Types of Birth

With advances in medical technology, birthing of a baby has become safer and more an organized experience today. As an expecting parent, it is good to know the different types of birth for a better awareness of the labor and delivery process.

Last Updated: 22 October 2020

Types of Birth
Types of Birth

The most natural childbirth is the vaginal delivery without any assistance. However, owing to the unpredictability of how a vaginal birth will proceed and research studies on childbirth, different childbirth types are now in practice. Here’s a brief list of the various birthing options available:

·         Natural Birth or Vaginal Delivery

·         Assisted Vaginal Birth

·         Caesarean Delivery (C-Section)

·         Vaginal Birth After Caesarean (VBAC)

·         Alternative Birthing Methods

Natural Birth or Vaginal Delivery

Vaginal birth is the passage of the baby through the birth canal. In general, vaginal birth occurs anytime between 38-41 weeks of pregnancy.

Natural birth has three distinct stages of labor:

1.       In the first stage, labor contractions begin in the pregnant mother which can last for a few hours or a day. Read the signs of labor here. With increasing contractions, cervical effacement and dilation happens in order to make way for the baby to pass through.

2.       The second stage of vaginal delivery involves active effort by the mother to push the baby out of the birth canal through the vagina. Under normal circumstances, the head of the baby is pushed through first followed by the rest of the body.

3.       In the third stage, the placenta that nourished the baby throughout pregnancy is pushed out, marking the end of the delivery.  

Until a few decades ago, natural childbirth occurred at home with the assistance of a midwife or a doula. However, by 1969, birthing care and facilities provided at hospitals and birthing centers have replaced 99% of home birthing.

Assisted Vaginal Birth

Natural birth is not devoid of complications. Assisted vaginal birth methods help to manage the impending complications during vaginal delivery.

Here are the most common assisted procedures during natural labor and vaginal birth:

1.       Membrane Sweep

When pregnancy has reached its full term, that is, 40 weeks, natural labor is expected to begin. However, only 5% of full term pregnancies deliver a baby. A few days past the due date should not be a concern, provided the doctor has examined the health of the mother and the baby through fetal stress test.

But, when there is no sign of labor onset in the late 40th week, membrane sweep might be done as a first step to stimulate labor manually. The procedure is usually carried out during a regular antenatal appointment. A doctor or a midwife will insert a finger through the vagina, into the opening of the cervix and make a firm but gentle circular, sweeping movement with the finger. This would separate the membranes of the amniotic sac which is pressed against the cervix.

Membrane sweep can be repeated at 41 weeks before proceeding with other methods of labor induction.

2.       Labor Induction

Pregnancy conditions like gestational diabetes, past the due date or no contractions after water breaking may require induction of labor. Here are some quick facts about how an induction is likely to progress:

·         If your cervix isn’t dilated or ‘ripened’ yet, prostaglandins will be administered through the vagina. This will induce cervical ripening and labor contractions.

·         If your body does not respond to prostaglandins or if your cervix is already dilated and thinned-out, Pitocin (a drug that contains oxytocin) will be administered intravenously to induce labor.

·         If contractions have started but labor doesn’t progress, your doctor may perform Artificial Rupture of Membranes (AROM), a manual breaking of the amniotic sac.

Labor induction can be a planned intervention in some cases while it might as well be needed as an unplanned intervention during labor.

3.       Epidural

An epidural is a local anesthetic administered to a pregnant mother during labor in order to ease the pain in the lower part of the body. On an epidural, one will still be awake and alert to proceed with the normal birthing process. An epidural is given as an injection of an anesthetic dose on the lower back. You will sit with a slight forward bend or lie on your side with your legs curled towards your inside. The anesthesiologist will then insert the needle on the lower spine, into what’s called the epidural space, outside the spinal cord and spinal fluid. Followed by the needle, a catheter will be passed through after which the needle is removed.

The medication will continue to pass through the catheter during the delivery. It may take anywhere between 10 to 30 minutes for the anesthetic to take its full effect. You will start to feel the loss of sensation in the lower part of your body but you will still be able to feel your contractions without the pain associated with it, helping you to push the baby.

4.       Episiotomy

If the vaginal opening isn’t expanding enough to let the baby’s head pass through during childbirth, episiotomy might be performed. Episiotomy is a surgical incision made on the skin in between the vagina and the anus (the area called as perineum). Local anesthesia might be administered before episiotomy is done.

5.       Forceps Delivery

If it becomes hard to push the baby’s head through the birth canal during delivery, the doctor might opt to assist the delivery of the baby’s head gently using forceps.

