The last weeks of the third trimester of pregnancy are a time of exciting anticipation for the expectant mother.
One of the most interesting questions for a woman is how contractions will go before childbirth.
Contractions are the surest signs that the baby is ready to be born.
Prenatal contractions are not at all similar to training contractions (Braxton Higgs contractions, which a pregnant woman has probably already encountered).
In case of real contractions, you need to act immediately. We'll look at how exactly next.
Contractions: how to understand that they have begun?
Start labor activity It happens differently for every woman. The pain and intensity of contractions will depend on the health of the pregnant woman and the presentation of the baby.
Answering the question “what are contractions like?”, some women compare their sensations with the discomfort they experienced in the first days of menstruation.
And other mothers note that at the beginning of contractions they felt a slight aching pain in the lumbar region, eventually spreading to the lower abdomen.
During contractions there is always a feeling that the stomach is turning to stone - before childbirth it can become hard and tense.
However, similar sensations sometimes appear during training contractions. The following signs will help you more accurately distinguish true contractions from false ones:
1
Regularity. do not last longer than 8-10 minutes. A woman can stop them herself by taking a warm bath or walking around the room.
True contractions appear rhythmically and do not stop when changing body position.
2 Frequency increase. The interval between false contractions can reach several hours. Before birth, the interval between contractions becomes increasingly shorter.
3 Progressive pain. Braxton Higgs contractions are most often painless, but as labor begins, the pain increases.
There are three phases of the prenatal contractions process:
- initial;
- active;
- transitional (deceleration period).
The latent (initial) phase is the longest. From the beginning of contractions until they enter the active phase, 6-8 hours usually pass. During this time, the cervix should dilate 3-3.5 cm.
In this case, contractions will last no more than half a minute, and the interval between them is up to 5 minutes.
The duration of contractions in the active phase reaches 1 minute. The interval between them is reduced to 2-3 minutes. At correct flow contractions, the cervix dilates up to 7 cm during this period.
In the active phase, a woman usually experiences severe pain in the area of the uterus. At the request of the woman in labor, antispasmodic drugs can be used.
In the active phase, the fetal bladder is opened, and the discharge of amniotic fluid increases. The outpouring of water may occur earlier. If no pregnancy complications were identified, then late birth will not be considered a pathology.
A pregnant woman can take a stopwatch and a piece of paper in order to record the duration of contractions and the sensations accompanying them.
Call ambulance needed at the very beginning of contractions.
When the duration of the intervals between contractions is about 7 minutes, the woman already needs to be in the maternity ward.
While the interval is still long enough (up to 30 minutes), start collecting the necessary things. If you wish, you can take a warm shower. Let someone close to you go into the shower with you - this will make you much calmer.
Under no circumstances should you take a shower or bath if your water has already broken. Amniotic fluid plays a protective role for the baby. Therefore, now the risk of infection getting to the baby is too great.
How to breathe correctly during labor and childbirth?
You can avoid pain during contractions and the birth process with the help of medicinal methods. The most popular is in which an anesthetic medication is injected into the epidural space of the spine.
Anesthesia has its advantages, but its use is not safe for all women.
A proper breathing system can significantly relieve pain during labor and childbirth. Its principle is to concentrate on inhalation and exhalation.
Start performing breathing exercises For childbirth, a pregnant woman can do it in advance. Master correct breathing follows already at the end of the second trimester. It takes a long time to learn to build the correct breathing rhythm; regular training is also required.
The principle of breathing must be memorized so that it can be easily recalled in a stressful situation.
When a woman feels that a contraction is about to begin (a feeling of tone appears in the pelvic area), inhalations and exhalations should be deep.
As the pain intensifies, the rhythm changes, becoming frequent and superficial.
At the peak moment of pain, you need to take several frequent and quick breaths, and only then slowly exhale the air.
In the interval between contractions, the respiratory rhythm is restored and becomes normal. At this time, the woman in labor needs to rest and gain strength for a new cycle of contractions.
Interesting! Emotional readiness for childbirth
In addition to breathing, massage can reduce pain during contractions. lumbar region backs.
A woman can be in a standing position, resting her hands on the headboard of the bed or chair. Massaging movements in the lumbar region block the passage of pain impulses from the sacral nerve to the spinal cord.
How to induce contractions during childbirth?
The optimal time to end pregnancy is 37-40 obstetric weeks. It happens that the harbingers of labor do not come even at 41-43 weeks. This abnormality is not desirable, and your doctor will likely share your concern.
The negative consequences of too long a pregnancy sometimes take on a very tragic nature. By 42-43 weeks, placenta aging begins - a natural process in which the walls of the placenta cease to perform their functions.
The baby ceases to be sufficiently protected, oxygen and nutrients much less may come to him.
If there are suspicions of aging of the placenta, the doctor may suggest induction of labor. There is no need to refuse stimulation. Timely measures will help maintain the baby's health.
It is not always necessary to induce labor. If there are harbingers of labor later pregnancy is not observed, and the analysis of amniotic fluid does not reveal any impurities, then induction of labor can be waited.
When your pregnancy is coming to an end, you can try to speed up the appearance of contractions on your own. The following factors can provoke labor:
1 Movement. Don't spend the last week of pregnancy lying down.
When the time for childbirth approaches, expectant mothers begin to wait for the appearance of harbingers of this process. Usually, first the mucus plug comes off, then the amniotic fluid comes out, after a while contractions begin and finally - pushing. However, childbirth does not always follow the standard scenario: some of the signs of the onset of labor appear already during the birth of the child, or even do not appear at all. So, not all women have amniotic fluid or mucous plug drained before contractions. It is important to know in which cases this is normal and in which cases specialist intervention is necessary.
Can contractions begin without the plug first coming out?
