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What Can We Do To Increase Chances Of Normal Delivery?

By Dr. Manju Khemani in Obstetrics And Gynaecology

Nov 13 , 2020 | 13 min read

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Normal delivery is the most common way for a baby to be born. It typically means that the baby moves through the birth canal and out of the mother’s body without being helped by instruments, such as forceps or vacuum extraction. Normal delivery or vaginal labour is one of the best ways to give birth. Normal delivery has fewer complications than a cesarean section. In addition, it is easier to recover from and causes fewer problems for future pregnancies.

In a normal delivery, the process of labour and delivery usually begins when contractions start in the pregnant woman’s uterus. When the baby is ready to be born, its head will slowly move down through the opening of the birth canal. When it reaches the pelvic opening, it will move out into the world. This process takes about 10 hours on average.

However, not every pregnant woman will be capable of giving natural birth. Each body is unique. Some women cannot produce the necessary levels of hormones to go through labour naturally. In these cases, a doctor will perform a C-section birth or other types of delivery.

Recent data from the National Family Health Survey 2014-15 (NFHS-4) reveals that at the all India level the rate of C-sections has doubled over the last decade, while in last 20 years, it has risen six times. Rates of cesarean section are much higher in private hospitals than in public hospital.

Until 2010, cesarean—or C-sections—were limited to 8.5% of all deliveries in the country, But in the last decade or so, the numbers have escalated in many parts of the country. It’s not only in India but all over world caesarean rates have increased. Turkey is at the opposite end of the scale with just over half of all babies delivered via c-section. The United States and Australia also have higher cesarean rates than average, 32.5 and 32.1 per 100 live births respectively.

The question that arises here is whether caesarean section delivery is free of all complications and if not, then what can a woman do to reduce the possibility of ending up in caesarean section?

Types of Delivery or Childbirth 

We believe mothers should have the birthing experience that's painless and less complicated. With advancements in healthcare, today we have a variety of birth types to choose from. Followings are some common childbirth options available:

  1. Vaginal delivery
  2. Cesarean delivery
  3. Forceps delivery
  4. Vacuum extraction
  5. Vaginal delivery after c-section

  • Vaginal delivery

    Normal or vaginal delivery is the delivery where the baby is born through the vagina. It is the most common way in which a baby is born. Normal delivery is preferred chiefly across the globe due to the low risks involved.

    Vaginal delivery usually occurs between 37 weeks and 42 weeks of pregnancy. This type of delivery is considered the safest method for both baby and mother. The benefits of vaginal delivery include a lower risk of infections, a stronger immune system for babies, and easy lactation.

  • Cesarean delivery

    Cesarean is a surgical method of delivering babies. It is also known as C-section. During a cesarean, the doctor makes a cut in the woman's belly to deliver the baby through an incision made in the uterus. This type of delivery is considered less safe for mothers and babies than normal delivery. However, in some cases, C-section might be necessary due to health complications or other reasons. It can be life-saving when something dangerous happens during childbirth.

  • Forceps delivery

    This is a type of delivery where the baby is delivered by grasping the baby's head and legs with forceps. The forceps are then placed in the birth canal. Once forceps have been placed in the birth canal, they will grab hold of the baby’s body and help to deliver it out of it. Forceps delivery is actually a type of assisted delivery used when there is no progression during vaginal delivery.

  • Vacuum extraction

    Vacuum extraction is an assisted method of delivery used to remove the baby from the woman’s body. The doctor will use a vacuum hose to suck the baby out of the birth canal. This type of delivery is usually used in cases where labour has stalled or there have been complications during normal childbirth.

  • Vaginal delivery after c-section

    Vaginal delivery after c-section, also known as vaginal birth after cesarean or VBAC, is a method of delivering a baby vaginally in women who have previously had a cesarean delivery. This is a type of delivery that is not possible in all cases. Vaginal delivery after c-section is used when there are no congenital risks for the baby, the mother is healthy, and there were no complications during the previous cesarean.

When is Normal Delivery Recommended?

Normal delivery is the most effective way to give birth. In some cases, however, it may become necessary for doctors to perform a C-section birth or other types of delivery. An obstetrician will make this determination based on the mother’s health and level of risk.

During normal labour, the baby moves into an upright position through the birth canal and into the world surrounding her. Normal labour takes 10 hours on average, but can take up to 20 hours in some cases.

Normal delivery is recommended when no complications arise during pregnancy, labour, or delivery. It is important to note that every pregnant woman has individual needs and thus, her doctor will recommend a delivery method based on any existing health factors or risks.

