Pregnancy is a period that contains feelings of great uniqueness. The excitement of experiencing the feeling of motherhood can be replaced by anxiety, worry, and sometimes fear as she thinks about what kind of birth awaits her in the future. The best way to cope with these is to not be aware of birth.

Feeling that a baby is growing inside of you, following its movements is the exact equivalent of unique emotions! To follow his movements, to talk to them, to wait for them to come impatiently...

When your pregnancy starts to progress, you and your physician will need to determine the most appropriate method of delivery for you. Yeditepe University Hospital Gynecology and Obstetrics Specialist gave information about birth methods.

Normal Birth Processes

The more descriptive name of normal delivery is normal spontaneous vaginal delivery. In other words, it is a form of delivery in which the baby, which naturally starts on its own, emerges vaginally.

There are 3 stages of birth. The first stage is the longest stage in which the cervix opens with pain. The second stage is the stage where the baby is born with pushes. The third stage is the stage in which the baby's partner (placenta) is completely removed. The first stage consists of latent and active phases.

Latent Phase: It is the phase where the opening of the cervix reaches up to 3-4 cm from the onset of labor pains. Birth pains may start with a slight feeling of pain, or they may start suddenly. In some women, the opening of the cervix can reach 3-4 cm by feeling very light, while some women may feel the pain strongly from a 1 cm opening. Generally, the severity of pain at the early onset stage is milder. Incoming pains may be seen every 5-30 minutes for 30-45 seconds. During this period, a pink discharge may be seen. Some women spend this period comfortably at home and can apply to the hospital while they are in the active phase.

Active Phase: The active phase is the phase that passes from 4 cm to 10 cm of the cervix opening, that is, to the full opening. During this period, the pain is now more regular and severe. During this period, when the pain comes, massages on the back or rhythmic exercises on the pilates ball may help. If there is a desire for epidural anesthesia, it can be applied in this period. The active phase lasts 3-5 hours on average.  Membranes are usually ruptured at this stage and water is observed to arrive.

The second stage is the pushing stage. This phase starts with the cervix being fully open and ends with the birth of the baby. In the first pregnancy, it may take 1.5-2 hours. In the following pregnancies, it can be as short as a few minutes and as long as 1 hour. This period is the phase of push-ups. The feeling of pushing will come on its own. Pushing will not be of any benefit other than exhausting the pregnant woman before the feeling of pushing comes. The pushing may tire the pregnant woman, there may be a feeling of weakness and fainting. During this period, your physician may want to open an episiotomy if deemed necessary.

The third stage is the exit stage of the placenta after the baby is born and the umbilical cord is cut. This phase may take from a few minutes to 30 minutes. During this period, a slight cramp may be felt, although not as much as at birth. During this period, the baby may be given to the mother's breast to help stimulate uterine contractions. After the placenta and membranes are fully protruded, the genital area is checked by your physician. If any, the episiotomy is repaired by anesthesia. If the episiotomy has not been opened, the tears, if any, are repaired. The likelihood of rupture in the first birth is higher than in the second and subsequent births.

The mother can be fed with any food she wants immediately, as all stages of labor are completed, and the mother may be tired unless there are any complications.

What Are the Benefits of Normal Birth for Mother and Baby?

It is the birth that is normal on the normal birth name, that is, everything develops as it should. C-section is an abdominal surgery. C-section is a procedure that saves the life of the mother and baby, if necessary, but it will not be correct to apply it if it is not necessary. First of all, in normal birth, the mother is a part of the birth and actively applies it. If the mother is in control and has access to sufficient information during her pregnancy, she will manage her birth well.

Since the normal delivery will take place in the delivery room instead of the operating room, the relative who will support the mother during the opening phase of the birth will be able to be with her constantly. In normal childbirth, the pregnant woman can move as she wants. Except for occasional baby heart monitoring, the mother's movement is not restricted. Minimally invasive interventions are performed on the mother; thus, the mother and baby complete the birth process with minimal damage. At the same time, according to new studies, the encounter with vaginal flora while the baby is passing through the birth canal will reduce the likelihood of diseases such as celiac disease, asthma, type 1 diabetes, and obesity in the future by creating the intestinal flora that will be supported by breast milk.

