We all know that childbirth is natural for a human being, but the certain peculiarities of the human anatomy require special attention to that particular process. Childbirth is a sacred event for every woman: it’s difficult to take easy the process of giving birth to a new life. The human body has survived the evolution but the evolution yet has led to imperfections of the pregnancy of the human being. Being bipedal, women take the bigger load than most animals do and the process of natural childbirth is naturally more complicated than that of the animals.
During the past century women have significantly reduced the physical activity. This fact doesn’t contribute to the natural course of childbirth. So doesn’t the tradition of the horizontal childbirth position in hospital environment. This position is surely more convenient for the medical stuff that assists the woman in childbirth, but excludes the gravity factor from the process. Thus, childbirth is inevitably causing a lot of emotions: anxious expectation, nervousness, joy and, of course, some fears.
Fear of pain and uncertainty. And a problem of paramount importance for every woman is to get rid of this fear before giving birth. Stress of the expectant mother may lead to severe complications in natural childbirth process and lead to extreme measures of delivery – C-section. The woman, getting ready to deliver, should be steady and self-confident. Your best ammo in the quest of childbirth is getting information about the process.
Natural Childbirth without pain
Any woman knows in word of mouth that childbirth is painful. However, the “painful” part of the childbirth are contractions and at proper preparation those pains can be minimized. The expectation of pain also does a bad job: the hormone of stress, cortisol, may enhance pain. Thus, the fear of pain provokes pain.
The painkillers can affect the intensity of contractions and prolong the duration of childbirth. In addition to it, the woman, feeling relieved, often becomes passive, and the duration of birth as well as its difficulty depends in many respects on a woman, after all.
The woman, who has understanding of the processes of natural childbirth is able to relieve the pain by changing position and acting the way she feels to keep it as close to natural, as possible.
Stages of Natural Childbirth
So, how is natural birth going along? During childbirth the woman and her baby pass through the three most important stages:
- cervical dilatation – the opening of cervix, the path for your baby is getting ready;
- expulsion of fetus – when the baby comes out from the fully-opened cervix
- placenta delivery (involution stage) – you are yet to deliver the luggage of the passenger
The duration of giving birth depends directly on quite a number of reasons, the main of them: if it is your first pregnancy.
Peculiarities of the first childbirth
The birth canal in the nuliparous women in the first natural childbirth is not trained yet, the baby has to stretch it and this makes childbirth difficult, so the first childbirth is longer than the subsequent. According to statistics, the first natural birth may last 8-18 hours. During all the subsequent childbirths the parturient canal will have already been stretched and, as a rule, childbirths are shorter in time, usually about 5-6 hours.
By the way, if the interval between the first and the second natural births is more than 8 years, maternal passages are considered to have completely recovered their elasticity, to have “forgotten” the process of birth, and the childbirth process gets back to the “first childbirth” conditions.
What may affect the duration of natural birth?
The size of the fetus. If the baby is big, it will be more difficult for him to pass through the birth canal. In this case there an emergency cesarean section is sometimes required. The same concerns the abnormal presentation (position) of the fetus as well.
The part of baby’s body which is situated closer to the birth canal is called presenting. The most common and desirable position is vertex presentation: the head of the baby is inclined, chin pressed to its chest, and it comes into the pelvic area with the back of its head first. This part has the least diameter and it makes the passage easier. Fetus takes such position in 95% of all natural births.
A baby with the face presentation is located with its face turned to the cervix of the uterus. When the fetus is in this position, the delivery is labored due to the enlarged diameter of the head, and in some cases, if there are any other complications, doctors insist on cesarean section. Among all the variations of cephalic presentation, brow presentation is the most complicated. In this case the head of the baby is inclined in such a way that it’s physically impossible for it to enter parturient canal. Brow presentation is a sufficient reason for cesarean, because the natural childbirth may take time and affect the health of the baby.
