7 facts about childbirth

The beginning of life is an exceptional experience. One none of us go on to remember. Unmatched in physical, mental and emotional intensity, giving birth is also a tremendous feat of strength. There’s still very little research on what exactly happens during birth, and it continues to be something of a medical mystery to this day.

Having already tackled the clitoris, periods, the vulva and the female breast, I’ve drawn up a list of seven facts about childbirth.

A medical mystery: what exactly happens during birth?

Childbirth is one of the most ordinary things in the world. Despite this, we know very little about it. I’ve taken a look at the reasons why, as well as why caesarean sections are on the rise and what orgasmic birth is.

1. Childbirth is one of the most under-researched subjects in medicine

Children are born every day. In Switzerland alone, around 224 new babies come into the world each day. Despite this, doctors know surprisingly little about the chemical, hormonal and physical processes that interact before, during and after birth, how the mother and child work together during the process and how it makes the baby feel.

A comprehensive investigation by the German newspaper «Süddeutsche Zeitung» (article behind a paywall, in German) explains why this is the case. According to Wolf Lütje, Head of Gynaecology and Obstetrics at Hamburg’s Evangelical Amalie Sieveking Hospital, childbirth is the «most under-researched area in all of medicine». He gives two reasons for this.

Studies on birth are currently based on observations and clinical experience. However, since they’d be unethical, there are no large-scale studies using control groups. Such studies would involve, for instance, one group of women giving birth naturally, while a control group would be subjected to unnecessary caesarean sections.

A second reason is the financing of the studies. The pharmaceutical industry has little interest in researching the effects of medication on pregnancy and childbirth, as pregnant women are rarely allowed to take medication anyway.

2. The birthing process begins four weeks before delivery

In movies, birth starts in a flash. In reality, however, it starts slowly. Your waters usually only break during birth, and it can take hours before you have to go to the hospital or clinic. For first-time mothers, childbirth lasts 12-18 hours on average (article in German). That being said, the baby might make an appearance pretty much any time between 1 and 48 hours. Future births reduce the duration to 6-8 hours. Exceptions prove the rule.

The actual start of labour takes place in the background, long before you even think about the birth: around four weeks before the due date. This is when the body starts gearing up for the birth, with the first contractions kicking in. At this point, the baby slides lower into the pelvis, its head adapting to the shape of the bone so that it can fit through the birth canal later. At the same time, the pregnancy bump literally sinks.

When they tested the blood of pregnant women in the weeks leading up to birth, researchers at Stanford University discovered messenger substances such as progesterone and cortisol increased. The results also showed anti-coagulant substances were released to keep blood loss low during birth. What’s more, the immune system is fine-tuned in the run-up to the due date, with the body producing a protein that puts the uterus on alert for the birth.

3. The baby is the one to trigger birth

It hasn’t been definitively proven what triggers the start of labour. However, studies suggest it’s the child who gives the starting signal by releasing free-floating pieces of genetic material from the placental tissue into the mother’s bloodstream. The baby’s DNA can be detected in its mother’s blood from as early as the fourth week of pregnancy. The closer the due date, the higher the concentration. This DNA causes inflammation in the mother’s body, signalling it’s time for labour to begin.

A protein important for the breathing process also appears to induce labour. When mature, the unborn child’s lungs release the protein, ensuring labour only begins when the child can breathe on their own.

4. There are four phases of birth

Once the starting signal has been given, the birth process moves through four phases. This begins with regular contractions triggered by oxytocin. These uterine contractions push the baby’s head lower into the mother’s pelvis. In the months leading up to birth, the hormone relaxin softens the tendons, ligaments and, later, the cervix. The pressure created by the baby’s head intensifies, causing the cervix and vagina to contract more and form a kind of funnel: the dilated cervix.

