First Semester | ECED36 Infant and Toddler Program Ms. Abby-Gail C.

Encarnacion

Module 2
Birth
Process
Introduction
In the previous module, you learned about the different stages of prenatal development, possible
environmental factors and their effects on the developing embryo or fetus, and the components of good
prenatal care. In the following chapters, you will learn about the stages of labor, methods of delivery,
possible implications of delivery, and the effects of medication during the birth process.

Objectives
At the end of this chapter, it is expected that you will be able to:
▪ describe stages of labor;
▪ compare methods of delivery;
▪ describe possible complications of delivery; and
▪ discuss effects of medication during the birth process.

Instructions
You are given four days to finish reading this module and do the activities, including the pretest and
posttest. Follow the suggested timeline:
Day 1
Chapter I: Stages of Labor

Day 2
Chapter II: Methods of Delivery

Day 3
Chapter III: Possible Implications of Delivery
Chapter IV: Effects of Medication during the Birth Process

Day 4
Quiz

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First Semester | ECED36 Infant and Toddler Program Ms. Abby-Gail C. Encarnacion

Pretest

Write true if the statement is correct. Otherwise, write false.

__________1. During the first stage of labor, contractions help your cervix to thin and begin to open.

__________2. After the birth of your baby, your uterus stops to contract to keep the placenta.

__________3. Nursing right after birth will help your uterus to contract and will decrease the amount of
bleeding.

__________4. When a baby is born through the birth canal of a woman’s body, the delivery is termed
as a natural childbirth.

__________5. In CS, the baby is delivered by opening up the abdomen of the mother and surgically
opening the uterus to remove the baby.

__________6. A special vacuum can also be used in delivery wherein a soft cup is placed on top of the
baby’s head.

__________7. The American Pregnancy Association define prolonged labor as lasting over 10 hours if it
is a first delivery.

__________8. Seven hours of labor can be considered as rapid labor.

__________9. Facing downward is the most common fetal birth position

__________10. Itchy skin may be a side effect of pain medication during the birth process.

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First Semester | ECED36 Infant and Toddler Program Ms. Abby-Gail C. Encarnacion

Pretest Feedback

Write true if the statement is correct. Otherwise, write false.

___true ___1. During the first stage of labor, contractions help your cervix to thin and begin to open.

___false___2. After the birth of your baby, your uterus stops to contract to keep the placenta.

___true ___3. Nursing right after birth will help your uterus to contract and will decrease the amount of
bleeding.

___false___4. When a baby is born through the birth canal of a woman’s body, the delivery is termed
as a natural childbirth.

___true ___5. In CS, the baby is delivered by opening up the abdomen of the mother and surgically
opening the uterus to remove the baby.

___true ___6. A special vacuum can also be used in delivery wherein a soft cup is placed on top of the
baby’s head.

___false___7. The American Pregnancy Association define prolonged labor as lasting over 10 hours if it
is a first delivery.

___false___8. Seven hours of labor can be considered as rapid labor.

___true ___9. Facing downward is the most common fetal birth position

___true ___10. Itchy skin may be a side effect of pain medication during the birth process.

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First Semester | ECED36 Infant and Toddler Program Ms. Abby-Gail C. Encarnacion

In this chapter, the author has written the text as if talking to a pregnant woman i.e. using the pronouns
you/your.

I. Stages of Labor

A. First Stage of Labor

Thinning (effacement) and opening (dilation) of the cervix
During the first stage of labor, contractions help your cervix to thin and begin to open. This is called
effacement and dilation. As your cervix dilates, your health care provider will measure the opening in
centimeters. One centimeter is a little less than half an inch. During this stage, your cervix will widen to
about 10 centimeters. This first stage of labor usually lasts about 12 to 13 hours for a first baby, and 7
to 8 hours for a second child.
The first stage of labor has three parts:
1. Early labor
Your cervix opens to 4 centimeters. You will probably spend most of early labor at home.
Try to keep doing your usual activities. Relax, rest, drink clear fluids, eat light meals if you
want to, and keep track of your contractions. Contractions may go away if you change
activity, but over time they'll get stronger. When you notice a clear change in how frequent,
how strong, and how long your contractions are, and when you can no longer talk during a
contraction, you are probably moving into active labor.
2. Active labor
Your cervix opens from 4 to 7 centimeters. This is when you should head to the hospital.
When you have contractions every 3 to 4 minutes and they each last about 60 seconds, it
often means that your cervix is opening faster (about 1 centimeter per hour). You may not
want to talk as you become more involved in dealing with your contractions. As your labor
progresses, your bag of waters may break, causing a gush of fluid. After the bag of waters
breaks, you can expect your contractions to speed up.
Slow, easy breathing is usually helpful at this time. Focusing on positive, relaxing images or music may
also be helpful. Changing positions, massage, and hot or cold compresses can help you feel better.
Walking, standing, or sitting upright will help labor progress. Relaxing during and between contractions
saves your energy and helps the cervix to open. Many hospitals have whirlpool or soaking tubs that may
help you relax and ease discomfort.
3. Transition to second stage
Your cervix opens from 7 to 10 centimeters. For most women, this is the hardest or most
painful part of labor. This is when your cervix opens to its fullest. Contractions last about 60
to 90 seconds and come every 2 to 3 minutes.
There is very little time to rest and you may feel overwhelmed by the strength of the
contractions. You may feel tired, frustrated, or irritated, and may not want to be touched.
You may feel sweaty, sick to your stomach, shaky, hot, or cold. Although you may find slow,
easy breathing to be most effective throughout labor, you may also find an uneven breathing pattern
most helpful at this time.

