What is a Vaginal Childbirth?
A vaginal childbirth is a process in which a fetus is delivered through the vagina following the three stages of labor. Most women have their babies through their vagina - many women are very nervous about labor and delivery; especially if this is their first birth.
It's important to note that while many babies are born via Caesarean Section (also known as C-Section), any outcome in which both mother and baby come through healthy is what matters. Many women who have planned a vaginal birth and ended up with a C-Section feel as though they have failed - that is simply not true.
Read more about Cesarean Sections.
Vaginal birth is the result of a gestation period of nine months and three stages of labor: dilation and shortening of the cervix, descent and birth of the newborn, followed by the expulsion of the no-longer-needed placenta.
Giving birth to a child is a very unique and special experience, but it's important to note that no two deliveries are identical - even among siblings.
What Are The Types of Vaginal Birth?
There are four types of vaginal delivery.
- Spontaneous delivery (SVD) is the term for when delivery and birth happen without the aid of inducing medications or extraction tools.
- Assisted vaginal delivery (AVD) describes a vaginal birth that occurs with the assistance of instruments such as forceps or a vacuum extractor.
- Induced vaginal delivery (IVD) describes a vaginal birth that utilizes intravaginal or intravenous medication or other procedures such as artificial rupture of the membrane (breaking the water) to start labor.
- Vaginal birth after cesarean (VBAC) describes a vaginal birth that occurs subsequent to a birth by caesarean section.
Read more about cesarean section birth.
What Are The Signs of Impending Labor?
While many women - especially those who have been pregnant with more than one fetus, experience contractions during pregnancy (called "Braxton-Hicks Contractions"). For women who have not been through labor, it can be hard to ascertain precisely what is labor and what is not.
In short: labor feels like labor and nothing else.
Labor is accompanied by intense and prolonged periods of pain - the levels of pain may vary wildly and may have something to do with the anxiety levels of the mother as well as the associated fear of impending childbirth.
Early labor contractions are often described as the worst type of menstrual cramps.
Other signs of labor can include:
- Losing the mucous plug - during gestation, a plug of mucous is formed to protect the cervical opening from any infectious agents. During late pregnancy, as the cervix thins, many women will pass the mucous plug - which, is not plug-shaped, but appears more as bloody, stringy mucous.
- Lightening - Feeling the baby drop into the pelvis (which may feel as though you have a watermelon in your vagina) which allows for easier breathing and increased (ugh!) pressure on the bladder. Lightening happens to many women, however it's important to note that not every woman experiences the baby "dropping."
- Nesting - most pregnant women report being fatigued for much of their pregnancy. During the end of pregnancy, some women notice that they have a sudden spurt of energy - an urgency - that may cause them to want to go on a cleaning spree, go shopping, start cooking lots of meals. If you experience this "nesting" energy, be sure to stay hydrated.
- Cervical Effacement - also known as "thinning of the cervix" - is an indication that the cervix is (finally!) beginning to stretch and thin in preparation for birth. The healthcare professional often checks for this during the final months of pregnancy.
- Dilation of Cervix - Dilation of the cervix is measured in centimeters (but as the health care practitioner cannot put a ruler up into the vagina, cervical dilation is often counted by fingers). Dilation of the cervix ranges from 0-10 with 10 being the sign of ready to start pushing that baby out.
- Rupture of Membranes - While a common sign of impending labor, only about 1 in every 10 women experience the rupture of membranes. Women who do experience their water breaking often notice that it happens while she is lying down. Amniotic fluid is an odorless fluid and - if the membranes rupture - may trickle slowly or as gush of fluid. Once the membranes rupture, most healthcare professionals want to deliver the baby within 24 hours so that no infection can set in.
- Consistent Contractions - If contractions begin to feel consistent - even if they occur 20-30 minutes apart, a pregnant mother should begin timing them. Most health care providers ask that the pregnant mother waits until the contractions are 5 minutes apart before going to the hospital.
What Do Labor Contractions Feel Like?
While many women experience "Braxton Hicks Contractions," throughout pregnancy, labor contractions are a little different. There are many apps available to count contractions once it's suspected that you might be starting labor. Early labor feels like the strongest menstrual cramps you've experienced or a non-persistent backache.
