‍Is vaginal delivery very painful?

The fear of pain does affect the decision about mode of delivery. Studies have shown that even culture of the country/regions influences a woman’s views towards labour pain, definition of labour pain and coping mechanisms against pain. 

One of the main goals of every medical team is to perform a safe delivery. C-section was first introduced to reduce the risks for the mother and baby. However, today, C-section is perceived as an escape from labour pain, and the false assumption that C-section is painless, safer, and healthier than vaginal delivery has become prevalent among women. 

Yes, childbirth is painful. But it is not something that will be unmanageable. In fact, nearly half of first-time mums (46 %) said the pain they experienced with their first child was better than they had feared. They had feared it too much!

Pain during labour is different for every woman. It varies widely from woman to woman and even from pregnancy to pregnancy. Women experience labour pain differently — for some, it resembles menstrual cramps; for others, severe pressure; and for others, extremely strong waves that feel like diarrhoea cramps.

Vaginal delivery is the first choice of most doctors if the pregnancy has moved on normally. Compared to other methods of childbirth, such as a cesarean delivery and induced labour, it’s the simplest kind of delivery.

A spontaneous vaginal delivery is a vaginal delivery that happens on its own, without requiring doctors to use tools to help pull the baby out. This occurs after a pregnant woman goes through labour. Labour opens, or dilates, her cervix to at least 10 centimeters.

Labour usually begins with the passing of a woman’s mucous plug. This is a clot of mucous that protects the uterus from bacteria during pregnancy. Soon after, a woman’s water may break. This is also called a rupture of membranes. The water might not break until well after labour is established, even right before delivery. As labour progresses, strong contractions help push the baby into the birth canal.

The length of the labour process varies from woman to woman. Women giving birth for the first time tend to go through labour for 12 to 24 hours, while women who have previously delivered a child may only go through labour for 6 to 8 hours.

Definitely, childbirth is one of the most painful experiences that humans can have. However, the pain of having a kidney stone is considered to be comparable.

In fact, some people have rated the pain of a kidney stone as being worse than that of childbirth.

One survey showed that many first-time mums held some false beliefs about labour pain management before they experienced childbirth:

• 74% thought you couldn’t have an epidural after a certain time in labour (you can have one up until the baby’s head begins emerging, known as crowning).
• 44% feared pain at the epidural injection site would last for a prolonged time. 
• 26% believed an epidural slows labour.
• Most concerning, 20% believed only one pain management option could be provided during labour and 16 percent thought about it but didn’t know.

How painful is each stage of labour?

In a study, more than half the women said having contractions was the most painful aspect of delivery, about one in five noted pushing or post-delivery was most painful. mums 18 to 39 years old were more likely to say post-delivery pain was the most painful aspect than those 40 years and older.

These are the three stages of labour that signal a spontaneous vaginal delivery is about to occur:

• Contractions soften and dilate the cervix until it’s flexible and wide enough for the baby to come out of the mother’s uterus.
• The mother must push to move her baby down her birth canal until it’s born.
• Within an hour, the mother pushes out her placenta, the organ connecting the mother and the baby through the umbilical cord and providing nutrition and oxygen.

In which conditions should a pregnant women NOT have a spontaneous vaginal delivery?

A spontaneous vaginal delivery is a vaginal delivery that happens on its own, without requiring doctors to use tools to help pull the baby out. This occurs after a pregnant woman goes through labour.

Labour opens, or dilates, her cervix to at least 10 centimeters. This is an ideal delivery method!

However, spontaneous vaginal deliveries are not advised for all pregnant women.

Because of possible health risks for the mother, child, or both, experts recommend that women with the following conditions avoid spontaneous vaginal deliveries:

• Complete placenta previa, or when a baby’s placenta fully covers its mother’s cervix.
• Herpes virus with active lesions.
• Untreated HIV infection.
• More than one or two previous cesarean deliveries or uterine surgeries.

Cesarean delivery is the desired alternative for women who have these conditions.

Advantages and Disadvantages of Normal Delivery

Advantages

• Undoubtedly, there are many benefits of normal delivery. Let’s look at some:
• Breast-feeding process is nicely enabled:  A caesarean section is considered a major operation and it takes the mother weeks to heal. Even sitting to feed the baby may be painful, initially. On the other hand, natural birth helps you to breastfeed with ease as you can recover from the process of childbirth faster.   
• Powers up the baby’s brain development: When the baby passes naturally through the birth canal. production of proteins in the baby’s brain increases! That boosts development and brain function. In a  caesarean section, this benefit is not there.
• Easier and better recovery for mum:  In a caesarean section, it takes nearly 50% more recovery time than a normal recovery period.
• Lower risk of respiratory problems: Babies born through a caesarean section do not get the benefits of the hormonal changes which happen during labour. These hormonal changes help in the proper development of lungs, allowing the lungs to function optimally. 
• Gut health is  better in babies born naturally: Studies have shown that babies born to caesarean section are more prone to asthma, allergies and infections later in life. Without natural birth the babies miss out on the good bacteria present in the mother’s body. This plays a major role in the immune system of the child. Vaginal birth gives the  baby a higher chance to be stronger in immunity.
• Risk of autism: When labour is induced by injections or any other medications, it may lead to autism or other neurological disorders in the baby.  
• Chance of blood transfusion: Hormones like Oxytocin when released in higher amounts in the body can decrease the risk of pneumonia and blood transfusion. If going for a caesarean section, one might need a blood transfusion though it's not that common.
• Risk with instruments used for a C-section delivery: In rare cases, if the instruments aren’t clean or cause an injury, it can be tough for the mum.