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B. Second Stage of Labor

Your baby moves through the birth canal
The second stage of labor begins when the cervix is completely dilated (open), and ends with the birth of
your baby. Contractions push the baby down the birth canal, and you may feel intense pressure, similar
to an urge to have a bowel movement.

Your health care provider may ask you to push with each contraction. The contractions continue to be
strong, but they may spread out a bit and give you time to rest. The length of the second stage depends
on whether or not you've given birth before and how many times, and the position and size of the baby.

The intensity at the end of the first stage of labor will continue in this pushing phase. You may be irritable
during a contraction and alternate between wanting to be touched and talked to, and wanting to be left
alone. It isn't unusual for a woman to grunt or moan when the contractions reach their peak.

C. Third Stage of Labor

Afterbirth
After the birth of your baby, your uterus continues to contract to push out the placenta (afterbirth). The
placenta usually delivers about 5 to 15 minutes after the baby arrives.

D. Fourth Stage of Labor

Recovery
Your baby is born, the placenta has delivered, and you and your partner will probably feel joy, relief,
and fatigue. Most babies are ready to nurse within a short period after birth. Others wait a little longer.
If you are planning to breastfeed, we strongly encourage you to try to nurse as soon as possible after
your baby is born. Nursing right after birth will help your uterus to contract and will decrease the amount
of bleeding.

II. Methods of Delivery

Bringing a baby into this world is a monumental feat and cannot be achieved easily. Although normal
vaginal delivery is commonly referred as the typical way of birthing. New techniques help laboring
women in many ways, either by dampening their pain or smoothening the delivery process.
Advancements in medical sciences have discovered various methods so that delivery can be made
successful even in the face of any complications or risks.

A. Vaginal Delivery
When a baby is born through the birth canal of a
woman’s body, the delivery is termed as a vaginal
delivery. It may or may not be assisted with epidurals or
pain-relieving medication. The exact time of birth cannot
be predicted in such a case, but most vaginal births tend
to happen once 40 weeks of pregnancy have been
completed.

Most doctors recommend a vaginal birth if there is a

possibility for it and advise against going for caesarean

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delivery. During the stress of labor pains, the baby secretes hormones for the development of its brain
and lungs; moreover, passaging through the birth canal squeezes the baby’s chest to clear all amniotic
fluid and expand its lungs effectively. For mothers planning to have multiple children, vaginal births are
highly recommended. When done with an incision above the anal area, the procedure is called
episiotomy.

With vaginal deliveries, mothers can recover from the stress of delivery quicker and return home sooner
with their babies. The chances of infection in such cases are lower than others. The baby too has a lower
chance of suffering from any breathing problems if born via the vagina.

B. Natural Childbirth
This is one of the types of birth that is steadily gaining popularity. In this method, there are no medical
procedures or invasive therapies involved, and the process takes place in the most natural manner
possible. This is mostly a personal choice and the mother needs to be committed throughout the way.

Various exercises and positions are taken into account while carrying out delivery in natural ways. A
midwife usually stays with the mother to ensure the delivery is successful and the mother is in good spirits.
The delivery can take place at the hospital or even at home, with all preparations done beforehand.

Water birthing or pool birthing with the help of upthurst (buoyancy) pressure of water can alleviate
labor pain in this procedure. Water birthing is the most natural and painless way of bringing new life to
the world.

Natural birth can be extremely empowering for a mother. Having skin-to-skin contact with the baby
immediately after delivery can foster a strong bond between the mother and the child. It also triggers
hormones in the body that start producing milk in the breasts right away.

C. Caesarean Section
Things don’t always go according to plan. A mother might want to undertake vaginal delivery but if
complications arise, caesarean delivery is an option that might have to be taken.

In this method, the baby is delivered by opening up the abdomen of the mother and surgically opening
the uterus to remove the baby. The name is derived from the Latin word ‘caedare’, which means ‘to cut’.
Hence, this type of the cut is called a C-section – that’s how the delivery method gets its name.

