PARTURITION

Child birth/parturition

Parturition simply means Childbirth. 

It derives from the Latin word “Partŭrĭo” which means “the process of bringing out an offspring” and is related to “Partŭs”, which means birth. Therefore, we can define parturition as the process of delivering the baby and placenta from the uterus to the outside world. The entire process of labour and delivery sums up to childbirth.

stages of child birth - labour and delivery

What is Labour?

The long process of contractions which body goes through to prepare itself for the childbirth is called labour. At this point of time, the weak rhythmic Braxton Hicks contractions are converted to strong and intensive labour contractions. This eventually leads to childbirth.

Stages of contraction in labour

Cycle of Labour 

  • The brain releases hormones for dilation of cervix as baby starts pushing downwards

  • This results in uterus contractions

  • Baby’s head further pushes downward into the uterus

  • This results in further stretching of the cervix

  • This in turn stimulates the increase in secretion of oxytocin by pituitary gland, followed by the dilation of cervix 

  • This cycle continues until the baby is out of the cervix

Stages of Labour

The first stage | Dilation of Cervix

Cervix pushes the head of the baby outward into the vaginal birth canal. During this stage, the cervix dilates from 1cm to 10 cm, almost the size of the baby's head. It usually lasts for up to 8-24 hours in the first pregnancy and usually shorter in subsequent pregnancies. During this stage, the mother experiences pain due to contractions of the uterine muscles. The contractions happen periodically and can last from 30 seconds to 90 seconds. The frequency of these contractions increase as the dilation keeps on increasing. This pops the mucus plug (which blocks the opening of cervix during pregnancy to prevent external infections  from reaching the baby). A clear or slightly bloody discharge flows through the vagina now.

The second stage | Childbirth

The foetus continues to push the cervix and the fetal membranes finally burst. This causes the expulsion of the amniotic fluid suddenly, through the vagina, also called breaking of water. The contractions continue to deepen and start appearing almost every 4 minutes. The baby's head first emerges out of the cervix and the rest of the body follows until it is completely out of the vagina. 

This stage may last for a few minutes to a few hours in some pregnancies. The pain undergone by the mother at this moment is very significant.

The third stage | Placenta delivery

After the delivery of child, final stage is the delivery of the placenta. Mother's uterus continues to contract. Due to a shearing effect, the placenta now gets detached from the uterine wall and is finally expelled through vagina. Here, bleeding is observed, resulting in about 350 ml of blood loss. The pain persists during this stage too.

Stages of child birth/parturition - dilation, child delivery and delivery of placenta

DELIVERY

The process of expulsion or extraction of the child and fetal membranes (amniotic sac, umbilical cord, placenta, etc.) from mother's body at childbirth is termed as delivery. 

The type of delivery is always pre-determined much before the mother reaches the labour stage. It depends on her medical history, phase of pregnancy and the growth of the baby. It is more likely, that the OB/ GYN will plan an alternative method of delivery in case of an emergency or an unexpected complication. Same should be discussed with the mother in prior. The doctor should also be discussing pre-mature delivery possibilities and the procedure to follow in that case. 
 

Types of Delivery

types of deliveries/child births plans

Vaginal Delivery | The Normal Delivery

 A vaginal birth is commonly known as normal delivery. This is the process of giving birth to an offspring through the vagina, also known as the birth canal. 

Characteristics of Normal Vaginal Delivery

  • This type of delivery generally takes place when the women completes the entire term of pregnancy which is around 38-40 weeks or 9 months

  • The mother enters the various stages of labour

  • In this method of delivery, the baby is persistently pushed out by the mother from the uterus through her vagina

  • The head of the baby comes out first, followed by the rest of the body

  • This is said to be the safest and the healthiest mode of parturition of the baby, having less chances of infection for the mother and lower risk of respiratory problems for the new-born

  • The recovery of the mother in this method is also quite faster compared to other methods of delivery 

  • The average length of a hospital stay for a normal vaginal delivery is 36–48 hours

Caesarean Section Delivery | The C-section Delivery

This is the process of giving birth to an offspring by means of a surgery. Here an incision is made in the mother's abdomen and the baby is taken out of the uterus directly.

A caesarean section is often vital when a vaginal delivery would put the baby or the mother at risk.

Caesarean section (C-section) delivery

The WHO, World Health Organization recommends that a caesarean section delivery should be performed only when medically necessary. Although in certain cases, like when the mother is not mentally prepared for a normal vaginal delivery, the mother decides the method of delivery without a medical reason and the same is usually adhered to. This is because the mother’s mindset to push the baby is strongly required in a normal delivery.

 

Common medical reasons to opt for a caesarean section delivery would be,

  • Obstructed labour

  • Twin or triplet pregnancy

  • Huge size of the baby

  • High blood pressure in the mother

  • Breech birth (the position of child is anything but head down)

  • Problems with placenta or umbilical cord

  • Shape of the mother Pelvis

  • History of C-section (while a trial of vaginal birth after C-section may also be possible)

 

Stages of C-section Delivery

The time taken to complete the surgery is usually 45-60 minutes. 

