Childbirth (Delivery)

Pregnancy lasts on average 280 days, or 40 weeks (9 calendar months), and ends with the birth of a baby. Childbirth therefore takes place between 38th and 42nd weeks.

Before the birth, a gynecological examination is carried out with an assessment of the readiness of the birth canal. It is evaluated:

• Birth canal condition - the state of the cervix is assessed. The cervix is gradually shortening and opening. As it expands, it gradually merges with the body of the uterus (we say that the cervix is being consumed). The opening of the cervix is measured in centimetres and so it opens - the gate opens.
• The condition of the baby - whether the baby lays with its head against the entrance of the pelvis, the sounds of the heart and the frequency and strength of contractions of the uterus (cardiotocogram).

You can find out about the available maternity hospitals already at your regular pregnancy check-up. A mother who is already close to the date of delivery should go to the hospital in the following cases:

• Amniotic fluid leakage - amniotic fluid is a clear fluid, but may contain a small amount of blood. If your amniotic fluid has leaked - “break your water” (rupture of amniotic sac), you need to go to the hospital.
• Bleeding - before the onset of childbirth, the mucous plug is released, often with small blood content. However, bleeding can have various serious causes, so a gynecological examination and hospitalization is necessary.
• Regular contractions - If you have regular uterine contractions every 5 - 7 minutes and they last around 30 - 40 seconds, this is a sign that labour has already started and admission to the maternity ward is required.

Childbirth consists of 3 parts, called birth stages:

• Dilatation - the first period of childbirth, the opening period. It lasts about 10 hours in first-born and 6-8 hours in multiparous women. The mom-to-be prepares for labour, she is examined every 2-3 hours.
• Expulsion (delivery of the baby) - the second period of labor, the period of own birth, when the cervix is ​​open to 10 cm, its edges are even (the cervix is ​​"consumed") and the baby can pass through the birth canal. The mother gives birth and helps the baby with the birth by pushing. This time lasts from 5 minutes to 2 hours.
• Placental delivery- the third stage of labor, separation of the placenta. During this time, the mother gives birth to the placenta and the umbilical cord with fetal membranes. Since there is a risk of greater blood loss in this part of the birth, it can be shortened by administering the hormone oxytocin (one-time injection).

Although childbirth is a natural activity, it is not a routine day for either the mother or the baby.

There are more risks and complications that can occur. Fortunately, the methods of modern gynecology and obstetrics are at such a high level that deaths of mothers and children due to complications during childbirth are rare compared to the past.

• Risks on the mother's side are: older age of the first-time mother, high blood pressure, preeclampsia, diabetes and gestational diabetes, findings on the uterus (myomas, conditions after caesarean sections), exhaustion of the mother during prolonged labor. Birth is also affected by other diseases of the mother, for example: asthma, cardiovascular and autoimmune diseases, oncological diseases, epilepsy and others. Therefore, it is necessary to inform the obstetrician about all diseases and medications that you regularly take.

The risks on the side of the child are:

• Changed position of the child in the uterus: breech (bottom-down) or transverse lie (sideways) position.
• High expected birth weight (more than 4000g - 8.18 lbs).
• The placenta is located in the lower part of the uterus and thus covers the birth canal.
• Premature birth of an immature baby (before the 37th week).
• Other diseases that were detected as part of prenatal diagnostics.

Current progress in medicine offers various interventions and treatments that serve to increase the safety of childbirth in the event that the mother or baby is in danger of health or life. Some procedures serve to protect against infection, others to speed up childbirth or enable better healing after childbirth.

Therefore, during the preparation for childbirth, you may encounter the following terms:

• Induction of labour - if the mother pass her due date (the pregnancy lasts longer than 42 weeks) labour can be induced using the hormone prostaglandin.
• Support of uterine activity - in case the contractions of the uterus are not sufficient, it is possible to support the contractions using the hormone oxytocin.
• Amniotomy - incision of the fetal membranes (amniotic sac), which causes the outflow of amniotic fluid and the onset of contractions. Amniotomy is usually performed when the cervix is opened to 3 - 4 cm. Contractions and pushing for delivery when the amniotic sacs are intact can cause premature placental abruption and bleeding.
• Episiotomy (cutting of the perineum) – the perineum refers to the skin and tissues between the vagina and the anus. If labor does not continue and there is a risk of lack of oxygen for the baby, cutting the perineum widens the birth canal and speeds up delivery. A cut is a better solution than if the perineum breaks on its own due to the pressure.
• Forceps delivery and vacuum extraction delivery - in a case of need for a quick termination of delivery due to asphyxia (lack of oxygen), the delivery is accelerated by grasping the baby (either with forceps or using vacuum to grasp the head) and removing it from the birth canal.
• C-section (Cesarean section) - an operation in which the uterus is opened from an incision placed in the lower abdomen and the obstetrician removes the baby. The uterus is then sutured and healed with a scar. The scar is hard enough to allow another pregnancy. It is performed if the baby is in an inappropriate position (breech or sideways), if the woman has already given birth by caesarean section or in case of other complications. It is performed under epidural, spinal or short-term general anesthesia. 
• Epidural labor analgesia (epidural analgesia) - it is the application of local anaesthetic into the upper part of the lumbar spine - into the epidural sac. This procedure is performed by an anesthesiologist by inserting a special catheter. It relieves pain, relaxes the pelvic floor muscles.
• Enema - emptying the bowels is suitable given because during childbirth, the mother helps by pushing in the same way as with stool pressure. The aim is to prevent fecal contamination during childbirth.