What You Need to Know about normal childbirth ?

Normal childbirth is the term for a mother who gives birth to a baby through the vagina.This is the process when the fetus in the womb is ready to be born.The exact gestational age for labor is generally between 37 to 42 weeks. The normal labor process begins with uterine muscle contractions, opening of the cervix (cervix), and is assisted by the urge of the mother's pelvic muscles, so that the baby can exit through the vagina.

What You Need to Know about normal childbirth

What You Need to Know about normal childbirth ? ....... :

Contraindications Normal Childbirth
The following are a number of conditions that make it impossible for a mother to give birth normally:

  • Cord prolapse. A condition in which the umbilical cord covers the birth canal, either before the fetal body part, or at the same time as the fetus is released. This condition risks creating an emphasis on the umbilical cord and causes fetal death.
  • Fetal position abnormalities. In general, the position of the normal fetus at birth is the top of the head facing the opening of the cervix (cervix), with the face facing forward or backward. Some fetal position abnormalities that are not recommended for normal labor include:
  • - Facial presentation, when the fetal head is very close and the fetal face is directly facing the cervical opening.
  • - Eyebrow presentation, which is when the position of the fetal head slightly looks up so that the fetal brow directly faces the opening of the cervix. This situation can change to a head presentation or a face presentation.
  • - Butt presentation, which is when the butt is directly facing the opening of the cervix, especially if the foot is directly facing the opening of the cervix.
  • Twin pregnancy. Twin pregnancies that are not permitted to give birth normally are when both in the buttocks presentation, conjoined twins, present in 1 membrane of amniotic fluid, or multiple pregnancies of more than 2 fetuses. 
  •  Have had a cesarean section. Although classified as safe for most cases, this is still a matter of controversy. But certainly, mothers who have had a caesarean section more than 2 times, or have a scar stretched or formed the letter T in the uterus due to previous cesarean section, should not give birth normally, because of the risk of causing uterine tears (uterine rupture).
  •  The fetal heart rate is unstable. This can be a sign of the fetus experiencing hypoxia. Some things that can cause hypoxia in the fetus include placental abruption or umbilical cord.
  •  Placental abnormalities. Like the location of the placenta that covers the birth canal (placenta previa), or the placenta that attaches to the uterine muscles (placenta accreta).
  • Macrosomia. Conditions in which the baby's body weight exceeds 4-4.5 kg, because the risk of fetal shoulder is pinched during labor (shoulder dystocia). 
  • Mothers infected with genital herpes or HIV. Mothers are not allowed to give birth normally if they have active or infected HIV genital herpes without treatment. 

Preparation Towards Normal Childbirth
To welcome the birth of a baby, the following steps can be taken so that the birth process is smooth:

  • Looking for the right obstetrician and pediatrician. Not only looking for an obstetrician, looking for the right doctor for babies who will be able to help provide comfort for the mother.
  • Learn the normal delivery process from the beginning of pregnancy. You can do the normal process by using a class managed by the hospital or asking other people who have done it before. Learn about the stages during labor, signs of labor, breathing techniques and straining, and management during labor.
  • Sports. Some exercises such as muscle warming, walking, jogging, squats, or automatic cycling can be done to produce breathing and flexibility of the pelvic muscles during childbirth. Mothers can also relate to pregnancy training classes. Help with the intake of nutritious foods and drinks so that the body becomes more fit. Consult your doctor first before doing any exercise or diet so that it can be adjusted to the condition of pregnancy.
  • Buy baby's needs. Baby needs such as clothes and diapers need to be prepared, but not too much.
  • Prepare needs in 1 bag. Prepare items needed during birth, 1 month before the estimated date of birth of your baby,
Signs of Normal Labor
The obstetrician will inform the estimated date of birth to the mother, but this date can go forward or backward by about 2 weeks. Therefore, it is important for the mother to know the signs felt when the fetus will be born:

  • The fetal head begins to descend into the pelvic cavity. This makes breathing lighter due to reduced fetal pressure on the diaphragm. In addition, the desire to urinate will increase due to a depressed bladder.
  • Exit mucus containing blood from the vagina. This mucus is produced by the cervix and serves to protect the fetus from infection. The mucus that comes out is a sign that the cervix has begun to open.
  • Back pain. Blunt pain in the lower back that arises, can appear with contractions or appear alone.
  • Contraction. Uterine muscle contraction is usually felt periodically every 10 minutes indicating the time of delivery is near.
  • Rupture of membranes. Do not imagine rupture of membranes like water flowing from the vagina, but like urinating but cannot be held by the mother. Amniotic fluid that comes out indicates that the membrane that protects the fetus is torn, so the fetus must be born within 24 hours.
Normal Stages Before Childbirth
Stages before normal childbirth or called stage 1 in the medical world are divided into 3 phases, namely the initial phase (latent), active phase, and transition phase.

The latent phase is the longest and most uncomfortable phase, can last 5-18 hours. Pregnant women will generally feel mild to moderate contractions periodically for 30-45 seconds, and have a distance of 5-20 minutes. The latent phase occurs until the cervical opening is around 3 cm.

The active phase occurs after the cervical opening has reached 3-4 cm. At present contractions will occur more often, which is every 2-3 minutes with a period of 50-70 seconds. When you have entered the active phase, it is advisable to immediately go to the hospital to undergo normal childbirth. If the membranes have not ruptured in this phase, the obstetrician will break the membranes. The level of contraction that continues to increase will cause anxiety, and make it difficult for the mother to stand up, and want to always change positions. Breathing exercises can be done to control pain and anxiety. If the pain is unbearable, the mother will be given epidural anesthesia. This drug can reduce pain and is given by injection in the spinal gap.

