Normal Childbirth, Here's What You Should Know

Normal childbirth is a term for mothers who give birth to babies through the vagina. This process will be carried out by pregnant women when the fetus they are carrying is ready to be born

Normal childbirth generally occurs between 37 and 42 weeks. The stages of normal delivery begin with uterine muscle contractions, followed by gradual opening of the cervix (cervix). After that, the mother's pelvic muscles will push the baby and the placenta out through the vagina.

Contraindications for Normal Childbirth

Every pregnant woman has the possibility to have a normal delivery. However, vaginal delivery is not recommended when the following conditions occur:

1. Umbilical cord prolapse

Umbilical cord prolapse is a condition where the umbilical cord covers the baby's birth canal. As a result, the umbilical cord can be compressed, causing the baby to be deprived of oxygen.

2. Fetal malpresentation

Fetal malpresentation or fetal position abnormality is a condition when the part of the fetal body that is facing the cervical opening is other than the crown of the head. Types of abnormal fetal position that are not recommended for normal delivery include:

• Occiput posterior, ie the position of the fetal head is in the birth canal, but the face of the fetus is turned towards the mother's abdomen
• Face presentation, namely the position of the fetus's face that is directly opposite the cervix
• Brows presentation, which is the position of the fetal head slightly raised, so that the fetal eyebrows are directly facing the cervix
• breech position, where the position of the feet or buttocks of the fetus is directly opposite the cervix
• Latitude latitude, i.e. the position of the fetus transversely or horizontally in the uterus, with the fetal shoulder facing the cervix

3. Twin pregnancy

Twin pregnancies that do not allow for normal delivery are when both fetuses are in a breech position, conjoined twins, are in one amniotic fluid, or twin pregnancies with more than two fetuses.

4. Have you ever had a cesarean section

Although in most cases it is considered safe, vaginal delivery after undergoing a cesarean section in previous deliveries can lead to serious complications, such as uterine rupture (uterine rupture)

Meanwhile, mothers who have had cesarean section more than twice, have a history of placenta previa, or have longitudinal scars on the uterus due to previous cesarean sections, are not allowed to give birth normally.

5. Unstable fetal heart rate

This condition can be a sign of the fetus experiencing hypoxia or low oxygen levels in the body. Some conditions that can cause hypoxia in the fetus are the separation of the placenta from the uterus before the delivery process (placental abruption) or the fetus being entangled in the umbilical cord.

6. Abnormal position of the placenta

Placental abnormalities, including the placenta blocking the birth canal (placenta previa) or the placenta attaching itself to the uterine muscle (placenta accreta), should not undergo a normal delivery.

7. Macrosomia

Macrosomia is fetal weight that exceeds 4–4.5 kg. This condition is at risk of causing the fetal shoulder to be pinched (shoulder dystocia) if undergoing a normal delivery process.

8. Genital herpes infection

Pregnant women who are infected with genital herpes are not advised to give birth normally, in order to reduce the risk of transmitting herpes to the baby.

Normal Childbirth Warning

Before deciding to give birth vaginally, pregnant women must first know the following things:

Induction of labor

The normal delivery process can be disrupted. If these disturbances occur, the doctor will induce labor (accelerate labor), for example by tearing the amniotic sac, giving contraction-boosting drugs, performing assisted delivery, or performing a caesarean section.

Some conditions that require labor induction are:

• Pregnant women suffer from preeclampsia or diabetes
• Pregnancy more than 41 weeks
• Fetal growth slows down
• The labor process is too long
• Fetal distress

Monitoring during labor

In some conditions, the baby's heart rate and the strength of the mother's contractions will continue to be monitored by the doctor during the delivery process. Some of these conditions are:

• Pregnant women suffer from diabetes, high blood pressure, or excess weight
• Pregnant women have had cesarean section before
• Pregnant women receive epidural anesthesia or contraction-boosting drugs
• The baby to be born is thought to be very small
• Baby to be born with twins
• The labor process is very slow

Normal delivery after cesarean section

Please note, normal delivery after previous deliveries via cesarean section (VBAC) is generally safe. However, based on research, 1 in 200 pregnant women who do VBAC are at risk of uterine rupture.

Therefore, first discuss with your obstetrician if you previously had a cesarean section and now want to give birth normally.

