Ultimate guide to vaginal birth
We look at what to expect if you have a vaginal childbirth and investigate what happens during this type of labour and delivery.
Stages of vaginal childbirth
The first stage of labour is where the body prepares itself for birth. When your baby is ready to be born, the balance of hormones in your body changes. This makes your cervix (the neck of your womb) become softer and shorter in preparation for opening wide enough to allow your baby to pass through.
You may also see what is called a ‘show’. This is when the plug of mucus that acts as a seal in your cervix during pregnancy falls out as your cervix changes shape. This may happen any time between several days and a few hours before labour starts. If you see a ‘show’ it is best to contact your midwife, doctor or delivery suite to let them know.
Hormones also cause contractions. The muscles in your womb tense and relax so that your cervix stretches and opens (dilates). Contractions typically come in waves, starting gently building in intensity and then easing off. It may take some time for your contractions to become regular but they gradually get stronger and closer together as the labour progresses. It is important to contact your midwife, doctor or delivery suite when you begin experiencing contractions.
The first stage of labour is often defined in two periods – the latent first stage and the established first stage.
In latent labour, contractions are often irregular, and the cervix will typically dilate by up to 4cm. This stage can last for several hours, especially if it is your first labour. For some women, these contractions are not particularly painful at this stage.
In the established first stage, contractions become more regular and are generally more painful, during this time the cervix will continue to dilate from 4cm up to 10cm. The cervix dilating is essential to having a vaginal delivery.
At first you may only have a contraction every 10 to 30 minutes. After a while, they will be more frequent and stronger, occurring every three to five minutes. The length of time that each contraction lasts is usually between 10 and 40 seconds to begin with. They get longer as your labour progresses, to around 45 to 60 seconds. But this will be different for every woman.
Prior to the birth of your baby, your ‘waters’ will break, for most women this occurs after contractions have been felt. This is a normal part of labour, where the amniotic sac (bag of fluid) in which your baby has been growing will break and the amniotic fluid that surrounds and protects your baby during pregnancy will release. The fluid may rush out in one go or in a steady leak. The fluid should be clear or slightly cloudy, if you notice that the water is brown or discolored it is important to tell your health care professional. When your waters break, it is important to contact your midwife, doctor or delivery suite and let them know.
At the end of the established stage of labour the cervix should have fully dilated (opened to 10cm in diametre), there is now space for your baby to move into your pelvis, and the second stage begins.
The second stage of labour is when you give birth to your baby. The second stage of labour usually lasts for about one or two hours, for some of this time the baby will move with the contractions, and for some of this time you will be required to push.
Your baby will move through the vagina for a large part on its own and with the assistance of the contractions. You may feel a strong urge to push, a unique feeling which your body does of its own accord, and typically in rhythm with the contractions.
Usually, your baby’s head is born first, followed by the shoulders and the rest of their body. Your baby's head will appear in the opening of your vagina, this is called ‘crowning’. Your midwife or doctor will guide you on when to push and when not to push, this guidance is designed to control the speed of your baby’s birth to avoid or minimise any tearing of the perineum (the skin below your vagina).
During the third stage of labour, the placenta and membranes that held your baby in the womb are passed out of your body. You can let this happen naturally or you can have medicine to help the process (active management). In Australia, most vaginal births will have an active management of the third stage of labour. You can discuss this with your midwife or doctor prior to your labour.
Active management of the third stage by your midwife or doctor
Your midwife or doctor can help the third stage to progress more quickly and safely. As your baby's shoulders and head are being born, you will be given an injection of a hormone. After a few minutes, the hormone causes your womb to contract strongly to help reduce serious bleeding. The umbilical cord is clamped and cut after your baby is born. After a vaginal delivery your midwife or doctor will then deliver the placenta by pulling gently with one hand on the part of the umbilical cord that is still attached to it.
This normally takes around five minutes but can take up to 30 minutes. Research has shown that this method reduces your risk of serious bleeding.
