Stages of birth

Active opening stage

The active opening phase begins when the cervix is already 3cm open. In this phase of labor, contractions become increasingly longer and more intense. They occur approximately every three to six minutes and cause the cervix to open further. This phase ends when the cervix has opened completely, to about 10cm.

Suitable birthing positions: During this phase, it helps many birthing women to adopt a standing or walking birthing position. Gravity and movement increase the downward pressure of the baby’s head, making it easier for the baby to push through the pelvic spaces. Many women also find forward-bending positions and the quadruped position comfortable because they can rest their arms and head.

Contractions are the rhythmic contractions of the uterine muscles controlled by the hormone oxytocin.

During a contraction, the muscles of the uterus contract. This causes the longitudinally striated uterine muscles to shorten, thereby opening the cervix. At the same time, the upper part of the uterus (the fundus) becomes thicker and stronger and can push the baby deeper with each contraction.

Discharge stage

When the cervix is fully open, the baby slides into the birth canal. As more oxytocin is released, contractions increase during this stage of labor. To move deeper into the birth canal with the least resistance, the baby turns its entire body.

The last contractions in the exit phase are called pushing contractions. This pushing phase can last about 20 to 40 minutes. However, this period is very individual (it may well last longer for first-time mothers and much shorter for multiples). The baby’s head exerts pressure on the rectum, which triggers the natural urge to push (pushing contractions are very strenuous for the expectant mother, so it is also useful to adopt a birthing position that relieves the mother during this phase).

First, the baby’s head is born. Here the midwife ensures perineal protection, i.e. exerting pressure on the muscles of the perineum in order to regulate the speed of the passage of the head. In this way, the likelihood of perineal rupture can be reduced. Delivery of the rest of the body occurs during the next contraction, when the baby’s body has turned so that the shoulders fit through the longitudinal oval pelvic outlet.

Appropriate birth positions: The best birthing positions during the exit phase include the quadruped position or deep squat. Again, it can be comfortable to alternate between positions to help the baby make its way through the birth canal.

Birth positions in detail

Walking or standing

This birth position is suitable in the opening phase. You can walk around between contractions and circle your pelvis so that your baby can slide lower. During labor it is better to stand still and hold on to something. This can be a wall bar or your partner. You can also hold on to a rope or cloth hanging from the ceiling and let yourself hang a little. This will take some weight off your legs.

• Advantages: Due to walking, gravity and pelvic circling, the cervix opens faster, so that the birth process is optimally advanced. The contractions are particularly effective and come more regularly. The movement allows the birthing woman to breathe easier and distract herself better from the pain.
• Disadvantages: Although walking around positively advances the birth process, it can become very exhausting in the long run or lead to circulatory problems.

Birth positions in detail

Walking or standing

This birth position is suitable in the opening phase. You can walk around between contractions and circle your pelvis so that your baby can slide lower. During labor it is better to stand still and hold on to something. This can be a wall bar or your partner. You can also hold on to a rope or cloth hanging from the ceiling and let yourself hang a little. This will take some weight off your legs.

• Advantages: Due to walking, gravity and pelvic circling, the cervix opens faster, so that the birth process is optimally advanced. The contractions are particularly effective and come more regularly. The movement allows the birthing woman to breathe easier and distract herself better from the pain.
• Disadvantages: Although walking around positively advances the birth process, it can become very exhausting in the long run or lead to circulatory problems.

Supine position

The supine position is the most famous among the birthing positions, because it is usually the only position shown in many movies or other media. However, as you will see in the advantages and disadvantages, it is not the most practical and comfortable position to give birth. In the supine position you lie slightly elevated on a bed or a special chair. During the exit phase you bend your legs and clasp the back of your knees with your hands.

• Advantages: The advantages of lying on your back are that you save strength (not like standing or squatting) and you can relax well during labor pauses. In addition, this position is the most favorable for the midwife and the doctor, because they have a good view of the birth process and can intervene quickly in case of complications.
• Disadvantages: The disadvantages outweigh the disadvantages with the supine position. Your birth canal is narrower when you are lying down and your pelvis is more immobile. In addition, gravity cannot be utilized, so labor is not as effective as in other positions. All this means that the birth will take longer and you may experience more pain. In this position it is also possible that your baby presses on the vena cava (vena cava syndrome). This prevents your blood from flowing back, which can lead to symptoms such as dizziness or nausea.

