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Giving birth vaginally

Published by Bupa's health information team, healthinfo@bupa.com, February 2008.

This factsheet is for people who would like information about giving birth vaginally.

Vaginal birth is the usual way for babies to be born. The process of giving birth to your baby is known as labour - there are three stages that will last different lengths of time.

There are a number of types of pain relief that you may wish to use to help you manage any pain during labour.

About giving birth vaginally
Complications
Pain relief
Further information
Sources
Related topics

About giving birth vaginally

There are three stages that you will go through when you give birth vaginally. Labour varies according to factors such as whether or not it's your first pregnancy, the size of your baby and its position in your womb.

First stage

Before active labour starts, your body goes through some changes in preparation, so it's not always easy to tell exactly when labour starts. When your baby is ready to be born, the balance of hormones (chemicals found naturally in your body) changes and makes your cervix (the neck of your womb) become softer and shorter. You may also have what is called a show. This is when the plug of mucus that acts as a seal in your cervix during pregnancy falls out as your cervix changes shape. This may happen any time between several days and a few hours before labour starts.

The labour hormones also cause you to have contractions. This is when the muscles in your womb tense and relax becoming shorter so that your cervix stretches and opens (dilates). It may take some time for the contractions to become regular but they will gradually get stronger and closer together. At first you may only have a contraction every 15 to 30 minutes. After a while, they will be more frequent, occurring every two to three minutes. The length of time that each contraction lasts will be different for all women.

When you have a contraction, you will feel a build-up of tension across your abdomen (tummy), pain in your back and possibly also between your thighs and low down in your pelvis. Contractions become more intense and painful as labour goes on.

You will have heard the phrase "your waters breaking". This is a normal part of labour and is when the bag of fluid that holds your baby breaks as your cervix widens. It's also referred to as your membranes rupturing. The fluid may rush out in one go or in a steady leak. When your waters break you should contact your midwife or doctor for advice on what to do next.

The first stage of labour continues until your cervix is fully dilated - about 10cm - allowing the baby to move lower through your pelvis. This stage can take from seven to 11 hours, but it's different for everyone. It's likely to take less time if it isn't your first baby because your pelvis and vagina have been stretched before.

Second stage

The second stage is when you give birth to your baby. It usually lasts about one to two hours.

As the baby's head gets lower, you will eventually feel the need to push and this helps the baby to be born. This is a unique feeling which your body does of its own accord. You will still be having contractions to help you push - they may be less frequent but longer. You may feel more comfortable if you are upright - kneeling, sitting or squatting.

As you push, your baby moves further down through your pelvis until his/her head stays at the entrance to your vagina between contractions. This is called 'crowning' and means your baby is ready to be born. Usually, the head is born first followed by the shoulders and the rest of the body.

Third stage

This is when the placenta and membranes that held your baby in the womb are passed out of your body. You may wish to let this happen naturally or you can be given a medicine to help the process.

Active management of the third stage by your midwife or doctor

If you have this sort of delivery, your midwife or doctor will help the third stage to progress more quickly and safely.

As your baby's shoulders are being born, you will be given an injection of a hormone called oxytocin or a combination of oxytocin and a medicine called ergometrine. Within about two minutes, these cause your womb to contract strongly to help reduce serious bleeding.
The umbilical cord is clamped and cut as soon as your baby is born.
The midwife or doctor will then deliver the placenta by pulling gently with one hand on the part of the umbilical cord that is still attached to it.

This takes about 10 to 20 minutes. Research has shown that this method reduces your risk of serious bleeding. However, it's possible that you will have some side-effects as a result of the medicines such as feeling sick.

Natural (physiological) management of the third stage

You may choose for the placenta to be delivered without any medicines. After your baby is born, you will be encouraged to cuddle him/her and try breastfeeding. This causes hormones to be released which help the womb contract and push out the placenta. The umbilical cord isn't clamped and cut until the placenta has been delivered - this can take anything from a few minutes to up to an hour.

There are a number of reasons why this type of third stage may not be possible, including:

if you had an epidural during labour
if you had heavy bleeding during pregnancy or during a previous labour
if there were problems during labour

Your midwife or doctor will give you more information about your options.

Complications

Induction of labour

Induction is when you are helped to go into labour. There are a number of reasons why this may be suggested, including:

if you have a medical condition such as diabetes or high blood pressure
if your baby's growth has slowed down or stopped
if your pregnancy is overdue (more than 41 weeks)
if labour hasn't started within four days of your membranes rupturing

There are several methods that can be used to induce labour.

Membrane sweeping - your midwife or doctor puts their finger inside your cervix and makes a circular movement. This means that the membranes around the baby are detached from here. It can also encourage the labour hormones to be released.
Prostaglandins - these are hormones which are usually produced by your body to trigger the beginning of labour. They stimulate your cervix to get softer and shorter. You will have either tablets or a gel placed into your vagina.
Oxytocin - this causes your womb to contract. You will receive it through a drip inserted into your arm. You will only be given oxytocin if your membranes have already ruptured.

