Procedures involved in a vaginal birth (normal delivery)

Vaginal delivery is the method of giving birth naturally which, at times, may need some assistance.

By: Dr Anitha Anchan | | Updated: November 2, 2015 6:54 pm

Most women would want a natural delivery. As you approach your due date and look forward to holding your bundle of joy, the thought of the impending childbirth may make you anxious. Every delivery is unique. But knowing what to expect as you deliver your baby can help ease your apprehensions.

The method of giving birth naturally is termed vaginal delivery. It is the birth of babies through the vagina. Vaginal delivery can either be spontaneous or assisted.

Spontaneous Vaginal Delivery: In a spontaneous vaginal delivery, a pregnant woman goes into labour without any form of induction through use of drugs or procedures. The baby is delivered in the normal manner without any assisted intervention like incision, forceps or suction.

Assisted Vaginal Delivery: At times, an assisted vaginal delivery may be necessary. Labour in a pregnant woman may be induced with the use of drugs or techniques. The baby may be delivered vaginally with the use of vaginal incision (episiotomy) or the use of special instruments like forceps (forceps delivery) or a vacuum extractor (vacuum extraction).

1. Induced labour

An induced vaginal delivery is normal delivery involving induction of labour. Labour is initiated through drugs or manual techniques.

2. Episiotomy

An episiotomy is the enlargement of the vaginal opening through an incision. It is done to ease the birthing process. To widen the vaginal opening during labour, an incision is done over skin between the vagina and anal opening (perineum). This is done for easy delivery, to protect the perineum and at times the baby (particularly in the case of premature births) from injury. Situations that require an episiotomy can be:

malpositioned baby (breech position)
large and heavy baby
prolonged first-time labour due to a thick and rigid perineum
if instrumental delivery (like a vacuum or forceps delivery) is required

Complications:

injury to the anal sphincter and rectum
excessive bleeding
vulvar hematoma – bleeding into a part of the outer structures of maternal genitalia

3. Vacuum extraction

Vacuum extraction (ventouse) is a vacuum-assisted vaginal delivery. Once the head is engaged in the birth canal, the baby is delivered vaginally with the assistance of a vacuum device (vacuum extractor). The suction cup of the device is correctly placed on the baby’s head and a vacuum is created using a pump. The baby’s head is then gently delivered down the birth canal as the mother’s uterus contracts. Once the head is out, the rest of the baby is delivered normally. Situations that require vacuum extraction:

if the mother is exhausted
prolonged labour
if prolonged pushing poses harm to maternal health due to pre-existing conditions like hypertension, heart disease, etc.
foetal distress – baby’s heart tracing test results during labour suggest that the baby may not be getting enough oxygen

Complications:

bruising on the baby’s head which is usually temporary
chignon – temporary swelling on baby’s head
bleeding within the skull

4. Forceps delivery

In forceps delivery the baby’s head is delivered through the vagina with the help of obstetric forceps. The forceps hasve two curved spoon-like branches that are inserted into the vagina and positioned firmly around the baby’s head. If needed, the position of the baby’s head is corrected. An episiotomy may be performed if necessary. The baby’s head is then delivered with a gentle pull. Once the head is out, the rest of the baby is delivered normally. This method can help reduce delivery time and in certain cases, avoid C-section. Situations that require forceps delivery:

if the mother is exhausted
prolonged labour
if prolonged pushing poses harm to maternal health due to pre-existing conditions like hypertension, heart disease, etc.
maternal bleeding
decreased or inhibited efforts at pushing due to epidural anaesthesia
foetal distress – baby’s heart tracing test results during labour suggest that the baby may not be getting enough oxygen
breech delivery (baby delivered with the buttocks or feet first as opposed to the normal head-first)

Complications:

bruising on the baby’s head which is usually temporary
deformation, skull fracture and injury to cervical cord in the baby
damage to nerve
abnormal connection between the rectum and vagina (rectovaginal fistula)
very rarely, injury to the baby’s eye

Doctors usually recommend a Caesarean section (C-section) if the baby cannot be delivered through a normal vaginal delivery. It is a surgical procedure in which one or more incisions are made through a mother’s abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies.

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