We can definitely say that childbirth is very much both. After all, giving birth is an amazing thing. As if growing a human being inside the womb wasn’t a big enough feat, now the mother has to push it all out. Through a coin-sized hole, at that.
And needless to say, the whole ordeal can get pretty painful. It’s not just the opening that expands to accommodate the baby’s head, which at term can be just about as big as a small watermelon, too. Everything else has to play a part to get the little one out. The hip bones literally separate the symphysis pubis. Muscles and soft tissue from the cervix down to the vagina down to the perineum have to stretch out. And all while the uterine walls contract harder the longer the labor progresses.
In the background, the heart and the cardiovascular system have to work extra hard to supply all these body organs hard at work with oxygen and nutrients. The brain, also, floods the body with a cocktail of hormones and electrical signals to keep the entire process of childbirth running smoothly.
All the things going on is certainly enough to make the average human biology scholar gape in wonder while, at the same time, making the mom-to-be dread the big day. But just like any other bodily process, childbirth is pretty much just another day’s (or several days’) work.
For vaginal deliveries, at least, the body goes through three major stages, each with their respective sub-stages. The end result, inevitably, is that a mother is born.
Before the official start of labor, the body will have been going through a series of changes late in pregnancy to prepare both mom and the baby for the big day. Mom might begin to feel Braxton-Hicks contractions. Think of these relatively mild contractions as the body’s dress rehearsals to make sure everything is prepared and running smoothly for when they’re needed. Unlike real contractions, they are irregular and usually disappear with rest.
Peculiarly, moms also go through a phase of “nesting”, where they suddenly have the irresistible urge to clean up the house, making everything spic and span. If she hasn’t done so yet, she might want to buy the baby’s things as well. In the meantime, the body continues to monitor the pressure that the baby is exerting upon the uterus, and therefore his size and weight. This is one among many of the body’s indicators that the bun in the oven is ready to come out.
14The First Stage
The first stage of labor is the longest among the three major stages of labor. It starts from the onset of labor, during which time the cervix, that neck of tissue that serves as the gateway between the uterus and vagina, begins to dilate and efface. Dilation pretty much means that the cervical opening is getting wider and wider, until it’s as wide as ten centimeters. Effacement, on the other hand, means that the thinning and the softening of the cervix. The length of time it takes for the cervix to fully efface and dilate varies from mom to mom. First-time moms will often take about ten to twenty hours, just in this first stage of labor. For subsequent pregnancies, however, it often won’t take as long.
There are three major sub-stages in the first stage of labor: early labor, active labor and the transition phase. We’ll discuss these three sub-stages separately.
13The First Stage: Early Labor
Early labor is a period of time in which the rate of effacement and dilation is pretty slow. By definition, early labor lasts until mom’s cervix has dilated to about three centimeters. Mom might also begin to have contractions that last only about half a minute or so. There will also be long periods of time between contractions, anywhere from five minutes to half an hour. In some cases, mom might even mistake these weak, seemingly irregular contractions for Braxton-Hicks contractions.
Over time, however, mom will begin to notice that the contractions become stronger, longer and more closely spaced as the hours go by. One tell-tale sign that labor has truly begun, although many times it will happen in later parts of the first stage of labor, is if mom’s water breaks. During this time, it should be mom’s priority to get some rest or perhaps prepare for the impending childbirth by going home and readying her hospital bag.
12The First Stage: Active Labor
While mom’s body changes during early labor will be relatively slow, she’ll definitely notice that they accelerate quite a bit during active labor. During this sub-stage of labor, the cervix will dilate from three centimeters to about seven centimeters in the span of about three to six hours. During this time, contractions will last for up to a whole minute, with only about five minutes of rest in between each contraction. Now, these contractions may already feel pretty painful at this point, but as the uterus isn’t doing “real” hard pushing yet, mom will have to brace herself for the worst.
This is the time in which mom will definitely want to head to the hospital or call her birthing attendant, if she hasn’t done so already. If mom is already at the hospital, she might want to employ the pain management techniques she learned during prenatal classes to help her manage the discomfort.
