Childbirth — Vaginal Delivery
With the exception of some women who opt to have their baby through a voluntary or medically necessary cesarean, most women hope to experience childbirth by vaginal delivery. Childbirth is an intense process, and is best approached with a careful balance of education and an open mind. While it is smart to make a birth plan with the assistance of a birth partner and doctor, keep in mind that during labor and delivery, things can change, complications can arise and you may need to change your mind. Just remember that the goal is a healthy baby!
Your baby is delivered during the second stage of labor, once your cervix is completely effaced and dilated to 10cm. By this point, it takes all of your focus and concentration to cope with contractions and eventually, pushing your baby through the birth canal. Most women will feel an intense urge to bear down and push, depending on where the baby is in the birth canal, and if she's had an epidural, this sensation may be reduced. If you're going "natural" or drug free, you may feel a lot of pressure on your rectum — if you've received an epidural, you may feel this pressure in varying degrees.
Your doctor or midwife may ask you what position you'd like to deliver the baby in, and you may end up trying several to see what works best. These include sitting, reclining and squatting. If you're hooked up to fetal monitoring and an IV, you may be limited to reclining or sitting up in the bed. Although childbirth education classes are extremely useful, you have to determine then and there what the best means of coping with the pain and pushing are for you, as well as what type of coaching you want from your midwife, doctor, birthing partner or doula. You may want a back rub, someone to count while you push, or give you a play by play of what's going on "down there." Some women need to concentrate and would rather their husband or birthing partner to remain quiet.
Once it is time to start pushing, the baby should be well positioned in the birth canal. Most doctors will have you push with every contraction for about ten seconds. Pushing can be a frustrating time of childbirth because for every bit you push the baby down the birth canal, he slips a back a little. As the baby nears the vagina, you will experience extreme pressure on the perineum, which is the skin between the rectum and vagina. Your nurse or doctor will hopefully be massaging and slowly stretching the perineum to avoid tearing, or may have to perform an episiotomy, where a small cut is made to accommodate the baby's head in a vaginal delivery.
Just before the baby crowns, you may experience a significant burning and stretching sensation. Relief is just around the corner as the baby fully crowns. Once his head is out, his body will rotate, then each shoulder comes through one at a time. His nose and mouth are suctioned to clear any fluid, and the doctor will guide the rest of his body out.
A vaginal delivery can take anywhere from a few minutes to several hours, depending on how many deliveries the mother has had, the size of the baby and other factors. Sometimes babies need a little bit of help during childbirth — doctors often use forceps or vacuums to gently pull the baby out. Some women will spend hours in labor, pushing unsuccessfully, only to have it end in a cesarean delivery. A vaginal delivery is sometimes not possible due to an incorrect positioning of the baby, a large baby who won't fit through the pelvis or when the baby or mother is in danger or distress.