Many mothers decide to have a caesarean delivery in advance, which allows the hospital and doctors to
start making preparations accordingly. This could be out of choice or even after a sonography has
revealed certain parameters which make it necessary to undertake a C-section, such as the presence of
twins or triplets, breech or transverse presentation, or a very large baby.

In other cases, if vaginal delivery fails even after a good trial of labor or if any complication arises, such
as breech position while delivering , meconium stained liquor or obstruction in the birth canal, the doctors
will have to quickly resort to undertaking a C-section and removing the baby out of the uterus in time.

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D. Forceps Delivery
This is a rather peculiar type of delivery method and is required in
certain cases of vaginal birth. This is an assistance to the usual vaginal
delivery when the baby is on its way via the birth canal but fails to fully
emerge out. This could be because of small obstructions, or the mother
being tired and exhausted and hence being unable to push the baby
out.

In these cases, the doctor makes use of specially created tongs which resemble forceps and inserts them
slowly into the birth canal. These are then used to gently grab the baby’s head and guide it outwards
through the canal.

E. Vacuum Extraction
Similar to the forceps delivery method, this delivery technique is used in the case of a vaginal birth. For
example, if the baby is on its way out but has stopped moving further down the canal, the vacuum
extraction method is applied.

The doctors make use of a specialized vacuum pump which is inserted up to the baby via the canal. The
vacuum end has a soft cup which is placed on the top of the baby’s head. Vacuum is created so that the
cup holds the head, and the baby is gently guided outwards through the canal.

F. Vaginal Birth after Caesarean (VBAC)

Most of the time, once a woman has had a caesarean delivery, her chances of having a vaginal delivery
after that are pretty much nullified. But in recent times, certain techniques are making it possible for
women to have successful vaginal deliveries even after the previous delivery method has been a C-
section. This is termed as vaginal birth after caesarean (VBAC).

Small hospitals do not opt for VBAC since an emergency C-section requires more staff and resources
which may not always be possible. Also, any previous complications during delivery or any conditions
faced by the mother could make the doctor advise against a vaginal delivery.

Birthing techniques have their own advantages and disadvantages. The focus should always be on
ensuring that the baby is delivered safely, the baby comes out healthy into the world, and the mother
stays safe throughout the entire process of delivery. When it comes to a delivery method you want to
choose versus one that your doctor recommends for you, it is always best to go with the doctor’s
recommendation to avoid any complications in the future.

III. Possible Complications of Delivery

The labor and birth process is usually straightforward, but sometimes complications arise that may need
immediate attention. Complications can occur during any part of the labor process.

According to the Eunice Kennedy Shriver National Institute of Child Health and Human Development,
specialized help is more likely to be needed if a pregnancy lasts more than 42 weeks, if there has been
a previous cesarean delivery, or when the mother is of an older age.

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Here are ten most common labor complications according to the Medical News Today:

1. Failure to progress
Prolonged labor, labor that does not progress, or failure to progress is when labor lasts longer than
expected. Studies suggest that this affects around 8 percent of those giving birth. It can happen for a
number of reasons.

The American Pregnancy Association define prolonged labor as lasting over 20 hours if it is a first
delivery. For those who have previously given birth, failure to progress is when labor lasts more than 14
hours. If prolonged labor happens during the early, or latent, phase it can be tiring but does not usually
lead to complications. However, if it happens during the active phase, medical assessment and
intervention may be needed.

2. Fetal distress
“Non-reassuring fetal status,” previously known as fetal distress, is used to describe when a fetus does not
appear to be doing well. The new term is recommended by the American College of Obstetricians and
Gynecologists (ACOG), because “fetal distress” is not specific, and it may result in inaccurate treatment.

Non-reassuring fetal status may be linked to: an irregular heartbeat in the baby; problems with muscle
tone and movement; low levels of amniotic fluid.

3. Perinatal asphyxia
Perinatal asphyxia has been defined as “failing to initiate and sustain breathing at birth.” It can happen
before, during or immediately after delivery, due to an inadequate supply of oxygen. It is a non-specific
term that involves a complex range of problems.

It can lead to: hypoxemia, or low oxygen levels; high levels of carbon dioxide
acidosis, or too much acid in the blood. Cardiovascular problems and organ malfunction can result.

4. Shoulder dystocia
Shoulder dystocia is when the head is delivered vaginally but the shoulders remain inside the mother. It is
not common, but it is more likely to affect women who have not given birth before, and is responsible for
half of all cesarean deliveries in this group.

Health providers may apply specific maneuvers to release the shoulders that may include changing the
mother’s position and manually turning the baby’s shoulders. An episiotomy, or surgical widening of the
vagina, may be needed to make room for the shoulders.

Complications are usually treatable and temporary. However, if a non-reassuring fetal heart rate is also
present, this may indicate other problems.