Natural (physiological) management of the third stage
You may choose for the placenta to be delivered without any medicines. After your baby is born, you will be encouraged to cuddle him or her and try breastfeeding. This causes hormones to be released which help your womb to contract and push out the placenta. The umbilical cord isn't clamped and cut until the placenta has been delivered. This can take anything from a few minutes to about an hour.
Natural management of the third stage increases the risk of bleeding after delivery. This risk is higher if you have given birth more than five times before. There are a number of reasons why this natural type third stage may not be possible:
- If you had a general anaesthetic or an epidural in labour, or you’ve had a long labour.
- If you had heavy bleeding during this pregnancy or with a previous birth.
- If there were problems during labour or if you had an assisted delivery.
Your midwife or doctor will give you more information about your options.
Complications that can happen during vaginal births
Complications can occur during or after a vaginal delivery. Sometimes labour doesn't go as planned and you may need help for your baby to be born safely.
Induction of labour
Induction is when you’re helped to go into labour. There are a number of reasons why induction may be suggested:
- If there’s a health concern for you or your baby and you need to give birth to your baby early.
- Some birthing units may induce you if your pregnancy is overdue. This can differ between birthing units though.
- If your waters have broken, but labour hasn't started 24 hours later.
There are several methods that can be used to induce labour for vaginal birth. Membrane sweeping is when your midwife or doctor puts their finger inside your cervix and makes a circular movement. This separates the membranes around the baby from your womb and releases hormones, which can start your labour. If this doesn't happen, there are a number of other ways that your labour can be started. These are explained below.
- Balloon catheter. A soft silicon tube with two small balloons on the end is inserted into the vagina and positioned on either side of the cervix and then inflated. This applies pressure to the cervix which encourages it to begin to dilate.
- Prostaglandins. Prostaglandins are hormones that are usually produced by your body to trigger the beginning of labour. They stimulate your cervix to get softer and shorter. Prostaglandins come in different forms including oral tablets, or gel and pessaries which are placed into your vagina.
- Rupture of membranes. This is when you artificially have your waters broken. It's done using a special plastic probe. Rupturing your membranes causes hormones to be released that can start your labour.
- Oxytocin. This causes your womb to contract. You will receive it through a drip inserted into your arm. Oxytocin is usually given if your membranes have already ruptured.
Having labour induced can be more painful than going into labour naturally. Talk to your midwife or doctor about pain relief during your labour.
Acceleration of labour
Sometimes, your labour may take a long time and not progress at the rate that would usually be expected. If this happens, you may be offered treatment to speed up the dilation of your cervix and strengthen your contractions. This is also known as augmentation of labour. You may be given oxytocin through a drip to help your womb contract more strongly. If your waters haven't broken, then your midwife or doctor may also suggest having the membranes ruptured to speed up labour.
Sometimes your doctor may need to use instruments to help you give birth to your baby. Some of the main reasons why you may need help are listed below:
- Your baby isn't getting enough oxygen, or there’s another problem putting his or her health at risk. This is called fetal compromise or fetal distress.
- Your baby’s in a position that means it's difficult to have a vaginal birth without help.
- You’ve been pushing for a long time and very tired, and can't manage without assistance.
- You have a health condition that means you may not be able to keep pushing.
You will usually be given local or regional anaesthesia before an assisted delivery. The two types of assisted delivery are listed below:
- Forceps. These are like large tongs with curved ends that fit around your baby's head. Your doctor will pull gently on them while you push.
- Vacuum extraction. This uses suction. A cup is placed on your baby's head and attached to a vacuum machine. The air is sucked out which attaches the cup strongly to the baby's head. Your doctor then pulls gently on the cup as you push.
If you need an assisted birth, your midwife or doctor will give you more information about your options.
If it's not possible for you to give birth to your baby through vaginal childbirth, you will need an operation called a caesarean delivery. This involves delivering your baby through your abdomen (tummy). For more information on caesarean delivery, check out our Ultimate Guide to C Sections here.