The process of a birth
The birth of a child is an exciting experience for parents. With the first child in particular, many parents are not sure what to expect.
Pregnancy and childbirth are not illnesses, but rather natural events to which the woman's body is adapted. Most women instinctively know what to do. The process of giving birth is similar for all women, but not exactly the same. The time from the beginning of the birth until the child is born can be very different and also run differently. Hospitals and birthing centers offer numerous antenatal courses and are available to answer questions.
When does the birth begin?
A normal human pregnancy lasts between 270 and 290 days. Only about four percent of all babies are born exactly on their calculated date. The actual birth begins plus minus 10 days around the calculated date.
The women go into regular labor and the cervix dilates. Before the actual birth, many women go into contractions, which serve to push the child's head further into the mother's pelvis. Although these are harbingers of the birth, they do not yet mark the beginning.
How long does the birth take?
The duration of a birth is very individual and depends on many factors. A mother who is expecting her first child is often in labor longer than a mother who has already given birth.
The size of the child is also decisive for the length of the birth.
Medically, a distinction is made between a fall birth, in which the child is born within a few minutes to hours, and a protracted birth, in which the mother is in labor for many hours.
A protracted birth lasts longer than 18 hours for the first birth and longer than 12 hours for a subsequent birth. A long birth can result from a child weighing more than four kilograms, from regional anesthesia or irregular contractions. In some cases, a birth is also induced with medication and thus accelerated.
A normal birth, i.e. between the two extremes, takes between three and 18 hours. The size of the mother's pelvis is also relevant for the duration of the birth, as this marks the bottleneck through which the child has to pass during the birth.
A caesarean section may be necessary in the event of a birth arrest. A birth arrest means that the birth has already started but is not progressing any further.
The opening phase
Before the actual birth, the woman has so-called back labor, in which the child's head is pushed further into the pelvis. The actual beginning of the opening phase is marked by the first regular contractions. These pains are called opening pains. The contractions are rhythmic muscle tensions of the uterus, which serve to push the child out of the maternal body. If the mother is not yet in the clinic or in the birthing center, now is the time to go to the clinic or notify the midwife.
The cervix begins to widen until it is about ten centimeters in diameter. A rough guideline is that an expansion of one centimeter per hour can be expected. This is also called cervical maturation, i.e. the maturation of the cervix in preparation for childbirth.
The opening phase lasts up to 12 hours for first-time mothers and around eight hours for a further birth. The first-time mothers have a longer time in the first phase of opening. When the cervix is about two centimeters open, the opening phase takes about the same length for all women in labor.
The opening of the cervix can be assisted by running or climbing stairs. The muscles of the uterus also prepare for the actual birth. The roof of the uterus becomes thicker and stronger, so that pressure acts on the child's body from above.
The baby presses against the cervix with the head or the lower part of the body. A part of the amniotic sac is pushed through the cervix. During this phase the bladder ruptures and the mother-to-be loses amniotic fluid. In some women, however, the so-called premature rupture of the bladder occurs before giving birth.
In the initial phase, the child's circulatory situation and labor are regularly monitored with a CTG. For this purpose, a sensor is placed on the mother's stomach and moved until the child's heart activity can be properly recorded. Regular blood pressure checks are also carried out on the mother. At the end of the opening phase, the woman may feel severe pain and develop a strong urge to push. This should be suppressed until the cervix is completely open. At the end of the opening phase, the actual expulsion of the child begins.
The expulsion phase
The expulsion phase represents the actual birth of the baby. The phase begins with the full opening of the cervix and only ends with the birth of the baby.
Birth is easier for the mother in an upright position. It does not matter whether the mother is sitting in a gynecological chair, squatting or pulling on a rope. In the maternal body there is a kind of guide rail made of muscles and bones that determines the path for the unborn child. The child is now in this rail.
Most children are born head first and the back of the head is on the front of the mother. In this position, the first thing you can feel is the small fontanel on the back of the child's head. At this point, the baby's skull bones have not yet grown together. In this position the child is pushed further towards the pelvic exit with each contraction.
