Childbirth (Normal Labor and Delivery)

What is childbirth?

It is the hope for every expectant mother- and the team that cares for her throughout the pregnancy- to have a successful pregnancy outcome i.e. healthy mother and baby. The birth plan outlines the ideal mode of delivery and may need to be adjusted as the actual situation unfolds. A birth plan may include other subjects like pain relief during labor, delivery positions, and other personal references. In Ghana, about 88% of births are through vaginal deliveries and it is the most preferred mode of delivery amongst Ghanaian women.

How do I know labor has begun?

For a vaginal delivery which begins without any direct aid, also termed spontaneous vaginal delivery, regular contractions may mean the beginning of labor.  Contractions are the tightening and releasing of the womb. These motions will eventually help your baby push through the cervix. Contractions, however, aren’t a reliable indicator of labor. You might already have felt Braxton-Hicks contractions, which may have started as early as your second trimester. Seeing liquor (water breaking), may be a sign of labour. However, water breaking may happen before labour itself starts. When water breaks way before your due date or in the absence of other signs of labour, visit your midwife immediately.

The cervix is the lowest part of the uterus that opens into the vagina. The cervix is a tubular structure approximately 3 to 4 centimeters in length with a passage that connects the uterine cavity to the vagina. During labor, the role of the cervix must change from maintaining the pregnancy (by keeping the uterus closed) to facilitating delivery of the baby (by dilating, or opening, enough to allow the baby through).  True, active labor is considered to be underway when the cervix is dilated 4 centimeters or more.

How long till the baby comes out?

Eventually, the cervical canal must open until the cervical opening itself has reached 10 centimeters in diameter and the baby is able to pass into the birth canal. This may take up to 6 hours from a 4 centimeter dilatation.  As the baby enters the vagina, the skin and muscles stretch. The labia and perineum (the area between the vagina and the rectum) eventually reach a point of maximum stretching. If the space for passage is still inadequate, an episiotomy- controlled incision- of the perineum is done. Once the baby’s head is delivered, the rest of the body follows with the next contractions. After delivery, the umbilical cordis clamped and cut.

The placenta and the amniotic sac that supported and protected the baby for nine months are still in the uterus after the delivery. These need to be delivered, and this can happen almost immediately or it may take as long as half an hour.  Once the placenta is delivered, it is inspected to make sure it was delivered in full. On rare occasions, some of the placenta does not release and may remain adhered to the wall of the uterus. If this happens, your provider will reach into your uterus to remove the leftover pieces in order to prevent heavy bleeding that can result from a torn placenta.

Is there pain relief during labour?

The epidural anaesthesia is the most popular, most effective method of pain relief during labor. If you have an epidural, what you feel during labor will depend on the effectiveness of the epidural block. If the medication properly deadens the nerves, you may not feel anything. If it’s moderately effective, you may feel some pressure. You may not feel the stretching of the vagina, and you probably won’t feel an episiotomy. Some IV medications can be given, but the timing for delivery is heavily dependent on the cervical dilatation.

Can a woman get injured during childbirth?

Normal labor and delivery often result in injury to the vagina and/or cervix. Up to 70 percent of women having their first baby will have an episiotomy or some sort of vaginal tear requiring repair. Fortunately, the vagina and cervix have a rich blood supply. That’s why injuries in these areas heal quickly and leave little or no scarring that could result in long-term problems. It is wise to prepare yourself for labor and delivery, but it’s a famously unpredictable process. Understanding the timeline and hearing about other mothers’ experiences can go a long way to making childbirth less mysterious.

Is it advisable to have a delivery at home?

Planned home birth means you opt to give birth at home instead of at a hospital or birthing center. You will still need the assistance of someone experienced and qualified during labor and delivery like a midwife. It is not safe for all people to give birth at home. For example, certain medical conditions, such as preeclampsia or type 1 diabetes, require more advanced care than can be offered at home.

Also, for people who have had a prior cesarean delivery, commonly referred to as a C-section, or who are pregnant with multiples like twins or triplets, home birth can be riskier than giving birth in a hospital. Even in the absence of any prior medical conditions, a planned home birth is not advisable if the home is not near a clinic.

Bam et. al, 2021. Factors influencing decision-making to accept elective caesarean section: A descriptive cross-sectional study