Lateral position

In the lateral position you lie similar to the supine position except that you turn on your side.

• Advantages: By lying on your side, your vena cava and pelvis are relieved and, similar to the supine position, you can relax better during breaks in labor. If your baby is not yet in the right position, you can encourage it to turn by using this position.
• Disadvantages: Similar to the supine position, the birth canal is much narrower in the side position (but still slightly wider than in the supine position) and the pelvis is more immobile. Gravity cannot be utilized here either and contractions are less effective. This can lead to a more painful and longer lasting birth.

Quadruped stand

In the quadruped position, also called knee-elbow position, you kneel on the floor or a bed. With your upper body bent forward, you can support yourself on the floor, a pillow or a pezzi ball.

• Advantages: In this position you have a lot of freedom of movement and you can relieve your back and spine. Since you can breathe better, the contractions are easier to endure and “breathe away”. The birth process is accelerated because gravity supports you and you can move your pelvis very freely. Since there is less pressure on the perineum, the risk of perineal tears decreases.
• Disadvantages: This posture is unfamiliar and can become very tiring in the long run.

Sitting

If you want to give birth to your baby in a sitting position, you have three options: a birthing stool, a pezzi ball or a normal chair. If you use a chair, you can sit on it with your back wide open and hold on to the backrest. If you feel most comfortable with a pezzi ball, you can sit on it, rocking slightly and circling your pelvis. The birthing stool has no backrest and is shaped like a semicircle. When you sit on it, you can either lean against your partner or hold on to a rope hanging from the ceiling. Only the birthing stool is suitable for the last phase of birth, as sitting positions on a Pezzi Ball or chair would block the exit.

• Advantages: In this seated position, you can be optimally supported or massaged by your partner. Since you are sitting upright, more pressure is exerted on the cervix, so gravity helps to drive the birth forward. Sitting gives you more freedom of movement and stability at the same time. There is less pressure on your sacrum and you get better air. If you bend forward in this position, you also relieve the back, pelvic floor and perineum.

Squatting

In this position you either squat on your heels or on a birth stool. If this position becomes too exhausting, your partner can support you or you can hold on to a rope hanging from the ceiling.

• Advantages: In the squat position, contractions are much more effective, as more pressure is exerted on the cervix and your pelvic outlet is particularly wide open. In this position, you can actively and purposefully push along, which is why it is also particularly suitable for the discharge stage.

Water birth

Water birth is becoming more and more popular. Today, about every 20th child is born in a birthing tub. The expectant mother lies in a birthing tub (also possible in a normal bathtub) with warm water (34 to 36 degrees Celsius), which helps with relaxation, as well as calming and pain relief. In addition, with water birth there is a lower risk of perineal tear, because the muscles and tissues are softer and more stretchable. A water birth is also gentler for the newborn because he or she slides from the amniotic fluid directly into the warm water of the tub, allowing him or her to acclimate more slowly to the new environment. You don’t have to worry about your baby breathing in water, because the breathing reflex still works underwater.

It is important to note that a water birth is only an option if there are no risks for mother and baby, because quick medical intervention is not possible during a water birth. In case of multiple births, a bad CTG of the baby (cardiotocography= simultaneous measurement of the contractions of the uterus and the heart sounds of the baby) or a breech presentation of the baby, a water birth is not possible. You must also keep in mind that an epidural is not possible for a birth in the tub. PDA (epidural anesthesia) is an anesthetic procedure to relieve severe pain during childbirth. For this, the doctor injects a drug near the spinal cord to suppress the signal transmission of the nerves for a certain time.

If you decide to have a water birth, it is important to keep the following point in mind when preparing: For a water birth, it is important for the safety of the clinic staff to have the results of an HIV test and a hepatitis C test of the pregnant woman. These tests are included in the standards of preventive care.

Which birth position is the best for me?

There is no universal answer to this question. In the course of the birth, depending on the birth phase and how you feel, you will intuitively move into the positions that feel best for you and with which you feel most comfortable. If you are not sure, your midwife will support you in choosing a suitable position that will optimally promote the birth of your baby in the respective phase.

Generally, it is recommended to give birth in an upright position, as this helps gravity, you can breathe better, your baby slides through the pelvis more easily and the risk of birth injuries is reduced.

