Birthing types

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Introduction of birthing types
Vaginal birth

Introduction of birthing types

The advancement of modern medicine has seen the introduction of new ways in which women can give birth. The traditional vaginal birth method is still widely used. However, more and more women are now opting to undergo elective caesarean delivery. The use of a water bath during labour and/or birth is also beginning to gain popularity. With so many choices, it is important for women to fully understand the procedures, benefits, and risks involved in each of these birthing types before selecting one.

It is, however, important to note that seemingly “elective” options, such as undergoing a caesarean delivery for no medical reason, carry with them significant risks. These risks have to be carefully considered and weighted against the benefits of such a procedure before making any decisions. Hospital policies can vary on the issue – some may not provide the facilities needed for a water birth, or may not carry out caesarean sections unless there is a medical reason to do to. In addition, some medical practitioners may refuse to carry out any procedure that may inflict a significant amount of unnecessary risk on the mother and baby, even if such a procedure is requested by the patient out of personal choice.

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Vaginal birth

Who is present

Doctor: It is possible to choose whether or not to have a doctor present at a vaginal birth. Doctors who specialise in pregnancy and delivery are known as obstetrician gynaecologists or OB/Gyn for short. However, it is also possible for general practitioners to deliver at a vaginal birth. Choosing what kind of doctor to overlook a vaginal birth generally depends on the personal wishes of the woman. Factors that may influence the type of doctor a woman chooses include:

Whether the pregnancy/birth is a high or low risk one
If a pregnancy is a particularly risky one, it may be better to have a more specialised doctor perform the delivery
The nature of any pre-existing relationships between the patient and the doctor
Some women may feel more comfortable having their baby delivered by the family practitioner because he/she may be someone they know well and trust

Doctors may tend to take on a more medical approach to pregnancy and delivery, which can be more of an advantage and disadvantage at the same time.

Advantages: They are capable of dealing with both high and low risk pregnancies, and are able to administer pain relief during labour if it is requested by the patient. They are also more likely to be better equipped to handle emergencies, such as a premature delivery, if they do arise, and have the authority to perform emergency procedures that may not be able to be performed by a midwife.

Disadvantages: Doctors are often overbooked with patients. This, combined with the general medical approach usually taken, may sometimes result in a lack of personal attention during labour and birth. Some patients may find that they are unable to establish a personal trusting relationship with their doctor. However, it is important to note that the level of personal attention received will vary between individual doctors.

Midwife: A midwife is usually a certified nurse specialising in the area of labour and delivery. They may perform the delivery on their own, or they may work together with a doctor. They provide continual assessment of labour, usually staying with the patient throughout labour and childbirth.

Advantages: Midwives generally provide a lot of personal attention during labour and childbirth, staying with the woman throughout the entire process. As a result, they usually build up a personal relationship with the patient, establishing a sense of trust which may put women at ease. They are also more likely to support more natural non-medical types of childbirth, if desired by the patient.

Disadvantages: Midwives are not qualified to perform certain procedures that doctors can, nor can they administer pain medication if required. In addition, they are less equipped to deal with emergencies and high risk pregnancies and births. If an emergency does arise, it will be necessary to consult a doctor at a hospital, which can be inconvenient and dangerous for both the woman and her baby.

Doctor’s assistant(s): Assistants do not usually play any major role in delivery. They are there to assist the doctor and midwife (if present) in performing the delivery. They may perform tasks such as sterilising medical instruments, cleaning the baby when it is born, and providing assistance during emergencies.

What happens

A vaginal birth generally takes place in a hospital in most developed countries. However, some women prefer to give birth at home, usually with the assistance of a midwife and/or doctor.

Women who have a vaginal birth in a hospital usually check into hospital when they start to experience contractions. When they arrive, their general condition is evaluated, including the vital signs of pulse, blood pressure, breathing and temperature. The condition of their foetus is also checked. In particular the foetal heart rate is closely monitored to check for signs of foetal distress.

Most hospitals encourage the patient to choose a birth companion to provide personal labour throughout labour and birth. This person is often, but not necessarily, the father of the child to be born. The birth companion is usually encouraged to provide emotional and mental support for the woman, as well as some physical support such as rubbing her back and assisting her to move about.

The woman is encouraged to empty her bladder regularly, and to eat and drink as desired throughout labour. Breathing techniques are also taught, where the woman is taught to breathe out more slowly than usual, and to relax during each breath out.

Confirmation of labour: Although the woman usually checks herself into hospital at the onset of contractions, labour is generally suspected if irregular abdominal pain is present after 22 weeks of gestation, blood-stained mucus associated with pain, and/or a watery vaginal discharge or a sudden gush of water.

The onset of labour itself is confirmed by checking the cervix. Cervical effacement (the progressive shortening and thinning of the cervix) and cervical dilation (the increase in cervical opening diameter) are indications of the onset of labour.

Progress of labour: Once labour has been confirmed, the doctor/midwife will assess its progress by monitoring changes in cervical effacement and dilation. The decent of the foetus through the birth canal is also tracked by examining the abdomen. In addition, vaginal examinations are usually carried out at least once every 4 hours during the first stage of labour to monitor the colour of amniotic fluid, extent of cervical dilation and stage of foetal descent.