The same is true for shoulder presentation when the baby is located across the uterus. Natural birth in this case is not an option. But with breech or pelvic presentation a woman can give natural birth if there are no other complications. Doctors carefully examine the woman before the delivery to make that sure, determine the size of the fetus, the size of the pelvis, etc.
But even if a woman gives natural birth in the latter situation, the delivery will take a bit longer. Besides, a woman in childbirth and a baby will require extra attention from the doctors.
The 1st stage: cervical dilatation
It is well-known that childbirth starts with the contractions. And what are the contractions? The uncontrollable movements of the uterine muscles. As you remember, the uterus is a peculiar muscle bag that tightly encompasses a baby. The contraction goes on gradually from the bottom to the cervix. So, the walls of the uterus are pulling the cervix causing its dilatation.
How do the contractions start, and what causes them? Childbirth starts from simultaneous appearance of two factors: excessive stretching of the uterus which is entirely natural for the last days of pregnancy; and ejection of oxytocin into the blood which is stimulating the contractions. The overstretched uterus tends to return to its normal size or at least to the one which doesn’t cause discomfort.
Hypophysis is in charge of the production of oxytocin. But what causes the ejection of this hormone into the blood hasn’t been found out yet. There are a few opinions on this matter. One of them is that a baby itself is responsible for the start of the delivery. The fetus tells its mother’s organism that he is ready to be born and the mother’s body reacts to these signals with intensive production of oxytocin.
The first contractions are not usually forceful and long and have quite a long interval between them. But, step by step, the more the cervix dilates the more frequent and forceful the contractions become. It is considered better to go to maternity hospital when the contractions occur every 10-15 minutes.
How’s the delivery in maternity hospital going on?
In an admission room of a maternity hospital a woman is thoroughly examined: weight, height, size of the belly, arterial tension is measured; gynecological examination is held to specify the state of the uterine cervix. Then the woman is sent to the maternity ward.
There the woman undergoes sanitary procedures: shaving off pubic hair, and sometimes enema. It’s more or less clear why pubic hair is shaved: it makes the gynecological examination easier. But what for is such an uncomfortable procedure as enema needed? All is quite simple: the purgation clears space in the abdominal cavity and it eases the delivery. Moreover, there is always a risk of complications which can result in emergency cesarean section, and for this surgery intestines should be cleared as well.
Only after all this the woman will be moved into delivery room and there she will endure the first stage of natural birth.
The cervical dilatation has three phases as well
The first of them is called latent – it’s usually about 6 hours long. If it isn’t your first natural birth – about 5 hours. After that the cervix is 1.2-1.6 inches dilated. The next phase is called active. The rate of cervical dilatation during it increases considerably and reaches 0.8 inches per hour. By the end of the active phase the diameter of the cervix is at least 3.2 inches. The deceleration phase is the last. By the end of this phase the cervical dilatation reaches expected 4-4.8 inches.
At the same time with the cervical dilatation the fetus gradually moves to the birth canal. It occurs also due to the rhythmic contractions of the uterus. So, by the time of the full dilatation a baby is ready to enter maternity passages. In this connection the pressure causes the uterine cervix to pull a part of the placenta. As a result it tears and amniotic fluid discharges.
In some cases the placenta doesn’t open by itself and then it’s torn by an obstetrician. Sometimes discharge of amniotic fluid occurs before the full dilatation of the cervix and in this case it’s called “early”. It also may happen that the waters discharge at the very beginning of the first stage of the delivery or even before the contractions begin. In such cases doctors speak of premature discharge of amniotic fluid.
That’s probably all that should be told about the first stage of natural birth. There is only one topic left: how the condition of a woman can be relieved during this stage. The main thing is to properly breathe during the contractions. What do you need it for? First of all, proper breathing provides needed amount of oxygen for a mother and a baby. It’s also important because the lack of oxygen usually entails the pain. So to speak, if there is not enough oxygen in the uterus, the contractions will be more painful.
