babies born through vaginal delivery tend to experience fewer respiratory complications compared to their counterparts delivered via C-section. It’s a win-win for both mother and baby!
Am I a candidate for a normal vaginal delivery?
You are more likely to have normal vaginal delivery if you have experienced a healthy pregnancy free of major complications, or previous successful vaginal deliveries. However, there can be many indications your doctor may recommend a cesarean birth instead, such as if you are delivering more than one baby, you have had a prior c-section, or your baby is breech.
The mean duration of pregnancy is 40 weeks or 280 days from the first day of last menstrual period. The period from 37 completed weeks (259 days) to 42 weeks (294 days) is called Term pregnancy .If a baby is born before 37 completed weeks , it is considered as a Pre mature delivery. Similarly ,if the baby is born after 42 weeks ,it is called a post term delivery .Most women ,around 80 percent, deliver between 37 and 42 weeks and 11 percent deliver prematurely (before 37 weeks).
Initiating Labor
Labor typically begins within a two-week window around the estimated due date. Although the exact cause of labor onset remains unclear, there are many theories involving mechanical and hormonal factors. The duration of labor varies, lasting 12 to 18 hours for first pregnancies and generally being shorter, around 6 to 8 hours, for subsequent pregnancies. Engaging in activities like standing and walking during the first stage can reduce its duration by over an hour.
Signs of Labor Onset
Pregnant women should be familiar with key signs that labor is commencing, including:
- Regular contractions in the lower abdomen
- Back pain
- The appearance of a bloody show, which is a discharge of blood mixed with mucus and often precedes contractions
- Rupture of membranes, known as “the water breaking,” where amniotic fluid flows from the vagina
If a woman has a history of rapid deliveries, she should promptly notify her doctor when contractions begin. Initially, contractions may be weak, irregular, and spaced out like menstrual cramps, but they intensify and become closer together as labor progresses.
Stages of Labor and Delivery
Labor is a complex process marked by rhythmic uterine contractions, which gradually facilitate the movement of the fetus through the cervix and birth canal, leading to its arrival in the outside world. It unfolds in three main stages:
First Stage: Labor Initiation and Progression
The first stage consists of two phases, the initial and active phases. During this stage, contractions gradually cause the cervix to dilate and thin (efface) until it merges with the rest of the uterus. These changes enable the fetus to enter the vagina.
- Initial (Latent) Phase
- Contractions start irregularly and become stronger and more rhythmic over time.
- Discomfort is minimal.
- The cervix begins to thin ,efface and dilate to approximately 1 1/2 inches (4 centimeters).
- Typically, this phase lasts around 8 hours for first pregnancies ( may go up to 20 hours) and 5 hours for subsequent pregnancies (up to 12 hours).
- Active Phase
- The cervix continues to dilate from about 1 1/2 inches (4 centimeters) to full dilation at 4 inches (10 centimeters) while effacing.
- The baby’s presenting part, usually the head, descends into the pelvis.
- The woman feels the urge to push as the baby descends, but she should resist it to avoid unnecessary fatigue and cervical tears.
- On average, this phase lasts 5 to 7 hours for first pregnancies and 2 to 4 hours for subsequent pregnancies.
Second Stage: Baby Delivery
During the second stage, the baby is delivered. This stage typically lasts about 2 hours for first pregnancies and approximately 1 hour for subsequent pregnancies. It may extend longer if pain relief measures, such as epidurals, have been administered.
Third Stage: Placenta Delivery
The third stage encompasses the delivery of the placenta, a stage that is usually brief, lasting only a few minutes but potentially extending to 30 minutes.
Managing Ruptured Membranes
When the amniotic sac ruptures before labor starts (prelabour rupture of membranes), it’s essential to contact a healthcare provider immediately. In most cases, spontaneous labor occurs within 24 hours. If not, induction may be necessary due to the risk of infection when bacteria can more easily enter the uterus after membrane rupture.
Admission to a Healthcare Facility
A woman should head to a hospital or birthing center under the following circumstances:
- Ruptured membranes
- Regular contractions occur at intervals of 6 minutes or less, lasting 30 seconds or more
- Cervix dilation surpasses 1 1/2 inches (4 centimeters)
Uncertainty about labor initiation might entail observation and fetal monitoring for an hour or so before making a definitive decision. Upon admission, healthcare providers monitor the strength, duration, and frequency of contractions, perform vital checks, and assess the baby’s position and presentation. The most favorable presentation consists of the head down,facing rearward, angled toward either side, with the chin tucked in and arms folded across the chest.
Fetal Monitoring
Fetal monitoring is critical, primarily through electronic fetal heart monitoring. It helps determine the baby’s well-being by tracking heart rate patterns, identifying distress indicators, and ensuring oxygen supply. Monitoring may be external, using an ultrasound device or fetoscope, or internal, involving electrode placement on the fetal scalp.
Pain Relief Options
Pregnant women often plan pain relief strategies well in advance in their birth plans, choosing from various options:
- Natural Childbirth: Emphasizing relaxation and breathing techniques to manage pain.
- Analgesics: Intravenous administration of pain relievers, such as opioids like fentanyl or morphine.
- Local Anesthetic: Numbing the vaginal area via a pudendal block or other procedures.
- Regional Anesthesia: Providing comprehensive pain relief through techniques like epidural or spinal injections.
- General Anesthesia: Inducing temporary unconsciousness, typically reserved for emergency cesarean deliveries.
The choice of pain relief depends on individual preferences, labor progression, and healthcare provider recommendations.
