The experience of giving birth is different for each woman, and the same woman can have very different experiences each time she gives birth to a new baby. Most of the mothers have in common a slight feeling of sadness when they physically separate from the baby. This feeling, very normal, disappears as soon as they hold and see the baby for the first time.
The birth experience
Against most common ideas, the boy or girl is not a passive participant in the process of birth, it is actually the baby who determines many of the factors that will start the labor. In fact, the last few weeks in the uterus, the baby is getting ready to face the challenges and risks that may affect the development and growth of his body and brain.
When the date of the delivery is near, the uterus grows to hold the baby to his maximum size. When they stop growing, the muscles of the walls of the uterus distend, increasing the irritability and the capacity to contract.
On one hand, the size of the baby stimulates the uterus to contract and, on the other, the baby goes down to the pelvis and his head presses down on the neck of the uterus activating nervous endings that send messages to the brain of the mother to produce oxitocyn, the hormone that stimulates the contractions of the uterus.
The baby indicates when the delivery will start by means of some complex biochemical activities. When his endocrine glands mature, the baby starts to produce hormones that start a series of chemical reactions that make the prostaglandin substances appear in the uterus that, along with the oxitocyn ensure the coordination of the contractions that dilate the neck of the uterus to ease the exit of the baby.
For the baby, birth is the first physical and emotional impact he experiences and, according to some research work, he never forgets it.
Many authors, such as Dr. Thomas Verny, consider that birth is a fundamental fact recorded in the personality. He argues that the way of being born, painful or easy, tranquil or violent, will determine to a great extent the baby's future personality and how he sees the world around him.
THE STAGES OF THE BIRTH
As we have explained, for the baby to be born in a natural way, efficient contractions are needed, as well as that the neck of the uterus dilates sufficiently and the head of the baby has to go through the pelvis of the mother.
All natural births develop in three stages: the first one, is dilatation, the second one is expelling and the third one is the delivery.
During the months before the birth, the neck of the uterus has an opening of about 3 cm . The contractions make the neck shorten and begin to dilate. The first time a woman gives birth the neck dilates about 1 cm per hour and in the following occasions, about 2 cm per hour. The dilatation is considered complete when the neck is about 10 cm wide.
In this stage, the contractions usually break the sack of fluid so that the head of the baby can exert direct pressure on the neck of the uterus. The duration of the period of dilatation depends on having efficient contractions, the placement of the head of the baby and the number of babies the mother has had before.
Doctors usually recommend that the mother goes to the hospital when the contractions take place every 5 minutes during one hour or when the sac of fluid breaks or the plug is expelled.
When the neck of the uterus has reached its maximum width, and there are long and frequent contractions, the stage of expelling begins.
The mother is taken to the delivery room and is placed face up on the table, with her legs spread and the feet on special stirrups at the end of the table. Her pubic hair is shaved and, if she has any difficulties to urinate, a catherer is placed. If she has not been monitored, the sensors are placed and she is connected to the fetal monitor until the end of the delivery.
The midwife or obstetrician will give the mother a series of instructions so that her efforts are efficient. In each contraction, the woman must inhale deeply, hold her breath and push two or three times, relaxing until the next contraction.
The expelling stage can last between 40 and 60 minutes when it is the first time the woman gives birth and between 15 and 30 minutes when she has had other children.
During this stage, the baby progresses by stages. With the neck of the uterus fully dilated, the head starts to go out of the uterus and go through the pelvis and when the muscles that separate the vagina from the anus (the perineum) is distended, the vagina dilates and the head shows up through the vulva. When the head is free, the shoulders go out and finally, the rest of the body.
After the birth, normally, the midwife will place the baby on the belly of the mother so that he feels safer. Almost always, the baby is covered with a whitish layer called vernix caseosa, some blood and he is slightly purple in color.
Immediately after that, the umbilical cord is cut and two clamps are placed. At that time, the neonatologist will reanimate and check the new born. Whenever necessary, the baby will be placed in a thermal cradle to give him some warmth.
Sometimes, the doctor finds it necessary to make a cut in the perineum to avoid the muscles to tear when the head of the baby goes through the vulva. This cut can be vertical or oblique.
Vertical when it is made from under the vulva towards the anus. It can be done this way when there is enough space. This cut is easier to saw and is less bothersome during the healing but it must be done very carefully to avoid harming the sphincter.
Oblique when the cut goes from under the vulva towards one of the buttocks. This is done when there is not enough space between the vulva and the anus.
The episiotomy is not painful in most cases and it is done when the head of the baby is too big for the opening of the vulva, when the perineum is too tense or too weak, if it is necessary to speed up or ease the delivery or when it is necessary to use a forceps.
After the placenta has been expelled, the tissues of the vagina and the perineum that were cut will be sown using local anesthesia, except when epidural anesthesia was used.
The childbirth stage
After the baby is born, comes the stage of delivery which consists of expelling the placenta.
Some minutes after the birth, the contractions start again but now they are less intense and painful. These contractions are to detach the placenta from the wall of the uterus and expel it outside.
When the birth has not been spontaneous, the doctor will withdraw the placenta by introducing his hand inside the uterus after applying anesthesia unless epidural anesthesia has been used.
After expelling the baby, it is normal for the mother to lose some blood but if the losses are large, it is considered as a delivery hemorrhage. In these cases, the doctors usually apply some anesthesia and artificially extract the placenta.
When the placenta is out, the doctor will examine it to verify that it is complete and that no remains have been left in the uterus.
After this process is over, the wound made during the episiotomy is sown and for a period of about two hours, the mother's temperature, blood pressure and losses of blood are controlled. If her evolution is correct, the mother is taken to her room after this time.