Childbirth is a process which results in the birth of the baby. Normally the baby is born between 37 and 42 weeks of gestation (40 weeks of gestation are typical). When a child is born before the 37 week it is called a preterm birth; when a child is born after the 42 week it is known as postterm birth.
Vaginal delivery is the common and natural way of delivery.
- Spontaneous vaginal delivery
Spontaneous vaginal delivery occurs without any assistance and commonly lasts for about 12-24 hours if a woman is giving birth for the first time or 6-8 hours when it’s not the first labor.
The delivery has 3 stages. During the first stage the cervix dilates until its opening is 10 cm wide. In the second stage the delivery of the baby takes place. After the baby is born begins the third stage+. In this stage a woman delivers placenta. During the delivery some medicines may be used to alleviate the pain, including meperinide, nalbuphine, phentanyl etc. Epidural, spinal anesthesia or combined spinal-epidural anesthesia may be given as well.
- Induced delivery
Delivery induction (also known as the augmentation) is used to stimulate the childbirth by the means of medicines or non-pharmacological methods which should be performed only in the hospital under the doctor’s supervision.
Delivery induction is indicated in case of premature rupture of the membranes, postterm pregnancy, severe intrauterine fetal growth restriction, gestational or chronic hypertension, preeclampsia, eclampsia, diabetes etc.
Induced childbirth is contraindicated in case of transverse fetal position, umbilical cord prolapse, active genital herpes infection, abnormal placenta position or a history myomectomy in the past.
Effective pharmacological methods of labor induction include intravaginal or endocervical administration of prostaglandin E analogues (misoprostol, dinprostone) or intravenous oxytocin.
Numerous non-pharmaceutical methods are used to induce the labor. These techniques are the following: sweeping or artificial rupture of the membranes; dilatation of the cervix with the help of balloon catheter, inserted endocervically.
- Vacuum extraction
Ventouse/vacuum-assisted vaginal delivery is performed when the cervix is fully opened, but the contractions are not strong enough to deliver a baby. The vacuum device is then placed onto the baby’s head and the child is “sucked” out of the uterus until the head is delivered and the device may be detached.
- Forceps-assisted delivery
Another technique (alternative to vacuum extraction) performed when the contractions are too weak and the cervix is fully dilated is forceps-assisted delivery. Forceps are then placed over the baby’s head and the fetus is pulled out.
Cesarian Section (C-Section)
Cesarian section is a type of surgery performed to deliver a baby/babies. C-section is indicated when vaginal surgery puts a child or a mother at risk. The surgery lasts approximately an hour. Planned C-sections are performed after the 38th week of gestation.
Cesarian section is recommended in case of:
- untreated HIV of the mother or other sexually transmitted diseases;
- abnormal presentation of the baby (for example, breech birth or transverse position of the fetus);
- size of the baby is too big (condition known as macrosomia when a baby is larger than 4000 grams) or the pelvis too narrow for a vaginal delivery;
- some congenital disorders of the baby;
- multiple pregnancy;
- abnormal position of the placenta or umbilical cord;
- obstructive lesions in the internal reproductive organs that interfere with the vaginal birth;
- hypertension, preeclampsia and other cardiovascular diseases in which vaginal delivery is contraindicated;
- labor dystocia (obstructed labor);
- the risk of uterine rupture;
Sometimes the C-section may be performed upon a mother’s request.
General anesthesia or a spinal block may be used. Then an incision in the lower part of the abdomen is done and the uterus is opened.
The mother may be discharged from the hospital 2-4 days after the surgery. Possible complications of the C-section include infections, deep venous thrombosis, pulmonary embolism, decreased tone of the uterus etc.
Vaginal birth after C-section
Nowadays vaginal delivery is not contraindicated after the previous C-section. However, before making the decision about the childbirth method all the pros and cons should be taken into consideration.