Childbirth: Normal Vaginal Delivery

What is normal vaginal delivery?

Normal vaginal birth is the childbirth process which takes place without any form of medical intervention. Nowadays to alleviate the pain and speed up the delivery process medications might be used (you can choose not to opt for any medical intervention).

All in all, a normal delivery is, in other words, a completely natural delivery of a baby by the mother without any medical intervention.

During normal/vaginal delivery the primary focus is on how and in which position will the mother be comfortable delivering the baby. The mother can lead the whole process of labor and delivery.

The doctor and attending nurses, aid her while being alert for any kind of emergencies.

What are the stages of normal vaginal delivery?

There are three major stages you will undergo during normal childbirth:

  • Labour and effacement of the cervix
  • Pushing & birth of the baby
  • Delivering the placenta

1. Labour and effacement of the cervix

This is the first stage of the normal delivery process and of labour. For the baby to be born, the cervix needs to become malleable, soften and stretch so that the baby can be delivered.

This first stage can last for up to 13 hours for a woman who is delivering a baby for the first time, and for seven to eight hours for a second or third child. Contractions occur which helps to dilate the cervix.

This first stage has three sub-stages:

  • Early labour: The cervix of the expectant mother opens to about 4 centimetres. You will probably spend most of the early labour at home. At this stage, the expectant mother can continue to perform her usual activities, relax often, drink plenty of clear fluids, eat light meals whilst keeping keep track of the contractions. With time the contractions grow stronger and when the expectant mother gets more frequent and stronger contractions and is not able to talk during contractions, it means she has moved to the stage of active labour.
  • Active labour: At this stage, the cervix of the expectant mother may open from 4 to 7 centimetres. This is the stage when the mother should be taken to the hospital. The contractions occur every 3 to 4 minutes and each of them lasts for about 60 seconds. These contractions show that the cervix is opening faster (about 1 centimetre per hour). As the labour progresses, the water may break causing a gush of fluid. Once the water breaks, the contractions speed up. The expectant mother at this stage needs to relax. She can change positions, receive gentle massages or hot and cold compresses, walk slowly or sit upright all of which will help. Relaxing in between the contractions is very important as it will help the cervix to widen. The expectant mother can also soak herself in a tub which will ease the discomfort.
  • Transitioning to the second stage: The cervix at this stage opens from 7 to 10 cms. This is the most painful and stressful part of the labour for most women as the cervix widens up to its fullest. The contractions occur every two to three minutes and last for upto 60 to 90 seconds. The mother at this stage may feel a strong urge to push because she feels the pressure in the rectal area and stinging in the vaginal area, as the baby’s head slowly moves down toward the vaginal opening. But she should not push at this stage and wait for her health caregiver to give the go-ahead to start pushing. The health caregiver will give the signal once the cervix is fully dilated. The expectant mother may feel fatigued, irritated, nauseous and alternately hot or cold. Slow and relaxed breathing is highly effective during this period.

2. Pushing & birth of the baby

Once the cervix completely widens or dilates the second stage of labour begins. The contractions at this stage continue to be strong, though they often come farther apart.
The frequent contractions help to push the baby down head first through the birth canal. The expectant mother’s health care provider may ask her to push with every contraction. The mother will feel an intense pressure similar to the urge while undergoing a bowel movement.

The mother may feel highly irritated at this stage and may alternate between wanting to be touched/soothed or being left alone. She will be highly fatigued and may also feel nauseous. The intensity at the end of the first stage of labour will continue in this pushing phase.

The mother may experience intense pain around the vagina and the surrounding pelvic areas as the baby’s head protrudes through the vaginal opening. It is at this stage that the attending doctor may decide to perform an episiotomy, i.e. an incision made in the area between the vagina and the rectum to widen the vaginal opening so that the baby can emerge smoothly if required. The mother may be asked to push gently or slowly as the rest of your baby’s head and body emerge, till the baby finally emerges into this world.

3. Delivering the placenta

After the birth of the baby, the contractions continue to push out the placenta, a process also known as the afterbirth. The delivery of the placenta can take from a few minutes to a half hour after the baby is born.

The healthcare provider may ask the mother to place the baby on her breast, as this stimulates uterine contractions. Alternatively, the healthcare attendant may gently massage the new mother’s abdomen to help stimulate placental separation.

Most babies are ready to nurse a few minutes immediately after birth while others may take a little longer. Healthcare providers usually ask the mother to nurse the child as soon as possible after birth, provided the mother is willing to breastfeed.

Nursing right after birth also helps the uterus to contract and so decrease the amount of bleeding.

What are the benefits of normal vaginal delivery?

The benefits of vaginal delivery include:

  • short hospital stays
  • low infection rates
  • quick recovery compared to caesarean
  • babies have a lower risk of suffering from respiratory problems
  • no post-surgical haemorrhaging

What are the risks of normal vaginal delivery?

The risks a mother may face before and during the normal vaginal delivery include:

  • rupture of the uterus
  • fetal distress (for example reduced oxygen supply to the baby)
  • vaginal tear
  • tears in the perineum, i.e. the soft tissue between the vulva and the anus
  • umbilical cord prolapse which occurs when the cord comes out before the baby
  • if the mother suffers from any infections, it may be passed on from the mother to the child
  • the baby is emerging buttocks/feet first (breech position)
  • the baby is emerging shoulder first
  • there is more than one baby
  • the size of the baby is big
  • cephalopelvic disproportion (when a baby cannot fit through a pelvis due to the small size of the mother’s pelvis)
  • undetected placenta previa, meaning the placenta covers the cervix

The risks a mother may face after a normal vaginal delivery include:

  • damage to the pelvic floor due to which the woman may suffer from temporary or chronic pelvic pain
  • pelvic organ prolapse which occurs when the bladder, uterus and/or rectum protrude into the vagina or outside the vaginal opening
  • retained placenta
  • urinary leakage with sudden coughing, sneezing, or laughing post delivery
  • postpartum haemorrhage
  • anaesthesia (if used) related complications

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