Vaginal Delivery

WHAT YOU SHOULD KNOW:

• A vaginal delivery occurs when a baby is born through the vagina (birth canal). This is also called a natural delivery. During labor, your uterus will contract (squeeze) to move your baby out of your womb (uterus) through your cervix (opening of the uterus). Your cervix will open to about 10 centimeters (nearly four inches) to let your baby pass from your womb into your birth canal.
  
  
• Many women go to a birthing room in a hospital or birthing center so they can have their baby naturally. These places may have special beds, chairs, birthing tubs, and other equipment to help make your labor and delivery easier. Some women want to have a caregiver come to their house so they may have their baby at home. Talk to your caregiver when deciding where to have your baby. If there are problems with labor or your baby, you may be moved to an operating room to have an operation called a Caesarean section (C-section). During a C-section, your baby is delivered through an incision (cut) in your abdomen (belly).

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

A vaginal delivery has risks for both you and your baby. During delivery, you may bleed too much, your blood pressure could go very high, or your labor may not progress. Your baby may not fit through the birth canal, or the umbilical cord may wrap around his neck. Your baby may not tolerate your contractions very well, and his heart rate may change. Some medicines and instruments that may need to be used during delivery also have risks. You or your baby could die. Caregivers will watch you and your baby carefully to prevent or treat problems. Talk to caregivers if you are worried or have questions about the medicine or care for you and your baby.

WHILE YOU ARE HERE:

Call Button: Use the call button to call your caregiver. Call if you need help getting out of bed, or moving around. Call if you feel the need to push, or feel like your baby is coming. Call if you feel your water break, if the pain of the contractions is too strong, or if you have other pain in your body.

External fetal heart monitoring: Caregivers may use this to monitor your baby's heartbeat, and the contractions of your uterus. A small metal disc (monitor) with gel on it is placed on your abdomen. A belt will be fastened around your waist to hold the monitor in place. The monitor may need to be moved as your baby moves inside you. It may also be put on and taken off, or left in place.. The monitor is attached to a machine with a TV-type screen, or a printer. The screen or the paper print out shows a tracing of your uterus contracting, and the baby's heartbeat.

Internal fetal heart monitoring: An internal fetal monitor allows caregivers to carefully watch your baby's heartbeat while you are in labor. It may also measure your contractions. To place the internal monitor, your caregiver will first make sure your bag of waters has broken. The opening to your birth canal must also be dilated (open) a little. Your caregiver will use a small plastic tube to guide a special wire through your birth canal. This small wire is attached to your baby's scalp (the skin covering the head). Then, the plastic guide is removed. This wire is attached to a machine with a TV-type screen. The screen shows a tracing of the baby's heartbeat and may also show your uterus contracting. Ask your caregiver about the risks and benefits of an internal fetal monitor.

Fetal ultrasound: This simple test uses sound waves to show pictures of your baby (fetus) inside your uterus. Jelly-like lotion is spread on your abdomen, and a small handle is gently moved through the lotion. As this is done, pictures of your baby can be seen on a TV-like screen. Caregivers can learn the age of your baby and see how fast he is growing. The movement, heart rate, and position of your baby can also be seen. Caregivers can see your placenta, and can tell if you have more than one baby.

Informed Consent: You have the right to understand your labor and delivery options in words you can understand. You should be told what tests, treatments, or procedures may be done to help you have a safe labor and delivery. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers your permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

During your vaginal delivery: The labor process may take hours, or even days. Ask your caregiver what is happening while you go through labor. Your body will go through three stages (parts) of labor. There is no way of knowing how long each stage will last. Women usually find the labor process very tiring, but are very happy when it is over and the baby is born. No matter where you choose to deliver your baby, your support person needs to be prepared. Your support person may need to wear a hospital scrub top and pants, a mask, and a cap.

The first stage of labor: In the first stage of labor, your uterus contracts to prepare your cervix for delivery, and to push your baby out of the birth canal. Caregivers may need to give you medicine to help make your contractions stronger, and make them come more often. Caregivers will explain the risks and benefits of using medicine during labor. The contractions help your cervix dilate and efface. When your cervix is dilated (open) 10 centimeters and effaced (thinned) 100 percent, you have completed the first stage of labor and your body is ready to have the baby.

• Dilation: Your cervix begins to dilate during the last phase of pregnancy and when you are in labor. Dilation of the cervix is measured in centimeters from zero to 10. Your cervix is fully open when it is dilated to 10 centimeters (nearly four inches).
  