If this is your first baby, it may be challenging to determine what is "real labor" and what is "false labor." Here are some characteristics of labor contractions:
- Labor contractions occur at regular intervals.
- Labor contractions have a particular pattern (such as ten minutes apart) while Braxton-Hicks contractions may occur sporadically and without a pattern.
- Labor contractions become increasingly longer
- Labor contractions become increasing closer together (from one every 10 minutes to one every eight minutes and so on).
- Labor contractions increase in intensity.
- Labor contractions do not stop with changes in activity or position.
- Labor contractions are felt in the lower back, radiating to the front.
What Are The Benefits of a Vaginal Delivery?
Vaginal birth tends to be the preferred method of childbirth (when conditions are favorable - like the baby is not breech, which generally necessitates a C-Section.) Here are some benefits of vaginal delivery.
- Lower risk of short and/or long-term respiratory issues for the baby
- Typically shorter recovery time for the mother
- Lower risk of neonatal trauma associated with delivery
- Feeling of control over birth experience
- Earlier mother-infant interaction
- Lower risk of maternal morbidity
What Are The Stages of Labor?
While no two labors are the same, labor is divided into three stages, and it is beneficial to the mother to know what these stages are and what to (generally) expect during labor, in order to reduce anxiety and fear associated with labor. The three stages of labor are:
Stages Of Childbirth: Stage I: the first stage of labor lasts from the onset of true labor until the cervix is dilated to a 10. This stage is the longest stage of childbirth and includes three separate phases of labor. Each phase of labor is characterized by differing emotions as well as physical changes.
- Early Labor Stage - the time that true labor begins until the cervix is dilated to 3 centimeters
- Active Labor Stage - the time it takes for the cervix to go from 3-7 centimeters.
- Transition Labor Stage - this is the time it takes for the cervix to go from 7-10 centimeters (fully dilated).
Stages of Childbirth: Stage II: Stage Two of childbirth involves the delivery of the baby.
Stages of Childbirth: Stage III: During stage three of childbirth is the time in which a woman - after giving birth to her baby - must deliver the placenta.
What to Expect During a Vaginal Delivery:
Each phase of labor has a different set of feelings, emotions, and challenges that are associated with the corresponding phase - it's important to note that no two labors are alike. Here are some tips associated with each phase of a vaginal birth.
Stages of Childbirth: Stage One:
1) Early Labor: In early labor, the cervix is beginning to open, or dilate, from 0-3 centimeters. The water may break or the mucus plug may be released. There may be a stringy, bloody discharge called the "bloody show." Contractions may be consistent and moderately strong, lasting up to several minutes at a time. Early labor can last from a few hours to several days.
- Take a bath
- Take a walk
- Practice relaxation techniques such as meditation
- Have a gentle massage
- Practice gentle stretching
- Use heat or ice on lower back
Tips For The Support Person:
- Offer to help the laboring woman take a walk.
- Remain a calming, soothing influence
- Reassure her that she's doing a great job.
- Talk to her about very simple things so she can focus on something other than contractions.
- Stay hydrated and fed - labor can last a long time!
What To Expect in Early Labor:
- Early labor typically lasts anywhere from 8-10 hours.
- Contractions can last between 30-45 seconds, which allows for up to thirty seconds of rest between contractions.
- The cervix will dilate to 3 centimeters.
- Contractions may start as mild and irregular but increase in strength and frequency.
- Rupture of Membranes
2) Active Labor - In active labor, the contractions increase in frequency and intensity and the cervix will dilate until it reaches 10 centimeters. Make certain to get to the hospital or birthing center during this phase of labor. Pain medication and/or anesthesia are often administered during this time, as the contractions grow in length, strength and occur more frequently.
Tips For Alleviating Anxiety and/or Pain During Active Labor:
- Ensure you have proper support surrounding you.
- Use the breathing exercises you've learned - breathe in through the nose and out through the mouth.
- Attempt to relax and rest between contractions.
- Switch positions as often as possible to achieve maximum comfort.
- Drink water or eat ice chips (if appropriate)
- Take a warm bath.
What To Expect During Active Labor:
- Active Labor may last up five hours, typically longer for first time mothers.
