Vitamin D Deficiency: Causes, Symptoms, and Prevention

Childbirth: Labor and Delivery 

Normal childbirth occurs at the end of pregnancy, between the 37th and 42nd week of pregnancy. Here is a description of the different stages of childbirth.

Natural childbirth

Definition

Childbirth (also known as labor and delivery) is the process by which a baby is born. It is the culmination of pregnancy. A normal childbirth (eutocic delivery) is a physiological process. Childbirth

involves three successive phases:

Labor: This is the stage of childbirth that begins with:

• Stage 1: Uterine contractions and cervical dilation (Labor)
• Stage 2: Expulsion of the fetus (Pushing).
• Stage 3: Delivery of the placenta.
• Stage 4: The recovery period is the time it takes for the mother's body to recover from childbirth.

Stage 1: Labor

The first stage of labor, also known as latent labor or early labor, begins when you feel regular contractions that accompany the dilation or effacement of your cervix. It ends when your cervix is fully dilated and ready for your baby to pass, which is typically around 10 centimeters.

Early labor signs and symptoms:

Vaginal discharge (Show) or Loss of the mucous plug

This is the elimination of cervical mucus that closes the cervix throughout pregnancy. It manifests itself as a mucous loss, pink, sometimes slightly bloody. It precedes the onset of labor for a few hours to a few days (on average 24 to 48 hours).

Uterine contractions

These are painful contractions of the uterine muscle, felt in the lower abdomen and radiating to the back. At the same time as these pains, the uterus hardens.

It is common to have a few contractions at the end of pregnancy, spaced several tens of minutes apart. 

When they get closer, occur every five minutes and increase in intensity, it is probably the start of labor. 

Each contraction lasts about 45 seconds. During labor, their frequency reaches 4 contractions in 10 minutes.

Water breaking - Rupture of membranes

It usually occurs after the start of uterine contractions, but it can also precede it. It is the spontaneous rupture of the membranes.

It manifests itself as a more or less abundant liquid loss through the vagina. It is the amniotic fluid that surrounds the baby. This liquid is usually clear and transparent.

Other signs that a woman is in early labor:

• Back pain: Back pain is a common symptom of labor, especially during the early and active phases. This pain is caused by the pressure of the contractions on the lower back.
• Nausea and vomiting: Nausea and vomiting are also common during labor, especially in the early phase. This is caused by the hormonal changes that are taking place in the body.
• Fatigue: Fatigue is another common symptom of labor. It is important to rest as much as possible during the first stage of labor, so that you will have the energy you need for the second stage.
• Cramps: These are like menstrual cramps, but they are usually stronger and more frequent. The cramps may come and go at first, but they will eventually become more regular and intense.
• Diarrhea: This is caused by the hormones that are released during labor. Diarrhea can also be a sign of dehydration, so it is important to drink plenty of fluids.
• Chills: This is another common symptom of early labor, and it is caused by the body's release of hormones.
• Irregular contractions: These are often felt as mild cramps or tightening in your lower abdomen or back. They may come and go, and they usually don't get stronger or closer together right away.
• Pelvic pressure: This is a feeling of fullness or pressure in your rectum or vagina. It's caused by your baby's head moving down into your pelvis.

It's important to note that not all women will experience all of these symptoms, and the order in which they experience them may vary. Some women may only have a few of these symptoms, while others may have all of them. And some women may experience them for a short period of time, while others may experience them for hours or even days.

If you're experiencing any of these symptoms, it's important to contact your doctor or midwife. They can help you determine if you're in labor and advise you on what to do next.

The length of the first stage:

The first stage of labor can vary greatly from one woman to the next. It's hard to predict how long it will last because every woman's childbirth experience is different. However, women who have already given birth tend to have shorter first stages.

Stage 1 consists of three phases:

The latency phase, the active phase, and the transition phase.

Latent Phase

The latent phase is the first stage of labor, and it can last for hours or even days. During this time, you will have contractions that are irregular and feel like menstrual cramps. They will gradually become stronger, longer, and closer together.

Your cervix will also start to dilate (open) during this phase. By the end of the latent phase, your cervix will be dilated about 3 centimeters (1 inch).

During this phase of labor, women experience a range of emotions, such as excitement or nervousness at the thought that the baby will be arriving soon. Some mothers are quiet, while others are chatty and talk more. Most of the time, you will be able to talk or walk during your contractions. However, it is possible that you will be very tired if this stage is prolonged and you have difficulty resting.

