WHAT IS A NORMAL CHILDBIRTH?

A normal birth is defined as the birth of a baby in cephalic position in the period of 37-42 weeks of pregnancy as a result of spontaneous sufficient uterine contraction and opening of the cervix.

HOW DOES A NORMAL CHILDBIRTH BEGIN?

The onset of normal labor is a difficult condition to understand, especially in the first pregnancies. Intermittent uterine contractions, also called false labor, can be felt before the onset of normal labor. The main indicator of the onset of labor are regular and periodic uterine contractions. It can also be felt as a feeling of pressure on the breech and vagina area. Another method of understanding is a vaginal examination performed during admission to the hospital. Usually 3-5cm vaginal opening and sufficient cervical softening are indicators of childbirth. However, bleeding, water breaking, and a decrease in baby movements are issues that must be evaluated in the hospital.

HOW DOES THE CHILDBIRTH PROCESS PROGRESS?

At the beginning of labor, first of all, the position of the baby relative to the birth canal, the path that the baby will follow, and the part that will enter the birth canal are determined. With the help of ultrasound and vaginal examination, the part where it will enter the birth canal is defined. According to these conditions, the mode of delivery is determined. For normal delivery, the head arrival is the most optimal situation. In the last months of pregnancy, the baby is positioned relative to the mother’s womb. According to this fit, the baby is positioned upside down, the legs are curled up according to the circumference of the abdomen, and the arms are folded in the rib cage. The umbilical cord, on the other hand, is usually located in the dec between the arms and legs. The baby’s head usually settles in the bone structures of the mother in the last weeks of pregnancy or in labor, which is called pelvic insertion. After that, the baby’s head goes down due to the force of amniotic fluid, regular contractions of the uterus from the top, and the mother’s pushing. After the head descends, the chin approaches the sternum, the head makes a rotational movement inside in order to fit the narrowest part of the bone structures to the narrowest diameter of its head. With these movements, the baby reaches out. At this time, the baby’s head usually looks at the back of the mother. After the baby’s head is born, the baby’s head and body turn 90 degrees so that the back shoulders can be born, creating a position for the back body and shoulders to come out of the structures called bone pelvis in the most appropriate way. It is called external rotational motion. The head is turned to the appropriate direction where the head comes out and then the shoulders are delivered. With the birth of the shoulders, the rest of the body part comes out more quickly. Then postpartum hemorrhage follows the removal of placenta.

HOW IS A NORMAL CHILDBIRTH MANAGED?

Management of normal delivery is based on evaluating the well-being of the mother and the baby and whether the course of delivery is normal or not. During the first admission of the pregnant woman to the delivery room, the evaluation of the estimated weight of the baby, the way of delivery, the condition of amniotic fluid, and the placement of the placenta is analyzed. According to this evaluation, doctors try to understand whether there is a situation that prevents normal vaginal delivery or not. If there is no obstacle to normal delivery, then the pregnant woman is admitted for delivery. The baby’s well-being is usually evaluated by monitoring the baby’s heartbeat (cardiotocography). After ultrasonography and the evaluation of the baby’s heartbeat, the risk assessment is completed and the decision on how to proceed is made. In particular, the decrease in the number of heartbeats per minute (bradycardia) of the baby during and after uterine contractions is considered as a sign that the baby is in distress. By monitoring the uterine contractions that will bring about the birth of the baby, it can also be understood whether the mother’s pushing force is sufficient/regular. If an abnormality is detected in uterine contractions, this situation is corrected and effective contractions are achieved. Finally, in cases where the baby’s heartbeat is good and uterine contractions are effective, it is evaluated whether the labor (uterus opening and the progress of the baby) proceeds normally, and in case of deviations from the normal labor graph, necessary interventions are made.

IS EPISIOTOMY NECESSARY IN NORMAL CHILDBIRTH?

Episiotomy means cutting of the pubic region in Greek. Episiotomy used to be the preferred method for avoiding uncontrolled tearing. However, studies have shown that episiotomy leads to increased tearing in the breech region. In another study, when spontaneous tears and episiotomy were compared; It was found that the risk of fecal and gas incontinence increased up to six times in patients who underwent episiotomy. Because of all these, episiotomy is not performed in every patient. Episiotomy is preferred in daily practice in cases where there is a high risk of trauma if the delivery is difficult, shoulder insertion, breech birth, baby’s head position, or if the episiotomy is not opened.

WHAT ARE THE BENEFITS AND HARMS OF NORMAL CHILDBIRTH TO THE MOTHER?

Normal birth carries low risks for mother and baby. Compared to cesarean section, bleeding, infection, removal of the uterus after or during delivery (peripartum-postpartum hysterectomy) or anesthesia complications are less common. However, pelvic floor dysfunction is more common in women who have had a normal delivery. In another study, it was also revealed that urinary incontinence while coughing, sneezing, straining, laughing, which is called stress urinary incontinence, is more common in women who gave birth normally than women who gave birth by cesarean section. Breastfeeding and interaction in the early period of the baby after normal delivery are also shown among its benefits.

WHAT ARE THE BENEFITS OF A NORMAL CHILDBIRTH FOR BABY?

During a normal vaginal delivery, the baby’s rib cage is compressed while passing between the hip bones, so the likelihood of fluid remaining in the lungs is lower than in cesarean section. This situation gives an advantage over cesarean section because the baby receives oxygen and releases carbon dioxide during breathing immediately after birth. This clearly reduces the likelihood of the newborn going to intensive care. The need for an operating room and anesthesia in case of cesarean section also takes away the chance for close contact between mother and baby (skin contact, emotional intimacy and expression). In this regard, normal childbirth also seems to have more advantages for babies than cesarean section.

Our published works on the subject:

Reassessing the length of labour in healthy Turkish women: a retrospective and descriptive study. Boz İ, Kumru S, Buldum A, Firat MZ.