‍Disadvantages

To be well-informed is best! So, while there are benefits, there are  a few risks in vaginal delivery that should be known:

For Mum

Firstly, waiting for labour can be a hugely stressful experience. Our iMumz App has successfully helped lakhs of women to lower this stress and be confident about labour. The reviews of mums who have just given birth are very heartening!

“My baby girl came yesterday. Morning, around 9:42. iMumz breathing and meditation made labour so better. Thanks so much. Amazing content, too-good videos!”

Sometimes, the labour doesn’t progress well. Or, there are complications that can lead to a drop in the baby’s heart rate. The mother could be given anaesthesia, and taken for an emergency C-section.

If there is an episiotomy, healing takes time. There may even  be sexual problems faced by the mother, due to injuries sustained during delivery.

‍For Baby

If the baby is large, the doctor might need to use  suction cups or forceps to get it out safely. 

There are some instances of the baby suffering an injury while passing through the vagina.

How to manage pain better in a vaginal delivery?

Here are some ways to prepare to manage pain in a normal, vaginal delivery. Remember, you have to get into a schedule for the same months in advance!

What Ayurveda says: 

गर्भस्तु मातुः पृष्ठाभिमुखो ललाटे

कृतांजलिः सड्कुचितान्गो गर्भकोष्ठे ।

(अष्टांगह्रदय शरीरस्थान) 

If the foetus is facing towards the back of the mother , both hands are joined above the head then that is an appropriate position for a vaginal birth. Due to any reasons if this position of the foetus changes then it decreases the chances of natural birth.

We have yoga, tips and exercises to prepare your baby to get into the right position and your ligaments well-toned to push him out!

‍Yoga and breathing

Yoga, if done daily, encourages a deep, intimate connection between the mum and baby, and it empowers a woman to trust her own instincts by listening to her body. 

Prenatal yoga is one way to help women access their emotional strength and confidence that they can put to use during contractions and pushing the baby out of the womb. Poses like a deep squat (malasana) can help relax and open the hips, providing control over strong, toned pelvic and hip muscles so they won't tense up when under stress.

Yoga's other benefits during labour include helping increase a pregnant woman's physical stamina if labour lasts a long time 

[Did you know: Regular yoga practice has also been shown to shorten the length of labour by as much as two hours!]

The increased stamina comes from the physical discipline required to hold postures long enough to get strength-building benefits. It also comes from the mental focus that results from yoga's concentration on breathing exercises that help the lungs expand to their full capacity which can feel challenging in late pregnancy.

High control over self  can be achieved by regular yoga practice. During the third trimester, when labour is around the corner ,this quality plays an important role in labour pain perception: Women stay in control of their bodies even during the most physically painful parts of the process

Yoga poses help optimize the baby's position for birth, by allowing the pelvic bones and ligaments to open and move apart from each other. This allows the baby's head to find more room to nestle at the bottom of the uterus as birth nears. Some yoga poses, like pelvic tilts, might even encourage a breech or posterior birth baby to turn into the head-down position that most hospitals require for a vaginal birth.

Meditation

At 32 weeks, the placenta transports hormones from the mother’s blood into the fetal environment. The foetus relies on the mother for reassurance about the safety of this environment through the hormonal bath. Meditation decreases the production of the stress hormones cortisol and adrenaline and gives the foetus a signal that it is safe and protected. This is essential as it sets the temperament of calm or anxiety in the baby. 

Meditation also produces endorphins, the happy or pleasure hormone, which assists with preparation of childbirth. It has a SUPERB  pain relieving effect. The effect actually improves with time, so the earlier you start practicing meditation during pregnancy, the greater your endorphin levels will be when it comes time to give birth.

Meditation lowers blood pressure and heart rate, which reduces the risk of preeclampsia, placental abruption, miscarriage, preterm labour which decreases the chances of c-section and directs towards the vaginal delivery. Using meditation one can stay focused during childbirth which will give you the mental and physical stamina for a successful outcome.

The iMumz App has well-researched Meditation sessions to prepare your mind and body for pregnancy.

‍Music

Music takes out your stress hormones! Yes, it does! Cortisol may not be the only hormone that music affects. Steroid hormones, androgens and estrogens, are suggested to be involved. After listening to music, women have a higher level of these hormones. Estrogen level is also altered by musical stimulation. Music changes the mood, leading to alterations in the levels of steroid hormones in the human body. Listening to the appropriate music throughout pregnancy manages the heart rate , rhythm and the breathing patterns which definitely play vital roles in the stages of labour.

