From: www.tiscali.co.uk/lifestyle/
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What is a normal and natural birth?
Most pregnant women give birth without complications.
The birth starts with the onset of labour, which is usually marked by the beginning of regular uterine contractions. These are felt as tightenings either in the woman's back or across the top of the womb. Sometimes the baby's waters break before the beginning of the contractions or, more commonly, once labour is under way.
A mucous show is often passed through the vagina at the beginning of labour that may have streaks of blood in it. Some women may pass the show days before going into labour, and other women do not pass a show at all, so it is not a reliable sign of labour.
During a natural birth, the muscles in the uterus contract and it is this contraction that is felt as labour pains. Labour is a painful experience, but breathing techniques learned in antenatal classes can make early labour less stressful.
The contractions cause the baby's head to be pressed down through the pelvis and against the inside of the cervix. This causes the cervix to stretch open (dilate) allowing the baby's head to pass through (descend) into the vagina and onwards into the outside world.
The midwife's role during a natural birth is to guide, support and observe, and to make sure that everything goes well. She should make sure sure the mother-to-be feels safe and finds the experience of giving birth as rewarding as possible.
What are the phases of a normal birth?
An
internal examination
is performed to see what is happening to the cervix. The cervix is the neck of
the womb. Before labour begins, a pregnant woman's cervix is about 3cm long and
closed (not dilated). When the labour starts, the cervix gets shorter (a
process called effacement) and opens or dilates. The cervix is said to be fully
dilated when it has opened 10cms. It is important that the mother-to-be does
not start pushing before she is fully dilated, because there will be a danger
of tearing the cervix.
When this stage is reached, then the first stage of labour is
completed and the second stage is about to begin. The first stage generally
lasts up to 12 hours in a first labour and seven hours in subsequent
deliveries, but each woman's labour is different.
The second stage of labour
The second stage of labour ends with the delivery of the baby.
It usually lasts for 45 minutes to two hours in a first labour and 15 to 45
minutes in subsequent deliveries.
The third stage of labour
It is routine that the mother is given an injection to
stimulate the uterus to contract after the baby's delivery and before the
delivery, of the afterbirth. Making the uterus contract in this way reduces the
risk of heavy bleeding during delivery of the placenta (post-partum
haemorrhage).
How are the mother and her baby monitored during
labour?
In certain circumstances, it is necessary to have a continuous
recording of the baby's heartbeat. This can be obtained via a belt placed
around the mother's waist or via a small electrode placed on the baby's scalp
through the mother's cervix and vagina.
By analysing the baby's heartbeat in these ways the midwife or
obstetrician is able to detect whether the baby is receiving enough oxygen
during the course of the labour.
Occasionally, the heartbeat pattern shows abnormalities and the
obstetrician may need to take a small sample of blood from the baby's scalp to
analyse the oxygen content (fetal scalp sampling).
Breech birth
Many breech babies can be delivered safely, and mothers who have
had a normal birth before will have fewer difficulties.
Complications may arise for the mother and baby in a breech
birth: there should always be an obstetrician and anaesthetist present as well
as the midwife. It may be necessary to use forceps to deliver the baby's head
or the obstetrician may decide to perform an emergency
Caesarean section. If
a breech baby is detected during pregnancy, or before labour begins, and
turning the baby is not an option or is unsuccessful, many women will choose in
advance to have an elective Caesarean section. This should be discussed
carefully with your obstetrician.
Birth with forceps or ventouse cap (suction cap)
The most frequent reasons for using forceps or the ventouse are:
When an instrumental delivery is necessary, the doctor puts the
forceps or the ventouse on the baby's head, then pulls carefully to ease the
baby out.
When using forceps or the ventouse, it may be necessary to make
a cut, also known as an episiotomy, in the mother's perineum - the area between
the vagina and the anus.
If the use of forceps or suction disc is not successful, it may
be necessary to perform an emergency
Caesarean section.
For the first couple of days after the birth, the baby will have
marks from where the forceps or ventouse suction discs were placed, but these
will disappear quickly and are not dangerous.