The transition phase is when the baby's position has begun to move down. In this phase, the frequency and length of time the contraction will continue to increase, it can even clash between contractions. In this stage, the mother feels anxious, anxious, scared, and tired, so she needs family support. If you have reached this phase, your baby will be born soon.

Normal Childbirth Process

Normal Childbirth Process

Also called the second stage, when the cervix is ​​fully open. The contractions that are felt will be slightly different, which is running around 60-90 seconds and subside every 2-5 minutes. Normally, the baby will be pushed into each contraction, but if the contraction decreases or does not make the fetus go down, the obstetrician will advise the mother to make a change in sleeping position, such as tilting to the right or left. If it doesn't work, the doctor can give drugs that trigger contractions. When contractions occur, the process of the fetal descent is also assisted by straining power from the mother.

During contractions and straining, the baby's head will begin to appear from the vagina which continues to widen (crowning). When this happens, the mother will feel a burning pain in the birth canal. The doctor will ask the mother to stop pushing, so the baby can come out slowly. This is also done to avoid perineal tears, the area between the vagina and the anus (anus). When needed, to avoid perineal tears or to expedite labor, an episiotomy will be performed, by cutting a small portion of the perineum and then stitching it back after the baby has come out. This action was preceded by giving a local anesthetic injection.

When the baby's head has come out perfectly, the mother is encouraged to push back to remove the entire body of the baby. After the baby comes out and is considered safe, which is marked by strong crying, the baby will be given to the mother so that early breastfeeding initiation is carried out so that a strong relationship between mother and baby is created. Then the umbilical cord will be cut and the baby will be cleaned and covered with cloth.

After the baby is born, there is still a struggle for the mother, which is removing the placenta. This period is called 3rd stage in labor. In this phase, contractions will still occur to remove the placenta from the uterus and remove it. The time needed is generally not long, which is 5-30 minutes. After making sure all the placental tissues are all out, the obstetrician will give oxytocin to maintain uterine contractions, which aims to minimize bleeding.

The time needed for normal childbirth from stage 1 to stage 3 is around 12-14 hours. Mothers who have had a normal birth before generally need a shorter time.

Problems That May Happen Before and After Normal Childbirth
Generally labor with normal birth occurs without causing problems. But some unexpected problems can occur, either before, during, or after a normal birth process, such as:
  • Premature birth. Premature birth can harm the baby because the function and growth of the organ is not perfect.
  • Late birth or postmatur pregnancy. This can harm the fetus if it reaches 42 weeks of pregnancy, especially when the placenta is unable to provide nutrition to the fetus.
  • Premature rupture of membranes. Normally amniotic fluid will rupture shortly before labor or during labor. This can lead to infection in the fetus.
  • A small proportion of mothers, who are generally mothers who give birth for the first time, can experience labor that is too long or labor does not progress.Both mother and fetus are at risk for infection with this condition.
  • Post partum hemorrhage. Severe bleeding can occur due to uterine tears or weak uterine contractions after childbirth.
  • Amniotic embolism. The condition when amniotic fluid enters the mother's blood vessels and clogs the pulmonary arteries. This complication is the most dangerous problem, not only during normal childbirth, but also during cesarean section. This complication rarely occurs when the labor process runs smoothly.
Some of the conditions above can be overcome by accelerating the process of childbirth (labor induction), assisted labor with vacuum or forceps, or caesarean section.

After Normal Childbirth
In general, after a normal childbirth, the mother will be allowed to return from the hospital after 24 or 48 hours of childbirth. The purpose of treatment at this hospital is to monitor the condition of the mother, and ensure there are no problems or complications.

There are changes that occur in the mother after the normal delivery process, among others :
  • Bedwetting. The mother can suddenly wet the bed when laughing or coughing due to a weak pelvic muscle.
  • Hemorrhoids. Hemorrhoids are very common after childbirth, but will disappear within a few days.
  • Exit lochia. Lochia is normal bleeding that occurs after labor and lasts for several weeks.
  • Removing colostrum and breast milk. Breast milk can come out on the third or fourth day, which is felt by breasts that are tight and sensitive to touch. Before breast milk is released, the mother's breast will produce colostrum, which is a yellow liquid that comes out of the breast before breast milk.
  • The stomach sags. After normal childbirth, the mother's stomach is still sagging due to stretched muscles after pregnancy. The shape of the stomach will return to normal gradually, by applying a diet with balanced nutrition and exercising.

If there is severe bleeding or blood clots from the vagina, fever, dizziness, palpitations, and visual disturbances, immediately inform the doctor.

For sexual activity, no one can ensure the right time to start again. But you should wait for the lochia to stop, usually 6 weeks after normal childbirth.

Vaginal birth after cesarean
Normal childbirth post-caesarean section (VBAC) is labor performed through the vagina, after a previous pregnancy the labor process is carried out by caesarean section. About 40% of women do this, with satisfying results. But keep in mind, 1 in 200 women who do this is at risk of causing dangerous complications, namely uterine tears. Before deciding this, make sure that the mother has just had a caesarean section and is not allowed to induce during labor, because it increases the risk of uterine rupture. The most important thing is to discuss with your obstetrician about the benefits and risks of normal childbirth after cesarean section.

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