The moment of birth is so anticipated, so emotional, solemn, and at the same time, worrying. When the birth is veiled in ambiguity, misunderstanding, and we do not know what to expect, and we have heard all kinds of stories, this great moment of the appearance of a new life becomes quite worrying and full of fear. Now I will try to explain the process of your delivery and I hope that the only thoughts are for your child and the first moments with him/her, the first caress, hug, kiss…

They are two – vaginal or caesarean section. For vaginal delivery, a vacuum extractor and/or forceps can also be used. Caesarean section is urgent, or selective and planned. Cesarean section requires certain medical indications and or reasons for doing so.

Natural birth has three stage: the shortening and the dialating of the cervix., the descent and the birth of the baby, and the delivery of the placenta. There may be birth precursors, but they may be delicately present or even absent. Some of them include: the fall of the abdomen and engagement of the fetal presenting part in mother’s pelvis, accompanied by relieving tension in the upper abdomen but accompanied by a more low pressure, which can lead to more frequent urination. This usually occurs about 2 weeks in the first pregnancy and around the estimated date of delivery during the second, third…, delivery. An increase in vaginal discharge may occur. Future mothers often feel the so-called Braxton Hicks contractions, more often at night, in hours when there is no other irritation.

Before delivery begins, immediately or a few hours, even days, pregnant women feel the detachment of the mucous plug. The mucous plug is found in the birth canal and acts as a barrier to the entry of infections that harm your child and your genital organs. If this condition is accompanied by regular uterine contractions 2-3 to 10 minutes, it is time to go to the hospital. It is important to mention that not only the frequency of contractions is important to indicate whether the birth has started. I believe this is something you have discussed with your doctor, but still – the contractions should last 20-30 seconds. There is no room for panic, gather your wits, and maybe your spouse/partner and go to the maternity clinic to determine what stage you are from birth if it has begun. I do not include women who have suffered a conization, have a shortened cervix, or women who deliver a baby (not for the first time) and for this reason it is faster and easier for them or have other pathological conditions – in which case you must have a plan built by your obstetrician or you are already in the hospital.

If the cervix is not changed or partially changed, it means that it is a false alarm and you have to wait a little longer until the sacred moment.

In the case of particular changes in the consistency of the cervix (part of the birth canal) – softening, shortening, centering, birth is at an early stage. Your cervix is yet to be shortened and completely disappeared under the pressure of the uterine contractions, which slowly become more intense and painful. Even your abdomen can feel your uterus hardening. Contractions are painful, but they have not reached the climax. Still the birth canal starts to retract (expand) to make your baby come out. At the same time, the uterus pushes the fetus out during the contractions so that it can move down into your small pelvis. The cervical dilatation that has to be reached is full or 10 cm, i.e. your baby should not have an obstacle to get out of the cervix. At some point, the amniotic fluid can spontaneously open or we can help and open it in an instrumental way – this is a manipulation where there is no pain for you and your baby, only the vaginal examination discomfort.

After full cervical dilatation, the first stage of birth ends and the period of delivery follows.

The second stage of birth starts from the full dilatation, and the uterus, already under the effert of contractions, pushes the fetus through the birth canal. Once the fetus enters the small pelvis and passes through it, the fetus reaches the pelvis outlet. Here is very important to help your child with strong pushing. The delivery abilities of the uterus should be assisted by the abdominal press and your strong push to give birth to the child. It is precisely in this situation that it is most vulnerable due to the strong press of its head in the narrow pelvis, clenching the umbilical cord, the already falling amniotic fluid, the powerful uterine contractions that reduce the blood flow to the placenta and hence to the child. Therefore, this is the next important moment in which to mobilize and follow the instructions of the midwife and doctor next to you. It is important to synchronize your actions, imagine you are a swimmer in the Olympic Games and your gold medal is your baby that you cared for 9 months during pregnancy, and how much earlier you wanted it, only you know…

Breathing is important at this point – when a contraction occurs, you have to breathe deeply so that you can hold your breath 20-40 seconds, but not only to hold it without releasing it, but to push heroically. Why do we make you take a deep breath and not release it? Apart from the presence of a strong abdominal pressure press, we want to reduce the volume of the abdominal cavity – by taking a deep breath, you fill your lungs with air, they in turn push the diaphragm (a muscle separating the abdominal and thoracic organs). Once the diaphragm has pressed down, it touches the bottom of the uterus and does not allow it, as well as the fetus, to climb up instead of down. Strictly follow the midwife’s instructions on when to take air and when to push. We make you push 2-3 times a lot with one contraction and one breath, and then we urge you to breathe, and breathe normally to catch our breath. Do not strain without having contractions and without prompting, it is an unnecessary waste of energy which is scarce after the exhausting process of giving birth. Everything should be well-calculated and coordinated, without coordination of actions you will not be able to swim, will you!?

