BUPA GLOBAL

Childbirth - vaginal delivery

This factsheet is for women who are planning to give birth vaginally, or who would like information about it.

Vaginal birth is the usual way for babies to be born. The process of giving birth to a baby is known as labour. There are three stages to labour that will for last different lengths of time. Pain relief helps to manage pain during labour.

Your care may differ from what is described here as it will be designed to meet your individual needs, and will also vary from country to country.

Click on the tabs below for more information about vaginal delivery.

Published by Bupa's Health Information Team, May 2010.

The three stages

The three stages

Most women are healthy and have a straightforward pregnancy and labour.

There are three stages that you will go through when you give birth vaginally. Labour varies according to a number of factors, such as whether or not it's your first pregnancy, the size of your baby and its position in your womb.

First stage


Before active labour starts, your body goes through some changes in preparation, so it's not always easy to tell exactly when labour has started.

When your baby is ready to be born, the balance of hormones (chemicals found naturally in your body) changes and makes your cervix (the neck of your womb) become softer and shorter.
You may also have what is called a show. This is when the plug of mucus that acts as a seal in your cervix during pregnancy falls out as your cervix changes shape. This may happen any time between several days and a few hours before labour starts.

Hormones also cause you to have contractions. The muscles in your womb tense and relax becoming shorter so that your cervix stretches and opens (dilates). Contractions feel like a wave. They start gently and gradually build, becoming intense and then easing off. It may take some time for the contractions to become regular but they will gradually get stronger and closer together.

At first you may only have a contraction every 15 to 30 minutes. After a while, they will be more frequent and stronger, occurring every two to three minutes. The length of time that each contraction lasts is usually between 10 and 40 seconds, but this will be different for every woman.

When you have a contraction, you will feel a build-up of tension across your abdomen (tummy), pain in your back and possibly also between your thighs and low down in your pelvis. You may also find that your waters break. This is a normal part of labour and is when the bag of fluid that surrounds your baby breaks as your cervix widens. It's also referred to as your membranes rupturing. The fluid may rush out in one go or in a steady leak. Your waters can break at any time during labour.

However, if your waters break when you're not in labour and labour doesn't start within the next few hours you should contact a midwife or doctor for advice on what to do next.

The first stage of labour continues until your cervix is fully dilated, about 10cm, allowing the baby to move lower through your pelvis. For women having their first baby, labour lasts on average for about 8 hours, most of which is the first stage of labour. Labour is unlikely to last for longer than 18 hours. It's likely to take less time if it's not your first baby, because your pelvis and vagina have been stretched before.

 

Second stage


The second stage of labour is when you give birth to your baby. It usually lasts about one to two hours.

As the baby's head gets lower, you will eventually feel a strong urge to push and this helps the baby to be born. This is a unique feeling which your body does of its own accord. You will still be having contractions to help you push, though they may be less frequent but longer. You may feel more comfortable if you are upright, kneeling, sitting or squatting.

As you push, your baby moves further down through your pelvis until his or her head stays at the entrance to your vagina between contractions. This is called 'crowning' and means your baby is about to be born. Usually, the head is born first followed by the shoulders and the rest of the body.
 

Third stage


This is when the placenta and membranes that held your baby in the womb are passed out of your body. This can happen naturally or you may be given a medicine to help the process.

Active management of the third stage by your midwife or doctor


A midwife or doctor may be able to help the third stage to progress more quickly and safely.

As your baby's shoulders are being born, you may be given an injection of a hormone called oxytocin, or a combination of oxytocin and a medicine called ergometrine. Within about two minutes, these cause your womb to contract strongly to help reduce serious bleeding. The umbilical cord is clamped and cut as soon as your baby is born. The midwife or doctor will then deliver the placenta by pulling gently with one hand on the part of the umbilical cord that is still attached to it.

This takes about 10 to 20 minutes. Research has shown that this method reduces your risk of serious bleeding. However, it's possible that you will have some side-effects as a result of the medicines. These can include headache and feeling or being sick if you were given an injection of ergometrine.
Availability and use of medicines may vary from country to country.

Natural (physiological) management of the third stage


You may choose for the placenta to be delivered without any medicines. After your baby is born, you will be encouraged to cuddle him or her and try breastfeeding. This causes hormones to be released which help your womb to contract and push out the placenta. The umbilical cord isn't clamped and cut until the placenta has been delivered. This can take anything from a few minutes to up to an hour.

There are a number of reasons why this type of third stage may not be possible, including:

  • if you had an epidural or pain relieving drugs during labour
  • if you have had a long labour
  • if you had heavy bleeding during this pregnancy or with a previous birth
  • if there were problems during labour or if you had an assisted delivery
Your midwife or doctor will give you more information about your options.

Complications of childbrith

Complications of childbrith

Complications are when problems occur during or after a vaginal delivery. Sometimes labour doesn't go as planned and you may need help for your baby to be born safely.

Induction of labour


Induction is when you are helped to go into labour. There are a number of reasons why this may be suggested, including:

  • there is a problem with you or your baby and you need to have your baby early
  • your pregnancy is overdue
  • your waters have broken but labour hasn't started
There are several methods that can be used to induce labour. Membrane sweeping is when a midwife or doctor puts their finger inside your cervix and makes a circular movement. This separates the membranes around the baby from your womb and releases hormones, which can start your labour. If this doesn't happen there are a number of other ways that your labour can be started. These are explained below.

  • Prostaglandins. This is the way that most women will have their labour induced. Prostaglandins are hormones which are usually produced by your body to trigger the beginning of labour. They stimulate your cervix to get softer and shorter. You will have either tablets or a gel placed into your vagina.
  • Rupture of membranes. This is when you artificially have your waters broken. It's done using a special plastic hook. Rupturing your membranes causes hormones to be released which can start your labour.
  • Oxytocin. This causes your womb to contract. You will receive it through a drip inserted into your arm. Oxytocin is usually given if your membranes have already ruptured.
Having labour induced can be more painful than going into labour naturally. Talk to your midwife or doctor about pain relief during your labour.

