In The Delivery Room With Normal Labor

Normal Labor

The purpose of labor is to deliver the baby. However, this is a process that can last many hours. In some native tribes it may only take 4 to 6 hours for a primigravida and 1 to 2 hours for a multigravida.

However, nutrition, personality and the fact that they deliver in the squatting position makes the circumstances in a primitive tribe quite different from conditions in the Western world. The Lamaze method attempts to copy the conditions of natural child birth. However, if only the physical positions during the delivery are copied, attempts achieving similar easy deliveries will fail. Another method is the Bradley way of natural childbirth.

Attention to the other factors such as a sensible diet (zone diet plan, see Ref. 2) should not be overlooked. There is evidence in the literature that difficult deliveries may just be another symptom of insulin resistance, so why not prevent and treat this with a sensible nutritional approach. See also this link: health, nutrition and fitness.

In industrialized countries a primigravida delivers her baby in a total of 12 to 18 hours on average. A multigravida may deliver the baby in much shorter time such as between 2 and 12 hours. However, there are a number of factors, which have an influence on this. With gestational diabetes pregnancy the baby is over weight by a few ounces or even 1 or 2 pounds heavier, which will slow down the delivery significantly and increase the Cesarean section rate as well. Faulty nutrition with too much starch and sugar will do the same.

Normal delivery:

With a normal delivery most of the energy of the labor pains is directed at dilating the cervical canal to allow the baby's head to fit through and descend into the small pelvis. With normal deliveries there is no problem (with abnormal ones there could be a head that is to big, necessitating an emergency Cesarean section).

This initial stage from the start of labor pains to the full dilatiation of the cervix is called the first stage of labor. This is verified by an internal examination in a sterile gloved manner. The second stage is the dilatation of the vagina, where the vagina transforms from a long narrow structure to a wide and short structure. This second stage lasts about 45 to 60 minutes in "multiparas" (women that already have had several children), but can be rapid in a few multiparas who tend to have "precipitous deliveries" (very rapid ones).

In a person like this sometimes the time from initial labor to the delivery of the baby may only be 30 to 60 mintues or two hours in total at the most.

On the other hand the second stage in a woman getting her first child (called "nullipara", has not yet had a prior delivery) will often last 2 hours and is very exhausting. In this stage the woman needs to push down along with the labor pains. In the first stage the woman is not allowed to push. The delivery room nurse or a certified midwife are wonderful coaches in all of these stages and the father should be there as well to coach and support his wife.

The Baby is Born:

One the baby's head has passed through, the rest of the body is usually born very quickly (the third stage).

During the birth crowning (head is born) the soft tissue between the anal opening and the vagina can break. In order to turn this into a controlled tear, the physician or the midwife may help along by making a small cut with scissors, called an episiotomy. Usually this is done after some quick freezing with a local anesthetic, if it is determined that the soft tissue is a significant barrier and is impeding baby's birth. Often though it is not necessary, and any spontaneous rupture can be fixed later with proper freezing and suturing when the delivery is done.

All attention turns to the baby now: Is it breathing, crying, healthy looking? There are whole books written on newborn resuscitation (reviving the baby). Suctioning of mucous from the back of the mouth may have to be done. If the baby is crying well it is briefly held upside down to allow gravity to remove some of the mucous from the trachea. The baby is wrapped into a soft cloth and put into a prewarmed crib. Shortly after, if all is well, it is given to the mother and father for bonding. The baby may need a few minutes of oxygen to quickly recover from the stress of being born.

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Disclaimer

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References

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19. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 251.

20. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 250.

21. Ignaz P Semmelweiss: "Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers" ("Etiology, the Understanding and Prophylaxis of Childbed Fever"). Vienna (Austria), 1861.

22. Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., 1998 Mosby-Year Book, Inc.

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Last Modified: Dec. 22, 2007