The Process of Delivery

Vaginal Delivery

The First Stage of Labor

During this stage, the cervix or opening to the uterus dilates to 10 centimeters or just under 4 inches. This may take around 12-16 hours for first children or about 6-9 hours for individuals who have previously given birth. In one in 9 labors, it takes over 24 hours for the cervix to dilate completely. Labor may also begin with a discharge of blood or amniotic fluid. If the amniotic sack breaks, which happens for one out of eight pregnancies, labor will be induced if necessary to reduce the risk of infection.

Video 5.4 Labor (Parturition)

The Second Stage of Labor

The second stage involves the passage of the baby through the birth canal. This stage takes about 30 minutes to 3 hours. Contractions usually come about every 2-3 minutes. The individual pushes and relaxes as directed by the medical staff. Normally the head is delivered first. The baby is then rotated so that one shoulder can come through and then the other shoulder. The rest of the baby quickly passes through. At this stage, an episiotomy, or incision made in the tissue between the vaginal opening and anus, may be performed to avoid tearing the tissue of the back of the vaginal opening. The baby’s mouth and nose are suctioned out. The umbilical cord is clamped and cut.

Video 5.5 Labor

The Third Stage of Labor

The third stage is relatively painless in comparison to the other stages. During this stage, the placenta or afterbirth is delivered. This typically occurs within 20 minutes after the delivery of the baby. If an episiotomy was performed during birth, it is stitched up during this stage.

Cesarean Delivery

Cesarean section, also known as C-section, or cesarean delivery, is the use of surgery to deliver babies. A cesarean section is often necessary when a vaginal delivery would put the baby or parent at risk. This may include obstructed labor, twin pregnancy, high blood pressure in the pregnant parent, breech birth, or problems with the placenta or umbilical cord. Cesarean delivery may be performed based upon the shape of the parent’s pelvis or history of a previous C-section.

The World Health Organization recommends that cesarean section be performed only when medically necessary. Some C-sections are performed without a medical reason, upon request by someone, usually the pregnant individual.

In recent years, some hospitals have begun to offer an adapted form of the C-section, termed a family-centered C-section or a gentle C-section. This method of birthing arranges for the C-section to occur using less restrictive equipment and for the newborn to be placed on the parent’s chest following birth allowing for earlier skin-to-skin contact. Gentle C-sections result in greater satisfaction with the birth and less fear compared to traditional C-sections (Onsea et al., 2018).

Although the surgery is relatively safe for mother and baby, it is considered major surgery and carries health risks. Additionally, it also takes longer to recover from a C-section than from 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. In the past, doctors were hesitant to allow a vaginal birth after a C-section. However, there have been recent changes in this recommendation and some women may have a vaginal birth after a C-section (VBAC). According to a review of the literature, factors such as maternal age, medical risks, and previous birth history should be considered when determining the likely success of a VBAC (Wu et al., 2019).