Normal Birth
A more descriptive name for normal birth is normal spontaneous vaginal birth. In other words, it is a natural spontaneous birth in which the baby comes out vaginally.
There are 3 stages of labor. The first phase is the longest phase when the cervix opens with pain. The second stage is when the baby is born with pushing. The 3rd stage is the stage when the baby’s partner (placenta) comes out completely.
Stage 1 consists of latent and active phases.
Latent phase: This is the phase from the onset of labor pains until the opening of the cervix reaches 3-4 cm. Labor pains may start with a mild onset or may start suddenly. In some women, the opening of the cervix can be felt very mildly and reach 3-4 cm, while some women may feel the pain strongly from 1 cm opening. Generally, the intensity of pain is milder in the early onset phase. Pains lasting 30-45 seconds and coming every 5-30 minutes can be seen. A pink discharge may be seen during this period. Some women spend this period comfortably at home and may apply to the hospital when they are in the active phase.
Active Phase: The active phase is the phase when the opening of the cervix goes from 4 cm to 10 cm, i.e. full opening. During this period, the pains become more regular and more severe. During this period, back massages or rhythmic exercises on a Pilates ball can be helpful when the pain comes. Epidural anesthesia can be applied during this period if desired. The active phase lasts for 3-5 hours on average. The membranes usually rupture at this stage and water ingress is observed.
The second phase is the pushing phase. This phase starts when the cervix is fully open and ends when the baby is born. It can last 1.5-2 hours in first pregnancies. In subsequent pregnancies, it can last as short as a few minutes or as long as 1 hour. This period is the pushing phase. The feeling of pushing will come spontaneously. Pushing without the feeling of pushing will not be of any benefit other than exhausting the pregnant woman. Pushing can tire the pregnant woman, weakness and fainting may occur. During this period, your doctor may want to open an episiotomy if necessary.
The third stage is the exit of the placenta after the baby is born and the umbilical cord is cut. This phase can last from a few minutes to 30 minutes. During this period, there may be mild cramping and pain, although not as much as during labor. During this period, the baby can be placed on the mother’s breast to help stimulate uterine contractions. After the placenta and membranes are completely removed, the genital area is checked by your doctor. If there is an episiotomy, it is repaired with anesthesia. If the episiotomy has not been opened, the tears, if any, are repaired. The likelihood of a tear is higher in first births than in second and subsequent births.
As long as all stages of labor have been completed and there are no complications, the mother can eat whatever food she wants immediately as she may be tired.
Benefits of Normal Birth
A normal birth is a birth in which everything happens as it should. A caesarean section is an abdominal surgery. Caesarean section is a procedure that saves the life of mother and baby when necessary, but it is not right to perform it when it is not necessary. First of all, in normal childbirth, the mother is part of the birth and is actively involved. The mother is in control and if she has accessed enough information during her pregnancy, she will manage her birth well. Since normal birth will take place in the delivery room instead of the operating room, a relative who will support the mother during the opening phase of labor will be with her at all times. In normal labor, the pregnant woman can move as she wishes. The mother’s movement is not restricted except for occasional baby heart monitoring. Minimally invasive interventions are performed on the mother, so that mother and baby complete the birth process with minimal harm. At the same time, according to new research, the baby’s encounter with vaginal flora while passing through the birth canal will reduce the likelihood of diseases such as celiac, asthma, type 1 diabetes and obesity in the future by creating the intestinal flora that will be supported by breast milk. After normal delivery, the rate of breast milk production is faster than after cesarean section. In a caesarean section, the mother undergoes an abdominal operation. The recovery process will be more difficult and more painful than normal delivery. In normal delivery, the mother has not undergone abdominal surgery and will not have any wounds that will bother her, except for episiotomy or birth tear repair sites, if any. A mother who has had a normal delivery is likely to have her next delivery vaginally. However, in case of a repeat pregnancy after cesarean section, the likelihood of normal delivery is lower and riskier than after normal delivery.
Caesarean section
Caesarean section is a surgical incision in the abdomen through which the baby is taken directly out of the abdomen and delivered. In general, a caesarean section can be performed when it is not possible to safely complete a vaginal delivery or when there are life-threatening risks to the mother or baby with vaginal delivery.
Caesarean section may be required urgently while waiting for or following a normal delivery, or it may be planned in advance, i.e. elective.
Causes of caesarean section related to the baby:
– Disturbance of the baby’s heartbeat, distress.
– Disorders of the baby’s posture in the womb: inverted posture (breech presentation), side posture (transverse posture), forehead presentation, facial presentation
– Multiple pregnancies (twin or more pregnancies)
Causes of cesarean section related to the mother:
– Having had a previous uterine operation (removal of fibroids from the uterus, previous cesarean section, etc.)
