Types of Delivery

There are several types of delivery for our patients. Whether patients are seeing an obstetrician or a certified nurse-midwife at Rosemark, the provider will complete a comprehensive physical examination, review your medical and birthing history and then determine the options best suited for your specific situation.

The types of delivery performed are:

VAGINAL BIRTH

A vaginal birth is the natural method of childbirth. In this method, the baby is born down the birth canal through the vagina of the mother. During this process, the mother will go through three different stages of delivery starting with labor and ending with the delivery of the placenta.

Stage One – Labor

During the labor stage, there are three phases, Early Labor, Active Labor and Transition as outlined below:

1. Early Labor Phase: Early labor is often the longest stage. In this phase contractions begin. The middle layer of the uterus known as the myometrium is the actual muscle that contracts during childbirth.  In early labor uterine contractions are mild to moderately painful and typically last from 30 to 45 seconds and patients can talk through the contractions in this phase. The contractions may be also be irregular starting between 5 to 20 minutes apart and may even stop. First-time births may include many hours of early labor without the cervix dilating. Early labor can be long and uncomfortable.
2. Active Labor Phase: The next stage of labor is Active Labor. In this stage, contractions are more intense and frequent starting every 2 to 3 minutes, and lasting a longer range of 50 to 70 seconds. In active labor the cervix dilates to about 3 cm to 4 cm. During this phase if the membranes of amniotic sac have not ruptured, your obstetrician may choose to rupture the membranes to facilitate the birth. This process is known as “breaking the water.”  The phase of active labor is complete when the cervix is fully effaced (thinned out) and dilated (open) and the baby is ready to be pushed out.
3. Transition Phase: In this phase of labor contractions become more intense, longer and closer together. A first time mother may take up to 3 hours in the transition phase. A mother who has had a vaginal birth before may take no longer than an hour.  As the name of the phase suggests, the Transition Phase moves from Stage One Labor to Stage Two Labor which is the actual birth of the baby.

STAGE TWO – Baby Delivery

During the second stage of delivery, the baby is born as the contractions of the uterine muscles push the baby from the mother. The birth or pushing stage can be as short as a few minutes or as long as several hours during which the delivering mother may have a strong urge to push or bear down with each contraction. During delivery, the mother will follow the directions of the obstetrician or midwife. When the baby crowns (baby’s head starts to emerge) one may feel a burning pain caused by the stretching of the perineum.

STAGE Three – Placenta Delivery

In this final stage, the placenta is delivered. While contractions will continue, they are less intense but help the placenta separate from the inside of the uterus and expel the placenta. Breastfeeding right away can help to shrink the uterus and reduce the amount of bleeding.

CESAREAN BIRTH (C-SECTION)

Cesarean birth is the delivery of a baby through incisions made in the mother’s abdomen and uterus when a vaginal birth is not optional.

The following situations are some of the reasons why a cesarean birth is performed:

• Mother may have concerning medical issues such as high blood pressure or diabetes.
• Mother may be positive for HIV or herpes.
• Baby may be in a breech position or be a large baby.
• There may be concerns for the baby. The umbilical cord may have become compressed or fetal monitoring may detect stress or abnormal heart rate in the baby.
• There may be problems with the placenta.
• Failure to progress, such as when contractions may not open the cervix enough for the baby to move into the vagina.
• Twins, triplets or other multiple pregnancy where the babies are being born too early, are not in good birthing positions or if there are other identified problems. The likelihood of having a cesarean birth increases with the number of babies being carried by the mother.

During a cesarean delivery, a nurse will prepare the patient for the operation by inserting an intravenous line into their arm or hand that will allow fluids and medications to flow into the bloodstream during surgery. The patient’s abdomen will be washed, pubic hair may be trimmed and a catheter (tube) will be placed to drain the patient’s bladder.

Appropriate anesthesia will be administered and then an incision is made through the skin and wall of the abdomen. The skin incision may be horizontal or vertical, near the pubic hairline. The abdomen muscles are not cut but are separated to make room for the surgeon to make another incision in the wall of the uterus.

Through the incisions, the baby is delivered along with the umbilical cord. Next, the placenta is removed and the uterus is closed with stitches that dissolve in the body. Either stitches or staples are used to close the abdominal skin.

If an epidural block is used instead of general anesthesia, the mother will likely hold her baby right away. Soon after surgery, the catheter is removed from the bladder and the patient is taken to a room for monitoring. Mothers should be able to breastfeed right away.

Plenty of rest will be required which typically includes a hospital stay of 2-4 days.

VAGINAL BIRTH AFTER CESAREAN DELIVERY (VBAC)

Some women who have had a cesarean birth before may be given the option to give birth vaginally which is known as a Vaginal Birth after Cesarean Delivery (VBAC). The decision to attempt a VBAC depends on many different aspects of a patient’s history.

Factors include the type of incision used during a previous cesarean delivery, the number of previous cesarean deliveries, medical conditions that make a vaginal delivery risky for the mother or baby, the type of hospital chosen for delivery and other factors. Talk to your Rosemark obstetrician or certified nurse-midwife about your options.

When a VBAC is the chosen method of delivery the attempt to give birth vaginally is termed Trial of Labor after a Cesarean (TOLAC). It is, in fact, a trial of delivery which may quickly turn to a cesarean delivery in case of complications.

The benefits of a TOLAC:

• Lower Risk of Infection
• No Abdominal Surgery
• Shorter recovery period
• Less blood loss

Risk of a TOLAC

The most concerning risk of a TOLAC is the possible rupture of the cesarean scar on the uterus or the uterus itself. Although a rupture of the uterus is rare, it is very serious and may harm both the mother and baby. If a patient is considered to have a high risk of rupture of the uterus, a vaginal birth after a Cesarean will not be attempted.

Talk with your Rosemark Doctor or certified nurse-midwife about the type of delivery you would like to have and they will help you to understand the risks and benefits of your choices.