  • Surgery takes place with either a spinal block (the mother is awake but her lower part of the body is numb) or epidural (blocks the pain in lower body but the movements can still be felt) or local anaesthesia (where the mother is temporarily unconscious)

  • The urinary bladder is drained with the help of a urinary catheter

  • The abdomen is cleaned before the surgery

  • Two incisions are made on mother's body 

    • One on the mother’s lower abdomen, just above the pubic hairline

    • Another through the mother’s uterus

  • The baby is then taken out or delivered out of the uterus

  • The incisions are then closed with dissolvable stitches

 

Characteristics of C-section Delivery

  • This method of delivery can be opted on either full-term of pregnancy or for a pre-mature delivery under medical reasons only, as per established guidelines

  • The mother typically begins to breastfeed her new-born as soon as she gains consciousness post-surgery

  • The recovery of the mother in C-section takes time, i.e., around 6-7 weeks more as compared to that of a normal vaginal delivery

  • There is a risk of amniotic fluid embolism (amniotic fluid entering the mother's main blood stream) and postpartum (post delivery) bleeding/infections in the mother

  • There is also an increased risk of respiratory problems in the baby

 

Natural Birth | Water Birth

The most famous natural child birth technique is water birth. It's carried about without any epidural/anaesthesia. The childbirth, in this process, takes place in a temperature regulated pool filled with warm water. The birth is vaginal. The pain in this birth process is minimum.

Water Birth/water child delivery

In the olden days, i.e., before the development of the healthcare fraternity, women gave birth to their babies at home. Usually, they carried out this process in a tub of warm water. 

Since last decade, this method of childbirth is growing popular again although there are certain risks involved. 

 

Benefits of Water Birth 

  • Water birth increases the comfort for the baby as compared to other methods. This is because the water feels similar to amniotic fluid in amniotic sac where the baby grew for the last 9 months inside the mother’s uterus

  • The water buoyancy encourages necessary contractions and speeds up labour for mother

  • The presence of warm water improves the blood circulation to the uterus, thus soothing the pain felt by the mother

  • The immersion in water allows lowering of the blood pressure which in-turn helps in lowering the anxiety levels 
     

Risks of Water Birth 

  • The umbilical cord can twist even before the baby is out of the water

  • The mother and child are at a risk of getting infections

  • The baby’s body temperature could end up being extreme, i.e., either too high or too low

  • The baby may have breathing issues

  • The baby could also develop convulsions

  • If the mother enters the birth pool a bit too early, it may slowdown the process of labour

 

Precautions to take for/ during water birth 

  • This method of delivery needs direction and monitoring by licensed and very skilled doctors along with their assisting staff to lower any risks

  • The pool and water should be clean and properly sanitised. The temperature of the water should be properly regulated 

  • Discuss the alternate methods of delivery in advance with the doctor incase of any emergency complications

  • Adequate fluid intake to avoid dehydration

 

Water Birth is not recommended if any of these exists

  • Breech Birth

  • Pre-mature delivery

  • Huge size of the baby

  • The mother’s age is either beyond 35 or below 18

  • Poor health history or complications like diabetes, cramp, etc. in mother

  • The mother is prone to infections in the past

  • Twins or triplet pregnancy

POSTPARTUM PERIOD

 

Postpartum period is the period after the process of parturition or childbirth. This is a very critical phase for the recovery of mother and for the baby to adjust to this new world.


The entire phase is divided into three periods:
 

1. The Acute Postpartum Period

  • This is the initial phase of postpartum period, which is the first 6-12 hours post childbirth

  • The greatest risk at this stage is postpartum bleeding

  • During the early stages of uterine involution, the mother shall face the vaginal discharge, containing blood, mucus, and uterine tissue, termed as lochia. This discharge continues for 4-6 weeks after parturition

  • The medical staff shall be present with the mother to monitor bleeding

  • Uterine massage is generally given to help the uterus contract

  • The vaginal tear during childbirth is stitched post-delivery, incase of vaginal delivery

 

2. The Subacute Postpartum Period 

  • The subacute postpartum period starts after the acute postpartum period concludes and it can last for 2–6 weeks

  • After 2–4 days of postpartum, the mother undergoes lactation, the process of production of milk from her breasts to feed her baby. This results in further reduction in size of the uterus 

  • The uterus shrinks and becomes half the weight as compared to the immediate stage after childbirth 

  • The mother may face infections, difficulty in urination, constipation, and haemorrhoids

  • This phase can lead to psychological disorders, such as postpartum depression, postpartum anxiety, postpartum mood disorders or postpartum stress disorder in mother

  • Approximately 70-80% of postpartum women will experience "baby blues" for a few days. This is due to the changing body, pain, and the fear of handling the child with proper care

  • Lochia discharge persists at this stage too. i.e., it persists for 4-6 weeks after parturition. However, this discharge will gradually decrease and turn from bright red, to brownish, to yellow and cease at around five or six weeks

  • The women are advised to wear adult diapers or disposable maternity briefs. The use of tampons or menstrual cups are not recommended as they may introduce bacteria and increase the risk of infection

 

3. The Delayed Postpartum Period

  • The delayed postpartum period starts after the subacute postpartum period concludes and can last up to 6 weeks

  • It is at this stage that the muscles and connective tissues return to pre pregnancy state.

  • Certain recoveries can slow down upon reaching this stage, such as urination and faecal difficulties and painful intercourse, if left unattended in the earlier stages

  • Normally by 2nd or 3rd month of childbirth, estrogen levels drop, leading to severe hair fall, predominantly in the temple area. However, the hair grows back gradually without any need for treatment. 

  • At this stage, the mother may start to have other health conditions such as postpartum thyroiditis.

  • By this time, the infant’s sleep patterns start adjusting to normal, allowing improvement in the sleep pattern of the mother too 


 

Changes in Menstrual cycle after childbirth

The delivery related bleeding may continue upto 6 weeks. The first period post pregnancy will occur after 6 to 8 weeks if the mother is not breast-feeding. Otherwise, it may take few months.

There are certain changes in the menstrual cycle initially, right after the episode of pregnancy and delivery.

  • You may feel cramps and pain stronger than before

  • Discharge of small blood clots

  • Heavier flow than usual

  • The bleeding will be irregular  

  • Length of the menstruation cycle may vary

  • Rise in intensity of uterine cramps due to hormonal changes and shedding of uterine lining, as the uterine cavity becomes larger after pregnancy