Section 4: Birth and the Newborn
4.1 Childbirth
What is the process of childbirth?
Learning Objectives
- Describe various approaches to childbirth
- Describe a normal delivery, including the stages of childbirth
Approaching Childbirth
Prepared childbirth refers to being not only physically in good condition to help provide a healthy environment for the baby to develop but also helping a couple to prepare to accept their new roles as parents and to get information and training that will assist them for delivery and life with the baby as much as possible. The more a couple can learn about childbirth and the newborn, the better prepared they will be for the adjustment they must make to a new life. Nothing can prepare a couple for this completely.
Once a couple finds out they are having a child, they begin to conjure up images of what they think the experience will involve. Once the child is born, they must reconcile those images with reality (Galinsky, 1987). Knowing more about what to expect helps them form more realistic images, thus making the adjustment easier. Let’s explore some of the methods of prepared childbirth.
Choices and decisions: There are numerous decisions and choices that can be made, such as what type of a practitioner will oversee one’s care, whether the delivery will occur at home or in a facility, vaginally or by Cesarean, and what, if any, pain management will be used.
HypnoBirthing
Grantley Dick-Read was an English obstetrician and pioneer of prepared childbirth in the 1930s. In his book Childbirth Without Fear, he suggests that the fear of childbirth increases tension and makes the process of childbearing more painful. He believed that if mothers were educated, the fear and tension would be reduced, and the need for medication could frequently be eliminated. The Dick-Read method emphasized the use of relaxation and proper breathing with contractions, as well as family support and education. Today, this method is known as the Mongan Method or HypnoBirthing. Women using this method report feeling like they are lost in a daydream but focused and in control.
The Lamaze Method
This method originated in Russia and was brought to the United States in the 1950s by Fernand Lamaze. The emphasis of this method is on teaching the woman to be in control of the process of delivery. It includes learning muscle relaxation, breathing through contractions, having a focal point (usually a picture to look at) during contractions, and having a support person who goes through the training process with the mother and serves as a coach during delivery. The Lamaze Method is still the most commonly taught method in the U.S. today.
The Bradley Method
This method originated in the late 1940s and helps women deliver naturally, with few or no drugs. There are a series of courses that emphasize excellent nutrition and exercise, relaxation techniques to manage pain, and the involvement of the partner as a coach. Parents-to-be are taught to be knowledgeable consumers of birth services and to take responsibility for making informed decisions regarding procedures, attendants, and the birthplace. In turn, this will lead to keeping mothers healthy and low-risk in order to avoid complications that may lead to medical intervention.
Nurse Midwives
Historically, in the United States, most babies were born under the care of lay midwives. In the 1920s, middle-class women were increasingly using doctors to assist with childbirth, but lay midwives were still assisting rural women. The nursing profession began educating nurse-midwives to assist these women. Nurse-midwives continued to assist most rural women with delivery until the 1970s and 1980s when their growth is thought to have posed a threat to the medical profession (Weitz, 2007). Women who are at low risk for birth complications can successfully deliver under the care of nurse-midwives. Some hospitals give privileges to nurse-midwives to deliver there. They may also deliver babies at home or in birthing centers.
Home Birth
Because one out of every 20 births involves a complication, most medical professionals recommend that delivery take place in a hospital. However, some couples choose to have their baby at home. About 1 percent of births occur outside of a hospital in the United States. Two-thirds of these are home births, and more than half of these are assisted by midwives. In the United States, women who have had previous children who are over 25 and who are white are most likely not to give birth in a hospital (MacDorman et al., 2010).
Birthing Centers
A birthing center presents a more home-like environment than a hospital labor ward, typically with more options during labor: food/drink, music, and the attendance of family and friends if desired. Other characteristics can also include non-institutional furniture such as queen-sized beds, large enough for both parents, and perhaps birthing tubs or showers for water births. The decor is meant to emphasize the normality of birth. In a birth center, women are free to act more spontaneously during their birth, such as squatting, walking, or performing other postures that assist in labor. Active birth is encouraged. The length of stay after birth is shorter at a birth center; sometimes, just 6 hours after birth, the mother and infant can go home. One-third of out-of-hospital births occur in freestanding clinics, birthing centers, physicians’ offices, or other locations.
Water Birth
Laboring and/or giving birth in a warm tub of water can help a woman relax. The buoyancy of the water can help alleviate discomfort and pressure for the mother. Many hospitals have birthing tubs that allow women to labor in them. However, only some hospitals allow births to take place in the water. Some believe that water birth gives a more calm and tranquil transition for the baby from the womb. Water births are more common at home or in birthing centers.
Hospital Birth
Most births in the U.S. occur in hospitals. Mothers have the choice to have a medicated or unmedicated delivery. Some women do fine with “natural methods” of pain relief alone. Many women blend “natural methods” with medications and medical interventions that relieve pain. Building a positive outlook on childbirth and managing fear may also help some women cope with the pain. Labor pain is not like pain due to illness or injury. Instead, it is caused by contractions of the uterus that are pushing the baby down and out of the birth canal. In other words, labor pain has a purpose.