– Some systemic diseases in the mother (diabetes, hypertension, high blood pressure due to pregnancy)
– Infections that can pass from the mother to the baby through vaginal delivery and cause infection in the baby (such as genital herpes…)
– Placental location abnormalities: Conditions such as placenta previa (placenta covering the cervix), vasa previa
Conditions that may require cesarean section while following vaginal delivery:
– Mismatch between the baby’s head and the mother’s genital canal
– Labor lasts longer than it should
– The baby is too big
– Prolapsed cord before the baby is born
Complications that may occur in cesarean delivery, an overview of the benefits and harms of cesarean section
A caesarean section is an abdominal operation, a surgery, and carries the same risks as any surgery. These include infection at the wound site, bleeding during surgery, formation of adhesions in the abdomen, increasing the likelihood that the next birth will be a cesarean section, and the possibility of injury to neighboring organs, most commonly the bladder (which is more likely in repeated cesarean sections). General anesthesia or regional anesthesia also has its own complications. In a normal delivery, the baby who passes through the birth canal gets rid of the fluid in the lungs more easily. In caesarean section, on the other hand, the likelihood of wet lung development, the baby’s inability to excrete fluids and the possibility of temporary respiratory problems in the baby are higher than in normal delivery. Recent studies on the microbiome suggest that babies born by caesarean section are more likely to develop diseases such as diabetes, celiac disease and asthma because they do not encounter the mother’s vaginal flora.
As for the benefits of cesarean section, first of all, cesarean section is a life-saving operation. It is an operation that saves the life of the mother and the baby at the right timing when the life of the mother and the baby is threatened in normal delivery. It is an operation that can prevent the development of spasticity or mental retardation in the baby when it is applied at the right time when the baby’s heartbeat and oxygenation problems develop during normal birth follow-up. Since the baby will not pass through the vaginal canal in cesarean delivery, the possibility of bladder and uterine prolapse and the possibility of urinary incontinence in the mother will be significantly less than normal delivery. Likewise, the feeling of vaginal dilatation will be much less common than in normal delivery. Caesarean section is painless compared to normal delivery, but the pain during the recovery period is more than normal delivery. Conditions such as shoulder impingement, which can be seen in normal delivery, and arm nerve paralysis due to this, and cephal hematoma, which may be seen in the baby in operative vaginal deliveries with vacuum or forceps, are not encountered in cesarean deliveries.
What is epidural delivery, when is it possible to have an epidural, can everyone have an epidural? What are the risks of epidural birth?
Normal birth with epidural analgesia, popularly known as painless birth or princess birth, has recently been widely used in private hospitals in our country. The pain of labor is alleviated with painkillers given intermittently through a soft thin catheter applied under the epidural membrane surrounding the spinal cord.
The expectant mother will still feel contractions, but there will be a significant reduction in pain. This allows the expectant mother to have a more comfortable birth. It is very important that the contractions do not go away completely, in order to achieve the sensation of pushing and to ensure pushing. In this case, dose adjustment is important and the anesthesiologist will perform the administration and dose adjustment.
The application of an epidural catheter in labor can prolong the labor time by 1-2 hours more than normal. For this reason, most doctors prefer to apply the epidural catheter when the active phase of labor begins, after the cervix opens 4-5 cm. However, there are also physicians who apply it as soon as the patient requests it without waiting for the active phase.
An epidural catheter may not be used in case of previous spinal operations, abnormally low blood clotting cells, or the use of blood thinners.
In deliveries with epidural analgesia, there is a possibility that the mother may lose the feeling of pushing. In this case, the mother may not be able to push adequately. For this reason, the possibility of using vacuum and forceps in normal deliveries with epidural analgesia is higher than in deliveries without epidural. Vacuum and forceps also have some risks for mother and baby.
On the other hand, in a controlled epidural analgesia, i.e. when the mother has the sensation of pushing but the pain is reduced, the mother is better able to listen to the doctor’s instructions, push where the doctor tells her to push and slow down where the doctor tells her to slow down. Uncontrolled pushing can therefore be prevented and vaginal injury is less likely to occur.
With epidural analgesia, the mother may have a more positive birth process because she feels less pain. She may have more energy. If, on the other hand, the pushing sensation decreases in contrast, she may exert herself more and more for longer, which can lead to fatigue in the mother.
Headache may occur in 1/100 of patients with an epidural catheter. Drugs administered through the epidural catheter may cause nausea and itching, especially on the face.
The use of epidural analgesia in labor, which has its advantages and disadvantages, should be left entirely to the mother’s own choice and desire. An expectant mother who has never wanted epidural anesthesia may suddenly change her mind, or an expectant mother with an epidural plan may easily give birth before the epidural procedure is administered.
Current Information on Water Birth
Water birth is practiced in many parts of the world, including Turkey. Although there are many different opinions, the most recent article by the American Obstetrics and Gynecology Association states the following.
In terms of shortening the first stage of labor and reducing the use of epidural analgesia, it can be recommended for healthy and problematic pregnant women who start labor between 37-42 weeks of gestation to spend the first stage of labor. It does not seem to carry an increased risk of side effects for mother and baby.
However, there is not enough data on the second stage of labor, i.e. the stage of the baby being born. Therefore, until sufficient data is available, the American College of Obstetrics and Gynecology (ACOG) recommends that the birth itself should take place on land, not in water.
It should be ensured that the infection control of the equipment related to water birth is adequate, that the experience of the team is sufficient, and that transfer from the water can be provided quickly and effectively in case of an emergency.
Here again, the choice is the mother’s. Although there is information that water birth reduces the mother’s pain and facilitates labor by reducing the need for epidural, it should be decided knowing that there is still not enough data and information available in terms of risks that may occur during labor, and detailed consent should be obtained from her.
Hypnobirthing method
Hypnobirthing is a form of childbirth applied by getting rid of the fears and anxieties in the subconscious of the person and providing awareness with deep relaxation methods. By getting rid of myths, the birth of the expectant mother, who experiences less fear and anxiety, progresses in a more controlled and natural course. Hypnobirthing can be applied by experienced physicians who are specialized in this field and have participated in the certification program.