Remark:

• Rest and relax as much as possible. This will help you conserve your energy for the active phase of labor.
• Stay hydrated by drinking plenty of fluids.
• Eat light meals and snacks.
• Time your contractions. This will help you track how your labor is progressing.
• Contact your healthcare provider if:
• Your contractions become very strong or close together
• You have a bloody show
• You lose your amniotic sac
• You have any other concerns

It is important to note that not everyone experiences the latent phase in the same way. Some women may have very few contractions, while others may have more frequent and intense contractions.

Active phase

The cervix dilates an average of half a centimeter per hour during active labor. However, progress is slower until 6 cm. In addition, women who are not giving birth for the first time tend to have rapid progress after 6 cm. Contractions now become longer, closer together, and more painful. They are spaced less than 5 minutes apart and last about 1 minute. This allows the cervix to open to 8 cm. It is during this phase that many women's water breaks.

You may have more difficulty managing pain and may need guidance to stay in control during contractions. It will also be more difficult for you to continue walking or talking during contractions. However, remember that movement is still important to help the baby descend into the pelvis.

Remark:

• The active phase of labor is typically the longest stage of labor, lasting from 6 to 12 hours for first-time mothers and 3 to 6 hours for subsequent mothers.
• It is important to stay hydrated and eat light meals during active labor.
• You may experience nausea, vomiting, and diarrhea during active labor.
• Your partner or support person can be a great help during active labor by providing comfort and support.

If you have any questions or concerns, do not hesitate to ask your midwife or doctor.

Transition Phase:

During this final stage of dilation, the cervix reaches its maximum opening of 10 centimeters. This is the shortest but most difficult stage. Contractions occur every 6 minutes at most, sometimes every 2 to 3 minutes, for 60 to 90 seconds. You may feel like there is no break between contractions.

Some women experience hot flashes while feeling cold in their hands and feet. Others have nausea and vomiting. You may feel like you are losing control, anxious, or irritable. It may also be more difficult to concentrate. This is all normal. Your partner, your support people, and the staff around you will be a great help in alleviating your doubts about your abilities and helping you cope with the pain. If you have chosen to be relieved by epidural anesthesia, you will still need the staff to move you and prepare you for delivery.

Try to encourage yourself by congratulating yourself on getting through one contraction at a time. Remember that with each contraction, your baby is getting closer to you. Focus on your breathing and find a breathing rhythm that suits you and makes you feel good. You can also vary your positions and alternate non-pharmacological pain relief methods. What worked before may be less effective now, and vice versa.

During this phase of labor, you may feel pressure in your rectum and increased vaginal secretions. However, you should not push until you are fully dilated, as this could cause the cervix to swell and slow down labor. If you feel the urge to push before dilation is complete, you can pant (like "hee-hee-hee-hoo 😏 "). This type of breathing helps to relieve pressure and hold back the urge to push. However, it can also sometimes cause dizziness and hand numbness. These sensations will subside with slower, deeper breathing.

Remark:

• The transition phase is often referred to as the "peak" of labor because it is the most intense and challenging part.
• It is important to remember that every woman experiences labor differently, so there is no right or wrong way to feel or cope.
• If you are feeling overwhelmed or scared, it is important to communicate with your support team. They can offer you reassurance and help you to manage your pain.
• With each contraction, you are one step closer to meeting your baby. Stay focused and positive, and you will soon be holding your little one in your arms 😍.

When to go to the maternity ward?

A pregnant woman, especially in late pregnancy, should go to the maternity ward where she is being followed in the following cases:

• Presence of painful and regular uterine contractions, occurring every five minutes;
• Rupture of the water sac, with or without uterine contractions;
• Abnormal vaginal bleeding;
• Abnormal decrease or absence of fetal movements;
• Any other worrying and unusual signs (abnormal pain, fever, etc.).

On arrival at the maternity ward, the pregnant woman is welcomed by the nursing team and placed in the pre-delivery room. The midwife or obstetrician will conduct an interview, a medical examination and fetal monitoring. Vaginal examination allows to assess the state of dilation and effacement of the cervix (Bishop score). Fetal monitoring allows to assess fetal well-being and to objectify the presence and frequency of uterine contractions. In case of labor onset, a biological assessment is performed.

The pregnant woman goes to the delivery room when the cervical dilation reaches 3 centimeters.

In the delivery room, in most maternity wards, an intravenous infusion and fetal monitoring (fetal heart rate or FHR) are set up. They allow the hydration of the parturient, the administration of drugs if necessary, the monitoring of fetal well-being and the dynamics of uterine contractions.

If the woman wishes, an epidural or spinal anesthesia is administered by the anesthesiologist.

During labor, all events are noted on a chart called "partogram": state of cervical dilation, height of fetal presentation, color of amniotic fluid, temperature, blood pressure, administration of drugs, etc.