The mucus plug is dense in structure, transparent or with a yellowish tint, and has no odor. There should be no traces of blood in it. Green color discharge, blood streaks, bad smell – alarms. The volume of the cork is no more than 40 ml (2 tablespoons).
This is what a mucus plug looks like during pregnancy (more details in the article:) Usually the plug comes off on its own one to two weeks before giving birth, but in some women it may come out during delivery along with amniotic fluid or during an examination by a gynecologist. Both options do not pose a risk to the health of the mother and child. If the plug does not come out, it will be removed by an obstetrician before the birth.
If a mucus plug comes off while going to the toilet or while washing in the bath or shower, a woman may simply not notice it. For some expectant mothers, the cork leaves the body not entirely, but in parts. When exiting, traffic jams are possible nagging pain in the lower abdomen, but sometimes there may be no pain at all.
Not everyone understands how a cork differs from amniotic fluid. Because of this, pregnant women panic when they find a clot of mucus on their underwear in the last months, thinking that it is time to give birth. The main difference between cork and water is in consistency and color: cork is viscous, jelly-like, colored pale yellow, pinkish or Brown color; waters are clear and liquid.
Contractions and pushing may begin before the plug comes out, but a situation in which it does not come out at all is impossible. If the plug does not come away before birth, then either it will leave the body along with the placenta, or the woman simply did not notice it.
Can contractions come without my water breaking?
Amniotic fluid - also called amniotic fluid - is a liquid medium that is produced by the membranes and in which the fetus remains until birth. The urine of the fetus and the blood plasma of the pregnant woman periodically enter the waters, but both are absorbed by the amnion.
Normally, amniotic fluid is clear or slightly cloudy. It contains proteins, fats, carbohydrates, hormones, cells that support the immune system, catalysts chemical reactions etc. Its functional significance is to ensure freedom of movement of the fetus, protect it from damage, and stimulate metabolism.
Childbirth without water breaking before contractions is a normal option. In this case amniotic sac bursts during the first contractions due to contractions of the uterine myometrium. The lower pole of the amniotic sac, filled with amniotic fluid, puts pressure on the cervix and promotes its dilatation. When the cervix is fully dilated, at the point where the fetal head comes into contact with pelvic bones, the bubble bursts, and the front waters come out. The posterior waters break when the baby is born.
Sometimes the water does not pour out even after the cervix is fully dilated. This is due to high density the walls of the amniotic sac or a small amount of water (oligohydramnios).
Oligohydramnios is a condition in which the amniotic sac contains less than 0.5 liters of amniotic fluid. It is often observed with miscarriages, fetal development abnormalities, and placental dysfunction. A small amount of water can be suspected if a woman has pain in the abdominal area, which intensifies when the fetus moves.
Labor often begins in women with oligohydramnios ahead of schedule, are slow and painful. To speed up the birth process and prevent premature separation of the placenta during oligohydramnios, the amniotic sac is opened with a special instrument.
What will be the consequences?
As mentioned above, contractions before the water breaks are a variant of the norm. Accordingly, this will not have negative influence neither for the woman in labor nor for the fetus. On the contrary, the breaking of water before the start of real and, especially, training contractions of the uterine muscles is considered more dangerous, since from the moment the amniotic sac is damaged, the child is no longer protected from bacteria. However, if the cervix is fully dilated and the fluid has not drained, measures should be taken, otherwise the birth will be delayed and the fetus may die.
If the plug does not come off before contractions and pushing, there is nothing to be afraid of. She will come out with the waters. IN as a last resort, the doctor will remove it.
What to do?
If the waters do not break due to the fact that the fetal sac remains intact when the cervix is fully dilated, doctors perform an amniotomy - a procedure in which the membranes are opened mechanically.
Obstetricians insert a hook into the vagina, sandwiched between the large and index fingers. This hook is used to pierce the bubble. The obstetrician controls with his hand the intensity of the outflow of water and makes sure that the umbilical cord does not fall out. The operation lasts several minutes, it is painless for both mother and child, since there are no nerve endings in the bladder.
- Excessive density of the membranes, due to which the bladder does not open on its own.
- Rare or weak and short contractions.
- Polyhydramnios. With polyhydramnios, spontaneous discharge of amniotic fluid is fraught with placental abruption, prolapse of the umbilical cord and fetal limbs (see also:). After dissection of the bladder, the volume of the uterus decreases and the risk of complications decreases.
- The preliminary period (the intermediate stage between the appearance of precursors of labor and childbirth) lasts more than 6 hours. They talk about pathological nature preliminary period, if the tone of the uterus is increased, contractions last more than a day, and the fetus is located high and is difficult to palpate.
- Flat bubble. If the walls of the bladder are too dense and there is no anterior water at all, it will not be able to stimulate the dilatation of the cervix. After the puncture, the baby’s head will directly press on the cervix, which will speed up the process of labor and avoid artificial stimulation.
- Increased arterial pressure.
- Low placenta previa. Due to its location, it is exposed to more strong pressure on the part of the child, which increases the risk of rupture or detachment.
- The edge of the placenta peels off. When the bladder is opened, the edge of the placenta is pressed and the bleeding stops.
- Preeclampsia. This life-threatening condition for the mother, which is the leading cause of maternal and perinatal mortality, is accompanied by seizures. With gestosis, the likelihood of dying increases with every minute of labor. An amniotomy is performed to speed up delivery.
- The cervix dilated completely, but the bladder remained intact. If the waters have not broken by the time the cervix is fully dilated, the baby may suffocate, so at this stage it is necessary to open the bladder.
- The period is more than 41–42 weeks. Due to postmaturity, it may begin oxygen starvation baby, and the bones of the skull will become less flexible and plastic, which will make it difficult for the fetus to exit the birth canal.
