There are no two identical births, however, there are general laws that are true for all women in labor, and knowledge of these stages of the process will allow you to understand what is happening to you.
DELIVERY AND PERMIT
As this amazing day draws nearer and the realization that you really will have a child, you, quite naturally, experience some fear. There are no two identical births, however, there are general laws that are true for all women in labor, and knowledge of these stages of the process will allow you to understand what is happening to you.
SIGNS OF THE BEGINNING OF THE BIRTH
By the end of pregnancy, most women get tired of their large abdomen and the associated inconvenience. As you approach the deadline, a feeling of impatience and anxious expectation may seize you. Listed below are indications of an approaching birth.
Lowering the baby. At some point, you may notice that the child in your stomach lowered. This phenomenon is called lowering or relief. Lowering of the child in primiparous women occurs in the period from two to four weeks before the expected date of birth, and in women bearing not the first child, lowering can occur only after the onset of childbirth. Changing the position of the child leads to a decrease in pressure on the diaphragm, and it becomes easier for you to breathe. In addition, the pressure on the stomach decreases, as a result of which the heartburn disappears. But now the child presses on the pelvic organs and especially on the bladder.
Lower back pain. This is not the usual pain of tired muscles that you felt during pregnancy. These new sensations are the result of not only the pressure of the child, but also the stretching of the sacroiliac joint - as the child becomes heavier and sinks lower.
Frequent urination and bowel movements. Now, when the child presses on the bladder, urination will occur more often. The hormones of labor act on the intestines, which leads to a kind of preventive cleansing; some women even have cramping and diarrhea. If you hardly sleep at night, but run to the toilet all the time, try the following remedy. Before you go to bed, stand on all fours and forty-four times raise the pelvis, as a result of which the child will slightly rise and the pressure on the bladder will weaken. Then, without straightening up or getting up, immediately lie on your side and try to fall asleep. This technique will provide you with an extra hour or two of sleep before you have to get up and go to the toilet.
Cramps and swelling. Menstrual cramps are a reminder that the child sank into the pelvic area. In addition, the baby's head squeezes nerve fibers and blood vessels passing through the pelvis, which can lead to thigh cramps, as well as swelling of the legs. With frequent convulsions, the cramped muscle should be stretched. Instead of jumping and walking, stretch your foot on a cool floor. If you have to sit a lot, substitute a bench under one leg and change the position of the legs from time to time. You should periodically get up, stretch and walk a little.
Outbreaks of activity. At one point, the usual tiredness and apathy of the last weeks of childbirth may be replaced by a desire to clean, wash and re-decorate the whole house, as if a very important person should come to visit you. This is a normal instinct for "arranging a nest," and such activities will help dispel the boredom of recent weeks, which stretch endlessly. Just don't overdo it. Save your strength for the most important event. A tired woman is not ready for the birth.
Enhanced vaginal discharge. You may notice more profuse discharge of milky white or pinkish color. They differ from the spotting described below.
Another schedule for experienced mothers
During the first vaginal birth, from the moment you feel the pressure of the baby’s head on the perineum, it takes half an hour or more to give birth to the entire head. Then one more effort for the shoulders, and the whole body of the child is born quite easily. After the second or third birth, very little time passes from teething to the birth of the baby. If the woman in labor does not lie on a soft surface, the doctor or midwife must be very careful to catch a slippery baby.
All these signs indicate the approach of childbirth, but do not allow to determine when this will happen. In some women, these symptoms are present for several weeks, while others notice them several days before the birth. Some do not notice anything at all. The time of occurrence and the intensity of these signs may vary with each new pregnancy. Nevertheless, none of them gives an answer to the question of when the baby will be born. However, in addition to them, there are other signs of the approach of labor, which are more accurate indicators of the time of the onset of this event.
When to call a doctor
When to make this long-awaited phone call depends on the situation, but at the ninth month during one of the planned visits to the doctor, you should ask him the question: "When should I call you?" Perhaps in your case it is necessary to call a doctor earlier than most women in labor do. If this is your fourth child, and previous births were quick, you need to call earlier. It is clear that if there are alarming signs (see below "If childbirth is delayed"), you should immediately call a doctor. If this is your first child and the first fight, and if nothing unusual happens to you and there is no reason for alarm, let the doctor sleep until morning - even if you yourself do not fall asleep. Doubts are interpreted in favor of the call - you paid for this privilege. You do not need to apologize for the false alarm.
It is very important to be careful and take responsibility for your own health. Call your doctor and tell what happens to you. If everything is normal and there are no alarming symptoms or problems, you should say something like this: "The waters flowed out at eleven in the evening. The fluid is clear and the baby’s movements are normal. I’m tired and rest at home until the contractions begin to intensify. It’s okay if I I’ll call you at night - if the process becomes rapid or alarming signs appear? (The doctor can remind you what to pay attention to.) Otherwise, I’ll call at eight in the morning and we will draw up a new plan if you consider it necessary. " If you show responsibility and express your preferences, the doctor is more likely to listen to your wishes and make decisions based on your interests, and not out of fear of prosecution.