Labor and delivery last about 6 to 8 hours for a primipara (a woman who has never given birth), one to two hours less for a multipara (a woman who has already given birth).

Stage 2: Expulsion of the fetus (Pushing and Birth)

Stage 2 of labor starts when your cervix is fully dilated (opened up) and ends with the birth of your baby. Your contractions will continue to be strong and close together. This stage is usually longer for first-time moms, and it can take up to three hours. For moms who have given birth before, this stage is usually faster.

During this stage, you will feel a strong urge to push your baby out. There are two different ways of thinking about when to start pushing.

Some people believe that you should listen to your body and start pushing when you feel the urge to do so. Your doctor, nurse, or midwife will give you instructions on when to push. If you have an epidural, you may not feel the urge to push as strongly, and your doctor may wait until you are fully dilated and your baby is in a good position before asking you to start pushing. This is because pushing too early can make it harder to deliver your baby and increase your risk of tearing.

Pushing during labor: two approaches

There are two main approaches to pushing during labor:

1. Pushing when you feel the urge

It has been established that pushing when you feel the urge has several benefits:

More effective pushing and less fatigue for the mother: When you push with your own urge, you are more likely to push effectively and with more force. This can help to shorten the second stage of labor and reduce fatigue.

Fewer assisted deliveries: Pushing with your urge can also help to reduce the need for assisted deliveries with forceps or vacuum. This is because your body is more likely to be able to push the baby out on its own.

Lower risk of perineal tears: Pushing with your urge can also help to lower the risk of perineal tears. This is because you are less likely to push too forcefully or for too long.

Less stress for the baby: Pushing with your urge can also help to reduce stress for the baby. This is because the baby is receiving more oxygen during the pushing phase.

As long as the baby is continuing to descend and the mother's condition is stable, it is therefore possible to wait to push until you feel the urge. However, after a certain amount of time, it may be necessary to stimulate the descent to avoid complications. It is also important that the contractions are adequate and that the pushing is active to avoid a halt in the progression of labor, which could represent a danger for the mother and the fetus.

2. Pushing as soon as complete dilation is confirmed

The second approach is to push as soon as complete dilation is confirmed. This is more common in patients who do not have anesthesia at this stage of labor.

In both cases, you should first breathe in, push for about ten seconds, and then relax and completely empty your lungs. This exercise can be done 2 to 3 times per contraction. Between contractions, you can breathe normally and relaxed.

Additional tips for pushing

• Position yourself in a way that is comfortable for you. Some women prefer to push in a squatting or kneeling position, while others prefer to lie on their side.
• Focus on pushing down through your diaphragm and abdominal muscles. Do not hold your breath or strain your face or neck.
• Rest between contractions. This will give your body a chance to recover and prepare for the next contraction.
• Listen to your body and your midwife or doctor. They will be able to give you guidance and support throughout the pushing phase.
• Pushing during labor can be a challenging but rewarding experience.

By following these tips, you can help to make the most of your pushing experience and welcome your baby into the world.

The most commonly used breathing techniques

The expired push. This involves pushing while allowing a stream of air to pass between pursed lips, as if blowing up a balloon. The air should come out with difficulty, so the lungs do not empty completely. This technique is said to result in less accumulation of CO2 in the blood of both the mother and baby. However, it must be well understood and practiced before the day of delivery in order to be done correctly.

The breath-holding push. This involves pushing while holding your breath, while directing the effort downward, towards the rectum and perineum. This technique offers more power and may be necessary when the baby needs to come out more quickly. However, it is met with some resistance from experts because some studies have shown a harmful effect on the perineum. However, it may be helpful for some women.

The woman's preferences and well-being, as well as the context in which the delivery takes place, should guide decisions about breathing.

Effective pushing ensures that the mother and baby receive enough oxygen and allows the perineum to stretch gradually. Here are some tips for pushing effectively:

• Change positions regularly, every 3-4 contractions or every 15 minutes. You can push lying on your side, squatting, semi-sitting, or on all fours. The caregivers can guide you when changing positions. The idea is that the best position may change as labor progresses. This is the Gasquet method.
• Bend your elbows, grip your legs or the support bar with your hands, and keep your knees aligned with your shoulders.
• Lower your chin towards your chest and open your mouth slightly.
• Relax the muscles of the pelvic floor (perineum) to let the baby down without pushing. This technique is also part of the Gasquet method.
• Focus on pushing your baby down.
• Imagine that you want to give your baby as much space as possible. This visualization will promote the baby's descent.
• Some women feel the need to groan during pushing. Groaning is an effective method because it lowers the diaphragm. This increases the force of expulsion directed towards the perineum. However, screaming can hinder effective pushing.
• The midwife or nurse who is with you will be able to inform you of the effects of your pushing on the baby's descent. So express how you feel between contractions. The caregivers will inform you or modify their interventions according to your needs and those of the baby.
• Push actively with the contractions, in 2-3 sustained efforts of about ten seconds each. Remember to breathe well between active pushes. Rest and relax between contractions.
• If you have had an epidural, you may not feel the need to push. In this case, the caregivers will tell you when to do so.

