Natural Birth

The ultimate experience of womanhood and the aspiration of the majority of couples attending the practice. Pregnancy and birth are physiological conditions and the female body is awesomely capable and superbly adapted to take on the challenge! Route of delivery is a pressing question and one I am often faced with early in our journey together. There is only one answer: Natural until proven otherwise! ...and in normal conditions this proof is only tested after 36 weeks gestation.

There are many, many variables involved in the process, the genetics of the unborn child, it's spacial orientation and the ultimate dimensions of the pelvis to name but a few. Accepting that all is in place for natural birth at 37 weeks, the waiting game commences. Labour is heralded by one of 3 things:

Labour is divided into 3 stages:

The first stage is divided into a latent and active phase.

Latent phase commences with the onset of contractions or rupture of membranes (whichever occurs first) and is characterised by effacement or thinning of the cervix. It is generally considered to be over when the cervix is fully effaced and 4 cm open. An enema may be offered or advised at this stage and various forms of pain relief are available ) A hot bath is always the first method).

Active phase occurs from 4 cm to fully dilated (10cm). This phase progresses at a minimum of 1 cm per hour in the first -timer to 1,5 cm per hour for the experienced. There is then a transition period as the head descends into the pelvis

Second stage labour is when the work starts! This is the active pushing phase! The technique of pushing is extremely important, however your midwife and I will help with on-the-job training, so no need to stress too much if you feel your unprepared! Basically its a pneumatic process...requiring air pressure ...this the closure or the vocal cords on a full breath of air and a big push as as though you are seriously constipated!

The head undergoes flexion and internal rotation the extension and external rotation at delivery. This correction process is necessary to allow the shoulders also to conform to the shape of the pelvis and all you have to do in this phase is listen to the instructions and execute them on request! At the end of the second stage, the baby is lifted onto your tummy and when it stops pulsating, the cord is clamped and the partner is requested to perform the ceremonial cut. Suctioning of the babies mouth and nose is rarely conducted and then only with good reason.

The third stage comprises the delivery of the placenta and contraction of the uterus. Any tears of the perineum may be sutured at this stage. A certain amount of blood loss is inevitable, however without correct management of this stage, this can be considerable and rapid. The stage lasts the first 24 hours after birth where monitoring remains appropriate.

If your birth is conducted at hospital you will remain overnight. Most medical aids fund 2 nights, which is especially helpful if junior fails to get to grips with breastfeeding 101!

A great resource is for a more detailed description.

Dr Douglas Seton, Obestetrician & Gynaecologist Knysna © 2021

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