Before picking up the phone, make a scrum table (see below “Example Scramble Table”) - the doctor will need this information to tell you when to go to the hospital or maternity center. Departure from home is a very important moment. If you do this too soon, you will lose the comfort of a familiar environment, which can lead to a delay in childbirth. If you pull too long, you have to scamper with all your heart that is not part of your birth plan. If the doctor has not given specific instructions in this regard, primiparous women should go to the hospital or maternity center when the contractions become strong and the interval between them is reduced to 5 minutes (see the section "When to go to the hospital"). If this is not your first birth, it is wiser to leave your home a little earlier. Upon arrival, a nurse or midwife will examine you and then call a doctor.
Prenatal contractions. As the date of birth approaches, the character of the Braxton-Hicks contractions changes (see below for more details). From simply unpleasant, they can turn into painful ones - especially in the lower abdomen. In addition, they can become more frequent. Passionate expectation of the onset of labor can lead to you rushing to the phone to happily tell the doctor: "It has begun!" Before you call, we advise you to clarify the differences between prenatal and labor. Many women describe their feelings as follows: as if inside their abdomen they tighten their belt, then release and tighten again. These contractions can either intensify or weaken within two weeks before the onset of labor, and eventually they turn into real contractions. Use prenatal contractions to train relaxation techniques to find out which ones bring relief. You may find that you still need to work out.
Bloody issues. As the baby's head goes down, the shape of the lower part of the uterus changes from conical to cup-shaped. Prenatal contractions lead to relaxation and thinning of the cervix - this process is called abrasion. This is what happens. Imagine pushing a baseball ball or grapefruit through the neck of a sweater. Please note that as the ball moves, the fabric becomes thinner (or wears out). The same thing happens with the cervix. As a result, the mucous plug covering the cervix softens, and the woman notices the release of mucus mixed with blood (see the table below. "Brief description of childbirth"). These spotting indicates that the baby has already moved down and childbirth will begin soon. The color of the discharge may vary from pale pink to red brown; blood flows from tiny blood vessels that burst when the cervix is erased. The amount of blood can also be different - from a few drops to a teaspoon. The consistency of mucus can be from viscous to dense and sticky.
In some women, the entire cork leaves immediately, while in others it slowly dissolves with ordinary vaginal mucus. Sometimes she remains on the doctor’s glove after a vaginal examination, and you may not see her. Usually, after the cork mucosa leaves, no more than three days remain before childbirth. However, some women hold on for another week or even two.
Rupture of the fetal bladder. The surest sign of an approaching birth is a rupture of the fetal bladder. Only in one out of ten pregnant women, the fetal bladder bursts before birth. For most expectant mothers, this does not happen until the birth process goes far enough or until the doctor pierces the bladder (for your actions in case of rupture of the fetal bladder, see "What to do if the water has passed"). If childbirth has already begun at the time of rupture of the membranes, a sharp increase in contractions should be expected. After the softening layer of water disappears, the baby's head acts like a wedge, expanding the cervix. Now the presence of the child is really felt.
Intact shells protect both the mother and the baby. They prevent the infection from entering the fetus in the first, slow stage of labor. In addition, the fluid reduces the pressure on the baby’s head during the first hours of uterine contractions and helps to more evenly distribute the pressure during the opening of the cervix. Studies have shown that spontaneous rupture of the membranes when opening from 2 to 4 centimeters stimulates and accelerates the process of childbirth. Sometimes the rupture of the fetal bladder occurs in a dream - a woman sleeps and does not know that childbirth has already begun, until violent contractions suddenly "begin". In other cases, contractions begin only a few hours after the water leaves (or do not begin at all).
Martha's remark. Births of women can startle labor pains. You have never experienced such feelings in your life, and, in addition, childbirth rarely goes the way you rehearsed in courses.When I gave birth to my first child, the first sign of an approaching birth was the departure of the waters - at three in the morning after going to the toilet. After about ten minutes, contractions hit me. They were not weak and gradually intensified, as is written in the books. Contractions quickly passed into the active stage of childbirth. It probably all started earlier - when I was sleeping. Having no experience, I considered these fights weak and thought I could not stand it when they intensified, but this did not happen. Since then, I have been telling the women who attend my courses that if you haven’t had any problems and the contractions become so strong that you can hardly stand them, it means that the pain has reached a peak. Your body knows its capabilities. To those women who are jealous of my quick birth, I say: "Provide me with a slow classic birth!"
Prenatal * and labor pains - how to distinguish them
• Follow in a certain rhythm, become more regular, stronger, longer and more frequent.
