Each natural delivery of a baby features its particular course and intensity of sensation of the mother. In general, the delivery itself can be divided into several stages:
Latent stage – the cervix dilates from zero to four centimeters
Active stage – the cervix dilates from four centimeters to the moment when the cervix fully dilates and is completely open, followed by the birth of the baby and the delivery of the placenta
Latent stage of labour
This stage always starts smoothly! The initial contractions may be confused with the preparatory ones and the mother may not feel any pain except some pressure in her abdomen, tightening and discomfort. In the beginning the contractions occur at longer intervals but gradually the intervals become shorter. At the same time the contractions last longer and become more intense. If you feel an increased and frequent need to urinate, it may be a sign of contractions but you may not feel any pain or pressure.
The latent stage of labour continues until the cervix is dilated approximately up to 4 cm. When the amniotic sac has not ruptured (the water has not broken) it is normal for the labour to stop and to start again a few hours later (or even a few days). This is why we call this phase "latent stage" – at this phase of labour the mother is not given any stimulation or pain relief medications, except when there are some obvious problems (the baby is not in a good health or the baby is over mature, or there are some signs of deviations from a normal birth).
If you are admitted to the hospital at this point of the labour phase, your contractions are very likely to stop (you may experience stress because of the different atmosphere in the hospital). During this phase of labour epidural analgesia is NOT applied!
Active stage of labour
The active stage goes through several phases, such as:
1. The cervix dilates and the presenting part descends in the bony birth canal and the membranes of the amniotic sac rupture;
2. Delivery of the baby;
3. Delivery of the placenta.
Namely this phase of the delivery often becomes part of exciting stories; this is why here we will explain in detail what happens during each phase of the delivery.
Dilation of the cervix
The first phase of the active stage includes the dilation of the cervix, descent of the presenting part through the bony birth canal and the rupture of the membranes of the amniotic sac:
Dilation of the cervix:
During this phase the amount of time spent when the cervix dilates varies and is different in different women, depending on their individual health condition and the type of their contractions. The typical “complete” dilation is considered to be about 10 centimeters. In fact a complete dilation of the cervix is dilation when your baby can pass through the cervix! At this point of the delivery are applied medications for stimulation and pain relief. Epidural analgesia is often applied along with the stimulation of the labor (most commonly by intravenous oxytocin).
Moving your body and changing your position frequently are a natural way to help you speed up the process of labour. For this purpose you can use the birthing balls, the sling for support, the wall ladder and the mattresses. Some warm water on the painful areas may have a good analgesic, relaxing and moisturizing effect. You can use the bathroom and the shower. Usually in the active labour the cervix dilates with a centimeter at every hour. (The active labour is considered to be the condition when the contractions last over a period of more than an hour, with a peak of 30-40 seconds each one and the interval between them is about 5 minutes). If the mother drinks some water during this period she should do it in small sips to ensure good wetting of her mouth and throat. Some sugar candy will provide quickly pure glucose, which is necessary for the muscle work of the uterus during the uterine contractions.
Rupture of the amniotic sac:
In a natural delivery the membranes of the amniotic sac rupture spontaneously when there is a dilation of the cervix of 6-7 cm. The function of the amniotic sac during the rupturing is to soften the pressure on the cervix. Thus the sensation of pain is weaker and the dilation of the cervix does not happen rapidly. In either case (a spontaneous rupture of the amniotic sac or with the help of a doctor) once the amniotic sac is ruptured, the feeling of pain becomes more intense because of the greater pressure against the cervix (caused by the baby’s head).
The early spontaneous opening of the amniotic sac does not mean "dry birth." The rest of the amniotic fluid behind the baby's head continues to leak slowly (mostly during the contractions), making the birth canal wet and slippery. The artificial opening of the membranes serves as a non-drug natural way of speeding up of the delivery. In a situation of delayed delivery when there is an appropriate cervical dilation, it is recommended the rupture of the amniotic sac to be induced by a doctor/a midwife.
The presenting part descends in the bony birth canal:
The descending of the baby’s head into the pelvis does not mean simply that it moves down. The pelvis has its own specific structure, narrow areas, extended areas and curves.
