Safe Childbirth

Every lady is having a dream of having her own baby, but it is a tough task. The pregnant lady carries her baby inside her womb for long 9 months and then the baby delivers. Delivery process is painful experience due to labour pains.
Gestational period is roughly 280 days or 9 months and 7 days for humans.
The due date of delivery is calculated by adding 9 months and 7 days after the first day of the last normal menstrual period.
If we calculate in weeks, this period is of 40 weeks from the first day of the last normal menstrual period.
The fetus matures 3 weeks prior to the expected date of the delivery. So delivery happening any time after 37 weeks is considered as normal and the fetus/baby is usually mature and needs normal care after birth. Few ladies deliver before 37 weeks of the pregnancy and this delivery is called as preterm delivery. The fetus/baby delivered preterm may require some support after delivery, depending upon birth weight. Lesser the birth weight more is the support baby will require. Generally these preterm babies are treated in neonatal Care units in specialty hospitals.

Some ladies will deliver after their due date of delivery is passed. Theses deliveries are known as the post term deliveries. This may also be problematic for the baby. As the baby spends more time in the womb, its weight tends to be more which causes problems for the delivery. Post dated or over mature bay may pass meconium (Stools of the fetus) which may play significant role in the health of the baby after delivery. If the baby stays more than 2weeks inside the womb,. So it is very important to have delivery anytime between 3 weeks prior up to the due date of delivery. The process of the natural birth is termed as labour. Labor is a series of continuous, progressive contractions of the uterus that help the cervix (the mouth of the uterus) dilate and efface (thin out). This lets the fetus move through the birth canal. Labor usually starts two weeks before or after the estimated date of delivery. The labour pains starts around the due date of delivery but, the exact trigger for the onset of labor is unknown.

While each woman experiences labor differently, some common signs of labor may include:

Different Stages of Labor

Typically, labor is divided into three stages

First stage
During the onset of labor, cervix (mouth of the uterus) will complete dilation. Early in this stage, lady may not recognize that you are in labor if your contractions are mild and irregular. Early labor is divided into two phases:
The latent phase is marked by strong contractions that usually occur at five- to 20-minute intervals. During this phase, cervix will dilate approximately 3 to 4 centimeters and efface. This is usually the longest and least intense phase of labor. Lady may be admitted to the hospital during this phase.
The active phase iis signaled by the dilation of the cervix from 4 to 10 centimeters. Contractions will likely increase in length, severity and frequency, occurring at three- to four-minute intervals. In most cases, the active phase is shorter than the latent phase.

Second stage
Often referred to as the pushing stage of labor, this stage starts when the cervix is completely opened and ends with the delivery of baby. During the second stage, lady becomes actively involved by pushing the baby through the birth canal. Crowning occurs when baby’s head is visible at the opening of the vagina. The second stage is usually shorter than the first stage, and may take between 30 minutes to one hour.

Third stage
After the baby is delivered, the lady will enter the third and final stage of labor. This stage involves the passage of the placenta (the organ that nourished your baby inside of the uterus) out of the uterus and through the vagina. The delivery of the placenta may take up to 30 minutes.

Since each labor experience is different, the amount of time required for each stage will vary. If labor induction is not required, most women will deliver their baby within 10 hours of being admitted to the hospital. Labor is generally shorter for subsequent pregnancies. Positions for delivery may vary, ranging from squatting or sitting positions to semi seated positions. In a semi seated position, patient is partially lying down and partially sitting up, allowing gravity to help you push the baby through the birth canal. During the delivery process, we continue monitoring vital signs, including blood pressure and pulse, and the fetal heart rate. We do internal examinations periodically to see cervical opening to determine the position of baby’s head and continue to support and guide you in your efforts to push.

Delivery can be done either vaginally or by C-section

Vaginal Delivery
During a vaginal delivery, we assist the baby’s head and chin out of the vagina when it becomes visible. Once the head is delivered, we apply gentle downward traction on the head to deliver the shoulders, followed by the rest of the body. The baby turns itself as the last movement of labor. In some cases, the vaginal opening does not stretch enough to accommodate the fetus. If the baby is in distress, it may be necessary to accelerate delivery using an episiotomy. During this procedure, a Cut is made on the vaginal wall and the perineum (area between the thighs, extending from the anus to the vaginal opening) to help deliver the baby. Episiotomies are not needed for every delivery. After the delivery of baby, the delivering lady is asked to continue to push during the next few uterine contractions to deliver the placenta. This process may take up to 30 minutes. Once the placenta is delivered, any tear or episiotomy cut is repaired. We give uterotonics drugs which will help to contract the uterus and prevent bleeding. These drugs will be injected into muscles or delivered intravenously. The uterus is then massaged to further help it contract and to help prevent excessive bleeding. Some bleeding is normal and should be expected following a vaginal delivery.

Cesarean Section
If we are not unable to deliver the baby vaginally, the baby will be delivered by a C-section. This surgical procedure is usually performed in an operating theatre. Some C-sections are planned and scheduled, while others may be performed as a result of complications that occur during labor. Once the anesthesia is given to the lady and it has taken effect, we make a cut in the abdomen and create an opening in the uterus. After the amniotic sac is opened, the baby is delivered through the opening. During the procedure, lady may feel some pressure and/or a pulling sensation. Following the delivery of the baby, we stitch up your uterus and the cut that was made in your abdomen. After a C-section, lady may still experience some vaginal bleeding.

Conditions for a C-Section
Several conditions may increase your chance of delivering via C-section, including:
Abnormal delivery presentation
A previous C-section
Fetal distress
Labor that fails to progress or progresses abnormally
Placental complications, such as placenta previa (the placenta blocks the cervix, which could cause the placenta to prematurely detach from the uterus)
Twins, triplets and higher-order multiple gestations

Possible Labor and Delivery Complications

Although serious complications are rare during labor, the most common complications include:
Fetal Meconium
When the amniotic sac ruptures, the normal color of the amniotic fluid is clear. If the amniotic fluid is green or brown in color, it may indicate fetal meconium, which is normally passed after birth as the baby’s first bowel movement. Meconium in the amniotic fluid may be associated with fetal distress.

Abnormal Fetal Heart Rate
The fetal heart rate helps indicate how well your baby is handling the contractions. This vital sign is usually monitored electronically during labor. The normal range is between 120 and 160 beats per minute. If your baby appears to be in distress, the fetal heart rate drops down. Once this happens, we need to deliver the baby as early as possible. If delivery is possible we hasten it and if not we do c. section and deliver the baby out.

Abnormal Fetal Positions during Delivery
The normal position for the baby during birth is head down, facing mother’s back. If the baby is not in this position, it can make delivery through the birth canal more difficult. The most common abnormal fetal delivery positions are; head down but facing your front (occipito posterior position), Face down in pelvis (instead of the top of the fetal head- face presentation), Brow down in pelvis, Breech (buttocks or feet are down first in your pelvis), A shoulder or arm in pelvis. Depending on the position, we may try to deliver the fetus as it presents itself, attempt to turn the fetus before delivery or perform a C-section.

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