Natural childbirth > Delivery > Childbirth

Natural childbirth

What is natural childbirth?

Natural childbirth is the traditional method of delivering a baby through the vagina, also known as vaginal delivery. The progression of childbirth is divided into three stages: the first stage involving cervix dilating to its maximum width as labor begins; the second stage involving descent and birth of the baby; and the third stage involving placental delivery. The time it takes to give birth is usually 9 to 18 hours for a first birth, and 6 to 13 hours for subsequent births. As labor progresses, appropriate breathing techniques and pain relief procedures can be used to reduce labor pain.

Stages of Childbirth (Korea Disease Control and Prevention Agency’s National Health Information Portal)

1. First Stage of Labor (Stage of Cervix Dilation or Preparation for Childbirth)
This is the period from the start of labor until full cervix dilation (of 10 cm). During this time, labor starts and the cervix dilates until fully dilated. This stage takes the longest amount of time during the entire labor process at approximately 10 to 12 hours for first-time mothers and 4 to 6 hours for multiparous women.

When contractions last about a minute and come regularly in intervals of 2-3 minutes, the pressure inside the uterus increases and the cervix begins to open. At this time, the fetus prepares to pass through the pelvis with its chin tucked against its chest and its head bowed. In the first phase of the first stage, contractions occur at 10-minute intervals, but the intervals gradually become shorter and last longer. In the late phase, contractions become more frequent, occurring in 2-3 minute intervals, and the cervix may open completely, leading to the rupture of membranes.

Through a physical examination, medical professionals will check the dilation of the cervix, softness of the birth canal, if your water has broken, and the degree of fetal descent. Fetal heartbeat is checked using a fetal monitor to ensure the fetus is safe. When labor is delayed due to mild pain, uterotonic agents may be administered depending on the situation.
2. Second Stage of Labor (Birthing the Baby)
This is the time from cervical dilation to birth. It takes typically 2 to 3 hours for first-time mothers and 1 to 1 1/2 hours for women who have given birth before, but this varies from person to person. Although it is a relatively short period compared to the first stage of labor, this is the most important as the baby is born! An episiotomy is sometimes performed to ensure smooth delivery.
3. Third Stage of Labor (Postpartum)
This is the period after the baby is born and before the placenta is delivered. It lasts between 5 and 10 minutes after the baby is born. During this period, the uterus contracts strongly to detach the placenta from the uterine wall. The placenta is typically delivered within 20 to 30 minutes, and labor is completed with the expulsion of the placenta and umbilical cord. When the placenta is delivered, the doctor will check to see if the uterus is contracting well, if there is bleeding, if there is any residue left in the uterus, and if there are any wounds. After, the vagina-perineal incision is sutured. In addition, the newborn's respiratory condition and presence of deformities and diseases are checked.

Preparation for Childbirth

If signs of labor appear and labor is confirmed through ultrasound and obstetric examination after visiting the hospital, you will be hospitalized, and if necessary, preparations for labor such as fasting, enema, intravenous fluid injection, and perineal hair removal are performed.

Actual Childbirth Process

1. Fetal Monitoring and Maternal Observation
When a pregnant woman is admitted to the hospital for delivery, their blood pressure, body temperature, pulse, and breathing are checked first, and prenatal records are reviewed. If the pubic hairs around the perineum of the vulva interferes with childbirth, the hairs may be shaved if necessary. The doctor will check the progress of labor through an internal examination but may also administer an enema in the early stage of labor to minimize infection from stool during labor.

Additionally, an electronic fetal heart rate monitor (EFM) is used to monitor the degree of uterine contractions and the fetal heartbeat during labor to monitor fetal condition.

Electronic Fetal Monitor (EFM) (Korea Disease Control and Prevention Agency’s National Health Information Portal)

<그림. 외부 태아 감시장치> 자궁수축변환기:자궁의 수축을 측정 체외 초음파 탐촉자:태아의 심박수를 측정 태동이 느껴질 때 버튼을 누름
태동과 연동되어 나타나는 태아의 심박수 변화를 관찰함으로써 태아의 안녕을 평가할 수 있습니다.

Figure. Electronic Fetal Monitor (EFM) (Korea Disease Control and Prevention Agency’s National Health Information Portal)
2. Labor Progress
Once the cervix is fully dilated and the fetus descends, you will lie down on a delivery table, take your birthing position, and begin pushing in sync with the uterine contractions under the guidance of your doctor. The most common position is the a “lithotomy position”, or where you’re on your back with your legs in straps and pushing

Labor Positions (Korea Disease Control and Prevention Agency’s National Health Information Portal)

<그림. 분만 시 임산부의 자세>
이러한 자세를 '동쪽면 골반내진자세' 라고 합니다.