The iMumz App has a fantastic Music section to prepare your mind for a healthy childbirth.

‍Making a ‘pact’ with the baby by talking

There's a lot of power in our words. When we speak of something, we believe in it. It affects our consciousness, our nervous system, and our way of being. Talking to the baby daily and giving directions about labour and childbirth phases will make you stronger to face the same. Talk about the positive birth stories to the baby daily. It may sound weird, but studies have proven its benefits!

Which is worse: C-section or natural birth?‍

Most doctors and experts would say, based on years of research, that a natural, vaginal birth is better. In fact, an unmedicated childbirth is an entirely achievable and reasonable goal for about 85 % of pregnant women. The other 15 % have health complications that put them in a high-risk category, and they need a  caesarean section.

And, if it is unavoidable, please do not panic. These days, hospitals and medical science are very well-equipped and your doctor is in the best place to make the right decision. ‍

In which conditions are C-sections safer?‍

Sometimes a C-section is safer for you or your baby than is a vaginal delivery. Your health care provider might recommend a C-section if:

• Your labour isn't progressing. Perhaps it started well but just stalled or stopped. Stalled labour might occur if your cervix isn't opening enough despite strong contractions over several hours.
• Your baby is in distress. If your doctor is concerned about changes in your baby's heartbeat, a caesarean section might be the best option.
• Your baby or babies are in an abnormal position. A caesarean section might be the safest way to deliver the baby if his or her feet or buttocks enter the birth canal first (breech) or the baby is positioned side or shoulder first (transverse).
• You're carrying multiples. A caesarean section might be needed if you're carrying twins and the leading baby is in an abnormal position or if you have triplets or more babies.
• There's a problem with your placenta. If the placenta covers the opening of your cervix (placenta previa), a caesarean section is recommended for delivery.
• Prolapsed umbilical cord. A caesarean section might be recommended if a loop of umbilical cord slips through your cervix before your baby does.
• If you have a prior health condition such as a heart or brain condition, a caesarean section will be done. Also,  if you have an active genital herpes infection at the time of labour.
• Mechanical obstruction. You might need a caesarean section if you have a large fibroid obstructing the birth canal, a severely displaced pelvic fracture or your baby has a condition that can cause the head to be unusually large (severe hydrocephalus).
• You've had a previous caesarean section Depending on the type of uterine incision and other factors, it's often possible to attempt a ‘VBAC” (vaginal birth after caesarean section). In some cases, however, your health care provider might recommend a repeat caesarean section.

Is water birth less painful?‍

Pregnant women who sat in a tub during labour felt less pain. This can be attributed to the release of endorphins or happy hormones. They felt more relaxed and did report a shorter duration of labour. The warmth of the water also helps in an increased flow of oxytocin - making contractions more effective. Some science suggests that the water may lower chances of severe vaginal tearing. 

A recent review of seven randomized trials with 2,615 participants looked at water immersion during labour, before normal land birth (Shaw-Battista 2017). The study found that labouring in water poses no extra risks to mother or baby and helps relieve pain, leading to less use of pain medication.

What are the risks in an ‘assisted’ Vaginal Delivery?

Forceps delivery. Sometimes the doctor has to use forceps (instruments resembling large spoon-end-tongs) to cup your baby's head and help guide the baby through the birth canal.

Vacuum extraction. Vacuum delivery is similar to forceps delivery. In this procedure, the doctor uses suction to apply a plastic cup to the baby's head and gently pull the baby from the birth canal.

Episiotomy. This is a surgical cut in the tissue between your vaginal opening and anus. This tissue is called the perineum. Doctors once thought it prevented large vaginal tears during childbirth, but newer research suggests that’s no longer true. Today, many doctors will only do the procedure if they need to quickly deliver your baby.

Amniotomy. This is also known as “breaking your water.” The doctor uses a small plastic hook to make an opening in your amniotic sac. You may feel a warm rush of fluid.‍

Induced labour. This is when the doctor starts contractions before labour begins on its own. They may suggest this if they’re concerned about your or your baby’s health. 

Is C-section safe?‍

With the current advances in medical science, yes, it can be considered safe.

But, as per a study, women are three times more likely to die during a cesarean delivery than during a vaginal birth, due mostly to blood clots, infections and complications from anesthesia, according to a 2006 study published in the journal Obstetrics & Gynecology.

If the first delivery is cesarean, can the 2nd delivery be normal?‍

Most women who have had a caesarean section may be able to have a vaginal birth later on. Your chances go up if:

• The surgeon made a horizontal incision in your uterus during your C-section called a low transverse incision.
• Your pelvis is large enough to fit an average-sized baby.
• You’re pregnant with one baby instead of multiples.
• Your first cesarean was due to a breech labour.

Most often, the need for a cesarean delivery is not determined until after labour begins. Once you have a cesarean delivery, your risk of uterine rupture goes up during future vaginal deliveries.