Preparations Before Normal Childbirth

In order for the delivery process to go smoothly, do the following before approaching the time of delivery:

• Find the right obstetrician and pediatrician.
• Learn about the process and stages of normal childbirth since the early days of pregnancy, for example by attending childbirth classes and pregnancy exercises, or by asking women who have given birth. Also learn the signs of labor, breathing techniques, and straining.
• Prepare mentally, for example by meditation or relaxation techniques. This is useful to help you during the delivery process as well as to deal with the possibilities that can occur if you are unable to give birth normally, for example in the condition that a cesarean section must be performed.
• Do light exercise, such as warming up your muscles, walking, or cycling on a stationary bike. This is useful for strengthening the pelvic muscles to push during childbirth.
• Eat a balanced nutritious diet to prevent excess weight. Being overweight during pregnancy has the risk of causing excess fetal weight and making delivery difficult.
• Prepare baby's needs, such as clothes, diapers, and milk bottles. Also prepare other needs for mothers, such as a nursing bra. Put these items in one bag, so that when signs of labor appear, the mother just has to carry the bag.

Signs Before Childbirth

The obstetrician will tell you the approximate date of delivery, but this date can go forward or backward by about 2 weeks. Therefore, it is important for mothers to know the signs that are felt when the fetus is about to be born, such as:

• Breathing becomes lighter

  This happens because the fetal head begins to descend into the pelvic cavity, thereby reducing the pressure on the lungs.

• Increased urge to urinateIncreased urge to urinate due to fetal pressure on the bladder. In addition to urinating, mothers can also become more frequent bowel movements or even frequent diarrhea.

• Mucous dischargeMucous discharge mixed with blood from the vagina indicates that the cervix (cervix) has begun to open.

• Lower back pain that comes and goesBack pain can occur alone or with contractions, and may be accompanied by a sensation of looseness in the joints, especially in the pelvic area.

• Muscle contractionsUterine muscle contractions can occur periodically every 10 minutes. These contractions can be described as a tightening feeling in the uterus or like cramps during menstruation with increasing intensity and frequency closer to the time of delivery.

• Amniotic fluid leaks outAmniotic fluid leaks due to the rupture of the fetal protective membrane. After the amniotic fluid comes out, the fetus must be expelled no later than 24 hours.

Stages Before Normal Childbirth

The stage before normal delivery in the medical world is called stage 1. This stage is divided into 3 phases, namely the early (latent) phase, the active phase, and the transition phase. The explanation is as follows:

Latent phase

The latent phase lasts for 8–12 hours. This phase is characterized by mild contractions of 30–45 seconds, every 5–30 minutes. These contractions then gradually become more frequent and increase in intensity. In the latent phase, the cervix will dilate in 3-4 cm increments.

In this phase, pregnant women are advised to remain calm and do not need to rush to the hospital. Mothers are still allowed to do light activities at home, but while maintaining the nutritional intake needed and recording contractions that occur.

Active phase

The active phase lasts for 3-5 hours, but can be longer in first-time mothers. Contractions in this phase last for 45–60 seconds, every 3–5 minutes. In the active phase, the cervix dilates about 4–7 cm.

Pregnant women who have entered the active phase are advised to immediately go to the hospital. The doctor will measure the blood pressure, pulse, and body temperature of the pregnant woman, as well as check the fetal heart rate.The doctor will also perform a pelvic exam, to determine the extent of the contraction process.

If needed, the doctor will give you an epidural to relieve pain due to contractions.

Phase transition

The transition phase lasts about 30 minutes to 2 hours. Contractions in this phase feel strong and continuous, and cause unbearable pain. In the transitional phase, the cervix will dilate 8–10 cm.

Please note, at this stage there will be an urge to push the fetus out immediately. However, don't do this until your doctor tells you to. Pushing the fetus before the cervix is ​​fully open can cause the cervix to swell and slow down the delivery process.

Normal Childbirth

The normal birthing process is also known as stage 2, which is when the cervix has fully opened by 10 cm. The process of giving birth in the 2nd stage can last 2 hours or more.

Contractions at this stage last about 60–90 seconds and subside every 2–5 minutes. Every time a contraction occurs, the mother will feel a strong urge to push. But keep in mind, pushing should only be done when asked by the doctor.

Normally, the baby will be pushed every time a contraction occurs. However, if the fetus does not descend, the doctor will advise the mother to change the position to squat, sit, or kneel. If the contractions are not strong enough, the doctor will give you medicine to strengthen the contractions.

