Understanding of Normal Childbirth that You Must Know

Understanding Normal Childbirth

Normal delivery is a term for mothers who give birth to babies vaginally. A pregnant woman will undergo this process when the fetus she is carrying is ready to be born. The normal birth process generally occurs between the 37th and 42nd weeks. The stages of normal childbirth begin with contractions of the uterine muscles, followed by the gradual opening of the cervix. After that, the mother’s pelvic muscles will push the baby and placenta out through the vagina.

Signs of Imminent Childbirth

During a pregnancy check-up, the obstetrician or midwife will tell you the estimated date of delivery, but the estimated date may be advanced or delayed by around 2 weeks. Therefore, it is very important for mothers to know the signs that they will feel when the fetus is about to be born, namely as follows:

1. The urge to urinate increases.
   Increased urge to urinate due to the fetus pressing on the bladder. Apart from urinating, mothers can also defecate more frequently or even experience frequent diarrhea.
2. Mucus comes out.
   The discharge of mucus mixed with blood from the vagina indicates that the cervix has begun to open.
3. Breathing becomes lighter.
   This occurs because the fetal head begins to descend into the pelvic cavity, thereby reducing pressure on the lungs.
4. Pain in the lower back that comes and goes.
   Back pain can appear alone or along with contractions, and can be accompanied by a sensation of looseness in the joints, especially in the pelvic area.
5. Muscle contraction.
   Uterine muscle contractions can occur periodically every 10 minutes. These contractions can be described as a feeling of tightening in the uterus or like cramps during menstruation with intensity and frequency increasing closer to the time of delivery.
6. Amniotic fluid comes out.
   The discharge of amniotic fluid occurs due to rupture of the protective membranes of the fetus. After the amniotic fluid comes out, the fetus must be removed no later than 24 hours.

Before deciding to give birth naturally, pregnant women must first know the following things:

• Labor induction
  The normal birthing process can be disrupted. If this disorder occurs, the doctor or midwife will induce labor (accelerate the labor process), for example by tearing the amniotic sac, administering contraction-strengthening medication, carrying out an assisted birth, or carrying out a caesarean section.
  Some conditions that require labor induction are:

1. 1. Pregnant women suffer from preeclampsia and diabetes.
   2. Gestational age more than 41 weeks.
   3. Fetal growth slows down.
   4. The labor process took too long.
   5. Fetal distress.

• Monitoring during labor
  In some conditions, the baby’s heart rate and the strength of the mother’s contractions will continue to be monitored by the doctor or midwife during the birth process. Some of these conditions are:
  1. Pregnant women suffer from diabetes, high blood pressure, or are overweight.
  2. The pregnant woman has had a caesarean section before.
  3. Pregnant women receive epidural anesthesia or contraction strengthening drugs.
  4. The baby to be born is thought to be very small.
  5. The babies will be born as twins.
  6. The labor process was very slow.
• Normal delivery after cesarean section
  It is important to know that giving bLearn about the process and stages of normal childbirth from the beginning of pregnancy, for example by taking childbirth and pregnancy exercise classes, or by asking women who have given birth. Also learn the signs of labor, breathing techniques, and pushing.irth normally after a previous delivery via caesarean section (VBAC) is generally safe. However, based on research, 1 in 200 pregnant women who undergo VBAC are at risk of experiencing uterine tearing. Therefore, discuss it first with your obstetrician if the pregnant woman previously underwent a caesarean section and now wants to give birth normally.

Preparation Before Normal Childbirth

So that the birth process goes smoothly, do the following things before the time of delivery approaches:

1. Look for the right obstetrician, midwife and pediatrician.
2. Learn about the process and stages of normal childbirth from the beginning of pregnancy, for example by taking childbirth and pregnancy exercise classes, or by asking women who have given birth. Also learn the signs of labor, breathing techniques, and pushing.
3. Prepare mentally, for example with meditation or relaxation techniques. This is useful to help you during the birthing process as well as to face the possibilities that could occur if you cannot give birth normally, for example if you have to have a caesarean section.
4. Eat balanced nutritious food to prevent excess weight. Being overweight during pregnancy risks causing excess fetal weight and complicating the birthing process.
5. Prepare the baby’s needs, such as clothes, diapers and milk bottles. Also prepare other necessities for the mother, for example a nursing bra. Put these items in one bag, so that when signs of labor appear, the mother just has to carry the bag.