- Rh conflict during pregnancy. From the 28th week, the blood flow between mother and fetus becomes more active, as a result of which the likelihood of the baby’s red blood cells getting into the bloodstream increases. circulatory system women. If a pregnant woman is Rh negative and the child is Rh positive, the mother’s body will produce antibodies that will destroy the fetal blood cells. This can lead to developmental defects and, in some cases, stillbirth.
This question is of more interest to those representatives of the fairer sex who are expecting their first child.
They are very worried about not missing out, so at the first signal they begin to rush to the maternity hospital. So can labor begin without contractions? What should a woman know about the potential start of labor?
Usually, all of which begin to intensify in waves. Then contractions begin to occur more often, the interval between them becomes shorter. But in some cases, the onset of labor may be non-standard.
Very often, the expectant mother initially experiences an outpouring of amniotic fluid. This is the liquid within which the fetus develops in the mother's womb. These waters are found in the membranes of the fetus, which, together with the placenta, act as a kind of barrier that protects the unborn baby.
During the entire gestation period, amniotic fluid allows the baby to develop in a sterile environment.
This fluid is normally poured out during the first stage of labor, that is, until the cervix dilates by 4 cm. This happens at the height of one of the contractions. If the waters pour out before the start of labor, then this outflow is called premature or prenatal.
Most often, premature rupture occurs in women who give birth to a baby again, that is, this is not the first child. It doesn’t hurt at all, there is no discomfort, there are no other unpleasant sensations.
If early rupture occurs, the amniotic sac may rupture above the cervix. In this case, water does not flow out quickly. But sometimes the bladder ruptures above the opening of the uterine cervix. In this case, water flows out very quickly and in large quantities.
When the amniotic sac ruptures high enough, it is not easy to identify what it is. It is not easy to differentiate such secretions, because they are quite similar to each other. For a woman giving birth for the first time, it is especially difficult to distinguish between these discharges.
So, it should be noted that the plug comes out approximately 2-5 days before the onset of labor. The color of the cork is single or beige. Sometimes it may contain blood impurities. The cork may come out not in one day, but in several.
When a woman coughs, sneezes, or squats, the discharge increases.
Symptoms of rupture of amniotic fluid
Amniotic fluid has a more watery structure, it is transparent, and sometimes may have a slight yellowish tint. They leak constantly, and when a woman sneezes or coughs, the discharge intensifies.
After this fluid has completely drained out, labor begins in about 2-3 hours.
It must be said that childbirth that begins with the release of water is more unsafe. After all, the baby in the womb remains without protection. Various bacteria from the vagina and cervix can penetrate it.
Delivery should occur within 12 hours of rupture. Under no circumstances later. Such a temporary restriction will help avoid various complications.
If labor begins with the breaking of the waters, then the mother in labor should look at the time so that, when questioned by the doctor, she can answer exactly when this happened. The first thing you should do is call an ambulance and also notify your husband. Don't wait for contractions.
When the water comes out, look if there is a greenish tint in it. If it is, then this directly indicates that it is present. In this situation, you urgently need to call an ambulance without delaying a second. If the waters are clear, then you can reach the maternity hospital on your own.
In order not to slow down labor in the car, a woman should not lie on her back. The optimal position is on your side. Lying on your side minimizes the risk of umbilical cord loops falling out.
This can happen if the water breaks early, it should also be said that it is in this position that the maximum amount of oxygen will flow to the baby.
What not to do when water breaks
- If the water breaks, then in any case you need to go to the maternity hospital. Under no circumstances should you stay at home, as it increases the risk of fetal hypoxia, as well as the risk of infection getting to it. In this case, the baby's head moves into uterine cavity and begins to clamp the umbilical cord.
- Taking a bath is also prohibited. This increases the risk of infection.
- Enemas are prohibited.
- Shaving is also prohibited.
- You should refuse food, because in cases where the water breaks, the need for surgery under anesthesia greatly increases.
Why are they still prohibited? hygiene procedures and eating? Because they will require precious time, and when the amniotic fluid breaks, you cannot hesitate.
You need to pull yourself together, don’t panic, try not to get nervous. You should prepare yourself for a difficult job and try to be in an optimistic mood!
- Pain as during intestinal upset
- Lower back pain
- Pain in unexpected places
- Contractions without pain
KEANA: The beds in the pregnancy pathology department were so hard that every morning I thought that contractions had started (I definitely had back pain like during menstruation), but when real contractions started, I realized that they couldn’t be confused with anything, that’s for sure!
mama_Levika: About two weeks before giving birth, a slight tingling sensation begins in the lower abdomen, it seems like contractions, but, girls! You can’t confuse contractions with anything, don’t rush to call an ambulance...
What are contractions
So, there comes a time when your baby is ready to be born. Labor begins, which many expectant mothers recognize by painful contractions. But what is a “confrontation” and what happens at this moment?
” A contraction is an involuntary contraction of the smooth muscles of the uterus of a wave-like nature. They allow the cervix to open - the only “way out” for the child.
To imagine how the muscles of the uterus move, think of a crawling snail: a wave passes along its sole from the tail to the head, and tense muscles push it forward. The same thing happens with the uterus: not all of it tenses at the same time.
The upper part of the uterus is more “muscular”. It is she who compresses the amniotic sac. As you remember from your school physics course, a liquid easily changes shape, but practically does not change volume. So the fertilized egg begins to press with all its might on the lower part of the uterus - here muscle fibers less, so that it does not shrink, but, on the contrary, stretches. The main pressure is on the cervix - “ weak link"muscle sac. The amniotic sac literally wedges there: the anterior fluid (amniotic fluid located in front of the baby) presses the amniotic sac into the birth canal and pushes it apart.
