What are the steps involved in birthing a child?

Steps to Birthing a Child

The birthing process involves several distinct stages that progress from the onset of labor through delivery of the baby and placenta, with specific interventions at each stage to ensure optimal maternal and neonatal outcomes.

First Stage of Labor: Early Labor to Complete Dilation

Early Labor Phase

• Regular contractions begin, typically lasting 30-60 seconds with 5-20 minute intervals
• Cervical dilation progresses from 0-6 cm
• Membranes may rupture spontaneously or remain intact
• Monitor maternal vital signs and fetal heart rate (FHR) periodically
• Position changes and ambulation are encouraged if appropriate

Active Labor Phase

• Contractions become stronger, lasting 45-60 seconds with 2-5 minute intervals
• Cervical dilation progresses from 6-10 cm
• Continuous electronic fetal monitoring (EFM) or structured intermittent auscultation should be implemented 1
• Monitor FHR every 15-30 minutes in first stage and every 5 minutes during second stage if using intermittent auscultation 1
• Assess contractions for frequency, duration, and intensity
• Evaluate baseline FHR, variability, accelerations, and decelerations 1

Second Stage: Complete Dilation to Birth

• Begins when cervix is fully dilated (10 cm) and ends with delivery of baby
• Characterized by maternal urge to push and descent of fetal head
• Continue monitoring FHR every 5 minutes during pushing 1
• Position mother for optimal pushing (semi-recumbent, side-lying, or squatting)
• Support perineum during crowning to prevent tears
• Monitor for signs of fetal distress requiring intervention:
  • Category III tracings (absent baseline variability with recurrent late/variable decelerations or bradycardia) require immediate intervention 1
  • Category II tracings require increased monitoring and possible interventions 1

Third Stage: Delivery of Placenta

• Begins after birth of baby and ends with delivery of placenta
• Active management includes:
  • Administration of oxytocin (10 units IM or IV) after delivery of anterior shoulder or immediately after birth 2
  • Controlled cord traction with counter-pressure on uterus
  • Uterine massage after placenta delivery to prevent hemorrhage
• Delayed cord clamping for at least 1 minute in term infants and at least 30 seconds in preterm infants is recommended 1
• Inspect placenta for completeness to ensure no retained fragments

Immediate Newborn Care

• Assess Apgar scores at 1,5, and 10 minutes after delivery 1
• Approximately 85% of term babies initiate spontaneous breathing within 10-30 seconds of birth 1, 3
• Maintain newborn temperature between 36.5°C and 37.5°C 1, 3
• Dry the infant immediately and cover the head to reduce heat loss 1
• Clear secretions only if they obstruct the airway; routine suctioning is not recommended 1, 3
• Initiate skin-to-skin contact between mother and newborn as soon as possible 1
• Support early breastfeeding within the first hour after birth 1

Fourth Stage: Recovery Period (First 1-2 Hours)

• Close monitoring of maternal vital signs and bleeding
• Assessment of uterine tone and lochia
• Continuous monitoring of mother-infant dyad, especially during the first 2 hours when 73% of sudden unexpected postnatal collapse events occur 3
• Support breastfeeding initiation
• Monitor newborn's respirations, activity, color, and tone 3

Common Complications and Management

Abnormal FHR Patterns

• For Category III tracings: discontinue oxytocin, change maternal position, administer oxygen, increase IV fluids, and prepare for expedited delivery 1
• For Category II tracings: consider discontinuing oxytocin, change maternal position, and monitor closely 1

Postpartum Hemorrhage

• For uterine atony: administer additional oxytocin (10-40 units in 1000 mL IV fluid) 2
• Perform uterine massage
• Consider additional uterotonics if bleeding persists

Important Considerations

• Continuous support during labor improves outcomes
• Avoid routine interventions without clear medical indications
• Position changes during labor can facilitate fetal descent and reduce pain
• Maintain adequate hydration and nutrition as appropriate
• Monitor for signs of maternal exhaustion or distress

Remember that while these steps outline the typical progression of childbirth, each birth is unique and may require individualized care based on maternal and fetal factors.