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Just before the head is delivered, it is common for the woman to be asked to pant. Why?
The head is quite considerably compressed in the birth canal. Because the woman at this stage will be trying to get the baby out, there is a risk of sudden decompression of the head if the expulsion is forceful and sudden. Panting removes this risk, as the assisting person can gently ease the head out. Sudden decompression of the head carries a risk of causing brain injury.
What happens after the head is delivered?
In most cases, another single push will help facilitate delivery of the shoulders. After that, the rest of the baby is eased out without the need of any maternal contribution. In fact, delivery of the shoulders does not necessarily require a uterine contraction
What is shoulder dystocia?
This is a difficult but fortunately rare complication of delivery. With a big baby, sometimes the head is delivered but the broad shoulders are stuck above the pelvic brim, with the neck stretched in the birth canal.
This requires quick action where the mother will be put in a special position, a large episiotomy (if not already there) is applied and special manipulations of the baby are made to allow delivery. This can be quite difficult and some fractures may result. Most vulnerable are the baby’s collarbones and the bone in the upper arm (humerus).
It is virtually impossible to predict shoulder dystocia.
The third stage of labour
What happens in the third stage of labour?
Moments after the baby is born, the uterus contracts, allowing the placenta to detach from its base. The midwife will wait for the telltale signs of this and then deliver the placenta by applying gentle traction on the severed cord.
The mother does not have to do any pushing. In most cases, this happens within minutes of delivering of the baby. Occasionally, the placenta does not detach and it has to be manually removed. This requires adequate pain relief, such as an epidural, spinal or general anaesthesia. It is not done under a local anaesthetic.
What happens after the third stage is complete?
If there was an episiotomy, this is repaired. Labour is then complete and the new mother can rest and savour this very special moment.
How is the episiotomy repaired?
Normally a local anaesthetic will have been injected before the cut is made. Some more local anaesthetic may need to be injected or, if there is an epidural in place already, this may be sufficient. The repair is done using suture material that dissolves with time. There is therefore no worry about having the stitches taken out.
The area will inevitably be sore when the local anaesthetic wears off after a few hours. Pain-killers are sometimes necessary. This soon resolves and the new mother is likely to be perfectly comfortable within three or four days. Complete healing may take a couple of weeks or so, even though she will not be aware of it.