Normal Delivery is a natural, physiological process that their bodies are capable of performing and which nature has been perfecting for thousands of years. Except for some severe medical conditions, over 95% of women are capable of normal delivery, provided they are supported, encouraged, and given the right facts about good diet, exercise, labor, childbirth, etc.
The Delivery
When it’s time for the baby’s head to deliver, the doctor will do his best to protect the delivery of the head and the mother’s perineum to reduce or minimize any tears that might occur. Once the baby’s head is delivered, the doctor will ask the mother to stop pushing temporarily. He will suction the mouth and nose of the baby, removing mucous secretion and amniotic fluid that may be present. He will check around the baby’s neck to make sure the umbilical cord isn’t wrapped around it. If it is, depending on how loose it is, he may unwrap the cord around the baby’s neck. Sometimes, the cord may be tightly wrapped around the baby’s neck; in that event, the doctor will clamp the cord in two places, cut the cord in-between the two clamps, unwrap the cord manually, and deliver the rest of the baby.
It’s a wonderful time for the mother to watch as her entire baby is delivered. Many times a large amount of amniotic fluid that was behind the baby will now flow out. The doctor will also maintain support of the perineum so that there is a minimal chance of tearing. After the baby is delivered, the umbilical cord will be clamped and cut. If the father is interested, he can be given the opportunity to cut the cord. Again, this is a great way of making the extra person feel included in the process.
The baby will be gently stimulated by the delivering doctor and may be placed on the mother’s chest or belly and covered with a blanket to provide warmth. The mother is asked to gently stimulate the baby during this time by rubbing the baby’s back. Alternatively, the baby may be transferred to the baby warmer station where the medical staff will clean him, warm him, and check his heart rate. If the baby is not doing well, then there may not be time for him to go to his mother. Out of medical necessity, in this case, the baby will go immediately to the warmer or the nursery.
After the baby is born, the doctor and nurse return their attention to their primary patient, the mother. The doctor will reassess the mother’s physical status, vital signs will be checked, and the amount of bleeding from the vagina will be determined. The doctor will assess his patient for tears or lacerations that might have occurred in the perineum or vagina or vulva. If any repairs are necessary, the doctor may proceed to do the repairs or opt to do them after the placenta is delivered. The doctor will also see if the cervix has any tears or lacerations, as well as examining the rectum for tears.
If there are any tears from a natural occurrence or from an episiotomy, the doctor will stitch the tears with absorbable sutures, meaning that the suture material will degrade on its own based on the body’s ability to break down the suture.
The placenta will be delivered within half an hour after the baby’s birth. After the delivery, there is a tendency for the uterus to squeeze down upon itself and return to a contracted state. The placenta will begin to sheer off with the contractions. As it sheers off, there is usually a visible sign of this by a large amount of blood coming out of the vagina and the umbilical cord will lengthen and advance out.
The doctor may aid this process by gentle traction (pulling), but he must be careful not to exert any unnecessary traction, as it could tear the cord off. After the placenta is delivered, the doctor will check to make sure that all of it is intact and no pieces remain in the uterus (which could cause bleeding and infection). The doctor will advise the nurse that the placenta has been delivered, so that she can note the time.
He will ask for pitocin to be administered intravenously, which aids in the contraction of the uterus and stops bleeding. To aid this process, the doctor will massage the uterus and stimulate it physically. The doctor will then check for any remaining clots before the placenta was delivered and evacuate those as necessary. Once the bleeding is under control and all lacerations have been repaired, the patient can be cleaned and her bed will be put back together. She can begin to rest. This is still a potentially dangerous time for the mother as bleeding may resume, so the nurse will continue to check her vital signs (including blood pressure) for the next several hours. The nurse will also check the uterus by pushing down on the abdomen, to make sure that the uterus is contracted and firm to touch. A soft, boggy or enlarged uterus could indicate that bleeding has occurred and the uterus is expanding with blood. That condition may necessitate additional measures, such as checking for clots remaining inside the vagina and uterus, recommendation for additional medications, and a possible blood transfusion. And if bleeding is extreme, surgical measures may be recommended, such as a D & C or a full hysterectomy.