Finally, when the baby's head starts to come out, the perineum swells and the skin stretches when you push. This causes a burning sensation, often called the "ring of fire." Once the head is out, you will take a short break before pushing again to get the baby's shoulders out. After the shoulders pass, the rest of the body comes out easily along its entire length.

Additional tips:

• Don't hold your breath while pushing. This can raise your blood pressure and make it harder to push effectively.
• Use your abdominal muscles to push, not your chest or back.
• Don't be afraid to make noise. This can help you relax and release tension.
• Listen to your body and your caregivers. They are there to help you have a safe and healthy delivery.

Remember, every woman's labor and delivery is different. What works for one woman may not work for another. The most important thing is to relax, listen to your body, and trust your caregivers.

Fetal expulsion or delivery

The cervix is now fully dilated. Still under the effect of uterine contractions, the fetal head passes through the maternal pelvis through the upper orifice (this is the engagement of the fetal head) and then through the lower orifice of the pelvis (this is the fetal expulsion or disengagement).

The head therefore gradually passes through the upper, middle and lower straits of the pelvis. This phase lasts an average of one to two hours.

During fetal expulsion, the mother-to-be pushes the baby out by contracting her abdominal muscles ("expulsive efforts") in order to allow it to pass through the lower orifice of the pelvis and then the perineum. The pushing efforts last about 15 to 30 minutes. Sometimes, the perineal tissues are not sufficiently supple and may tear. The midwife or obstetrician will then perform an episiotomy if they deem it necessary.

When the baby presents in a vertex presentation (head first), the head comes out of the vulvar orifice, followed by the shoulders and the rest of the body. The baby is placed on the mother's stomach (if she wishes, this is "skin-to-skin"), which helps to warm and reassure the baby. He may not cry right away. The blood vessels of the umbilical cord gradually contract, which results in the cessation of blood exchange of nutrients and oxygen between the baby and the mother. The newborn's breathing gradually takes over this function. The cord is clamped when it stops beating and then cut between two clamps. It is at this time that a cord blood sample can be taken to freeze stem cells.

Stage 3: Delivery of the Placenta (Afterbirth)

After the baby is born, the uterus contracts and the placenta begins to detach from the uterine wall. You may be asked to push a few times to help expel the placenta.

In most cases, the placenta is delivered spontaneously within 5 to 30 minutes after childbirth. A hormone called oxytocin is often given to help the placenta expel naturally and reduce the risk of hemorrhage. Uterine massage is also often performed for the same purpose. If too much time passes or if there is excessive bleeding that endangers the mother, medical intervention may be necessary. The doctor will then remove the placenta manually or surgically.

Stage 4: The Recovery Period (Embracing New Beginnings)

This special stage prioritizes your comfort and well-being while you begin your incredible journey as a family. It's a time for you and your precious newborn to connect and get to know each other.

Following delivery of the placenta, your doctor may stitch any tears or episiotomy. You might also receive medication to aid uterine contraction and minimize bleeding. The nurse or midwife might massage your uterus to keep it firm, which may cause slight discomfort. Remember your labor breathing techniques for this!

The healthcare team will ensure everything runs smoothly while respecting your family's privacy. The nurse will monitor your vitals – breathing, heart rate, blood pressure, temperature – frequently at first, gradually reducing the frequency.

They'll also clean your perineum, provide a sanitary pad, and apply ice to reduce swelling. A clean gown and warm blanket will be offered, as feeling chilly after delivery is normal, similar to post-workout.

After all that exertion, you might be hungry or thirsty. Eat gradually according to your appetite and tolerance.

Now, it's time to relax and bond with your baby! Skin-to-skin contact promotes breastfeeding. This can even encourage your baby to latch on within the first hour after birth. Their alert state and the stimuli of your nipple, colostrum scent, and touch all contribute to successful breastfeeding initiation. If skin-to-skin isn't possible for you initially, your partner or another loved one can do it until you're ready.

Finally, depending on your location, you'll be transferred to the postpartum unit for a refreshing shower, further education, and continued rest.  The team will also perform a more thorough examination of your baby, take measurements, and administer any medication.