Medical Questions » Pregnancy Questions » Question No. 805
Question:I am well into my pregnancy, and keep hearing all these horror stories about childbirth. What really happens? Is it really terrible for the woman? Can you just be knocked out with an anaesthetic?
Answer:No, things are not that bad. Although I am a male doctor, I have delivered over 300 babies, and so have reasonable experience of observing women in the last stages of pregnancy and labour. I will do my best to describe what happens. In the last few weeks you waddle around uncomfortably. Every few hours you have Branxton-Hicks contractions that can be quite uncomfortable and sometimes wake you at night, but they always fade away. Your back aches, and you are going to the toilet ever}' hour because your bladder has nowhere to expand. One day you notice that you have lost some blood-stained fluid through the vagina, and the contractions are worse than usual. You have passed the mucus plug that seals the cervix during pregnancy, and if a lot of fluid is lost, you may have ruptured the membranes around the baby as well. Labour should start very soon after this ' show' . Shortly afterwards you can feel the first contraction. It passes quickly, but every ten to fifteen minutes more contractions occur. Most are mild, but some make you stop in your rracks for a few seconds. They are rather like the cramping pains you may have with a heavy period. When you find that two contractions have occurred only five to seven minutes apart, it is time to be taken to hospital or the birthing centre. You are now in the first of the three stages of labour. This stage will last for about 12 hours with a first pregnancy, but will be much shorter (4 to 8 hours) with subsequent pregnancies. These times can vary significantly from one woman to another. Once you arrive at hospital, you change into a nightie and answer questions. Soon afterwards, you may be given an enema. By the time the obstetrician calls in to see how you are progressing, the contractions may be occurring every three or four minures. The obstetrician examines you internally ro check how far the cervix (the opening into the womb) has opened. This check will be performed several times during labour, and leads may be attached through the vagina to the baby' s head to monitor its heart and general condition. The cervix steadily opens until it merges with the walls of the uterus. A fully dilated cervix is about 10 cm in diameter, and you may hear the doctors and nurses discussing the cervix dilation and measurement. As the labour progresses, you are moved into the delivery room. In a typical hospital delivery room, white drapes hide bulky pieces of equipment, there are large lights on the ceiling, shiny sinks on one wall, and often a cheerful baby poster above them. The contractions become steadily more intense. If the pain in your abdomen doesn' t attack you, the backache does, and your partner (who has hopefully attended one or two of your antenatal classes) should massage your back between pains. The breathing exercises you were taught at the antenatal classes should prove remarkably effective in helping you with the more severe contractions. Even so, the combined backache and sharp stabs of pain may need to be relieved by an injection offered by the nurse. Breathing nitrous oxide gas on a mask when the contractions start can also make them more bearable. Eventually you develop an irresistible desire to start pushing with all your might. Your cervix will be fully dilated by this stage, and you are now entering the second stage of labour, which will last from only a few minutes to 60 minutes or more. Then you are being urged to push, and even though it hurts, it doesn' t seem to matter any more, and you labour with all your might to force the head of the baby out of your body. The contractions are much more intense than before, but you should push only at the time of a contraction, as pushing at other times is wasted effort. Another push, and another, and another, and then a sudden sweeping, elating relief, followed by a healthy cry from your new baby. Immediately after the delivery, you are given an injection to help contract the uterus. A minute or so after the baby is born, the umbilical cord which has been the lifeline between you and the baby for the last nine months is clamped and cut. A small sample of cord blood is often taken from the cord to check for any problems in the baby. About five minutes after the baby is born, the doctor will urge you to push again and help to expel the placenta (afterbirth). This is the third stage of labour. If you have had an episiotomy (cut) to help open your passage for the baby' s head, or if there has been a tear, the doctot will now repair this with a few sutures. You should be allowed to nurse the baby for a while (on the breast if you wish) after the birth. Then both you and the baby will be washed and cleaned, and taken back to the ward for a good rest. Your pregnancy is over, and you have a new baby to prove it.

       
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