Vaginal Delivery

Choosing a vaginal delivery

Every delivery is as unique and individual as each mother and infant. In addition, women may have completely different experiences with each new labour and delivery. Giving birth is a life-changing event that will leave an impression on you for the rest of your life.

Of course, you’ll want this to be a positive experience and to know what to expect. Here’s some information about what may happen as you’re delivering your baby.

Birth plans: Should you have one?

As you approach the latter part of your pregnancy, you may want to write a birth plan. Consider carefully what’s important to you. The overall goal is a healthy mother and baby.

The birth plan outlines your ideal birth and may need to be adjusted as the actual situation unfolds.

Talk with your partner and decide who you want to have attending the birth. Some couples feel that this is a private time and prefer not to have others present.

A birth plan may include other subjects like pain relief during labour, delivery positions, and more.

Early phases of labour

Amniotic sac

The amniotic sac is the fluid-filled membrane surrounding your baby. This sac will almost always rupture before the baby is born, though in some cases it remains intact until delivery. When it ruptures, it’s often described as your “water breaking.”

In most cases, your water will break before you go into labour or at the very beginning of labour. Most women experience their water breaking as a gush of fluid.

It should be clear and odourless — if it’s yellow, green, or brown, contact your doctor right away.

Contractions

Contractions are the tightening and releasing of your uterus. These motions will eventually help your baby push through the cervix. Contractions can feel like heavy cramping or pressure that begins in your back and moves to the front.

Contractions aren’t a reliable indicator of labour. You might already have felt Braxton-Hicks contractions, which may have started as early as your second trimester.

A general rule is that when you are having contractions that last for a minute, are five minutes apart, and have been so for an hour, you’re in true labour.

Cervix dilation

The cervix is the lowest part of the uterus that opens into the vagina. The cervix is a tubular structure approximately 3 to 4 centimetres in length with a passage that connects the uterine cavity to the vagina.

During labour, the role of the cervix must change from maintaining the pregnancy (by keeping the uterus closed) to facilitating delivery of the baby (by dilating, or opening, enough to allow the baby through).

The fundamental changes that occur near the end of the pregnancy result in a softening of the cervical tissue and thinning of the cervix, both of which help prepare the cervix. True, active labour is considered to be underway when the cervix is dilated 3 centimetres or more.

Labour and delivery

Eventually, the cervical canal must open until the cervical opening itself has reached 10 centimetres in diameter and the baby is able to pass into the birth canal.

As the baby enters the vagina, your skin and muscles stretch. The labia and perineum (the area between the vagina and the rectum) eventually reach a point of maximum stretching. At this point, the skin may feel like it’s burning.

Some childbirth educators call this the ring of fire because of the burning sensation felt as the mother’s tissues stretch around the baby’s head. At this time, your healthcare provider may decide to perform an episiotomy.

You may or may not feel the episiotomy because the skin and muscles can lose sensation due to how tightly they’re stretched.

The birth

As the baby’s head emerges, there is a great relief from the pressure, although you’ll probably still feel some discomfort.Your nurse or doctor will ask you to stop pushing momentarily while the baby’s mouth and nose are suctioned to clear out amniotic fluid and mucus. It’s important to do this before the baby starts to breathe and cry.Usually the doctor will rotate the baby’s head a quarter of a turn to be in alignment with the baby’s body, which is still inside you. You’ll then be asked to begin pushing again to deliver the shoulders.

The top shoulder comes first and then the lower shoulder.Then, with one last push, you deliver your baby!

Delivering the placenta

The placenta and the amniotic sac that supported and protected the baby for nine months are still in the uterus after the delivery. These need to be delivered, and this can happen spontaneously, or it may take as long as half an hour. Your midwife or doctor may rub your abdomen below your belly button to help tighten the uterus and loosen the placenta.

Your uterus is now about the size of a large grapefruit. You may need to push to help deliver the placenta. You may feel some pressure as the placenta is expelled but not nearly as much pressure as when the baby was born.