• May feel like strong menstrual cramps. Sometimes accompanied by lower back pain, which extends to the lower abdomen. There is a feeling of pressure inside the abdomen, spreading to the hips.
• Strengthen when walking.
• Do not stop when you lie down or change position.
• Examination shows softening and abrasion of the cervix; disclosure is gradually increasing.
• Usually accompanied by discharge in the form of pinkish mucus
• Irregular, do not get stronger, more often or longer.
• May not cause discomfort or cause mild discomfort in the lower abdomen and groin. The uterus becomes like a hard ball.
• Do not intensify or disappear when walking.
• Stop when you lie down or change position. Become weaker or disappear when you take a bath or shower.
• Prior to the onset of labor, some opening and abrasion of the cervix may be observed, but examinations do not reveal significant changes.
• Usually not accompanied by spotting; sometimes there is only brownish mucus.
* We prefer the terms "patrimonial" and "prenatal" contractions, rather than "true" and "false". There are no "false" labor pains. Prenatal contractions (also called Braxton-Hicks contractions), which can last several weeks, do useful work: tone the uterus, correct the position of the baby, erase the cervix, and help prepare the birth canal for the onset of labor.
If you are not sure what your contractions are, patrimonial or prenatal, watch them for an hour. In the general case, if there were six or more contractions, the duration of each exceeded thirty seconds (see "Example of the contractions table"), and the intensity increased, it is likely that childbirth has already begun.
Nevertheless, quite often there are situations when a woman for two or even four hours feels regular contractions (with an interval of five to ten minutes), which are perceived as mild discomfort (pulling sensation in the groin) and which then pass. Do not be upset because of such a start of labor, which in fact turned out to be prenatal contractions. The better the cervix will prepare for childbirth, the less work will fall on its share during childbirth.
If you are concerned about the progress of childbirth or you are worried about yourself and the baby, contact your doctor or midwife to assess the situation and confirm that everything is going fine.
Language of childbirth
Each profession has its own professional jargon, and obstetrics is no exception. To help you understand the people who will be giving birth, we give some terms that apply to you and the baby that you are likely to encounter.
|Lowering||The child descends into the pelvic area.|
|Disclosure||Describes the opening of the cervix, which either follows erasure (seebelow), or occurs simultaneously with it. A doctor or midwife measures the opening in centimeters. At the very beginning, most primiparous women have an opening of 1 or 2 centimeters. “Ten centimeters of erection” means that the cervix has fully opened. From the point of view of an obstetrician-gynecologist, the beginning of the opening of the cervix means the beginning of childbirth.|
|Erase||The cervix becomes thinner, turning from a thick-walled cone into a thin-walled cup, which includes the precursor of the fetus (see below). As a result of the examination, the doctor or midwife evaluates the degree of erasure. “Zero percent erase” means that the cervix has not yet begun to thin. “Fifty percent erase” means the process is half completed. “One hundred percent erasure” means that the cervix is completely obliterated.|
|Entry||The underlying part of the fetus is at level 0 (see below). The phrase “The head of the child entered” means that it sank into the aperture of the pelvis.|
|Swimming||The underlying part of the fetus is located above the aperture of the pelvis or at level - 4 (see below) and can easily rise up.|
|Total number of pregnancies||This term, along with the term "number of births" (see below), will appear on your medical record. The entry G1 / P0 means that this is your first pregnancy. The entry G111 / P0 indicates that the pregnant woman had two miscarriages. Very often for women giving birth for the first time, the term "primiparous" is used.|
|Position||The position of the child in the uterus is either longitudinal (vertical to the pelvis, which is considered normal and the most common), or transverse (horizontal to the pelvis, which is rare and is one of the indications for cesarean section).|
|Number of births||How many times a woman gave birth.|
|Position||Describes the position of the baby's head in the mother’s pelvis. If the back of the head of the child is facing the pubic bone, they speak of the front position. If the neck of the child is facing the sacrum, then we are talking about the back position.|
|The preceding part||The child is partially turned to the cervix. In 96 percent of cases, the child is turned head down, that is, is in the "occipital", or vertical presentation. In 3-4 percent of cases, the child is in the “buttock” presentation (buttocks or legs down). Very rarely, the child is bent or folded in half so that the shoulders fall first, or the head is thrown back - the so-called facial presentation.|
|Birth stage||There are three stages of childbirth. The first stage, or opening of the cervix, begins when contractions become regular, and ends with the full opening of the cervix. The second stage is associated with the passage of the child through the birth canal; it begins after the full opening of the cervix, and ends with the birth of a child. This stage is the real birth. The third stage is the expulsion of the placenta.|
|Level||How deep the present part of the fetus sank into the pelvis of the woman in labor. Level 0 corresponds to the middle of the pelvis, where the doctor probes the protrusions of the pelvic bones. Each centimeter up or down from this position represents a certain level. A level of 0 means that the widest part of the baby’s head has entered the pelvic aperture. If you are told that the child is at +4, this means that his whole head went through the pelvis and you can see it.|