And after the hard physical labour comes the happiest moment of your child’s birth!!! Crying echoes the maternity room!!! Congratulations!

Now the midwife will show you your baby and then take it so that she and the neonatologist can examine it, wash and dress.

Your delivery is not over yet. The last stage of placental birth follows. It usually occurs soon after baby’s birth, but sometimes we have to wait for it. The placenta should be examined. We need to examine you for tears, bruises and bleeding. If there is a bleeding, a careful examination should be taken and the cause to be ascertained. In case of rupture, we need to sew these places.

I suppose you have been impressed by the fact that I did not mention the role of the midwife and obstetrician gynecologist so far and what they do. I will now explain what interventions to expect and why.

In most nursing homes, an enema is made or a suppository is given to empty the colon. I prefer to use suppositories, and I even think this can happen at home before you arrive at the hospital.

The midwife will take blood for analysis that we need to compare after birth. She will insert a cannula to have quick access if needed for fluid and medication intake. It is important to insert the cannula before birth because in extreme situations it may be even impossible, and at the very least will extend the time to help you and your baby.

When you are in the delivery room, we will be connected to a monitor recorder which aims to track the intensity, strength and duration of your contractions, and also to track your child’s heartbeat.

And here comes the question that is controversial for many people – how much do we, the medical team, intervene in your delivery. Recently, there have been certain movements and beliefs that with our intervention we only do harm and the birth has to be left on its own course. Dear future parents, I will give you my arguments why I want to intervene in your delivery, if necessary of course. Here is a moment to explain to you what the directed birth means. The goals of the directed birth are to preserve the physical and psychic strengths of the mother, to shorten the period of birth, to reduce the birth traumatism of the fetus and the mother, to reduce the blood loss, and to reduce the pain. Of course, in the case of a birth that runs smoothly the interference would be minimal. There are many women who suffer from pain, and yet there are very few who can endure to the end, even despite the strong suggestions of their loved ones. The difference in a well-managed birth, with good analgesia, is extremely great than a long and painful birth without our intervention. It exhausts and dehydrates you to a great extent, and you do not even have the strength and the desire to enjoy the most important moment in your life.

In my opinion, our intervention and team work with the anesthesiologist, who will relieve your pain by epidural or spinal anesthesia, greatly shortens the process of delivery, relives the pains from it, we control ruptures with episiotomy (controlled expansion of the birth canal), and blood loss. The goals are clear, the results are controlled by professionals with a lot of knowledge and experience.

The other birth method is by surgery. Caesarean section is an operative way of delivery that can be planned and urgent. Planned caesarean section is performed for a particular medical reason we are aware of during pregnancy. Causes may be due to the mother, the fetus or the placenta. Urgent caesarean section is carried out in the course of normal labour for various reasons, particularly endangering the life and health of the fetus. Urgent caesarean section can be done at any stage of delivery.

Like any surgery, the caesarean section has its own risks. Therefore, the benefits and risks of this intervention should be measured before the intervention. Recently, there has been a significant increase in the number of operational deliveries that are not induced. There are many attempts to reduce this process, but for now unsuccessful. In my opinion, the only way to make it is a direct and frank conversation between a pregnant woman and her obstetrician-gynecologist. According to the late Professor Milchev – a doctor, who has a high percentage of caesarean sections is a poor obstetrician – and I think he is right. The fear of pain, the vague and the unknown, are bad counselors! Do not succumb to them, but make an open conversation with your attending obstetrician-gynecologist, ask questions and clarify everything which is unclear. Do not ask people who have given birth once or twice for advice – they are bad counselors, have just as much knowledge as much as you, minimal experience and their own opinion. Talk about birth to people with knowledge and experience, and these are only obstetricians-gynecologists!

Author: Dr. Boris Stoilov


Center for Fetal Medicine

Get informed about the world of Fetal Medicine with Dr. Boris Stoilov.

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