” It is believed that in the uterus there is a dominant focus of excitation, most often localized in the right corner of it (“pacemaker”), from here the wave of contractions spreads to the entire musculature and goes in a downward direction.
A woman cannot control contractions, unlike pushing, which involves the muscles of the perineum, the muscles of the abdominal wall, and the diaphragm. That is why, in the last stage of labor, the midwife asks the woman to push or, on the contrary, hold back for a few seconds. Indeed, we can all tense our abdominal muscles, but it is absolutely impossible to strain, for example, the muscles of the stomach through willpower.
When the uterus is tense and stretched, the blood flow to its muscles is blocked (if you clench your fist with all your might, you will see certain areas of the skin turn white), and the nerve endings leading to the uterus are also compressed. This is what determines the sensations that arise: the pain is dull, periodic (“it will grab you, then it will let go”), and most importantly, it is perceived differently by all women (depending on the location of the child, the uterus, and also on where the nerve endings are most compressed ). But the pain during pushing, which is caused by the movement of the child along the birth canal, is perceived by all mothers in the same way: the unpleasant sensations are concentrated in the vagina, rectum, perineum, and the pain is quite acute.
This is why the sensations during contractions raise so many questions - are these really contractions or, for example, osteochondrosis? Let's look at the most typical examples pain!
Pain “like menstruation”
Unpleasant sensations localized in the lower abdomen and resemble pain during the onset of menstruation.
Lyalechka: The pain is like menstruation, only worse.
SV1980: The contractions were similar to menstruation at the beginning.
As a rule, women in labor who perceive contractions as “pain during menstruation” also feel the occurrence of - “petrification” of the abdomen.
Pain as during intestinal upset
Abdominal pain during contractions reminds many expectant mothers of discomfort during intestinal disorder, cramping attacks accompanying diarrhea.
ANelli: at the beginning it didn’t hurt, it was just a feeling that you really needed to go to the toilet, but when you go to the toilet early in the morning with an interval of 20-30 minutes, but there is no result, you understand that the intestines have nothing to do with it!
Zuleyka: I thought I had been poisoned by something the day before, my stomach was churning...
By the way, immediately before childbirth, intestinal function actually becomes more active, and bowel movements may occur more than once.
Lower back pain
Quite often, the source of pain is the lumbar region: “pulls”, “grabs”.
vedetta: I had such pain - it seized my lower back and the pain rose from the bottom up my back and stomach. And then she also went down and passed through. To be honest, it doesn’t look much like menstruation...
Tanyusha_I'll be a mother: suddenly my lower back began to hurt every 15 minutes and then decrease a little bit... I didn’t wait right away and went to the maternity hospital.
The phenomenon of back pain has two explanations: the pain can radiate to the lower back, or it can be felt lower, in the tailbone area - most likely it is caused by the divergence of the pelvic bones.
Pain in unexpected places
Sometimes pain can radiate to the most unexpected places, so that a woman in labor complains that, for example, her hips or ribs hurt.
Alma: contractions started - it hurts in my side and radiates to my kidney and leg!
Most often, women identify radiating pain as “kidney pain,” especially if they have experienced it before. Pain in the hips, knees, numbness of the legs - may be a consequence of pinching large blood vessels lower abdomen.
Contractions without pain
This also happens, especially at the very beginning of labor. The sensations, however, are quite unpleasant. Expectant mothers usually feel how the uterus becomes toned for a few seconds - the stomach “turns to stone”, then relaxes again. Similar sensations arise if during contractions you do .
Ksyusha_SD: I kept walking and thinking, how will I understand that this has begun? I felt good and there were no changes in my appetite either. I really understood only when the contractions started - the tone of the tummy just began periodically.
Of course, not everyone is so lucky, but it happens that a woman is not very susceptible to pain. So at the beginning of labor, while the pressure on the cervix is low (or, for example, she has a flat membrane in which ), the sensations may be unpleasant, but not painful.
As you can see, descriptions of contractions vary greatly. How to recognize them?
Periodicity. Contractions, no matter how they feel, occur at regular intervals. This is how labor contractions differ from “training” ones - .
Increasing frequency. During childbirth, contractions occur more and more often.
Gain. The intensity of pain increases.
Lack of response to your actions. The unpleasant sensations do not disappear if you change your body position, walk, lie down, or take a shower.
Displacement of painful sensations. Gradually, the pain shifts to the perineal area, on which the baby’s head begins to press.
Did everything coincide? It's definitely time for you to go to the maternity hospital!
That's it over last weeks expectations. Contractions begin. The climax of the entire pregnancy is coming - a few more hours and you will see your baby. Of course, you will worry and worry about the outcome of labor, but if you are well prepared and understand what to expect, what happens at each stage of labor, then your courage will also return. Give life to a child! After all, this is such happiness! Prepare yourself, master techniques and methods of relaxation and breathing control in advance - they will help you maintain composure and cope with pain. And don’t be alarmed if during contractions something doesn’t turn out quite as you expected.
HOW TO DETERMINE THE BEGINNING OF CONTRACTIONS
YOUR ANXIETY that you will miss the onset of contractions is absolutely groundless. Although false contractions that occur in the last weeks of pregnancy can sometimes be mistaken for the beginning of labor, you will not confuse real contractions with anything.
SIGNS OF CONTRACTS
Appearance
By opening slightly, the cervix pushes out the blood-stained mucus plug that clogged it during pregnancy.
What to do This can happen a couple of days before contractions start, so wait until the abdominal or back pain becomes constant or the amniotic fluid has broken before calling your midwife or hospital.
Leakage of amniotic fluid
Rupture of the amniotic sac is possible at any moment. The water may flow out in a stream, but more often it oozes out little by little - it is retained by the child’s head.
What to do Call a midwife or ambulance immediately. Hospitalization is safer, even if there are no contractions yet, since infection is possible. In the meantime, place a waffle towel to absorb moisture.
