(See also Overview of Labor and Delivery.)
For delivery in a hospital, a woman may be moved from a labor room to a birthing or delivery room, a room used only for deliveries. Usually, the father, partner, or another support person is encouraged to accompany her. Or she may already be in a private room where she stays from labor through delivery until discharge—a labor, delivery, recovery, and postpartum (LDRP) room. The intravenous line remains in place.
When a woman is about to give birth, she may be placed in a semi-upright position, between lying down and sitting up. Her back can be supported by pillows or a backrest. The semi-upright position uses gravity: The downward pressure of the fetus helps the vagina and surrounding area stretch gradually, decreasing the risk of tearing. This position also puts less strain on the woman’s back and pelvis. Some women prefer to deliver lying down. However, with this position, delivery may take longer.
As delivery progresses, the doctor or midwife examines the vagina to determine the position of the fetus’s head. When the cervix is fully open (dilated) and thinned and pulled back (effaced), the woman is asked to bear down and push with each contraction to help move the fetus’s head down through her pelvis and to widen the vaginal opening so that more and more of the head appears. The midwife may massage the area around the opening of the vagina (called the perineum) and apply warm compresses to it. These techniques may help the tissues around the vaginal opening stretch slowly and help prevent tears, but they may increase the risk of infection.
When more than 1 inch (3 to 4 centimeters) of the head appears, the doctor or midwife places a hand over the fetus’s head during a contraction to control the fetus’s progress. As the head crowns (when the widest part of the head passes through the vaginal opening), the head and chin are eased out of the vaginal opening to prevent the woman’s tissues from tearing.
Vacuum extraction can be used to assist in delivery of the head when the fetus is in distress or the woman is having difficulty pushing.
Forceps are sometimes used for the same reasons but are used less often than vacuum extractors.
Episiotomy is an incision that widens the opening of the vagina to make delivery of a baby easier. It is no longer done routinely. It is used only when the tissues around the vagina's opening do not stretch enough and are preventing the baby from being delivered. This procedure prevents tissues from overstretching and may help tissues from tearing raggedly. For this procedure, the doctor injects a local anesthetic to numb the area and makes an incision in the area between the openings of the vagina and anus (called the perineum). If the muscle around the opening of the anus (rectal sphincter) is damaged during an episiotomy or is torn during delivery, it usually heals well if the doctor repairs it immediately.
After the baby’s head has emerged, the body is rotated sideways so that the shoulders can emerge easily, one at a time. The rest of the baby usually slips out quickly after the first shoulder comes out. Mucus and fluid are suctioned out of the baby’s nose, mouth, and throat. The umbilical cord is clamped and cut. This procedure is painless. (One clamp is left on the stump of cord near the baby's navel, until the cord has sealed, usually within 24 hours.) The baby is then dried, wrapped in a lightweight blanket, and placed on the woman’s abdomen or in a warmed bassinet.
After delivery of the baby, the doctor or midwife places a hand gently on the woman’s abdomen to make sure the uterus is contracting. After delivery, the placenta usually detaches from the uterus within 3 to 10 minutes, and a gush of blood soon follows. Usually, the woman can push the placenta out on her own. However, in many hospitals, as soon as the baby is delivered, the woman is given oxytocin (intravenously or intramuscularly), and her abdomen is periodically massaged to help the uterus contract and expel the placenta. If the woman cannot push it out and particularly if she is bleeding excessively, the doctor or midwife applies firm pressure on the woman’s abdomen, causing the placenta to detach from the uterus and come out. If the placenta has not been delivered within 45 to 60 minutes of delivery, the doctor or midwife may insert a hand into the uterus, separating the placenta from the uterus and removing it. Pain relievers or anesthesia is needed for this procedure.
After the placenta is removed, it is examined for completeness. Fragments left in the uterus prevent the uterus from contracting. Contractions are essential to prevent further bleeding from the area where the placenta was attached to the uterus. So if fragments remain, bleeding can occur after delivery and may be substantial. Infections of the uterus can also occur. If the placenta is incomplete, the doctor or midwife may remove the remaining fragments by hand. Sometimes fragments have to be surgically removed.
The doctor stitches up any tears in the genital tissues and, if an episiotomy was done, the episiotomy incision.
The woman is then moved to the recovery room or remains in the LDRP. Typically, a baby who does not need further medical attention stays with the mother. Typically, the woman, baby, and father or partner remain together in a warm, private area for an hour or more so that bonding can begin. Many women wish to begin breastfeeding soon after delivery.
Later, the baby may be taken to the hospital nursery. In many hospitals, the woman may choose to have the baby remain with her—a practice called rooming-in. All hospitals with LDRPs require it. With rooming-in, the baby is usually fed on demand, and the woman is taught how to care for the baby before she leaves the hospital. If a woman needs a rest, she may have the baby taken to the nursery.
Because most complications, particularly bleeding, occur within the first 24 hours after delivery, nurses and doctors carefully observe the woman and baby during this time.