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A vaginal birth involves several incredible but complex processes that come with risks. We break it down step by step. Plus: How exercise and therapy after pregnancy can strengthen both body and mind.
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00:07Pregnant and out in the world in media, society, politics, it's becoming a more common sight in
00:15everyday life. But let's be real, growing an entire human inside you takes a ton of energy.
00:21When you're pregnant, going about life as usual is no small feat. Pregnancy isn't an illness,
00:27but the experience of pregnancy and birth can leave lasting effects, physically and mentally.
00:34We're lifting the stigma and showing how a vaginal birth unfolds like a grand symphony.
00:39Now on In Good Shape.
00:56Imagine a perfectly rehearsed orchestra, every instrument working in harmony, playing each
01:04note with purpose and determination, all building toward the final breathtaking crescendo.
01:13This orchestra is the female body when it performs one of life's most astonishing acts, giving birth.
01:22Nature's composition and design are incredible, but a lot of things need to work in harmony for
01:28everything to go smoothly. This is Laura Trost. She's a gynecologist who has helped hundreds of
01:34women have their babies. There's obviously no right or wrong way of giving birth, but in most
01:45low-risk pregnancies, a vaginal birth still has the least overall risk for both mom and baby.
01:51Let's meet the performers. First up, the uterus, an organ the size of a lemon that expands to the size
01:58of
01:58a watermelon. It's also an extremely strong muscle. It sets the rhythm of labor with powerful contractions.
02:10The cervix is like the door to the uterus, and all through pregnancy, that door has been locked.
02:18During birth, it shapeshifts, thinning out and opening up to allow the baby to pass.
02:24For that, the bones that make up the pelvis have to widen and move aside a little.
02:31Then there are the pelvic floor muscles, stretching up to more than twice their resting length.
02:39A range of chemical messengers act like a conductor for the symphony of birth.
02:45Endorphins help with pain relief.
02:50Oxytocin fuels contractions.
02:54Prostaglandins encourage the cervix to open.
03:02And the baby performs a complex choreography of twists and turns as it navigates the narrow pelvis.
03:15Like any great performer, the mother's body likes to warm up a little before opening night.
03:23False labor or Braxton Hicks contractions can happen weeks or even months before the due date.
03:31The biggest difference to real contractions?
03:34They don't cause the cervix to open. Yet.
03:40Meanwhile, the baby's head has dropped, settling into the pelvis.
03:50Finally, after 37 to 42 weeks of pregnancy, it's time for the overture to begin.
03:57A plug of mucus kept the cervix closed during pregnancy.
04:01When it slips out, labor is about to start.
04:08As the first contractions hit, the cervix starts to dilate,
04:12slowly opening a few centimeters.
04:16But it can still take several hours to enter full-blown labor.
04:22In movies, the beginning of birth is often shown as something that hits with full force out of the blue.
04:29Usually, a woman's water breaks and gush all over the floor.
04:33But even though this can happen, most of the time, the onset is much slower and more subtle.
04:41Labor is in full swing once the cervix has opened about four to six centimeters.
04:47Contractions by then are coming regularly, at least every five minutes, and lasting for around 30 seconds.
04:56You're riding the waves of contractions as they ebb and flow.
05:01This can go on for eight to 18 hours if you are giving birth for the first time.
05:09Breathing and relaxation techniques, taking a bath, getting massage from your birth partner,
05:15and of course, pain relief with medication.
05:18All of those things can help to make this phase of labor more bearable.
05:23There's no point in labor pain comparisons.
05:25It's different for everybody.
05:27But everyone agrees on one thing.
05:29It's intense.
05:32The method that's most effective at relieving pain is an epidural.
05:36That's when a thin plastic tube is placed into your spine near the nerves that carry pain.
05:42It's used to inject medication that blocks any pain signals in their tracks.
05:48That numbs your lower body to some degree.
05:52And remember, the pain isn't your enemy.
05:55It's actually helping you to give birth to your baby.
05:58So it can be useful to view the pain as an ally.
06:04Cozy lights, relaxing sounds, and nice smells can also set you more at ease.
06:10And the less medical equipment on display, the better.
06:15There's no need to lie down all the time.
06:18Movement actually accelerates labor.
06:21And women who get up also need fewer interventions.
06:25Find out what works for you.
06:28Discuss when or if you want certain exams.
06:31Writing a birth plan in advance can also be helpful.
06:35All this can be empowering.
06:37Even if things feel a bit out of your control.