After a normal birth, the rate at which breast milk arrives is faster than in C-section. As a result of the C-section, the mother undergoes abdominal surgery. The recovery process will be more difficult and more painful than normal delivery. In normal delivery, the mother has not undergone abdominal surgery and will not have a wound that will disturb her except for episiotomy or birth rupture repair sites, if any. The mother who has had a normal birth is also more likely to have her next delivery through the normal vaginal route. However, when pregnancy is repeated after a C-section, it is less likely to give birth normally and is riskier than after normal delivery.

What Is C-section, in Which Cases Is It Preferred?

C-section is the procedure of delivering the baby directly out of the abdomen with a surgical incision made to the mother's abdomen. In general, a C-section can be performed if it is not possible to complete the vaginal delivery safely, or if there are life risks in the mother or baby with vaginal delivery.

C-section may be required while normal delivery is expected or followed up urgently, or it may be applied in advance, that is, electively.

Causes of C-section with the baby:

• Disruption of the baby's heartbeat, getting into trouble.
• Posture disorders in the mother's womb of the baby: conditions such as reverse posture (anus), side posture (transverse posture), forehead arrival, face arrival
• Multiple pregnancies (if there are twins or more pregnancies)

Causes of C-section with the mother:

• Prior uterine surgery. (Removal of myoma from the uterus, such as a previous C-section.)
• Some systemic diseases in the mother (diabetes, hypertension, high blood pressure due to pregnancy)
• Infections that may pass from mother to baby with vaginal birth and cause infection in the baby (such as genital herpes...)
• Placement abnormalities of the placenta: Conditions such as placenta previa.

C-section may be required when following vaginal delivery:

• The incompatibility of the baby's head with the mother's genital canal
• The birth takes longer than it should.
• Baby is very big.
• Cord sagging before the baby is born.

Benefits of C-section

As a result, a C-section is an abdominal operation, a surgery, and carries the risks that can be seen in every operation. These are infection at the wound site, bleeding during surgery, causing adhesion in the abdomen, increasing the likelihood of cesarean section at the next birth, and the likelihood of injuring neighboring organs, most commonly the bladder (which is more likely in repeated C-sections). General anesthesia or regional anesthesia to be performed also has its own complications that may occur. In normal delivery, the baby passes through the birth canal and gets rid of the fluid in the lungs more easily. In C-section, wet lung development, the likelihood of the baby not being able to assign fluids is higher and the likelihood of developing temporary respiratory problems in the baby is higher than in normal birth. Recent studies on the microbiome suggest that diseases such as diabetes, celiac disease, and asthma are more common in babies born by cesarean section because they do not encounter the mother's vaginal flora.

As for the benefits of a C-section, first of all, a C-section is a life-saving operation. It is an operation that saves the life of the mother and the baby at the right time, in a situation that threatens the life of the mother and the baby in normal birth. Normal birth follow-up is an operation that can prevent the development of spasticity or mental retardation in the baby when applied at the right time when heartbeats and oxygenation problems develop. Since the baby will not pass through the vaginal canal during C-section, the possibility of sagging of the bladder and uterus and urinary incontinence in the future in the mother will be significantly less than normal delivery. Likewise, vaginal width sensation will be seen much less than in normal birth. C-section is painless compared to normal delivery, but the pain during recovery is higher than normal delivery. Shoulder insertion, which can be seen in a normal delivery, is not seen in C-sections due to arm nerve paralysis, or cervical hematoma, which is likely to occur in the baby in operative vaginal deliveries with vacuum or forceps.

Epidural Delivery

The method known as normal birth with epidural analgesia, that is, painless birth or princess birth among the people, is commonly used in births performed in private hospitals in Türkiye recently. The pain of childbirth is alleviated with painkillers given intermittently from the soft thin-type catheter applied under the epidural membrane surrounding the spinal cord.

