Definition & Overview

Vaginal delivery is the natural process by which a baby is born from the mother without significant medical intervention. It is also known as natural childbirth wherein the mother is guided through the labour process until the baby comes out through the birth canal. The process involves:

  • Going through labour and delivery without medications, such as pain relievers or epidurals
  • The mother is allowed to lead the labour and delivery, going through it as childbirth progresses in a way that she feels most comfortable
  • Using very few or almost no artificial medical interventions such as continuous foetal monitoring or episiotomy (an incision made in the perineum between the vagina and anus to make more room for the baby)


Vaginal delivery is considered to be the most "low-tech" of childbirth options available today but still the most preferred means for low-risk pregnancies to avoid any possible risks that medications might pose for the mother or baby.

There now are different terms or kinds of vaginal delivery depending on patient circumstances and requests. These include:

  • Spontaneous vaginal delivery (SVD) - A term used to medically describe delivery where the mother goes into labour naturally without the use of medication and any form of intervention

  • Assisted vaginal delivery (AVD) - Also known as instrumental vaginal delivery, this is performed when certain specialised instruments such as vacuum extractor, forceps, and episiotomies are used to deliver the baby

  • Induced vaginal delivery (IVD) - A form of natural delivery but involves the induction of labour, wherein manual techniques or medications are taken by the mother to initiate the labour process

  • Normal vaginal delivery - Whether or not induced or assisted, this is the term used for natural childbirth wherein the baby is delivered through the vagina, in contrast to delivery by Caesarean section (C-section) where incisions are made in the abdomen and uterus to deliver the baby.

Who Should Undergo and Expected Results

Practically, all childbearing women are capable of vaginal delivery. However, there are a few cases when Caesarean delivery should be pre-planned if there is sufficient medical evidence that natural delivery is not possible. C-section is usually recommended in cases that involve:

  • Previous Caesarean birth - Though vaginal delivery could be done even after a previous C-section, it might not be an option for some as the uterine incision can rupture with vaginal birth

  • Cephalopelvic disproportion (CPD) – A medical term to describe the condition where the baby's head or body is too large to safely pass through the mother's pelvic structure or the pelvis is too small to accommodate a normal-sized baby

  • Multiple pregnancy

  • Placenta pravia - A condition where the placenta is attached very low in the uterine wall such that the baby would be unable to exit through the cervix

  • Breech presentation - When the baby is positioned feet or bottom-first

  • Transverse lie- When the baby is positioned sideways in the uterus and is difficult to reposition through manual manipulation


Moreover, unplanned C-section might be required in emergency cases where the labour fails to progress, when there are cord complications (cord compression or prolapsed cord), and in the case of abruptio placentae (when the placenta separates before the baby is born).

How is the Procedure Performed?

Vaginal delivery is usually done in the hospital where medical support is readily available. However, there are women who still opt to deliver in a non-hospital setting such as birthing centres or institutions that are solely focused on natural childbirth.

Vaginal delivery, as a procedure, is quite straightforward. At the onset of active labour, the mother is brought to the hospital or facility and the progress of the labour is monitored. Mothers experience labour differently; for some women, labour pain comes similar to menstrual cramps, while for some, it could be like strong waves of diarrhoea -like cramps. In some cases, women in labour opt to get an epidural, an anaesthesia administered in the spinal column that blocks labour pain and sensation.

There is no standard timetable when giving birth, and women have different stories to tell. In general, there are three stages of labour and these are:

  • First stage - In this stage, the uterus contracts to dilate or open the cervix. As the cervix becomes more open, the baby becomes more and more ready to come out. This is where regular labour pain contractions occur. The dilation of the cervix may be constantly monitored by the healthcare provider during this time.

  • Second stage - When the cervix is almost fully dilated, the mother is wheeled into the delivery room and is instructed to push during contractions to move the baby through the birth canal.

  • Third stage - The healthcare provider puts clamps onto the cord before it is cut and the uterus pushes out the placenta.

Possible Risks and Complications

Vaginal delivery continues to be the safest means for childbirth. However, it can become risky for women who ignore doctors’ recommendations or if they refuse medical intervention even when necessary. Among rare complications include severe bleeding, infection, scarring, and more longer-lasting pain.

References:

  • Dudding TC, et al. Obstetric anal sphincter injury: Incidence, risk factors, and management. Annals of Surgery. 2008;247:224.

  • Life-Saving Skills: Manual for Midwives. 4th ed. American College of Nurse-Midwives; 2008. http://www.midwife.org/ACNM-Publications. Accessed Dec. 23, 20

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