- Cervix will dilate from 4-7 centimeters
- Contractions will last up to sixty seconds followed by five minutes of rest between contractions.
- Contractions will be longer and more intense.
- This is the time women should head to the birthing center or hospital.
Tips for the Support Person During Active Labor:
- Encourage, motivate and support the laboring woman
- Help her remember her breathing techniques - do them with her.
- Remind her to change positions regularly.
- Attempt to distract her from the pain
- Don't become hurt if she ignores you - labor is a lot of work.
- Accompany on a walk, unless spinal block has been administered
- Assist in changing positions
- Help to make the new mom comfortable - rearrange pillows to increase comfort.
- Massage the abdomen and lower back of the mother
- Put a cool washcloth on forehead or feed ice chips if hospital staff gives the okay.
3) Transition Phase: during the transition stage of labor the cervix widens from 8-10 centimeters. The contractions come faster, are more painful and often seem to flow together. During this time there is often an increased desire to push and a heavy pressure in the lower abdomen.
What To Expect During Transition Phase of Labor:
- Emotions will be volatile - ranging from anger to sadness, and everywhere in between, thanks to all the hormones racing through the body.
- The transition period is the shortest, lasting a few minutes to up to two hours.
- Contractions will last about a minute to a minute-and-a-half with up to two minutes to rest between.
- Transition stage of labor is the hardest - and the shortest phase of labor.
- Mother-to-be may vomit, become gassy, have hot flashes, or chills.
Tips For The Support Person During Transition Labor Phase:
- Offer encouragement and praise - a simple "you can do this" can go a long way for someone who is in transition labor.
- Help remind her to breathe and use breathing techniques.
- Encourage relaxation between contractions
- Don't make small talk to her - she may throw you out of the room.
- Don't get upset if she's kinda...mean. Transition labor is FULL of emotions and hormones.
Stage II of Childbirth:
Stage II of Childbirth occurs after a mother is fully dilated to 10 centimeters and ready to push her baby out. Pushing the baby is typically done in conjunction with contractions. The healthcare provider advises on when and how long those pushes should be, often saying things like, "PUSSSSHHHH" which may or may not make you want to kick them in the head. Resist that urge
Occasionally, the baby's head gets stuck and the health care provider must use instruments - such as forceps or a vacuum extractor - to assist the baby's exit from the vagina. A mirror is often offered so that the mother can view the baby's emergence.
What to Expect During Stage II Childbirth:
- This stage of childbirth can last from minutes to hours.
- There may be an intense urge to bear down and push.
- There may be heavy pressure in the lower abdomen
- Most women (gulp) have a bowel movement during this stage of labor
- When the baby's head emerges, or "crowns," many mothers report a stinging, painful sensation.
- It's also likely that the attending will ask a woman to stop pushing while the baby is crowing.
What To Expect And Do While Pushing:
- Use gravity to your advantage while pushing.
- Push when the urge overtakes you.
- Rest and try to sleep (ha) between contractions.
- If you'd like, you may use a mirror to watch the baby emerge
- If you're using a mirror to mark your progress, don't be too upset if the baby's head emerges, then goes back into the vaginal canal.
- Throw ALL your energy into pushing.
Tips for The Support Person During Stage II Labor:
- Encourage the mother-to-be
- Make sure to look her in the eyes and tell her how proud of her you are.
- Help her to get into a comfortable position.
- If using stirrups for delivery, hold one of her legs and massage her shoulders.
- Tell her that she's doing great!
- Practice breathing with her during contractions.
- If she gets angry or mad, don't take offense - pushing out an infant is HARD work!
What is Baby Doing During Delivery?
While the mother is doing all of the pushing, the baby is doing plenty on his or her own:
- Baby will turn his or her head to one side, tucking chin to chest so the back of the head makes way out first.
- Baby's head will lead the way as he or she moves his or her torso to face your back when he or she goes through the vaginal canal.
- Baby's head "crowns" through the vaginal cavity.
What To Expect From Baby Immediately Post-Delivery:
Most babies aren't born ready to model. After soaking in a warm bath of amniotic fluid for nine months, then having to make his or her way through the vagina, well, that's enough to make for a goofy looking baby. Don't worry - that goes away. Here's what baby MAY look like after birth:
- Head may be shaped like a cone (especially if Baby was in the vaginal canal for a long time).