The expectant mother will still feel the contractions at this time, but there will be a significant reduction in the feeling of pain. This allows the expectant mother to have a more comfortable birth. The fact that the contractions do not completely pass is very important in terms of realizing the feeling of pushing and ensuring pushing. In this case, dose adjustment is important, and administration and dose adjustment is performed by the anesthesiologist.

Administration of an epidural catheter at delivery may prolong delivery time by 1-2 hours longer than normal. Therefore, most physicians prefer to apply an epidural catheter after the cervix is opened by 4-5 cm when the active phase of labor is started. However, there are physicians who apply at any time without waiting for an active phase.

In the case of previous spine operations,  blood clotting cells are lower than normal, or if blood thinning medicine is used, an epidural catheter may not be applied.

There is a possibility of a loss of the mother's feeling of pushing in births performed with epidural analgesia. In this case, the mother may not be able to push enough. Therefore, the likelihood of using vacuum and forceps in normal births accompanied by epidural analgesia is higher than in births without an epidural. Vacuum and forceps application also has some risks for the mother and the baby.

On the other hand, in controlled epidural analgesia, that is, when the mother has a feeling of pushing but her pain decreases, the mother can listen to the physician's instructions better and can push where the physician says push and slow down. Therefore, uncontrolled pushing can be prevented and vaginal injury that may occur is less common.

When epidural analgesia is administered, the mother may have more positive labor because she feels less pain. The energy may be higher. On the other hand, if there is a decrease in the feeling of pushing, it may tire itself more for a longer time, which may cause weakness in the mother.

Headache may occur in 1/100 of patients who receive an epidural catheter. The drugs applied through the epidural catheter may cause a feeling of nausea and especially a feeling of itching on the face.

Epidural analgesia in childbirth, which has advantages and disadvantages, should be left entirely to the mother's own choice and will. A mother who does not want epidural anesthesia at all can suddenly change her mind or the mother with an epidural plan can easily give birth before the epidural procedure is applied.

Water Birth

Water birth is practiced in many parts of the world, including Türkiye. Although there are many different opinions, the most recent article by the American Society of Obstetrics and Gynecology expresses its opinion on this issue.

In terms of shortening the first stage of labor and reducing the use of epidural analgesia, it may be recommended to pregnant women who start labor between 37-42 weeks, which is healthy and problematic, to spend the first stage of labor. It does not seem to carry an increased risk of side effects for the mother and the baby.

However, there is no adequate data on the second stage of birth, that is, the birth stage of the baby. For this reason, the American College of Obstetrics and Gynecology (ACOG) recommends that childbirth itself should take place on land, not in the water until adequate data can be obtained.

It should be ensured that the infection control of water birth-related equipment is sufficiently ensured, that the experience of the team in this regard is sufficient and that the transfer from water in case of an emergency can be provided quickly and effectively.

Here again, it is your mother's choice. Although there is information such as water birth reducing the pain of the mother and facilitating the birth by reducing the need for an epidural due to this, she should decide this knowing that there is still not enough data and information in terms of the risks that may occur during birth and detailed consent should be obtained from her.

Mindful Birth 'Hypnobirthing'

Mindfulness reduces tension and stress not only in the process of childbirth preparation and delivery but in every moment of life.

The hypnobirthing method is the method in which the expectant mother gives birth not only physically but also spiritually, completely preparing herself for childbirth, abstracting the birth impulse from the traditional fearful painful stories with deep relaxation breathing exercises. Although hypnosis is generally known as drowsiness, falling asleep, or going into a trance, it is actually a state of deep awareness. It is a method in which the tension in the body and the uterus is removed with deep relaxation by being abstracted from the stories heard and affected. Although there are not many large-scale studies on this subject yet, I think that this is a facilitating delivery method for both the expectant mother and the physician since it is not a harmful application for the expectant mother and this will increase her motivation and reduce the anxiety and fear of the mother, which is one of the most important factors that make birth difficult.