How does childbirth progress?

Delivery is the final stage of pregnancy, during which the child is born. Generally, delivery consists of three parts, i.e. the beginning of childbirth, the stage of dilation and the stage of expulsion. In this article you read all there is to know about childbirth.

Stages of delivery

Delivery (also called 'birth') is the phase of pregnancy during which the fetus comes out as a baby via the cervix from the uterus. Delivery can simply be broken in three different stages, viz the beginning of delivery, stage of dilation and stage of expulsion.

The beginning of delivery

When childbirth is about to begin, the uterus will start to contract. This is called labor pains. As a result of these contractions, the cervix will change. It will first grow thin and soften, and then dilate. Delivery will begin with either contractions of the uterus or rupture of the membranes, which will cause amniotic fluid to leave the body through the vagina. If the membranes rupture high in the uterus, there is also a chance that amniotic fluid is lost drop by drop. Labor is likely to start (i.e. the uterus contracts) after rupture of the membranes, although there are exceptions to the rule. In case uterine activity fails to occur 24 to 48 hours after rupture of the membranes, labor will generally be induced.

It is a sign of childbirth on the point of beginning when a highly pregnant woman is losing bloody mucus, a kind of plug that blocked the cervix during pregnancy. The loosening of this plug of mucus indicates that dilation has been started off, but, in some cases, it can also be the result of an internal examination. Even then it may take a few more days before childbirth continues and the baby is born.

The stage of dilation

The stage of dilation is the stage of childbirth during which the cervix opens (also called ‘portio’). This dilation will take place at the beginning of childbirth, and is aimed at making room for the expulsion of the fetus. During every contraction the cervix will be stretched a little. In all, the cervix will be stretched approximately 4 inches (10 centimetres). However, as already mentioned in the paragraph above, the cervix should first soften and grow thin before dilation can start.

It is hard to determine how long the stage of dilation lasts exactly. Depending on their nature or sensitivity, one pregnant woman hardly notices that dilation has started, whereas an other may already notice dilation in an early stage. Apart from that, it is also true that, on average, dilation in a woman who has never given childbirth before lasts longer than if she has gone through a delivery before. When a woman gives childbirth for the first time, the stage of dilation can last as long as 24 hours, a period that will generally be shorter during the next deliveries.

When labor pains start in a woman, they will at first come every time 10 to 30 minutes. In this period every contraction lasts approximately 40 to 60 seconds. As childbirth advances, the contractions of the uterus will happen in increasingly rapid succession, and labor will also become stronger, longer and more painful. Consequently, this period is called the stage of dilation. Dilation can be broken in three phases, i.e.:

The early phase. In this phase dilation is between 0 to 1.6 inches (0 to 4 centimetres). When a pregnant woman has reached the end of this phase, she has a contraction about every hour, which continues a minute on average. The initial phase of dilation can take a very long time, i.e. even two days is not called abnormal.

The active phase. This is the phase where dilation is 1.6 to 3.2 inches (4 to 8 centimetres). Contractions happen in more rapid succession and will become considerably more intense, recurring every 3 to 4 minutes now.

The transition phase. This is the final phase of dilation. During this phase a woman has a dilation of 3.2 to 4 inches (8 to 10 centimetres) and contractions happen in even more rapid succession than in the second phase. The woman giving birth should focus sharply on taking care of the contractions. It also occurs frequently that the woman has had enough at this point, and, consequently, she wants to get it done and over with as quickly as possible. When dilation has reached 4 inches (10 centimetres), dilation will be complete and expulsion can start.

The stage of expulsion

This is the stage where the opening of the cervix has been fully stretched and full dilation has taken place. As soon as dilation has reached 4 inches (10 centimetres), the stage of expulsion starts. In this process the baby is pushed through the birth canal by strong contractions of the uterus (about 80% of the expulsive force). The remaining 20% of the expulsive force is contributed by the mother's active pushing. These intense contractions are called labor contractions, and are described by some women as the feeling that one is in a state of urgency while going to the toilet (be it irresistibly strong). Owing to the intensity of these contractions, a woman has no choice but to actually start pushing. If the membranes have not yet ruptured during early labor or later stage of dilation in childbirth, they will generally do so during the stage of expulsion. Every now and then, in case the membranes do not rupture, a baby will be born in them. This is also called 'born in the caul' (Latin: head helmet).