5. Excessive bleeding
On average, women lose 500 milliliters (ml) of blood during the vaginal delivery of a single baby.
During a cesarian delivery for a single baby, the average amount of blood lost is 1,000 ml. It can occur
within 24 hours after delivery or up to 12 weeks later, in the case of secondary bleeding. Around 80
percent of cases of postpartum hemorrhage result from a lack of uterine tone.

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Bleeding happens after the placenta is expelled, because the uterine contractions are too weak and
cannot provide enough compression to the blood vessels at the site of where the placenta was attached
to the uterus. Low blood pressure, organ failure, shock, and death can result.

6. Malposition
Not all babies will be in the best position for vaginal delivery. Facing downward is the most common
fetal birth position, but babies can be in other positions. They include: facing upward; breech, either
buttocks first (frank breech) or feet first (complete breech); or lying sideways, horizontally across the
uterus instead of vertically.

7. Placenta previa
When the placenta covers the opening of the cervix, this is referred to as placenta previa. A cesarian
delivery is usually necessary. It affects around 1 in 200 pregnancies in the third trimester. The main
symptom is bleeding without pain during the third trimester. This can range from light to heavy.

It is most likely to occur in those who: have had previous deliveries, and especially four or more
pregnancies; previous placenta previa, cesarean delivery, or uterine surgery; have a multiple gestation
pregnancy; are aged over 35 years; have fibroids; or smoke.

8. Cephalopelvic disproportion
Cephalopelvic disproportion (CPD) is when a baby’s head is unable to fit through the mother’s pelvis. This
can happen if: the baby is large or has a large head size; the baby is in an unsual position; or the
mother’s pelvis is small or has an unusual shape.

9. Uterine rupture
If someone has previously had a cesarian delivery, there is a small chance that the scar could open during
future labor. If this happens, the baby may be at risk of oxygen deprivation and a cesarian delivery
may be necessary. The mother may be at risk of excessive bleeding.

10. Rapid labor

Together, the three stages of labor typically last for 6 to18 hours, but sometimes it lasts only 3 to 5 hours.
This is known as rapid labor or precipitous labor. The chances of rapid labor are increased when: the
baby is smaller than average; the uterus contracts efficiently and strongly; the birth canal is compliant; or
there is a history of rapid labor

Rapid labor can start with a sudden series of quick, intense contractions. This can leave little time in
between for rest. They may resemble one continuous contraction. Disadvantages of rapid labor are that:
it can leave the mother feeling out of control; there may not be enough time to get to a health care
facility; or it can increase the risk of tearing and laceration to the cervix and vagina, hemorrhage, and
postpartum shock.

Risks for the baby include aspiration of amniotic fluid and a higher chance of infection if delivery takes
place in an unsterile location.

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IV. Effects of Medication during the Birth Process

The obvious pro to medications for labor is the pain relief. While you may still feel dull sensations during
contractions, most of the process is virtually pain-free. The downside is that pain medications always carry
a risk of side effects.

These can include:

▪ drowsiness ▪ itchy skin
▪ headaches ▪ urinating difficulties
▪ nausea ▪ not every pain medication works for
▪ vomiting every person
▪ low blood pressure ▪ slowed labor progress

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Posttest

A. Match each stage of labor to its description.

_____1. First stage a. recovery

_____2. Second stage b. thinning and opening of the cervix

_____3. Third stage c. baby moving though birth canal

_____4. Fourth stage d. afterbirth

B. Name at least three methods of delivery. Describe each method in 2-3 sentences.
1.

2.

3.

C. Enumerate five common labor complications.

1.

2.

3.

4.

5.

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Posttest Feedback

A. Match each stage of labor to its description.

___b__1. First stage a. recovery

___c__2. Second stage b. thinning and opening of the cervix

___d__3. Third stage c. baby moving though birth canal

___a__4. Fourth stage d. afterbirth

B. Name at least three methods of delivery. Describe each method in 2-3 sentences.
1.

2. Answers may vary.

3.

C. Enumerate five common labor complications.

1.

2.

3. Answers may vary.

4.

5.

Reminder:
Prepare for a quiz (Module 2).

References:
▪ Chandraharan, E., & Krishna, A. (2017, September 27). Diagnosis and management of postpartum hemorrhage
[Abstract]. The BMJ, 358
▪ Buckley SJ. (2015). Executive summary of hormonal physiology of childbearing: evidence and implications for women,
babies, and maternity care.
▪ https://wa.kaiserpermanente.org/healthAndWellness/index.jhtml?item=%2Fcommon%2FhealthAndWellness%2Fpre
gnancy%2Fbirth%2FlaborStages.html
▪ https://parenting.firstcry.com/articles/different-childbirth-methods-you-must-know/

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