THE BIRTH PROCESS
A normal birth always follows the same pattern. As the unborn baby becomes developed enough to exist independently, the muscles of the mother's uterus push to expel the fetus from her body. This process is known as labor. It is still not known what signals the uterus to begin the birth process.
Although the distance the fetus must travel is short - only 4 inch. It is a difficult journey. The baby must be pushed through the bony pelvic passage and the narrow vaginal canal. Fortunately, nature has arranged to make this easier. The unborn baby's skull is soft and flexible so it can become longer and narrower. It consists of five soft, pliable bones which overlap each other to fit through the pelvis. This "molding" helps the baby's skull pass through the mother's pelvis more easily.
The Beginning of Labor
Labor may start in one of three ways:
- The expectant mother may notice slight cramps and a backache. This may not concern her first because she has probably felt this way occasionally for the last few weeks. Gradually she will realize that these cramps are different. They are not getting weaker as they did before; they are getting stronger and longer. As she has been told, she will watch the clock to see if these cramps come at regular intervals. At first they may appear every half hour or so , then every 25 minutes. As each cramp comes, the muscles of the abdomen tighten. As the cramp passes, the muscles relax. When these cramps - or contractions - become very regular and continue to become stronger active labor has probably start. It is time to notify the doctor or nurse - midwife. He or she will want to know two things - how often the mother is having contractions and how long each one lasts. The doctor will advise the mother from there.
- For another expectant mother labor may begin differently. She may feel fine and be following her usual routine. Suddenly, she feels a warm trickle or gush of liquid from her vagina. She has been told of this possibility and knows want it is. The membrane holding the amniotic fluid which surrounds the baby has broken and the fluid is draining away. When this happens, the mother should note the time, the amount of fluid, and the color and odor of the fluid. She should then inform her doctor or nurse - midwife. He or she will probably want to deliver the baby within 24 to 48 hours after the membrane has broken to avoid possible infection to the baby.
- Other mothers may become aware that labor is near when "shown" appears. This may be a few drops of blood or a slight pinkish vaginal staining. This often means that the plug of mucus that sealed the cervix - the lower part of the uterus - has become loose. Show does not always mean that labor has begun. It is possible to have shown several days before labor begins. It dose mean that things are ready to start. The mother should notify the doctor or nurse - mid wife if this happens.
Stages of Labor
When actual labor begins, it progresses through three stages:
- First stage: contractions open the cervix.
- Second stages: the baby is born.
- Third stage: the placenta is expelled.
The First Stage
The first stage of labor is the longest. It may last as long as 12 hours. In the beginning, the contractions are mild and brief. They probably occur about 15 to 30 minutes apart. These contractions cause the cervix to dilate (widen) and become thinner. Ordinarily, the opening of the cervix is about the size of the end of a pencil. For birth, it must widen to about 4 in. (10cm) in diameter. The cervix normally about ¾in. (19 mm) thick becomes as thin as a piece of paper
As the hours pass, the contractions become progressively stronger, more frequent, and longer lasting. The doctor or nurse midwife will tell the expectant mother when to go the hospital or birthing center. As the cervix is opening, the baby will probably move down into the lower pelvis and into position for birth. The baby is usually head down, but occasionally babies are born in other positions. In this stage of labor, the mother can help most by relaxing as much as possible between and during contractions. Fear and tension cause muscles to tighten. This slows up labor and makes it more difficult. If the mother has taken a prepared childbirth education class, she will do breathing exercises with her coach to relax and help the labor progress. She should also change her position every 30 minutes. If necessary, the mother may be given medication to reduce the discomfort of labor. Depending on what type is used, the effects range from numbing the area around the cervix to putting the mother to sleep. Many of these drugs can affect the newborn, making the baby sluggish instead of alert. Some also interfere with the mother's ability to push during labor. Most doctors and children educators encourage expectant mothers to give birth without drugs, if possible. However, medication will be given if the mother requests it or if complications call for use.
As the first stage of labor ends the contractions are very strong and frequent. With each contraction, the cervix stretches and opens more. When the cervix is fully dilated, room. The first stage is over.