Your healthcare provider will inspect the delivered placenta to make sure it was delivered in full. On rare occasions, some of the placenta doesn’t release and may remain adhered to the wall of the uterus.

If this happens, your provider will reach into your uterus to remove the leftover pieces in order to prevent heavy bleeding that can result from a torn placenta. If you would like to see the placenta, please ask. Usually, they’ll be happy to show you.

Pain and other sensations during delivery

If you opt for a natural childbirth

If you decide to have a natural childbirth (delivery without pain medication), you’ll feel all types of sensations. The two sensations you’ll experience the most are pain and pressure. When you begin to push, some of the pressure will be relieved.

As the baby descends into the birth canal, though, you’ll go from experiencing pressure only during the contractions to experiencing constant and increasing pressure. It will feel something like a strong urge to have a bowel movement as the baby presses down on those same nerves.

If you choose to have an epidural

If you have an epidural, what you feel during labour will depend on the effectiveness of the epidural block. If the medication properly deadens the nerves, you may not feel anything. If it’s moderately effective, you may feel some pressure.

If it’s mildly so, you’ll feel pressure that may or may not be uncomfortable to you. It depends on how well you tolerate pressure sensations. You may not feel the stretching of the vagina, and you probably won’t feel an episiotomy.

Possible tearing

Although significant injuries aren’t common, during the dilation process, the cervix may tear and ultimately require repair.

Vaginal tissues are soft and flexible, but if delivery occurs rapidly or with excessive force, those tissues can tear.

In most cases, lacerations are minor and easily repaired. Occasionally, they may be more serious and result in longer-term problems.

Normal labour and delivery often result in injury to the vagina and/or cervix. Up to 70 percent of women having their first baby will have an episiotomy or some sort of vaginal tear requiring repair.

Fortunately, the vagina and cervix have a rich blood supply. That’s why injuries in these areas heal quickly and leave little or no scarring that could result in long-term problems.

The outlook

It’s not impossible to prepare yourself for labour and delivery, but it’s a famously unpredictable process. Understanding the timeline and hearing about other mothers’ experiences can go a long way to making childbirth less mysterious.

Many expectant mothers find it helpful to write out a birth plan with their partner and share it with their medical team. If you do create a plan, be prepared to change your mind if the necessity arises. Remember that your goal is to have a healthy baby and a healthy, positive experience.

How to Treat Vaginal Prolapse

Most vaginal prolapses will gradually worsen over time and can only be fully corrected with surgery. However, the type of treatment that is appropriate to treat a vaginal prolapse depends on factors such as the cause and severity of the prolapse, whether the woman is sexually active, her age and overall medical status, her desire for future childbearing, and her personal preference.

• Nonsurgical options may be most appropriate for women who are not sexually active, cannot undergo surgery because of medical reasons, or experience few or no symptoms associated with the condition.

• Surgical repair is the treatment option that most sexually active women who develop a vaginal prolapse choose because the procedure is usually effective and durable.

Vaginal Prolapse Self-Care at Home

Treatments at home for vaginal prolapse.

Activity modification: For a vaginal prolapse that causes minor or no symptoms, the doctor may recommend activity modification such as avoiding heavy lifting or straining.

Pessary: A pessary is a small device, usually made of soft plastic or rubber, that is placed within the vagina for support. Pessaries come in many different varieties. This nonsurgical treatment option may be the most appropriate for women who are not sexually active, cannot have surgery for medical reasons or because of advanced age, or plan to have surgery but need a temporary nonsurgical option until surgery can be performed (for example, women who are pregnant or in poor health). Pessaries must be removed and cleaned at regular intervals to prevent infection or erosion into the vaginal walls. Some pessaries are designed to allow the woman to do this herself. A doctor must remove and clean other types. Oestrogen cream is commonly used along with a pessary to help prevent infection and vaginal wall erosion. Some women find that pessaries are uncomfortable or that they easily fall out or that they cannot be retained (i.e., they fall out).