Secondly, proper breathing helps to relax muscles and relieve stress. And relief from stress positively affects the state of woman in childbirth.
So, how to breathe properly? Firstly, your breathing should correspond with certain moment. Before the contraction starts, when the woman already feels the tension in the uterus, she should breathe as deeply as possible – that will provide her with well-timed inflow of oxygen.
When the pain of the next contraction starts, the breathing of the woman should become fast and shallow. Diaphragm has almost nothing to do with such breathing and that means the pressure on the uterus will be minimal. When the contraction reaches its peak you should take four rapid breaths and then exhale slowly and calmly. After the contraction you should deeply inhale and exhale in the same calm and slow way. During the intervals between the contractions breathe as usual.
Besides the breathing, the position and overall mobility have an influence on woman’s sensations. Doctors recommend not lying for the whole period of contractions, but walking along the ward, sitting, standing and taking the positions which are comfortable for you. A human’s body instinctively tends to occupy the position which is most comfortable for it. Women often try to squat or kneel down.
And one more note: in the stage of cervical dilatation many women attempt to push, counting on speeding up the process by their actions. But the contractions are quite uncontrollable and it’s hardly possible to speed them up. You’ll only expend your energy in vain, and energy is important for the second and third stages of natural birth. You’d better listen to an obstetrician in respect of labor.
The 2nd stage: expulsion of fetus
From the moment of full dilatation the second phase of delivery begins: expulsion of fetus, or the childbirth proper. It’s considerably shorter than the first stage and usually takes 20-30 minutes. By this time the woman will be invited to occupy the position in which she is going to give birth.
Quite recently it meant lying down on a bulky structure, reminiscent of the mixture of a bed and gynecological chair. Such a position might be comfortable only for the doctors and gynecologists. Indeed, when a woman is lying in such a position it is possible for an obstetrician to study the process in detail.
However, the woman in childbirth will certainly want to choose something else. The optimal position is that when the woman is supported from her back by the armpits. In this position everything is assisting the delivery, even gravitation.
Though, the position during childbirth is, of course, a significant, but not uppermost factor. More important for a woman is to feel support and understanding during the whole second stage of natural birth. That’s why it’s so important to find a skilled and attentive obstetrician. Due to the same reason partner childbirth, which requires a person close to the woman (most often a husband) attend delivery room, become more and more popular. However, women in childbirth often ask their mothers or other relatives attend as well.
The most important thing during the second stage of delivery is that now a woman can help her baby to be born. The contractions are accompanied by labor: conscious strain of muscles of the uterus, diaphragm and abdominal cavity. To reach desirable effect you should push only during exact time, not constantly. Pay attention to your obstetrician’s advice.
And also important thing to know is what happens to your baby during the delivery. Hypothetically, everything that is going on is a shock to it. And that is understandable: it lived in the most comfortable and pleasant place for nine months, it didn’t have to do anything – food and oxygen were received through the umbilical cord, it was warm and cozy. And suddenly its small and cozy home begins to clench, literally pushing the baby out into uncertainty.
About by the end of the second stage of natural birth a baby sort of finds a way out: maternal passages. But on its way out it will have to overcome so much: cervix of the uterus, pelvic bones, and perineum muscles. And all that only to endure sharp pain when its lungs abruptly fill with air, to feel the coldness of its new environment and other such sensations.
However, the nature is wise and won’t put its children under intolerable conditions. A baby and its mother are fully capable of enduring the delivery. Both organisms are adapted to ease the vital process.
So, by the end of the pregnancy pelvic bones of a woman part a bit due to the relaxation of joints and chords for the purpose of letting out a baby. Besides, bones of the cranium of a baby are not inosculated yet. Due to this fact they can compress, altering the form of the cranium a bit, and help to let the baby out. The perineum muscles of a woman are the last barrier on the way to a new life. They are flexible enough to stretch under the weight of a baby.