IF THE BIRTH IS TIGHTENED
In "classical" births, a woman feels the increasing frequency and intensity of contractions. During the vaginal examination, it turns out that the cervix reacts to contractions. However, some births are delayed at this early stage. They are often called prodromal birth, and in reality they represent the long phase of the early phase of childbirth. In some women, and especially primiparous, this period is similar to the additional phase of childbirth.Prodromal birth can be considered an excessively prolonged early or “hidden” phase of labor (although according to the testimony of women in labor there is nothing hidden), when the cervix slowly erases for two or three days. In primiparous women, neck erasure can take up to two weeks, and therefore, formally, the onset of labor can be counted from the moment when the neck is almost completely erased. Prodromal birth is difficult not only to interpret, but also to withstand - both physically and psychologically. With this version of the early phase of labor, the frequency and intensity of contractions hardly increase, and the cervix is practically not opened. So, for example, with prodromal labor, contractions can be felt for three days with an interval of eight to ten minutes, and after this time the cervical abrasion will be 75 percent, and the opening will be only 2 centimeters. During this period, contractions are not particularly strong, but they do not allow you to fall asleep and require certain measures to ensure the comfort of the woman in labor. The biggest problem with such births is the fatigue and decline in childbirth. These negative feelings increase like a snowball, and weak fights begin to seem strong, and the prospect of the onset of “real birth” looks frightening.
It may be difficult for spouses to make a reasonable choice when the situation begins to develop differently than they did in the preparation for childbirth courses. They can get upset and angry due to severe pain and slow progress, and then begin to suspect that the woman’s body is not working as it should. They understand that if you adhere to the recommendations given by your doctor, then it’s too early to go to the hospital. But since the contractions began a long time ago, they lose confidence in their abilities and decide that someone else is able to accelerate the course of childbirth. This sets them up for a series of interventions that turn a woman in labor into a passive patient, rather than helping her give birth. The following recommendations will help you make smart decisions with this type of delivery.
Try to sleep. If the contractions do not allow you to fall asleep or wake you up all the time, try turning to self-help methods or sleeping pills. Take a warm bath. Sometimes this one remedy is enough for the contractions to weaken and you could take a little nap. When you wake up, the contractions will be less intense - or you will have enough rest and be ready for more intense contractions. While relaxing in the bath, try to analyze possible psychological barriers, for example, specific fears (see the section "Fear is the enemy of childbirth"), which at the subconscious level make you reject childbirth. Perhaps you are not ready to obey the requirements of your body and unknowingly resist fights. For those who do not reject alcoholic beverages, some doctors recommend drinking some wine for relaxation. In many cases, the combination of a warm bath and a glass of wine causes restorative sleep. We do not recommend drinking alcohol during pregnancy, as it can adversely affect the development of the baby, but in this situation, wine is a medicine. Ask your doctor about this.
If the prodromal birth still keeps you awake, ask your doctor for prescription oral sedatives to help you relax and cause sleep. Some doctors, in order to be able to closely monitor you, may put you in a hospital and inject, for example, morphine to cause sleep. This will allow you to relax and sleep for several hours. Waking up, you will find that the opening of the cervix is 3-4 centimeters, and you have had enough rest before the active phase of childbirth. However, with prolonged childbirth it is still better to rest scrap, rather than in a hospital. Staying in the hospital can have the opposite effect, as staff will often wake you up for examination.There is also the possibility that childbirth will stop progressing, and in this case you will encounter all kinds of methods of stimulation - once you have already been to the hospital.
If you rested and felt a surge of strength, and the contractions continue, try to push the development of labor by walking, vertical position of the body or stimulation of the nipples. In addition, if the membranes are intact, the doctor or midwife may suggest an enema or castor oil to stimulate the intestines and promote the production of prostaglandins, these natural birth stimulants. A side effect of an enema or castor oil is possible short-term intestinal cramps. If the contractions have stopped, it is better to allow yourself more sleep, and not make a feverish effort to resume childbirth. Sleep is the best friend of childbirth. Do not leave home without rest.
Restore strength. Drink when thirsty and eat when you are hungry. This will prevent dehydration and maintain the necessary blood sugar level, which will help to avoid depletion of strength (see further “Food and Drinks During Childbirth”).
Do not miss the signs of trouble. If you are good at managing prodromal birth at home and don’t want to go to the hospital until the real birth starts, you need to be aware of alerts that may indicate the need for medical attention.