06:40But why is giving birth so hard?
06:44Blame evolution.
06:45Compared to other primates, humans labor longer and have more complications.
06:50To walk upright, we developed narrower pelvises.
06:53But to house our powerful brains, also larger heads.
07:00So during birth, a rather big something has to fit through a rather small something.
07:08And that means...
07:13Sometimes the body's concert simply goes a little off-key.
07:19A birth doesn't progress.
07:24If your water hasn't broken yet, a small nick in the amniotic sac can release the fluid.
07:30This speeds up labor.
07:34Or you might be offered an oxytocin drip.
07:38Oxytocin is sometimes referred to as the bonding hormone.
07:42But it also induces contractions.
07:46Interventions also involve some risks.
07:48Or the need to monitor the baby more closely.
07:51And they might make the contractions much more intense.
07:54So the best way forward should be discussed together.
07:58The grand finale is approaching.
08:01Baby's chin is pressed down towards the chest, ready to plunge into the birth canal.
08:07Choreography steps two and three.
08:10The second stage of labor, pushing the baby out, begins once the cervix is dilated to 10 centimeters.
08:19Experienced midwives can sometimes tell when a woman transitions into that second stage of labor.
08:25Just by the different sounds she starts making.
08:29The pushing that ends with the baby's arrival can last between 20 minutes and four hours.
08:36During this stage, the one thing you really want to avoid, if possible, is lying on your back with your
08:43legs up in the air.
08:45But isn't that how most babies are born?
08:50In many cultures, upright positions like sitting, kneeling, and standing used to be common when giving birth.
08:59In 17th century France, though, things took a different turn.
09:03Because of this doctor, Francois Morisot.
09:06He wrote the era's most influential book on childbirth.
09:10A central claim that lying down was more comfortable for women and more convenient for the attending doctor.
09:17So for the man.
09:19Male doctors had started taking charge of childbirth.
09:22Something that had been in the hands of midwives since time immemorial.
09:28Maternity care today aims to achieve a kind of ideal collaboration between midwives and doctors.
09:35So what birthing positions are best?
09:38On your back, the pelvis is restricted and the tailbone is kind of in the way.
09:43So when lying down, women have to push their baby out uphill against gravity.
09:51In a more upright position, gravity lends a helping hand.
09:58Maybe you want to be on all fours.
10:01Maybe you have a birthing sling to hold onto.
10:04Studies show that women are most satisfied when they choose their birthing positions themselves.
10:13Being upright can speed up delivery and even reduce numbers of assisted deliveries.
10:24Baby's head performs an internal rotation.
10:28It now faces the mother's spine.
10:31Choreography, step four.
10:36The intense pressure you feel now can instinctively create the urge to push.
10:45How you push is totally up to you.
10:48You don't need to adopt a specific technique.
10:50If it feels better, then go with your own flow.
10:59Baby's head now dives underneath the pubic bone, extending the neck.
11:04The head is crowning.
11:06Choreography, step five.
11:10Again, things don't always go according to plan.
11:13And if the mother's or the baby's well-being is at stake, we sometimes have to intervene.
11:19This can mean a doctor delivers the baby via a vaginal surgery or a C-section.
11:25In some situations, doctors might also make a cut in the perineum, widening the vaginal opening to
11:33deliver the baby as fast as possible.
11:36This is called an episiotomy.
11:38In some countries, it's still routinely performed under the erroneous assumption that it prevents
11:44severe birth injuries.
11:45Studies show there's no reason to do it.
11:48A cut also heals slower than a tear would.
11:51So there's no advantage for mother or baby.
11:54Except in an emergency situation.
12:00Baby performs another rotation facing mommy's leg.
12:05The shoulders are appearing.
12:07The body is born.
12:10Choreography complete.
12:15Time to bond and enjoy the first moments of skin-to-skin contact.
12:25After a few minutes, the baby's umbilical cord is clipped off and cut.
12:30Usually after the cord has stopped pulsing.
12:36And then you might think, that's it.
12:39But hold on.
12:40There's an encore.
12:42The birth of the placenta.
12:44But we talk about that in another episode.
12:48If both mom and baby are fine, we really try to limit any kind of intervention in that first hour
12:55to give them time to bond.
12:57This also makes breastfeeding easier.
13:01The orchestra of the body has given its all.
13:04It lost about half a liter of blood and in many cases also suffered injuries to the perineum or vagina.
13:14Birth is a somewhat violent process.
