Understanding Delivery

Natural Childbirth

Some women decide that before the birth of the baby that they are going to labor and deliver with natural childbirth. While the definition of natural childbirth varies, most people understand this to mean drug-free labor and delivery. Natural childbirth is not for everyone and you may decide once the contractions begin that an epidural may be appropriate.

There are three major methods for natural childbirth:

• Lamaze: This is the oldest technique of childbirth preparation. It conditions the mother through training to replace unproductive labor efforts with fruitful ones. It emphasizes relaxation and breathing as ways to relax during labor and delivery.
• Bradley Classes: In this method there are many types of relaxation and focus used. Strong emphasis is put on relaxation and deep abdominal breathing to make labor more comfortable. Classes begin when pregnancy is confirmed and continue until birth.
• Grantly Dick-Read: this method attempts to break the fear-tension-pain cycle of labor and delivery primarily through education, exercise and relaxation.

It is important to keep an open mind during labor and delivery. The goal is to delivery a healthy baby and make sure you are safe and comfortable. Sometimes labor and delivery plans change, so do not feel guilty or disappointed you cannot do all of the things you planned before labor.

Caesarean Section (C-section)

Most women plan on a normal vaginal delivery, but a Caesarean delivery is always a possibility. With a C-section, the baby is delivered through an incision made in the mother's abdominal wall and uterus.

C-sections are done for many reasons. The most common reason for having a C-section is a previous Caesarean delivery. However, some women who have had C-sections can have a vaginal delivery with later pregnancies.

Other reasons for having a C-section include: if the baby is too big to fit through the birth canal, fetal distress during labor, a compressed umbilical cord, the placenta is blocking the birth canal, or if the baby is in a breech position (the baby's feet or buttocks enter the birth canal first).

In 1965, only 4 percent of all deliveries were by C-section. In the United States today C-Sections account for nearly 20 percent of all deliveries.

Will you need a C-section?

Unfortunately there is no true way to predict if you will need one until you start your labor contractions. Your doctor will assess your labor and delivery options and make the appropriate decision at the appropriate time.

The Baby's Apgar Score

After a baby is born it is examined and evaluated at one minute and then at five minutes after delivery. The system of evaluation is called an Apgar score. The scoring system is a method of evaluating the overall well-being of the newborn infant.

In general, the higher the score, the better the infant's condition. The baby is scored in five areas. Each area is scored 0, 1 or 2. Two points is the highest score for each category, so the highest score an infant can get is a 10.

• Heart Rate:
  • 0 points if absent
  • 1 point if slow (less than 100 beats per minute)
  • 2 points if it is over 100 beats per minute
• Respiratory Effort: the baby's attempt at breathing
  • 0 points if it is not breathing
  • 1 point if the breathing is slow or irregular
  • 2 points if crying and breathing well
• Baby's Muscle Tone: how well the baby moves
  • 0 points if the arms and legs are limp and flabby
  • 1 point if some movement is observed and arms and legs bend
  • 2 points if the baby is active and moving
• Reflex Irritability: stimulus is provided such as rubbing the back or arms
  • 0 points if there is no response
  • 1 point if there is small movement or a grimace
  • 2 points if there is a vigorous response
• Baby's Color:
  • 0 points if the baby is blue or pale
  • 1 point if the baby's body is pink, but arms and legs are blue
  • 2 points if the baby is completely pink

It is important to note that a perfect score of 10 is very unusual. Most babies receive scores of 7-9 in a normal healthy delivery. A baby with a low one-minute Apgar may need to help to be resuscitated. This means a pediatrician or nurse will help stimulate the baby to breathe and recover from the delivery. In most cases, the five-minute Apgar is higher than the one-minute score because the baby becomes more active and more accustomed to being outside the uterus.