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Labour and Delivery

Choosing Your Mode of Delivery

Vaginal Delivery (aka Natural Delivery)

The most common form of delivery is through the vagina, also commonly known as natural delivery. Your obstetrician will usually recommend a vaginal delivery unless a pre-existing condition or unforeseen complications during labour will make a vaginal delivery dangerous to the mother, baby or both. Read here to learn when C-section will be required or recommended.

Advantages of Natural Delivery:
Natural delivery is associated with a shorter hospital stay, quicker recovery period for the mother and lower infection rate. It also helps to establish bonding between mother and baby as well as help start breastfeeding earlier than in the case of a Caesarean section.

Disadvantages of Natural Delivery:
Some women will experience tearing of the skin and tissues during a vaginal delivery, which will require stitches. Repeated vaginal deliveries may result in weakened pelvic floor muscles and is associated with conditions such as urinary incontinence. However, that can be managed through non-invasive treatments such as vaginal laser rejuvenation.

During the course of a vaginal delivery, your doctor may apply a vacuum cup or forceps to the baby’s head to help guide the baby out of the birth canal. Forceps are like large spoons, which are inserted into the vagina and positioned around the baby’s head. While the mother pushes during labour, the forceps apply mild pressure to guide the baby’s head out. A vacuum cup, on the other hand, is a suction cup with an attached handle. The suction cup is inserted into the vagina and placed on top of the baby’s head. While the mother pushes during labour, the vacuum cup applies mild traction to guide the delivery of the baby’s head.

A caesarean section or C-section is a surgical procedure where an incision is made in the mother’s abdomen and uterus to deliver the baby. A C-section is done under epidural anaesthesia where the mother’s body is numbed below the waist and she remains conscious during the procedure or under general anaesthesia depending on the reason for the surgery and the mother’s preference.

When is C-section Recommended?

In the event of multiple pregnancies
When there is a very large baby, a baby in a breeched position, a baby in distress
In pregnancy conditions such as placenta previa (low placenta) or pre-eclampsia (high blood pressure)
When the mother has certain existing medical conditions

Apart from medical reasons, some mothers may choose to c-section as their mode of delivery for social reasons such as having the ability to time the baby’s birth. While a C-section is generally safe, it is after all an invasive procedure, and there may be increased risk of heavy bleeding, infection, and injury to other organs at times. The recovery period is longer as compared to a vaginal birth as the surgical scar on the tummy is bigger and requires time to heal. Mothers who have undergone a C-section may also sometimes face problems with breastfeeding.

If you have had a C-section during your first birth, you may be able to deliver vaginally during your subsequent births, also known as having a VBAC. However, this is dependent on several factors, such as the reason for your initial C section, number of previous C-sections and the type of incision made during your first C-section.

What is Labour?

The entire labour process and experience varies between each woman and can last between 12 to 24 hours, especially for a first-time mother. Labour is usually shorter for subsequent pregnancies.

Early Signs: Am I In Labour?

You may go into labour anytime from 37 weeks to 41 weeks gestation. The following signs are an indication your labour will begin very soon:

A brownish or pinkish discharge known as ‘bloody show’ – this is a mucus plug which is released from the cervix before or at the onset of labour
Contractions: Periodic contractions may start as early as several days before your baby is actually born.
Water breaking: The amniotic fluid sac cushioning your baby in the womb ruptures and leaks out from your cervix and vagina. While this can happen in early labour, some women’s waters do not break until the 2nd stage of active labour.

During the early stage of labour, you will experience mild, irregular contractions about 15 – 20 minutes apart. These will gradually become more frequent and your cervix will begin to dilate up to 3cm.

What Can I Do?

If your contractions are bearable, you may continue resting at home or doing some light relaxing activities to cope with the labour pains. You should continue eating and stay hydrated during this period. There are various positions or breathing exercises which can help ease early labour discomfort. Head to the hospital if your contractions are becoming more painful (a contraction is considered strong if you are unable to talk through it) and occurring regularly about 10 minutes apart, or if you notice any vaginal bleeding or leakage of water.

From Active Labour to Birth

In the active labour stage, the cervix starts to dilate more rapidly from 4cm to 10cm. Your contractions will increase in frequency and intensity – occurring around every 5 minutes and lasting about 60 – 90 seconds each time. This stage may last as short as 1 hour or up to 8 hours for some women. Some women experience side effects of the intense pain such as nausea and shakiness at this stage. Your obstetrician will monitor you and your baby’s heartbeat closely throughout this process. When the cervix has fully dilated to 10cm, the doctor will encourage you to start pushing until your baby’s head and body emerges. This process may last for 1 – 2 hours. If necessary, your doctor may make an incision called an episiotomy to widen the vaginal opening and assist the delivery of your baby.

Pain Management During Labour

During labour, you may opt for medical options for pain relief, or practice natural pain management techniques to manage the pain. The most common agents used for pain management are epidural (a local anaesthetic which numbs the nerves carrying the pain impulses from the birth canal to the brain), gas and air, and intra-muscular injection.

What Happens Now?

Congratulations, your baby has arrived! Immediately after delivery, amniotic fluid, mucus and blood will be suctioned from your newborn’s mouth and nose. Your baby will be placed on your chest for skin-to-skin contact and the umbilical cord will be cut. At this stage, you may feel lighter contractions starting again as your placenta detaches itself in preparation for delivery. Your doctor may gently pull the umbilical cord and massage the uterus to facilitate the process. The placenta, which has provided your baby with nourishment in the womb, is also delivered. Your doctor will then clean and stitch up the wound. Over the next few hours, you will also be monitored to ensure the uterus is contracting back in size and no excessive bleeding is taking place.

Now that the hard work is over, it’s time to have a good rest before looking forward to the next stage of your journey: motherhood.

What are the Modes of Delivery?

There are several delivery methods which can safely bring your baby into this world. Over the years,medical advancements have allowed women to have a safe delivery experience even in the event of high-risk pregnancies and unexpected complications. These are: Vaginal Delivery (aka Natural Delivery), Assisted Vaginal Delivery andCaesarean Section (C-Section).