13:18Nature puts it through a lot.
13:20But most mothers will later say they've never been so proud of their body and its ability to bring life
13:28into this world.
13:30An astonishing performance.
13:40When a baby is born, all eyes are on the child.
13:44Concerns about the mother often little more than an afterthought.
13:48Yet three out of four women worldwide experience injuries during vaginal birth,
13:53from minor tears to severe perineal ruptures.
13:57Even during pregnancy, hormones like relaxin loosen up ligaments and tissue
14:02to prepare to stretch for birth, weakening the pelvic floor.
14:07At this strain of delivery, and it's a lot.
14:12But the good news is there are ways to help.
14:16Pain and incontinence after birth shouldn't just be written off as normal.
14:23It's been 18 years since she gave birth to her daughter Leonie.
14:27But 48-year-old Anka Hawava still remembers almost every detail
14:32and still lives with the impact of the injuries it caused, like incontinence.
14:38For many years, she kept the problems she'd had since giving birth to herself.
14:43She knew she'd had a perineal tear, but no one ever explained the possible consequences to her.
14:49She's also a passionate horse rider.
14:56I felt completely alone.
15:00I mean, who wants to talk about being incontinent in your early 30s?
15:10And that fear of not making it to the bathroom in time is just deeply embarrassing.
15:20Anka Hawava's felt the effects of incontinence every day, struggling through life for 10 years
15:25despite the discomfort, until an incident occurred during a tournament.
15:31I finished the ride and just thought, what do I do now? I can't get off the horse. I don't
15:38have a second
15:38pair of riding pants. And that was the moment I said, okay, this is the start of a new era,
15:44and it's not one I want. I need to face this head on and get help.
15:51Urogynaecologists like Sophia Dankvat and Rebecca Vestfars see many cases like Anka's.
15:57They explain that after a vaginal birth, up to 50% of women experience incontinence.
16:02About half stay that way for years or even decades, sometimes for life.
16:08There are various treatment options, including surgery with a mesh to support the abdominal organs.
16:13But first, women need to be informed, taken seriously, and understand what's happening.
16:20Too often, that education is lacking.
16:23We're talking about issues that affect the majority of women at some point in their lives.
16:28And these are not minor complaints. They can severely impact quality of life.
16:35I keep hearing that women aren't taken seriously by their gynecologists, especially male doctors.
16:41These are serious injuries, either in the muscles or connective tissue.
16:45And for patients, it's a big problem and a big taboo.
16:52During childbirth, all the tissues in the pelvis come under extreme strain.
16:58Connective tissue, muscles, fascia and ligaments are stretched and can tear.
17:04Sometimes nerves are damaged.
17:07The organs most affected are the uterus and vagina, bladder, bowel, anus and pelvic floor.
17:14The bladder, uterus and bowel can drop, slip out of place and stop working properly.
17:20Pelvic floor muscles and the anal sphincter can tear.
17:26In the worst case, even younger women can end up with the uterus or the bladder dropping into the vagina.
17:33Or even both, that can also happen.
17:36Or they have problems with bowel movements because of perineal tears or severe lacerations.
17:45This affects every aspect of life. Sexuality, self-image, a woman's role in society, how she sees and cares for
17:54herself.
17:56It affects the activities she takes part in, her interactions with her family and children, and it affects her health.
18:08Anke Hawawas tried pelvic floor training for years.
18:12Eventually, she found help at a hormone center with physiotherapist Juliana Afram, who specializes in pelvic floor therapy.
18:20She explained exactly which muscles and organs were affected and which could be activated.
18:28The physiotherapist did a thorough assessment, a detailed pelvic exam, tests, manual checks and an ultrasound, and she found the
18:37cause of the problem.
18:41The pelvic floor can't work properly because the bladder is in the way, so you can't contract the muscle enough.
18:49Or it's really tense because it's trying to hold the organs in place.
18:55Anke's bladder had dropped, making pelvic floor training basically ineffective.
19:00Plus, the bladder was constantly irritated.
19:04Finally, she understood what was going on and began treatment.
19:07A pessary, a ring or cube made of soft plastic that's inserted into the vagina.
19:13She's been using this treatment for two years now.
19:17I think I yelled, yippee, on the horse.
19:21Because I just thought, wow, such a tiny cube can change your life so positively.
19:30I couldn't believe it.
19:31When I first put it in, I just thought, yeah, fine, I'll give it a go.
19:40The pessary is inserted like a tampon and stays in during exercise or daily life.
