“He part it is an unavoidable fact that ends every pregnancy. Despite being a natural process, in humans it has more difficulties than in other mammals. Being able to walk upright modified the pelvis: the birth canal was bent and the fetuses must do more maneuvers to be able to be born. The larger size of the skull of human fetuses requires a flexion of the head to facilitate the smallest possible diameter, and allow it to pass through the pelvic bones, until it exits through the maternal vulva,” explains Dr. Mercedes Herrero, from HM Hospitales.
(What can I expect from a birth?)
Who goes on to say: “Childbirth has been a moment of vital risk for women throughout history. In our country maternal mortality is one of the lowest in the world (3 per 100,000). All thanks to health advances “, which have made it possible to control puerperal infections and hemorrhage. The two most frequent causes of maternal death in relation to childbirth. Now it is time to fight so that these advances reach the greatest number of women in the world”.
According to the WHO, In 2020, a woman in childbirth died every two minutes in the world. 95% in low- and middle-income countries. Most for preventable causes. The care of deliveries by qualified professionals “can save the life of the mother and the newborn.”
(Your body is warning you to get ready: labor is near)
stages of labor
The gynecologist and obstetrician continues to explain to magasIN the phases of childbirth:
- Dilatation. Pains are felt, they are the contractions of the uterus, they come and go. There is a pause of pain between them. The hormone oxytocin, which our brain secretes, is responsible for causing and maintaining contractions throughout the process. The bag may break. The amount of amniotic fluid expelled can range from little, with or without some blood, to enough to wet clothes and seats. The color of the fluid can be clear, bloody, or even brown in tone.
When dilation is complete, up to four inches, the fetus begins to descend through the birth canal. This process can last hours, especially in primiparas (women giving birth for the first time).
During this time, fetal well-being is monitored thanks to a system that is harmless to the fetus: fetal monitoring. The fetal heartbeat is recorded on a trace, and we can know how it is at all times. Maternal contractions are also recorded. The behavior of the fetus with contractions is another piece of information to know its well-being.
- Expulsive. It is the descent of the fetus along the birth canal. There, the head must make a few turns to adapt to the larger diameters of the pelvis, in each part of the elbowed path. That turn is accompanied by the descent along the channel.
The contractions are pushing the fetus in that way. The mother’s position during that time can favor the process. The professionals, midwives and obstetricians, accompany the woman to facilitate these postural changes and that the fetus can make this descent.
In the end, the fetus comes out through the vulva. The fetal head emerges from the maternal perineum. After lighting the head, it must rotate again to allow the shoulders to use that larger diameter to pass through the channel. One shoulder comes out first, then the second. At that time, the birth of the baby is already assured.
This process is also carried out with fetal monitoring, in order to detect any changes that make us suspect a loss of fetal well-being during the descent.
- Delivery. We call this the exit of the placenta and the amniotic bag. It usually takes a few minutes after the baby is born. At that moment, the uterus contracts intensely, allowing the blood vessels that have nourished the placenta to contract vigorously, avoiding the dreaded obstetric haemorrhage.
Types of childbirth
Dr. Herrero classifies the types of childbirth as easy, difficult or impossible.
Easy or eutocic deliveries
According to the expert, they are those in which the woman is in labor, the contractions favor complete dilation, which may or may not require external oxytocin.
“The descent through the canal is done by the fetus naturally. Allowing an expulsive, with professional accompaniment, but without the need for special maneuvers. After birth, delivery is spontaneous, and there is no subsequent bleeding. Cared for in a sanitary environment with aseptic measures, the risk of infections is also minimized,” he explains.
And he continues: “Some of these births can start naturally (spontaneous), or need medical treatment to start. We call the latter induced. We have different drugs to achieve this. Maternal, fetal or pregnancy reasons may recommend this medical indication. The fact that a labor is induced does not mean that it cannot be a vaginal, eutocic delivery.
These deliveries are attended by midwives or obstetricians.”
Difficult or dystocia deliveries
The professionals call dystocia difficulties in the birth process. Above all, the expulsive.
“You can complete dilation and start the descent of the baby, up to a point where
that the exit must be vaginal. The fetus is in that angled channel,” says Herrero.
instrumental deliveries
“There may be problems in rotation and descent. That moment, if it is prolonged in time because the space is very tight for the size of the fetus or it shows signs of losing its well-being, we can use instruments that help in these final phases. These are suction cup, forceps or spatulas“says the doctor.
And he adds: “They are instruments that, used at the right time, and by expert professionals such as obstetricians, prevent fetal damage caused by lack of oxygenation. They have a greater risk for the maternal birth canal, which is why it is essential to indication in its use and the expertise of professionals. These deliveries are attended by obstetricians”.
shoulder dystocia
It occurs when, after leaving the head, the shoulders do not make a descent
appropriate. It is an important risk situation for the fetus. “Obstetricians and midwives are trained in the maneuvers to resolve the situation. It is something little known, but feared by professionals,” says Herrero.
Impossible deliveries or caesarean section
If the fetus fails to adapt to the maternal pelvis, if dilation is not complete, or the fetus is unable to pass through the birth canal after full dilation, delivery cannot be vaginal.
“Also in cases of obstetric emergency such as loss of fetal well-being, hemorrhage, preeclampsia or eclampsia, or cord prolapse, among others. All those situations in which a rapid birth is necessary, which does not allow waiting time for the delivery process “, explains the gynecologist and obstetrician.
And he adds: “At that time a cesarean section is performed. It is the delivery through the abdominal wall. The maternal abdomen is opened and the uterus is sectioned, allowing a rapid exit of the fetus and the placenta with its membranes. The cesarean sections are performed by the obstetricians”.
a reassuring message
“My message to pregnant women is always soothing. childbirth is a process
natural, not without risk. But we are lucky to have the means
human and material so that our children are born in the best conditions that
we have known throughout history. The professionals who attend deliveries,
midwives and obstetricians, we always keep in mind the fetal well-being and the care of the
mother, they are the protagonists of the process”, says the doctor.
And he concludes: “The couple plays a very important role of accompaniment and support. We have come this far thanks to the scientific advances and knowledge. Confidence in the health professionals who care for them will make them experience the best birth possible. Even a dystocic birth or a C-section can be very intense and personal growth experiences for the mother.”
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