Many women who give birth at hospitals use epidural anesthesia during delivery (American Pregnancy Association, 2015). An epidural block is a regional analgesic that can be used during labor and alleviates most pain in the lower body without slowing labor. The epidural block can be used throughout labor and has little to no effect on the baby. Medication is injected into a small space outside the spinal cord in the lower back. It takes 10 to 20 minutes for the medication to take effect. An epidural block with stronger medications, such as anesthetics, can be used shortly before a C-section or if a vaginal birth requires the use of forceps or vacuum extraction.
A Cesarean section (C-section) is surgery to deliver the baby by being removed through the mother’s abdomen. Since 1996, c-sections have been on an almost steady rise in the United States. In 2018, approximately one-third (31.9%) of all births occurred through cesarean delivery (Martin et al., 2019).
Most C-sections are done when problems occur during delivery unexpectedly. These can include:
- Health problems in the mother.
- Signs of distress in the baby.
- Not enough room for the baby to go through the vagina.
- The position of the baby, such as a breech presentation where the head is not in the downward position.
C-sections are also more common among women carrying more than one fetus. This surgery is relatively safe for mother and baby, but it is considered a major surgery and carries health risks. And it typically takes longer to recover from a C-section than from a vaginal birth. After healing, the incision may leave a weak spot in the wall of the uterus. This could cause problems with an attempted vaginal birth later. However, many women who have a C-section deliver vaginally after a C-section. Click this link to learn more about options available for childbirth preparation: ACOG Labor and Delivery.
Another form of pharmacologic pain relief available for laboring mothers is inhaled nitrous oxide. This is typically a 50/50 mixture of nitrous oxide with air that is an inhaled analgesic and anesthetic. Nitrous oxide has been used for pain management in childbirth since the late 1800s. Inhaled analgesia is commonly used in the UK, Finland, Australia, Singapore, and New Zealand, and it is gaining popularity in the United States. More quality research is needed to evaluate its effectiveness and any adverse effects (Likis et al., 2014).
Father/Partner Involvement
Women whose partners were involved in their pregnancy received more prenatal care and were more likely to adopt healthy behaviors (Martin et al., 2007). According to Johansson et al. (2015), expecting partners’ birth experiences are multidimensional: many want to be involved in the birthing process and benefit from active preparation.
During pregnancy, some partners experience a sympathetic pregnancy or couvade syndrome (Devi & Chanu, 2015). Common symptoms were weight gain, changes in appetite, and taking on some of the negative emotions of their partner (Kazmierczak et al., 2013).
Making a Birth Plan
As you can see, women have many choices when it comes to the approach they want to take in preparing for childbirth. What decisions would you make? Learn how to create a birth plan.
Stages of Birth for Vaginal Delivery
For vaginal birth to occur, the cervix must dilate fully to 10 cm in diameter—wide enough to deliver the newborn’s head. The dilation stage is the longest stage of labor and typically takes 6–12 hours. However, it varies widely and may take minutes, hours, or days, depending in part on whether the mother has given birth before; in each subsequent labor, this stage tends to be shorter.
The first stage of labor: Cervical Dilation
The first stage is typically the longest. It begins with uterine contractions that may initially last about 30 seconds and be spaced 15-20 minutes apart. These increase in duration and frequency to more than a minute in length and about 3 to 4 minutes apart. Typically, practitioners advise that they should be contacted about every five minutes when contractions occur. Some women experience false labor or Braxton-Hicks contractions, especially with the first child. These may come and go. They tend to diminish when the woman begins walking around. Real labor pains tend to increase with walking.
True labor progresses in a positive feedback loop in which uterine contractions stretch the cervix, causing it to dilate and efface or become thinner. Cervical stretching induces reflexive uterine contractions that dilate and efface the cervix further. In addition, cervical dilation boosts oxytocin secretion from the pituitary, which in turn triggers more powerful uterine contractions.
When labor begins, uterine contractions may occur only every 3–30 minutes and last only 20–40 seconds; however, by the end of this stage, contractions may occur as frequently as every 1.5–2 minutes and last for a full minute. During this stage, the cervix or opening to the uterus dilates to 10 centimeters or just under four inches. This may take around 12-16 hours for first children, about 6-9 hours for women who have previously given birth, and it may take up to 24 hours for others.
Labor may also begin with a discharge of blood or amniotic fluid. If the amniotic sack breaks, labor will be induced (if necessary) to reduce the risk of infection. The amniotic membranes rupture before the onset of labor in about 12 percent of women; they typically rupture at the end of the dilation stage in response to excessive pressure from the fetal head entering the birth canal (Goerling and Wolfe, 2022).
A baby’s arrival may need to be induced or delivered before labor begins if there is concern for the health of the mother or baby. For example:
- The mother is approaching two weeks beyond her due date, and labor has not started naturally.
- The mother’s water has broken, but contractions have not begun.
- There is an infection in the mother’s uterus.
- The fetus has stopped growing at the expected pace.
- There is not enough amniotic fluid surrounding the fetus.
- The placenta peels away, either partially or completely, from the inner wall of the uterus before delivery.