11The First Stage: Transition
During the transition phase, both cervical changes and uterine contractions go on steroids. (Not in the literal sense, though. Oxytocin is not categorically a steroid but, instead, a peptide hormone. But more on that later.) The transition phase lasts only about thirty minutes to a couple of hours. During this time, however, the cervix will dilate from seven to ten centimeters. Contractions will also amp up, lasting to more than a minute, with only a minute or so’s worth of rest in between.
The contractions during this time will be extremely strong. This is the phase where women often describe the onset of “unbearable” pain. As such, it’s important for her to pace herself and relax in between contractions in order to conserve her energy. Continuing with deep breathing exercises and other pain management techniques may be challenging at this point, but they are still important to help her focus and keep her mind off the pain.
10The Second Stage
If you thought the first stage of labor was something, you’re in for a big surprise. The second stage is actually where things get real, very quick. The second stage of labor can last anywhere from twenty minutes to a couple of hours. Unlike the first stage of labor, there isn’t much of a distinct gradation between phases in the second stage. It’s, mostly, just a lot of pushing to get the baby out.
It is basically a cycle between contractions with short rests in between. During the entire process, the baby gets pushed further and further down the birth canal. And, if all goes right, there will be an event called “crowning”, leading up to the delivery of the baby. In fact, the definition of the second stage of labor is pretty much just from when the cervix dilates to ten centimeters until the moment the baby is born.
9The Second Stage: Contractions
The first stage of labor may have involved contractions, but it’s here that they take on a center stage, with the very clear intent of pushing the baby out. After all, with intense pain and an irresistible urge to push, the body cannot be any more clear about what it wants. Just like with the transition phase, contractions during the second stage of labor last for more than a minute (up to ninety seconds) with five minutes of rest in between contractions. But while the duration and interval of the contractions remain about the same, their intensity increases drastically.
This is because it is at this stage that oxytocin, the “happy hormone” which also has the secret sinister function of fueling those painful uterine contractions, is at its peak. See, oxytocin is released through a positive feedback mechanism. This means that as labor progresses, more and more of it is produced until the baby comes out and it has achieved its function. It is because of the increasing abundance of oxytocin that contractions become stronger.
8The Second Stage: Between Contractions
As a wise man once said that music is not only in the notes but in the silence in between. That wise man could be Debussy or it could be Mozart or even some Zen philosopher, depending on which reference you believe. Nevertheless, the same wisdom applies to labor contractions as well. After all, labor contractions are very intense, and the body knows it’s important to get periods of rest in between for the sake of both mom and the baby. This is pretty much in the same way that listening to a score of notes without rests can give anyone a headache.
As such, it’s important for mom to take the time in between contractions to gather up her strength to prepare herself for the next round or pushing. The five minutes in between contractions may not seem like a lot of time. But when you’re in constant pain, it can make a world of difference.
7The Second Stage: Crowning
While the name itself might give one visions of a young king taking his rightful place on the throne, actual crowning during delivery isn’t as pleasant, depending on who you’re asking at least. Crowning is basically when the baby’s head begins to emerge from the external vaginal opening. This is a signal that birth is imminent. As such, the delivery team must prepare to catch the baby as he comes out of the vagina and, if necessary, help ease him out.
Delivery of the head is often the hardest part of childbirth, as it is the part of the body with the largest circumference. It’s no wonder, then, that it can be one of the most painful parts of childbirth. Other than the uterine contractions, which should be pretty much run-of-the-mill for mom by now, she will also experience a burning sensation down in her lady parts as they stretch out to accommodate the little one’s head. Take heart, however, as after that things get a bit easier.
6The Second Stage: Delivery
The event that marks the end of the second stage of labor is the delivery of the baby. While delivering the head is the hardest part of the process, there are also a few parts of the rest childbirth that the doctor or birth attendant has to pay special attention to. For one thing, babies that are large or moms that have small pelvises will be prone to shoulder dystocia, a condition where the shoulders get stuck in the birth canal. The doctor may therefore need to manipulate the baby in order to ease him out. This typically happens in babies of moms who are diabetic.