Usually, normal delivery is recommended for young and healthy women. An active lifestyle, normal blood pressure, and the position of the fetus are important components in recommending a normal delivery.

Here are different signs doctors usually take into account for recommending normal delivery:

  • An excessive urge to urinate due to increased pressure in the bladder by the growing uterus

  • Increased vaginal discharge due to impaction of blood vessels in the reproductive organs and growth of the cervix

  • Sore breasts are a good sign that you are ready to give vaginal birth

  • A pain in the lower back as the fetus starts to get into a head-down or cephalic position

  • Breaking the water bag before the labour starts

  • Cephalic position of the baby in an ultrasound scan

Stages of Normal Delivery

  1. First stage: Cervix dilation

    This stage begins when a pregnant woman starts to feel contractions on one side of her uterus. The strength of the contraction will increase gradually, and they will become longer and more frequent over time. And the cervix widens along with the contractions. The cervix may dilate up to 10 centimetres in the first stage.

    There are three sub-stages to the first stage of delivery. They are:

    1. Early labour

      • Cervix widens up to 4 centimetres

      • The mother may experience contractions at the interval of 3 to 5 minutes

      • Pregnant women usually spend early labour at home

    2. Active labour

      • The contractions become stronger, occur at an interval of 3 to 4 minutes, and last about 60 seconds

      • Cervix opens up to 7 centimetres

      • Pregnant women should be taken to hospital at this stage

    3. Transition

      • Cervix opens up to 10 centimetres

      • Painful and strong contractions at an interval of 2 to 3 minutes and lasts up to 60 to 90 seconds

      • Most painful stage

  2. Second stage: Birth of baby

    The birth of the baby takes place after painful and strong contractions and the mother pushing the baby out of the birth canal. Sometimes an incision might be required for the baby to come out of the vagina.

  3. Third stage: Expelling placenta

    After the delivery of the baby, the placenta is expelled from the uterus. It might take a few minutes and up to half an hour for the placenta to come out after the arrival of the baby.  The mother may experience some bleeding, which is normal.

Tips to Increase Chance of Normal Delivery

According to a WHO report, 21% of women have a c-section instead of a normal delivery. Normal delivery is still the preferred option as it save women from scarring and other complications. Follow the below tips to increase the chances of vaginal birth.

  • Eat a well-balanced diet - Pregnant women should include a lot of fresh fruits and vegetables, whole grains, and lean proteins in their diet. A healthy diet will provide you with the necessary vitamins and minerals needed to keep you energised during natural labour. Natural labour requires a lot of energy and you can build energy easily by having a well-balanced diet

  • Create a stress-free environment - Negative thoughts and emotions can affect the labour process. Meditate, take a walk, listen to upbeat music, and try to create a more positive environment for yourself. A positive thought process will not only boost your energy, but will also help you focus on what you need to do during the labour.

  • Exercise and movement - How often do you exercise? How many minutes do you spend on daily exercise? If your answer is more than once a day, then natural labour is definitely for you. Regularly exercising will provide your body with the energy it needs to fight the pain and get through labour.

  • Attend birthing classes - Having a good birthing class with a certified professional is a great way to build up your confidence and enjoy your labour. Your practitioner will also be able to share information on how to manage the pain associated with the delivery process and will provide you with several normal delivery tips.

  • Hire trained labour support - A good midwife will teach you how to get normal delivery. She will provide you with the necessary instructions for natural labour. Your midwife will be able to assist you in reaching a normal delivery using her knowledge and experience.

  • Try to avoid induction - During labour, many factors can affect the process. A major reason for induction is to stop the contractions and make the mother relaxed. There are times when a couple might feel they cannot handle the pain of natural labour and decide to induce birth before it is time. So, if you want a normal delivery, then you should try to avoid induction.

  • Go to the hospital only during active labour - You should only visit the hospital during the active labour stage. Pregnant women can spend the early labour stage at home itself. This way, you can avoid unnecessary stress.

  • Perineal massage - Perineal massage is one of the normal delivery tips that help dilate the cervix faster. To get a normal delivery, you have to keep your body very calm and relaxed. Perineal massage helps in relaxing the muscles and body for stress-free labour.

Benefits of Normal Delivery

  • Quick recovery - Natural delivery is a type of childbirth where there is no instrument or surgery involved. This means that the recovery process will be a lot faster than the other types of deliveries. You will recover from normal delivery within a few days and can enjoy your motherhood.

  • Boosts immunity for child - A child born from a normal delivery will have improved immunity. This is because, during natural delivery, the baby is exposed to a lot of vaginal bacteria that help in the defence system of the child. It doesn't happen in a c-section delivery.

