Hello, everyone, Dr. Boyd, welcome back to parently. Today we're talking about the delivery process the journey because that's what it is. And it is so incredible, but so overwhelming to so many people that I want to go through this piece by piece event by event, the journey. Now, when you are completely dilated, you start your second stage of labor, you're going to push and you're going to push anywhere from five minutes to three hours. If it's your first maybe you're going to push longer. If it's your second, third or fourth Baby, you're going to push less long.

So on average, if you have a first time baby plan on two to three hours of pushing, if you've had multiple babies, it's usually one to two hours but that's an average. Now what to expect at the actual delivery. Now, as you know, we've talked about this you are hooked to a monitor. So we're monitoring the baby, as it relates to your contractions, the entire process of labor. Sometimes your baby will have what's called an internal scalp electrode. That means a little device that's screwed right into their skin at their scout.

And it's a better monitoring effect of the baby. You also might have a tube inside your uterus called an intrauterine pressure catheter, at the time of delivery, usually when the baby's crowning. So that means when we look down in the vagina, we're seeing this much of the head that's called kaput. That's usually a process that is indicating it, imminent delivery. Now, if the baby's heart rate is fine, there's no problems with your blood pressure etc. The delivery process will occur naturally at this point.

However, if there's a problem with the baby's heart rate, so Assume that it's really low or it's really high. your health care provider may talk to you about a vacuum. It's a little suction device that goes right on the baby's head, or forceps, forceps or a tool that kind of looked like salad tongs, that slide right around the baby's head and help guide the baby's head out of the vagina. Now only a small percentage of patients have a vacuum, have forceps. Now at the time of kaput again showing this much at the baby's head, your health care provider will make a decision on whether to cut you in the vagina. So again, this much kaput, they're going to talk to you or they've made a decision to perform a cut called an A peasy Atomy.

In this scenario, with the baby showing this much hand, the cut is typically made at the six o'clock position on the vagina. Now if you've got a good epidural, they don't need to numb this area. If you don't have a good epidural, they will inject light cane into this area. There's a smaller percentage of surgeons, obstetricians that make a side cuff. So again, if the cap is here, they will make a side cut here at four o'clock or here at eight o'clock position. Again, it's important that you talk to your healthcare provider, and what they perform on a normal basis.

Most healthcare providers, we don't make a PC obvious like we used to earlier my career, routinely, we made a PCR dummies. However, it's important for you to understand even if I don't cut you, you still may tear at the time of delivery. We don't like it when you tear, but again, you're delivering a baby through a small opening like this, and sometimes your tissue tears, so the delivery occurs. If everything is fine with the baby, we like to put the baby right against the mom's skin. It's called skin to skin and the baby's still attached to the umbilical cord. So we can't pull Baby really hard, but we typically take the baby and put the baby right up against the breast.

And oftentimes, we'll put a towel over the baby. As we're doing that the nurse is stimulating the baby, making sure that the baby's crying, making sure that there's nothing in the mouth that's occluding breathing, assuming everything's fine, then we can go ahead and cut the umbilical cord. And oftentimes, when we clamp the umbilical cord up by the belly button, we will have the father cut the umbilical cord at that point. Now, father's, I encourage you to do that. It's a way for you to be involved. After we cut the umbilical cord, then we drain the umbilical cord.

We need some blood to identify the baby's blood type, and then we need to deliver the placenta. placenta is very, very important for your baby's pregnancy. But after delivery, you don't need the placenta anymore and you want that Call Center to be delivered, it typically comes out anywhere from two to 10 minutes after delivery, you will feel some pulling on the umbilical cord, your uterus is contracting and the placenta should deliver spontaneously. And there is a group of women that the placenta will not deliver spontaneously, we have to put our hand up into the uterus to grab the placenta and pull it out and make sure all of the placenta is removed. If we don't do this, potentially, you could have bleeding from your uterus. That leads me into the next topic that many, many women do not like that uterine compression, uterine massage, and this is typically done by the labor nurse after delivery, and plan on this for one to two hours after delivery.

So after delivery, the uterus is going to decrease very quickly. It's going to decrease from its full term size down to your umbilicus your belly button. That means it's going to decrease One half in size. In doing this, this compresses the uterus constricts the blood vessels in the uterus and decreases your risk for bleeding. The uterus can sometimes fill with blood during this process. Therefore, the nurse needs to push on your uterus and decrease the risk for bleeding.

Now, some women say that nurse pushed on my belly, push on my abdomen, it hurt. I know it hurts, but it's very, very important and they will continue to do that. The other thing sometimes they have to do, it's either the nurse or the doctor of the healthcare provider, not only will we push on your uterus, potentially, we're going to put our hand back in the vagina up into the uterus and sweep the uterus of blood clots. In order to diminish your risk for bleeding. You have to understand the risk for bleeding can be dramatic and large amounts of blood can be lost very, very quickly. So we need to decrease the The size of the years and keep it firm so that your bleeding becomes minimal.

It is uncomfortable, but chapped to understand why we're doing this after we make sure that the bleeding is completely under control. At that point, the healthcare provider will inspect your vagina and make sure there's no tears that need to be repaired. In doing this, they will talk to you and say, you have a tear down by your rectum around your urethra, that's the pee tube coming from your bladder, and we need to put some sutures in this area. These are dissolvable so you won't have to have them removed. But obviously the greater the tear, the more uncomfortable you're going to be the next day after the delivery process, we've assessed for bleeding we've assessed for any type of tears, your health care provider if they feel satisfied that your bleeding is under control. Well simply Continue to iv pitocin to keep your uterus contracted.

So the pitocin is a medicine that was started right after delivery, and will help keep your uterus contract it. Now, if you're bleeding or your or your uterus is not firm like we want it to be, we may play some medication either in your vagina, or you're wracked and called side attack. These are tiny little pills that will slide in and help keep your uterus nice and contracted. You're going to spend the next several minutes with the with the nurse and the healthcare provider watching you closely. Looking at your blood pressure, looking at your heart rate to make sure that you're stable. When we feel comfortable that you're stable.

At that point, we should start the process of cleaning you up. And at that point, the delivery process by definition will end and then you will start your postpartum period. This is extremely important to understand why We do what we do. It's for the health care of you and your baby. I hope this was helpful. encourage you to watch through this video several times.

Have a great day.