- Fetal activity decreased. In most cases, the child’s movements are felt six to ten times per hour - if the child is not sleeping. If counting gives fewer shocks, drink some juice, change your level of activity, and listen to your child again. If it takes more than an hour to restore the frequency of movements, call the doctor and head to his office or hospital for a more detailed check (see "Counting fetal movements"). '
- The uterus remains firm between the peaks of contractions, and contractions themselves occur continuously.
- Profuse vaginal bleeding (more blood than menstruation).
- Isolation of a greenish or colorless fluid from the vagina.
- The inner feeling that something is wrong with you or that you noticed one of the symptoms that the doctor warned you about. If you feel the need to call a doctor and he wants to examine you, or you just need to see him to make sure everything is in order, try to have him examine you in his office, not in the hospital. When you have little strength, it’s easy to persuade you to stay in the hospital and agree to various kinds of interventions in order to “deal with this once you are here.” If the doctor comes to the conclusion that both you and the child tolerate this difficult period, it is best for you to relax, and not rush the birth, for which you may not have enough strength.
Be patient. When you wait, time is slow. You may be tired of sitting and watching your womb. If the spouse is anxious, send him to the store or to work. If you are afraid to stay home alone, invite a friend to stay with you a little. Do not forget that getting to the hospital before the start of the active phase of childbirth, you are at risk of numerous interventions. (An example of a prolonged birth is the story “I should have slept!”, See below.)
SUSPENSION OF GENERAL ACTIVITY
It may happen that you give birth for several hours, and the doctor or midwife after the examination declares that there is no progress. Before becoming a hostage to the counterproductive cycle of frustration and anxiety leading to weakened fights, think about the following points.
What is progress?
Your assistant measures the progress of labor with two indicators - disclosure and lowering fetus: how many centimeters the cervix has opened and how many centimeters the fetus has descended.Obstetrician-gynecologists have a guideline - one centimeter per hour for opening and one centimeter per hour for lowering (1.5 centimeters for women who have already given birth) after the onset of the active phase of labor. However, these rules of thumb may not be appropriate for your uterus. Some women have their own rhythm. These averages simply help the assistant monitor the delivery and warn you that you may need help. Deviation from the mean does not mean at all that childbirth does not develop as it should, or that the child is in danger.
In many cases, additional work is required before the cervix begins to open and the baby gets the opportunity to lower. So, for example, in a primiparous woman, the cervix may need to be completely erased before it opens even by 3 or 4 centimeters. Thus, if cervical abrasion is observed for several hours, and the disclosure has not yet begun, there is no reason for excitement. The same logic holds true for lowering the child: if the child’s turning from the back to the front position — this allows him to lower — took several hours, but by standard standards, there is no progress, you should know that positive changes are still taking place, and not lose heart . If the cervix slightly opened, the baby began to lower slightly, and the mother and baby feel normal, progress is evident.
Do not look at the watch. Perhaps this is not a stop, but simply a slowdown in labor. The uterus itself determines the pace of its work. Prohibit all references to time. You do not need discouraging phrases like "all the same" or "it seems, without movement." Remember that interruptions in childbirth are a normal occurrence, and they help you relax and gain strength.
Think of stimulants. Take measures that help the progress of childbirth (relaxation and change of position are especially useful) and try not to do things that slow down childbirth (for example, lie on your back for a long time, listening to your fears and pains).
Make hormones work. After the start of the second stage of labor, your body will automatically begin to produce hormones that increase contractions. However, even before this point, you can yourself stimulate their production. Try taking measures that make your body throw oxytocin into your bloodstream, such as nipple stimulation. Kisses and hugs of the spouse can also accelerate the onset of childbirth. If the membranes are not damaged, experienced mothers often turn to sexual intercourse as a means of stimulating the production of hormones (semen contains prostaglandins, which contribute to the maturation of the cervix). With psychological and physical stress, your body produces stress hormones that counteract the hormones responsible for the normal course of labor. Try immersing yourself in a bath of warm water (about 97 ° F). Water will relax you by lowering the level of counterproductive hormones, and if the water reaches the nipples, it stimulates the production of hormones that enhance contractions.
Do you still have strength? Maybe your body is dehydrated or you are lacking in calories? Drink to quench your thirst, and have a bite to eat in the early phase of labor to maintain strength for future work (see Food and Drinks During Delivery). If you are unable to eat due to nausea and the threat of vomiting, two tablespoons of honey will help you.
Boost your efficiency. To maintain strength, lie down in between fights - this will help you relax and unwind, and during fights, call for help motion and gravity. Get up and move. The alternation of rest in the supine position and physical activity stimulates contractions. During pauses, the uterus needs to rest - like everyone else. The bladder should be empty - empty it every hour.
