What You Need to Know about Normal Childbirth
Normal childbirth is a term for mothers who deliver babies through the vagina. This is the process that pregnant women will go through when the fetus they are carrying is ready to be born.
The appropriate gestational age to give birth is generally between the 37th and 42nd week. The process of giving birth normally starts with uterine muscle contractions, opening of the cervix, and is assisted with a push from the mother’s pelvic muscles, so that the baby can come out through the vagina.
Contraindications Normal Childbirth
The following are a number of conditions that make it impossible for a mother to give birth normally:
Umbilical cord prolapse. Conditions during which the duct covers the passage , both preceding fetal body parts, also because the discharge of the fetus. This condition risks causing stress on the duct and leading to fetal death.
Fetal position abnormalities. In general, the normal position of the fetus to be born is the crown of the head facing the opening of the cervix (cervix), with the position of the face facing forward or back (head presentation). Some abnormalities in the position of the fetus that are not recommended for normal childbirth, include:
- Facial presentation, when the fetal head is very loud and the face of the fetus is directly opposite the cervical opening.
- Eyebrow presentation, when the fetal head is slightly raised so that the fetal eyebrow is directly facing the cervical opening. This situation can turn into a head presentation or face presentation.
- Buttocks presentation, which is when the buttocks are directly facing the opening of the cervix, especially when the feet are directly facing the opening of the cervix.
Twin pregnancy. Twin pregnancies that are not allowed to give birth normally are when both are in breech presentation, conjoined twins, present in 1 membrane of the amniotic fluid, or twin pregnancies of more than 2 fetuses.
Having had a cesarean section. Although classified as safe for most cases, but this is still a controversy. But certainly, mothers who have had cesarean section more than 2 times, or have a longitudinal scar or form the letter T in the uterus due to previous cesarean section, shouldn’t give birth normally, due to the danger of causing uterine tearing (uterine rupture).
Fetal heart rate is unstable. This can be a sign of a fetus experiencing hypoxia. Some things that can cause hypoxia in the fetus include placental abruption or umbilical cord.
Placental disorders. Like the location of the placenta that covers the birth canal (placenta previa), or placenta that attaches to the uterine muscle (placenta accreta).
Macrosomia. Conditions where the baby’s weight exceeds 4-4.5 kg, due to the risk of fetal shoulders being squeezed during labor (shoulder dystocia).
Mothers infected with genital herpes or HIV. Mothers are not permitted to give birth normally if they have an active genital herpes infection or are infected with HIV without treatment.
Preparations for Normal Childbirth
To welcome the birth of a baby, the following steps can be taken so that the birth process is smooth:
- Finding the right obstetrician and pediatrician. Not just looking for an obstetrician, finding the right pediatrician for the baby to be born can help provide comfort for the mother.
- Learn the process of giving birth normally since early pregnancy. Mothers can learn the traditional childbirth process by attending labor classes organized by the hospital or asking other mothers who have born before. Learn about the stages of childbirth, signs of labor, breathing and straining techniques, and pain management during labor.
- Exercise. Some sports such as warming up muscles, walking, jogging, squats, or static bicycles on a regular basis can be done to strengthen the breath and flexibility of the pelvic muscles during childbirth. Mothers can also take pregnant pregnancy classes. Help with the intake of nutritious foods and drinks so that the body becomes fitter. Consult with your doctor before doing any exercise or diet so that it can be adjusted to the conditions of pregnancy.
- Buy baby’s needs. Baby needs like clothes and diapers need to be prepared, but don’t overdo it.
- Prepare your needs from the start. Start preparing the items needed during labor 1 month before the estimated delivery date, so that when signs of delivery appear, the mother only needs to carry the bag.
Signs of Normal Childbirth
The obstetrician will notify the estimated date of birth to the mother, but this date can go forward or back about 2 weeks. Therefore, it is important for mothers to know the signs that are felt when the fetus is about to be born or while waiting for delivery:
- The fetal head begins to descend into the pelvic cavity. This makes breathing easier due to reduced fetal pressure on the diaphragm. In addition, the urge to urinate will increase due to a suppressed bladder.
- Mucus that contains blood from the vagina. This mucus is produced by the cervix and serves to protect the fetus from infection. The mucus that comes out is a sign that the cervix has begun to open.
- Back pain. Blunt pain in the lower back that arises, can appear with contractions or appear alone.
- Contraction. Uterus muscle contractions are usually felt regularly every 10 minutes indicating the time of delivery is near.
- Rupture of membranes. Do not imagine rupture of membranes such as water flowing freely from the vagina, but like urinating but cannot be held by the mother. Amniotic fluid that comes out indicates the membrane that protects the fetus has been torn, so the fetus must be born within 24 hours.
Stages Before Normal Childbirth
Stages before normal delivery or called stage 1 in the medical world are divided into 3 phases, namely the initial phase (latent), active phase, and the transition phase.
The latent phase is the longest and most uncomfortable phase, which can last from 5-18 hours. Pregnant women generally will feel mild to moderate contractions periodically for 30-45 seconds, and have a distance of 5-20 minutes. The latent phase occurs until the cervical opening is around 3 cm.
The active phase occurs after the cervical opening has reached 3-4 cm. Currently contractions will occur more often, that is every 2-3 minutes with a period of 50-70 seconds. When it has entered the active phase, it is advisable to immediately go to the hospital to undergo the normal childbirth process. If the amniotic fluid has not broken in this phase, the obstetrician will break the amniotic membrane. The level of contractions that continues to increase will cause anxiety, and make it difficult for women to stand up, and want to always change positions. Breathing exercises can be done to control pain and anxiety. If the pain is unbearable, the mother will be given an epidural. This drug can reduce pain and is given by injection in the spinal gap.