Augmentation of labour

It's possible that if labour is taking a long time and isn't progressing at the rate that would usually be expected, you may be offered oxytocin to help your womb contract more strongly. You will receive this through a drip.

Assisted delivery

Sometimes your midwife or doctor may need to use instruments to help you give birth to your baby. This may be because:

your baby isn't getting enough oxygen, or there is another problem putting his/her health at risk - this is called fetal distress
you had an epidural late on in labour - this may reduce how hard you can push and may also make it difficult to know when to push
your baby may be in a position that means it's difficult for him/her to be born without assistance
you have been pushing for a long time and have a health condition that means your ability to push any more may be limited

You will be given local anaesthesia before an assisted delivery. This completely blocks feeling from your lower body and you will stay awake during the procedure. There are two types of assisted delivery.

Forceps - these are like large tongs with curved ends that fit around your baby's head. Your midwife or doctor will pull gently on them while you push.
Vacuum extraction (ventouse) - this uses suction. A cup is placed on your baby's head and attached to a vacuum machine. The air is sucked out which attaches the cup strongly to the baby's head. Your midwife or doctor then pulls on the cup as you push.

If you need an assisted birth, your midwife or doctor will give you more information about your options.

Pain relief

All women cope differently with labour. You may have one idea about the pain relief you wish to have before labour, but change your mind once it's actually happening. There is evidence to show that having someone with you throughout labour can reduce your need for painkillers.

Self-help

There are a number of other methods of pain relief that you can try if you don't wish to use medicines, including:

focusing on your breathing
massage
moving around
using a TENS (transcutaneous electrical nerve stimulation) machine - two electrodes are placed on your back and electrical impulses are sent to the nerves to block the perception of pain going from your womb to your brain

If you decide to use medicines, all these methods can also be used at the same time.

Medicines

There are a number of medicines you can choose for pain relief - they can be used in combination if necessary. It's important to talk to your midwife or doctor about these and be sure that you are aware of the risks and benefits of each.

Gas and air (eg Entonox)

This is a mixture of nitrous oxide (laughing gas) and oxygen. As you feel a contraction starting, you breathe it in through a mouthpiece or a mask placed over your nose. It's a mild painkiller and will probably make your contractions less painful, although not all women find it effective.

Opiates

These medicines include diamorphine and pethidine. They are stronger and very effective at relieving pain but because of this you may have side-effects including feeling sick or dizzy. Opiates may affect your baby making him/her sleepy at birth. Sometimes these medicines can reduce your baby's ability to breathe after birth - this may require urgent treatment. Opiates usually take effect within 10 to 15 minutes and the pain relief will generally last for about two to three hours. They may give you a sense of being "high" or as if you are floating.

Epidural

This method involves having an injection of local anaesthetic into your lower back, just above your waist. This means you probably won't be able to feel anything in your abdomen or the tops of your legs. Epidurals are usually very effective but take about 30 minutes to work. If you have an epidural, your second stage of labour may take longer because you won't feel the urge to push. It may also make moving around more difficult because you have less feeling in your back and legs.

Further information

National Childbirth Trust
0870 444 8709
www.nct.org.uk
National Institute for Health and Clinical Excellence (NICE)
www.nice.org.uk
Royal College of Obstetricians and Gynaecologists
020 7772 6200
www.rcog.org.uk

Sources

Oats J, Abraham S. Fundamentals of obstetrics and gynaecology. 8th ed. Elsevier Mosby, 2005
Greer I. Pregnancy. The Inside Guide. 1st ed. Collins: London, 2003
McGrail A, Metland D. Expecting. Everything you need to know about pregnancy, labour and birth. 1st ed. Virago: London, 2004
Labour and birth: what to expect this time around (referenced). The BabyCentre. www.babycentre.co.uk, accessed 1 February 2008
British National Formulary (BNF). Prostaglandins and oxytocics. BMJ Publishing group, 2007. 54: 414-415
Evidence based guidelines for midwifery-led care in labour. Royal College of Midwives, 2005. www.rcm.org.uk, accessed 8 November 2007
Inherited clinical guideline - induction of labour. National Institute for Health and Clinical Excellence (NICE), 2001. www.nice.org.uk, accessed 8 November 2007
Chamberlain G, Steer P. Turnbull's Obstetrics. 3rd ed. Churchill Livingstone: London, 2001
Pain relief in labour. Norfolk and Norwich University Hospital NHS Trust. www.nnuh.nhs.uk, accessed 9 November 2007
British National Formulary (BNF). Opioid analgesics. BMJ Publishing Group, 2007. 54: 226-227