Pregnancy, Vaginal Delivery

What is a vaginal delivery?

A vaginal delivery is childbirth that happens when the baby is pushed down the birth canal and delivered through the vagina. Every labor and delivery is different. How long labor and delivery lasts and how it progresses varies depending on previous births, the position of the baby's head, and the size of the baby and the birth canal. There are, however, general stages of labor and delivery that a healthcare provider uses to decide whether it is progressing normally for a vaginal delivery. The 3 stages of labor are:

• First stage: The cervix opens and thins until it is wide enough for the baby to pass through the birth canal.
• Second stage: The baby moves through the birth canal and is born.
• Third stage: The placenta (afterbirth) passes through the birth canal and is delivered.

How is a vaginal delivery done?

Before vaginal delivery:

• Your healthcare provider will ask you to sign a consent form for any necessary treatment during childbirth. The consent form will state any possible treatments you may need during delivery, what may happen during treatment, and what you may expect afterward.
• Tell your healthcare provider if you have any food, medicine, or other allergies such as latex.
• Tell your healthcare provider if you are taking any medicines, including nonprescription drugs, herbal remedies, or recreational or illegal drugs.
• You will have a small tube (IV catheter) inserted into a vein in your hand or arm. This will allow for medicine to be given into your blood system and to give you fluids.
• If the membrane and fluid surrounding the baby (often called the bag of water) has not broken, your healthcare provider may gently break it with a sterile instrument.
• Your provider may use fetal monitors to monitor the progress of your labor and your baby’s response to contractions. This will help your provider decide if you can deliver your baby through the vagina and how well the baby is tolerating the contractions.
  • External fetal monitoring is done by small monitors placed on the mother’s abdomen. They are held in place by 2 elastic belts. On one belt is a pressure gauge that records the pressure of contractions. Attached to the other belt is a small ultrasound instrument, which records the baby's heart rate.
  • If the external monitor shows that the baby's heart rate is abnormal or your contractions are too frequent, an internal monitor may be used to measure the baby's heart rate and the mother's contractions. This is done by placing a small wire into the uterus and directly on the skin of the baby's scalp to record the baby's heart rate. A narrow, flexible tube (also called a catheter) will be inserted through the vagina and cervix into the uterus. A pressure gauge attached to the catheter measures the strength and frequency of your contractions.
• You may be given a sedative through your IV to help you to relax.
• You will be given medicines to relieve pain during labor and delivery. These may include:
  • Local anesthesia, which may be shots of medicine given into the cervix before it is fully dilated to help control labor pains or shots of medicine given inside the vagina just before delivery of the baby to help relieve pain around the vagina and rectum as the baby comes down the birth canal
  • An epidural block, which is pain-relieving medicine given in the lower spinal area of your back. Usually a small tube is inserted into your back, inside the spinal canal, through the needle. Then the needle is removed, leaving the tube in place. More medicine can later be given through the tube instead of with another shot.
  • In rare cases, general anesthesia may be necessary for a difficult vaginal delivery. General anesthesia relaxes your muscles and puts you into a deep sleep. It also keeps you from remembering the operation. While you are asleep, you will have a tube in your throat to help you breath and to make sure you are getting enough oxygen. The tube may be removed before you wake up after the surgery.
• If your baby is not in the normal position for delivery because its head is not facing down or the baby’s bottom, knees, or feet would come out before the head (breech position), your provider may try to turn the baby into the correct position for vaginal delivery.
  • Your provider may place pressure on the outside of your abdomen to try to turn the baby.
  • Your provider may place one hand on the baby by reaching inside the vagina and placing pressure on the outside of the vagina with the other hand to try to turn the baby.
  • Your provider may use forceps or a vacuum instrument to help turn the baby inside the uterus.

During vaginal delivery:

• When your cervix is fully dilated, you will feel the urge to push the baby down the birth canal. If you do not feel this urge because of the pain medicine you have been given, your healthcare provider will let you know when it is time to push.
• Although contractions of the uterine muscle will push the baby down the birth canal, you will need to help push the baby out by tightening your muscles and pressing downwards. This may feel like you are bearing down to have a bowel movement.
• You may find it helpful to breathe in a rhythm to help prevent pushing without a contraction.
• While your baby is coming out through the birth canal, your healthcare provider may press down firmly on your abdomen over the top of your uterus to help the delivery.
• Your healthcare provider may perform an episiotomy to make your baby's delivery easier. An episiotomy is a 1- to 3-inch cut made from your vagina toward your rectum to make the vaginal opening bigger.
• Your healthcare provider may use forceps or a vacuum instrument to help deliver the baby.
• Your healthcare provider will deliver the placenta after your baby has been delivered.
• If you had an episiotomy, your provider will stitch the closed.

After vaginal delivery:

• You will be checked often by nursing staff.
• Your blood oxygen level may be monitored by a sensor that is attached to your finger or earlobe.
• Your heart rate, blood pressure, and temperature will be checked regularly.
• Your provider may prescribe medicine to:
  • Treat pain
  • Treat or prevent an infection
  • Soften your bowel movement and reduce straining
  • Reduce swelling in the area of your rectum
• Your provider may recommend other types of therapy to help relieve pain, other symptoms, or side effects of treatment.
• You may have some pain and swelling of the vaginal area, especially if you had an episiotomy. This may be treated with:
  • Cloth-covered ice packs on the area
  • Warm tub baths 2 or 3 times a day for 20 minutes (called sitz baths) to help with the soreness, starting at least 24 hours after delivery

What can I do to help?

• You will need to tell your healthcare team if you have new or worsening:
  • Heavy vaginal bleeding
  • Dizziness or lightheadedness
  • Swelling, redness, or pain in your legs
  • Nausea and vomiting
  • Chest pain
  • Shortness of breath
• Ask questions about any medicine or treatment or information that you do not understand.

How long will I be in the hospital?

The average amount of time to stay in the hospital after a vaginal delivery is usually 2 days. Talk with your provider about how long your stay may be.