You can also study and practice the different birthing positions before you give birth. This gives you the opportunity to discuss with your midwife and/or partner which positions you feel comfortable with. This will give you security and confidence for the upcoming birth of your child.

No matter which birthing position you decide on or which one you end up taking: always stay focused and positive! Think about your little baby that you you will hold in your arms soon.

Pregnancy myth 1: Your belly shape reveals the sex of the baby.

Before the invention of ultrasound, other means had to be used to predict the sex of the child. Even in ancient times, the shape of the belly was therefore considered an indicator of gender. According to this pregnancy myth, a broad, rounded belly is supposed to indicate a girl, while a pointed belly is supposed to indicate a boy. However, this myth is not medically proven.

Rather, the shape of the abdomen depends on very different factors. For example, the woman’s weight and abdominal girth before pregnancy play a role. The woman’s stature has a decisive influence on how the baby bump develops. In petite women, for example, the baby bump often shows a little earlier. In addition, the size of the pelvis and the shape of the pelvis also determine how the baby bump develops. With a narrow pelvis, the uterus does not have as much space in the pelvis and therefore expands more forward and upward. This can make the belly appear more pointed. If the pregnant woman has a wider pelvis, the uterus may initially expand laterally. The size of the baby also has an influence on the shape of the abdomen. The baby’s growth is in turn related to genetic factors and the child’s nutrient supply. In addition, the amount of amniotic fluid also plays a role in the size and shape of the abdomen. The less amniotic fluid there is, the smaller the babybelly. Finally, there are three other influencing factors that play a decisive role in determining the shape and size of the abdomen. These include the condition of the abdominal wall and the connective tissue in the woman. Firm muscle and connective tissue often means that the abdomen is smaller. The abdomen is also usually smaller in the first pregnancy than in subsequent pregnancies. Lastly, the belly is often rounder and larger if it is a multiple pregnancy.

So the fact is: Based on the shape of the belly and the size, some things can be recognized by trained professionals. However, no statement can be made about the sex of the baby.

Pregnancy myth 2: Pregnant women need to eat for two.

“You have to eat for two now!” – every pregnant woman has certainly heard this sentence before. But what is really true about this pregnancy myth? In fact, pregnant women have an increased daily requirement of calories, which, however, does not correspond to twice the normal daily amount. How much the calorie requirement increases can vary somewhat from woman to woman and also changes in the course of pregnancy. For example, toward the end of pregnancy, one usually has more caloric needs. The average calorie requirement during pregnancy increases by about 200 to 250 calories. This is roughly equivalent to an apple and a slice of whole-grain bread with an egg.

So this pregnancy myth is also not true. More important than the amount is what you eat during pregnancy. You should eat a balanced and nutritious diet to support your baby’s development. If you want to know which foods are particularly suitable for a balanced diet during pregnancy and what you should rather keep your hands off, you are welcome to read this article on nutrition during pregnancy.

Pregnancy myth 3: A girl robs the mother of beauty, a boy makes her shine.

Another pregnancy myth is about the so-called baby glow that some expectant mothers give off during pregnancy. Others, on the other hand, struggle with skin blemishes or even pregnancy acne. If you believe the myth, blemished skin predicts the birth of a girl and baby glow indicates a boy.

In fact, however, the changes in skin appearance have very little to do with the sex of the baby, but are mainly due to hormonal changes during pregnancy. During pregnancy, for example, the placenta produces more estrogen. This hormone supports the cardiovascular system and promotes blood circulation. Due to this increased blood circulation and additional water retention, the skin becomes clearer, firmer and a rosy glow develops – the famous Baby Glow. Incidentally, the likelihood of baby glow is highest in the second trimester. However, in addition to increased estrogen production, progesterone levels also rise and more androgens are released. The result of this can be skin blemishes such as pimples or blackheads. In addition, the testicles of boys produce testosterone from about the 16th week of pregnancy, which can also have a negative influence on the skin appearance of the expectant mother. So a small connection between the mother’s skin and the sex of the child even exists. However, this influence is rather small and the connection additionally contradicts the myth.

Every pregnant woman reacts differently to hormones and the hormone balance itself can also vary from woman to woman. Whether in pregnancy the baby Glow, skin blemishes or perhaps even both in succession appears, no one knows. For this reason, no statements can be made about the sex of the baby based on the skin appearance of the expectant mother.

