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Anatomy and Physiology of Childbirth

 Childbearing Classic the Series' - with Illustrations by Jan Ruby Baird.

Childbearing Classic the Series' - with Illustrations by Jan Ruby Baird.

Anatomy and Physiology of Childbirth

Women, miraculously made, are a perfectly designed vessel to bring a baby into the world.

Each body part is created for a purpose and specifically placed where and when it is so babies can be born.

It’s a dance between feminine bodies and their babies… each knowing exactly what they are supposed to do. I empower women to get their minds out of the way, and learn to work the brilliant natural process.

When given the opportunity to flourish… and to rise up to the moment…. A woman’s body has the capacity deliver almost every time.

Watch this video where CNM Anne Margolis talks about the anatomy and physiology of childbirth and what to expect physically and emotionally in all its stages. Charts used are from 'Childbearing Classic the Series' - with Illustrations by Jan Ruby Baird.

What is my body doing during childbirth?

During pregnancy, you’re looking at what your appearance is on the outside.  You see your skin stretching, meeting the physical space of encasing a growing being.

Most of the conversation is external, comments of size, possible stretch marks.

Just behind this wall of protection, lives a breathing, vibrant and meticulous ecosystem.

Swimming in a double wrapped membranous bag of amniotic fluid, lives your baby. Baby is encased in the womb, which is surrounded by the uterus. The placenta connects to the baby through the umbilical cord. All of baby’s nutrients are delivered to him or her through this cord, which also removes waste.

5 Things That Change With Pregnancy and Labor:

·         Through pregnancy, your uterus grows as your baby grows.

·         Moving into labor, your cervix changes. It is firm, thick, long, and closed during pregnancy, and during labor, it softens, thins, shortens and opens.

·         As your cervix dilates, you may release a mucus plug. This could, but not always, allow for some blood to show.

·         Your vaginal canal of muscles is stretched, holding space for your baby’s head to come through.

·         Your pelvis, which is 3 bones connected by ligaments, can stretch. It can get smaller or larger depending on your position. When we talk about station, it’s in reference to whether the baby’s head is engaged in the mid pelvis, or how many centimeters it is above or below it.

Movement and position during labor is important.

Lying down gives the pelvis less room to allow for the baby’s head. Squatting, kneeling, hands and knees, lunging, standing, walking, or dancing open up the pelvis and helps baby to navigate his or her way down.

 Photo by @seasonaldoc

Photo by @seasonaldoc

What does it mean if my water breaks?

Since your baby is double wrapped, in two bags of amniotic fluid, the first bag can break, sometimes in early labor, which releases no more than a few tablespoons of fluid that can make up to a pancake sized stain on your underwear. This could prompt thoughts and concerns about ‘ruptured membranes’ - your main bag of fluid breaking - and may lead to unnecessary interventions to prevent infection of risk, especially when there is a prolonged period of time between this and birth – when in actuality your water did not break.

On the contrary, this tiny gush of fluid ONCE, is usually a sign that labor is beginning, and only the first bag has broken. As long as there are no signs on evaluation, and no continual flow of fluid, the main bag is often still intact and will break during later stages of labor. It’s imperative to check with your health care provider if you have concerns over any flow of fluid to confirm what is going on.

How is my baby’s head able to make it through such a small area?

The miraculous design of a baby’s body, includes their skull, which is not fused yet… the soft spots (fontanels- between certain suture lines) on it are there because these bones are not yet closed together, so your baby’s head can mold to accommodate the pelvis. And women’s birth canals can stretch and expand to accommodate baby.

What is happening to my body before I go into labor?

Every body is different but there are some general signs.

Pre-labor could last a few weeks. Here are some signs labor could be approaching:

·         A dropping sensation as baby descends lower in the pelvis

·         More pelvic pressure

·         Trips to the bathroom more frequently

·         Easier to breathe

·         Less heartburn

·         More sensation of Braxton Hicks – as the uterine muscles warm up and ripen the cervix

·         Bowel movements become more frequent and loose

·         Excited surge of energy

·          “Nesting” – feeling the urge to clean, organize and prepare

I am humbled by the many various and unique ways women start labor!

Just as women come in so many different shapes, sizes and forms, labor is just the same.