Kegel exercises: These are exercises used to tighten the muscles of the pelvic floor. Kegel exercises can be tried to treat mild-to-moderate cases of vaginal prolapse or to supplement other treatments for prolapses that are more serious.

Vaginal Prolapse Medical Treatment

Vaginal Prolapse Medications

Oestrogen replacement therapy may be used to help the body strengthen the muscles in and around the vagina. Oestrogen replacement therapy may be contraindicated (such as in a people with certain types of cancer) and has been associated with certain health risks including increased risk of blood clots and stroke, particularly in older postmenopausal women. Women’s bodies cease producing oestrogen naturally after menopause, and the muscles of the vagina may weaken as a result.

In mild cases of vaginal prolapse, oestrogen may be prescribed in an attempt to reverse vaginal prolapse symptoms, such as vaginal weakening and incontinence. For more severe prolapses, oestrogen replacement therapy may be used along with other types of treatmenT.

Vaginal Prolapse Surgery and Recovery

Many women with a vaginal prolapse may benefit from oestrogen replacement therapy. Oestrogen helps strengthen and maintain muscles in the vagina. As with hormone therapy for other indications, the benefits and risks of oestrogen therapy must be weighed for each individual patient. A generalized weakness of the vaginal muscles and ligaments is much more likely to develop than are isolated defects. If a woman develops symptoms of one type of vaginal prolapse, she is likely to have or develop other types as well. Therefore, a thorough physical examination is necessary for the surgeon to detail what surgical steps are necessary to correct the vaginal prolapse completely. The typical surgical strategy is to correct all vaginal weaknesses at one time.

Surgery is usually performed while the woman is under general anaesthesia. Some women receive a spinal or epidural. The type of anaesthesia given usually depends on the anticipated length of the surgical procedure. Laparoscopic surgery is a minimally invasive surgical procedure that involves slender instruments and advanced camera systems. This surgical technique is becoming more common for securing the vaginal vault after a hysterectomy and correcting some types of vaginal prolapse such as enteroceles or uterine prolapses.

Vaginal vault prolapse: This is a defect that occurs high in the vagina, so it may be approached surgically through the vagina or abdomen. Generally, the abdomen is the entry of choice for a severe vaginal vault prolapse. This corrective surgical procedure usually involves a technique called a vaginal vault suspension, in which the surgeon attaches the vagina to strong tissue in the pelvis or to a bone called the sacrum, which is located at the base of the spine.

Prolapsed uterus: For women who are postmenopausal or do not want to have more children, a prolapsed uterus is usually corrected with a hysterectomy. The common approach for this procedure is through the vagina.

Cystocele and rectocele: These are usually corrected through the vagina. Typically, the surgeon makes an incision in the vaginal wall and pushes up the organ. The surgeon then reinforces the tissues beneath the vaginal wall to restore the organ to its normal position. Any excess tissue is then removed, and the vaginal wall is closed. On occasion, the surgeon may elect to use a surgical procedure called a laparoscopic bladder suspension, or modified Burch procedure, to correct a cystocele. If urinary incontinence is present, the surgeon may need to support the urethra (bladder neck suspension).

Women who undergo surgery for vaginal prolapse repair should normally expect to spend 2-4 days in the hospital depending on the type and extent of the surgical. After surgery, women are usually advised to avoid heavy lifting for approximately 6-9 weeks. After surgery, most women can expect to return to a normal level of activity after 3 months. A woman undergoing treatment should schedule follow-up visits with her doctor to evaluate progress. Pessaries need to be removed and cleaned at regular intervals to prevent infection.

Alternative Therapy for Vaginal Prolapse

Physical therapy such as electrical stimulation and biofeedback may be used to help strengthen the muscles in the pelvis.

Electrical stimulation: A doctor can apply a probe to targeted muscles within the vagina or on the pelvic floor. The probe is hooked up to a device that measures and delivers small electrical currents that contract the muscles. These contractions help strengthen the muscles. A less intrusive type of electrical stimulation is available that magnetically stimulates the nerve that supplies the pelvic floor muscles from outside the body. This activates these and may help treat incontinence.

