Vaginal Delivery

What is a vaginal delivery?

A vaginal delivery occurs when your baby is born through your vagina (birth canal). There are three stages of labor that occur during a vaginal delivery. The first stage begins when you start having contractions, the tightening of your uterine (womb) muscles. The second stage begins when your baby enters your birth canal and ends when your baby is born. The third stage begins after your baby is born and ends when your placenta is delivered. The placenta provides oxygen and food to your baby during pregnancy.

What happens during the first stage of labor during a vaginal delivery?

• During the first stage of labor, your uterus contracts to help your cervix dilate (open) and efface (soften and thin). This will allow your baby to exit the womb so you can push your baby out of the birth canal. You will have regular contractions that occur more often and may become more painful over time. During the first stage of labor, the amniotic sac (fluid sac that surrounds your baby in the womb) may break open. You may hear your caregiver say that your water broke. When your water breaks, you may have a slow leaking or a gush of fluid from your vagina. Your water may break open by itself or your caregiver may need to break your water. Caregivers will do vaginal exams to check how much your cervix has dilated during this stage. Caregivers may give you medicine to induce (start) your labor if the first stage is moving too slowly.
  
  
• During the first stage of labor, caregivers may have you change your position in bed. Caregivers may also suggest you stand or walk during this time. Changing positions and activity can help relieve some discomfort and may help your baby move into position for birth. Caregivers may place a special belt on your abdomen (stomach) to measure the strength of your contractions. Your unborn baby’s heartbeat may be watched constantly or at different times during this stage. You may also be given pain medicine to help lessen the pain from contractions. The first stage of labor ends when your cervix is fully dilated to 10 centimeters.

What happens during the second stage of labor during a vaginal delivery?

• The second stage of labor is when you begin to push during your contractions. Pushing helps to move your baby through your birth canal. You may be lying down to push, or you may stand or squat. Caregivers may suggest that you change your position. Caregivers may tell you when to push or you may be told to push when you feel the urge (need). Do not hold your breath while you push. If your baby is coming too fast, you may be shown how to pant. Panting can help slow the birth and may help prevent your perineum from tearing. Your perineum is the area between your vagina and anus.
  
  
• When you are pushing your baby out, caregivers may use tools to help deliver your baby. Birthing tools include a forceps or a vacuum device. Caregivers may use tools if your baby is coming very slowly or if he is having problems. Problems may occur if your baby is larger than your birth canal or your baby is not getting enough oxygen. These tools help guide your baby through your birth canal. You may also need an episiotomy to make the vaginal opening larger for your baby to be born. An episiotomy is an incision (cut) in the skin and muscles from your vagina towards your rectum or your leg. The cut may help prevent you from getting tears in your perineum. The second stage ends with the birth of your baby.

What happens during the third stage of labor during a vaginal delivery?

Once your baby is born, your caregiver puts clamps on the cord that connects your baby to the placenta. Your caregiver then cuts the cord. Your uterus continues to contract to push out the placenta. You may feel a sudden gush of fluid come out of your vagina. This stage of labor ends when your placenta is pushed out of your uterus through your vagina.

What happens right after a vaginal delivery?

• Your caregiver will check your placenta to make sure the entire placenta came out. Your caregiver also checks the placenta for any abnormal areas. Caregivers may massage your lower abdomen to help stop bleeding from your uterus. If you have an episiotomy or a tear that occurred during the birth, your caregiver will close it with stitches.
  
  
• During this time, caregivers will check your baby’s skin color and how active he is. You may be able to hold your baby soon after he is born. Many birthing centers and hospitals encourage parents to be with their baby right after the birth. This is a time to touch him and hold him. This gives you a chance to bond with your baby. Once caregivers see that you and your baby are okay, you may be taken to another room.

What else may happen after a vaginal delivery?

• Activity: Your caregiver may suggest you get out of bed to sit in a chair or walk. Activity will help your blood flow and can help prevent blood clots from forming.
  
  
• Breast care: If you will breastfeed, ask caregivers to show you how to hold and breastfeed your baby. Ask caregivers for more information about how to care for your breasts, whether or not you are breastfeeding.
  
