Obstetrician Perth | Specialised in vaginal birth
Vaginal Birth or Natural Birth
What is a vaginal birth?
Vaginal birth is often thought of as “natural delivery” or “normal birth”. Some believe this is mother nature’s plan.
Normal delivery can be explained, in brief, like this:
You feel regular intermittent contractions of the muscular upper part of the uterus. This stretches the elastic lower part of the uterus and the cervix, which dilates.
The uterus contracts and retracts, or shortens. It pushes the head of the baby down through your cervix and through the tissues of the pelvic floor.
The baby passes through the bones of the pelvis until it reaches the perineum. It then stretches the tissues of the vagina.
The baby’s head is pushed out into the world.
The pressure of the head on the rectum produces the same pressure that stimulates you to empty your bowel. This urges you to assist the expulsive forces of the uterus by straining or pushing, helping the delivery along.
Once the head delivers, the shoulders and the rest of the baby usually follow quickly.
Following birth, the baby undergoes an amazing transformation. The baby passes from having all of its needs met through the placenta, to feeling its lungs filling up with air for the first time. Its circulation transforms rapidly and completely. Shunts begin in the atrium of the heart, and the outflow vessels of the heart close.
This closing forces more blood to travel into the lungs. Although there are no obvious visible changes, the circulation of your baby transforms to the normal adult state. The right side of the heart supplies blood to the lungs and the left side supplies the entire body. The oxygen levels in the baby’s blood rise rapidly. Your baby’s lips, face, and then hands and legs become pink instead of blue for the very first time.
Following birth, the placenta — the critical lifeline during pregnancy — separates from the wall of the uterus in response to contractions. Then, just as the baby was, the placenta is expelled through the birth canal. This amazing organ goes from being critical to no longer necessary in just a few minutes.
Problems during and after vaginal birth
The ideal natural childbirth does not always happen, and that is why my profession exists. We predict and prevent problems whenever possible, and manage any that do occur.
The most common problem occurs when the tissues of the pelvic floor have to stretch a lot to allow for delivery. These tissues will often stretch beyond their elastic limit and may tear. Tears in the perineum may require stitching after the delivery. At other times, the perineum may be cut preemptively with an episiotomy.
Ultrasound studies have been conducted on women after vaginal delivery, and often show invisible injuries. These include when the muscles of the pelvic floor have been pulled off their anchor point high in the pelvis. The consequences of these injuries are often not seen for years.
Other common problems include difficulty fitting the baby’s head through the pelvis, or when the baby is stressed by the delivery. In both cases, vaginal delivery becomes assisted delivery.
Forceps were a great step forward in obstetric care 300 years ago, but have largely been replaced by vacuum-assisted delivery. An assisted delivery is often associated with more pelvic floor damage than a normal delivery. It is my least preferred type of delivery.
Labour and delivery are difficult for the human species. What mother nature “designed” for us is just a reflection of the evolution point of our species. We deliver babies with large heads because of our large brains, that then need to pass through narrow pelvises.
We compound these problems with good health and nutrition, which means that we produce bigger babies. We are also delivering babies later in our lives. The first child now commonly arrives during our 30s. At this age, time has already significantly reduced the elasticity of our tissues.
C-section or vaginal birth?
Whether you choose c-section or vaginal birth depends on many factors, which is why risk management is so important. Things to consider include:
Previous birthing experienceHave you given birth before, and how was the delivery?
Your age and healthWe want to choose the option with the lowest risk for you and your baby.
Your baby’s healthFor example, is the baby strong enough to handle vaginal birth?
Healing from vaginal delivery
Care and sexual intercourse after normal delivery
To read about sexual intercourse after vaginal birth or care after normal delivery, visit our page on birth recovery.
Advantages and disadvantages of vaginal birth
Simple vaginal delivery has immediate benefits over a caesarean section. Recovery can be faster — especially if the labour is short, the pain is well-managed, and there is little or no vaginal tearing.
The problem is the “ifs”. If the pain relief is poor, if the labour is long, if the injuries are large, then recovery from natural birth can be much slower than recovery from a caesarean section. Unfortunately, it is hard to know in advance how your labour will last. After a successful first vaginal delivery, however, it is much easier to predict the outcome.
Long-term outcomes for the pelvic floor are usually a low priority for women at the time of having a baby. When you have your baby in your 20s or 30s, your focus is usually on immediate postnatal care. Most women aren’t considering any long-term consequences that vaginal delivery may have.
Vaginal prolapse is caused by many factors, but there is one thing that significantly reduces your risk of prolapse: avoiding the damage of a vaginal delivery.