Pregnancy myth 4: Pregnancy nausea indicates a girl.

And here we go with our pregnancy myths about the baby’s sex: If a pregnant woman suffers from frequent morning sickness, this is supposed to be a sign that she is having a girl. In fact, 50% to 90% struggle with morning sickness and especially from the 6th week of pregnancy. This nausea usually fortunately does not last the whole pregnancy, but often passes with the 12th SSW. But does this nausea predict the sex of the child?

It is true that when you are pregnant with a girl, you have an increased level of HCG (pregnancy hormone human chorionic gonadotropin), which can increase morning sickness. However, this connection is not a must, i.e. there may be increased nausea due to a high HCG level, but this is not necessarily always the case. Here, too, we can see that every woman reacts differently to hormones. Thus, it can be said that there is nothing to this myth either. Some women unfortunately suffer from severe nausea, some from none at all – regardless of whether they are pregnant with a boy or a girl. Besides, nausea always depends on the lifestyle, diet and stress of the expectant mom.

Pregnancy myth 5: Whether you have sweet or salty cravings is an indication of gender.

Pregnancy cravings are also said to be a clue as to whether pregnant women are having a boy or a girl. According to this myth, pregnant women who have increased sweet cravings should be pregnant with a girl, while salty cravings are more likely to indicate a boy. So whether a pregnant woman craves sour pickles or chocolate predicts the gender? Clearly wrong! Preferences for certain foods during pregnancy have nothing to do with the sex of the child, but are rather related to hormones. Hormones, in fact, influence the sense of taste and smell and thus also the eating behavior of expectant mothers. Cravings, however, can even make sense. During pregnancy, the body needs a particularly large amount of vitamins and nutrients. Cravings can lead to eating foods in particular that contain nutrients and vitamins that the body needs at the time. Cravings for chocolate, for example, are often due to a magnesium deficiency, as dark chocolate contains a lot of magnesium

Pregnancy myth 6: Pregnant women are totally forgetful.

Does pregnancy dementia really exist or is it just an excuse for pregnant women? In fact, this pregnancy myth is true: pregnant women often become more forgetful! Pregnancy dementia is also mainly caused by the changed hormone levels. Around 80% of pregnant women notice a deteriorated memory and a reduced ability to concentrate. Most expectant moms notice the increased forgetfulness towards the end of pregnancy or even afterwards. For example, the stress hormone cortisol plays an important role in increased forgetfulness. Just as lack of sleep can also have an influence on it. Once the baby is born, the mothers’ forgetfulness is called breastfeeding dementia. The hormones oxytocin and prolactin, which are produced after birth and promote the bond between mother and child, are then particularly important. Mothers focus very strongly on their child and the bond with their child, causing other things to fade into the background and be forgotten.

However, the term dementia is misleading in this context because there is no change or damage in the brains of pregnant women. Both pregnancy dementia and breastfeeding dementia pass as soon as the hormone balance settles down again.

Pregnancy myth 7: Each child costs a tooth

The pregnancy myth that a woman loses a tooth during every pregnancy is at least not completely wrong. Of course, it is not true that women lose a tooth during every pregnancy. However, expectant moms should pay special attention to their dental and oral hygiene. This is because the changes in hormone balance cause the pH value of saliva to change slightly. This can make pregnant women more susceptible to tooth decay. In addition, the increased estrogen levels increase blood circulation, which can lead to more frequent gingivitis and bleeding gums. In addition, there is an increased need for calcium and fluoride during pregnancy, which can deprive the teeth of these. Expectant mothers should therefore pay particular attention to proper dental hygiene during these nine months so that the pregnancy myth “every child costs a tooth” does not become true. In addition, dental hygiene is also important because bacteria easily enter the body through the gums, which can lead to infections.

Pregnancy myth 8: Sport harms the baby.

The last pregnancy myth to be discussed concerns sports during pregnancy. Often, the topic of sport during pregnancy is met with concern or doubts are stirred up by others with phrases such as: “Sport harms the baby”. However, it cannot be said across the board that sport during pregnancy harms the baby. This myth is simply wrong. It is important that no dangerous sports or extreme sports are practiced. Pregnant women should listen to their bodies and be as active as is good for them, then sport can even offer benefits. In this article, you will find out what you should keep in mind when it comes to sports during pregnancy.