BIRTH PROCESS, Birth

 

Birth

Nature writes the basic script for how birth occurs, but parents make important choices about conditions surrounding birth. We look first at the sequence of physical steps when a child is born.

THE BIRTH PROCESS

The birth process occurs in stages, occurs in different contexts, and in most cases involves one or more attendants.

Stages of Birth

The birth process occurs in three stages. The first stage is the longest of the three stages. Uterine contractions are 15 to 20 minutes apart at the beginning and last up to a minute. These contractions cause the woman’s cervix to stretch and open. As the first stage progresses, the contractions come closer together, appearing every two to five minutes. Their intensity increases. By the end of the first birth stage, contractions dilate the cervix to an opening of about 10 centimeters (4 inches), so that the baby can move from the uterus to the birth canal. For a woman having her first child, the first stage lasts an average of 6 to 12 hours; for subsequent children, this stage typically is much shorter.

The second birth stage begins when the baby’s head starts to move through the cervix and the birth canal. It terminates when the baby completely emerges from the mother’s body. With each contraction, the mother bears down hard to push the baby out of her body. By the time the baby’s head is out of the mother’s body, the contractions come almost every minute and last for about a minute. This stage typically lasts approximately 45 minutes to an hour.

Afterbirth is the third stage, at which time the placenta, umbilical cord, and other membranes are detached and expelled. This final stage is the shortest of the three birth stages, lasting only minutes.

Childbirth Setting and Attendants

In the United States, 99 percent of births take place in hospitals, a figure that has remained constant for several decades (Martin & others, 2005). Who helps a mother during birth varies across cultures. In U.S. hospitals, it has become the norm for fathers or birth coaches to be with the mother throughout labor and delivery. In the East African Nigoni culture, men are completely excluded from the childbirth process. When a woman is ready to give birth, female relatives move into the woman’s hut and the husband leaves, taking his belongings (clothes, tools, weapons, and so on) with him. He is not permitted to return until after the baby is born. In some cultures, childbirth is an open, community affair. For example, in the Pukapukan culture in the Pacific Islands, women give birth in a shelter that is open for villagers to observe.

Midwives

Midwifery is practiced in most countries throughout the world (Wickham, 2009). In Holland, more than 40 percent of babies are delivered by midwives rather than doctors. However, in 2003, 91 percent of U.S. births were attended by physicians, and only 8 percent of women who delivered babies were attended by a midwife (Martin & others, 2005). Nonetheless, the 8 percent figure in 2003 represents a substantial increase from less than 1 percent of U.S. women attended by a midwife in 1975 (Martin & others, 2005). Ninety-five percent of the midwives who delivered babies in the United States in 2003 were certified nurse-midwives.

Doulas

In some countries, a doula attends a childbearing woman. Doula is a Greek word that means “a woman who helps.” A doula is a caregiver who provides continuous physical, emotional, and educational support for the mother before, during, and after childbirth. Doulas remain with the parents throughout labor, assessing and responding to the mother’s needs. Researchers have found positive effects when a doula is present at the birth of a child (Berghella, Baxter, & Chauhan, 2008).

In the United States, most doulas work as independent providers hired by the expectant parents. Doulas typically function as part of a “birthing team,” serving as an adjunct to the midwife or the hospital’s obstetric staff.

Methods of Childbirth

U.S. hospitals often allow the mother and her obstetrician a range of options regarding their method of delivery. Key choices involve the use of medication, whether to use any of a number of nonmedicated techniques to reduce pain, and when to have a cesarean delivery.

Medication

Three basic kinds of drugs that are used for labor are analgesia, anesthesia, and oxytocin/pitocin.

Analgesia is used to relieve pain. Analgesics include tranquilizers, barbiturates, and narcotics (such as Demerol).

Anesthesia is used in late first-stage labor and during delivery to block sensation in an area of the body or to block consciousness. There is a trend toward not using general anesthesia, which blocks consciousness, in normal births because general anesthesia can be transmitted through the placenta to the fetus (Lieberman & others, 2005). An epidural block is regional anesthesia that numbs the woman’s body from the waist down. Researchers are continuing to explore safer drug mixtures for use at lower doses to improve the effectiveness and safety of epidural anesthesia (Balaji, Dhillon, & Russell, 2009).

Oxytocin is a synthetic hormone that is used to stimulate contractions; pitocin is the most widely used oxytocin. The benefits and risks of oxytocin as a part of childbirth continues to be debated (Vasdev, 2008).

Predicting how a drug will affect an individual woman and her fetus is difficult (Lowdermilk, Perry, & Cashion, 2011). A particular drug might have only a minimal effect on one fetus yet have a much stronger effect on another. The drug’s dosage also is a factor (Weiner & Buhimschi, 2009). Stronger doses of tranquilizers and narcotics given to decrease the mother’s pain potentially have a more negative effect on the fetus than mild doses. It is important for the mother to assess her level of pain and have a voice in the decision of whether she should receive medication.

Natural and Prepared Childbirth

For a brief time not long ago, the idea of avoiding all medication during childbirth gained favor in the United States. Instead, many women chose to reduce the pain of childbirth through techniques known as natural childbirth and prepared childbirth. Today, at least some medication is used in the typical childbirth, but elements of natural childbirth and prepared childbirth remain popular (Oates & Abraham, 2010).

Natural childbirth is the method that aims to reduce the mother’s pain by decreasing her fear through education about childbirth and by teaching her and her partner to use breathing methods and relaxation techniques during delivery.

French obstetrician Ferdinand Lamaze developed a method similar to natural childbirth that is known as prepared childbirth, or the Lamaze method. It includes a special breathing technique to control pushing in the final stages of labor, as well as more detailed education about anatomy and physiology. The Lamaze method has become very popular in the United States. The pregnant woman’s partner usually serves as a coach, who attends childbirth classes with her and helps her with her breathing and relaxation during delivery.

In sum, proponents of current prepared childbirth methods conclude that when information and support are provided, women know how to give birth.

Cesarean Delivery

Normally, the baby’s head comes through the vagina first. But if the baby is in a breech position, the baby’s buttocks are the first part to emerge from the vagina. In 1 of every 25 deliveries, the baby’s head is still in the uterus when the rest of the body is out. Breech births can cause respiratory problems. As a result, if the baby is in a breech position, a surgical procedure known as a cesarean section, or a cesarean delivery, is usually performed. In a cesarean delivery, the baby is removed from the mother’s uterus through an incision made in her abdomen (Lee, El-Sayed, & Gould, 2008). The benefits and risks of cesarean sections continue to be debated (Bangdiwala & others, 2010).