The Delivery: What to Expect
Every delivery is as unique and individual as each mother and infant. In addition, women may have completely different experiences with each consecutive labor and delivery. Giving birth is a life-changing event that will leave an impression on you for the rest of your life. Obviously, you will want this to be a positive experience and would like to know what to expect. This section can give you some ideas of different things that may happen as you deliver your baby.
Creating a Birth Plan
As you approach the latter part of your pregnancy, you may want to write a birth plan. Consider carefully what things are important to you. The overall goal is for a healthy mother and baby. The birth plan outlines your ideal birth and may need to be adjusted as the actual situation unfolds. Talk with your partner and decide who you want to attend the birth. Some couples feel that this is a private time and prefer not to have others present.
Pain and Other Sensations
The amount of pain that a woman feels during labor and delivery is very individual. Most women feel a lot of pain and some do not. You probably have a good idea about how you respond to pain and how much you can tolerate. This should give you some idea of what to prepare for.
If you decide to have a natural childbirth (delivery without pain medication), you will feel all types of sensations. The two sensations you will experience the most are pain and pressure. When you begin to push, some of the pressure will be relieved. As the baby descends into the birth canal, though, you will go from experiencing pressure only during the contractions to experiencing constant and increasing pressure. It will feel something like a strong urge to have a bowel movement as the baby presses down on those same nerves.
As the baby enters the vagina your skin and muscles stretch. Eventually the head will appear. With every push, more of the baby's head can be seen. The labia and perineum (the area between the vagina and the rectum) eventually reach a point of maximum stretching. At this point, the skin may feel like it is burning. Some childbirth educators call this the ring of fire because of the burning sensation felt as the mother's tissues stretch around the baby's head. The intensity of these sensations depends on your pain threshold and the tightness of your vaginal opening. At this time, your health care provider may decide to perform an episiotomy. You may or may not feel the episiotomy because the skin and muscle can lose sensation due to how tightly they are stretched.
If you have had an epidural, what you feel during labor will depend on the strength of the epidural block. If the medication is very strong, you may not feel anything. If it is moderate, you may feel some pressure. If it is mild, you will feel pressure that may or may not be uncomfortable to you. It depends on how well you tolerate pressure sensations. You may not feel the stretching, and you probably would not feel an episiotomy.
The Cervix and Vagina During Labor and Delivery
The cervix is the lowest part of the uterus that opens into the vagina. The cervix is a tubular structure approximately 3 to 4 centimeters in length with a passage that connects the uterine cavity to the vagina. During labor, the role of the cervix must change from maintaining the pregnancy to facilitating delivery of the baby. The fundamental changes that occur near the end of the pregnancy result in softening of the cervical tissue and thinning of the cervix. Eventually, the cervical canal must open until the cervical opening itself has reached 10 centimeters in diameter and the baby is able to pass into the birth canal. Though significant injuries are not common, during this process the cervix may tear and ultimately require repair.
Like the cervix, the vagina and vaginal opening must stretch and dilate to at least 10 centimeters to allow the baby's head to pass during delivery. Although vaginal tissues are soft and flexible, when delivery occurs rapidly or with excessive force, the tissues can tear. In most cases, the lacerations are minor and easily repaired; occasionally, though, they may be severe and result in long-term problems.
Normal labor and delivery often results in injury to the vagina and/or cervix. Up to 70% of women having their first baby will have an episiotomy or some sort of vaginal trauma requiring repair. Fortunately, the vagina and cervix have a rich blood supply; therefore, injuries in these areas heal quickly and leave little or no scarring that could result in long-term problems.
Did you know?
As recently as the 1920s, the maternal death rate from direct obstetric complications in the exceeded 1%. If you apply that rate to the over 6 million pregnancies now occurring each year in the (including miscarriages and terminations), it would represent about 200 maternal deaths every day! While pregnant women in the today fortunately have mortality risks that are several orders of magnitude less than a century ago, there are still areas of the world where such maternal mortality rates exist or are even exceeded.
As the baby's head emerges, there is a great relief from the pressure, although you will probably still feel some discomfort. Your nurse or doctor will ask you to stop pushing momentarily while the baby's mouth and nose are suctioned to clear out amniotic fluid and mucus; it is important to do this before the baby starts to breathe and cry.
Usually the doctor will rotate the baby's head a quarter of a turn to be in alignment with the baby's body, which is still inside you. You will then be asked to begin pushing again to deliver the shoulders. The top shoulder comes first, then the lower shoulder. Then with one last push, you deliver your baby!
After the baby is delivered, you may be exhausted and relieved. Even in a weakened state, you may have a huge surge of adrenaline that makes you feel elated. Some women cry, laugh, or are so tired they can only smile. The baby's umbilical cord is clamped and then cut, often by dad or another family member. Sometimes the nurse, midwife, or doctor will do this, depending on how the baby is doing.
Delivering the Placenta
The placenta and the amniotic sac that supported and protected the baby for nine months are still in the uterus after the delivery. These need to be delivered and this can happen spontaneously or it may take as long as half an hour. Your midwife or doctor may rub your abdomen below your belly button to help tighten the uterus and loosen the placenta. Your uterus is now about the size of a large grapefruit. You may need to push to help deliver the placenta. You may feel some pressure as the placenta is expelled, but not nearly as much pressure as when the baby was born.
Your health care provider will inspect the delivered placenta to make sure it was delivered in full. On rare occasions, some of the placenta doesn't release and may remain adhered to the wall of the uterus. If this happens, your provider will reach into your uterus to remove the leftover pieces in order to prevent heavy bleeding that can result from a broken placenta. If you would like to see the placenta, please ask-usually, they will be happy to show you.