Normal delivery

by Dr Anshu Verma Clinical Nutritionist

Normal labor is spontaneous expulsion of single mature alive fetus through birth canal (natural passage) in vertex position within a reasonable period of time, without any maternal or fetal complications. The mother usually has completed 37 to 42 wks of pregnancy. Onset of labor is determined by regular, painful contractions of uterus that result in progressive cervical dilatation and effacement.

Normal delivery Stages

Ø 1st stage of labor: It begins with regular contractions of uterus and ends with complete dilatation of cervix at 10 cm.
Ø 2nd stage of labor: It begins with complete dilatation of cervix and ends with fetus delivery.
Ø 3rd stage of labor: It is the duration between fetus delivery and delivery of fetal membranes and placenta.

Symptoms and Signs of Normal delivery

Labor can start even 3 wks prior to or 2 wks after due date.

Lightening: It takes place when baby’s head drops into pelvis during preparation for delivery.
The belly looks lower and the mother finds it easier to breathe because the baby does not crowd the lungs any more. There may be increased frequency of urination as the baby presses on the bladder.
Bloody show: A brownish or blood tinged discharge takes place from the cervix. A mucus plug seals the mouth of the womb during pregnancy to prevent infection. It is released during this period which causes the discharge.
Diarrhea: Increased frequency of loose stools can indicate labor is imminent.
Ruptured membranes: Fluid gushing or fluid leakage from vagina indicates the membranes of amniotic sac which surrounds and protects the baby have been ruptured. It can take place few hrs prior to onset of labor or during labor. After this, most of the women go into labor within period of 24 hrs.
If there is no natural occurrence of labor during this time period, doctors may need to induce labor artificially for preventing infections and complications during delivery.
Contractions
Contractions which take place at less than 10 minutes intervals usually indicate that labor has started.

Complications of Normal delivery

Labor complications

Ø Mal presentation of fetus i.e. breech birth

Ø The fetal head fails to descent

Ø poor uterine contraction

Ø shoulder dystocia

Ø CPD - cephalo-pelvic disproportion

Maternal complications

Ø Vaginal birth injury

Ø Infection in uterus

Ø Pelvic girdle pain

Ø heavy bleeding

Fetal complications

Ø Neonatal infection

Ø Mechanical fetal injury

Ø Neonatal death

Ø Intra partum asphyxia

Management of stages of labor

Ø 2-hourly temperature, pulse and blood pressure must be measured
Ø Fetal heart rate and contractions must be monitored.
Ø Descent of fetal head and cervical dilatation must be assessed after every 4 hrs.
Ø Position of fetal head with regard to pelvis of mother must be assessed.

Second stage management

Ø Make sure that a doctor or midwife is present besides the mother all times during labor that encourages pushing during contractions and advises to relax in between contractions.

Ø Contractions to be monitored. FHR must be measured after every 5 min

Ø 'Hands on' - pressure is placed on head of the baby and perineum must be supported.

Ø Position during 2nd stage of labor: generally lithotomic

Third stage management

Ø Expectant management (traditional): After the placenta lies in vagina, a contraction must be produced by rubbing the uterus and pushing it towards the vagina. This helps to expel the placenta and membranes.

Ø Active: Synthetic oxytocin to be administered intramuscularly at appearance of head of fetus.

Ø The umbilical cord to be clamped and it should be cut soon post delivery. Then the placenta expels out.

Home remedies and care

Be active, stretching exercises; help to open the pelvis for delivery, Walk regularly, Practice meditation, Warm water shower to be taken before going to bed, Drink plenty of fluids to avoid dehydration, Eat nutritious food and diet rich in iron and folic acid etc