Is the process of giving birth or delivery of a newborn infant or fetus from a women’s uterus.
Vaginal birth is the most often form of delivery and progression follows several stages or transformation of the cervix with dilation and effacement.
Caesarean section is occasionally required or chosen depending on the circumstance, where a surgical incision in the abdomen allows for delivery of the fetus.
On average there are 12,000 new births everyday in the World
Interesting fact is that at any given time almost 3.25% of the female population is pregnant.
Though this number can be somewhat misleading because it is only taking into account those who deliver live births and often do not take into account miscarriages.
Another thing to consider is that this number is compared to those women who are child bearing age and does not take into older women.
Three main aspects of labor are categorized:
1.) Shortening and dilation of the cervix
2.) Birth of the infant
3.) Delivery of the placenta
Vaginal Birth
Vaginal delivery has been in style for thousands of years and the process, can be, in most cases rather simple while in other circumstances can be quite difficult and complex.
The pelvic anatomy of humans are uniquely structured to allow for birth through the vagina.
The pelvic floor is important and allows for the weight and controls the passage of the urethra, vagina, and rectum
Main Stages of Labor and Childbirth
1.) Latent phase
- Also referred to as Prodromal labor
- Lasts several days to a few hours prior to birth
- Contractions become increasingly intense
Braxton Hicks Contractions often occur in this stage of birth
- False contractions
- Seen in 2nd and 3rd trimesters
Cervical Effacement is an important progressive effect during this stage
- This is when the contour of the cervix changes from a bottleshaped area impossible for birth
- A smoother and flatter cervix thins making the passage of the fetus much more plausible
- When cervix is dilated about 3cm – latent phase ends
2.) First Stage of Labor: Dilation
Vaginal examination is often necessary during this stage
Bishop Score is a predictive score to determine when the second stage begins
It also helps determine if induction of labor is required
First stage begins when dilation of cervix has reached 3 cm
Uterine muscles begin working
Contractions allow uterine muscles causing the uterus to shorten
The cervix gradually dilates – from 3cm to 10 cm.
When 10 cm is reached then the Baby’s head can can pass through the cervix
This stage can last from “on average” 8 hours for first time vaginal deliveries and 4 hours for someone who has previously given birth
The stoppage of this Stage:
- When cervix dilation no longer continues at 1.2cm per hour for 2 hours
- ”Failure to Progress” possibility is then evaluated
- Adequate time must be done to evaluate this period
- Cesarean or C-section may be an option
3.) Second Stage of Labor: Expulsion
Begins with the complete dilation of cervix
Continues through the birthing of the baby
Following dilation – the baby then progress to the pelvis region
The pelvic brim and the baby’s head passing is an important aspect
This is typically the narrowest part of the pelvis
Next the head will pass the pubic arch and introitus
Bearing down and pushing are essential during this part
“Crown” occurs when labia part and a burning or stinging feeling may be felt by the
mother at this point.
Often the baby is then completely birthed
4.) Third Stage of Labor: Placenta
12-30 minutes following birth of the baby the placenta will be expelled
Expectant management
- No medical assistance is required
- Breastfeeding helps this process
- Massaging of top of uterus helps this process
- Uterine contractions occur
Active management
- Medical requirement is used or is necessary
- Oytocic agents used to cause uterine contraction
- Cord reactions helps expel the placenta
Blood loss
- Uterine will contract after placenta is expelled
- This will help dramatically prevent excess blood loss
- Blood loss is often closely monitor and most cases is not a concern
Complications During Childbirth:
1.) Breech Birth.
The baby is in a breech presentation when the baby enters the birth canal with the feet or buttocks pointing first.
Typical finding for a “normal birth” is when the baby is in a head first presentation.
Overall occurs generally between 5-10% of births when at term.
2.) Difficulty of descent of fetal head
Often seen with difficulty through the pelvic brim
3.) Shoulder Dystocia
Occurs once the head is delivered a problem with the shoulder is seen
The anterior portion of the shoulder can not continue further during the delivery.
Several options or maneuvers are available.
Complications include hypoxia, hemorrhage, and possible paralysis
4.) Cephalo-pelvic disproportion (CPD)
When the pelvis is unable to expand enough to all the baby to progress in labour
A small pelvis is often the cause, but a large fetus may also be a risk factor.
Pelvic fracture and a disease like rickets may lead to this condition
5.) Child Swelling
6.) Hypoxia – difficulty breathing
7.) others
Maternal Complications
1.) Episiotomy
- A surgical incision during childbirth to assist in delivery
- This procedure was once the standard of practice in Europe, Australia, and the United States.
- Is now only used when required
- Latin America allows this procedure 90% of the time.
- Increased complications arise when normal births use Episiotomy
2.) Vaginal Injury
- Tearing
- Nerve Damage
- Pain
- Stool incontinence
- Urine incontinence
- Sexual dysfunction
3.) Hysterectomy
- May be required in some cases of emergency
4.) Infection
5.) Excess bleeding or Hemorrhage
- Heavy blood loss is the #1 cause of maternal death world wide
- Shock often follows loss of large amount of blood
- Blood transfusions may be required
6.) Others
Importance of C-section
- When complications arise due to breech, c-section is often a logical choice.
- Several risks are associated with a surgery
- Risks include – internal injury, hysterectomy required, infertility, injury to baby, bleeding, others
Time immediately following Birth
- Breastfeeding and comfort of mother and child are often seen
- Rest is important following birth
- Proper nutrition is important
Pain Control during Birth
Non-medical and Medical options
Non-Medical includes
- Psychological preparations done prior to childbirth
- Water Therapy
- Massages
- Meditation
- Hypnosis
- Family support
- Friend support
- Doula who is an assistant for this process
- Sterile water
- others
Medical pain control
Very Early stage of Childbirth
- Pethidine [Demerol]
- Fentanyl
- Pethidine with Promethazine
Epidural blocks
- Generally safe
- Medicine can cross the placenta
Nitrous Oxide - prescribed in Europe
Statics given by: CIA World Factbook (https://www.cia.gov/library/publications/the-world-factbook/geos/us.html),