Giving Birth 3

When your baby is almost here, the practitioner will don gown and gloves in preparation for catching your new arrival. There's tremendous excitement in the room. Everyone shouts encouragement with each contraction. "Push, push, a little bit harder, a little harder!" Everyone is anticipating the birth, anxiously waiting. What exactly is the baby doing at this point?

The baby has just one more obstacle to negotiate. The top of his or her head must slip under your pubic bone before delivery can take place. With every push, the head comes down a little farther, but between contractions, it also seems to slide back a little each time. You feel the next contraction starting and summon all the strength that you have left. You push and push and push. There is a wild cheering. The baby's head has slipped past your pubic bone and is crowning!

Most practitioners do not decide whether an episiotomy is needed until this point. (See Chapter 21.) That's because it's difficult to anticipate how large the baby's head is and how much the mother's tissues can stretch. As the head is crowning, if the tissues of the vagina and perineum stretch to maximum capacity, and begin to tear and bleed, it may become clear that an episiotomy is warranted.

You feel tremendous pressure and burning, and the mixture of sensations is almost overwhelming. Your practitioner tells you, "With the next contraction, the baby's head will be born. As the head is being delivered, I'll ask you to stop pushing so the baby can have a gentle birth. Then I'll suction the nose and mouth so the baby's first breath will be easier." Once again you feel a contraction beginning and start to push. "Stop pushing," the practitioner calls. Your eyes are probably closed, but everyone present watches as the baby's head is born. The top of the head comes first, then the eyes, the nose and the mouth; finally the whole head is out.

The baby's mouth and nose are gently suctioned for mucus and amniotic fluid. The head, which has been facing the floor, naturally turns to one side. That's because the shoulders are entering the pelvis; they fit best if the baby is facing your side. Your practitioner then says, "With the next contraction, you'll push again for the baby's shoulders." Sure enough, the next contraction begins, as if on cue. The practitioner tilts the baby's head toward the floor and the top shoulder slips underneath the pubic bone. As the baby's head is tilted toward the ceiling, its bottom shoulder is born. "Open your eyes!" someone shouts. You look down in time to see the rest of the baby slip out.

Your practitioner tells you either, "It's a boy!" or "It's a girl!" and then hands you the wet and wriggling baby. The umbilical cord is still pulsating. Your newborn draws his or her first breath and cries out. You're laughing and crying at the same time. Your baby is here!