Do not refuse medical care. If you are tired and tried all the methods of self-help, and the cervix does not open or the baby does not fall, the doctor or midwife can offer medications. These include prostaglandin gel, which will help the cervix soften and open, intravenous administration of pitocin to stimulate contractions or analgesia, breaking the cycle of pain - depletion. A timely dose of anesthetic (intramuscularly, intravenously or with epidural anesthesia) will help restore strength and contribute to the progress of labor. Sometimes the best way to help your uterus is to sleep, and medications will allow you to take a little nap.
Refuse medical attention. If the birth was normal, but after epidural anesthesia, labor has stopped, check with your doctor to see if you can turn off the anesthesia. If necessary, it can always be renewed. If you are bedridden (continuous epidural anesthesia, a dropper and continuous electronic monitoring of the fetus), ask for freedom of movement. If the doctor insists on a dropper and fetal monitoring, ask for a heparin lock and use a telemetric monitoring system. Take a walk. Take a bath or shower. If you think that there are too many people in the room, ask for privacy. Take effective help and refuse the one that only interferes. When you sleep, put a Do Not Disturb sign on the door, such as the one used in hotels.
WHAT TO DO IF WATERS DRAIN
During pregnancy, the baby stays in its own, “bespoke” pool. The water in this pool is called amniotic fluid, and the "bag" in which it is contained is fetal membrane. In most women in the first phase of childbirth, the membranes remain intact and weaken the pressure on the cervix. As a rule, the fetal membrane ruptures spontaneously - at the moment most suitable for specific births. This happens painlessly, because there are no nerve endings in the membranes. In about 10 percent of women in labor, the membranes rupture even before the birth, and in 80 percent of cases this is a signal that the birth will begin in the next twenty-four hours. Sometimes the membranes rupture before the onset of labor, and this situation requires close attention of the doctor to protect the child from infection. During pregnancy, leakage of amniotic fluid may occur, however, in most cases, defects in the membrane are eliminated automatically without causing any problems. This "pool" is replenished every three hours, and therefore the loss of fluid is quickly compensated.
The final rupture of the fetal membrane can manifest itself in the form of a thin trickle of liquid - for example, when coughing - which raises some doubts: whether it really "started" or is it simply urinary incontinence. A thin stream means that the rupture most likely occurred in the upper part of the fetal membrane. If the membrane breaks in the lower part, in the region of the cervix, you feel an internal “clap”, accompanied by the outflow of a strong stream of fluid. Get ready that after the first stream some more liquid will come out of you during contractions. As a rule, women in labor do not have difficulties with determining the nature of the leaking fluid: usually amniotic fluid is colorless and odorless; a slight sour smell is also possible. Urine is yellow, and the specific smell will leave no doubt in the diagnosis. In addition, if you regularly performed Kegel exercises, you can stop urine leakage. Sometimes amniotic fluid is difficult to distinguish from vaginal discharge, and the doctor may use a litmus test to determine the type of fluid. Vaginal secretions have an acidic environment, and amniotic fluid is alkaline.Vaginal secretions usually only moisturize the panties, and the amniotic fluid soaks through them.
When there was a rupture of the membranes
If spontaneous rupture of the membranes has occurred, you should respond as follows:
• Record the time, as well as the amount (trickle or stream) and color (transparent, with blood, greenish) of the liquid.
• Tell your doctor or midwife. The recommendations received from them will depend on whether the delivery is already over, on the color of the liquid (the greenish color may be due to meconium and indicate the abnormal condition of the fetus, which requires immediate examination) and on how much the baby has lowered (this is determined by weekly inspection). If the baby has not yet lowered, the doctor may advise you to immediately go to the hospital or maternity center - or, in the case of home birth, he will come to conduct an examination. The danger is that the umbilical cord can get into the birth canal before the baby’s head, which will lead to a serious complication called umbilical cord prolapse. If the baby’s head has already lowered, the doctor will most likely advise you to stay home until regular contractions intensify and the active phase of childbirth begins.
• Do not insert anything into the vagina after tearing the membranes, as the natural barrier to bacteria disappears. Avoid swabs, sexual intercourse, and optional vaginal examination.
• Take a shower instead of a bath. After rupture of the membranes, doctors do not recommend taking a bath because of the theoretical risk of infection. Experts who have experience using water during childbirth do not report an increased likelihood of infection when immersed in water after rupture of the membranes if active contractions are observed that push everything out.
Artificial opening of the fetal bladder
Women in labor should take care of their “bag” of water. There is a serious reason for this. Before allowing anyone to touch the fetal bladder, think about the benefits of this procedure, as well as the associated risk. The doctor may advise the artificial opening of the fetal bladder (another name for this procedure is amniotomy) to stimulate delivery during a post-term pregnancy or during the termination of labor (although not all obstetrician-gynecologists recognize the benefits of this method - given the risk), or the introduction of a sensor and catheter for internal monitoring of the fetus. However, premature rupture of the membranes is associated with a certain risk. A bubble with water protects the baby from infection and facilitates the delivery of the mother. Amniotic fluid evenly distributes pressure during contractions, stretching the lower section and the cervix - more efficiently than the baby's hard head pressed to these tissues. Amniotomy carries with it not only an increased risk of infection - usually the procedure is performed at the moment when the baby's head has not yet entered the pelvic aperture, which can lead to prolapse of the umbilical cord and serious fetal distress. If the doctor or midwife recommends artificial opening of the fetal bladder, discuss with them all the benefits and dangers of the procedure and participate in the decision.