Uterine contractions
First they make themselves known as dull pain in the back or hips. After some time, contractions will begin, similar to the sensations during painful menstruation.
What to do When contractions become regular, fix the intervals between them. If you think contractions have started, call your midwife. As long as they are not very frequent (up to 5 minutes) or painful, there is no point in rushing to the maternity hospital. The first birth usually lasts quite a long time, 12-14 hours, and part of this time is best spent at home. Walk slowly, stopping to rest. If your water has not yet broken, you can take a warm shower or have a light meal. IN maternity hospital you may be advised not to come before the contractions become stronger and begin to repeat every 5 minutes.
HARNESSES OF CONTRACTS
Weak uterine contractions occur throughout pregnancy. In the last few weeks, they become more frequent and more intense, so sometimes they can be mistaken for the beginning of contractions. When you feel such contractions, get up, walk around and listen to see if they continue and if the pauses between them become shorter. Precursors of contractions are usually irregular.
FREQUENCY OF CONTRACTS
Monitor the dynamics of contractions over the course of an hour: beginning and end, intensification, increase in frequency. When contractions stabilize, their duration should be at least 40 seconds.
FIRST PERIOD
AT THIS STAGE, the muscles of the uterus contract to open the cervix and allow the fetus to pass through. During the first birth, contractions last on average 10-12 hours. It is possible that at some point you will be overcome by panic. No matter how well prepared you are, the feeling that something is happening to your body beyond your conscious control can be frightening. Stay calm and try not to disturb your body, do what it tells you. It is now that you will truly appreciate the presence of your husband or girlfriend nearby, especially if they know what contractions are.
BREATHING IN THE FIRST PERIOD OF LABOR
At the beginning and end of the contraction, breathe deeply and evenly, inhaling through your nose and exhaling through your mouth. When the contraction reaches its peak, resort to shallow breathing, but now inhale and exhale through the mouth. Don't breathe like this for too long - you may get dizzy.
ARRIVAL AT THE MATERNITY HOSPITAL
IN reception department you will be greeted by a nurse-midwife who will complete all the formalities and preparatory procedures. Your husband may be next to you at this time. If you are giving birth at home, you will be prepared for the birth in the same way.
Midwife Questions
The midwife will check the registration records and your exchange card, and will also check whether your water has broken and whether there has been any release of mucus plug. In addition, he will ask a series of questions about the contractions: when did they start? how often do they happen? How do you feel? what is the duration of the attacks?
Survey
They will measure you when you change clothes. blood pressure, temperature and pulse. Your doctor will do an internal examination to determine how dilated your cervix is.
Fetal examination
The midwife will feel your stomach to determine the baby's position and use a special stethoscope to listen to the baby's heart. It is possible that she will record the fetal heartbeat through a microphone for about 20 minutes - this recording will help determine whether the child receives enough oxygen during uterine contractions.
Other procedures
You will be asked to provide urine to be tested for sugar and protein. If your water hasn't broken yet, you can take a shower. You will be directed to the prenatal ward.
INTERNAL INVESTIGATIONS
The doctor will, if necessary, conduct internal examinations, monitoring the position of the fetus and the degree of dilatation of the cervix. Ask him questions - you should also know what is happening. Usually the uterus dilates unevenly, as it were. in jerks. The examination is carried out in the intervals between contractions, therefore, if you feel the next contraction approaching, you will have to inform the doctor about it. You will most likely be asked to lie on your back, supported by pillows, but if this position is uncomfortable, you can lie on your side. Try to relax as much as possible.
CONTRACTS
The cervix is a ring of muscles that are normally closed around the uterine os. They are moving away from him longitudinal muscles, forming the walls of the uterus. During contractions, they contract, pulling the cervix inward and then stretching it enough to allow the baby's head to pass through the uterine os.
1.
The cervix relaxes under the influence of hormones.
2.
Weak contractions smoothly smooth the cervix.
3.
Strong contractions cause the cervix to dilate.
PROVISIONS FOR THE FIRST STAGE OF LABOR
During the first period, try to try different body positions, finding the most comfortable one for each stage. These positions must be mastered in advance so that at the right time you can quickly take suitable posture. You may suddenly feel like it would be better to lie down. Lie not on your back, but on your side. The head and thigh should rest on pillows.
Vertical position
On initial stage during contractions, use some kind of support - a wall, a chair or a hospital bed. You can kneel if you wish.
Sitting position
Sit facing the back of a chair, supported by a pillow. The head is lowered on the hands, the knees are spread apart. Another pillow can be placed on the seat.
Leaning on my husband
During the first stage of labor, which you will probably endure on your feet, during contractions it is convenient to place your hands on your husband’s shoulders and lean on him. Your husband can help you relax by massaging your back or stroking your shoulders.
Kneeling position
Get on your knees, spread your legs and, relaxing all your muscles, lower yourself top part bodies on pillows. Keep your back as straight as possible. In the intervals between contractions, sit on your thigh.
Four point support
Kneel down, leaning on your hands. This is convenient to do on a mattress. Move your pelvis forward and backward. Don't hunch your back. Between contractions, relax by lowering yourself forward and resting your head on your hands.
LABOR PAIN IN THE BACK
In cephalic presentation, the baby's head pushes against your spine, causing back pain. To make it easier:
during contractions, lean forward, placing your weight on your hands, and make forward movements with your pelvis; walk at intervals
In the intervals between contractions, let your husband massage your back.
Lumbar massage
This treatment will relieve back pain and also calm and reassure you. Let your husband massage the base of your spine, pressing on it with the heel of his palm in a circular motion. Use talcum powder.
HOW TO HELP YOURSELF
Move more, walk between contractions - this will help cope with pain. During attacks, choose a comfortable body position.