Delivery: Once the cervix is fully dilated, the woman is said to be in the expulsive phase of the second stage of labour. It is at this time that she is encouraged to assume her preferred birthing position and to push. Contractions may decrease just prior to the urge to push is felt. During the actual pushing stage, the contractions are usually strong and forceful, and may be accompanied with an urge to push, so that the woman can push in time with the contractions of the uterus. Most women feel in increased pressure in their lower back, perineum (vaginal tissue) and rectum during this stage. The rectal pressure can feel the same as having a bowel movement to many women.

The delivery of the head is generally controlled in part by the doctor/midwife, who place their fingers of one had against the baby’s head to keep it flexed. As the head is being delivered, the woman may feel a stretching or burning sensation. If needed, this process may be assisted by the use of forceps or a vacuum suction cup.

Once the baby’s head is delivered, the doctor/midwife will feel around the neck for the umbilical cord. If the cord is present around neck, it will either be slipped over the baby’s head or doubly clamped, cut, and unwound from around the neck before the rest of the body is delivered.

The rest of the body is generally easier to deliver, requiring only gentle contractions from the woman. When the whole body is delivered, the woman enters the third stage of labour, during which the placenta is delivered. The delivery of the placenta only required gentle pushing, and is much easier to deliver than the baby.

After delivery of the placenta, the whole process of labour is complete. The doctor/midwife will examine the placenta and its membranes to ensure that it is intact. The patient’s abdomen will also be felt to check that the uterus is contracting in order to stop the bleeding that occurs when the placenta is torn away. The woman will also be examined for tears to the cervix or vagina.

Labour and a subsequent vaginal birth takes an average of 13 hours in women giving birth for the first time, and 8 hours in women who have given birth before. However, the exact duration varies a great deal from one woman to another.

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Delivery

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Assisted Delivery

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How to prepare

It is necessary to prepare for a vaginal birth well before going into labour, so that when labour does occur, there is no rush to pack things for the hospital. It is advisable to have a hospital bag packed by the time a woman is 36 weeks pregnant. It should be noted that various hospitals provide different things (eg. number of pillows and cushions), and that they may have restrictions on what you can bring. Hospitals are also often short on space, only providing a small bedside cabinet to store items. It is therefore a good idea to check with the hospital before packing.

What to pack: Items to be brought can be divided three ways – a set of items for the patient, a set of items for the baby, and a set of items for the patient’s birth companion.

The patient: It is advisable to bring at least 2 extra sets of clothes, in addition to what is worn to the hospital. One set should be brought to wear during labour, keeping in mind that they are likely to get messy. The other set should be a set of maternity clothes to wear after the birth on the way home. Comfortable slippers should also be packed, in case the patient wishes to walk around the hospital during early labour. A dressing gown may also be useful for this purpose.

Other things to pack include toiletries, snacks and drinks, items to help the patient relax (eg. books and music), and watch to help time contractions. The patient may also wish to bring other items to make her more comfortable, such as pillows from home, or a hand-held fan to keep cool.

Items should also be packed for after the birth, including maternity pads and nursing bras.

Finally, it is quite common and useful for patients to write up a birth plan before going into labour. The birth plan is then brought to the hospital and given to the doctors and midwives when the woman goes into labour. This plan describes to the midwives and doctors the kind of birth and labour the patient desires. It is important to remember that births can be unpredictable, and that things may not go exactly to plan. However, it is useful to write down what the woman wants to happen and what she wants to avoid beforehand.

A birth plan can include (but is not restricted to) what birthing and labour positions are preferred, what kind of pain relief is to be used (if any), whether the baby is to be breastfed or bottle-fed, and what the woman wishes to do if the baby has to go to the intensive care unit. Any religious needs should also be mentioned.

The baby: Clothes should be packed for the baby to wear in hospital and on the way home. Other items to pack include socks, a blanket, and nappies. An infant car seat should also be prepared beforehand so that the baby can be taken home safely.

The birth companion: Extra clothes and toiletries should be packed for the birth companion, as well as food and drinks to keep him/her refreshed. The birth companion may also want to bring items such as books and magazines, in addition to those the patient might bring.

Benefits

Contrary to popular belief, vaginal birth remains the safest birth option for delivery, compared to elective caesarean section, for a normal low-risk pregnancy. Babies born by this method have been found to have a lower incidence of respiratory problems, as it is thought that the contractions that occur during labour help prepare the baby’s lungs for breathing. There is also less risk of blood loss and infections to the mother, compared to caesarean section deliveries.

Also, despite the process of labour and birth itself being painful, women who give birth vaginally usually recover very quickly. Mothers are often able to walk and care for the baby within a few hours after birth. Women are generally discharged from hospital the same day of the birth, or the day after.

Risks

Vaginal birth is generally only more risky than a caesarean option if the baby is in breech position, or if there is an emergency that requires the baby to be delivered quickly. Babies delivered vaginally in breech position are at risk of oxygen deprivation as a result of cord prolapse or prolonged cord compression due to head entrapment.

If the attending doctor/midwife has not had much experience in breech vaginal deliveries, it may be safer to perform a caesarean section.

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