Occasionally, babies run into a few difficulties on their way out of the uterus. For instance, special procedures may be needed to aid your babys exit from the birth canal. Or, if your babys health is at risk, a cesarean delivery may be required. Dont forget, that no matter how the birth goes, a healthy baby is the primary goal.
The contractions that occur during labour serve the purpose of opening up the cervix to allow the birth of your baby. When your cervix has opened to 10 cm, you will notice a distinct feeling of wanting to bear down. This can feel like the urge to move your bowels, but much, much stronger. Your contractions may begin to slow down at this point, and it may actually feel good to push.
You will be instructed to push with each contraction. Your partner can participate in this process by counting out loud while you push. With each push, your baby will begin the descent through the birth canal. Your doctor or midwife may perform a small cut to widen the opening of the vagina to speed up the delivery. Local anesthesia is used before the cut is made, so you shouldnt feel a thing. However, you can expect some pain afterwards as your episiotomy cut heals.
Some lucky women only need to push a couple of times before a baby is born, while others will work for hours. After your babys head emerges from the birth canal, one shoulder will slip out and then the other. After the shoulders the rest of your babys body will follow quickly. After delivery, the placenta will peel away from the wall of your uterus, and you may need to push a couple of more times to expel it from your vagina. You may continue to feel contractions that will help your newly empty uterus return to its former size
Sometimes a woman may push for hours without making much progress. Other times, the babys heartbeat becomes erratic or slow, or the position can make delivery harder. In these cases, the doctor of midwife may need to assist delivery by using forceps or vacuum extraction. This is done in about 10 percent of vaginal deliveries.
Forceps look like two large tongs. They are inserted into the vagina and placed around the babys cheeks and jaw. Then, the forceps are used to gently guide the babys head out of the birth canal.
Vacuum extraction is used similar to forceps, except a plastic cup is inserted into the vagina and applied to the babys head. Suction holds the cup in place. A handle attached to the cup allows for the baby to be pulled through the birth canal. In the vast majority of births where either forceps or vacuum extraction is used, there are no major problems. Still, both tools can bruise the babys head and cause tearing to the vagina and cervix.
About 20 percent of babies are born by cesarean birth. This means the baby is delivered from an incision in the mothers uterus and abdomen. While some cesarean births are planned in advance, some situations can occur during labour that can make a cesarean birth the safest choice for the baby.
You may require a cesarean deliver if:
You have had a prior cesarean birth.
You have certain medical conditions such as an active genital herpes outbreak.
You have a large baby or a small pelvis. This is called cephalopelvic disproportion.
Your baby is in an unusual position such as buttocks or feet down.
You have a multiple pregnancy. Many women give birth vaginally to twins, but the chance of cesarean increases dramatically with each additional fetus.
There are problems with the placenta blocking all of part of the cervix.
The umbilical cord is pinched or compressed.
Your labor fails to progress. This is the cause for 1 in 3 cesarean births.
Most cesarean births are fairly straight forward and quick. In most cases, the birth goes something like this:
1. You will be given an epidural, a spinal block, or general anesthesia to numb the pain during surgery.
2. The anesthesiologist will hook you up to equipment that will monitor your hear rate, breathing, and blood pressure. You will also be fitted with a mask or tubes in your nostrils to receive oxygen.
3. Your partner or labor coach will be asked to put on a sterile mask and gown and then will be seated next to you in the operating room.
4. A nurse will prep you for surgery by washing our abdomen and shaving any hair between your pubic bone and navel. As well, a catheter will be inserted into your bladder, and an IV line will be started in a vein in your arm or hand. Your abdomen will then be swabbed with antiseptic, and sterile drapes will be placed around your abdomen.
5. The doctor will make a small incision through your skin and the wall of your abdomen. Depending on the position of the baby, the cut could be made either vertically or horizontally.
6. The doctor will then spread apart your abdominal muscles and cut through the lining of your abdominal cavity. The doctor will then make another cut in the uterine wall.
7. Your baby will be delivered through the incisions. Next, the umbilical cord will be cut, and the baby will be passed to a nurse. The doctor will also remove the placenta at this time.
8. The uterus and abdominal wall will then be closed and stitched with sutures that will dissolve in your body. Stitches or surgical staples will be used to also close the incision in your skin. A dressing will be placed over the incision.
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