During the contraction and pushing process, the baby's head will begin to appear from the vagina. At this stage, the vagina and perineum, the area between the vagina and anus, will be so stretched that it causes a burning pain.

To speed up the labor process and prevent the perineum from tearing, the doctor will perform an episiotomy, which is to cut a small part of the perineum. This procedure is preceded by the administration of a local anesthetic. The doctor will sew the perineum back together after the delivery is over.

After the baby's head comes out perfectly, the doctor will suck blood, mucus, and amniotic fluid from the baby's mouth and nose with a special tool. At this stage, the mother is advised to keep pushing to remove the whole body of the baby.

Once the whole body of the baby comes out, the doctor will hand the baby over to the mother. In addition to establishing a strong bond between mother and baby, it is also important to initiate early breastfeeding. After that, the doctor will cut the baby's umbilical cord.

After the baby is born, the mother still has to remove the placenta or the placenta. This stage is called the third stage. In this phase, contractions will still occur to remove and expel the placenta from the uterus. This phase can last up to 20 minutes.

After all placental tissue has been removed, the obstetrician will give oxytocin to minimize bleeding.

Overall, the time required for a normal delivery process from stage 1 to stage 3 is 12–24 hours. For mothers who have given birth vaginally before, the time required is generally shorter.

After Normal Childbirth

After a normal delivery, the mother must undergo treatment in the hospital for 1-2 days. The aim is to restore the mother's condition before going home, as well as to monitor the condition of the mother and baby and ensure that there are no problems after giving birth.

Women who have just given birth vaginally are advised to wait until the bleeding is complete, or about 4-6 weeks, before having sex again. This is to ensure the mother's condition is completely recovered. Meanwhile, for mothers who experience vaginal tears during delivery, it is recommended to wait longer.

How many conditions may a mother experience after a normal delivery, namely:

• Hemorrhoids appear, or pain when defecating, but will go away in a few days
• It's hard to stop urinating or wet the bed when laughing or coughing, due to weak pelvic muscles
• Postpartum bleeding (lochia) that can last for several weeks, then subsides gradually
• Colostrum comes out, which is a yellow liquid that comes out before breastfeeding, followed by milk coming out on the third or fourth day after giving birth
• Stomach sag due to abdominal muscles that have been stretched since pregnancy, but can gradually return to normal by eating a balanced nutritious diet and exercising regularly

Please note, the return of menstruation can be different for each mother. In mothers who give exclusive breastfeeding, menstruation may only be experienced again when they stop breastfeeding. Meanwhile, for mothers who do not exclusively breastfeed, menstruation can occur 5-6 weeks after giving birth.

Complications of Normal Childbirth

Most of the normal delivery process goes without problems. However, sometimes complications can occur, either before, during, or after the normal delivery process. These complications can be:

• Premature birth

  Birth prematurely or earlier than expected can be dangerous for the baby, because the function and growth of the organs are not yet perfect.

• Postmature pregnancyPostmature pregnancy is a condition in which the fetus has not been born after 42 weeks of gestation or more. This condition can harm the fetus, because the placenta is no longer able to provide adequate nutrition to the fetus.

• Premature rupture of membranes

  Premature rupture of membranes that is not followed by delivery 6–12 hours later can increase the risk of infection for both mother and fetus.

• Postpartum haemorrhage

  Postpartum haemorrhage is heavy bleeding that occurs after delivery. This can occur due to a torn uterus or weak uterine contractions after delivery.

• Amniotic fluid embolismAmniotic fluid embolism is a condition when amniotic fluid enters the mother's blood vessels and clogs the pulmonary arteries. This complication is the most dangerous problem, both during normal delivery and during caesarean section.However, this complication rarely occurs when the delivery process goes smoothly.

For pregnant women who experience the above conditions, doctors can perform labor induction (accelerated delivery), assisted delivery with a vacuum or forceps, or perform a caesarean section.

Besides the above conditions, there are also several other complications that are more dangerous and require immediate treatment, namely:

• Infection, which can be characterized by fever and abdominal pain
• pulmonary embolism, which can be characterized by chest pain and shortness of breath
• Preeclampsia, which is characterized by complaints of headaches, vomiting, and sudden visual disturbances
• Deep vein thrombosis (DVT), which is characterized by pain and swelling in the calf muscles