The point in time when the child becomes visible during a contraction is also called incision of the head. From this point on, the mother's perineum, i.e. the skin between the vagina and anus, must be supported or incised in a targeted manner. After the head is born, the child's shoulders must pass through the pelvis. This requires a 90 degree rotation, as the basin exit is not round, but oval.
There is often a brief pause in labor between the birth of the head and shoulders. During this break, the midwife checks whether the umbilical cord is around the child's neck and pushes it over the head or cuts it directly. With the head and shoulders, the widest part of the child is born and the rest of the body can quickly cross the pelvis. During the expulsion phase, the woman should give in to the urge to push and thus promote the birth. The midwife can support the woman in this by giving commands to squeeze when the natural contractions come.
After each contraction the mother should take two deep breaths. Since the expulsion phase is the most critical phase for the child, the child's heartbeat is checked after each contraction. While the child is in the birth canal, oxygen deficiency can occur if the umbilical cord is squeezed. This can be heard in the child's heartbeat.
After the baby is born, the mouth is suctioned off and the umbilical cord is cut. Many clinics allow the father to cut the umbilical cord himself. In most cases, the child is placed on the mother's breast right after birth. The mother's familiar heartbeat soothes the child and helps it adapt to the new environment.
Also, find out about the different types of contractions below: The different types of labor.
The postpartum phase describes the period between the birth of the child and the full birth of the placenta. After childbirth, labor pains turn into postpartum labor and the placenta begins to detach from the uterus.
The midwife can support the birth of the mother cake by gently pulling the umbilical cord. The administration of the hormone oxytocin can also promote the afterbirth. About five to 30 minutes after the baby is born, the placenta is born. This must be checked directly for completeness, as remains can cause bleeding and infection for the mother. If there are missing parts, they are scraped off.
Learn more at: Placental detachment after childbirth
If there is a perineal tear or incision, this is surgically treated and covered.
Read our article about this: The perineal incision at birth.
In the first few hours to days, there is still an increased risk of bleeding for the mother.
After the birth, medication can help the uterus to contract and thus reduce the risk of bleeding. The child is examined and dried during the afterbirth phase and then placed on the mother's breast. With the birth of the mother cake, the entire birth ends and the mother and child can be taken to the normal ward.
You can also find extensive information on this topic on our main page: The afterbirth.
Complications in the birthing process
The first complication that can occur during childbirth is premature rupture of the bladder. An infection can cause amniotic fluid to leak before labor begins. In most cases this leads to the birth of the child within 48 hours and can also mean premature birth.
Various complications during childbirth can lead to a worsening of the child's heartbeat.
One reason for this is pressure on the umbilical cord, which in some cases becomes trapped between the maternal pelvis and the child's head. This leads to an insufficient supply of oxygen to the child and can have serious long-term consequences.
The child's position can also lead to complications. Not all babies lie head first in the birth canal, and lying on the side can complicate the birth.
Multiple pregnancies can also lead to difficulties during a natural birth.
In addition, birth can be arrested at any time during the birth. If the child is already in the birth canal, natural birth must be continued.
If complications are foreseeable in advance, a caesarean section should be considered.
Another complication is endangering the mother. If the mother's circulatory system cannot withstand the strain, an operative delivery may also be necessary.
Also read our article: The most common complications during childbirth.
Umbilical cord around the neck
The umbilical cord is a well-protected system that supplies the unborn child with oxygen and nutrients. About 20 percent of all children have the umbilical cord wrapped around the child's neck during birth.
A loose loop is not dangerous for the child. After the birth of the head, the midwife checks whether the umbilical cord is around the neck. In this case, the midwife carefully places the umbilical cord over the head. If the wrapping is tight, the umbilical cord must be cut. An emergency caesarean section may only be required if there are abnormalities in the CTG.
You can find more on this topic on our website Umbilical cord around the neck