Forced by the contractions, the baby’s head gradually adjusts its shape and position to the pelvis so that the less wide dimensions of the head can pass through the widest part of the bony birth canal. The process is slow and happens simultaneously (in a normally progressing labor) with the dilation of the cervix.
The duration of the rotation and the descent of the presenting part dependens in most cases on the type of the pelvis, the size of the baby and its individual abilities to adapt, as well as on the uterine contractions. If the woman in labour tries to walk and stand up when the labour has started it may enable and additionally stimulate the descent (along with the role of the uterine contractions and the gravity).
The baby’s condition is observed by periodic monitoring of the baby’s heart tones and, if necessary, they are recorded with the use of an obstetric monitor. The vaginal examinations (shading) are usually carried out approximately every two hours (and if necessary, more often) so that the progress of the labor can be determined.
Delivery of the baby
The delivery of the newborn is conducted in the delivery room, under the supervision and guidance of an obstetrician/midwife and a physician. In cases when epidural analgesia is applied our team of anesthesiologists take care of the woman in labour. A pediatrician is ready to take care of and (if necessary) resuscitate the newborn.
Body position at the time of delivery:
The beds in our Maternity ward allow a choice of different body positions and it is desirable that before the onset of the pushing you find out together with the midwife which position is most comfortable for you during your labour.
At this point of the delivery there is no sensation of pain - now it is replaced by an urge to push. You should wait until the urge to push becomes most intense and then perform a push with your abdominal muscles and diaphragm. A semi-erect body posture will enable the mother to perform a push and it will reduce the pressure on the soft tissues of the pelvic outlet and prevent injuries.
Baby’s heart rate is checked after each contraction which ensures a timely assessment of the baby’s condition and behavior and reassessment of the approach applied if there is a risk to the baby’s life and health!
When the midwife/obstetrician that helps you, gives you a signal and tells you to stop pushing and start breathing, try to follow her instructions - at this point she/he is helping you so that the delivery of the baby's head can go smoothly and any possible injuries and lacerations can be avoided!
The delivery of the baby's shoulders and body usually does not cause problems. If you have difficulty during this phase, you should follow the instructions of the midwife and the physician who will guide you and help the baby shoulders to be delivered properly.
Delivery of the placenta
At the phase when the placenta is delivered there is no feeling of pain and the medical staff will ask you to push to deliver the placenta spontaneously or they will enable the process by applying light pressure on your uterus. Medication is often applied to speed up the delivery of the placenta (intravenous infusion, most often it is methergine/ oxytocin in case of epidural analgesia), and to reduce blood loss.
After the separation of the placenta and its delivery, the placenta is observed so that the placental integrity can be evaluated. If there is doubt about some parts of the placenta that may have left after the separation of the placenta, the uterine cavity is cleaned with special instruments (revision of the uterine cavity). The manipulation is performed under short intravenous anesthesia (you will sleep for about ten minutes) or under analgesia performed through an epidural catheter (in case of epidural analgesia). When intrauterine manipulations are applied, the standards of good medical practice require the application of intravenous antibiotics.
If you have chosen to store your baby’s stem cells, after the umbilical cord has been cut, a specialist will collect the blood that has remained in the umbilical cord and the placenta. You should notify the team about your decision to store the stem cells, as well as the team of the tissue bank that you have previously chosen. They should be at the hospital (the delivery room) at the time of the delivery of your baby.
If you do not wish to store stem cells, after the delivery of the placenta and its observation, the placenta is processed according to the Biowaste Ordinance. An observation of the soft birth canal is carried out after each vaginal birth, and if there are some lacerations they are repaired with sterile instruments and suture materials. The restoration is conducted with local anesthesia, under epidural analgesia, or if necessary a short intravenous anesthesia.
When the delivery is completed it is described in the Labor and Delivery Record (LDR), the Birth Record and in the Registry Book of the Delivery room. During the next two hours after the delivery you and your baby will be under constant observation in the delivery room. When this early postpartum period goes smoothly, there will be some time when you will start walking and moving your body and you and your baby will be transferred to the postnatal clinic.