The transition phase is when the baby’s position has begun to move down. In this phase, the frequency and duration of contractions will continue to increase, even between the contractions. In this stage the mother’s anxiety, anxiety, fear, and fatigue can be felt, thus requiring family support. If you have reached this phase, the birth of the baby is not long.
Normal Childbirth Process
Also called stage 2, which is when the cervix is fully open. The contractions that are felt are going to be a touch different, which is walking around 60-90 seconds and subsides every 2-5 minutes. Normally, the baby are going to be pushed into each contraction, but if the contractions decrease or don’t make the fetus go down, the obstetrician will advise the mother to make changes in sleep position, such as tilting to the right or left. If that doesn’t work, the doctor can give medicines that trigger contractions. When contractions arise, the process of the fall of the fetus is also assisted by straining force from the mother.
During contractions and straining, the baby’s head will begin to appear from the vagina that continues to widen (crowning). When this happens, the mother will feel pain like burning in the birth canal. The doctor will ask the mother to no longer push, so the baby can come out slowly. This is also done to avoid vaginal tears and perineum, which is the area between the vagina and rectum (anus). If necessary, to avoid perineal tears or to speed up the delivery process, an episiotomy will be performed, which is to cut a small portion of the perineum and then stitch it back after the baby has come out. This procedure is preceded by giving a local anesthetic injection.
When the baby’s head comes out perfectly, the mother is recommended to push back to remove the baby’s entire body. After the baby comes out and is considered safe, which is marked by strong crying, the baby will be given to the mother for early initiation of breastfeeding (IMD) to create a strong relationship between mother and baby. Then the umbilical cord will be cut and the baby will be cleaned and covered with cloth.
After the baby is born, there is still a struggle for the mother, which is removing the placenta. This period is called the 3rd stage of labor. In this phase, contractions will still occur to release the placenta from the uterus and expel it. The time required is generally not long, which is 5-30 minutes. After making sure all the placental tissue is completely out, the obstetrician will give oxytocin to maintain uterine contractions, this aims to minimize bleeding.
The time needed for normal childbirth from stage 1 to stage 3 is around 12-14 hours. Mothers who have born normally before generally need a shorter time.
Problems That May Occur Before, During and After Normal Childbirth
Generally, labor with a traditional delivery occurs without causing problems. But some unexpected problems that can occur, either before, during, or after the normal childbirth process, such as:
- Premature birth. Premature birth can harm the baby because the function and growth of organs isn’t perfect.
- Late birth or postmature pregnancy. This can harm the fetus if it reaches week 42 of pregnancy, especially when the placenta is unable to provide nutrition to the fetus.
- Premature rupture of membranes. Normally the membranes will rupture just before labor or during delivery. This can cause infection in the fetus.
- Childbirth did not progress. A small proportion of mothers, who are generally first-time mothers, can experience labor that is too long or labor is not progressing. Both mother and fetus are at risk for infection of this condition.
- Post partum hemorrhage. Severe bleeding that can occur due to tearing of the uterus or uterine contractions are weak after giving birth.
- Amniotic fluid emboli. The condition when amniotic fluid enters the maternal blood vessels and blocks the arteries of the lungs. This complication is the most dangerous problem, not only during normal childbirth, but can also occur during a cesarean section. This complication rarely occurs when the delivery process goes smoothly.
Some of the conditions above can be overcome by accelerating the process of childbirth (induction of labor), assisted delivery by vacuum or forcep, or cesarean section.
After Normal Childbirth
In general, after parturition normally, the mother are going to be allowed to travel home from the hospital after 24 or 48 hours of delivery. The purpose of treatment at this hospital is to monitor the condition of the mother, and ensure there are no problems or complications.
There are changes that occur in the mother after the normal childbirth process, among others
- Bedwetting. Mother can wet the bed suddenly when laughing or coughing due to weak pelvic muscles.
- Hemorrhoids arise. Hemorrhoids are very common after childbirth, but will disappear within a few days.
- Get out of Lochia. Lochia is normal bleeding that happens after delivery and lasts for several weeks.
- Removing colostrum and breast milk. Breast can begin on the third or fourth day that’s felt with breasts that are tight and sensitive to the touch . Before the milk comes out, the mother’s breasts will produce colostrum, which may be a yellow liquid that comes out of the breast before breast milk.
- Stomach sagging. After a normal childbirth, the mother’s stomach is still sagging due to the muscles that stretch after pregnancy, in addition to the stomach the skin may also be seen to relax. The stomach will return to normal gradually, by adopting a balanced nutritional diet and exercising.
If severe bleeding or blood clots arise from the vagina, fever, dizziness, palpitations, and vision problems, immediately inform the doctor.
For sexual activity, no one can ensure the right time to start again. But you ought to await lochia to prevent , usually 6 weeks after parturition normally.
Childbirth Normal After Caesarean section
Normal childbirth after a caesarean section (VBAC) is a labor done through the vagina, after the previous pregnancy the birth process is done by cesarean section. About 40% of women do this, with satisfying results.
But please note, 1 in 200 women who do this risks causing dangerous complications, namely the uterine tear. Before deciding this, make sure that the mother has only had a cesarean section once and is not allowed to induce during labor, because it increases the risk of uterine tears. The most important thing is to discuss with the obstetrician about the benefits and risks of giving birth after a Caesarean section.