WHAT TO DO IN CASE OF AN EXTENDED PREGNANCY
The estimated date of birth has arrived, and the baby is in no hurry to be born. You ask yourself whether this pregnancy will ever end. The doctor begins to worry if everything is in order with the child. In the meantime, each time you get angry at the remark of an impatient girlfriend: "How, are you still pregnant?"
Most of the problems associated with the date of birth and a post-term pregnancy are due to confusion in terminology. As a result, unnecessary anxiety arises when the appointed day has passed and childbirth has not yet begun. The exact medical term is as follows: estimated delivery date. This is exactly an assumption.You can calculate the term yourself on the first day of the last menstruation - count back three months and add seven days. However, only about 5 percent of children are born in the time calculated in this way. Biological systems do not obey exact mathematical laws. The duration of the menstrual cycles is inconsistent - as is the time the baby spends in the uterus. The speed of uterine enlargement, the time when the doctor first heard the baby’s heartbeat, the moment you felt the first jolt — all this helps confirm the estimated date of delivery or casts doubt on it, but in different women these signals appear at different times. Even an ultrasound examination does not accurately determine the date of birth of the child. It is best to talk about the estimated month of birth or the beginning or end of the month, rather than giving a specific date. Think about the fact that the child will not be born on September 21, but at the end of September.
Do I need to worry?
You are looking at the circled day on your calendar. You look at your stomach and ask yourself how large it can grow. The doctor begins to prescribe examinations to check if everything is in order with the child. What is going on? According to statistics, among children whose residence time in the uterus exceeds forty-two weeks from the day of conception, there is a large mortality rate, and childbirth usually goes more difficult. One of the dangers of staying in the mother’s womb for too long is that the work of the placenta may be disrupted, and then the baby will wrinkle and be born too small. This happens with only 10 percent of children with a gestational age of more than 42 weeks. Another big danger is that the child can grow too large, which will lead to a difficult birth or to a suspension of labor.
What to do?
You have a choice of one of three options. Firstly, you can just have patience and wait until the child himself is born. Secondly, the doctor can intervene and induce labor. The third option - the doctor will closely monitor the condition of the child and intervene only if necessary. Recent studies have shown that anxiety for a born child is in most cases baseless and that the less aggressive is the best option. Let's try to consider each approach in more detail.
Just wait. You need to have patience and faith that nothing bad happens. Statistics are on your side. After the birth, it turned out that most of the newborns considered to be born were born on time and they did not observe any deviations. Only about 4 percent of the children turned out to be really left-over, but in almost all cases deviations from the average terms did not exceed the permissible limits, and no serious problems arose. However, increased risk does indicate that just waiting may not be the smartest choice. The question is what kind of medical care you choose. There are two options.
No accidents. The doctor has the ability to artificially induce childbirth by various methods. The stimulating effect is exerted by a prostaglandin gel applied to the cervix. In addition, the doctor may prefer the artificial opening of the fetal bladder (if the child’s head dropped low enough to make this procedure safe) and induce labor with pitocin. However, taking into account the fact that in most cases the pregnancy is not postponed and the baby can be quietly in the womb for some time, this choice may also not be the best. Induction of childbirth is fraught with complications, and, in addition, you may not get such satisfaction from childbirth, as if you would have given nature the freedom to do its job without interference.
Wait and watch. This is the most reasonable line of behavior for most women with a postponement of pregnancy.Observation means that the doctor thrice a week with a series of tests — usually a daily count of the baby’s movements (see “Counting the movements of the fetus”, see Chapter 5 “Screening tests”) and a non-stress test (ibid.) - will assess the condition fetus, and twice a week using ultrasound to measure the volume of amniotic fluid. If everything is in order with the child, you can calmly wait for nature to do its job. If the test results indicate a possible threat to the health of the child, the doctor may suggest that the delivery be artificially induced. Depending on your condition and test results, he will advise a method of stimulation (see ibid.). Recent studies, in which artificial stimulation of labor was compared with the option to "wait and observe," did not reveal any difference in the condition of newborns.
Whatever actions you take during a postponed pregnancy, do not forget about your role in childbirth. The doctor evaluates the condition of the child and confirms that everything is in order with him. You walk your part of the journey, relaxing during these endless last weeks. When worrying about a baby and convincing yourself of the danger of going on a circled day, you risk even more delaying the onset of childbirth. Remember that a little less than 1 percent of children are waiting for the forty-third week after conception - the moment when the likelihood of complications increases significantly. It is important to take full responsibility in assessing the condition of the child during an extended pregnancy, but not to overdo it with excitement or interventions.
