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Childbirth - Vaginal Delivery

Vaginal birth is the usual way for babies to be born. The process of giving birth to a baby is known as labour. There are three stages to labour that will for last different lengths of time. Pain relief helps to manage pain during labour. 

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.  

Most women are healthy and have a straightforward pregnancy and labour. About nine out of 10 women give birth vaginally to a single baby after 37 weeks of their pregnancy with the baby being born head first.

There are three stages that you will go through when you give birth vaginally. Labour varies according to a number of factors, such as whether or not it's your first pregnancy, the size of your baby and its position in your womb. 

Before active labour starts, your body goes through some changes in preparation, so it's not always easy to tell exactly when labour has started.

When your baby is ready to be born, the balance of hormones (chemicals found naturally in your body) changes and makes your cervix (the neck of your womb) become softer and shorter.

You may also have 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.

Hormones also cause you to have contractions. The muscles in your womb tense and relax becoming shorter so that your cervix stretches and opens (dilates). Contractions feel like a wave. They start gently and gradually build, becoming intense and then easing off. It may take some time for the contractions to become regular but they will gradually get stronger and closer together.
At first you may only have a contraction every 15 to 30 minutes. After a while, they will be more frequent and stronger, occurring every two to three minutes. The length of time that each contraction lasts is usually between 10 and 40 seconds, but this will be different for every woman.
When you have a contraction, you will feel a build-up of tension across your abdomen (tummy), pain in your back and possibly also between your thighs and low down in your pelvis. You may also find that your waters break.

This is a normal part of labour and is when the bag of fluid that surrounds your baby breaks as your cervix widens. It's also referred to as your membranes rupturing. The fluid may rush out in one go or in a steady leak. Your waters can break at any time during labour. However, if your waters break when you're not in labour and labour doesn't start within the next few hours you should contact your midwife or doctor for advice on what to do next.

The first stage of labour continues until your cervix is fully dilated, about 10cm, allowing the baby to move lower through your pelvis. For women having their first baby, labour lasts on average for about 8 hours, most of which is the first stage of labour. Labour is unlikely to last for longer than 18 hours. It's likely to take less time if it's not your first baby, because your pelvis and vagina have been stretched before. 

The second stage of labour is when you give birth to your baby. It usually lasts about one to two hours.

As the baby's head gets lower, you will eventually feel a strong urge to push and this helps the baby to be born. This is a unique feeling which your body does of its own accord. You will still be having contractions to help you push, though they may be less frequent but longer. You may feel more comfortable if you are upright, kneeling, sitting or squatting.

As you push, your baby moves further down through your pelvis until his or her head stays at the entrance to your vagina between contractions. This is called 'crowning' and means your baby is about to be born. Usually, the head is born first followed by the shoulders and the rest of the body. 

This is when 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 be given a medicine to help the process. 

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 are being born, you will be given an injection of a hormone called oxytocin, or a combination of oxytocin and a medicine called ergometrine. Within about two minutes, these cause your womb to contract strongly to help reduce serious bleeding. The umbilical cord is clamped and cut as soon as your baby is born. The 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 takes about 10 to 20 minutes. Research has shown that this method reduces your risk of serious bleeding. However, it's possible that you will have some side-effects as a result of the medicines. These can include headache and feeling or being sick if you were given an injection of ergometrine.

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 up to an hour.

There are a number of reasons why this type of third stage may not be possible, including:

  • if you had an epidural or pain relieving drugs during labour
  • if you have 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 are when problems 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 is when you are helped to go into labour. Around one in five women will have their labour induced. There are a number of reasons why this may be suggested, including:

  • there is a problem with you or your baby and you need to have your baby early
  • your pregnancy is overdue (more than 41 weeks)
  • your waters have broken but labour hasn't started

There are several methods that can be used to induce labour. 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.

  • Prostaglandins. This is the way that most women will have their labour induced. Prostaglandins are hormones which are usually produced by your body to trigger the beginning of labour. They stimulate your cervix to get softer and shorter. You will have either tablets or a gel placed into your vagina.
  • Rupture of membranes. This is when you artificially have your waters broken. It's done using a special plastic hook. Rupturing your membranes causes hormones to be released which 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. 