Stay as straight as possible: the baby's head will rest against the cervix, contractions will become stronger and more effective.
Focus on your breathing to calm yourself and take your attention away from your contractions.
Relax during breaks to save energy for when you need it most.
Sing, even scream, to relieve pain.
Look at one point or object to distract yourself.
React only to this fight, don’t think about the next ones. Imagine each attack as a wave, “riding” which you will “bear” the child.
Urinate more often - bladder should not interfere with the advancement of the fetus.
HOW CAN A HUSBAND HELP
Praise and encourage your wife in every possible way. Don't be put off if she gets annoyed - your presence is still important.
Remind her of the relaxation and breathing techniques she learned in the courses.
Wipe her face, hold her hand, massage her back, offer to change her position. You need to know in advance what kind of touches and massage she likes.
Be a mediator between your wife and medical personnel. Stay on her side in everything: for example, if she asks for a painkiller.
TRANSITION PHASE
THE HARDEST time of labor is the end of the first period. Contractions become strong and long, and the intervals are reduced to a minute. This phase is called transition. Exhausted, you will probably be either depressed or overly agitated and tearful at this stage. You may even lose track of time and fall asleep between contractions. This may be accompanied by nausea, vomiting and chills. In the end, you will have a great desire to strain and push the fetus out. But if you do this ahead of time, swelling of the cervix is possible. So ask your midwife to check that your cervix is fully dilated.
BREATHING IN THE TRANSITION PHASE
If premature pushing begins, take two short breaths and one long exhale: “oof, oof, fu-u-u-u.” When the urge to push stops, exhale slowly and evenly.
How to stop pushing
If the cervix has not yet opened, in this position, take a double breath and exhale long: “oof, oof, fu-u-u-u” (see above right). You may need pain relief. Kneel down and, leaning forward, put your head in your hands; pelvic floor it should seem to hang in the air. This will weaken the urge to push and make it more difficult to push the fetus out.
HOW CAN A HUSBAND HELP
Try to calm your wife down, encourage her, wipe away the sweat; If she doesn't want it, don't insist.
Breathe with her during contractions.
Put some socks on her if she starts getting chills.
If you start pushing, call your midwife immediately.
WHAT HAPPENS TO THE CERVIX
The cervix, palpable at a depth of 7 cm, is already sufficiently stretched around the fetal head.
If the cervix can no longer be palpated, it means that its dilation has completed.
SECOND PERIOD AS soon as the cervix is dilated and you are ready to push, the second stage of labor begins - the period of expulsion of the fetus. Now to involuntary contractions uterus, you add your own efforts, helping to push the fetus out. The contractions have become stronger, but they are less painful. Pushing is hard work, but your midwife will help you find the most comfortable position and guide you on when to push. Don't rush things, try to do everything right. During the first birth, the second stage usually lasts more than an hour.
BREATHING IN THE SECOND STAGE OF LABOR
When you feel the urge to push, take a deep breath and, leaning forward, hold your breath. Take deep, calming breaths between pushes. Relax slowly as the contraction subsides.
POSITIONS FOR EXPELATION OF THE FETUS
When pushing, try to stay straighter - then gravity will work for you.
Squatting
This is the ideal position: the lumen of the pelvis opens, and the fetus comes out under the influence of gravity. But if you haven't prepared yourself for this pose in advance, you will soon feel tired. Use a lighter option: if your husband sits on the edge of the chair with his knees apart, you can sit between them, resting your hands on his thighs.
On the knees
This position is less tiring and also makes pushing easier. Having support from both sides will give your body greater stability. You can just lean on your hands; your back should be straight.
Sitting
You can give birth sitting on the bed, surrounded by pillows. As soon as you start pushing, lower your chin and clasp your legs with your arms. In the intervals between attempts, rest by leaning back.
HOW TO HELP YOURSELF
At the moment of contraction, strain gradually, smoothly.
Try to relax your pelvic floor so much that you feel it sinking.
Relax your facial muscles.
Don't try to control your bowels or bladder.
Rest between contractions, save your strength for pushing.
HOW CAN A HUSBAND HELP
Try to somehow distract your wife between attempts, continue to calm and encourage her.
Tell her what you see, such as the appearance of a head, but don't be surprised if she doesn't pay attention to you.
CHILDREN
THE PEAK OF BIRTH has arrived. The baby is about to be born. You will be able to touch your baby's head, and soon you will be able to hold him in your arms. At first, you will probably be overcome by a feeling of great relief, but it will be followed by surprise, and tears of joy, and, of course, a feeling of immense tenderness for the child.
1. The fetal head approaches the vaginal opening, pressing on the pelvic floor. The top of the head will soon appear: with each push it will either move forward, or perhaps roll back somewhat as the contractions weaken. Don't worry, this is completely normal.
2. As soon as the top of the head appears, you will be asked not to push any further - if the head comes out too quickly, perineal tears are possible. Relax, catch your breath a little. If there is a risk of serious ruptures or any abnormalities in the child, you may have an episiotomy. As the head expands the vaginal opening, a burning sensation occurs, but it does not last long, giving way to numbness, which is caused by strong stretching of the tissue.
3. When the head appears, the baby's face is turned down. The midwife checks to make sure the umbilical cord is not wrapped around the neck. If this happens, it can be removed when the entire body is released. The infant then turns his head to the side, turning around before fully releasing. The midwife will wipe his eyes, nose, mouth and, if necessary, remove mucus from the upper respiratory tract.
4. The last contractions of the uterus, and the baby's body is released completely. Usually the baby is placed on the mother's stomach, since the umbilical cord is still holding it in place. Perhaps at first the baby will seem bluish to you. His body is covered with vernix, and there are traces of blood on his skin. If he is breathing normally, you can pick him up and press him to your chest. If breathing is difficult, he will be relieved Airways, and if necessary, they will give you an oxygen mask.
