The term delivery refers to the process of birth that occurs at the end of a pregnancy. After an average of 266 days, the fetus leaves the maternal body. The natural birth process can be divided into four stages.
What is childbirth?
The term delivery refers to the process of birth that occurs at the end of a pregnancy. Childbirth can last several hours and shows a phasic progression. For a woman giving birth for the first time, it is considered to take about thirteen hours. For women who are already mothers, the average birth takes eight hours. The birth begins with the opening phase, followed by the transition and expulsion phase and finally the postpartum phase. Most deliveries in Germany take place in a delivery room in a hospital. It is also possible to give birth in a birth center or at home. In most cases, a birth proceeds without complications. Medical intervention, for example, with medication, emperor or perineal incision is rarely necessary.
Function and task
Human birth starts with the opening phase. Irregular contractions appear. These initial contractions, which occur about two to three times every half hour, cause the cervix to shorten and the cervix to dilate. If the water has not broken before the opening stage, it will do so now. The frequency of contractions increases as they progress until there are then about two to three contractions within 10 minutes, with one contraction lasting about one minute. Already in the opening phase, the baby is pushed down toward the pelvis. The last third of the opening phase is called the transition phase. The contractions now come more frequently and are accompanied by more intense pain. In the transitional phase, the baby also turns so that its face is directed toward the coccyx. When the cervix opens sufficiently, about eight to ten centimeters, the actual birth begins, i.e. the expulsion phase – as it is somewhat insensitively called. The contractions are now very strong and come irregularly. The so-called pressing urge is now triggered in the woman. This is caused by the pressure of the baby’s head on the mother’s intestine. The woman supports the birth process with her uterine and abdominal muscles due to this pressing urge. The contractions may be accompanied by nausea. After a few contractions, the baby’s head pushes through the birth canal and finally emerges. Now the baby turns 90°C again so that the rest of the body can follow without any problems. In the postpartum period, the delivery of the placenta and the amniotic sac takes place. This is followed by a check to ensure that the afterbirth is complete, because residual placenta left in the uterus could cause postpartum hemorrhage or infection. If parts of the afterbirth are missing, a scraping is therefore performed. After the afterbirth, the child is cared for and can usually immediately go to the mother for the first contact. This is important for the so-called bonding, i.e. the bond between mother and child. Any perineal tears that may have occurred during the birth are then cared for or, if necessary, sutured.
Illnesses and complaints
Even if delivery usually occurs naturally without problems, complications can occur. Risk factors that may make natural childbirth impossible include miscarriage or stillbirth in previous pregnancies, twin and multiple pregnancies, diabetes in the pregnant woman, rhesus incompatibility, and early (under 18 years of age) or late (over 35 years of age) childbearing. Drug, alcohol and cigarette use can also lead to complications before and during delivery. The most common life-threatening complication during childbirth is thrombosis with subsequent embolism. Here, overweight women and women with high blood pressure are particularly at risk: If the blood clot formed in the leg veins during thrombosis travels to the lungs, heart failure can result. However, an embolism can not only be caused by a blood clot; amniotic fluid can also enter the woman’s bloodstream and then lead to a so-called amniotic fluid embolism in the lungs. After a surgical delivery, the risk of amniotic fluid embolism increases. Bleeding also poses a risk during delivery. In rare cases, heavy bleeding occurs when the placenta detaches.The risk of hemorrhage increases when twins are born or when very large children are born. If bleeding continues for a long time, there is a risk of circulatory failure. In severe cases, the uterus may even have to be removed. If blood pressure was already elevated during pregnancy, a blood pressure crisis can occur during delivery, with severely elevated blood pressure values. This is also known as gestosis. This is accompanied by nausea, vomiting or even seizures. Gestosis can be life-threatening due to complications such as a stroke, a heart attack or a rupture of the skin artery with a risk of bleeding. If bacteria or other pathogens enter the mother’s body after or during the birth process, puerperal fever (also known as childbed fever) can develop. This is sepsis, or blood poisoning, with type A streptococci. Puerperal fever presents with rather nonspecific symptoms such as high fever, aching limbs, and fatigue. If left untreated, the infection leads to shock and subsequent death. A dangerous complication for the child is umbilical cord entanglement. This is when the umbilical cord wraps around the baby’s neck during the birth process. There is a risk of strangulation with deficient supply to the brain. The result can be a severe physical and/or mental disability of the child. Incorrect or absent rotation of the child can also lead to difficulties during delivery. The wrong position can lead to delays in the birth process or even to a birth arrest. In the event of an obstructed labor, a cesarean section is required to deliver the baby in good health.
