Giving birth | Birthing methods | Natural Childbirth | Epidural | Water birth | Lamaze | Cesarean Section | Going into labour

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Women's bodies are designed to give birth.but there is no one right way to give birth.There are a variety of options open to pregnant women. Each birth is unique and woman have the right to choose the method she feels will best suit her needs.

For some that may be a hospital. For others it may mean at home or in an alternative birthing center.

Your baby has two ways out: a vaginal delivery or through a Cesarean section (surgery procedure).

 

BIRTHING METHODS:

 

NATURAL BIRTH

For the mother, a natural birth increases the probability of a healthier postnatal period and an easier recovery due to fewer post-intervention discomforts including recovery from major abdominal surgery (caesarean section), instrumental delivery (by forceps or vacuum), cutting of the perineum (called episiotomy), bruises from IV lines, or severe headache or backache due to a possible side effect of epidurals.

 

For the infant, a natural birth reduces the exposure to narcotics and drugs that augment labour.

 

A natural birth also reduces the likelihood of needing to separate the infant from its mother after birth. This is important, as immediate skin-to-skin maternal contact and breastfeeding in the first hour after birth increases the likelihood of successful breastfeeding for a longer duration.

 

It is important to prepare a birth plan before arriving at the hospital to be sure that the staff is aware of your choices. Having a written birth plan that has been pre-approved by your doctor or midwife will help ease the stress of making a decision during labour, when the pain is very real and strong. In addition, if the staff knows that pain intervention is not an option, it won't be offered.

 

Lithotomy position

In the lithotomy position the mother is lying on her back with her legs up in stirrups and her buttocks close to the edge of the table.This position is convenient for the caregiver since it enables him or her more access to the perineum. However this is not a comfortable position for most patients considering the pressure on the vaginal walls due to the baby's head is uneven and the labour process is against gravity.

Squatting position

The squatting position increases pressure in the pelvic cavity with minimal muscular effort. The birth canal will open 20 to 30% more in a squat than in any other position. It is recommended for the second stage of childbirth.] As most Western adults find it difficult to squat with heels down, compromises are often made such as putting a support under the elevated heels or having another person support the squatter.

This position may be difficult to maintain during the birth process since it can become uncomfortable or tiring.

The squatting position opens the pelvis outlet and stretches the perineum naturally making it easier to push. An advantage to this is that there is even pressure on the vagina from the head of the baby.

All-fours

Some mothers may choose this position instinctively. It can help the baby turn around in the case of a malpresentation of the head. Since this position utilizes gravity it also decreases back pain.

The reduction of back pain is due to the ability for the mother to tilt her hips.

Side lying

Side lying may help slow the baby's descent down the birth canal giving the perineum more time to naturally stretch. To assume this position the mother lies on her side with her knees bent. To push a slight rolling movement to be propped up on one elbow is needed while one leg is held up. This position does not use gravity but still holds an advantage over the lithotomy position since it does not weigh the vena cava under the uterus so that blood flow to both mother and baby are reduced.

http://en.wikipedia.org/wiki/Natural_childbirth

 

PRO'S

  • Most women's bodies are designed to give birth naturally
  • There are no side effects from drugs or invasive surgery
  • This means that the recovery time is much quicker than it would be after a cesarean birth
  • There is usually a strong feeling of accomplishment afterward.
  • You will be awake and active during labour and birth and can move find positions that help with the birth process.
  • You're less likely than women who get epidurals to need interventions such as oxytocin (Pitocin) to make your contractions stronger, bladder catheterization, or a vacuum extraction or forceps delivery.
  • Your partner can be involved in the process to help guide you with breathing exercises, visualization, and self-hypnosis
  • Baby is more able to be alert and placed on the mother's skin (promoting maternal bonding) and breastfeeding is more likely to be enjoyable and successful

CON'S

  • Natural Childbirth can be rather painful. Natural childbirth does not eliminate pain  - mothers will feel everything connected with childbirth, from the labour, to the pushin. Mothers only have the choice of breathing, meditation, and changing their positions to help lighten the pain that they feel during childbirth.
  • Can lead to prolonged labour  - mothers who have low tolerances for pain tend to be weak when they need to push hard.
  • Natural childbirth can wear mothers out. Because there is no pain management, mothers usually end up being exhausted, leaving them with no strength to continue.
  • Various medical situations can affect both the mother and the baby, so there are doctors who are strongly against natural childbirth in complicated cases.
  • Natural childbirth can heighten the risks of blood loss

 

Water birth

Water birth is a method of giving birth, which involves immersion in warm water.