Once it’s fully dilated (10 centimetres), the baby makes its exit. In most cases, the amniotic sac bursts and the baby moves into the birth canal. It still has a few hurdles to overcome, including passing the mother’s lesser pelvis, chin instinctively pressed against its chest. After that, it has to turn 90 degrees and pass the pubic bone, which can only happen if the baby hyperextends its neck. It’s just as well the unborn child’s skull plates aren’t yet fused together, as this allows its head to change shape inside the narrow birth canal. Using magnetic resonance imaging, a French research team observed what this looks like and created these 3D scans.

As the baby’s making its way out, an important microbiome transfer takes place between mother and child. The vagina alone contains 400 different strains of microbes, which the child absorbs through its orifices. This forms the basis for building up your own diverse microbiome and a healthy immune system. A British study examined stool samples from 600 newborns, half of whom were born by caesarean section. It concluded the caesarean babies’ microbiomes had significantly fewer strains, statistically making them more susceptible to respiratory diseases or allergies.

The third phase is the pushing stage. At this point, the mother supports the contractions by actively pushing. Known as the Ferguson reflex, this is triggered by the pressure of the child’s head on the nerve plexus on the coccyx, stimulating the pudendal nerve. The head passes through the perineum, followed by one shoulder and then the second, until the rest of the baby’s body follows.

With this feat of strength done and dusted, the fourth phase (the postnatal period) begins. About thirty minutes after birth, the placenta is delivered. It’s examined to see if it’s been delivered in its entirety before any remains are removed from the uterus. Afterwards, birth injuries such as perineal tears are sutured.

5. The caesarean section rate has risen sharply

In Germany, the caesarean-section rate has doubled since 1991. In 2020, 1 in 3 women in the country gave birth by C-section. At 32.3 per cent, Switzerland’s C-section rate is also relatively high compared to the European average. This is far more than the World Health Organization considers medically necessary, a figure between 10 and 15 per cent. According to this study (in German), the environment in which a birth takes place has an impact on whether a baby will be born naturally. It states that «alternatively equipped birthing rooms» could probably reduce the number of caesarean sections.

There are many reasons for the uptick in C-sections. In Switzerland, most caesarean sections are performed when a baby’s breech, i.e. when it’s positioned buttock-first in the mother’s pelvis. According to an Austrian-Italian study, however, the size of babies in relation to their mothers is increasing significantly, leading to more complications and an increased need for caesarean sections.

6. Up to 68 per cent of mothers worldwide suffer birth trauma

The birth of a child is a momentous experience in a woman’s life. Both during and after childbirth, the mother’s hormone composition is completely recalibrated, with her brain also changing as a result.

Many experience birth not only as dramatic, but also as downright overwhelming – or even traumatic. Whether it’s severe pain, unwanted obstetric interventions (e.g. episiotomy or cervical dilation) or concerns about the child’s well-being, women often feel helpless and at the mercy of others during childbirth.

Depending on the country, 20-68 per cent of women worldwide suffer from birth trauma. Psychological distress is often a consequence of this. Switzerland’s Netzwerk Verarbeitung Geburt (Birth Processing Network) provides important addresses of specialist institutions that offer professional support in processing childbirth experiences.

7. Orgasm during childbirth: rare, but possible

Childbirth isn’t traumatic for all women. Finally getting to meet your child for the first time is often a magical moment. For some women, the birth even ends in ecstasy. According to the few available studies, so-called orgasmic births only occur in around 0.3 per cent of vaginal births (at least in the USA).

With pain and a lack of privacy in the delivery room, it’s rare to experience pleasure (including orgasm) during birth. But it’s not impossible. This is partly because childbirth involves using the same body parts as sex, and partly because it releases the same hormones (for example, oxytocin) as an orgasm.

Whether a woman can experience an orgasm during childbirth depends on a number of factors, including her pain threshold and anatomy. According to a Canadian study, however, at least trying to experience childbirth as more pleasurable and not just painful (even if it doesn't end in orgasm) gives women a greater sense of self-determination and control, reducing the risk of birth trauma.