- Baby may be covered in a cheesy-white substance called "vernix caseosa," that helps Baby in the womb.
- Genitals may be overly-large. Swelling does tend to go down a few hours post-birth.
- Baby's eyes may be a bit puffy.
- Baby may be covered in a fine hair from shoulders to back to forehead, called "lanugo" hair.
After the baby has been delivered, it's typically placed on the mother's chest for bonding and skin to skin contact. During this time, the placenta will be delivered. It typically takes up to 30 minutes and usually does not cause any pain. Your healthcare provider may massage the abdomen and do any necessary repair work during this time. The healthcare provider will bathe the baby, check them over thoroughly and provide guidance and assistance with breast or bottle-feeding.
Third (and Final) Stage of Childbirth:
Third Stage of Childbirth occurs after the infant is born. After birth, the health care professional will begin to see when the uterus begins to contract again - a signal that the placenta is separating from the uterine wall.
What To Expect During Third Stage of Childbirth:
- Third stage of childbirth is the shortest and ranges from 2-30 minutes.
- While the contractions begin to signal that the uterus is getting ready to expel the placenta, the healthcare provider may gently massage the abdomen.
- The umbilical cord may also be tugged at, gently, to help remove it from the wall of the uterus.
- When the time is right, you will again push and deliver the placenta, or "afterbirth."
- Many women experience shaking and shivering following the delivery of the placenta - this may feel terrifying, but it's common.
- After delivery, the new mom will be monitored for bleeding.
Complications During Delivery:
Most deliveries are routine but, as with anything requiring medical supervision, complications are possible. Some of these complications may require a cesarean section.
- Excessive bleeding
- Rise in white blood cells, indicating an infection begun.
- Preterm labor - onset of labor prior to 37 weeks gestation
- Breech position - baby is positioned the wrong way - instead of head down, he or she is breech - or feet first
- Umbilical cord problems
- Tearing of vaginal and/or rectal tissue (which range on a scale of 1-4, with four being the most severe tearing)
- Blood clots
- Injury to the baby during delivery - while uncommon, this does happen.
Recovery from Vaginal Delivery:
Childbirth is a major event for both mother and baby. It takes time to get used to new roles and to heal - both physically and psychologically. It's important to heed the advice of the healthcare provider and to listen to the physical and emotional cues of the body. The following are some issues that may affect women postpartum.
- Vaginal soreness is extremely common due to the nature of the process and to any cutting and/tearing that occurred during delivery. Clean the wound after using the toilet with a squeeze bottle of warm water. Use ice packs, any creams provided by the doctor, witch hazel pads to provide comfort. Ask your healthcare provider which, if any, medications can be used.
- Elimination Issues - Swelling of the tissue around the vulva and/or the anus can make elimination extremely uncomfortable. Urine can sting the sutured area. Hemorrhoids can be painful or unpleasant. Icing the area and using witch hazel pads or hemorrhoid medication can help with pain, as can using a squeeze bottle of water while urinating. Incontinence typically resolves within a few months. Practicing Kegel exercises can help.
- Emotional Issues after delivery are very common (but often not discussed) due to the hormonal changes, lack of sleep and the pressures of new responsibilities. The "baby blues" are a natural response to becoming a new parent. The baby blues usually resolve on their own within a month. Having an outlet and someone to talk to about those feelings can help decrease the length and severity of symptoms.
- Postpartum Depression (PPD) has similar symptoms to the baby blues, but does not resolve on it's own or after a month's time. PPD is a serious, potentially life-threatening mood disorder. A new parent who has feelings of hopelessness, severe anxiety and/or panic attacks or a feeling of wanting to hurt themselves or others should speak to a qualified mental health professional. PPD is a real disorder that is both normal and very treatable through therapy and/or medication.
Read more about all postpartum mood disorders
Additional Vaginal Delivery Resources:
National Institute of Health's video tutorial on vaginal birth - actual presentation about childbirth.
Labor and Delivery - the US government's guide to childbirth.
March of Dimes - extensive lists of what to expect with a vaginal delivery, how to cope with the pain of a vaginal delivery and other in depth discussions of vaginal delivery.