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4.3.1 LABOR AND DELIVERY
Doctors divide the process of childbirth into three stages: 1. the gradual dilation of the cervix, 2. the actual delivery of the baby into the world, and
3. the delivery of the placenta or afterbirth. Using this medical classification, we now discuss each of the stages separately.
The First Stage of Labor
The first stage of labor takes the longest time. (In general, about 16 hours for women delivering their first baby and about 8 hours for the others.) During this period, labor pains begin to be felt and slowly become more frequent and more intense. These recurring pains are caused by rhythmic muscular contractions of the uterus followed by complete relaxation.
At first, the contractions last about 30 seconds and occur about every 15 to 20 minutes. As labor progresses, the periods of relaxation shrink to about 3 to 4 minutes while the contractions last 60 seconds or more. A woman who has prepared herself for childbirth by appropriate exercises can ease much of the physical strain by relaxing and breathing in certain ways which support rather than fight the process taking place inside her body. This process is aimed at dilating the cervix to the point where the baby's head can pass through it into the vagina. Once this is accomplished, the first stage of labor has come to an end and the actual birth is near.
Labor contractions lasting close to a minute and which recur about every five minutes are reason enough to proceed to the hospital. Another sign that birth is at hand is the expulsion of the cervical mucous plug which acts as a barrier between vagina and uterus. (It will be flecked with some light red blood.) Still another sign is the rupture of the membranes of the amniotic sac (commonly called bag of waters). This rupture will produce a flow of clear, water-like fluid from the vagina.
The Second Stage of Labor
The second stage of labor is considerably shorter than the first. (About two hours for women delivering their first baby and about one hour for the others.) During this time, the baby passes head first from the uterus through the vagina into the outside world. The mother can do much to help this process by contracting her abdominal muscles and bearing down with all her strength. Once the head has emerged, the rest of the baby's body follows easily.
The newborn child is still connected to the placenta inside the uterus by the umbilical cord. However, from now on this source of nourishment and oxygen is no longer needed. The sudden change in temperature and atmospheric pressure (sometimes also a slap on the buttocks) causes the baby to draw the first breath. As soon as breathing has become regular, the umbilical cord is cut a few inches from the abdomen. (There is no pain since the cord does not contain any nerves.) After a while, the remaining stub dries up and then falls off by itself.
The Third Stage of Labor
The third and final stage of labor brings the expulsion of the placenta and the umbilical cord from the uterus about fifteen minutes after the baby's birth. The delivery of this so-called afterbirth takes only a few minutes, after which the uterus begins to shrink back to its former shape and size.
Possible Complications
Giving birth is a normal function of the female body. Most dangers and complications popularly associated with childbirth belong to the past. Usually they were caused not by the delivery itself, but by the primitive and unsanitary circumstances under which it took place. A modern woman who has been consulting her doctor throughout the pregnancy and who gives birth with expert assistance has no reason to fear serious problems. Possible difficulties can now be handled quickly and effectively. For example, very often the pressure of the appearing fetus threatens to tear the vaginal opening. In these cases, the doctor makes a small incision (an episiotomy) to prevent such a tear. The incision is easily repaired with some stitches and heals within a short time. Another problem may arise when the baby's feet or buttocks appear first (instead of the head as in most cases). This so-called breech presentation may prolong the process of delivery and can be somewhat risky to the baby. A possible risk for all babies is an eye infection with gonorrhea. In order to prevent such infections, the eyes of each newborn infant are treated with a solution of silver nitrate.
In some rare cases, a normal delivery may be impossible for one reason or another, and a Caesarean section may become necessary. This means that the doctor cuts through the abdomen into the uterus to remove the baby before it passes through the vagina. The term "Caesarean section" refers to the legend that Julius Caesar was born in this fashion.
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