THE DELIVERY OF A BABY THROUGH THE VAGINA

Parts of the Body Involved

  1. Uterus
  2. Vagina
  3. Perineum (the area between the vulva and the anus)

REASONS FOR PROCEDURE

To give birth

RISK FACTORS FOR COMPLICATIONS DURING THE PROCEDURE

  1. Multiple gestation (two or more babies)
  2. High blood pressure
  3. Pre-eclampsia (high blood pressure combined with swelling and protein in the urine)
  4. Premature rupture of membranes
  5. Group B Streptococcal infection of the mother
  6. Placenta previa (placenta positioned over the cervical opening)
  7. Abruptio placentae (premature separation of the placenta from the uterine wall)
  8. Umbilical cord prolapse (umbilical cord slips out of the cervical opening before the baby's head)
  9. Small mother with big baby
  10. Diabetes (insulin-dependent, non-insulin-dependent, or gestational)
  11. Anemia
  12. Bleeding disorder
  13. Lung or heart disease
  14. Obesity
  15. Baby with congenital disease
  16. Mother with infectious disease (e.g., active genital herpes infection, HIV)
  17. Rh-negative incompatibility between mother and baby

WHAT TO EXPECT

Prior to Procedure
During your pregnancy:

  1. Read as much as possible to prepare yourself for labor.
  2. Consider taking a childbirth class.
  3. Choose a support person to be with you during labor and delivery.
  4. Consider writing a "birth plan" with your support person. This outlines how you'd ideally like the birth to go, and also helps you think about what you would like to have happen if you should encounter a complication during labor or delivery.
  5. Eat nutritiously and drink eight 8-ounce glasses of water a day.
  6. Get as much sleep as possible.
  7. Once labor begins:
  8. Follow your health care provider's instructions regarding eating, drinking, and activity.
  9. Follow your health care provider's guidelines concerning when to contact him or her, and when to leave for the hospital or birthing center. Keep a written copy of these guidelines close at hand, so that when you are distracted by labor you can refer to them to make good decisions.
  10. If this is your first baby, you may be asked to come to the hospital as soon as your contractions are 5 minutes apart; with subsequent babies, you may be asked to come to the hospital or birthing center when contractions are 10 minutes apart.
  11. Make sure you understand what your health care provider wants you to do if your water breaks. If it breaks before labor begins, or during labor, some health care providers ask you to come to the hospital or birthing center immediately; others allow you to remain at home for 12-24 hours before being admitted to the hospital or birthing center.

DURING PROCEDURE

What happens once you reach the hospital or birthing center depends on your health care provider's practice philosophy, how far along you are in labor, and whether or not any complications are present. If things are optimal, you may simply be checked into a room where you will stay throughout your labor (and perhaps throughout the actual delivery of the baby).

  1. Your practitioner may request any or all of the following:
  2. Cervical checks (to check how dilated your cervix is)
  3. External fetal monitor (to monitor your baby's heartbeat)
  4. Internal fetal monitor (to monitor your baby's heartbeat)
  5. Internal uterine monitor (to measure the strength of your contractions)
  6. Intravenous fluids
  7. Medications to augment labor (e.g., Pitocin)
  8. Sedatives, pain medications (can be given by mouth, injection, or IV)
  9. Epidural anesthesia (numbing medications given through a flexible catheter tube placed in the spine)
  10. Enema
  11. Bladder catheter
  12. Shaving of pubic hair
  13. Medications to lower your blood pressure
  14. Medications to prevent seizures (if you have pre-eclampsia)

What happens during the actual delivery depends on where you choose to deliver your baby, the specific policies of your health care provider, and the health of both you and your baby. In a completely uncomplicated delivery, once your cervix has reached 10 centimeters of dilation, you'll be encouraged to begin pushing.

Anesthesia - Epidural or spinal anesthetic, if requested. A general anesthetic may be used if serious complications present themselves, requiring emergency cesarean section. If you have an episiotomy, you may be given a local anesthetic to numb your perineum.
Description of the Procedure - When the baby seems to be heading down the birth canal, the health care providers in the room may move you to a delivery room, which looks a lot like a surgical suite. Or, if you are in a hospital or birthing center with all-in-one rooms, you may stay in the room you've been laboring in for the actual delivery.