THIRD STAGE OF LABOR
At the end of the second stage of labor, you will probably have intravenous injection a drug that increases uterine contractions - then the placenta will come out almost instantly. If you wait for it to peel off naturally, you may lose a lot of blood. Discuss this point with your doctor in advance. To remove the placenta, the doctor places one hand on your stomach and gently pulls the umbilical cord with the other. After this, he must check that the placenta has come out completely.
APGAR SCALE
After delivering the baby, the midwife evaluates his breathing, heart rate, skin color, muscle tone and reflexes, calculating a score on the 10-point Hangar scale. Usually in newborns this indicator ranges from 7 to 10. After 5 minutes, a second count is carried out: the initial score, as a rule, increases.
AFTER CHILDBIRTH
You will be cleaned and, if necessary, stitches will be placed. The neonatologist will examine the newborn, the midwife will weigh and measure him. To prevent the baby from developing rare disease, associated with insufficient blood clotting, he may be given vitamin K. The umbilical cord is cut immediately after birth.
Question and answer
"I'm afraid of injury during childbirth. Is there such a danger?"
Don’t be afraid, there is no such danger - the vaginal walls are elastic, their folds can stretch and allow the fetus to pass through. “Should I breastfeed my baby immediately after birth?”
You can give breastfeeding, but if the baby doesn’t take it, don’t insist. In general, the sucking reflex in newborns is strong, and when they suck, they are in a good mood.
ANESTHESIA
CHILDREN RARELY painless, but pain also has a special meaning: after all, every contraction is a step towards the birth of a baby. You may need painkillers, depending on how your contractions are progressing and your ability to cope with the pain. You may be able to overcome it using self-help techniques, but if the worsening pain becomes unbearable, ask your doctor for pain medication.
EPIDURAL ANESTHESIA
This anesthesia relieves pain by blocking the nerves of the lower body. It is effective when contractions cause back pain. However, not every hospital will offer you an epidural. The time of its use should be calculated so that the effect of the anesthetic ceases by the 2nd stage of labor, otherwise labor may be slowed down and the risk of episiotomy and forceps may increase.
How does this happen
Epidural anesthesia requires approx. 20 minutes. You will be asked to curl up with your knees touching your chin. Anesthetic will be injected with a syringe into the lower back. The needle is not removed, which allows you to administer an additional dose if necessary. The effect of the anesthetic wears off after 2 hours. It may be accompanied by some difficulty in movement and trembling in the hands. These phenomena will soon pass.
Action
On you The pain will pass, clarity of consciousness will remain. Some women feel weak and headache, as well as heaviness in the legs, which sometimes lasts for several hours.
Per child None.
NITRIC OXIDE WITH OXYGEN
This gas mixture significantly reduces pain without completely eliminating it and causes euphoria. Used at the end of the 1st stage of labor.
How does this happen
The gas mixture enters through a mask connected by a hose to the apparatus. The effect of the gas appears after half a minute, so at the beginning of the contraction you need to take several deep breaths.
Action
On you The gas dulls the pain, but does not relieve it completely. When you inhale, you will feel dizzy or nauseous.
Per child None.
PROMEDOL
This medicine is used in the 1st stage of labor, when the woman in labor is excited and finds it difficult to relax.
How does this happen
An injection of promedol is administered into the buttock or thigh. The onset of action is after 20 minutes, duration is 2-3 hours.
Action
On you Promedol manifests itself in different ways. For some, it has a calming effect, relaxing, causing drowsiness, although the consciousness of what is happening is completely preserved. There are also complaints about loss of self-control and intoxication. You may feel nauseous and shaky.
Per child Promedol can cause respiratory depression and drowsiness in a child. After childbirth, breathing can be easily stimulated, and drowsiness will disappear on its own.
ELECTRO-STIMULATION
The electrostimulation device reduces painful sensations and stimulates internal mechanism overcoming pain. It works on weak electrical impulses that affect the back area through the skin. A month before giving birth, find out if there is such a device in the maternity hospital and learn how to use it.
How does this happen
Four electrodes are placed on the back where the nerves leading to the uterus are concentrated. The electrodes are connected by wires to the manual control panel. With its help you can regulate the current strength.
Action
On you The device reduces pain at the initial stage of labor. If contractions are very painful, the device is ineffective.
Per child None.
MONITORING THE CONDITION OF THE FETAL
DURING the entire period of labor, doctors constantly record the fetal heart rate. This is done with a regular obstetric stethoscope or using an electronic monitor.
OBSTETRIC STETHOSCOPE
While you are in the delivery room, the midwife will regularly listen through abdominal wall fetal heartbeat.
ELECTRONIC FETAL MONITORING
This method requires sophisticated electronic equipment. In some hospitals, such monitoring (control) is used throughout labor, in others - occasionally or in the following cases:
if labor is induced artificially
if you have had an epidural
if you have complications that could threaten the fetus
if abnormalities are detected in the fetus.
Electronic monitoring is absolutely harmless and painless, but it significantly limits freedom of movement - thus you cannot control contractions. If your doctor or midwife has suggested continuous monitoring, find out if this is really necessary.
How does this happen
You will be asked to sit or lie down on a couch. The body will be supported with pillows. Adhesive tapes with sensors will be placed on the abdomen to detect the fetal heartbeat and record uterine contractions. The instrument readings are printed on paper tape. After the amniotic fluid has broken, the baby's heart rate can be measured by placing an electronic sensor near his head. This monitoring method is the most accurate, but not very convenient. Some maternity hospitals use radio wave monitoring systems with remote control(telemetric monitoring). Their advantage is that you are not tied to bulky equipment and can move freely during contractions.