Birth and pain-relieving medication (analgesia)
Analgesia is prescribed by a doctor or midwife after discussion
with the mother. The most frequently used drugs are listed below:
Morphine or pethidine
Epidural and spinal anaesthesia
An
epidural is long
lasting and is suitable from the beginning of labour right through to the
delivery.
A spinal anaesthesia is for short term use, say for a forceps
delivery or Caesarean section.
Serious side effects from epidural and spinal anaesthesia are
rare, and midwives and anaesthetists are specially trained to watch out for
them. Epidurals do not make the labour slower, but sometimes make it more
difficult for the woman to push effectively in the second stage of labour.
Tears in the vagina or perineum
What if the muscle of the anus (anal sphincter)
tears?
The sphincter will be stitched up by a doctor and this is
usually performed under a spinal, epidural or general anaesthetic as it can be
very painful.
If women experience any kind of incontinence after childbirth,
they should consult their doctor.
Why do some births end in an emergency Caesarian
section?
All deliveries are different and every mother's experience of
labour and childbirth will be different. But most births are normal and natural
- and most women are happy to go through it again.
The second stage starts when the cervix is completely open (10
cm dilated). The woman usually has the sensation of fullness in her vagina or
bowel and wishes to push. Most women will find that the labour pains in the
second stage of labour are more bearable, as they can now actively help
themselves by pushing.
This is the stage of delivery of the afterbirth (placenta).
The placenta is usually delivered within 5 to 15 minutes after the birth of the
baby. The last stage of birth is a co-operation between the new mother and the
midwife, although little effort is required to deliver the
placenta.
The mother's blood pressure, pulse and temperature are checked
at regular intervals throughout and after the delivery. It is usual to monitor
the baby by listening to its heartbeat. This is commonly done by listening to
the heart with a special, hand-held amplifier and recording the heart rate at
regular intervals during the labour.
In a breech birth, the baby is positioned in the uterus so that
its head is up near the mother's ribs and its bottom is over her cervix.
Because the baby's bottom is slightly smaller than its head, there may be
difficulty giving birth safely. An alternative is to gently turn the baby
before labour begins (known as external cephalic version) so that it is head
first when labour begins.
Between 5 and 20 per cent of all births require the help of
forceps or the ventouse cap. This type of delivery is known as instrumental
delivery. It is performed by an obstetrician who will use forceps or ventouse
only under certain circumstances. Instrumental delivery is only performed in
the second stage of labour.
There are different kinds of pain relief that can be offered to
women during childbirth. Some women have decided in advance that they do not
want to use any analgesia, but may change their mind during labour.
These are strong painkillers given via an intra-muscular
injection. They are often used in combination with entonox. Serious side
effects are rare. Minor side effects are that the mother may become drowsy,
develop an itchy nose or feel nauseous. The drugs cross into the baby's
bloodstream and, occasionally, the baby may be slow to start breathing when
born. If this is the case, the midwife or paediatrician will give the baby a
drug called narcan (naloxone) to reverse the effects of
the painkiller. These painkillers are given once or twice during the course of
labour and women do not get hooked on them.
These techniques are provided by anaesthetists. They both
involve placing a tube or needle near the spinal cord in the lower region of
the back. They usually provide excellent pain relief.
If the skin around the vagina has been torn or cut in an
episiotomy, it will usually to be need stitched. Many women are nervous about
whether or not cuts and tears will heal again after the birth, but fortunately
most do. Most women will be given some local
anaesthesia in the
perineum and in the vagina or some other form of anaesthetic, before receiving
stitches. Dissolving stitches are used so they do not need to be
removed.
Very few women will experience their anal sphincter tearing
during childbirth. This usually only happens if the baby is very big, but it
can also sometimes be torn if the doctor uses forceps or a ventouse.
Some births require an emergency
Caesarean if
unexpected complications arise and the baby is showing signs of a lack of
oxygen. If the labour is progressing slowly a Caesarean is usually necessary.
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