Episiotomy
Often the baby may not be delivered because the vaginal opening is too small or constricted. At other times, the vaginal opening may be appropriate in size, but it has not had enough time to stretch for the baby. Or the baby’s heart rate may be of concern to the doctor, so an attempt to expedite delivery may occur. These are all good examples of why an episiotomy might need to be performed.
An episiotomy is a process by which a doctor will make an incision or cut in the space between the vagina and rectum in order to expand the opening for the baby’s head. Most doctors do not do this routinely, but rather only when a medical indication arises. When the doctor makes the cut, the vaginal space is enlarged. Of course, after the baby is delivered, the incision or episiotomy must be repaired to restore it to its original anatomy. Occasionally, the episiotomy may be so extensive that it extends to the rectal area. Obviously, this will necessitate more extensive repair afterwards.
Forceps or a Vacuum
In rare circumstances, your baby may need to be delivered with the aid of forceps or a vacuum device. The concept of doing an instrumented vaginal delivery is not new. Forceps have been utilized over the centuries, and they can provide a means to assist in the delivery of a baby when certain conditions arise. For example, if a mother is too tired to push or if the fetal heart rate becomes worrisome, then conditions may warrant the use of forceps or a vacuum. Very strict criteria need to be met before the use of these instruments can be offered to the patient.
If the doctor thinks the conditions are ideal for an instrumented vaginal delivery, then he should discuss his thoughts with the patient so the patient understands the indications, risks, and benefits. Unfortunately, sometimes there isn’t time to have a lengthy discussion when the baby’s life is at stake, so it’s good to go over these procedures with your doctor in advance of the delivery.
The benefit to these two procedures is obvious: They may assist in getting the baby out quickly when there is a fetal heartrate problem.
The risks of using either vacuum or forceps are also obvious. They include the potential to injure the baby and create vaginal tears in the mother. You may see slight bruising of the side of the head on a baby where forceps were used. This bruising usually goes away in a few days.
The choice between using a vacuum or forceps is up to the doctor, depending on the patient’s condition. The clinical situation will dictate which instrument is chosen. Safety for both the patient and the baby is of utmost importance.
Stages of Labor
You’ll find that the medical community uses a lot of jargon while you’re in labor. We’ll try to clear up some of what you’re likely to hear and what it means throughout this chapter. There are three stages of labor, and you have to go through all three stages to get to the final outcome, aka the baby. The length and duration of these three stages may vary slightly for each woman.
The first stage of labor is when you are actively having contractions and officially diagnosed as being in labor. This can last a few hours or from to 8-14 hours. The first stage of labor is divided into two phases. The latent phase is the first portion of the first stage. This is the slow, drawn out portion that everybody hates (and they’re told, “no, you’re not in labor, go home.”) Active phase is the second portion of the first stage of labor, and this is when the delivery process occurs at a faster rate. Because labor is more predictable at this point and the progress is steady, patients are typically admitted to the hospital once they reach this point.
The second stage of labor occurs when the cervix is maximally dilated (10 centimeters). This is usually when the mother is told she can push. For a first-time mother if she doesn’t have an epidural, this second stage of labor can last one to two hours; with an epidural two to three hours (an epidural can slow labor down).
The third stage of labor begins after the baby is delivered until the placenta comes out. This stage can last up to 30 minutes. We’ll break down these stages more completely in the sections that follow.
When You’re First Admitted to the Hospital: The Preliminary Exam
After you are evaluated in the labor and delivery area and a determination is made that you are indeed in labor, you will be admitted to the hospital. Forms will need to be signed and papers filled out, but the hospital staff is conscious of the fact that you may be otherwise preoccupied (insert primal scream: I’M IN LABOR – LEAVE ME ALONE!). Your partner can help with this part of the administrative process. In fact, he or she is expected to do so, except for any signatures that you may need to provide.