SPECIAL DELIVERY METHODS
EPISIOTOMY
This is a dissection of the vaginal opening to prevent rupture or to shorten the second stage of labor if the health of the fetus is threatened. To avoid an episiotomy:
learn to relax your pelvic floor muscles
When expelling the fetus, stay straighter.
Indications
An episiotomy will be needed if:
the fetus is in a breech position, large head, other deviations
you are in premature labor
use forceps or vacuum
you don't control your attempts
the skin around the vaginal opening does not stretch enough.
How does this happen
At the climax of the contraction, an incision is made into the vagina - downwards and, usually, slightly to the side. Sometimes there is no time for an anesthetic injection, but you still won’t feel pain, since partial numbness of the tissues also occurs due to the fact that they are stretched. Suturing after an episiotomy or rupture may be quite lengthy and painful - a complex procedure that requires special care. Therefore, insist that they do you a good job. local anesthesia. Suture material After a while it dissolves on its own; there is no need to remove it.
Consequences
It's normal to feel discomfort and inflammation after an episiotomy, but the pain can be severe, especially if it becomes infected. The incision heals in 10-14 days, but if something bothers you then, consult a doctor.
FRUIT EXTRACTION
Sometimes forceps or vacuum extraction are used to help the baby be born. The use of forceps is possible only when the cervix is fully dilated and the fetal head has entered it. Vacuum extraction is also permissible in case of incomplete dilatation - in the case of protracted labor.
Indications
Forced extraction is performed:
if you or the fetus have any abnormalities during childbirth
in case of breech presentation or premature birth.
How does this happen
Forceps You will be given anesthesia - inhalation or intravenous anesthesia. The doctor applies forceps, wraps them around the child’s head, and gently pulls it out. When applying forceps, pushing is completely eliminated. Then everything happens naturally.
Vacuum extractor This is a small suction cup connected to a vacuum pump. It is brought through the vagina to the fetal head. While you push, the fetus is gently pulled through the birth canal.
Consequences
Forceps may leave dents or bruises on the fetus's head, but they are not dangerous. After a few days these marks disappear.
Vacuum The suction cup will leave a slight swelling and then a bruise on the baby's head. This too will gradually go away.
STIMULATION OF LABOR
Stimulation means that contractions will have to be induced artificially. Sometimes methods are used to speed up contractions if they are going too slowly. Physicians' approaches to stimulation often vary; so try to find out what the practice of inducing labor is in the area where you will be giving birth.
Indications
Contractions are induced artificially:
if, when labor is delayed for more than a week, signs of abnormalities in the fetus or dysfunction of the placenta are detected
if you have high blood pressure or any other complications that are dangerous for the fetus.
How does this happen
Artificially induced labor is planned in advance, and you will be asked to go to the maternity hospital in advance. There are 3 methods of stimulating contractions:
1.
The hormonal drug cerviprost is injected into the cervical canal, softening the cervix. Contractions can begin in about an hour. This method is not always effective during the first birth.
2.
Opening of the amniotic sac. The doctor makes a hole in the amniotic sac. Most women do not experience any pain. Soon uterine contractions begin.
3.
A hormonal drug is administered intravenously through a drip that promotes contraction of the uterus. Ask for an IV to be placed on left hand(or to the right if you are left-handed).
Consequences
Introduction hormonal drug preferably, you can move freely during contractions. When using an IV, contractions will be more intense and the intervals between them will be shorter than during normal labor. Besides, you have to lie down.
BUTICAL PRECTION
In 4 cases out of 100, the baby comes out with the lower body. Childbirth in this position of the fetus is longer and more painful, so it must take place in a hospital. Since the head, the largest part of the baby's body, will be the last to appear during birth, it is measured in advance with an ultrasound scanner to ensure that it will pass through the pelvis. An episiotomy will be required; often used C-section(in some clinics this is mandatory).
TWINS
Twins must be delivered in a hospital because forceps are often used to remove them. In addition, one of them may have a breech presentation. You will likely be offered an epidural. There will be one first stage of labor. There are two second pushes: first one child comes out, followed by the second. The interval between the birth of twins is 10-30 minutes.
C-SECTION
With a CESAREAN section, the baby is born through an open abdominal wall. You will be informed in advance about the need for surgery, but this measure may be caused by complications during childbirth. If a caesarean section is planned, an epidural will be used, meaning you will be awake and able to see your baby right away. If the need for surgery arises during contractions, then epidural anesthesia is possible, although sometimes it is required general anesthesia. It is difficult to come to terms with the fact that you cannot give birth normally. But these experiences can be overcome if you prepare yourself psychologically.
HOW DOES THIS HAPPEN
Your pubic area will be shaved, an IV will be placed in your arm, and a catheter will be inserted into your bladder. They will give you anesthesia. If you have an epidural, a screen will probably be placed between you and the surgeon. Typically a horizontal incision is made, then the surgeon uses suction to remove the amniotic fluid. The child is sometimes removed using forceps. After the placenta is delivered, you will be able to hold him in your arms. The operation itself lasts about five minutes. Stitching takes another 20 minutes.
Incision
The bikini incision is made horizontally, above the upper pubic line, and once healed it is almost invisible.
AFTER OPERATION
After giving birth, you will not be allowed to lie down for a long time without getting up. Walking and movement are completely harmless for you. The incision will still be painful for the first few days, so ask for pain relief. Stand straight, supporting the seam with your hands. After two days, start light exercise; in another day or two, when the bandage is removed, you can swim. The stitches are removed on the 5th day. In a week you will feel quite good. Avoid for the first 6 weeks heavy loads. After 3-6 months the scar will fade.
How to breastfeed
Place the child on pillows so that his weight does not put pressure on the wound.
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