6.       Vacuum Extraction

If the mother’s pushing efforts don’t provide adequate force to push the baby or for other reasons, external force using a vacuum pump might be used. A vacuum extractor is placed on the baby’s head and using vacuum pressure, the baby’s head is pulled out gently.

Caesarean Delivery (C-Section)

Although every pregnant woman would wish for a short, not-too-painful and uncomplicated childbirth experience, especially a vaginal delivery, sometimes caesarean section might become necessary. A C-section could either be pre-planned or decided on an emergency after labor begins and is one of the most important types of birth, next to vaginal birth.

Here are a few situations when C-section delivery is scheduled:

·         The baby is in breech; that is, instead of the expected head-down position, baby is in the bottoms-down or feet-down position.

·         You are carrying more than one baby, like in the case of carrying twins or triplets.

·         You previously had a uterine surgery, like a C-section for your first baby.

·         If there is a problem with the position of the placenta – in rare cases, placenta might cover the cervix (called placenta previa).

·         If you or the baby had been diagnosed with any medical complications - that might pose a risk during vaginal birth.

Below are a few reasons why emergency C-sections are done:

·         Labor contractions aren’t getting intense as expected and pain or induction medicines aren’t working on your body.

·         Baby’s heart rate becomes abnormal or any condition that signals a fetal distress.

·         Baby has already released meconium out while still in the womb. This poses a risk of baby breathing it into the lungs or choking the throat.

·         Complications that can arise out of umbilical cord issues, like wrapping the baby around in a dangerous angle or umbilical cord prolapse (blocking the birth canal before the baby can pass through).

Vaginal Birth After Caesarean (VBAC)

Vaginal birth after caesarean (VBAC) is the vaginal birth of subsequent deliveries after the first or second delivery through C-section. Earlier, the fact that C-section deliveries involved surgical opening of the abdominal region, trying for a vaginal delivery with the subsequent pregnancy made it one of the least preferred types of birth. However, today, many doctors and hospitals encourage pregnant mothers to undergo VBAC provided certain health conditions are met by the pregnant mother. A few are:

·         The prior C-section delivery was done by a low transverse incision and not by a high vertical incision.

·         The pregnant mother has not had other types of uterine complications or surgery like removal of fibroid.

·         More than 18 months has elapsed post the prior C-section delivery.

·         The pregnant mother has never had a uterine rupture before.

·         The pregnant mother has had no history of pregnancy complications like preeclampsia and maternal obesity.

Alternative Birthing Methods

Today childbirth types are not limited to vaginal delivery and C-section alone. Here are some alternative birthing methods:

1.       Water Birth

Water birth can happen either at a birthing center or from the comfort of your home and must be assisted by an experienced doula, midwife or doctor. During labor, you’ll be seated comfortably with belly immersed and legs stretched inside a huge tub or pool of warm water. Rejuvenating salts like Epsom salts may be added to the water to make the experience more soothing. Some women prefer to stay in the water only during labor and change to the traditional birthing way while some others continue both labor and birthing inside water.

The health of the pregnant mother and the growing fetus must be in favor, in order to consider water birthing. Some of the conditions that are mandatory for water birth are:

·         You are at least 37 weeks pregnant

·         Your baby is in head-down position when labor begins

·         You do not carry any risks for infection

·         You had a normal pregnancy with no serious complications

·         Your baby shows no signs of fetal distress

 2.       Hypnosis

Childbirth through hypnosis uses hypnotic tools and techniques such as audio guidance, visualization, meditation and relaxation to deliver the baby. Research shows that pregnant mothers trained in hypnosis methods have successfully delivered babies without other interventions. It must be noted that hypnosis method of childbirth needs proper preparation and practice throughout pregnancy and cannot work at the time of labor.

3.       Acupuncture and Acupressure

The techniques of acupuncture and acupressure, that is, stimulating certain nerve points in the body using needles or finger pressure respectively, have helped to manage labor pain during delivery, though the two remain one of the least practiced types of birth.

 

References

1.       Spontaneous Vaginal Delivery. Healthline. https://www.healthline.com/health/pregnancy/spontaneous-vaginal-delivery#1

2.       Assisted Delivery. American Pregnancy Association.

https://americanpregnancy.org/labor-and-birth/assisted-delivery/

3.       C-section. Mayo Clinic.

https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655

4.       VBAC. Mayo Clinic.

https://www.mayoclinic.org/tests-procedures/vbac/about/pac-20395249

5.       Water Birth. Healthline.

https://www.healthline.com/health/pregnancy/water-birth

6.       Hypnosis for pain management during labour and childbirth. https://www.cochrane.org/CD009356/PREG_hypnosis-pain-ma

 

7.       Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour. BMJ Journals. http://bmjopen.bmj.com/content/6/7/e010691

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