Mother’s Preparation for Childbirth

1. Physiological preparation.
   Activities that make it easier for mothers to ensure that labor goes smoothly are doing pregnancy exercises, walking, light exercise, because by doing these activities the muscles and body parts that will later play a role in the birth process such as the pelvic bones, abdominal muscles, so that they can regulate breathing, relaxation and flexibility.
2. Psychological Preparation.
   Mothers can control excessive anxiety and fear about the birth process, and are encouraged to learn how to actually prepare for birth. By knowing this, the mother will be further prepared, followed by worship and prayer so that the birth can go smoothly.
3. Social Preparation.
   Things that must be considered in social preparation are the social environment, economic conditions, standard of living and culture related to the prospective mother who is about to give birth, for example, malnutrition will result in IUGR during pregnancy and a dirty environment will result in poor personal hygiene.
4. Cultural Preparation.
   As a mother, you must know local customs or customs, you must know which habits are good for pregnancy, and try to avoid these habits.
5. Preparation for Maternity Savings
   The existence of savings for maternity mothers really helps the community, because this program is very effective and appropriate in improving the health of the community, especially mothers giving birth, and families do not feel burdened by the cost of giving birth. As health workers who will help with the birth process, they must explain to pregnant women how important the benefits of tabulin are. so that mothers have the awareness to pay for it, Tabulin is usually formed based on RW or Posyandu.
6. Emergency Preparation
   The preparations that must be considered when making a referral are as follows:

1. 1. (Midwife): Make sure the client is accompanied by competent health workers who have the ability to carry out emergency emergencies
   2. (Equipment): Bring the necessary equipment and materials such as syringes, infusion sets, blood pressure monitors and stethoscopes.
   3. (Family): Tell the family about the mother’s latest condition and the reason why she was referred. The husband and other family members must take the mother to the referral place.
   4. (Letter): Give a letter to the referral place containing the mother’s identification, the reason for the referral, a description of the results of the referral, the care or medication the mother has received.
   5. (Medicine): Bring essential medicines needed during the referral trip.
   6. (Vehicle): Prepare a vehicle that is good enough to enable the mother to be in a comfortable condition and can reach the referral place quickly.
   7. (Money): Remind families to bring sufficient money to buy necessary medicines and health materials at the referral point.
   8. (Blood): Prepare blood (blood donor) for any time you need a blood transfusion if bleeding occurs.

Stages of Normal Childbirth

The stages before normal delivery in the medical world go through several phases, namely as follows:

Stage 1 (Opening stage).
This stage is divided into 3 phases, namely the initial (latent) phase, the active phase and the transition phase. The explanation is as follows:

1. 1. Latent phase.
      The latent phase lasts 8–12 hours. This phase is characterized by light contractions lasting 30–45 seconds, every 5–30 minutes. These contractions then gradually become more frequent and increase in intensity. In the latent phase, the cervix will gradually open 3–4 cm. In this phase, pregnant women are advised to remain calm and do not need to rush to the hospital. Mothers can still do light activities at home, but still maintain the required nutritional intake and note the contractions that occur.
   2. Active phase.
      The active phase lasts 3–5 hours, but can be longer in first-time mothers. Contractions in this phase last for 45–60 seconds, every 3–5 minutes. In the active phase, the cervix opens approximately 4–7 cm. Pregnant women who have entered the active phase are advised to go to the hospital immediately. The doctor will measure the pregnant woman’s blood pressure, pulse and body temperature, and check the fetus’ heartbeat. The doctor will also perform a pelvic examination, to find out the extent of the contraction process.
   3. Transition phase.
      The transition phase lasts approximately 30 minutes to 2 hours. Contractions in this phase feel strong and continuous, and cause unbearable pain. In the transition phase, the cervix will open 8–10 cm. Please note, in this phase there will be an urge to push the fetus to come out quickly. However, do not do this before being asked by a doctor or midwife. Pushing the fetus before the cervix is ​​completely open can cause the cervix to swell and slow down the labor process.

Stage 2 (Normal labor process)
The normal labor process is also called the second stage, which is when the cervix has opened completely by 10 cm. The second stage of labor can last 2 hours or more. Contractions at this stage last around 60–90 seconds and subside every 2–5 minutes. Every time a contraction appears, the mother will feel a strong urge to push. But remember, pushing should only be done when asked by a doctor or midwife.

Normally, the baby will push every time a contraction occurs. However, if the fetus does not descend, the doctor will advise the mother to change position to squatting, sitting, or kneeling. If the contractions are not strong enough, the doctor will give medicine to strengthen the contractions. During the contraction and pushing process, the baby’s head will begin to appear from the vagina. At this stage, the vagina and perineum, namely the area between the vagina and anus, will be very stretched, causing burning pain.