  
• Effacement: A woman's cervix is about one and one-half inches thick. Your cervix thins and softens as it gets ready for birth. Effacement of the cervix is measured in percents. Your cervix is half its original thickness when it is 50 percent effaced, and is completely thinned out when it is 100 percent effaced.

The second stage of labor: In the second stage of labor, your uterus continues to contract to push your baby through the birth canal. This stage ends with the birth of your baby.

• Pushing: You may have the urge to push early in your labor when it is not yet time to push. Pushing too early can injure your cervix. Caregivers will show you other ways to cope with the urge to push, such as special ways to breathe. When you are completely dilated and fully effaced you will be able to push, and your baby will soon be delivered. Caregivers will tell you when to push, and help you push in ways to help the delivery of your baby. Do not hold your breath when you are pushing. Holding your breath decreases blood flow and oxygen to your brain, and to your baby. Caregivers will ask you to use grunting and exhale pushing.
  
  
• Crowning: This is when your baby's head is at the opening of the vagina. You may be able to see the top or crown of your baby's head with the help of a mirror. Your baby's head may not fit through your vagina. Your caregiver may make an incision (cut) in your perineum, which is skin and muscles between the vagina and rectum. This will help make the area larger for your baby's head to fit through. This incision may also prevent lacerating (tearing) your vagina as your baby is being born. This incision is called an episiotomy. You may get medicine to make you lose feeling in the area before the incision is made. The incision will be sewn back together after your baby is born.
  
  
• Instrument-assisted delivery: Your caregiver may need to use instruments and procedures to help your baby come out of your vagina. Using instruments such as forceps, and procedures such as vacuum extraction have risks and benefits. Caregivers will only use these if they are needed. Forceps look like two large spoons that are hooked together. During a forceps delivery, the forceps are put into your vagina and carefully placed around your baby's head. Your baby is delivered by gently pulling on the forceps. During a vacuum extraction, caregivers place a suction cup on your baby's head. Gentle traction is put on the cup to guide your baby's head and body out of the birth canal.
  
  
• Completing the delivery: After your baby's head comes out, a caregiver will suction his nose and mouth. One or more pushes will deliver the rest of your baby's body. Your baby will then try to take his first breath and cry. Most babies start to breathe and cry right away. Some babies may need help from caregivers to get them to breathe and cry. Caregivers will suction your baby's nose and mouth again. They may hand your baby to you, or they may put your baby in a special bed that keeps him warm. Your baby may be very alert and responsive to your touch, voice, and warmth for about an hour after birth. Touch, look closely at, and talk to your baby during this time. You may also want to try and breast feed your baby at this time.
  
  
• Taking care of your baby: Eventually your baby will be dried off, weighed, and measured. All newborns are slightly low in Vitamin K, so your baby may be given a shot of this vitamin with a needle. Your baby may be given special eye drops or ointment to help prevent eye infections. Caregivers will wrap your baby in a warm blanket and may bring him or her over so you can hold your baby again. Other tests may be done to your baby if they are needed.

The third stage of labor: The last stage of labor is when the placenta (afterbirth) is delivered out of your uterus through your vagina. After your baby is delivered, your uterus continues to contract to push out the placenta. This usually happens within 30 minutes after your baby is born. The placenta is the tissue (skin) that joined you to your baby when your baby was growing inside your uterus. Its job was to bring food and oxygen to your baby, and take away wastes. If you needed an episiotomy, or had a laceration of your perineum during the birth, your caregiver will repair it during this time.

After Delivery:

• Identification: Caregivers put matching identification (ID) bracelets on both you and your baby before your baby is taken to the nursery. The ID bracelets have your name and other information to prove that this baby is yours. Many hospitals also footprint newborns. Caregivers may move you to a different room after your baby is born. You will be watched closely for problems, such as bleeding. Your temperature, pulse, blood pressure and respirations (vital signs) will be checked often. If you and your baby are doing well, you will be able to hold, feed and spend time with your baby.
  
  
• Baby Care: Your baby may be taken to the nursery. Caregivers check your baby's temperature, breathing, and heart rate. Caregivers also check your baby's skin color and activity. Your baby is then given a warm bath, and medicine may be put on the umbilical cord stump to prevent infection. Your baby may rest in the nursery, or he may be brought to you in your room. Try to sleep as much as possible after the delivery. Let caregivers help you take care of your new baby.
  