- The mother has a medical condition that might put her or her baby at risk, such as high blood pressure or diabetes (Mayo Clinic, 2014).
By the end of this stage, contractions may occur as frequently as every 1.5–2 minutes and last for a full minute.
The second stage: Expulsion
The expulsion stage begins when the fetal head enters the birth canal and ends with the birth of the newborn. It typically takes up to 2 hours, but it can last longer or be completed in minutes, depending in part on the orientation of the fetus. The vertex presentation known as the occiput anterior vertex is the most common presentation and is associated with the greatest ease of vaginal birth. The fetus faces the maternal spinal cord, and the smallest part of the head (the posterior aspect called the occiput) exits the birth canal first.
Vaginal birth is associated with significant stretching of the vaginal canal, the cervix, and the perineum. Until recent decades, it was a routine procedure for an obstetrician to numb the perineum and perform an episiotomy, an incision in the posterior vaginal wall and perineum. The perineum is now more commonly allowed to tear on its own during birth. Both an episiotomy and a perineal tear need to be sutured shortly after birth to ensure optimal healing. Although suturing the jagged edges of a perineal tear may be more difficult than suturing an episiotomy, tears heal more quickly, are less painful, and are associated with less damage to the muscles around the vagina and rectum.
Upon birthing the newborn’s head, an obstetrician aspirates mucus from the mouth and nose before the newborn’s first breath. Once the head is birthed, the rest of the body usually follows quickly. The umbilical cord is then double-clamped, and a cut is made between the clamps. This completes the second stage of childbirth.
The third stage: Afterbirth
The delivery of the placenta and associated membranes, commonly referred to as the afterbirth, marks the final stage of childbirth (Figure 4). After the expulsion of the newborn, the myometrium continues to contract. This movement shears the placenta from the back of the uterine wall. It is then easily delivered through the vagina. Continued uterine contractions then reduce blood loss from the site of the placenta. Delivery of the placenta marks the beginning of the postpartum period—the period of approximately 6 weeks immediately following childbirth, during which the pregnant person’s body gradually returns to a non-pregnant state. If the placenta does not birth spontaneously within approximately 30 minutes, it is considered retained, and the obstetrician may attempt manual removal. If this is not successful, surgery may be required.
It is important that the obstetrician examines the expelled placenta and fetal membranes to ensure that they are intact. If fragments of the placenta remain in the uterus, they can cause postpartum hemorrhage. Uterine contractions continue for several hours after birth to return the uterus to its pre-pregnancy size in a process called involution, which also allows the abdominal organs to return to their pre-pregnancy locations. Breastfeeding facilitates this process. We will learn more about breastfeeding and the life of a newborn in the next section.
Think About It: The Placenta
The placenta often plays an important role in various cultures, with many societies conducting rituals regarding its disposal. In the Western world, the placenta is most often incinerated.
Some cultures bury the placenta for various reasons. The Māori of New Zealand traditionally bury the placenta from a newborn child to emphasize the relationship between humans and the earth. Likewise, the Navajo bury the placenta and umbilical cord at a specially chosen site, particularly if the baby dies during birth. In Cambodia and Costa Rica, the burial of the placenta is believed to protect and ensure the health of the baby and the mother. If a mother dies in childbirth, the Aymara of Bolivia bury the placenta in a secret place so that the mother’s spirit will not return to claim her baby’s life.
The placenta is believed by some communities to have power over the lives of the baby or its parents. The Kwakiutl of British Columbia bury girls’ placentas to give the girl skill in digging clams and expose boys’ placentas to ravens to encourage future prophetic visions. In Turkey, the proper disposal of the placenta and umbilical cord is believed to promote devoutness in the child later in life. In Transylvania and Japan, interaction with a disposed placenta is thought to influence the parents’ future fertility.
Several cultures believe the placenta to be or have been alive, often a relative of the baby. Nepalese think of the placenta as a friend of the baby; Malaysian Orang Asli regards it as the baby’s older sibling. Native Hawaiians believe that the placenta is a part of the baby and traditionally plant it with a tree that can then grow alongside the child. Various cultures in Indonesia, such as Javanese, believe that the placenta has a spirit and needs to be buried outside the family house.
In some cultures, the placenta is eaten, a practice known as placentophagy. In some eastern cultures, such as China, the dried placenta (ziheche, literally “purple river car”) is thought to be a healthful restorative. It is sometimes used in preparations of traditional Chinese medicine and various health products. The practice of human placentophagy has become a more recent trend in Western cultures and is not without controversy. Some cultures have alternative uses for the placenta, including the manufacturing of cosmetics, pharmaceuticals, and food.
Video Example
Watch “Life’s Greatest Miracle”
Watch it: Vaginal and Cesarean Birth
Attributions
Human Growth and Development by Ryan Newton is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License,
Individual and Family Development, Health, and Well-being by Diana Lang, Nick Cone; Laura Overstreet, Stephanie Loalada; Suzanne Valentine-French, Martha Lally; Julie Lazzara, and Jamie Skow is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License,
Human Development by Human Development Teaching & Learning Group under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License,
References
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