Physical and Emotional Sensations

In general, when you start to feel a regular pattern of sensations of uterine tightening, we would consider that the onset of labor. These regular sensations, are commonly referred to as contractions, but that is a limited term, and that can create a sense of tension.

The top of the uterus does contract, so the bottom shortens, thins and expands. The sensations come and go, build to a peak and then gradually lessen as waves, with no such sensation in between, like the calm waters between the waves.  SO, let’s use the word wave instead – some mamas prefer surges, or make up their own affirmative positive term, like hugs to the baby.

They are different than Braxton Hicks.  

Labor waves tend to be felt low in the pelvis, and go around the back of the body.  They come in a pattern. This means they keep coming. Maybe one comes in 5 minutes, another in 10, then another in 7, and then another in 20… it becomes a pattern when they persist. Just like they can range in interval, they range in duration – lasting in the early stages from 20-60 seconds on average. And they feel different.

How will I feel at the onset of labor?

Early waves can feel like menstrual cramping. As they progress, the sensations become more intense, last longer and come more frequently.  They can feel like a tightening with pressure down low in your belly and sometimes low back. You’ll be able to have a conversation and go about your day. You’ll be coping well, sociable and excited.

How do I know when I am progressing in labor by how I am feeling?

Waves of the cramping will come more frequently, lasting a little bit longer. They tend to come more consistently, like every 4-6 minutes and last anywhere from 45-75 seconds.

These feel more intense, and you’ll generally not be able to speak through them. Some women will begin to moan, breathe and need to become inwardly focused. When not disturbed, laboring women make natural opiates that lessen sensation of pain and enable them to enter a trance-like state.

Midwife Pam England calls this “labor land.” This trance-like state is important because it takes us out of our thinking brain and more into an instinctual, primal and sensual experience that allows our bodies to do their job of birthing.

As labor progresses, the main bag of amniotic fluid may break. This could result in a large gush of fluid releasing at once, or periodically – either making a large puddle on the floor, soaking through your clothes and surface beneath you, or making a large maxi pad heavy like a babies full diaper after a night’s sleep. There can also be a small amount of normal bleeding, from a few streaks or spotting, to no more than a light period. Some women in transition will belch, vomit, get sweats, feel shaky and restless.

Moving into active labor, a woman needs more support.

Emotions to Consider

When the first stage of labor reaches the final stages, ‘transition’ labor feels most intense – but means progression to pushing out and meeting your baby is coming soon. Labor sensations are coming every few minutes, lasting an average of 60-90 seconds. They are still coming in waves, which rise and fall, with a delicious rest in between.

I encourage women to stay present and know what is common, so you can embrace, rather than fear it.

I like everyone at the birth to know that our birthing mom will experience intense emotions towards the end of labor and that’s normal. So no one will be scared, I reinforce to everyone that she is working hard and she is internally focused.  

It’s important for everyone at the birth to know and understand the items below, and it’s also ok for you to know the signs during this period, as it may help relieve doubt that arises.

A woman in transition may:

·         Lose her ability to cope and feel overwhelmed

·         Doubt her decision to birth in the way she wanted to

·         Want to give up

·         Ask for drugs

·         Curse

·         Panic

·         Think she is dying or that something is really wrong

These are all signs that more support is required.

At this point we bring her back to the present, let her know she is not alone, we reassure her all is well, and remind her we are moving closer to meeting her baby!

This intensity is normal and it’s healthy. It is just part of the process, necessary for the huge transformation that is about to occur.  And in the scheme of things, it does not last that long. To the mama experiencing it, it feels long, but the earlier part of labor, although easier, is usually much longer – up to several days. And in transition we are talking no more than several hours, in the course of a lifespan – around one minute plus, at a time. You can take normal healthy labor sensations for 60-90 seconds with rests in between.

So I actually should NOT push at this point?

This is something I feel very strongly about.

The medical model of care defines active labor when a woman is at least 6 centimeters dilated, and the pushing or second stage when a woman is full dilated. Fully dilated means there is no longer any cervix in front of and encircling the baby’s head.

 Photo by Mary Elliot O'Haire.

Photo by Mary Elliot O'Haire.