To speed up the labor process and prevent the perineum from tearing, the doctor will perform an episiotomy, namely by cutting a small part of the perineum. The doctor will stitch the perineum back together after labor is complete. After the baby’s head comes out completely, the doctor will suck blood, mucus and amniotic fluid from the baby’s mouth and nose with a special tool. At this stage, the mother is advised to keep pushing to expel the baby’s entire body. Once the baby’s entire body is out, the doctor will hand the baby over to the mother. Apart from ensuring that a strong bond is established between mother and baby, it is also important to initiate early breastfeeding. After that, the doctor will cut the baby’s umbilical cord.

Contraindications for Normal Childbirth

Every pregnant woman has the possibility of undergoing a normal delivery. However, normal delivery is not recommended if the following conditions occur:

1. Umbilical cord prolapse. Umbilical cord prolapse is a condition where the umbilical cord covers the baby’s birth canal. As a result, the umbilical cord can be compressed, causing the baby to lack oxygen.
2. Fetal malpresentation. Fetal malpresentation or abnormal fetal position is a condition when the part of the fetus’s body that is facing the cervical opening is other than the top of the head (fontanel).
   Types of fetal position abnormalities that are not recommended for normal delivery include:

• • Occiput posterior, namely the position of the fetus’ head in the birth canal, but the fetus’ face looks up to the mother’s stomach.
  • Facial presentation, namely the position of the fetus’ face directly facing the cervix.
  • Eyebrow presentation, namely the position of the fetus’s head slightly raised, so that the fetus’s eyebrows are directly facing the cervix.
  • Breech position, where the fetus’ legs or buttocks are directly facing the cervix.
  • Latitudinal position, namely the transverse or horizontal position of the fetus in the uterus, with the fetus’ shoulders directly facing the cervix.

2. Twin pregnancy. Twin pregnancies that do not allow for normal delivery are when both fetuses are in a breech position, conjoined twins, contained within one amniotic membrane, or multiple pregnancies with more than two fetuses.
3. Have had a caesarean section. Although in most cases it is considered safe, giving birth normally after undergoing a caesarean section in a previous delivery can cause serious complications, such as a torn uterus (uterine rupture). Meanwhile, mothers who have had a caesarean section more than twice, have a history of placenta previa, or have a longitudinal scar on the uterus due to a previous caesarean section, are not allowed to give birth normally.
4. The fetal heart rate is unstable. This condition can be a sign that the fetus is experiencing hypoxia or low oxygen levels in the body. Several conditions that can cause hypoxia in the fetus are detachment of the placenta from the uterus before delivery (placental abruption) or the fetus being entangled in the umbilical cord.
5. Placental abnormalities. Abnormalities in the location of the placenta, including the placenta covering the birth canal (placenta previa) or the placenta attaching to the uterine muscle (placenta accreta), do not allow for normal delivery.
6. Macrosomia. Macrosomia is a fetal body weight that exceeds 4–4.5 kg. This condition carries the risk of causing the fetus’ shoulders to become pinched (shoulder dystocia) if it undergoes a normal delivery process.
7. Genital herpes infection. Pregnant women infected with genital herpes are not advised to give birth normally, to reduce the risk of transmitting herpes to the baby.

Complications of Normal Childbirth

Most normal births take place without problems. However, sometimes complications can occur, either before, during or after the normal birth process.
Some complications that may occur are as follows:

1. Premature rupture of membranes
   Premature rupture of membranes that is not followed by labor 6–12 hours later can increase the risk of infection for both the mother and fetus.
2. Premature birth
   Being born prematurely or sooner than expected can be dangerous for the baby, because the function and growth of the organs are not yet perfect.
3. Postmature pregnancy
   Postmature pregnancy is a condition where the fetus has not been born after the gestational age reaches 42 weeks or more. This condition can harm the fetus, because the placenta is no longer able to provide adequate nutrition to the fetus.
4. Postpartum hemorrhage
   Postpartum hemorrhage is heavy bleeding that occurs after childbirth. This can occur due to uterine tearing or weak uterine contractions after giving birth.
5. Amniotic fluid embolism
   Amniotic fluid embolism is a condition when amniotic fluid enters the mother’s blood vessels and blocks the pulmonary arteries. This complication is the most dangerous problem, both during normal delivery and during caesarean section. However, this complication rarely occurs if the birth process goes smoothly.

For pregnant women who experience the conditions above, doctors can induce labor (acceleration of the birthing process), delivery can be via caesarean section.

Apart from the conditions above, there are also several other complications that are more dangerous and require immediate treatment, namely:

1. Preeclampsia, which is characterized by complaints of headaches, vomiting and sudden visual disturbances.
2. Infection, which can be characterized by fever and abdominal pain.
3. Pulmonary embolism, which can be characterized by chest pain and shortness of breath.
4. Deep vein thrombosis (DVT), which is characterized by pain and swelling in the calf muscles.