19:47It lifts the dropped organs, uterus, bladder and bowel, back to their original position.
19:53And the tissue tightens.
20:00The pessary supports the pelvic connective tissue.
20:03It helps the overstretched tissue and moves the organs back closer to their original positions.
20:11Then, in the next step, the pelvic floor can be activated much better.
20:15And pelvic floor training actually helps.
20:20With the right physiotherapy, Anke can now reduce strain on the pelvic floor
20:24and strengthen it effectively.
20:29She also pays out of pocket for electrical stimulation with a vaginal probe
20:34to help muscle fibres reconnect.
20:38The muscles get stronger and the connective tissue heals better.
20:42But it will never be exactly like it was before and it doesn't have to be.
20:45The important thing is to help women with their symptoms,
20:49so they can live symptom-free or with fewer of them.
20:54There are solutions for everyone, both surgical and non-surgical.
20:59There are lots of options for all patients.
21:03Nowadays, Anke Hauerwas is doing well.
21:06She sought help and found it.
21:08Now she feels liberated and can fully enjoy life again.
21:16It's not just the body.
21:18Pregnancy and birth impact the mind as well.
21:21Many women experience the baby blues in the first few days,
21:26a temporary dip in mood caused by hormonal changes.
21:29But globally, nearly one in five mothers faces postpartum depression,
21:35a serious condition that needs professional care.
21:39Learning to embrace both inner and outer changes can help restore balance.
21:44Though for many, that's easier said than done.
21:57How do all these people have such a great figure after pregnancy?
22:01I've fallen apart.
22:03I'm always looking at people wondering what they know that I don't.
22:07How did they get thin again?
22:08I don't know.
22:14Ten new mums in Lucho in northern Germany are getting back in touch with their own bodies
22:19after giving birth through buggy fitness.
22:22Friederike Küchler leads the class.
22:26I want you to do this with one hand and let the other swing.
22:30We're going for a nice power walk.
22:34Buggy fitness is a mix of strength and endurance training, with baby in tow.
22:39Among the participants is 35-year-old Franziska Götler with her nine-month-old son Jonas.
22:45The workout is a challenge.
22:48You can really feel it in your thighs.
22:52Franziska has struggled with the changes in her body, one aspect in particular.
22:57The stretch marks.
22:59What annoys me is that they didn't even appear during pregnancy, but afterwards when I gained weight.
23:05Nothing during pregnancy.
23:07And they stay even if I lose weight.
23:12They'll always remind me of this time.
23:15And the c-section scar, you just learn to live with it.
23:21The other women know the feeling.
23:25My belly skin is still really soft, like pudding, before everything was tight and toned.
23:33People say you look amazing, just like before, but no one sees you without clothes.
23:38Only you see yourself in the mirror and think it's not the same as before.
23:43Summer can make those feelings worse.
23:48I hide a bit and buy looser, bigger clothes.
23:51Before I'd go out in leggings like now, no problem.
23:55I only wore them today because I knew it would be warm running around with the baby.
23:59Normally I wouldn't.
24:02Engage the pelvic floor, pull it towards the pelvis.
24:06Friderike Küchler wants to help mums feel comfortable in their bodies again.
24:11Since 2023, she's been offering these special fitness classes for mothers with babies.
24:16Eight sessions cost 100 euros, which is partly covered by health insurance.
24:21Around 40 women are already taking part.
24:27Pregnancy and birth aren't just like running one marathon, they're like running several.
24:33And also afterwards, with the breastfeeding hormones, it's all very hormone driven.
24:40The body needs at least a year to fully recover hormonally.
24:47So give women the time they need.
24:50We're not instantly back to our old selves, especially not emotionally.
24:59The body has a big effect on the mind.
25:02Studies show that new mothers, who are unhappy with their bodies,
25:06are more likely to suffer from depression.
25:08Exercising in a group can help.
25:14It's at a fixed time, so I stick to it.
25:16I meet nice mums and we work out together, which is important because motivating yourself alone is hard.
25:24Nine months after giving birth, Franziska Küchler is more active and feels better.
25:29She's not completely happy with her body yet.
25:31She still wants to lose a few more kilos, but she's learned to appreciate it.
25:39I have to make peace with my body. What others say doesn't matter. I carried him for almost 10 months.
25:45Everything I went through, even after pregnancy, I'd like to see them try it.
25:57That's all this time around on In Good Shape, the DW Health Show. See you next time.
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