This is sometimes called augmentation of labour. If labour is taking a long time and isn't progressing at the rate that would usually be expected, you may be offered treatment to speed up the dilation of your cervix and strengthen your contractions. 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.

Assisted delivery

Sometimes your midwife or 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 is another problem putting his or her health at risk. This is called fetal compromise or fetal distress.
  • Your baby is in a position that means it's difficult for him or her to be born without help.
  • You have been pushing for a long time, are 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 be given local anaesthesia before an assisted delivery. This completely blocks feeling from the waist down and you will stay awake during the procedure. 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 midwife or doctor will pull gently on them while you push.
  • Vacuum extraction (ventouse) - 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 midwife or doctor then pull 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.

Pain relief

All women cope differently with labour. You may have one idea about the pain relief you wish to have before labour, but change your mind once it's actually happening. There is evidence to show that having someone with you throughout labour can reduce your need for painkillers.

Self-help

There are a number of other methods of pain relief that you can try if you don't wish to use medicines. These methods include:

  • using breathing and relaxation techniques or massage
  • being in warm water, such as in a birthing pool
  • moving around, standing up, kneeling and leaning forward

Using a TENS (transcutaneous electrical nerve stimulation) machine can also help in early labour, though it isn't recommended later on. Two electrodes are placed on your back and electrical impulses are sent to the nerves to block pain signals going from your womb to your brain.

If you decide to use medicines, all these methods can also be used at the same time.

Medicines

There are a number of medicines you can choose for pain relief. They can be used in combination if necessary. It's important to talk to your midwife or doctor about these and be sure that you are aware of the risks and benefits of each.

Gas and air (Entonox)

This is a mixture of nitrous oxide (laughing gas) and oxygen. As you feel a contraction starting, you breathe in the mixture through a mouthpiece or a mask placed over your nose. It's a mild painkiller and will make your less aware of your pain although not all women find it effective. Some women find that Entonox can make them feel sick and light-headed.

Opiates

These medicines include diamorphine and pethidine. They are strong painkillers but may have a limited effect during labour. They can cause side-effects including feeling sick or dizzy. Opiates may also affect your baby making him or her sleepy both at birth and for a few days afterwards. This can reduce your baby's ability to breathe after birth and this may need urgent treatment. Opiate drugs can also make it harder for you to breastfeed.

Epidural

This method involves having an injection of local anaesthetic into your lower back, just above your waist. An epidural completely blocks feeling from the waist down. It's very effective and nine out of 10 women who have one have no pain at all. However, there are side-effects. If you have an epidural, your second stage of labour may take longer because you won't feel the urge to push. It may also make moving around more difficult because you have less feeling in your back and legs. 

Can I have a drink or something to eat while I'm in labour?

Answer

Yes, although you may not feel like eating anything once you are in active labour. It's a good idea to try to drink some water or other fluids as you will probably sweat a lot during the birth.

Explanation

You can eat during labour, unless you have had opiate painkillers, such as pethidine or diamorphine, or if there is a high chance that you will need to have a general anaesthetic.

Unless you are advised not to, eating something in the early stages of labour may be helpful because you will use up a lot of energy giving birth to your baby. It may help to have carbohydrates such as cereal, bread or a banana as these release energy slowly over a longer period of time.

You are likely to feel thirsty during labour. If you can, it's best to drink isotonic drinks or water. Isotonic drinks provide you with energy and help to replace any minerals, such as salt, that you lose when you sweat.

Are Braxton Hicks contractions the same as the contractions that I will have during labour?

Answer

No, Braxton Hicks contractions are different from the contractions that result in the birth of your baby.

Explanation

Braxton Hicks contractions are also sometimes called practice contractions. After about 30 weeks of pregnancy you may start to get this kind of contraction. As pregnancy progresses, you may feel them more often and they may get stronger.

Braxton Hicks contractions are different from the contractions that occur during labour, which are more powerful and come at regular intervals. Braxton Hicks contractions are irregular and you probably won't find them as painful although they may be uncomfortable.

Are there any benefits to using water during labour?

Answer

Yes, there is evidence to show that being in water during labour may reduce your need for pain-relief medicines and may make your contractions less painful. It may also reduce the need for labour to be speeded up.

