Birth

Prenatal classes (also called antenatal or birthing classes) help pregnant women and their partners to prepare for the birth of their child. The classes cover things like what happens during labor and what can help you cope better with labor pain. They are typically offered by maternity hospitals or midwives. In Germany, statutory health insurers cover the costs of these classes for their members.

Preparing for the birth also means thinking about where you would like the child to be born, and who should be there to support you. Most women give birth in a hospital. But it’s also possible to have your baby in a birthing center or in your own home (homebirth) if there’s no medical reason not to. Expectant mothers usually want the baby’s father or another loved one to be by their side during the birth. A midwife is also there to support them.

The pre-registration appointment at the hospital or birthing center is a good opportunity for pregnant women and their support person to talk to the birthing team about their own wishes and worries – for instance, if you’d prefer not to use any medication or if you’re very anxious about the birth.

Toward the end of pregnancy, the baby bump drops down because the baby gets into a head-down position and their head moves lower down into the pelvis. Many women can breathe more easily after that. But they often feel more pressure on their bladder instead, and have to go to the toilet more frequently.

Practice labor contractions (known as Braxton Hicks contractions) can occur days or even weeks before the birth. These contractions make your tummy or back feel tight, and your belly hardens. They come at irregular intervals, don’t last long, and are usually not very painful. It is thought that they prepare the woman’s body for labor.

In the days leading up to the birth, you may also notice other signs that you’re likely to go into labor soon:

• The mucus plug comes out (a thick protective clump of mucus that blocks the opening of your cervix during pregnancy). This may be accompanied by slight bleeding known as the “bloody show.”
• Back pain
• Stomach and bowel symptoms, like mild diarrhea
• Feeling restless and finding it hard to sleep

When your waters break, the sac surrounding the baby bursts and amniotic fluid flows or trickles out of your vagina. The labor contractions usually start just a few hours after that. But your waters might only break when you’re already in labor.

Different women experience different signs of labor starting. Sometimes women go into labor without noticing any telltale signs before.

Labor begins when you start having regular contractions. During a contraction, the muscles of the womb (uterus) tighten and the cervix gradually opens up so the baby will be able to pass through it. As the birth progresses, the contractions get stronger and closer together. If it’s your first child, you should make your way to the hospital or birthing center – or call your midwife to prepare for your homebirth – when you have regular contractions every 5 minutes. If you’ve previously given birth to another child or children, you should already do this when the contractions are 10 minutes apart.

The length of labor varies. Sometimes the child is born after just a few hours, but it can also take one to two days. Your birthing team will regularly check on you and the baby to see how you’re doing. They will also help you cope with the labor pain.

Labor typically happens in several stages:

• First stage: During this stage, your cervix gets shorter and thins out (effaces) until your cervix has fully opened (dilated). In the early phase of the first stage (early labor), the contractions are usually still quite weak and last less than one minute. There are sometimes long breaks between the contractions. The active phase starts once the baby’s head has entered the pelvic girdle. Then the contractions get stronger, closer together and last longer.
• Second stage: The baby’s head passes through the opening of the cervix and moves down through the vagina. If it’s your first child, this can take several hours. Once the baby is low down in the pelvis, you feel a strong urge to push, so you automatically push during contractions. Eventually the baby’s head comes out (“crowns”), followed by their shoulders and the rest of their body.
• Third stage: The placenta is delivered and the baby’s umbilical cord is cut.

Your newborn baby will likely be placed on your belly and covered in a warm towel. The midwife or doctor will check to see whether you and the baby are doing okay. If all is well, you will now have time to cuddle your child and start getting to know them. Most babies look for a breast soon after they are born. You can then try to breastfeed them for the first time.

The main thing that helps women to cope with labor pain is having a reliable, caring person by their side. This person can try to encourage you, make you as comfortable as possible, and perhaps give you a massage and keep you warm.

Many women also find it helpful to change position regularly. You need to find out for yourself which position feels good at the time – whether that’s standing, sitting, squatting, lying down or walking around. Contractions come in waves. This means that every contraction is followed by a break where you can gather strength to face the next contraction.

Some women say that things like breathing exercises, a warm bath, heat packs or a massage provide relief as well. If that’s not enough, medication can help. The most effective kind is an epidural, where medication stops pain signals traveling up the spinal cord to the brain. Epidurals can also be used if a Cesarean section needs to be done. The medication doesn’t harm the child.

Medical interventions might be needed in certain situations. They include:

• Oxytocics: If the contractions are too weak, they can be strengthened with hormones given in the form of a drip, tablet, suppository or a gel that is applied to the cervix.
• Episiotomy: This procedure can be done toward the end of labor to speed up the birth. It involves making a cut in the area between the vaginal opening and the anus (the perineum) under local anesthesia. This makes it easier for the baby to leave the vagina. An episiotomy may be carried out if there are signs that the baby is in trouble, for instance.
• Vacuum or forceps delivery: This type of assistance may be used if your labor stalls (stops progressing) toward the end. A local anesthetic is sometimes given beforehand. The doctor or midwife places the vacuum or forceps on the baby’s head. This allows them to gently pull the baby out of the vagina during a contraction.

A Cesarean section (C-section) is an operation where the baby is taken out of the womb through a cut in the mother’s belly. It is sometimes needed if a normal birth is too risky or not possible.

Some C-sections are planned (scheduled) in advance, perhaps because the child is lying sideways in the womb or the placenta is blocking the birth canal. The need for an unplanned C-section only arises during labor – for instance, if the labor stops progressing or the baby’s heart rate drops dangerously low.

But it’s more common for women to have scheduled C-sections that aren’t absolutely medically necessary. The reason is usually because they have risk factors that could lead to complications during a “normal” (vaginal) delivery. Examples of such risk factors include having had a C-section in the past, or the baby lying bottom-first instead of head-first (breech position). Then the doctors will discuss the options with the expectant mother, and decide together which type of birth would be best in this particular case.

C-sections can be done under regional anesthesia (numbing just part of the body, like in an epidural) or under general anesthesia. If everything goes smoothly, the operation takes about an hour in total. The mother and baby stay in the hospital for about three to six days afterwards.

If your due date has already passed but there are no signs of labor, waiting can become a real test of patience. Being one to two weeks late is usually no cause for concern. After that, the risk of health problems in the child increases a bit. It is usually not known why the baby still hasn’t come.

After two weeks it is considered to be a post-term pregnancy. The birth is usually induced at that point. This can be done in various ways – for example, using medication ( hormones).

There are also other reasons to induce labor medically, including pre-eclampsia and premature rupture of membranes (when your waters break before labor begins).

Premature or “preterm” birth is when a baby is born before 37 completed weeks of pregnancy. There are usually certain warning signs when this happens. The most obvious sign is contractions.

If signs of a preterm birth are recognized early enough, it’s often possible to prevent it from happening, or at least delay the birth for some time. If the labor can no longer be stopped, medication is given to speed up the development of the baby’s lungs. This prevents breathing problems in babies that are born so early that their lungs wouldn’t be ready yet otherwise.

Children who are born long before their due date often need special care. As well as receiving intensive medical care, it is important for the baby to feel that their parents are there for them, for instance through plenty of skin-to-skin contact. Nowadays most preterm babies have a good chance of developing normally. But they sometimes need a little more time.

A lot of information (in German) about pregnancy, childbirth, and the time afterwards can be found at Familienplanung.de (BZgA). The section on pregnancy provides answers to many questions about the course of pregnancy, early childhood development, screening tests, childbirth and the time after birth.