A Walk to Beautiful

Anatomy of Childbirth

When a mother brings a baby into the world, it should always be a joyous occasion. In developed nations like the United States, it usually is. But in developing countries, particularly in poor villages far from proper medical care, childbirth can be fraught with life-threatening hazards. The World Health Organization estimates that roughly 529,000 women die each year from problems related to childbirth, and the number of babies that are stillborn is even higher. In this feature, follow the stages of normal labor and delivery, and learn about potential problems that can arise as well as treatments used to cope with them.—Rima Chaddha

Note: This feature is not meant to be comprehensive. For more complete details on the birthing process, please see the National Institute of Health's MedlinePlus: Childbirth.

Stage 1: Active labor

Duration: Usually up to 10 hours

Birth diagram 1

The process
Under normal conditions, a mother is pregnant for about 38 weeks before entering labor, the process of delivering her baby. As labor begins, the mother's body produces large quantities of the hormone oxytocin, which causes the muscles in her uterus to contract. When contractions are about five minutes apart and the cervix, the baby's passageway out of the uterus, has opened to a diameter of about four centimeters (1.5 inches), the mother has entered what doctors call "active labor." During this stage, the cervix gradually becomes shorter as it continues to open. Eventually, it dilates to around 10 centimeters (four inches), which is when the baby's head begins its descent from the uterus.

Some risks
In some cases, labor can slow down or even stop completely, especially if the mother is delivering her first child. In the developing world, where access to adequate medical care is often limited, women can sometimes be in labor for days. If there is an obstruction—if the baby is too large to descend through the pelvis or if the mother's cervix does not open all the way, for example—the baby's head can place so much pressure on the uterine wall bordering the bladder or rectum that blood cannot get to that tissue. If it lasts long enough, this pressure can cause the tissue to die and small holes called fistulas to form. About 9,000 women develop fistulas each year in Ethiopia alone.

Treatment options
If labor is not progressing normally, doctors or midwives may intervene to augment or induce labor, sometimes by giving the mother intravenous synthetic oxytocin or by applying a hormonal gel directly to the cervix to encourage it to open. Usually the mother's "water" has already broken—that is, the amniotic sac of fluid surrounding the baby has ruptured. But if it hasn't, the caregivers may puncture the sac manually to help the labor progress. In secluded parts of the developing world, such treatments are often not available, nor is the relatively straightforward surgery needed to correct fistulas, which could result from inadequate medical care. (See "Second Chances" for more on fistula surgery and its enormous benefits.)

Stage 2: Delivery

Duration: 20 minutes to 2 hours

Birth diagram 2

The process
Stage Two begins when the cervix is fully dilated and ends with the delivery of the baby. At the beginning of this stage, also called the "pushing stage," the baby's head moves through the opening of the pelvis. By complying with the natural urge to push, the mother helps the infant into the world. But if the mother does not experience the need to push, a possible result of having received an epidural, an injection of anesthetic to help ease the discomfort of labor, doctors or nurses will coach her through this process.

Some risks
In developing nations, where many women are physically small from malnourishment yet whose full-term fetuses may be of normal size, vaginal birth can sometimes prove all but impossible. Without the option of cesarean (surgical) birth, a too-small pelvis is likely to result in infant and sometimes maternal death. Other risks to the infant during both labor and delivery can include the early detachment of the placenta or damage to the umbilical cord, which together supply the fetus with its oxygen and nutrients.

Treatment options
Even in developed nations, where nutrition is typically adequate, some women possess smaller-than-average pelvises. When the fetus is too large to be delivered vaginally, doctors will perform a cesarean section to surgically remove the infant from the womb. Cesareans may also be performed if other complications arise to make vaginal birth too risky. Tragically, such emergency surgery is often not an option in remote villages in the developing world.

Stage 3: Post-delivery

Duration: 10­-30 minutes

Birth diagram 3

The process
Typically within 15 minutes of the baby's delivery and after doctors have cut the umbilical cord, the placenta is expelled from the uterus, usually after a few more pushes from the mother. Since the placenta developed during pregnancy specifically to deliver nutrients and oxygen to the baby, the mother no longer needs it.

Some risks
During childbirth, mothers usually lose less than 20 ounces of blood, but women lacking proper medical care will often lose far more. In fact, postpartum hemorrhage, or excessive bleeding after delivery, is the leading cause of maternal death in developing countries. The second leading cause is sepsis, or an infection of the blood, which can occur at any time during delivery. Altogether, one in every 2,500 mothers worldwide dies each year of childbirth-related causes. (The developed world sees far fewer deaths; that figure in the United States, for instance, is one in every 10,000 mothers.)

Treatment options
Studies have found that the hormone oxytocin can aid in preventing postpartum hemorrhaging. While women produce the chemical naturally, doctors will sometimes administer synthetic oxytocin as needed. Breastfeeding also triggers the release of oxytocin—the chemical is associated with bonding in humans, which helps explain the particularly strong bond between mothers and their children. Cases of sepsis are rare in developed nations, where sanitary conditions in hospitals have greatly improved over the past century. When an infection does occur, a dosage of antibiotics can help fight it.


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