The Second stage
As soon as the cervix is completely dilated and the contractions are about two to four minutes apart, the second stage of labor will begin. This stage lasts from a few minutes up to three hours. It includes the actual birth. During the second stage, the movement of the uterus changes. The cervix is no longer opening. Instead, the contractions push the baby out through the pelvis vagina. In some hospitals, the mother having a normal delivery may remain in the birthing room, a home - like room designed especially for a comfortable labor and safe delivery. In other hospitals, the mother may be moved from the labor room to a separate delivery room. The mother can usually help during this stage. She will be told how and when to help her muscles bear down to make the baby come along. The mother will feel a constant and uncontrollable urge to bear down. However, she will be instructed to push only during a contraction.
If necessary, the doctor will perform a surgical procedure called an episiotomy. For this, the physician makes an incision (cut) to enlarge the external opening of the vagina. (The normal opening is about 1 in. [2.5 cm] smaller than the baby's head.) Enlarging the opening this way is occasionally done to protect a larger baby's head from excessive pressure from the muscles. It also prevents the mother's tissues from being torn by the baby. The clear incision heals better than a ragged tear. The mother is now ready for delivery. The most common procedure is for the mother to lie in a semi - sitting position with her knees flexed. Her legs are supported at the sides of the delivery table in stirrups. Sometimes an ordinary hospital bed or a special birthing chair is used instead.
The baby's head usually emerges first. This is followed gently by one shoulder, then the other. Then the rest of the slippery little body slides through. The baby is born!
Sometimes, forceps must be used by the doctor to help guide the baby's head during delivery. Forceps are specialized tongs made from bands of surgical steel that are molded to fit the shape of a baby's head. With this instrument, the doctor can better control the movement of the head, helping the baby emerge more quickly or slowly as needed.
The Third Stage
In the third stage labor, the uterus continues to contract to expel the placenta - sometimes referred to as the "afterbirth". This stage lasts anywhere from two minutes to half an hour. It involves little or no discomfort.
The uterus contracts as the air is let out. As this happens, the placenta begins to separate from the uterus. It is soft and comes away easily. The doctor will ask the mother to push again to expel the placenta. The Birth process is now completed.
The Newborn at Birth
The newborn is no longer completely dependent on the mother's body for life support. During birth, many changes take place in the infant's circulatory system so that it can survive on its own
As the birth process begins, the pressure of being squeezed down the birth canal forces much of the fluid out. When the baby emerges, the pressure is released and the lungs automatically expand. The baby's first breath is taken.
Usually the breathing reflex continues on its own. If necessary, the doctor or nurse midwife may gently rub the baby's back to get the process started. Any fluid that remains in the lungs or mouth is gently suctioned out.
Once the lungs have begun taking in oxygen, the baby's circulatory system changes. A valve in the heart closes and over the next few days becomes permanently sealed. Blood now circulates to and from the loungers, instead of bypassing them as before. The umbilical cord, through which the baby has received oxygen and nourishment, is no longer needed. Within a few minutes it stops pulsing and begins to shrink. The cord is clamped, tied and cut off.
How Dose the Newborn Look?
The newborn's head is wobbly and large-one-fourth the size of the body. It may appear strangely lopsided or pointed from the passage through the birth canal. The bones of a baby's skull are tightly knitted together as they are in adults. They can be molded together during birth without harm. Any such lopsidedness is temporary. Babies have two fontanels - or open -spaces - in the bones of the head. The largest of these "soft spots" is just above the baby's forehead. Most babies also have a fontanel to ward the back of the head. These spaces allow the bones of the baby's skull to move together during birth. As the baby grows older, usually between the ages of six and eighteen months, the bone structure comes together to cover the space completely. Meanwhile, the soft spots are protected by skin that is as tough as heavy canvas.
The newborn typically has fat cheeks, a short, flat nose and a receding chin. These features are useful for sucking purposes because the nose and chin are out of the way.
At birth, a baby's eyes are nearly adult size. They are usually dark grayish - blue at birth. Permanent eye color becomes apparent within several months.
The skin of the newborn is blotchy. The baby's circulation is not yet regulated so the fingers and toes may feel cold and appear bluish. The hands and feet may peel if any of the cheesy material that covered the baby's skin before birth remains.