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Expulsion and the expulsion reflex during childbirth
Expected for months, sometimes feared, the expulsion requires a lot of energy since it will be essential to push to accompany the progression of the baby in the pelvis until its release. This phase of childbirth is intense but it usually does not last more than thirty minutes and ends with the most beautiful of rewards.
Deportation, step by step
After several hours of labor during which the uterine contractions increasingly strong and closer have allowed the erasure and dilation of the cervix, the baby’s head engages in the pelvis and makes a quarter turn. Its progression to discharge then occurs under the effect of contractions accompanied by the mother’s pushes. This is obviously the most classic configuration of childbirth, with a baby presenting himself upside down, his chin close to his chest. Expulsion requires more interventions from the medical team when the baby presents in breech, obliquely, the head partially flexed on his chest …
What is the expulsion reflex?
As the baby’s head descends into the pelvis, there comes a time when it presses on the rectum, located just behind the vagina. It makes you want to push hard. This expulsion reflex is a natural reflex that must be followed by letting yourself be guided by the midwife or the gynecologist.
In which position to expel baby?
In France, traditionally, women give birth in a gynecological position, lying on their back, the bust raised, the legs apart, with the knees raised and the feet wedged in the stirrups. Many doctors favor this position because it gives them perfect control of the expulsion and allows them to intervene easily if necessary. But in recent years, we have seen a return to more physiological childbirth positions: lying on your side, standing suspended from a rope, sitting … Not all maternity hospitals offer this possibility yet. But as recalled by the National College of French Gynecologists, these positions more respectful of the physiology of the woman and generally less painful, without being imposed, should be authorized or even recommended during any delivery of normal quality.
Episiotomy and instruments to help baby come out
The midwife or the surgeon must sometimes intervene to accelerate the expulsion and help the baby to disengage from the pelvis.
The episiotomie
A few seconds before the expulsion, when a contraction numbs the perineum, the midwife or the gynecologist make a slight incision to enlarge the natural opening of the vagina. Then, if there was no epidural, they do a few stitches under local anesthesia. Very widespread a few years ago, episiotomy is not so systematic today. The incision is often larger than a natural tear, causes more bleeding and heals less quickly. This is why, ideally, the medical team does it only when it deems it really necessary: there is a risk of very important tearing, the baby is a little big, he presents himself by the breech, he is in fetal distress, forceps must be used …
Forceps
Resembling two large spoons, they are used under epidural or local anesthesia to help the baby’s head come out, when labor is prolonged or in case of fetal distress. They require an episiotomy. The forceps may leave marks on the side of your baby’s head, but they will soon disappear.
Suction cups
Obstetric suction cups are applied to the top of a baby’s head to gently suck it out of the vagina during a contraction. Used as a replacement for forceps if there is a problem at the time of expulsion, they do not necessarily require an episiotomy. Some babies may have a slightly conical head and / or carry the suction cup mark during the days after birth.
That’s it, baby is born!
The minutes following the expulsion are well filled. The dad or the midwife cut the umbilical cord. Baby is carefully examined and a bracelet is attached to his wrist or ankle to identify him. Contractions occur again, this time intended to expel the placenta. You will then have to stay two hours in the delivery room before being able to return to the room. Moments conducive to the practice of skin to skin and latching on for mothers who plan to breastfeed. Baby is then exceptionally awake and his sucking reflex is at its maximum. This early latching has two virtues: it generally guarantees a good start of lactation and causes contractions which participate in the detachment of the placenta.