Childbirth: A Guide for First-Time Mothers

Giving birth for the first time is a life-changing and often overwhelming experience. And when it comes to your birth plan, it can be hard to know where to start.

This guide breaks down various delivery options as well as their benefits and risks so you can get a better sense of how to prepare and what to expect when you go into labour.

Always speak to a gynaecologist for professional advice on what the best option is for you!

Natural birth – vaginal delivery

What happens during a vaginal birth?

Amniotic sac

In a typical vaginal delivery, you'll experience all the early stages of labour. The amniotic sac, which is a fluid-filled membrane cocooning your baby in the womb, may burst first. The clear, odourless liquid that comes out is described as your 'water breaking'.

Alternatively, you may experience vaginal bleeding first, which is usually accompanied with a mucus-like vaginal discharge.

Contractions

You may first begin to experience contractions – intermittent tightening and releasing of your uterus, which may feel like heavy cramping or pressure moving from your back to front.

Cervix dilation

Your cervix, the tube which connects your uterus to the vagina, will also begin to dilate (open). 'True' labour technically begins when you experience one contraction every 2 to 3 minutes, and when your cervix is 3cm dilated or more.

Birth

Eventually, when the cervix has dilated enough, your baby will pass into the birth canal. You will likely feel a burning sensation and intense pressure as you push. You can opt for an epidural (for pain relief during labour) if you want to reduce the level of pain.

Once the baby's head has emerged, your doctor or nurse may remove the amniotic fluid out of the baby's mouth and nose so they can breathe properly before you resume pushing.

Delivering the placenta

After your baby has arrived (yay!), you will need to deliver the placenta, the organ that developed during pregnancy, to help nourish your baby in the uterus. Sometimes this happens spontaneously, and sometimes your doctor may need to rub your abdomen to help detach it.

Can I give birth vaginally?

You should be able to plan for vaginal childbirth unless your doctor advises against it. This sometimes happens if you have a pre-existing health condition such as high blood pressure as it could lead to complications during the birth.

There's also the chance your birth plan will change unexpectedly. With vaginal childbirth, your baby will ideally be in the right position (head first, with face turned towards your back) before entering the birth canal. But of course, it's not always as easy as that! There's a chance your baby will be facing the wrong way, or pushing against the canal bottom first. If your doctor can't redirect your baby's position, they may have to perform an unplanned caesarean section to help ensure a safe delivery.

What are the benefits of vaginal birth?

Vaginal childbirth is often a long and exhausting process. But on the upside, it usually leads to a shorter hospital stay and shorter recovery time than with a C-section. For a vaginal birth, you would typically stay at the hospital for 24 – 48 hours. The hospital stay for a C-section can be up to 4 days.

What are the risks of vaginal birth?

It's very common to experience tears in your vagina after giving birth vaginally. In most cases, these tears are minor and can easily be repaired, but occasionally they can lead to weaker pelvic muscles and problems with bowel or urinary incontinence. Speak to your doctor if you have concerns about the risks of vaginal delivery.

Caesarean section (C-section)

What happens if I have a C-section?

A C-section refers to the surgical delivery of your baby. If you need to have a C-section, your doctor will make a low horizontal incision in your abdomen and uterus to deliver your baby. To numb your lower body, you'll be given either:

• A spinal block, which is injected into the sac surrounding your spinal cord
• An epidural, which is injected into the space outside the sac surrounding the spinal cord, or
• General anaesthetic to put you into a painless sleep

After a C-section, you'll probably need to stay in the hospital for around 3 days to recover. Then you'll probably need a couple of weeks at home to rest.

Can I have a C-section?

Doctors will usually only advise having a caesarean if there's a health reason behind it. But you can also elect to have a C-section if that feels right for you.

Your doctor may also recommend a C-section if giving birth vaginally would put you or your baby at risk. Some of the reasons why you might need a C-section include:

• Your baby's head is too big for the birth canal
• Your baby is in the wrong position
• You have a health condition, such as high blood pressure or heart disease
• You have active genital herpes
• You have already had a C-section previously
• There's a problem with the umbilical cord or placenta
• Your labour has stalled

What are the benefits and risks of having a C-section?

Some women may choose to have a C-section for non-medical reasons, and this can be discussed with their doctors. Preference for a C-section delivery is usually because parents have more control in deciding when their baby is born and it can also reduce some anxiety of waiting for labour to start.

Some of the benefits of a C-section are:

• Lower risk of incontinence and sexual dysfunction after the birth of the baby
• Lower risk of the baby being deprived of oxygen during delivery
• Lower risk of the baby experiencing trauma while passing through the birth canal

What are the risks of having a C-section?

A C-section is often more predictable than a vaginal birth, but it is also a major surgery, so it's not surprising that it comes with some risks. These include:

• Bleeding and infection. There is a higher risk of blood loss and infection as a C-section involves cutting into the abdomen, adjusting the organs and making incisions near the bladder and bowel.
• Blood clots. There is a higher chance of developing blood clot inside a deep vein, especially in the legs or pelvic organs after a C-section. It can be life-threatening if the blood clot travels to the lungs and blocks blood flow.
• Increased risks for future pregnancies. After a C-section, a woman faces a higher risk of potentially serious complications in a subsequent pregnancy than after a vaginal delivery. Women who have three or more C-sections are at higher risk of experiencing complications during the surgery than those who have not. Therefore, it’s important to keep the procedure limited to those that are medically necessary.
• Injury to the baby during surgery. Although rare, accidental cuts to the baby's skin can occur during surgery.
• Breathing problems for the baby. Babies born via a scheduled C-section are also more prone to developing a breathing problem marked by abnormally fast breathing during the first few days after birth.

