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Natural (Vaginal) Delivery

Obstetrics Types of Delivery, Natural Vaginal Delivery, Menopause Center Los AngelesA vaginal delivery is when a baby is born through the mother’s birth canal. A vaginal or “natural” delivery, is usually preferred in healthy pregnancies over Cesarean delivery – a surgical delivery performed by a doctor through an incision in the mother’s abdomen and uterus. An Ob/Gyn, nurse practitioner, doula, or midwife can facilitate a natural delivery though the multiple stages of labor. Talk with your doctor about your desires, questions, and concerns for vaginal delivery.

Labor

Labor is the process a pregnant woman’s body undergoes in order to deliver a baby naturally. The duration of labor varies widely from birth to birth. Some deliveries take only a few hours, while others may take a couple days, in extreme cases.

Labor is typically measured by certain biological milestones. It’s important to understand the signs of these milestones and what they mean, so you can understand the changes your body goes through to prepare for vaginal delivery.

Contractions

Contractions are the rhythmic tightening and relaxing of your pelvic muscles that prepare the baby for birth. Although contractions can range from uncomfortable to extremely painful, they are completely natural and necessary for vaginal delivery.

Braxton-Hicks Contractions.  Some women start to get “practice” contractions as early as 24 weeks. These may come as a surprise, but they don’t usually indicate the start of labor. Unlike labor, Braxton-Hicks contractions come at random intervals, and won’t intensify over time. They can be uncomfortable, but they’re usually not painful.

Dilation

Maternity care providers measure the progress of your labor by the dilation of your cervix. The cervix is the small doughnut-shaped organ located at the bottom of your uterus, at the entrance to the birth canal. During labor, the cervix naturally and gradually opens to allow the baby to pass through the birth canal. Dilation is the diameter of the cervical opening in centimeters. The baby is ready to come out at 10 cm dilation.

Early Labor

In most cases, labor begins with the rupture of the amniotic sac, also known as the moment the woman’s “water broke.” The amniotic sac is the pocket of fluids that surrounds and cushions your baby in the womb. When the water breaks, a clear, odorless fluid will stream out of the vagina. There should be no cause for alarm, unless:

  • The fluid is smelly.
  • It has a green, yellow, or brown color.

Contact your doctor right away if you believe something is wrong.

Signs of Labor. Typically, a woman is considered “in labor” if she’s experiencing regular minute-long contractions, in approximately 5-minute intervals, for 60 minutes.

Some other signs of labor include:

  • Achy back
  • Cramping
  • Pressure and warmth in your lower belly
  • Diarrhea or indigestion
  • Bloody show – vaginal discharge mixed with a little blood
  • Dilation of at least 3cm

Active Labor

In active labor, your contractions will grow stronger and the breaks between them will get shorter and shorter. This stage is very painful, and you may need to start using your pain management techniques, whether that involves medication or relaxation exercises.

If your water did not break during early labor, it will likely break during active labor.

This stage of labor usually only lasts for a few hours. Your medical staff will be there to check up on you, but they will allow you and your birthing partner some space and privacy as long as everything is going smoothly.

Signs of active labor include:

  • Worsening pain in the pelvis and back.
  • Contractions lasting up to 60 seconds, occurring 3-4 minutes apart.
  • Discomfort and pressure in the legs.
  • Feeling fatigued, anxious, excitable, or emotionally drained.
  • Dilation approximately 7cm.

Relaxation techniques for active labor:

  • Ask for medication, if this is a part of your birthing plan.
  • Practice breathing exercises.
  • Have a light snack and drink plenty of fluids. Keep cool by sucking on ice chips or a popsicle.
  • Keep your blood flowing by walking around the room, or switching positions.
  • Urinate normally. With all the pressure on your pelvis, you may not always feel the urge to pee during labor. Try to use the restroom at normal intervals – a full bladder may slow the process of labor.

Note that if you are using an epidural, you will be numb from the waist down and won’t be able to walk. You will also have a catheter keeping your bladder empty.

Transitional Labor

During the final phase of labor, your contractions will suddenly intensify, becoming extremely painful and lasting up to 90 seconds. The intervals between contractions will last only a couple minutes, giving you very little time to rest. Luckily, this is the shortest phase of labor, lasting between 15-60 minutes on average.

Signs of transitional labor may include:

  • Intense pressure in the lower belly and rectum, sometimes involving the urge to push.
  • Heavy “bloody show,” as cervical capillaries begin to burst.
  • Chills, hot flashes, and sweats.
  • Nausea, vomiting.
  • Feeling shaky and crampy, especially in the legs.
  • Drowsiness and fatigue between contractions.
  • Restlessness and overwhelming emotions, including irritability, frustration, and exhaustion.
  • Cervical dilation 7-10cm.

Once your cervix has reached 10cm dilation, it’s time to deliver the baby. Your medical staff will move you to the delivery room, or your bed will be prepared to facilitate the process.

Pushing During Labor

The urge to push may feel like the urge to have a bowel movement. This is because the same nerves that detect pressure in your colon are sensing the baby.

If you have an epidural, the sensations will be significantly numbed, and you will need to listen to your doctor to know when it’s time to push. Your doctor will be able to tell you if you need to push harder or take it easy. Sometimes pushing too forcefully can cause a tear in your vaginal tissues.

It’s important for you to speak up about your needs and feelings. If you need to hold someone’s hand, or if you don’t want to be touched, don’t hesitate to ask. If you’d like, you can ask for a mirror to see your baby’s progress. You have the hardest job in the room, and everyone close to you will be working to make sure that you are as comfortable as possible. Keep breathing, listen for when your doctor tells you to push, and try to focus on that moment when you get to meet your baby!

After Birth

After your baby is born, your doctor will clear his or her airway, and the umbilical cord will be cut and tied. If your baby appears healthy, you’ll be able to cuddle him or her close to your chest right away, and you may want to try breastfeeding.

Within about 5-30 minutes, you will need to deliver the placenta as well. This will be much easier than delivering your baby! You will likely continue to have small contractions, and your doctor may massage your belly to help it along. You may need to push again to completely expel the placenta.

Your doctor will examine the placenta to make sure that nothing was left behind in your uterus. If any bits of tissue remain, they will need to be removed to avoid an infection. Your doctor will also check to see if there are any tears in your vagina or vulva, and stitch them up to control bleeding and promote healing.

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