Pregnancy - Delivery-2

Conceiving and carrying on pregnancy for nine months smoothly is one part and delivery is the another part of safe outcome.  Gravida’s apprehensions increase as pregnancy progresses to term.  The fear of labour pains increases anxiety, sometimes cause difficulty in sleeping.  In the present day, under professional supervision delivery will be a smooth affair.  If the gravida is prepared what to expect at the time of delivery her co-operation will be more and tolerance to pain will increased.

Once the gravida has observed any of the symptoms of delivery she should immediately visit the doctor.  It is essential not to eat or drink before setting out to the hospital.  In pregnancy stomach emptying is slow and this further slows in anxiety and with labour pains.  If patient is on full stomach, and the condition demands emergency operation it may result in complications.  Even if the gravida continues in labour waiting for normal delivery she can have vomiting, causing inconvenience.  Also if gravida prefers analgesia or anesthesia for painless delivery it will be a difficult situation.  So once in labour gravida should not take any solid food, she can take sips of water or fruit juice, and follow the advice of the obstetrician.

The process of labour is divided into three stages.  The first stage of labour is the opening up of uterus (dilation of cervix) and descent of fetus into the pelvis (birth canal).  In the second stage the baby is born, and the expulsion of placenta (after birth) is the third stage. In general, in a normal case the process of labour takes 12 - 24 hours for the first delivery and gravida delivering 2^nd or later it will be 10 - 12 hrs.  Old text books say that a woman in labour should not see second sunrise.  But depending on the condition of gravida and fetus it may be prolonged for more than 24hrs.

Once the patient is having active labour pains, having pains once in 3-4 minutes and pain lasting for 40-50 seconds, and increasing gradually in frequency and duration will result in opening the passage of uterus and at the same time the fetus – head will slowly enters the birth canal.  With passing time there should be gradual progressive change in the passage and moving down of the fetus.  This is first stage which will be 6 – 18 hrs in first delivery and decreases in the later deliveries.  Once the passage opens up and head comes down low into the birth canal, the second stage of labour starts.  It takes 1-2 hrs for the birth of baby in first delivery and later deliveries it will take 30 minutes to an hour.  After the birth of the baby placenta will be expelled within 5 minutes.  It will not take more than half an hour.  This is same in first or later deliveries.

During the first stage of labour gravida should move about and can have small quantity of water or fruit juice.  If the labour is getting prolonged intravenous fluids are administered as per requirement.  Late in the first stage gravida will get confined to the bed.  When progressed to second stage she will be shifted to labour room or birth room and on to birthing table.  Woman who cannot tolerate pain can opt for analgesics in the early first stage and if facilities are available she can opt for epidural anaethesia.  Epidural anaethesia for vaginal delivery is not common practice even in metro cities and corporate hospitals in India.  

In the second stage the time of impending birth of baby, the labour pains are more frequent, once in every two minutes and pain lasting for more than a minute.  At this time gravida will have a strong urge to pass motion.  These are bearing down pains. With the bearing down pains and effort to push out will finally result in birth of baby.  Once the baby is out gravida feels relaxed. Obstetrician takes care of the baby, cleans eyes, clears throat and nostrils of the baby and hands it to the assisting staff.  By this time placenta is separated and expelled.  Obstetrician takes care to see that bleeding is minimal and examines for any injuries on the perineum or birth canal.  Any cut made in the perineum (area between the vagina and anus) to facilitate delivery and/or any injuries are sutured.  The parturient woman is cleaned and shifted on to her bed in post natal ward or room.  She is closely observed for another hour to watch for any excessive bleeding.  Later she will be under general nursing care. 

Woman who had endured pain for hours to give birth to a baby forgets everything in an hour and happily starts feeding it, and the bond between mother and child is strongest one on this earth.