  
• Breast Care: Your milk should "come in" (your breasts should fill) two to four days (48 to 96 hours) after delivery. Before your milk comes in, your breasts may feel soft. When the milk comes in, your breasts may feel full and hard. Colostrum is the "early milk" or yellow liquid that you can squeeze from your breasts after delivery. Colostrum is what your baby will drink during the first couple of days after birth if you choose to breast feed. Colostrum has fat, carbohydrates, protein, and other special ingredients in it that help keep your baby healthy. If you plan to breast feed, ask caregivers to show you the correct ways to hold and breast feed your baby. Ask caregivers for more information about how to care for your breasts whether or not you are breast feeding.
  
  
• Constipation: Constipation is a condition where you have hard, dry stools which are difficult to pass. You may also have a feeling of fullness, feel sick to your stomach, and have stomach pain. Do not try to push BMs out if they are too hard. Walking is the best way to get your bowels moving. Eat foods high in fiber and drink lots of fluids to make it easier to have a BM. Good examples are high fiber cereals, beans, vegetables, and whole grain breads. Prune juice may help make the BM softer. Caregivers may give you fiber medicine or a stool softener to help make your BMs softer and more regular.
  
  
• Episiotomy Care:
  
  
  • Keep your vaginal area clean to prevent an infection. Caregivers may give you a squirt bottle of warm water or special cleaning solution. After urinating or having a BM, squirt warm water or the solution over your perineum, and then gently dry it. You may need to use a gentle soap and warm water to carefully wash the vaginal area. Change your sanitary pad every time you use the bathroom. Do not put anything inside your vagina for three to four weeks after delivery. Do not have sexual intercourse (sex) until your caregiver says it is OK. Be sure to use birth control if you do not want to get pregnant. Do not use tampons.
    
    
  • Use ice for the first 24 to 48 hours after delivery to help with pain and swelling. Put an ice pack wrapped in a cloth between your legs. Use heat after the first 48 hours if you still have pain or swelling. Sitting in a clean bathtub with warm water may also help the episiotomy heal faster and feel better.
  
  
• Fundal checks and pain: The top part of your uterus is called the fundus. After delivery, your fundus should start to become hard. This helps control bleeding. Caregivers push on your abdomen to feel how soft or hard the fundus is. If it feels soft, caregivers massage it to make it firm. This may be uncomfortable. Your fundus is checked often the first hour after delivery, and checked regularly after that. You may have "after pains" after giving birth. Contracting and relaxing of your uterus causes these pains. You may feel these pains for up to three days. The contractions get rid of blood from inside the uterus and also help to stop bleeding. These contractions may be stronger and hurt more while you breast feed your baby.
  
  
• Hemorrhoids: Hemorrhoids are swollen veins in the rectum or anus. You may have inside or outside hemorrhoids. Inside hemorrhoids are found where the anal canal (rectum) starts. Outside hemorrhoids are found around your anus. The anus is the hole where you have a BM. You may have rectal pain because of the hemorrhoids. Medicine and warm baths may help the pain and swelling. With time, the hemorrhoids should get smaller and may go away.
  
  
• Vaginal Discharge: You will have a vaginal discharge called "lochia" after delivery. The lochia is bright red the first one or two days after delivery, and later turns a pink color. The lochia changes to a white or yellow color by about the tenth day after delivery. It is normal to have discharge on and off for six weeks after delivery. How long you have lochia is different for each woman. Use a sanitary pad rather than a tampon. This helps prevent a vaginal infection. The lochia should not have a bad smell.

Going home:

• You are your baby may go home within 24 to 48 hours after the birth if there are no medical problems. You may need to stay in the hospital longer if you had a difficult labor or delivery. Your caregivers will decide with you when it is best for you and your baby to go home. Going home too early can cause problems for you or your baby, especially if you are breast feeding. Your baby may not get the amount of liquid that it needs. Ask caregivers for more information about the correct ways to hold and breast feed your baby.
  
  
• You must make sure that you, your home, and your car are ready to take your baby home. Make sure you have a safe crib, and enough diapers, clothing, and blankets for your baby. Make sure you have enough of the right formula and bottles if you are not going to breast feed. You must have a rear-facing child-safety seat to take your baby home in the car. Read the safety seat instructions before using the seat. Ask caregivers for more information about child-safety seats.
  
  
• A caregiver may be able to visit you at home if you feel that you or your baby may need help. A caregiver can help you learn about breast feeding, bottle feeding, baby care, perineal care, and other things.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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