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Vaginal Birth

(Vaginal Delivery)

By

Julie S. Moldenhauer

, MD, Children's Hospital of Philadelphia

Reviewed/Revised Mar 2024
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Vaginal birth is the passage of the fetus and placenta (afterbirth) from the uterus through the birth canal and vaginal opening.

For delivery in a hospital, a woman may give birth in the same room where she has been laboring or may be moved from a labor room to a delivery room. Usually, a woman's partner or another support person is encouraged to accompany her.

The Uterus, Cervix, and Cervical Canal
VIDEO

When a woman is about to give birth, she may be placed in a semi-upright position, between lying down and sitting up. Her back can be supported by pillows or a backrest. The semi-upright position uses gravity: The downward pressure of the fetus helps the vagina and surrounding area stretch gradually, decreasing the risk of tearing. This position also puts less strain on the woman’s back and pelvis. Some women prefer to deliver lying down. However, with this position, delivery may take longer.

Positions for Birth
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Birth of the baby

As delivery progresses, the doctor or midwife examines the vagina to determine the position of the fetus’s head. When the cervix is fully open (dilated) and thinned and pulled back (effaced), the woman is asked to bear down and push with each contraction to help move the fetus’s head down through her pelvis and to widen the vaginal opening so that more and more of the head appears. The midwife may massage the area around the opening of the vagina (called the perineum) and apply warm compresses to it. These techniques may help the tissues around the vaginal opening stretch slowly and help prevent tears, but they may increase the risk of infection.

When more than 3 to 4 centimeters of the head appears, the doctor or midwife places a hand over the fetus’s head during a contraction to control the fetus’s progress. As the head crowns (when the widest part of the head passes through the vaginal opening), the head and chin are eased out of the vaginal opening to prevent the woman’s tissues from tearing.

Delivery
VIDEO
Assisted Delivery
VIDEO

Episiotomy is an incision that widens the opening of the vagina to make delivery of a baby easier. Episiotomy is used only when the tissues around the vagina's opening do not stretch enough and are preventing the baby from being delivered. For this procedure, the doctor injects a local anesthetic to numb the area and makes an incision in the area between the openings of the vagina and anus (called the perineum).

Episiotomy
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    During pregnancy, a woman's uterus houses and protects the developing fetus. After approximately 40 weeks, the fetus reaches full term and is ready to be born.

    At the time of delivery, the opening to the uterus, called the cervix, dilates to allow the baby to pass from the uterus into the vagina. The vagina is a muscular tube that expands to accommodate the head and shoulders of the baby while uterine contractions continue to push the baby outward.

    Occasionally, the vaginal opening is too narrow to allow the baby to be born without tearing the vagina. When this risk is present, a procedure called an episiotomy may be performed.

    During an episiotomy, a doctor makes an incision at the bottom of the vagina. This enlarges the vaginal opening to prevent vaginal tears as the baby's head is delivered. Following delivery, the incision is then stitched closed for healing. However, this procedure lengthens the time of the mother's recovery.

    There are several potential complications associated with this procedure that should be discussed with a doctor prior to the procedure.

After the baby’s head has emerged, the doctor or midwife supports the body and helps the baby rotate sideways so that the shoulders can emerge easily, one at a time. The rest of the baby usually slips out quickly after the first shoulder comes out.

Mucus and fluid are suctioned out of the baby’s nose, mouth, and throat. The umbilical cord is clamped and cut. This procedure is painless. (One clamp is left on the stump of cord near the baby's navel, until the cord has sealed, usually within 24 hours.) The baby is then dried, wrapped in a lightweight blanket, and placed on the woman’s abdomen or in a warmed bassinet.

Delivery of the placenta

After delivery of the baby, the doctor or midwife places a hand gently on the woman’s abdomen to make sure the uterus is becoming smaller (returning to its original size). After delivery, the placenta usually detaches from the uterus within 3 to 10 minutes, and a gush of blood soon follows. Usually, the woman can push the placenta out on her own. However, in many hospitals, as soon as the baby is delivered, the woman is given oxytocin (intravenously or intramuscularly), and her abdomen is periodically massaged to help the uterus contract and expel the placenta.

If the woman cannot push the placenta out and particularly if she is bleeding excessively, the doctor or midwife applies firm pressure on the woman’s abdomen, causing the placenta to detach from the uterus and come out. If the placenta has not been delivered within 45 to 60 minutes of delivery, the doctor or midwife may insert a hand into the uterus, separating the placenta from the uterus and removing it. Pain relievers or anesthesia is needed for this procedure.

After the placenta is removed, it is examined for completeness. Any fragments left in the uterus can cause an infection of the uterus Infections of the Uterus After Delivery Infections that develop after delivery of a baby ( postpartum infections) usually begin in the uterus. Bacteria can infect the uterus and surrounding areas soon after delivery. Such infections... read more or prevent the uterus from contracting. Contractions are essential to prevent further bleeding Excessive Uterine Bleeding at Delivery Excessive bleeding from the uterus refers to loss of more than 2 pints of blood or symptoms of significant blood loss that occur within 24 hours after childbirth. After the baby is delivered... read more after delivery. So if the placenta is not complete, the doctor or midwife may remove the remaining fragments by hand. Sometimes fragments have to be surgically removed.

After birth

Oxytocin is usually given to the woman after the baby is delivered. This medication causes the uterus to contract and minimizes blood loss. The doctor also massages the uterus to ensure that it is firm and well contracted. Usually, breastfeeding the newborn also causes the uterus to contract.

The doctor repairs any tears in the vagina or surrounding tissues and, if an episiotomy was done, the episiotomy incision.

Typically, a baby who does not need further medical attention stays with the mother. Usually, the woman, baby, and partner remain together in a private area for an hour or more so that bonding can begin. Many women wish to begin breastfeeding soon after birth.

Later, the baby may be taken to the hospital nursery. In many hospitals, the woman may choose to have the baby remain with her—a practice called rooming-in. With rooming-in, the baby is usually fed on demand, and the woman is taught how to care for the baby before she leaves the hospital. If a woman needs a rest, she may have the baby taken to the nursery.

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