Pregnancy and Birth

Birth is the end of the pregnancy. It encompasses two major phases, referred to as labor and delivery. Labor typically begins with mild contractions of the uterus that occur five to thirty minutes apart. Each contraction lasts approximately thirty to forty seconds. As labor progresses, the contractions become stronger, occur more frequently, and last up to one minute. Throughout labor, the cervix (the opening of the uterus to the vagina, or birth canal) dilates progressively and the baby moves downward into the birth canal. Delivery occurs when the baby is born by being expelled from the birth canal or when a cesarean section is performed. Although the cesarean section rate varies from country to country, an increase in the cesarean method of birth is evident in both developed and developing countries. Cesarean birth requires a cut to be made through the abdominal wall and into the uterus. The woman receives medication so that she does not feel the cut. The physician then removes the baby and the placenta. When the baby is born through the birth canal, the placenta detaches from the uterine wall and is expelled through the birth canal. In some cultures, the placenta is considered sacred and is given a ceremonial burial at the family home. For example, some Maori people of New Zealand bury the placenta because they regard it as a twin who gave up life so the other twin, the live baby, could live.

In some cultures, pregnancy is viewed as a gift from God, and reliance on the spiritual aspects and sacredness of birth for a positive outcome is common. Throughout labor, the woman experiences sensations ranging from mild discomfort to intense pain. Cultural norms and expectations vary, such as acceptable vocalizations of pain, who may attend the birth and/or provide comfort and support, and the mother's birthing position. The belief that to give birth one must endure some pain is universal. Cultural norms about expressions of that pain vary from silence to frequent crying out. Herbal remedies; massage; relaxation and breathing exercises; medications administered by a physician, midwife, or nurse; and various rituals typically are employed to help alleviate the pain of labor and birth.

In many cultures, female members of the woman's extended family, especially mothers and mothers-in-law, provide comfort and support, with a lay midwife present for the birth. In other cultures, a nurse midwife is present for the labor and birth. In still other cultures, a registered nurse may be present for the labor and birth, and a physician delivers the infant. The woman's position varies from standing and/or walking to reclining in bed during labor, and from squatting to reclining in bed for the baby's birth.

The setting for birth also varies across cultures. In many cultures, the woman's home or the home of a relative is regarded as the most psychologically safe and comfortable birth environment. In other cultures, a hospital is viewed as most appropriate. In still other cultures, women and their partners may plan to have their baby at home but are ready to go to a hospital if a difficulty is encountered.

The role of a male partner during birth varies among cultures. In many cultures, norms about modesty may prohibit a male partner or other men from being with the woman during labor and delivery. In other cultures, the male partner is expected to be present, if only to observe the woman's suffering and be more willing to participate in family planning. In still other cultures, the male partner is regarded as a provider of much support and comfort to the laboring woman.

Women and their partners or such other support persons as family members or friends who plan to be together for the labor and birth can learn the proper relaxation and breathing exercises in childbirth preparation classes taught by trained childbirth educators. These classes also help the woman and support person to understand what happens during labor and delivery and to learn how the woman's support person can be present at the birth to coach her throughout labor and delivery.