In most cases, however, the rest of the baby practically just slips out. Once this happens, the doctor must then cut the baby’s umbilical cord. The standard as to when the cord must be cut depends on the facility or the country you live in. In most cases, it will be cut right after birth. However, there are a limited number of studies that suggest that delaying it could be beneficial for the baby. Some practitioners subscribe to this.
5The Third Stage
Once the baby is born, many people pretty much forget that there is one last stage of labor to attend to. Many people, that is, except the delivery room team, who all know that a third stage of labor that goes by smoothly means that mom has a lower risk of developing complications such as postpartum hemorrhage later on. The third stage of labor is basically from when the baby is born to when the placenta is delivered.
Now, the placenta is a pretty important part of the pregnancy. It is basically the connection through which the baby received nutrients and oxygen from mom’s blood. It is connected to the baby via the umbilical cord and is, genetically, “part” of the growing baby in the womb. After childbirth, however, it will have served its purpose and must be expelled from the womb as well. This stage of labor can take anywhere between five to thirty minutes.
4The Third Stage: Contractions Again
Now, the contractions may have eased up a little bit following the delivery of the little one. When it’s time for the placenta to come on out, however, they may resume again. If the baby is able to breastfeed right after childbirth, all the better. Breastfeeding triggers another surge of oxytocin, just the hormone mom things to get things working again. If not, however, the oxytocin regulating center of mom’s own body should take care of that. If all else fails, most hospitals and birthing facilities have a ready stock of synthetic oxytocin as any delay in the delivery of the placenta could lead to complications postpartum.
Just the right contractions help loosen the placenta, releasing it and allowing it to fold over itself so that it can be delivered smoothly. The doctor might also tug it gently via the placenta side of the umbilical cord to facilitate its delivery.
3The Third Stage: Placental Delivery
The delivery of the placenta isn’t just a case of pull it out and we’re done. The delivery room team has to assess the placenta once it comes out. In particular, they must make sure that it is complete and intact, as any fragments of the placenta left in the womb can increase mom’s risk for postpartum bleeding and, if it is retained for days, infection.
A “normal” placenta will appear somewhat rounded, regular and smooth. This is a sign that the placenta has folded over itself like an umbrella, with the baby-side out. If the placenta appears rough and uneven, however, this indicates that it has folded over mother-side out. This presentation signals the possibility that portions of the placenta have been left behind. The medical team must therefore assess mom’s womb. If there is any evidence that there are remnants, these will be removed under anesthesia by a doctor.
2Immediate Postpartum Period
The postpartum period is defined as the period right after childbirth, until about six weeks after. Many health care professionals even call it the fourth stage of childbirth, as it is a period of recuperation from the effects of the delivery. The most critical part of it, however, is the first few days following childbirth, as this is a period where postpartum complications often pop up.
In particular, the new mom and her caregivers must be able to monitor vaginal discharge post-delivery. Postpartum vaginal discharge is called lochia and goes through three distinct stages in mom’s process of recovery. Discharge will initially be red (called lochia rubra) for up to five days after birth. If this discharge is excessive or if it lasts for longer than that, tell the doctor immediately. Otherwise, it will then thin out and slowly transition to a brown or pink-tinged fluid (called lochia serosa) for up to ten days. Finally, the discharge will turn whitish or yellowish.
Many new moms are often lost in the process of caring for their new baby that they sometimes don’t give enough attention to the healing process during the postpartum period. It is during this time that their circulatory system, which may have been overloaded during childbirth, reverts back to normal function. The now-overly stretched uterus, vagina and perineum, all of which may have been considerably damaged, may require plenty of time to recover. In addition, mom may also be prone to the postpartum blues at this time.
As such, mom’s care must not stop when she comes home from the hospital. Getting enough rest (despite a newborn asking for milk every few hours) and adequate nutrition should be a priority. Helping mom out with child care and giving her emotional support will both also help her in achieving full recovery. After all, childbirth may look simple on the outside. But it’s actually a long, complex process in which mom needs all the support she can get.
Sources: American Pregnancy, Webmd, Baby Centre, Parents, Mayo Clinic
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