If your doctor has advised you to have a C-section, it's because they believe it will be a safer, healthier option for you and your baby. Speak to your doctor if you have any concerns.

Can I give birth vaginally after having a C-section?

It's often possible to have a vaginal birth after C-section (VBAC), but there are a lot of factors involved, so you'll need to discuss it with your doctor before you decide if it's right for you.

One big factor is your scar. If your previous C-section was an emergency and resulted in a vertical scar, there's a high risk of this bursting during labour. If, however, your scar is horizontal and low on your tummy, VBAC is more likely to be possible.

Bear in mind that if you have high blood pressure during pregnancy (pre-eclampsia), you’re older than 35 or your body mass index is 30 or higher, your doctor will probably recommend that you don't have a VBAC.

Vaginal birth after caesarean (VBAC)

If you have had a child delivered via C-section, you might be able to opt for a vaginal birth after caesarean (VBAC) for your subsequent pregnancy.

If your pregnancy is healthy and the incision in your last C-section was low transverse, you may be a suitable candidate for a VBAC. Talk to your doctor to know if this is something you can opt for.

Can I have a VBAC?

You might be a suitable candidate for a VBAC if you are:

• Pregnant with one baby, have a history of one or two prior low transverse C-sections and have no problems that would prevent a VBAC
• Pregnant with one baby, have a history of one prior C-section with an unknown type of uterine incision and have no problems that would prevent a VBAC
• Pregnant with twins, have a history of one prior low transverse C-section and are otherwise a candidate for a twin vaginal delivery

Problems that would prevent a VBAC include:

• A prior high vertical uterine incision
• An unknown type of prior uterine incision, which is suspected to be a high vertical incision
• A prior uterine rupture
• Certain types of prior uterine surgery, such as fibroid removal
• Any health conditions that would prevent vaginal delivery

Women who have had a prior vaginal delivery have the greatest chance of having a successful VBAC.

What are the benefits of having a VBAC?

Benefits of having a VBAC include:

• Lower risk of complications in future pregnancies. With VBAC, there are lower risk of complications associated with multiple C-sections, such as placenta previa, for subsequent pregnancies.
• Lower risk of surgical complications. There is a lower risk of excessive bleeding, infection and blood clotting in the deep veins with a successful VBAC. Additionally, VBAC might also decrease the risk of surgical removal of the uterus and injury to organs, such as the bladder or bowel.
• Shorter recovery time. After a VBAC, you will need a shorter hospital stay compared with after a repeat C-section. You will also be able to resume your daily activities sooner.

What are the risks of having a VBAC

There are several complications that are associated with a failed trial of labour after a C-section, including, rarely a uterine rupture.

An emergency C-section will be needed if a scar on your uterus from a previous C-section tears open during a trial of labour.

Treatment of complications that arise may involve surgical removal of the uterus. If this happens, pregnancy will not be possible again.

Vacuum-assisted delivery

What happens if I have vacuum-assisted delivery?

With vacuum-assisted delivery, you'll experience all of the same early labour symptoms as a traditional vaginal birth. The difference will be when your baby is in the birth canal. Once your cervix is properly dilated, your doctor will use a vacuum device, which features a soft cup to attach to your baby's head, to guide your baby out the canal.

Can I have vacuum-assisted delivery?

If your baby's descent is delayed and you're exhausted from pushing for several hours, your doctor may recommend you to try vacuum-assisted delivery. It's also an option if you have a medical condition like high blood pressure or heart disease, but want to avoid having a C-section.

What are the benefits and risks of vacuum-assisted delivery?

Vacuum-assisted delivery is a valuable option if your labour lasts for too long, or if your baby is in distress. However, it does come with some risks. You may notice some minor swelling or even small superficial cuts on your baby's scalp after vacuum-assisted delivery. More rarely, vacuum-assisted delivery can trigger internal bleeding.

But don't panic – your doctor will carry out all the necessary precautions and check carefully that your baby is in the right position to minimise these risks before using the vacuum device.

Forceps delivery

What happens if I have a forceps delivery?

Forceps are medical tools that look a bit like oversized salad tongs. Your doctor will use them to gently grip your baby's head and guide them out of the birth canal. You'll need to lie on your back on a slight incline with your legs spread apart for your doctor to insert the forceps and locate the baby's head. When you push, your doctor will gently guide your baby downwards. This is an alternative to vacuum-assisted delivery.

Forceps can also be used to rotate your baby's head if it's stuck in the wrong position.

Can I have forceps delivery?

Your doctor will usually only recommend forceps delivery if you need help during the birth. This can happen if your baby isn't travelling down the birth canal as expected, or if you're struggling to push.

What are the benefits and risks of forceps delivery?

Forceps delivery can help to deliver your baby quickly and safely if they are stuck or in distress. However, much like vacuum-assisted delivery, there's also the risk of the forceps causing superficial injuries or more serious damage to your baby's head. Occasionally, forceps can also cause issues for you, such as short-term incontinence or weakened pelvic muscles.

The most important thing to remember is that you can't predict what your delivery will be like. No matter your preferences, sometimes a C-section, vacuum-assisted delivery or forceps delivery is unavoidable. But there is something you can do in advance. The best way to prepare for childbirth without complications is to aim for a healthy pregnancy.

Follow your doctor's recommendations and try to stay calm and relaxed, even when labour starts. And remember: you've got this!

If you've more questions on pregnancy or childbirth types, make an appointment with an O&G specialist.