So, what is the normal delivery?
- Spontaneous vaginal delivery is a physiological process. It can be defined as delivery of baby with vertex presentation through vaginal canal of the mother without any injury of infant and the mother, after labor pain spontaneously occur at gestational age of 38-42 weeks.
- In spontaneous vaginal delivery, placenta and membranes are also spontaneously removed out the uterine cavity, after baby is delivered.
- Different maneuvers and incision, also known as episiotomy, can be applied in order to facilitate delivery of the baby.
Who is qualified for supervising and intervening spontaneous vaginal delivery?
- In general, spontaneous vaginal delivery can be planned if there is no incompatibility between presentation of fetus and maternal pelvis, heartbeats of baby are normal, and if there is no any heart disease, bleeding and cord prolapsus as well as if body weight of the fetus is within acceptable ranges.
When is spontaneous vaginal delivery contraindicated?
- In pregnancies where pelvis is narrow such that it does not allow delivery or if there is incompatibility between the head of baby and pelvic bone;
- Positional disorders such as breech and shoulder presentations;
- In multiple pregnancy like twins and triplets;
- In case the baby is big (macrosomia) or premature;
- In case of high blood pressure such as preeclampsia or eclampsia;
- In cases of big babies (especially secondary to diabetes);
- In case the placenta obstructs cervical canal or it is detached early before delivery, possibly resulting with massive bleeding;
- Spontaneous vaginal delivery will be contraindicated at all conditions that indicate distress at part of baby and that requires urgent intervention (heartbeat disorders, cord prolapsus etc.);
- If there is a peripheral retinal thinning, which is accompanied by high myopia, or if the patient has history of retinal break or retinal detachment;
Can caesarian be an alternative for spontaneous
- Caesarian and spontaneous vaginal delivery are different from each other. Each delivery method has specific advantageous and disadvantageous. What should be known is that caesarian is not an alternative to spontaneous vaginal delivery and that it is an ‘operation’ which can be chosen under medically necessary conditions for mother and baby.
What are the advantageous of spontaneous vaginal delivery?
- Spontaneous vaginal delivery is a natural and physiological process. The mother can return back to normal life and begin her daily activities soon after the delivery.
- Mother can eat everything she desires, can do care of her baby and feed the baby in a few hours after normal delivery.
- Relationship and communication between mother and baby can be established simply and easily. This is very important for the baby in order to facilitate attachment to mother and growth and development.
- There is no limitation on number of pregnancies, since there is no damage and incision scar in the womb of the mother, who gave a birth via spontaneous vaginal delivery. It does not bear a risk for abdominal operations she might have in future life.
- As patient can be soon discharged after spontaneous vaginal delivery, time of exposure to hospital infections (nosocomial infection) will be shorter. This is important for both human health and financial aspects.
- ‘Maternal death rate during delivery’ is lower in normal delivery in comparison with the caesarian.
- Conditions such as infection, bleeding and pain in normal delivery are infrequently experienced after spontaneous vaginal delivery in comparison with the caesarian section.
- For spontaneous vaginal delivery, babies are more infrequently transferred to intensive care units, in comparison with caesarian section (but this finding can be secondary to the fact that risky deliveries are generally performed via caesarian method).
- For spontaneous vaginal delivery, babies are exposed to compression while they are passing through cervical canal, the amnion fluid in the lungs can be removed out easier. Thus, the risk of respiratory problems is less.
- It is observed that the babies born via normal delivery have better skills like adhering to mother’s breasts and sucking.
What are the disadvantageous of spontaneous vaginal delivery?
- Delivery can begin at any time of the day in any day. It is impossible to plan date and time of the delivery.
- Since some difficulties may occur along course of labor or during delivery (labor may decelerate or stop, and in utero fetus may suffer from distress), it is possible to suddenly decide starting caesarean section. Prolonged labor is associated with longer hypoxia periods and therefore, it may lead to cerebral dysfunction(s).
- Vaginal injury and tear/laceration may occur during delivery. Troubles may occur, such as fecal incontinence, secondary to tears and injuries.
- Infection, hematoma and detachment of incision site can be seen at episiotomy site after spontaneous vaginal delivery. Patient will not feel comfortable at sitting position for a while.
- Problems such as prolapsed urine bladder and urinary incontinence can be observed over time following spontaneous vaginal delivery.
- Various conditions can be observed secondary to insufficient oxygenation or nerve injury, when baby is entrapped in delivery canal or exposed to labor trauma, although such conditions are rare.
What are concerns of mothers about spontaneous
- The labor pain,
- Length of the delivery and its unpredictability,
- Fetal and neonatal problems,
- Influences of negative attitudes of relatives for spontaneous vaginal delivery,
- Possibility of episiotomy (incision made on vaginal wall during delivery),
- Inability to communicate with physician during labor.
Considering all of these conditions, the expectant mothers should be informed about the spontaneous vaginal delivery, starting from the first date of gestation, and all question marks in their minds should be resolved and they should be encouraged for exercises that may facilitate spontaneous vaginal delivery. They should be duly informed that there are very effective methods available for alleviating labor pain, such as epidural analgesia in the field of anesthesia, and, if necessary, the expectant mothers should be directed to anesthesiologists to discuss this matter. It should be explained that spontaneous vaginal delivery is a natural and physiological process, and caesarian section can only be chosen for overcoming medical problems that mother and baby may face.