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What is Spontaneous Vaginal Delivery?
It involves the birth of a baby and delivery of the placenta from the uterus and through the cervix and the birth canal (vagina). This process results from contractions of the uterus during labor. Most women deliver 38 to 40 weeks after becoming pregnant (conception). In some vaginal deliveries, additional assistance is used to assist vaginal delivery by using forceps or vacuum extraction applied to the baby's head. In combination with hormonal changes, the regular muscular contractions of the uterus in labor cause the cervix to soften, thin out, and open (dilate) so that the baby may travel from the uterus through the bony pelvis to the vaginal opening. The average labor lasts 12 to 14 hours for a woman having her first baby (nulliparous) and about 6 to 8 hours for subsequent babies (Beers). Labor occurs in 3 stages. The first stage begins with regular contractions that causes cervical dilation and ends when the cervix dilates to 10 cm. The second stage ends with the baby's birth. The third stage ends with delivery of the placenta, which usually separates from the uterine wall within 5 minutes after delivery. Assisted vaginal delivery can usually occur when the cervix is fully dilated and the baby's head is visible (crowns). Spontaneous vaginal delivery is the expected outcome for most pregnancies. Assisted vaginal delivery may occur when the second stage of labor is prolonged or when the baby appears to be in distress and delivery time needs to go faster. Purpose Vaginal delivery proceeds if the maternal pelvis can accommodate the baby's presenting part, usually the head. The pelvis ordinarily widens and softens during labor to allow passage of the baby's head. The decision to proceed with a vaginal delivery may be affected by the obstetrical history of previous labors, types of deliveries and estimated infant weight and status of mother and baby. Forceps or vacuum extraction delivery is needed in any condition threatening the mother or fetus that is relieved by delivery. Some maternal indications include pulmonary injury or compromise heart disease, intrapartum infection, exhaustion, certain neurological conditions or prolonged second stage of labor (from full cervical dilatation of 10 cm to fetal delivery). Some fetal indications for operative delivery include umbilical cord prolapsed, premature separation of the placenta, or a non-reassuring fetal heart rate pattern. Complications Complications of assisted or spontaneous vaginal delivery affecting the mother include excessive bleeding (hemorrhage), inability to urinate (urine retention), loss of bladder control (urinary incontinence), bruising (hematoma) of the perineum, varying degrees of tearing (laceration) of the perineum, infection, and anal-sphincter dysfunction (fecal incontinence). Pressure on the nerve supplying the genitalia (pudendal nerve) may lead to decreased sensation in this area and/or sexual dysfunction What to expect before the procedure Admitted as per physician order. Consents must be secured. Nothing by mouth until delivery as ordered by physician. If indicated by the physician, cleansing or fleet enema will be given for further bowel preparation. You will also meet with the anesthesiologist to go over details of the method of anesthesia to be used. Insertion of Intravenous line. Diagnostic exams as ordered by the physician like Complete blood count, blood typing and urinalysis. Instructions regarding change of gown, removal of jewelries, dentures, contact lenses, hair accessories, nail polish, and make up will be given. You will be wheeled to the labor room for labor watch and will be hooked to a fetal monitor. Series of internal exams will be done. If you cannot tolerate the labor pains, anesthesia will be given as ordered. If you are fully dilated, 10 cm, you will be wheeled in and transferred to the OR-DR room. What to expect during the procedure The perineal area is cleaned with an antibacterial scrub (usually Betadine). After the baby comes out, newborn care will be immediately rendered by the pediatric team. Proper identification will be placed (applying I.D. band and taking footprints). The baby will be given to you for maternal bonding. After the bonding, the baby will be transferred to nursery for further care. The physician will stitch your cut (if any) and then you will be transferred to the recovery room. What to expect after the procedure In the recovery room, you will be observed usually for 2 hours as the anesthetic wears off. You will be hooked to the cardiac monitor to check your vital signs. Oxygen support is also given thru nasal cannula. Post-operative medicines will be given to you.v After 2 hours in the recovery period, you will be examined and will be transferred to your room if there are no complications. Minimal vaginal bleeding is expected. |