Natural Childbirth Techniques
Natural childbirth involves conscious techniques to cope with pain, including relaxation and various breathing methods. Preparation through childbirth classes is essential to master these techniques.
- Relaxation: Involves tensing and relaxing specific body parts to ease tension during contractions and between them.
- Breathing: Utilizes different breathing patterns for distinct stages of labor, such as deep breathing, panting, and blowing to manage contractions.
Partners and support persons play a pivotal role in aiding women during labor by reminding them of appropriate techniques, providing emotional support, and potentially offering massages for relaxation.
The Process of Delivery
Delivery occurs as the fetus and placenta are expelled from the uterus. The birthing environment can vary, from specialized delivery rooms to labor, delivery, recovery, and postpartum rooms (LDRP). During the pushing phase of labor, the healthcare provider assesses the fetus’s head position and guides it through the vaginal opening, ensuring a gradual stretch and minimizing tearing. Vacuum extraction or forceps may be employed if assistance is needed. Episiotomy, an incision to widen the vaginal opening, is no longer routine but is performed only when necessary to facilitate delivery.
Delivery of the Placenta
After baby delivery, the healthcare provider ensures that the uterus contracts properly and monitors the placenta’s detachment. Typically, the placenta detaches within 3 to 10 minutes, followed by expulsion. The woman may push it out herself, but sometimes assistance is required if it doesn’t occur within 45 to 60 minutes. The provider checks for placental completeness as retained fragments can lead to bleeding and infection. Repairs are made to genital tears or episiotomy incisions if needed.
Post-Delivery Care
Following delivery, oxytocin is administered to contract the uterus and minimize blood loss. The doctor addresses any genital tissue tears and episiotomy repairs if necessary. Bonding and skin to skin contact between the mother, baby, and partner often begins immediately after delivery, and breastfeeding is encouraged. The baby may remain in the room with the mother, a practice known as rooming-in. Observation is critical during the first 24 hours for any post-delivery complications, with healthcare professionals monitoring both the mother and baby closely.
Possible complications of normal delivery?
Although serious complications are rare during labor and delivery, some problems can develop during this time. Here are some of the more common complications:
1. Fetal meconium
When the amniotic sac ruptures, the normal color of the amniotic fluid is clear. However, if the amniotic fluid is greenish or brown in color, it may show fetal meconium, which is normally passed after birth as the baby’s first bowel movement. Meconium in the amniotic fluid may be associated with fetal distress if associated with abnormal heart pattern on CTG(cardio tocography) monitoring. A woman should talk with her healthcare provider immediately.
2. Abnormal fetal heart rate
The fetal heart rate during labor is a good sign of how the baby is handling the contractions of labor. Heart rate monitoring is typically done electronically throughout labor. The normal range typically falls between 120 and 160 beats per minute. If a baby appears to be in distress, immediate action can be taken. The mother can be given oxygen, intra venous fluids, and change of position as immediate measures to relieve fetal distress.
3. Abnormal position of the baby during birth
During birth the normal position for the baby is head-down, facing the mother’s back. However, on occasions, the baby may not be in the correct position, which can potentially complicate the delivery process through the birth canal. There are several abnormal positions for a baby, including the following:
- Face Presentation: This occurs when the baby’s face, rather than the top of the head, is positioned to enter the birth canal first. It can make delivery more challenging.
- Brow Presentation: In this position, the baby’s brow (forehead) is facing downward instead of the top of the head ,making it impossible to navigate the pelvic bones .
- Breech Presentation: When the baby is positioned with the buttocks or feet descending first into the birth canal, it’s called a breech presentation. This is considered abnormal because the head is not leading the way, which is the ideal position for delivery.
- Transverse Lie: In this position, the baby is lying horizontally across the mother’s pelvis, making a vaginal delivery impossible.
- Compound Presentation: This happens when one of the baby’s limbs, usually an arm, is alongside the head, creating a more challenging situation during delivery.
- Occiput Posterior Position: In this position, the baby’s head is down, but it’s facing the mother’s abdomen rather than her back. This can lead to a more prolonged and painful labor.
Depending on the position, a healthcare provider may try to deliver the baby as it presents itself, attempt to turn the baby before delivery, or perform a Cesarean delivery.
4. Vaginal bleeding and tears
Vaginal bleeding and tears during childbirth are common occurrences, but severe bleeding can be dangerous and requires immediate medical attention. Typically, a woman loses approximately 1 pint of blood during and after vaginal delivery. This blood loss is a result of some blood vessels opening when the placenta detaches from the uterus. Thankfully, the contractions of the uterus aid in closing these vessels until they can heal. In the context of vaginal deliveries, losing more than approximately 1 pint of blood during or after the third stage of labor (when the placenta is delivered) is considered excessive. Excessive blood loss typically occurs shortly after delivery but can occasionally occur up to a month afterward.
It’s worth noting that around 90% of women experience tearing during childbirth. However, some women may experience more severe tears. Unfortunately, it’s not always possible to predict or prevent these types of tears.
Do I need to follow any post-delivery recovery guidelines?
Yes. Recovery from a normal vaginal birth is usually quick and easier than recovery from C-Section birth, but there are still some guidelines you must follow to protect your health. If you have any vaginal tears or stitches during your delivery, you must keep it clean. For at least six weeks after delivery, you should avoid taking baths or swimming. However, you may take shower normally. You should also abstain from sex for the same duration. Contact your doctor if you pass blood clots larger than golf balls, have difficulty urinating, experience uterine tenderness, or have a fever.
