In a vaginal delivery your baby comes out through your birth canal, which includes your cervix, vagina and vulva. For this to happen your vagina and cervix need to be made much wider and this is called dilation. The opening of your cervix, called the os, is normally closed. Towards the end of your pregnancy your cervix becomes shorter and softer than normal. Your body is making your cervix ready to dilate to deliver your baby. This happens because of changes in your hormones.
The labour is divided into three stages. The first stage lasts until your cervix fully dilates, stated as ten centimetres dilated. The second stage then begins and this lasts until your baby is born. The last stage is between birth and the delivery of the placenta.
Who should have a vaginal delivery?
The following features place you in the low risk category and a midwife will probably do your vaginal delivery.
- You have had no complications during your pregnancy
- Your baby is well grown
- Your baby is in a head down position
- Your baby is full term (38-42 weeks gestation)
Your midwife may still do your vaginal delivery if these features are not present, but you may need extra monitoring. A specialist doctor, called an obstetrician, may be involved with the decision-making and even the delivery.
If you have complications during your labour your midwife will inform an obstetrician immediately. They may hand your care over to the obstetric team.
We aim to safely deliver your baby and make sure you come to no harm.
A vaginal delivery is the natural way of giving birth. You should return to normal health safely and quickly. You and your baby should avoid undue trauma or distress.
Are there any alternatives?
One alternative to vaginal delivery is birth by Caesarean section. This is an operation to deliver your baby through a cut in your lower abdomen.
We use a Caesarean section when you or your baby have problems, such as you not being able to give birth vaginally or your baby being in distress. Sometimes we do a Caesarean section because you request it. This would be because you need to avoid labour or you need a planned delivery. In this case, you will have to discuss the options with your obstetrician, including the increased risks to you and your baby. There is another leaflet in this series covering Caesarean section.
The other option is a vaginal delivery with assistance to help your baby come out. This is called an assisted vaginal delivery. During this, an obstetrician uses forceps or suction to help deliver your baby. The reasons for needing an assisted delivery include:
- Fetal distress in the second stage of labour.
- Maternal tiredness.
- Prolonged second stage of labour.
Your vaginal delivery
When you are in labour we may follow this routine:
Assessment of mother - We will regularly check your pulse, temperature and blood pressure. We may also test your urine each time you pass water.
Assessment of labour - We will examine you regularly, about every four hours. This will involve feeling your abdomen to find out the strength and frequency of your contractions and the position of your baby’s head.
We will also examine your vagina to assess the dilation of your cervix and how far down the baby’s head has come. We may do the vaginal examination more often as your labour progresses.
Assessment of baby - Watching your baby’s heartbeat during labour is called fetal monitoring. If you are in the low risk category you will not need continuous fetal monitoring unless you request it. Instead, you will have fetal monitoring every 15 minutes, for about a minute at a time. This is usually done using a Pinard stethoscope or a hand held electronic monitor called a sonic aid. If we see any problems during the monitoring you will be put on a continuous fetal monitor.
If you have complications during labour you are no longer in the low risk category. You will need continuous fetal monitoring for the rest of your labour.
The first of the three stages of labour lasts until your cervix fully dilates. Your cervix dilates because the contractions of your uterus push your baby’s head against it. Your contractions also turn your baby so that the baby’s head is in a good position for delivery. This is with the back of your baby’s head, called the vertex, towards the front of your pelvis. This position is called occipito-anterior or OA for short. When the baby is in this position delivery is easier as only the smallest width passes through your birth canal.
As your labour progresses the number and strength of your contractions increases. Your cervix will become fully dilated, stated as ten centimetres dilation. This may take as long as 16 hours for your first birth but it is often shorter if you have given birth before.
Pain from your contractions increases as they become stronger and more frequent. Simple techniques that you or your partner can use to control this pain include:
- back rubbing and massage
- walking around
- breathing exercises
- warms baths.
Attending your antenatal appointments, your parent craft groups and discussing your fears with your midwife can help you prepare for the pain. You may also consider hypnosis and acupuncture. Other methods of pain relief include:
Transcutaneous electrical nerve stimulation (TENS) - An electrical stimulation machine.
Entonox - A pain relieving gas to breathe.
Narcotics - Pain relieving injections.
Epidural - A pain relieving injection around the nerves in the spine that numbs the lower half of the body.