From the time that you are admitted, doctors and nurses will be discussing your examination findings, based on the fetal heart rate tracings and contraction patterns. But first things first – you’ll be given a preliminary exam, either by a doctor or a nurse.
Your first exam at the hospital will include a cervical exam, where three areas are measured: your dilation, effacement, and the station.
Dilation of the Cervix
The dilation of the cervix is measured in centimeters. During the exam, the doctor basically is trying to decide how dilated (or open) the cervix is. The doctor will place his hand gently (we hope) inside your vagina all the way up to the cervix to feel the presentation of the baby’s body part. He should feel the head if all is well. Occasionally, the baby will be breech – that is, the doctor will feel the baby’s butt or feet. If this condition is diagnosed, the patient will probably be advised to have a c-section, or the doctor may try to turn the baby to the head-down position.
Dilation can be measured anywhere from 1-10 centimeters, one being the beginning of the dilation process and 10 being fully dilated (i.e., the baby is almost out). If the cervical dilation is approximately 3-4 centimeters or greater and the mother is contracting regularly, then she will usually be diagnosed as being in active labor and will be admitted to labor and delivery (in first stage labor).
Effacement of the Cervix
In most cases, the baby’s head is down, so the doctor continues with his exam and measures the effacement of the cervix (or the thinness of the cervix). Effacement is measured in percentages. In a normal, nonlaboring woman the cervix is 3-4 centimeters long, which is 0% effacement. If a woman is in labor, then the cervix thins. As it thins, it starts to stretch and becomes incorporated into the lower part of the uterus. For example, if the doctor determines the cervix is about 2 cm. thick, then the effacement is approximately 50%.
While there is no magic wand that will guarantee a 100% normal delivery outcome, there are definitely things that you can do to help yourself become an active participant in your baby’s birth and not be relegated to a “patient” in your hospital subject to IVs, drugs, and medical procedures. These include the following:
1. Have a balanced diet for each stage of your pregnancy
2. Maintain an active lifestyle, with regular, brisk walking schedules
3. Drink lots of water (8 – 10 glasses a day)
4. Do gentle exercises that will make your body fit and flexible, especially the pelvic region, for the baby’s descent to become easy
5. Keep yourself emotionally happy and stress free. Listen to Qur’aan and try to be positive
6. Avoid “test syndrome” where some women are constantly testing themselves (e.g. ultrasound, blood tests, scans etc) and worrying themselves to death
7. Conduct your due diligence on hospitals/doctors you are going to select for your childbirth. Check if your doctor or hospital will support your wish for normal delivery? Check what are their normal delivery rates. After all, it is you who are the customer. Become an informed customer, who has done their research. Dont you do due diligence when you buy a car?
8. Create a Birth Plan, which is a document that articulates your and your husband’s expectations of your hospital when you go there for giving birth. You might want to create the Birth Plan in advance and share it with your doctor who will be at birth, and work with her to arrive at a mutually acceptable plan.
9. Attend a childbirth class or prenatal class in your city or neighborhood. If there is one thing that you can do for yourself to help you during your pregnancy and childbirth, it is this.
10. Try to study and recognize the phases and stages of labor so you know where you are in the process. Make sure that your partner is equally well informed.
11. Pay attention to what the doctors and nurses say to you. Often, they are asking for or giving you information that will expedite your delivery.
12. Don’t allow too many people into the labor and delivery room with you. Remember – you’re there to do a job – deliver your baby. Doing that job requires your full attention and focus. The baby’s health is at stake, as is yours.
13. When it’s all finished, take a moment to bask in what you’ve accomplished. You’ve just delivered a new life into the world. Congratulations! It’s a miracle each and every time.
Courtesy: Sudha, Pregnancy.familyeducation.com