 

Proponents believe that this method is safe and provides many benefits for both mother and infant, including pain relief and a less traumatic birth experience for the baby.

Seen as "the gentlest of gentle births," mom-to-be climbs into a tub of warm water, usually heated to body temperature. Advocates of water births cite the physical relief for the mother and the easy transition for baby since the temperature of the water is similar to the mother's body temperature. Sometimes a tub is used just during labour to help moms relax and ease their pain. You'll first want to check if your hospital or birthing center offers water births.

However, critics argue that the procedure introduces unnecessary risks to the infant such as infection and water inhalation.

 

Hypnobirthing

Hypnobirthingnis a term used in the hypnotherapy and medical professions for the use of hypnosis or hypnotherapy in childbirth, but is also a specific branded commercial method of (usually self-applied) hypnotherapy during childbirth.

 

The use of hypnobirthing has become widely known among women and in obstetric units as an increasingly popular means of achieving a natural childbirth. In 2011

 

There are many hypnobirthing programmes which utilise hypnosis for childbirth.

 

The Lamaze Technique

Often referred to as Lamaze, - a prepared childbirth technique developed in the 1940s by French obstetrician Dr. Fernand Lamaze as an alternative to the use of medical intervention during childbirth. The goal of Lamaze is to increase a mother's confidence in her ability to give birth; classes help them understand how to cope with pain in ways that both facilitate labour and promote comfort, including focused breathing, movement and massage.

 

The rise of the epidural by 1980 and the widespread use of continuous electronic fetal monitoring as standard care practices changed the nature and purpose of the Lamaze method. Today, Lamaze International is an organisation which promotes a philosophy of personal empowerment while providing general childbirth education. Modern Lamaze childbirth classes teach expectant mothers many ways to work with the labour process to reduce the pain associated with childbirth, and to promote normal (physiological) birth and the first moments after birth. Techniques include allowing labour to begin on its own, movement and positions, massage, aromatherapy, hot and cold packs, informed consent and informed refusal, breathing techniques, the use of a "birth ball" (yoga or exercise ball), spontaneous pushing, upright positions for labour and birth, breastfeeding techniques, and keeping mother and baby together after childbirth.

 

EPIDURAL

Epidural anesthesia is the most popular means for pain relief during labour. In fact, more women ask for an epidural by name than any other method of pain relief.

The goal of an epidural is to provide analgesia, or pain relief, rather than complete anesthesia, which is total lack of feeling.

Epidurals block the nerve impulses from the lower spinal segments resulting in decreased sensation in the lower half of the body.

 

PRO'S

  • Takes away the pain of labour
  • Allows you to rest, relax and remain focused if your labour is prolonged
  • Relieving the discomfort of childbirth can help some woman have a more positive birth experience
  • Most of the time an epidural will allow you to remain alert and be an active participant in your birth
  • If you deliver by cesarean, an epidural anesthesia will allow you to stay awake and also provide effective pain relief during recovery
  • The incidence of postoperative respiratory problems and chest infections is reduced
  • The incidence of postoperative myocardial infarction ("heart attack") is reduced.
  • The stress response to surgery is reduced.
  • Use of epidural analgesia during surgery reduces blood transfusion requirements

CON'S

The risks of an epidural are numerous. The complications that are most common are things like :

  • a drop in mom's blood pressure, which can usually be quickly treated by medications and position changes.
  • fetal distress
  • fetal malpositioning
  • increase in the cesarean rate
  • Paralysis, numbness, nerve injury and infection for mom are really rare but do occur.
  • After your epidural is placed, you will need to alternate from lying on one side to the other in bed and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labour to slow down or stop
  • You may experience the following side effects:
    • shivering,
    • ringing of the ears,
    • backache,
    • soreness where the needle is inserted,
    • nausea,
    • difficulty urinating
  • An epidural may make pushing more difficult and additional interventions such as Pitocin, forceps, vacuum extraction or cesarean may become necessary

 

An epidural is usually done with you on your side or sitting up, but in these positions you curl up tightly over your pregnant abdomen to give the anesthesiologist the best view of your spine.