Explanation

You may find water helpful as a method of pain relief. There is evidence that being immersed in water during the first stage of labour may help you to feel more relaxed and this could mean you need less medicine for pain relief. You may also be able to progress with labour without needing help. All midwives should receive training so that they are able to care for you if you wish to use water during labour.

You may also want to give birth to your baby while you are in water. You should speak to your midwife or doctor for more information about giving birth in water as there is a lack of evidence to show whether or not there are any increased risks to you or your baby.

Some hospitals and birth centres have birthing pools.

What will happen if I'm having twins or triplets?

Answer

If you are pregnant with twins you may be able to give birth vaginally to one or both of your babies. If you are having triplets these will be delivered by caesarean.

 

Explanation

If you are pregnant with twins, triplets or even quadruplets, this is called a multiple pregnancy. Women who become pregnant after in vitro fertilisation treatment have a higher chance of having twins.

If you are pregnant with triplets or quadruplets, you will be advised to have them delivered by caesarean. If you are expecting twins, you are more likely to need a caesarean delivery than if you were pregnant with one baby. However, it's often possible for at least one if not both of your twins to be born vaginally. If the first twin is in the head downwards position, then it's likely that normal labour and birth can go ahead.

After the first baby is born, you may stop having contractions. If they don't start again, you will probably be given oxytocin to encourage your womb to start contracting. Your midwife or doctor will examine you to see which way your second baby is pointing. He or she may try to turn the baby if it's not in a good position to be born normally, or you may have to have a caesarean.

Is complementary therapy helpful for pain relief during labour?

Answer

Acupuncture or hypnotherapy may be helpful to reduce pain during labour. However, there is a lack of evidence to show whether other kinds of complementary therapies are effective.

Explanation

Many women give birth with little use of medicines for pain relief. Aromatherapy massage and other complementary therapies may help you to relax and reduce your anxiety, and therefore you may find you need less pain-relief medicine during labour.

There is some evidence that acupuncture and hypnotherapy may help to reduce pain in labour. However, there is no evidence that other types of complementary therapy can help to reduce your pain. It's important to speak to your midwife or doctor before trying any complementary therapy. If you do decide to use a complementary therapy, make sure that you only go to a registered practitioner. 

Further Information

Sources

  • Intrapartum care: care of healthy women and their babies during childbirth. National Institute for Health and Clinical Excellence (NICE), September 2007. www.nice.org.uk
  • Maternity data 2010–11. HESonline. www.hesonline.nhs.uk, published 2011
  • Arulkumaran S, Symonds I, Fowlie A. Oxford handbook of obstetrics and gynaecology. 1st ed. Oxford: Oxford University Press; 2004
  • Blott M. The day-by-day pregnancy book. 1st ed. London: Dorling Kindersley; 2009
  • Guide to labour. NCT. www.nct.org.uk, accessed 22 February 2012
  • Begley C, Gyte G, Devane D, et al. Active versus expectant management for women in the third stage of labour. Cochrane Database of Systematic Reviews 2011, Issue 11. doi:10.1002/14651858.CD007412.pub3
  • Joint Formulary Committee. British National Formulary. 63rd ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2012
  • Induction of labour. National Institute for Health and Clinical Excellence (NICE), July 2008. www.nice.org.uk
  • Your third trimester: how your body is preparing for labour. Emma's Diary. www.emmasdiary.co.uk, accessed 7 February 2012
  • Home births. Royal College of Obstetricians and Gynaecologists/Royal College of Midwives. www.rcog.org.uk, published April 2007
  • Olsen O, Jewell D. Home versus hospital birth. Cochrane Database of Systematic Reviews 1998, Issue 3. doi:10.1002/14651858.CD000352
  • The Pregnancy Book 2009. Department of Health. www.dh.gov.uk, published 29 October 2009
  • Cluett E, Burns E. Immersion in water in labour and birth. Cochrane Database of Systematic Reviews 2009, Issue 2. doi:10.1002/14651858.CD000111.pub3
  • Multiple pregnancy: the management of twin and triplet pregnancies in the antenatal period. National Institute for Health and Clinical Excellence (NICE), September 2011. www.nice.org.uk
  • Smith C, Collins C, Cyna A, et al. Complementary and alternative therapies for pain management in labour. Cochrane Database of Systematic Reviews 2006, Issue 4. doi:10.1002/14651858.CD003521.pub2

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