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A good start is half the work, and that includes choosing the right birthing position. We will show you the options, you can try them at home! We will also take you into the world of contractions and pushing. What do you do when they do not come or come too early? And sometimes you and the baby need a helping hand during birth. We tell you about cutting in and giving birth with a vacuum pump or forceps. Do you want to read along?

Bye, labor pains. Hi, push contractions. 

When you have reached full dilation, the dilation contractions turn into pushing contractions. The way out is clear and your baby can begin its journey to the adult world. Just a little longer, mama, and the little one will be in your arms. In this final stage, the hormones in your body change. The hormone endorphins that helped fight the pain of dilation are gone, and adrenaline replaces them, making you more alert. Because your baby is now lying so low, he presses against your anus which causes an enormous push that can hardly be stopped. Press contractions are very powerful and usually come every two to three minutes and can last up to a minute and a half. When such a push contraction occurs, take a breath of air, hold on to the air and try - no matter how difficult it is - to push down without making any noise (Pregnant Fit, 2008). Between the contractions there is often enough time to catch your breath. Breathe in, breathe out!

Sometimes you will get push contractions when you are not fully dilated yet and then you will have to push them away. Giving in to the urge to push can cause the cervix to swell (especially in a lying position) which makes it more difficult to get the little one out (see the section on pushing).The Midwife). Hang in there, mom, this phase will pass! We promise. 

The other way round is also possible: you are fully dilated but the contractions do not start. In this case the exorcism phase is often postponed until the contractions start, provided mum and baby are doing well of course. If it is necessary for your baby to be born quickly, you may be asked to push anyway. Pushing without pressure is not more difficult, but it does cost a lot more energy and the birth will often take longer (Pregnant Fit, 2008). With a first delivery the exorcism phase can last one to two hours, but a second or third delivery is often a piece of cake. Your little one may only need a few minutes (Medicinfo Encyclopedia). 

Birthrates

The most obvious position for giving birth is lying on your back, but it is good to know that there are many other options. You can also give birth in a standing or sitting position or on your hands and knees. It is even true that regularly changing your birth position can make sure that you experience less pain. Standing upright or sitting down during labour has many advantages. In that case gravity is your best friend. The pushing will take less time, you will experience less pain during the contractions and moreover, there is less chance of contractions, a forceps delivery or the use of a vacuum pump (The Midwife). We'll tell you more about those last three later in this blog.

You can also give birth hanging over a bed or bath. And have you ever heard of the birthing stool? This is a kind of toilet you can sit on without having to squat on your own. Many women find this position very pleasant. Because gravity causes the head of your little one to put more pressure on your anus, this can also help you when you have little or no urge to push (Birth Centre Pure). Research the possibilities and try everything out before you give birth. You will find out for yourself what position to give birth to. 

Our tip: try to relax as much as possible during the first contractions and do not lie down too quickly. Do you want to lie down? Then preferably on your side. 

Clip

In other words: episiotomy (in short: epi). Sometimes a cut may be made to prevent a large rupture or because there is an urgent need for rapid expulsion. Incision is also often made when delivering with the use of a vacuum pump (Practical Obstetrics, 2009). In general, an epilation is always done during a contraction because the skin is stretched so much that it is often numb, but you are always given anaesthetic just to be sure. In the Netherlands, an epi is placed at an angle of 40 to 60 degrees and will be placed to the left by a right-handed gynaecologist or midwife (Pregnant Fit, 2008). An epi is usually about 3 to 4 cm long and is always stitched under local anaesthetic. Often the anaesthetic used for the cut will not have worn off yet, so if only a few stitches are needed, they will not use extra anaesthetic. Often the head will follow immediately after the cut (Practical Obstetrics, 2009). 

Vacuum pump or forceps delivery

We mentioned it earlier: the vacuum pump. This is sometimes used to speed up the birth of your baby. The vacuum pump is a suction cup with a diameter of about 5 cm and is usually made of metal or plastic. The suction cup is placed against the head of the baby after which the midwife, with the help of a pump or manually, sucks the air out of the suction cup which creates a vacuum. During a contraction, the midwife or obstetrician can help the baby by gently pulling the cord. You can also choose to use forceps. This may sound a little scary but don't worry, it is not harmful for your baby! The forceps consist of a kind of spoons that are placed around the baby's head on both sides. The 'spoons' have a handle the midwife or obstetrician can pull during a contraction. 

A cut is almost always performed during a forceps or vacuum delivery, but it depends on the strength of the pelvic floor muscles, the speed at which the baby needs to be born and the risk of tearing (among other things).Health.be, 2015). Do not worry too much about a forceps or vacuum delivery. About one in five women will experience it during their first childbirth. 

Moms, you can do it! Practice birthing positions and prepare mentally for the big moment. As scary as some things may sound, they are all for the good of you and your baby. And once you have that little one in your arms, it will all be worth it.

Sources:

Birthing stool | Birth Centre PUUR Obstetrics, Echo and Maternity Care. (s.d.).  https://www.geboortecentrumpuur.nl/baarkruk

Hentzepeter-Van Ravensberg, H. D. (2008). The birthhttps://link.springer.com/chapter/10.1007/978-90-313-6304-9_15?error=cookies_not_supported&code=32642369-bc7d-4c18-96bb-9a195fcfbfb3

Knov, D. B. V. (s.d.-a). Birthrates.  https://deverloskundige.nl/bevalling/tekstpagina/50/bevalhoudingen/

Knov, D. B. V. (s.d.-b). De Verloskundige - an initiative of KNOV.  https://deverloskundige.nl/krachtigeverhalen/verhaal/1/donja#:%7E:text=Probeer%20verticaal%20te%20baren.,je%20hier%20geen%20last%20van

Medicinfo Encyclopedia. (s.d.). Non-advanced extrusion.  https://encyclopedie.medicinfo.nl/niet-vorderende-uitdrijving/04653b3858bc45c386b05f3310c95db7

Nv, G. (2015 October). Giving birth using forceps or vacuum cups | health.be.  https://www.gezondheid.be/index.cfm?fuseaction=art&art_id=3499

Prins, M. (2009). 5 The normal parturition.  https://link.springer.com/chapter/10.1007/978-90-313-8144-9_5?error=cookies_not_supported&code=9263e2ee-ea2a-4edd-8fd8-8a6ed0b3e22c