Problems During Pregnancy and Childbirth

Childbirth, or parturition, begins with labor (contractions of uterine muscles, opening of the cervix, and bearing down on the fetus) and concludes with delivery (expelling the baby and placenta from the vagina). Early signs of labor include short but mild contractions, blood‐tainted vaginal discharge, and ruptured membranes (broken water).

The first stage of childbirth

The first stage of childbirth, or labor, typically lasts from 2 to 24 hours, depending on the number of previous deliveries. (In most cases, labor is longer for a first‐time mother.) Regular contractions begin, and the cervix dilates, or opens up.

Labor occurs in three phases. During the early phase, mild, minute‐long contractions occur every 15 minutes. During the middle phase, contractions increase in strength and frequency, and the cervix dilates to at least 2 or 3 inches. During the late phase, contractions become very painful, and the cervix dilates completely to about 10 cm, or 4 inches.

The second stage of childbirth

As contractions move the fetus through the birth canal, the woman may feel an urge to bear down and help expel the baby. By this time the cervix should be completely dilated. Crowning occurs when the baby's head can be seen at the vaginal orifice. In some cases, the baby presents hips or feet first. In such cases, the breech baby sometimes can be manually turned into a head‐first position before delivery.

Once crowning begins, the woman may undergo an episiotomy. This procedure involves a physician making an incision in the perineum (the area between the vagina and anus) to prevent tearing as the baby moves through the vagina during birth.

The baby is delivered head and neck first, sometimes with the help of forceps. Upon delivery, the infant's mouth and nose are suctioned to prepare the baby's lungs to receive oxygen, and the umbilical cord is clamped and severed. Some physicians then gently pat the baby on the buttocks to initiate a breathing response. Drops of silver nitrate are administered to the newborn's eyes to prevent potential infection transmitted by the mother during birth.

A physician performs a cesarean section (C‐section) when regular delivery of the child through the vagina is not recommended. To execute a C‐section, the doctor makes an incision in the woman's lower abdomen, surgically opens the uterus, and removes the baby. Some reasons for C‐sections include breech presentation, exceptionally difficult labor, disease (such as vaginal infection, herpes), and fetal distress.

The third stage of childbirth

During this final but short stage of childbirth, the placenta (the afterbirth) separates from the uterine wall and expels through the vagina. Before the physician repairs the episiotomy using stitches, it is important that the placenta is completely expelled. Infection and bleeding may occur when pieces of the placenta remain in the uterus.

The postpartum stage of childbirth

Bonding between the newborn and mother first takes place during the postpartum stage of childbirth. Many CNMs and physicians encourage the mother to hold her baby immediately after delivery to foster the bonding process. An infant who, for whatever reason, is separated from the mother at birth is not doomed to a life of emotional and mental difficulties. Immediate bonding is optimal, but infants can later make up for any problems resulting from initial separation.

A woman's hormone levels change dramatically after giving birth; in particular, the higher‐than‐usual levels of estrogen and progesterone suddenly decrease. These hormonal changes may be responsible, in part, for a new mother's postpartum depression, or baby blues. Postpartum depression can last from hours to months and may range in intensity from mild to severe.