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Childbirth and vaginal delivery
Childbirth (also called labor, birth, or parturition) is the
culmination of pregnancy, the emergence of a child from its mother's
uterus. It can be considered the opposite of death, as it is the
beginning of a person's life. Age is defined relative to this event in
most cultures.
Introduction
The medical science of childbirth is obstetrics and a doctor who
specializes in attending births is an obstetrician. A person who is
not a doctor but who is specially trained to assist at births is a
midwife.
First stage of labor
A typical human childbirth will begin the onset of the first stage of
labor: contractions of the uterus, at first every 10-30 minutes and
lasting about 40 seconds each. Occasionally the labor will begin with
a rupture of the amniotic sac, the paired amnion and chorion
("breaking of the water"). The contractions will accelerate until they
happen every two minutes. Each contraction dilates the cervix until it
reaches 10 centimeters (4") in width.
The duration of labor varies wildly, but averages some 13 hours for
women giving birth to their first child ("primiparae") and 8 hours for
women who have already given birth.
Second stage of labor
In the second stage of labor, the baby is expelled from the womb
through the birth canal by both the uterine contractions and by
powerful abdominal contractions ("bearing down"). The baby is most
commonly born head-first. With difficulty, babies can be delivered in
the "breech" position where the baby's buttocks or feet are delivered
first and the legs are folded onto the baby's body. Babies in a
"footling breech" position should not be delivered via vaginal birth.
Immediately after birth, the child undergoes extensive physiological
modifications as it acclimatizes to independent breathing. Several
cardiac structures start regressing immediately after birth, such as
the ductus arteriosus and the foramen ovale.
The medical condition of the child is assessed with the Apgar score,
based on five parameters. A "good start" refers to higher scores,
while a child doing poorly with have low scores that do not improve
rapidly over time.
Third stage (placental)
The last stage of labor occurs about a quarter to a half-hour after
the baby is born; in this stage, the placenta or afterbirth is
expelled.
After the birth
Usually soon after birth the parents assign the infant its given
names. Many cultures feature initiation rites for newborns, such as
circumcision or baptism, amongst others.
Variations
When the amniotic sac has not ruptured during labor or pushing, the
infant can be born with the membranes intact. This is referred to as
"being born in the caul." The caul is harmless and easily wiped away
by the doctor or person assisting with the childbirth. In medieval
times, a caul was seen as a sign of good fortune for the baby, in some
cultures was seen as protection against drowning, and the caul was
often impressed onto paper and stored away as an heirloom for the
child. With the advent of modern interventive obstetrics, premature
artificial rupture of the membranes has become common and it is rare
for infants to be born in the caul in Western births.
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Pain control
Due to the relatively-large size of the human skull and the shape of
the human pelvis forced by the erect posture, childbirth is more
difficult and painful for human mothers than other mammals. Many
methods are available to reduce the pain of labor, including
psycological preparation, emotional support, epidural analgesia,
spinal anesthesia, nitrous oxide and opioids, the Lamaze Technique.
Each method has its own advantages and disadvantages.
Complications
Complications occasionally arise during childbirth; these generally
require management by an obstetrician.
Non-progression of labor (longterm contractions without adequate
cervical dilation) is generally treated with cervical prostaglandin
gel or intravenous synthetic oxytocin preparations. If this is
ineffective, Caesarean section may be necessary.
Fetal distress is the development of signs of distress by the child.
These may include rising or decreasing heartbeat (monitored on
cardiotocography/CTG), shedding of meconium in the amniotic fluid, and
other signs.
Non-progression of expulsion (the head or presenting parts are not
delivered despite adequate contractions): this can require
interventions such as vacuum extraction, forceps extraction and
Caesarian section.
In the past, a great many women died during or shortly after
childbirth (see puerperal fever) but modern medical techniques
available in industrialized countries have greatly reduced this total.
Social aspects
In modern times, participation of the father during childbirth is now
the norm. However, before the 1960's, in most cultures the father was
forbidden to enter childbirth area, as were other men with the
exception of the doctor.
The exception to this rule were Poleshuks from Polesie. In this
culture the wife gave birth sitting on her husband's knees.
Legal aspects
In many legal systems, the place of childbirth decides nationality of
a child. The birth certificate is the basic document, which proves
that the individual is a human being.
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