Acceleration of labour


This is sometimes called augmentation of labour. If labour is taking a long time and isn't progressing at the rate that would usually be expected, you may be offered treatment to speed up the dilation of your cervix and strengthen your contractions. You may be given oxytocin through a drip to help your womb contract more strongly. If your waters haven't broken, then your midwife or doctor may also suggest having the membranes ruptured to speed up labour.

Assisted delivery


Sometimes your midwife or doctor may need to use instruments to help you give birth to your baby. Some of the main reasons why you may need help are listed below.

  • Your baby isn't getting enough oxygen, or there is another problem putting his or her health at risk. This is called fetal compromise or fetal distress.
  • Your baby is in a position that means it's difficult for him or her to be born without help.
  • You have been pushing for a long time, are very tired and can't manage without assistance.
  • You have a health condition that means you may not be able to keep pushing.
You may be given regional anaesthesia before an assisted delivery. This completely blocks feeling from the waist down and you will stay awake during the procedure. The two types of assisted delivery are listed below.

  • Forceps - these are like large tongs with curved ends that fit around your baby's head. Your midwife or doctor will pull gently on them while you push.
  • Vacuum extraction (ventouse) - this uses suction. A cup is placed on your baby's head and attached to a vacuum machine. The air is sucked out which attaches the cup strongly to the baby's head. Your midwife or doctor then pull gently on the cup as you push.
If you need an assisted birth, a midwife or doctor will give you more information about your options.

Pain relief

Pain relief

All women cope differently with labour. You may have one idea about the pain relief you wish to have before labour, but change your mind once it's actually happening. There is evidence to show that having someone with you throughout labour can reduce your need for painkillers.

Self-help


There are a number of other methods of pain relief that you can try if you don't wish to use medicines. These methods may include:

  • using breathing and relaxation techniques or massage
  • being in warm water, such as in a birthing pool
  • moving around, standing up, kneeling and leaning forward
Using a TENS (transcutaneous electrical nerve stimulation) machine can also help in early labour, though it isn't recommended later on. Two electrodes are placed on your back and electrical impulses are sent to the nerves to block pain signals going from your womb to your brain.

If you decide to use medicines, all these methods can also be used at the same time.

Medicines


There are a number of medicines you may be able to choose for pain relief. They can be used in combination if necessary. It's important to talk to a midwife or doctor about these and be sure that you are aware of the risks and benefits of each.

Gas and air (Entonox)


This is a mixture of nitrous oxide (laughing gas) and oxygen. As you feel a contraction starting, you breathe in the mixture through a mouthpiece or a mask placed over your nose. It's a mild painkiller and will make your less aware of your pain although not all women find it effective. Some women find that Entonox can make them feel sick and light-headed.

Opiates


These medicines include diamorphine and pethidine. They are strong painkillers but may have a limited effect during labour. They can cause side-effects including feeling sick or dizzy. Opiates may also affect your baby making him or her sleepy both at birth and for a few days afterwards. This can reduce your baby's ability to breathe after birth and this may need urgent treatment. Opiate drugs can also make it harder for you to breastfeed.

Epidural


This method involves having an injection of anaesthetic into your lower back, just above your waist. An epidural completely blocks feeling from the waist down. However, there are side-effects. If you have an epidural, your second stage of labour may take longer because you won't feel the urge to push. It may also make moving around more difficult because you have less feeling in your back and legs.

Sources

Sources

  • Intrapartum care: Care of healthy women and their babies during childbirth. National Institute for Health and Clinical Excellence, http://www.nice.org.uk, September 2007
  • Oats J, Abraham S. Fundamentals of obstetrics and gynaecology. 8th ed. Elsevier Mosby, 2005
  • First stage of labour.National Childbirth Trust, accessed 14 December 2009
  • A guide to labour.National Childbirth Trust, accessed 14 December 2009
  • Collins S, Arulkumaran S, Hayes K, et al. Oxford handbook of obstetrics and gynaecology. 2nd ed. Oxford: Oxford University Press, 2009:264
  • The second stage of labour. National Childbirth Trust. www.nct.org.uk, accessed 14 December 2009
  • Oxytocin. Joint Formulary Committee, British National Formulary. 58th ed.British Medical Association and Royal Pharmaceutical Society of Great Britain, 2009, accessed 14 December 2009
  • Third stage of labour. National Childbirth Trust , accessed 14 December 2009
  • Induction of labour. National Institute for Health and Clinical Excellence NICE, July 2008.
  • Induction and acceleration (augmentation). National Childbirth Trust, accessed 14 December 2009
  • Working with pain in labour.National Childbirth Trust, accessed 14 December 2009

This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. This content was compiled by Bupa based on clinical information and practice current as at the stated date of publication. Content is likely to reflect clinical practice in a particular geographical region (as indicated by the sources cited) – accordingly, it may not reflect clinical practice in the reader’s country of habitation. This content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Photos and videos are only for illustrative purposes and do not reflect every presentation of a condition.

Want to speak to an adviser?

If you have any questions or would like help choosing the right level of cover, please get in touch.

Contact Us

Want to see the breadth of our network? 

Find thousands of medical facilities worldwide

View Facility Finder

The Bupa Global difference

Over 40 years of medical expertise and dedication to health. A global team of advisers and health experts who, between them, speak multiple languages – and a service that exceeds expectations. These are just a few of the things that make Bupa Global different. Explore how we provide you with world-class cover and stand apart from the rest.