  • Avoids the risk of major surgery - Cesarean delivery is risky as it is major surgery. It involves cutting the abdominal and uterus wall. So, a normal delivery is far safer than that and doesn't have any major side effects.

Difference Between Normal Delivery Vs C-Section

Advantages of Normal Delivery

Advantages of C-Section

  • No surgical procedure or anesthesia involved
  • Low risk of blood loss
  • Quick recovery
  • Improved immunity power to the baby due to exposure to bacteria in the vagina
  • Short hospital stays
  • Easy lactation
  • Safe option if the mother or fetus is diagnosed with any medical conditions
  • Delivery can be scheduled at the convenience of pregnant women
  • Life-saving during dangerous conditions during childbirth

Disadvantages of Normal Delivery

Disadvantages of C-Section

  • Longer process
  • The process can be physically draining for the mother
  • Higher risk of a vaginal tear
  • Long hospital stays
  • Breastfeeding or lactation might be a tedious task at first
  • Slow recovery
  • Higher risk of blood loss
  • Higher risk of uterus scarring
  • Low immunity in babies

What Are The Complications Of A Caesarean Delivery?

Let's see what are the complications of caesarean section vis a vis normal delivery-

  1. More women die during caesarean section than in normal delivery.
  2. The woman is also exposing herself to complications of anaesthesia.
  3. She is more likely to have a fever, and wound infection.
  4. Blood loss is more than double as compared to normal delivery and hence woman feels weak for a long time after caesarean section.
  5. She is also more prone to have clots in veins.
  6. In the next pregnancy, she may have an ectopic pregnancy or caesarean scar pregnancy. Rarely she may end up in getting her uterus removed because of a rupture uterus in the next pregnancy or placenta accreta.

All this information is important for patients who request caesarean section on demand.

Is Caesarean Section A Result Of Lifestyle Diseases?

The answer is yes. All over the world, because of economic growth food is abundant Average weight gain during pregnancy in an affluent society is 14 -20 kgs as compared to recommended 9-11 kgs. Exercise in day-to-day life is almost nil. Because of hired help for household work manual work is extinct. All these lifestyle changes have made labour much longer as compared to 50 years back. Lastly, the majority of educated working women are not ready to bear pains.

Tips For Pregnant Women to Avoid Ending Up In Caesarean Section

We do not know what brings labour pains. In France, it was seen that washer woman who was doing lot of manual work were usually delivering very prematurely and once government intervened and they were made to stop work in 7th month these women could carry pregnancies till term. So we can extrapolate that if pregnant woman will do some exercise it may push her towards normal delivery. In one population based study from Denmark it was seen that those women who were doing some leisure time activity were less likely to have emergency caesarean section. This study also proved that increasing leisure time physical activity before and during pregnancy was associated with a less complicated delivery.

It’s a myth that doing exercise can lead to preterm birth. Scientific studies have proven that Aerobic exercise for 35-90 minutes 3-4 times per week during pregnancy can be safely performed by normal-weight women with singleton, uncomplicated pregnancy because this is not associated with an increased risk of preterm birth or with a reduction in mean gestational age at delivery. Studies have also shown that exercise during pregnancy is associated with a significantly higher incidence of vaginal delivery and a significantly lower incidence of caesarean delivery. It also helps with weight management, reduces the risk of gestational diabetes in obese women, and enhances psychologic well-being. Before starting any regular exercise routine it’s essential to take permission from your obstetrician.

How Much Exercise A Woman Should Do During Pregnancy?

For healthy pregnant and postpartum women, the guidelines recommend at least 150 minutes per week of moderate-intensity aerobic activity (ie, equivalent to brisk walking). This activity should be spread throughout the week. Serena Williams continued to play tennis during her pregnancy. If you are not accustomed to doing exercise then start slowly and gradually increase over a week. Maybe one can start 5 minutes of walking per day and gradually increase to reach 30 minutes per day. Remember that during pregnancy, joints are relaxed because of pregnancy hormones so avoid doing sudden and jerky movements. Avoid doing anything which is making you breathless.

One should drink plenty of water before and after exercise to avoid dehydration.

Examples of safe exercise during pregnancy are brisk walking, swimming, cycling on the static bicycle or modified yoga. When a person is doing exercise a feel-good hormone endorphin is released from the brain which makes a person happy. If a pregnant woman is happy she will have a happy baby.

Conclusion

Normal delivery is one of the best ways to have a baby. It is completely natural, it is free from any type of side effects, and the recovery time is short. So, if you have normal delivery planned for yourself, then you should follow normal delivery tips and learn more about how to get normal delivery.