If the stage of expulsion lasts longer than 1 to 2 hours, additional examination of the baby's condition will be necessary. This is done because the little child, still unborn, may develop health problems if it stays in the birth canal too long. If a woman is giving birth at home, there is a good chance that, after a stage of expulsion lasting two hours, she still has to be taken to the hospital. At this moment, in order to see if the baby is still in good condition and up to childbirth, the gynaecologist will make an electrocardiogram (ECG) of the baby. This specialist will examine as well if there is a specific reason why childbirth is taking so long. For instance, this may take longer than the average time if the baby's head lies in a malposition in the uterus. However, the main cause of a prolonged childbirth is generally poor uterine contraction strength, as a a result of which not enough impetus can be developed to expel the baby from the birth canal. If this is the case, an oxytocin infusion will be administered. Oxytocin, a natural hormone from the hypophysis, is an agent that causes and induces labor and intensifies the contractions.

If childbirth makes good progress at this moment, the mother has sufficient energy left to push and if the baby is still doing well, there is no problem to go on pushing for longer than an hour. However, if childbirth stagnates (non-progressive expulsion), then either an assisted vaginal delivery (vacuum extraction or forceps delivery) or a Caesarian section (sectio caesarea) will be performed. In some cases, episiotomy of the perineum suffices to still give the baby a normal birth. Once the baby's little head has been born, it often takes only one more labor contraction to expel the rest of the baby's little body from the birth canal.

The afterbirth

When the baby has been born at last, the placenta will be expelled after 10 to 30 minutes. This is called the afterbirth. Childbirth is not over until the moment the placenta has left the body. If the delivery of the placenta takes too much time, the woman can be administered an oxytocin injection. It is also recommended to suck the woman's nipple, which generally causes the placenta to be born much faster. Sucking the nipple can be done by the baby, but by, say, the woman's partner as well.

If the placenta has not been expelled within an hour after childbirth, it will generally not leave the body in a normal way. Usually, an operating theatre is arranged for at this moment and the placenta will be removed surgically. If the placenta loosens (in the natural way or due to surgery), this will cause an injury in the uterus. This injury will bleed too, causing the brandnew mother to flow for a number of weeks. However, this is more severe than an ordinary period and will decrease in time, until the injury has healed.

Possible problems during delivery

In many cases childbirth will end well, but during childbirth problems may arise too. In the list below you see a number of problems that may arise during childbirth:

• Lag in growth
• Pre-eclampsia and/or HELLP-syndrome
• Premature rupture of membranes
• Premature labor
• Malpositions of the child
• Disrupted fetal rotation
• Shoulder dystocia
• Poor uterine contraction strength
• Other causes of stagnation of childbirth
• Excessive loss of blood
• Complications of the umbilical cord
• Complications of the placenta
• Congenital defects in the child
• Aid during childbirth

There is always a chance that one or more complications occur during childbirth. In this case, it can be decided by the gynaecologist to not have a baby delivered in the natural way, but via a Ceasarian section. This implies that the baby will be removed from the uterus surgically. At that moment a horizontal incision will be made in the mother's belly. In this situation, in order to keep the risks for mother and child as low as possible, it is important that a Ceasarian section can be performed very quickly. When the Ceasarian section has started, the baby will be born within 10 minutes.

It is also possible that the gynaecologist chooses to not perform a Ceasarian section, but to have the baby delivered in the natural way, with the aid of forceps or vacuum extraction, which will cause the birth of the baby to be sped up.

The period after childbirth

When childbirth is over and the baby is lying comfortably in the mother's arms, the life of the brandnew family will still be dominated by childbirth for a while. For instance, the woman will still flow for about ten days and this flow will be more severe than an average period. After ten days or so, this flow will decrease in severity and just about equal an ordinary period. Likewise, the woman will occasionally suffer from pain in the belly and back in the weeks after childbirth. The reason for this is that the uterus, being a big muscle, contracts again in this period and thus regains the same size as before pregnancy. The size of the uterus will also be examined by the family's maternity assistant and obstetrician in the first weeks after childbirth.

If a mother breast-feeds her brandnew son or daughter, the uterus will shrink faster and recovery will be sped up. If she does not breast-feed, she will generally flow a little longer than a woman who does, but, on the other hand, in case of actual breast-feeding there is also a chance that she will flow longer than a woman who does not. Likewise, this varies from woman to woman. When the baby boy or girl is six weeks old, the mother will be examined by an obstetrician or gynaecologist.

The maternity weeks

The maternity weeks are the weeks immediately after childbirth, during which the woman is still recovering from childbirth and the baby and the family have the opportunity to get used to each other. During the third or fourth day after childbirth, it occurs frequently that women suffer from maternity tears. This phenomenon is understood to mean that a woman is extremely emotional for one day and can suddenly burst out crying. These tears are very normal and are generally caused by all new impressions and physical changes going on, like change in hormones, stasis and, sometimes, even stitches. Considering everything, childbirth is a tremendous experience for a woman, both physically and mentally.

Sources: www.todio.nl