Towards the end of the second stage of labor, you will feel the baby’s head stretching your lower vagina and especially the skin between the back of the vaginal opening and the anus (perineum). Although the perineum becomes very elastic in labor it usually tears with theof the first baby .
The tear involves the perineal skin and the skin of the back of the lower vagina and underlying muscle tissues. The baby’s head stretches the perineum most, so it is important that the head should be born gently and slowly. Slow delivery of the head is achieved by pushing gently at this time.
The midwife will tell you when to stop pushing hard and will often tell you to pant quickly in and out so that the final push comes from the uterine contractions alone. Sometimes you will be asked to push gently at this stage, or asked to push gently and pant at the same time. At the same time the midwife will gently restrain the baby from ‘popping out’ and will ensure that it eases its way gently into the world.
As soon as the head is delivered, the mouth and nose will be gently cleaned. If there is much mucus present this will be sucked out with a soft plastic tube. With the next contraction you will be asked to push gently again and this will bring about theof the shoulders and the rest of the baby’s body.
Your beautiful newborn baby will now be lying between your legs on the bed. You will want to know if it is perfect and if it is a boy or girl: don’t worry-everyone will be telling you the good news. Early bodily contact between you and the baby is important; the baby is usually lifted gently up on to your tummy.
You may not be able to get the baby up to your breasts at this stage because the cord is still attached. As soon as the baby has cried and established regular breathing, the cord will be cut and you can cuddle the baby more easily.
Quite often, some more cleaning of the baby’s air passages will be necessary. For this, the baby will be placed on a small tilted table which has special suction apparatus and a supply of oxygen in case the baby is a little blue, as is often the case immediately after. Do not worry if your baby needs this kind of attention. It is all part of the normal procedure to ensure that normal breathing is established.
THE BIRTH OF THE PLACENTA
With the excitement of the baby’s birth you may not notice an injection being given into your thigh muscles to make your uterus contract more strongly and squeeze the placenta out of the uterus and into the upper part of the vagina. From there is it usually delivered by the midwife who draws the cord and, therefore, the placenta down into the vagina and out into a bowl. Sometimes you will be asked to help by giving a final push down.
The placenta is quite soft and slips out quite painlessly.
Once the third stage of labor, the delivery of the placenta, is complete, all that remains is a general clean up. Liquor amnii and a certain amount of blood can certainly spread quite a long way! Once cleaned up, your temperature and blood pressure will be checked. You are now ready to go to the lying-in ward where you will spend the next few days accustoming yourself to the idea of being a mother and getting to know your baby.
For the first twenty-four hours after delivery you will probably feel tired and excited. Visitors, at this time, should be kept to a minimum and should not stay long. Once you have had a good night’s sleep, however, you will enjoy receiving visitors and their congratulations. Remember to give your husband his fair share of attention and credit!
About forty-eight hours after the birth, the breasts will fill with milk and become obviously bigger and often tender. The baby’s sucking helps to bring the milk into the breasts. Do not expect your tummy to flatten and return to its normal shape at once. You will still be quite big to start with, but as the uterus contracts down and you do your post-natal exercises your figure will return. Much will, of course, depend on weight.
If you have not gained an excessive amount of weight during pregnancy you should get back to normal quite quickly. Apart from the weight of the baby and the placenta, the retained fluids will be disposed within a few days of birth.
By the find of the first week there should be no more than a fourteen to sixteen pound gain over your pre-pregnancy weight. Aim to be back to your ideal weight by three months from the birth. To do this you will need to eat sensibly and, perhaps, diet gently. Sensible dieting and breastfeeding are perfectly compatible and the baby will not suffer.
GETTING BACK TO NORMAL
After the birth your perineum will be rather numb-and if you have had stitches it will feel distinctly sore. The soreness can be relieved by sitting in a warm, by using a rubber ring to sit on when not in the bath and by taking a small dose of pain-killing tablets.
The soreness may make it difficult to pass urine for the first few hours after birth. You will usually manage this, but Occasionally the midwife will need to help you to empty the bladder with the aid of a small soft plastic tube called a catheter.
The thought of having your bowels open, with the stitches in place, may worry you. If so, remember that you will probably not empty your bowels for two or three days after the birth and by then the tissues will be well on the way to being healed and will certainly be much less painful. An aperient (laxative) or a simple suppository is often needed to get things on the move again.
After delivery, vaginal bleeding continues for two or three weeks or sometimes longer. The blood becomes darker and darker and finally brown before drying up completely. The first period will occur towards the find of breastfeeding or in four to six weeks after the birth if you do notat all.
In the first six weeks after delivery your uterus will return to its normal non-pregnant size. You may feel it contracting for some days after delivery, especially when the baby is feeding at the breast. These after-pains are most likely to be noticed by women who have had second or subsequent babies.
Birth is such a happy event that it is hard to understand why some mothers becomeafterwards. However, nervous strain coupled with anxiety about the ability to cope with the new problems presented by the baby, result in some women becoming depressed two or three days after delivery.
This reaction is quite normal and in the great majority of cases passes quickly. Too many visitors and over-tiredness from lack of sleep make the situation worse, but for most women any slightgoes within a day or two without treatment. If it persists beyond this time expert medical help will be needed. In hospital, doctors will be on the lookout for any prolonged unhappiness. If when you get home you, or your husband, or any member of your family, think you are depressed go and see your general practitioner.