Labour and birth. (Birthing in the '90s: part 2)(includes related article on breech birth)

Birthing in the '90s

After nine months of intrauterine development, the fetus finally emerges to greet its parents as a newborn child. Where and how to give birth is an individual choice. While there are many birthing or "lying-in" centres in the U.S. - and calls for similar facilities here - at present, most Canadian births take place in hospital a method favoured by physicians because of instant access to services and equipment.

Amid mounting criticism of "medicalized" childbirth, most hospitals now try to mute the clinical surroundings and provide a softer, friendlier birthing atmosphere. Some hospitals have set up birthing units that simulate the cosy decor of a home environment. "Walkabouts" during first-stage labour are widely promoted - to aid uterine contractions. Breastfeeding is encouraged, and many newborns "room in" around the clock to help get breasffeeding off to a good start.

"At the McMaster Medical Centre," says one obstetrician, "nurses now do much of the first-stage labour care. We've long ago stopped routine enemas and use of stirrups (except in problem births). Instead of the flat-on-the-back delivery position, with the mother working against gravity to push the baby out, women are encouraged to give birth in any chosen position - sitting, squatting or even standing - with the father sometimes cutting the cord (if he wants to)." Mothers are often discharged 24 to 48 hours after birth, if all goes well. Shorter maternity stays reduce the risk of infection, enhance family closeness and are cheaper. However, the shorter stay sometimes means that new mothers leave hospital without learning much about newborn care or breastfeeding.

The three stages of labour

The process that triggers labour is not yet fully understood. The first stage begins as the uterus contracts and the cervix, or neck of the uterus, begins to open. The mucus plug that fills the cervix is dislodged as the "show" - a small pinkish blob-that often heralds the start of labour, but may precede it by several days.

The first stage of labour usually lasts 12-18 or more hours in first-time mothers, and less, perhaps only 4-6 hours, in subsequent births. The fetal heart rate is checked regularly-babies at risk may be electronically monitored throughout labour - and the mother is occasionally examined internally to see how labour is progressing. There's a gradual increase in the frequency, strength and duration of uterine contractions which feel somewhat like very strong menstrual cramps. The contractions dilate the cervix, ultimately to 10 centimetres (about four inches) - wide enough to let the baby's head through. The sac that holds the water or amniotic fluid usually ruptures before full dilatation, towards the end of the first stage, but …