Figure. Labor Positions (Korea Disease Control and Prevention Agency’s National Health Information Portal)
3. Episiotomy
During childbirth, an episiotomy is performed to widen the vaginal opening for safety when a baby is very large, when vacuum extraction delivery is necessary, or to reduce the risk of perineal tears.
4. Cord Clamping and Placenta Delivery
When the fetus is born, the umbilical cord is held with sterilized clamps at a length sufficiently long from the fetal navel, then cut between the two clamps. After disinfection, the umbilical cord is clamped again.
After, the placenta is typically delivered within the next 5 to 10 minutes. If it does not detach naturally, nurses may apply pressure to your lower abdomen. In rare cases, if the placenta does not detach easily, your doctor may perform a manual removal of the placenta. After the full delivery of the placenta, your doctor will repair an episiotomy (if performed) with stitches.

Postpartum Process

After delivery, you will be observed in a recovery room. If your blood pressure and pulse are stable and you have no complications such as bleeding, you are moved to a ward. A few hours after delivery, you can eat as instructed by your doctor, and if you have no complications, you can be discharged after 1-2 days.

Health Care and Precautions after Discharge

1. Visiting the hospital after giving birth
When you are discharged, the nurse will inform you of the schedule of visits. In general, postpartum check-ups are performed within 1 to 3 weeks to check how you’re recovering. One month after delivery when lochia has completely stopped, you will be checked for cervical cancer screening and abnormalities.
2. Postpartum pain and lochia
Postpartum pain is pain that occurs intermittently as the uterus contracts after childbirth. It is more common in multiparous women than in first-time mothers, and the pain may be worse when your baby is suckling. This is because suckling releases a hormone called oxytocin, whichcauses the uterus to contract. Postpartum pain is a normal process of expelling blood clots from the uterus, so if the pain is severe, you can take pain relievers such as Tylenol.
Lochia is the vaginal discharge you have after giving birth. When your body heals during the postpartum recovery period, the color of the lochia gradually becomes lighter and the amount also gradually decreases. Meanwhile, if bleeding does not decrease after about 3 weeks after giving birth and the bleeding remains red for a long time, you should visit a hospital and get examined.
3. Perineum care and sitz baths
During vaginal delivery, the tissues of the vagina and perineum can be damaged, and some patients may require an episiotomy. Perineal care and sitz baths are necessary to reduce the risk of infection and promote rapid healing and cleanliness.
When changing pads, first wash your hands thoroughly, then remove the pad from front to back to prevent germs around the anus from touching the perineum. After, put it back on in the same direction. When removing moisture after a sitz bath or bowel movement, wipe with a dry tissue from front to back.
Sitz baths are recommended 2-3 times a day with warm water.
On the other hand, it is recommended to avoid using the bidet too strongly, washing the inside of the vagina too forcefully, or applying hot compresses because these can cause wounds to open or acute inflammation to occur.
4. Bathing
Showering is possible after giving birth. Bathing in the tub is generally recommended after the lochia has stopped.
5. Restoring bladder function
Pregnancy and childbirth may prevent your bladder from recovering properly, so after giving birth, if you have difficulty urinating or feel like your bladder is not empty, you should see a doctor. Temporary urinary incontinence may occur after childbirth, but it usually improves after the puerperal phase. Kegel exercises can help.
6. Constipation and hemorrhoids (Piles)
To prevent constipation, it is recommended to eat foods rich in fiber, such as vegetables and fruits, and to exercise regularly and have regular bowel movements.
In most cases, hemorrhoids caused by pregnancy and childbirth often gradually improve by alleviating constipation, reducing the time spent sitting on the toilet, and taking sitz baths. However, if you experience severe bleeding or pain, you should see your doctor.
7. Nutrition and anemia
The amount of breast milk produced is proportional to the mother's nutrition. Therefore, you need to eat foods high in protein and calcium on a regular basis. If your test results show anemia, you should take medication as instructed by your doctor.
8. Sex
Sexual intercourse can begin up to two weeks after giving birth, but this decision is made after discussion with your doctor during a regular checkup after giving birth. During the postpartum checkup, the recovery of the uterus, the presence of lochia, and the suture site of the perineum will be checked. If your recovery is smooth, you can begin having sex again. When having sex, it is best to keep the wounds from childbirth clean to prevent bacterial infection and to choose a position that does not put strain on the abdomen, such as missionary position or from behind (doggy style).
9. Menstruation
After giving birth, the return of your menstrual cycle varies from person to person. If you are breastfeeding, your period may not start until you stop breastfeeding, and some women may start before lochia has completely stopped. Even after your first period starts, your period may be irregular for a while, but your normal menstrual cycle usually returns after 3 to 4 months.
Ovulation occurs before menstruation begins, so pregnancy can occur before the first menstruation. Contraception should be used if necessary.

(Source: Korean Society of Obstetrics and Gynecology, Discharge Education for Mothers Who Had Natural Delivery)

Guide to Natural Childbirth (Korean Society of Obstetrics and Gynecology)