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Childbirth

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Childbirth

Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist

Role of the midwife

Most 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 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.

The midwife's role during birth is to guide, support and observe, and to make sure everything goes well.

The midwife should make sure the mother-to-be feels safe and finds birth as rewarding as possible.

What are the phases of birth?

The first stage of labour The birth begins when labour contractions start becoming frequent, intense and of sufficient duration to cause the cervix to open. At the beginning of labour, you will usually be examined externally (abdominal examination), to see how the baby is lying and to be certain that the baby is coming head first.

An internal examination is performed to see what is happening to the cervix (neck of the womb). Before labour begins, your cervix is about 3cm long and closed (not dilated).

When labour starts, the cervix gets shorter (a process called effacement) and opens (dilates). The cervix is fully dilated when it has opened 10cm. During labour, it's important you don't start pushing before you are fully dilated, because there will be a danger of tearing the cervix.

Once your cervix has fully dilated, 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 labour is different.

The second stage of labour

The second stage starts when your cervix is completely open (10cm). Usually, there is a sensation of fullness in your vagina or bowel and you wish to push.

Most women will find that the labour pains in the second stage of labour are more bearable, because you can now actively help yourself by pushing.

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

During this stage the afterbirth (placenta) is delivered. 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 yourself and the midwife, although little effort is required to deliver the placenta.

After your baby's born, it's routine that you will be given an injection to stimulate the uterus to contract, which helps delivery of the placenta.

Making the uterus contract in this way reduces the risk of heavy bleeding during delivery of the placenta (post-partum haemorrhage).

How are mother and baby monitored during labour?

Your blood pressure, pulse and temperature will be checked at regular intervals throughout labour 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, recording the heart rate at regular intervals.

In certain circumstances, it can be necessary to have a continuous recording of the baby's heartbeat. This can be obtained via a belt placed around the mother's waist. Alternatively, a small electrode can be placed on the baby's scalp via your cervix.

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 (foetal scalp sampling).

Breech birth

Turning baby One option for a breech birth is for your obstetrician to try to gently turn the baby before labour begins.

This is done by massaging the abdomen.

The procedure is known as external cephalic version (ECV).

ECV is only recommended at term (37-42 weeks), in case the baby becomes distressed and needs to be delivered immediately.

Birth with forceps or ventouse cap

Between 5 and 20 per cent of all births require the help of forceps or the ventouse cap (suction cap). This type of delivery is known as instrumental delivery.

An instrumental delivery is performed by an obstetrician who will use forceps or ventouse only under certain circumstances. It is only performed in the second stage of labour.

The most frequent reasons for using forceps or ventouse are:

the baby has an abnormal heart rate recording, suggesting lack of oxygen (foetal distress).

there has been a long period of pushing and birth is not imminent.

the mother is exhausted and has no more energy to push.

the baby's head is in an unusual position in the pelvis.

When an instrumental delivery is necessary, the doctor puts the forceps or the ventouse cap on the baby's head, then pulls carefully to ease the baby out.

When using forceps or ventouse, it may be necessary to make a cut, known as an episiotomy, in the mother's perineum - the area between the vagina and the anus. An episiotomy can also be required in an otherwise straightforward (non-instrumental) delivery.

If the use of forceps or suction cap 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 suction discs were placed, but these will disappear quickly and are not dangerous.

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