The effort of a woman also has an influence on making natural childbirth easier. That’s why a mother should take active part in such an important for her process. Her main task will be labor and correct breathing. What can the woman do for her baby during the second stage of natural birth?
When the woman in childbirth feels that another contraction is close, she should take comfortable position, relax perineum muscles and be as calm and relaxed as possible. It’s important to breathe deeply.
When the contraction begins, the woman should inhale deeply through the nose and then hold her breath. It will make possible to shift the diaphragm downwards. The diaphragm will press on the uterus, strengthening the impact. After taking a breath the woman should clench the muscles of the abdomen, starting with the stomach area. But the perineum muscles should be relaxed.
If the contraction is long and it is impossible for you to hold your breath during it, exhale harshly through your mouth, take another deep breath and hold it again. The labor is going on till the end of the contraction. In the intervals between the contractions the woman’s breathing should be deep and calm.
The most difficult part has passed: the head of the baby has become visible from the vagina. The head is the biggest part of a newborn baby’s body; this means that the remaining part will be easier. The obstetrician will help the baby to free one shoulder, then the other, and after it everything won’t be hard at all.
When the baby leaves maternal passages it takes its first breath. Usually it cries out after that. This cry has been considered a sign of vital capacity of the child for a long time; and if a baby didn’t want to cry out the doctors were trying every way to cause it. Now more attention is paid to the color of the baby’s skin, its reflexes, breathing, etc. First of all, the baby is examined, and after that (if the mother’s condition doesn’t cause any worry as well) the newborn is put onto its mother’s abdomen.
The skin to skin contact, as this action is called, is very beneficial for establishing a connection between the mother and her baby. Immediately after childbirth they are still bound to each other by the umbilical cord, but now it’s useless, the doctor cuts and ties it. There are no nerve endings in the cord, so neither the mother nor the newborn feels it. After a few days the remaining bit of the cord on the baby’s navel gets dry and falls off. After a few more days the small wound left by it is fully healed.
The 3rd stage: delivery of afterbirth
What happens to the other end of the umbilical cord? The placenta to which it is fastened is still inside the uterus. This problem is solved during the third period of natural childbirth: delivery of the afterbirth. After a small period of rest the uterus begins to contract again. These sensations are not so painful, but they’re as vital as the contractions.
As a result of the contractions the placenta flakes off the walls of the uterus and gets out the same way – through the cervix and perineum. The last contractions are closing blood vessels which has provided the placenta with blood. This is necessary for preventing the bleeding after delivery. It’s not possible to avoid bleedings at all, of course, but the less blood the woman will lose the better.
To increase the final contractions of the uterus the mother’s nipples may be postulated, or it’s even better to give breast to the baby. This will cause the ejection of oxytocin into the woman’s blood, this hormone, in addition to all the rest, stimulates the contractions.
After the expulsion of afterbirth the doctor thoroughly examines the placenta. It is necessary to make sure of its satisfactory condition. Moreover, the doctor checks its integrity. In some cases the placenta isn’t fully detached from the uterus. In this case the additional intervention is necessary, or the remnants of the placenta will rot inside of the uterus and that is fraught with most complicated pathologies, to the point of infertility and hysterectomy.
The final part of natural childbirth is stitching of muscle tearing if it hasn’t been possible to do without them. The mother and her baby spend two more hours after that in a postnatal ward, and they will remain there until they’re discharged. During the next few days their condition will be closely observed, including changes in baby’s body weight, its reflexes, the condition of mother’s stitches and the amount of bleeding. After 3-5 days the woman and the baby are usually discharged for home, and that’s another story, though it is no less exciting.
That’s, in fact, all that every woman needs to know about natural childbirth. Of course, the reality may be a bit different from the scenario we described here. Especially if the delivery goes with complications. A lot of things depend on which stage the woman will be in when she gets to a maternity hospital, which complications she had during pregnancy, what will be found out during the examination before delivery and so on. If you worry about your state of health because of any complications you heard about, consult your doctor about your exact case.