Birth
From Encyclopedia of Sex and Sexuality
The birth of a baby begins with the onset of labor—the rhythmic uterine contractions that force the baby out of the womb and into the birth canal toward delivery and its first moment of life outside its mother. One of the remaining mysteries of life is the precise biological mechanisms that signal a pregnancy is complete and the birth process should begin. It is assumed that they are hormonal.
The first uterine contractions felt at the beginning of labor may be fifteen to twenty minutes apart and can last up to one minute. There is, however, great variation in their patterns and some women experience no more than isolated early contractions or cramping. Contractions usually become more frequent. Early contractions may be accompanied by other symptoms, most commonly a discharge of bloody mucus or a sudden release of amniotic fluid through the woman’s vagina. The mucus is from a plug that seals the cervix during pregnancy and prevents infections from entering the uterus. The amniotic fluid is the fluid in which the fetus is suspended, protecting it in the course of pregnancy. One out of ten women experiences an early rupture of the membranes surrounding it, releasing the fluid. This is commonly called the “breaking of the bag of waters.” If it occurs before contractions begin, labor will usually commence within twenty-four hours.
Labor contractions are the major force that pushes the baby out of the womb. Most women experience these as “labor pains.” They can be moderate or extremely severe, but they can also be controlled with medication and the use of special breathing and other techniques.
When contractions have established a definite frequency of one every five or six minutes for women having their first child, they should call their physician. (Those who already had children are often advised to call earlier.) Women who have chosen to have their babies in a hospital are generally advised to come to the maternity section when their contractions are coming at regular intervals of four to five minutes apart.
Many hospitals and other labor and delivery facilities have a “birthing room,” where both parents may participate in the birth experience together. They have immediate access to all the hospital equipment that may be needed during labor and delivery—especially if there is an emergency—but birthing rooms are designed to be much less formal or intimidating than maternity facilities of the past. Their surroundings provide a nonmedical setting for childbirth in a hospital (see Home Birth; Hospital Birth).
On arrival at the hospital, the woman is usually seen by a nurse or other member of the hospital staff responsible for the conduct of her labor and delivery. A brief general physical examination is done, as is a vaginal examination to determine the thickness and dilation of the cervix and the position the baby will present at birth. Many physicians will order the fitting of an external monitoring system to record the fetal heart rate and patterns, as well as the time, duration, and intensity of the woman’s contractions. The monitor is followed closely by the attending obstetrician and nursing staff throughout labor. Fastened to the woman’s abdomen, it provides both visual and auditory readings, so the medical staff can both see and hear how the labor is progressing. An internal monitoring system can also be employed when necessary. An electrode and a pressure catheter are passed through the dilating cervix. The electrode is attached directly to the baby and the catheter lies within the uterine cavity. This is a more accurate monitoring system, but it is invasive and entails a certain risk.
The duration of labor varies widely from one woman to another and from one birth to another in the same woman. It generally takes longer for the births of first babies. Labor may take as little as a few hours but it may also last twenty-four hours or more. It averages about fifteen hours for the birth of a first baby and under ten hours for successive births.
Medical terminology divides labor into three stages. First-stage labor is preparation for the delivery to follow. It begins with the first contractions felt by the woman even before she has come to the medical facility. In this early first-stage period the cervix begins to thin and dilate to enable the baby to pass from the uterus into the upper end of the birth canal. As labor progresses, contractions are stronger and more frequent and the cervical opening dilates to two inches or more. It is at the end of the first stage, during a period called the transition stage, that contractions become most intense and painful and the cervix dilates to four inches or more.
Second-stage labor is the process of delivery. It starts when the baby begins to emerge from the womb into the upper end of the birth canal, propelled by the force of the mother’s contractions. These contractions are regular and stronger, and the baby descends deeply into the pelvis. It sometimes happens that the baby is not in the proper head-down position when the birth process begins and may move through the birth canal bottom or feet first. This called a “breech birth”; although it is more difficult, physicians are trained to cope with it. In some cases potentially difficult births may be accomplished by cesarean section.
The climax of the delivery nears when the baby’s head “crowns” and becomes visible at the vaginal opening. The mother’s vagina can stretch to permit the baby’s head and body to pass, but usually the attending physician will (with the mother’s permission) perform an episiotomy, an incision in the tissue just behind the vagina, to prevent tearing that may be more damaging and difficult to stitch. The new baby is then eased from its mother’s body, and any mucus is cleared from its mouth to clear the way for its first breaths. When the baby’s breathing has been established, the umbilical cord attaching it to the mother is tied and cut, separating them. Usually, the baby’s first cries have already been heard.
A brief third-stage of labor follows the birth of the new infant. The placenta detaches from the uterus and, together with the fetal membranes, is expelled from the woman’s body. These are known as the “afterbirth.” Finally, the attending physician sutures the woman’s episiotomy and any tears that may have occurred.
[edit] Pain Control During Labor and Delivery.
Since the nineteenth century it has been possible to control or eliminate the pain of childbirth with the use of drugs or anesthetics. Since the 1920s most women in the West who delivered their babies in hospitals were using some form of pain control, and in some cases were almost totally anesthetized during labor and delivery. However, in the past thirty years opposition to the use of drugs has grown, especially among groups of women who assert that they have been used excessively, depriving women of an important life experience and posing a risk to the baby: most drugs can cross the placental barrier and enter the baby’s bloodstream. Another view asserts that pain control need not be excessive if it is carefully tuned to the individual woman’s needs, that there is no genuine risk to the baby, and that proper medication can prevent childbirth from becoming a negative or traumatic experience. Although in the past many physicians routinely administered drugs without permission, today they discuss the pain control options available to women giving birth before the process begins.
Whether or not they decide to use pain control medication, prospective mothers can play an important part in helping to control the pain most will encounter in childbirth. This can be begun by coming to childbirth in the best possible physical condition. They can prepare for childbirth with exercises and training recommended by any of the prepared or natural childbirth methods, especially the relaxation and breathing techniques taught by the Lamaze method. Prospective fathers can also play a key role in childbirth by training themselves to assist women in carrying out breathing and other exercises before and during labor and supporting them psychologically during the process.
There will still be some pain from contractions and many women will want medication to deal with it. Most physicians will employ pain medication when labor is well established and there is evidence of progressive dilation of the cervix and the baby’s descent toward the birth canal. Many doctors prefer to use epidural analgesia or sometimes Demerol, given intravenously, and Phenergan, given intramuscularly, during the active phase of labor. Others use Valium or other tranquilizers.
Other methods of relieving pain can also be used during labor and delivery. One, the pudenal block, controls feelings in the woman’s external genitalia