You are then numbed with a local anesthetic to minimize the pain you feel from the actual epidural needle going in.

A test dose is delivered to be sure that the medication is going into the right space. The needle is removed and a thin, plastic catheter is left in your back and taped down for security.

Some women feel the contractions but do not experience it as pain.

Other women report that they feel nothing from their chest to their feet.

 

Cesarean Section

A cesarean section is also known as a c-section. This type of birth is done by a surgical incision in the abdomen and uterus to allow a baby or babies to be born safely when a vaginal birth is not the safest route.

 

VAGINAL DELIVERY VERSUS CAESAREAN SECTION

  • With a vaginal delivery the risk of maternal death is about five times lower.
  • Although the risk of incontinence or pelvic floor disorders is slightly higher after a vaginal delivery, all women are at risk of this after pregnancy
  • The pain associated with labour and childbirth is one of the main reasons for elective caesarean sections
  • You may opt for an epidural injection to eliminate the pain and still give birth vaginally.
  • The recovery period after a normal delivery is about two days and for a caesarean section up to two weeks, although many women may recover earlier
  • If you are an HIV-positive woman and desire a vaginal delivery:
    • this should be discussed with medical experts.
    • Vaginal delivery may be considered if you are :
      • monitored throughout the pregnancy
      • use antiretroviral medication
      • your viral load is very low
  • Convenient
    • Both doctor and mother-to-be can select the date together, and be fully prepared for the day.
  • Reduced pain during birth but :
    • longer recovery time afterwards
    • it may be difficult for you to breastfeed due to the pain from the incision.
  • Caesarean deliveries are much safer now due to advancements in medical and surgical techniques.
  • It is also potentially lifesaving when it is performed for medical reasons (i.e.
    • severe pregnancy-related hypertension/heart conditions)
    • complications during pregnancy or labour
  • It is still considered to be major abdominal surgery, which means the procedure carries more risks than a vaginal delivery.
  • The risks include :
    • infection
    • anaesthetic reactions
    • surgical complications.
  • A caesarean delivery is recommended for HIV-positive mothers in order to decrease the risk of transmitting the virus to the newborn.baby

 

WHAT HAPPENS DURING LABOUR

Every pregnancy is different, and there's wide variation in the length of labour. For first-time moms who are at least 37 weeks along, labour often takes between ten and twenty hours. For some women, though, it lasts much longer, while for others it's over much sooner.

 

Labour generally progresses more quickly for women who've already given birth vaginally.

The process of labour and birth is divided into three stages:

 

The first stage

This stage is divided into two phases: early , and active labour

During early labour, your cervix gradually thins out and dilates

The early stage of labour begins with the onset of contractions that cause progressive changes in your cervix and ends when your cervix is fully dilated.

 

You're officially in early labour once your contractions are coming at fairly regular intervals and your cervix begins to progressively dilate and thin out.

 

Early labour contractions are sometimes hard to distinguish from Braxton Hicks contractions that may immediately precede them and contribute to so-called false labour.

If your labour is typical your early contractions won't require the same attention that later ones will. You'll probably be able to talk through them, wander around the house, take a short walk.

Tou can also take a warm bath, watch a video, or doze off between contractions

 

You may notice an increase in a mucus vaginal discharge, which may be tinged with blood -- the so-called "bloody show".

Iif your water breaks, even if you're not having contractions as yet, you need to move to the hospital and cease becoming active..

 

During early labour, your contractions will gradually become longer, stronger, and closer together. Early labourmight start with contractions coming every ten minutes and lasting 30 seconds each. Eventually they'll be coming every five minutes and lasting 40 to 60 seconds each as you reach the end of early labour.