This time is not to be spent trying to push before the natural urge is felt, but honored as a resting phase. Often the waves naturally slow down, and there is a sense of calm. Some women sleep to recharge, and wake up to a surge of increased energy needed for pushing. I believe we are to honor this time, and allow our body and baby to do the work they were perfectly designed to do – the vast majority of times. When the natural physiologic process of birth is allowed to progress on its own, the baby will soon lower into the pelvis on its own, and then you may feel a strong instinctual urge to push; that is the actual start of pushing, the second stage of labor, not when your cervix is examined to be fully dilated.

When a woman is told to push as soon as she is fully dilated, especially her first vaginal birth, she will exhaust herself, as the baby is not low enough in the pelvis to create the urge to push. She will have to work longer and harder, as baby is higher, she is working against her body, not with it.  It’s like pushing out a bowel movement when you don’t feel the urge to. Once baby naturally lowers and the laboring mom will have rested, her body creates a natural strong urge to push; it is much easier to wait and use that internal force to do much of the work for you.

I like to honor the resting phase when all is well. It typically lasts several minutes to an hour or more.

Baby will lower him/herself down, and a woman will feel pressure and a powerful urge to push.

Like having a bowel movement, you will know when you have to push your baby out.

Although contractions are not as frequent as they were in the latest part of labor, many women feel a renewed excitement, a renewed determination, become hyper-focused on what is happening and getting the job done.

Baby starts the descent and glimpses of her head may be seen that come and go, as it makes a few steps forward and a little back, before it begins to actually come out. The birth canal opens to accommodate. In a healthy childbirth, the baby’s head emerges and the shoulders and the rest of the body follow more easily.

 Baby's head is emerging. Mama is pushing naturally, working hard, but not suffering. Mama loved her birth. Photo by  @birth_unscripted

Baby's head is emerging. Mama is pushing naturally, working hard, but not suffering. Mama loved her birth. Photo by @birth_unscripted

When does the placenta come out?

The third stage of labor is between the birth of the baby and the birth of the placenta.

When left undisturbed, this stage can last anywhere from 5 minutes to an hour.

This is a sacred time between parents and baby. Everyone is meeting for the first time.

Physically, you’ll know when the placenta needs to come out. Cramping will occur. It’s not like in labor but cramping increases and is accompanied by a gush of blood. It’s common to lose up to 500 ccs of blood or a bit more at birth.

The uterus clamps down and pushes out the placenta. It contains no bones, like a slab of raw meat, so it doesn’t hurt to push out.

The baby takes time to adjust to life outside the womb. She becomes very alert and an unfolding is happening… She is looking around, moving her arms and legs, and eventually starts rooting, sucking and other breastfeeding reflexes.

Women know how to birth their babies and babies know how to be born.

Let me help you not only cope with birth but love your experience no matter where you plan to give birth and despite any challenges you may face! For more info on my online LOVE YOUR BIRTH course click here. I’ve taken everything I’ve learned, trained and supported women with locally for over 20 years in my private practice and I’ve poured all of my love, passion, knowledge and experience into creating something truly special for you - it is an ultimate guide to pregnancy, childbirth, postpartum and beyond!

Learn how to LOVE YOUR BIRTH wherever it is and however it unfolds. I’ve taken everything I’ve learned, trained and supported women with locally for over 20 years in my private practice and I’ve poured all of my love, passion, knowledge and experience into creating something truly special for you and created the LOVE YOUR BIRTH online course. 

 Photo by Megan Hancock Photography

Photo by Megan Hancock Photography

 

Please let me know if you found this information useful! Also, please let me know you have any questions that you’d like to submit for our Ask the Midwife series. And I’d love if you shared this information with anyone you think may benefit!

You are supplying your baby's complete nutrition and hydration requirements, as well as your own. It is difficult to get everything you need even from the best of whole food varied organic diet. Do you need supplements? Here are some of my favorite I recommend to mamas in my practice.

Make your Red Raspberry Leaf and Nettle herbal infusion.....rich in needed nutrients and specifically nourishing for pregnancy, birth and postpartum. Place 1 oz of dried red raspberry leaf, 1 oz of dried nettle leaf in a quart-sized glass canning jar with strainer, fill it with boiling water, cover and steep for at least 2 -4 hours at room temperature. Strain and place in a covered pitcher. You can make it in larger quantities and store in the fridge. For taste, dilute with water or steep for less time (but no less than half an hour), add lemon or lime juice, mint leaves or a teaspoon of honey. Drink 1-4 cups daily hot or cold.