  
• Fundal checks: The top part of your uterus is called the fundus. After delivery, your uterus will start to return to its normal size and your fundus will get harder. This helps control bleeding. Your fundus will be checked often the first hour after delivery, and as needed thereafter. Caregivers may push gently on your abdomen to feel how soft or hard your fundus is.

When might I go home after a vaginal delivery?

You 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 trouble during your labor or delivery. Your caregivers will decide with you when it is best for you and your baby to go home. If you are worried about going home with your baby, ask your caregiver about home visits by another caregiver. This caregiver can help you learn about breastfeeding, bottle feeding, baby care, and perineal care. Having support at home will help you adjust to having a new baby.

How can I care for myself after a vaginal delivery?

• Constipation and hemorrhoids: You may have constipation and hemorrhoids for a period of time after you have your baby. Constipation is hard bowel movements (BMs) that are difficult to pass. Hemorrhoids are swollen veins around or in your rectum that may cause you pain. Ask your caregiver about preventing constipation and caring for hemorrhoids.
  
  
• Perineal care: Keep your perineum clean to help prevent an infection. Your caregiver may suggest using sitz baths. You can use warm or cold water sitz baths, but cold baths may help relieve pain more quickly. Ask your caregiver for more information about how to take sitz baths. If you have stitches in your perineum, wash the area gently with soap and water when you bathe or shower.
  
  
• Vaginal discharge: You will have vaginal discharge, called lochia, after your delivery. The lochia is bright red the first day or two after the birth. By the third or fourth day, the amount decreases, and it turns a red-brown color. Sometimes the discharge has a slight odor (smell). You may need to wear a pad and change it many times each day. You may be able to use tampons if you can insert them without any problems. Caregivers may advise you not to use tampons at night time to lessen the risk of infection. It is normal to have lochia up to eight weeks after your baby is born.

What are the risks of a vaginal delivery?

• If your labor is not moving forward as it should, you may need a Cesarean section (C-section) to deliver your baby. A C-section is surgery to deliver your baby through your abdomen. A C-section may also be needed if your baby has a slow heartbeat or low oxygen levels during labor. Forceps or a vacuum used to help deliver your baby may injure your baby’s face or head. The tools may also cause damage to the nerves in your baby’s neck and arm. Your baby may also be at risk for bleeding in his brain. Your baby may get a hematoma (blood pooling under the skin) from birth with or without tools. A hematoma may cause your baby to have jaundice (yellow skin).
  
  
• When delivering your baby, your vagina and perineum may tear. You may also tear into your anus (where bowel movements leave your body). These tears will need to be closed with stitches and may be painful. You may lose more blood than expected and develop anemia (low blood iron levels). You may need a blood transfusion or surgery to stop the bleeding. You may also have damage to the nerves in your perineum and legs. After you deliver your baby, you may get an infection in your uterus, urinary tract, or perineal tears. You may leak urine, BMs, or gas and having a BM may be painful. If you have had a C-section before, your uterus may rupture (tear) during a vaginal delivery.
  
  
• After a vaginal delivery, having sex may cause you to feel pain. You are also at risk for uterine prolapse (when your uterus falls into your vagina). When you are pregnant, and for a short time after delivery, your blood becomes thicker. You may be at risk for a blood clot. A blood clot can cause pain and swelling and it can stop blood flow. The blood clot may break loose and travel to your lungs. A blood clot in your lungs can cause trouble breathing. This problem can be life threatening. Talk with your caregiver if you have questions or concerns about a vaginal delivery.

Where can I find support and more information?

Ask your caregiver about classes to help you get ready for labor and the delivery of your baby. You may want a support person with you during labor and delivery to help you feel more comfortable. The support person can also help you breathe and push at the right times. You can also contact the following:

• The American College of Obstetricians and Gynecologists
  409 12th Street, SW
  Washington , DC 20090
  Phone: 1- 202 - 638-5577
  Web Address: http://www.acog.org
  

When should I call my caregiver?

Call your caregiver if:

• You have a fever.
  
  
• You think your water broke.
  
  
• You think you are having contractions.

When should I seek immediate care?

Seek care immediately or call 911 if:

• You are bleeding from your vagina.
  
  
• You do not feel your baby kicking as often as he usually does.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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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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