 

Some women have much more frequent contractions during this phase, but the contractions will still tend to be mild and last less than a minute. Sometimes early labour contractions are quite painful although progress is slower that you would like.

 

The length of early labour is variable and depends in large part on how ripe your cervix is at the beginning of labour and how frequent and strong your contractions are. With a first baby, if your cervix isn't dilated to begin with, this phase may take about 6 to 12 hours, although it can be longer or significantly shorter. If your cervix is already very ripe or this isn't your first baby, it's likely to go much more quickly.

Early labour ends when your cervix is about 4 centimeters dilated and your progress starts to accelerate.

During active labour, your cervix begins to dilate more rapidly and contractions are longer, stronger, and closer together.

Your contractions become more frequent, longer, and stronger, and you'll no longer be able talk through them. Your cervix begins dilating more quickly, going from about 4 to 10 centimeters. (The last part of active labour,

 

Toward the end of active labour your baby may begin to descend, although he might have started to descend earlier or he might not start until the next stage. As a general rule, once you've had regular, painful contractions (each lasting about 60 seconds) every five minutes for an hour, it's time to head to the hospital or birth center.

 

On average, it takes about four to eight hours for a woman having her first baby to go from 4 centimeters to full dilation, if she's not being given Pitocin or doesn't have an epidural. Pitocin generally speeds up the active phase, while epidurals tend to make it last longer. If you've already had a vaginal birth, active labour is likely to go much more quickly.

 

The last part of active labour is sometimes known as "transition." IS when the cervix dilates from 8 to 10 centimeters

This is the most intense part of labour. Contractions are usually very strong, coming every two and a half to three minutes or so and lasting a minute or more, and you may start shaking and shivering. By the time your cervix is fully dilated and transition is over, your baby has usually descended somewhat into your pelvis. This is when you might begin to feel rectal pressure, as if you have to move your bowels. How long transition takes Transition can last anywhere from a few minutes to a few hours. It's much more likely to be fast if you've already had a vaginal delivery.

 

The second stage

The second stage of labour begins once you're fully dilated and ends with the birth of your baby.

At this stage, you will feel a strong compulsion to "push" - called "bearing down".

 

Some women begin to bear down spontaneously and there's often a lot of bloody discharge. You may feel nauseated or even vomit now.

 

Some babies descend earlier and the mom feels the urge to push before she's fully dilated.

Others don't descend significantly until later, in which case the mom may reach full dilation without feeling any rectal pressure.

 

If you've had an epidural, the pressure you'll feel will depend on the type and amount of medication you're getting and how low the baby is in your pelvis. If you'd like to be a more active participant in the pushing stage, ask to have your epidural dose lowered at the end of transition.

 

The third stage

The third and final stage begins right after the birth of your baby and ends with the separation and then the delivery of the placenta.

 

TIPS

  • Don't forget to urinate often, even if you don't feel the urge. A full bladder may make it more difficult for your uterus to contract efficiently, and an empty bladder leaves more room for your baby to descend.
  • Try some relaxation exercises or do something to distract yourself a bit -- like watching a movie or reading a book.
  • Breathing exercises and visualization may help you during labour, whether or not you're planning to receive medication.
  • A good labour coach can be a huge help And you'll probably appreciate lots of gentle encouragement.
  • It may feel good to walk, but you'll probably want to stop and lean against something (or someone) during each contraction. You should be able to move freely around the room after as long as there are no complications.
  • If you're tired, try sitting in a rocking chair or lying in bed on your left side.
  • Ask your partner for a massage
  • If you have access to a tub and your water hasn't broken, you can take a warm shower or bath.
  • If you Hhave already decided you want pain medication or you're having a hard time coping with contractions and nothing else seems to help, now's the time to ask about getting an epidural or systemic medication.
  • Some women appreciate light touch, some prefer a stronger touch, and others don't want to be touched at all.
  • Sometimes a change of position provides some relief -- for example, if you're feeling a lot of pressure in your lower back, getting on all fours may reduce the discomfort.
  • A cool cloth on your forehead or back may feel help, or you may find a warm compress more comforting
  • It may help to visualise the baby's movement down with each contraction.

 

 

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