Vaginal delivery

If you are coming to hospital to give birth it is important to know all you can about it.

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is a vaginal delivery?

Each year there are around 600,000 births in the UK. About one in 5 (20%) of these is by Caesarean section, although this varies by hospital. The rest are vaginal deliveries.  More than one in 10 vaginal deliveries (10-15%) are assisted deliveries using forceps or suction. The rest are normal, usually done by a midwife without the involvement of doctors.

To understand what happens during birth you need to know a little about your pregnancy. The baby grows in your uterus. The baby is attached to the placenta, commonly called the afterbirth, by the umbilical cord. The placenta is attached to the inside of your uterus. The placenta gives your baby blood, oxygen and all the food that it needs to grow.

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.

The aim

We aim to safely deliver your baby and make sure you come to no harm.

The benefits

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.

First stage

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.

Second stage

The second stage lasts from full dilation of your cervix until your baby is born. This may be as long as three hours, especially with an epidural for pain relief as this makes pushing difficult. During this stage your baby’s head comes down through your cervix and vagina. After a time the baby’s head is low enough in your vagina so that we can see your perineum bulging with each push. Your perineum is the area between your vagina and anus. You may have bloodstained fluid coming from your vagina. You will feel a strong urge to push and your midwife will encourage you to do so.

Pushing combined with your contractions will deliver your baby’s head. At some point during the delivery of the head your midwife will advise you not to push as strongly to avoid a skin tear. The urge to push at this time can be so great that to counter it you may need to blow or pant. Your baby’s head, and then the rest of your baby, will be gently delivered.

We will clamp and cut the umbilical cord. We will check, dry and wrap your baby in a towel to stop it getting cold and will hand your baby to you or your partner.

As your baby is being delivered we may give you an injection to help your uterus become smaller to reduce your chances of heavy bleeding. This may be injected through a cannula into your vein or into a muscle in your thigh or buttock. We only give this injection with your consent.

Third stage

The third stage of labour is between your baby being born and the delivery of the placenta. A midwife will usually deliver the placenta by supporting your uterus and gently pulling on the umbilical cord.

Your midwife will then examine you to make sure that you have no tears. Some small tears will be left to heal naturally. We will repair large or bleeding tears and any episiotomy. We will numb the area with local anaesthetic injections if you do not have an epidural in place.

Extra / other procedures

If there are problems with delivering your baby’s head you may need an episiotomy. An episiotomy is usually done as a cut in the right side of your perineum. It helps in delivery of your baby’s head and body through your vagina. It can help to avoid an uncontrolled tear that might otherwise affect your anus. We will numb your perineum with a local anaesthetic injection before doing the episiotomy if you do not have an epidural in place. There is a separate leaflet in this series covering episiotomy.

Author: Dr Chineze Otigbah MRCOG. Consultant obstetrician and gynaecologist.

© Dumas Ltd 2006

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