Biofeedback: A sensor is used to monitor muscle activity in the vagina and on the pelvic floor. The doctor can recommend exercises that the woman can use to strengthen these muscles. In some cases, these exercises may help strengthen the muscles enough to reverse or relieve some symptoms related to vaginal prolapse. The sensor can monitor the muscular contractions during the exercises, and the doctor may be able to determine if the targeted muscles would benefit from the exercises.

Vaginal Prolapse Follow-up

After surgery, most women can expect to return to a normal level of activity after 3 months.

A woman undergoing treatment should schedule follow-up visits with her doctor to evaluate progress. Pessaries need to be removed and cleaned at regular intervals to prevent infection.

Vaginal Prolapse Prognosis and Cure

• Vaginal prolapse is rarely a life-threatening condition.

• Some mild cases can be treated without surgery.

• More severe cases of vaginal prolapse will likely require surgery for correction.

• Vaginal prolapse surgery is generally successful, but recurrence remains an issue.

Prevention of Vaginal Prolapse

Women at risk for vaginal prolapse (including those who have had corrective surgery) should, if possible, avoid heavy lifting or any activity that increases pressure within the abdominal cavity. Obesity puts extra stress on the muscles and ligaments within the pelvis and vagina. Weight reduction can help prevent this condition from developing or recurring.

Symptoms of this condition

A pessary is a removable device that is inserted into the vagina (birth canal) to provide support in the area of a prolapse. In most cases, a pessary is used when a woman who has a prolapse wants to avoid surgery or has medical problems that make surgery too risky.Many tumours of the colon develop as a benign (noncancerous) growth before becoming malignant (cancerous).

A colonoscopy is first done to detect the presence of any polyps. If any are detected, a polypectomy is performed, and the tissue is removed. The tissue will be examined to determine if the growths are cancerous, precancerous, or benign. This can prevent colon cancer.

Polyps aren’t often associated with any symptoms at all. However, larger polyps may cause:

• rectal bleeding

• abdominal pain

• bowel irregularities

A polypectomy would help relieve these symptoms as well. This procedure is required any time when polyps are discovered during a colonoscopy.Symptoms most commonly associated with a vaginal prolapse depend on the type of vaginal prolapse present. The most common symptom of all types of vaginal prolapse is the sensation that tissues or structures in the vagina are out of place. Some women describe the feeling as “something coming down” or as a dragging sensation. This may involve a protrusion or pressure in the area of the sensation. Generally, the more advanced the prolapse, the more severe the symptoms.

General symptoms that may be seen with of all types of vaginal prolapse include pressure in the vagina or pelvis, painful intercourse (dyspareunia), a mass at the opening of the vagina, a decrease in pain or pressure when the woman lies down, and recurrent urinary tract infections.

Symptoms specific to certain types of vaginal prolapse include:

• Difficulty emptying bowel: This may be indicative of an enterocele, vaginal vault prolapse, or rectocele. A woman with difficulty emptying her bowel may find that she needs to place her fingers on the back wall of the vagina to help evacuate her bowel completely. This is referred to as splinting.

• Difficulty emptying bladder: This may be secondary to a cystocele, urethrocele, enterocele, vaginal vault prolapse, or prolapsed uterus.

• Constipation: This is the most common symptom of a rectocele.

• Urinary stress incontinence: This is a common symptom often seen in combination with a cystocele.

• Pain that increases during long periods of standing: This may be indicative of an enterocele, vaginal vault prolapse, or prolapsed uterus.

• Protrusion of tissue at the back wall of the vagina: This is a common symptom of a rectocele.

• Protrusion of tissue at the front wall of the vagina: This is a common symptom of a cystocele or urethrocele.

• Enlarged, wide, and gaping vaginal opening: This is a physical finding frequently seen in combination with a vaginal vault prolapse.

Some women who develop a vaginal prolapse do not experience symptoms.