The delivery of a baby has been called one of life's most treasured events. In reality, while marking the event of a new life in the world, childbirth can also be painful and can bring the possibility of complications for both mother and baby. The delivery of a baby is a process that typically requires intervention from a healthcare professional as a method of guiding the mother through labor and delivery. The baby must also be monitored to ensure a smooth transition through labor, and there are several types of delivery that can take place.
Labor and Delivery
Labor is the period of time when a mother's body is preparing to deliver a baby. The muscles of the uterus tighten, producing contractions. At the same time, the cervix begins to widen, preparing an opening for the baby to come through. During a vaginal birth, the baby's head is typically down in this birth canal, and the mother pushes the baby out with each contraction. Several positions may be more comfortable for the mother, or give her better capabilities of pushing. A physician or nurse midwife works to guide the baby out as he is being delivered, and assists in delivering the placenta following the birth of the baby.
Assisted Vaginal Birth
There are times when assistance is needed for a baby to be delivered. The position of the baby as it is coming through the birth canal is not always in the best place for a smooth transition. If a mother has been trying to push the baby out for an extended period of time, or if the baby's head is down but is not facing a direction that will facilitate delivery, a physician may use tools to assist with a vaginal birth.
Forceps are used to guide the baby's head out of the birth canal and to speed the process of delivery. Forceps have the appearance of large tongs, and a physician places one on either side of the baby's head while she is still in the birth canal. The physician then uses the forceps to pull down while the mother is pushing during labor. This process assists with delivery of the baby's head, allowing the rest of delivery to quickly follow. Forceps can leave bruising on the baby's head and face.
Vacuum extraction is another method of assisted delivery that can be used when a mother has been pushing for a prolonged period. A cap is placed on the baby's head while she is still in the birth canal, and suction is applied. While the mother pushes, the physician pulls with the suctioned cap to bring the baby's head down and out of the birth canal. A vacuum extraction can leave a bruise or swelling on the baby's head after delivery.
If the vaginal opening is too small for the baby's head to pass through, the physician may perform an episiotomy. An episiotomy is the process of cutting an incision between the vagina and the perineum, thereby making a larger opening for the baby's head to pass. If left unchecked, a vaginal delivery without a large enough opening can lead to tearing of the skin. An episiotomy helps to prevent this from occurring and controls the size of the incision, which can reduce the amount of pain and scarring involved. The episiotomy is sutured closed after the delivery.
Cesarean Section
According to the Journal of the American Medical Association, cesarean deliveries occur in 20 percent of births, and the Nemours Foundation states that the number of deliveries in this method is close to 30 percent. Cesarean sections can occur when there are complications preventing a vaginal birth, such as a breech presentation that causes difficulty with delivery. Cesarean sections may also be performed emergently as a faster method of delivering a baby when there is not enough time for a vaginal birth. Some examples of emergent cesarean sections include extremely premature births or large amounts of bleeding in the uterus that can be harmful for the baby. Women who have had a cesarean section for a previous delivery are also more likely to have the procedure again with successive pregnancies.
During a cesarean section, a mother is taken to an operating room where the surgeon performs the procedure. The mother may be awake during the process, with pain control given through an epidural that provides medication to anesthetize the lower part of the body. The doctor makes an incision in the abdomen, cutting through the abdominal wall and into the uterus. The baby is then lifted out, the umbilical cord is cut and the baby is taken to a waiting nurse for assessment. Following delivery of the placenta, the physician closes the surgical site. Recovery from a cesarean section is longer than that of a vaginal delivery, requiring three to four days of hospitalization.
Vaginal Birth after Cesarean
Because a cesarean section involves cutting into the abdominal wall and the uterus, many women who have had previous deliveries with this method choose to have a cesarean section again for successive pregnancies. Another option of delivering a baby vaginally for a subsequent pregnancy is called vaginal birth after cesarean (VBAC).
Many women, after undergoing a long recovery process from a cesarean section, choose to try the VBAC method to ensure a shorter hospitalization and to avoid having surgery again. According to the American Congress of Obstetricians and Gynecologists, 60 to 80 percent of women who try a VBAC procedure are able to successfully deliver a baby vaginally. VBAC does have some risks associated with the method, and it is not a safe choice for all deliveries after a cesarean section. The process of cutting through the uterine wall during a cesarean section can weaken the structure of the uterus. If an attempt is made at a vaginal delivery following a cesarean birth, the act of pushing during labor can cause tearing in the uterine wall at the site of the previous surgery. Women who would like to consider a VBAC should discuss the options available carefully with their physician.
Complications
During labor, if a baby is showing signs of distress, there may be meconium noted in the amniotic fluid. Meconium is the first type of stool that is in the bowel of the baby during development. Meconium-stained fluid will appear dark green and requires assistance at delivery from trained healthcare providers. A baby may need suctioning of the airway immediately following delivery to ensure that none of the meconium is taken into the lungs during an initial breath.
A mother will wear a fetal monitor during labor, which allows a nurse to watch the baby's heart rate. At times, the heart rate of the baby may increase or decrease, especially during contractions. If the baby's heart rate slows considerably with each contraction, it is an indication that the baby may be in distress. The baby may need to be delivered more quickly, or healthcare personnel should be standing by to assist after the birth.
There are potential complications with all types of baby deliveries that can disrupt the health of both mother and baby. Fortunately, healthcare professionals are trained in discerning potential problems and acting quickly during circumstances that require intervention.
References
- University of Virginia Health System: Pregnancy and Childbirth
- New York University Medical Center: Forceps Delivery and Vacuum Extraction
- American Congress of Obstetricians and Gynecologists: Vaginal Birth after Cesarean Delivery
- Nemours Foundation: Cesarean Section
- Journal of American Medical Association: Childbirth