The health care providers in the room will put on sterile gloves to catch the baby. They may drape you with cloths, and may clean your vulva and perineum with antiseptic solution. You may be asked to put your feet up into stirrups, although this is no longer considered necessary, and many women are more comfortable delivering their babies without the use of stirrups. The nursing staff and your support person may hold your legs in a comfortable position to help you push. Many practitioners encourage women to find the position that is most comfortable for them, rather than insisting that all women deliver their babies while lying flat on their back.

Crowning is when the baby's head is seen at the opening to the vagina. When the baby has crowned, you may be asked to slow your pushing. Depending on what you have requested and your health care provider's policies, the practitioner may massage your perineum and try to gently stretch it, in order to fit the baby's head through without tearing your perineum or requiring an incision into your perineum (called an episiotomy). Once your baby's head is out, you'll be asked to stop pushing while the baby's nose and mouth are suctioned clean of all fluids. Then you can push the rest of the baby's body out. If the baby appears healthy and is breathing well, he or she is often laid on your stomach. The umbilical cord will be clamped and cut, and sometime within the next 20 minutes the placenta will be delivered.

Sometimes the baby's head doesn't move as expected through the birth canal. If this happens, and your health care provider feels that the baby needs to be born more quickly, your provider may choose to help your baby out by using forceps or vacuum extraction.

AFTER PROCEDURE:

  1. If your perineum has torn or if you've had an episiotomy, this will be closed with stitches
  2. A nurse may massage your abdomen, to help your uterus clamp down and decrease bleeding
  3. Your vaginal area, perineum, and rectum will be washed to remove all of the birth fluids and blood
  4. You may be given an ice pack to apply to your perineum, to soothe it and to decrease swelling
  5. You may require a shot of Pitocin to help decrease bleeding
  6. You may be given pain medications, either by mouth, injection, or IV

How Long Will It Take? This is extremely variable. First babies often take longer than subsequent babies, although there's no guarantee of this. The average length of time for a first baby (and its placenta) to be born, once a mother is in active labor, is 12 hours.

Will It Hurt? Yes, but you can learn various techniques to try to lessen the pain. You should learn as much as possible about childbirth ahead of time, so that you can decide if you want to use an epidural or other pain medications.

POSSIBLE COMPLICATIONS:

  1. Bleeding
  2. Uterine infection
  3. Urinary tract infection
  4. Perineal tears, including tears through the rectum
  5. Complications requiring forceps, vacuum extraction, or cesarean section
  6. Blood clots
  7. Mastitis (breast infection)
  8. Postpartum depression

Average Hospital Stay: 1-2 nights

POSTOPERATIVE CARE:

  • Use ice packs on your perineum for the first 24 hours after delivery; sitz baths may also be soothing
  • For the first 3-5 days, you may want to use a squirt bottle of warm water to clean your perineum after using the toilet
  • Acetaminophen or ibuprofen may be taken for pain
  • Expect heavy bleeding for the first several days after the delivery; this bleeding will change color from red to pink, and taper off over the weeks following your baby's birth
  • A stool softener may be prescribed, since constipation is a common and uncomfortable problem after childbirth

OUTCOME

A healthy mother and baby

CALL YOUR DOCTOR IF ANY OF THE FOLLOWING OCCURS

  • Nausea and/or vomiting that you can't control with the medications you were given after delivery, or which persist for more than two days after discharge from the hospital
  • Saturating more than one sanitary napkin per hour
  • Passing several golf-ball sized clots from your vagina
  • An unpleasant odor to your vaginal discharge
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
  • Either breast becomes red, swollen, or tender
  • Signs of infection, including fever and chills
  • Cough, shortness of breath, chest pain, severe nausea or vomiting
  • Pain in the calves of your legs
  • Feeling depressed or blue for more than just a few days, or concern that you may hurt yourself, your baby, or anyone else

SOURCE:

Obstetrics: Normal & Problem Pregnancies, 3rd ed. Churchill Livingstone, 1996.

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