THE BIRTH BEGINS
For some women, the transition to childbirth is gradual, and they cannot say exactly when they started. For others, the first contractions turn out to be very strong, and there is no doubt that the child has moved on. Despite the fact that the feelings experienced during childbirth are purely individual, there are general patterns that are true for all women in labor.
Scrum table example
|Fight time (night)||Duration, sec||The interval between contractions, min|
First stage of labor
If the contractions become regular and do not weaken, this means that the real work begins. You will hear staff discuss how far the birth has progressed. This question interests everyone, and especially you. There are special terms that describe the progress of childbirth. Childbirth is divided into three stages, and the first stage has three phases: hidden (it is sometimes called early), active and transitional phase. Some women can distinguish between each of these phases, while for others they all merge into one. The duration of each phase can also be different. In most women, and especially primiparous, childbirth begins with slow contractions, which gradually increase and become more frequent. It also happens that childbirth begins suddenly and proceed rapidly. The average duration of labor in primiparous women is thirteen hours, and in those giving birth, eight. The main difference between the two groups is the duration of the early phase of the first stage. We should not take any figures we cited as dogma, since they were obtained as a result of large-scale studies of women in labor in the 50s of the twentieth century, when most women lay still during childbirth, and the medical staff of the hospitals were not familiar with methods of accelerating childbirth.
Imagine the uterus in the form of an inverted pear, braided by hundreds of longitudinal rubber bands - muscles. These long muscle fibers unfold over the upper and widest part of the uterus, called the "bottom". The lower and narrowest part of the "pear", the cervix, contains more fibrous structures than muscles. Before giving birth, the hormones of pregnancy contribute to its maturation, or softening, and during childbirth, the upper muscle group pulls it on the baby, like a sweater with a high throat is pulled on a tennis ball.Thus, the uterus during childbirth performs two functions: pushes and pulls (in the same way you put on elastic tights, sticking your foot into the lower part and simultaneously stretching the upper one). As a result, the uterus turns from a pear-shaped into a cylindrical. For the birth to be successful, both muscle groups must work synchronously. The upper muscles tighten and contract, while the lower muscles relax and expand. This amazing muscle group is unlike any other muscle in your body. After stretching (or contracting), the remaining muscles usually relax and return to their original size. The muscles of the uterus behave differently. These muscles are shortened at the end of each bout. That is why the uterus decreases in size during childbirth and in the postpartum period.
Other labor muscles
During the first stage of labor, the uterus muscles do all the work. You do not need to make conscious efforts and push. After the upper part of the uterus has completed its main task - pushed the baby down and pulled up the fully open cervix, the uterus continues to contract to push the baby out. However, she now needs help from her abdominal muscles. These muscles should be given rest in the first stage of labor so that they can get connected to work as soon as this becomes necessary. Unlike uterine muscles, which contract automatically, you must control the work of the abdominal muscles. In addition, with relaxed abdominal muscles, contractions are easier to carry.
Early phase of labor
For most women, this is a period of inactivity. If this is your first child, get ready that this phase will last about eight hours (sometimes much longer). This time can be safely spent at home. The early phase is also called hidden, because for many women it goes unnoticed or is not mistaken for childbirth. During the early phase, the cervix is erased (thinned) and begins to open up to 3 or 4 centimeters. Contractions gradually become more frequent, until the gap between them is reduced to five minutes. In addition, they lengthen - from thirty to forty-five seconds - and become more intense.
Many of the symptoms discussed in the section on the prenatal period can also be observed in the early phase: spotting, rupture of the membranes, upset stomach, back pain, anxiety. During this early phase, try to ensure your comfort and save energy for your upcoming work. If delivery begins at night, try to fall asleep again - or at least rest. Keep up with your daily activities. Take a shower, eat a light lunch (see the section "Food and drink during childbirth") or enjoy a walk. Walking in the early phase of childbirth helps you maintain a vertical position, while gravity directs the baby down. Use one of the relaxation methods. Relax between contractions. Do what is required of you, but do not overdo it. Collect all the necessary things (see the section "List of necessary things that you will need during childbirth"), call the doctor and your assistant. Get ready for the fact that you will be overwhelmed by mixed feelings: the joyful excitement that the moment of birth is approaching, and the anxious expectation of what lies ahead. At this moment, there is still no need to concentrate all attention on childbirth and retire to a quiet, secluded place.
The early phase of labor is usually the longest and easiest. The discomfort is not very strong, and you, without straining, can do the usual things for this time of day. Towards the end of the early phase — even if the contractions are quite bearable — you may feel the need to retire, indulge in thoughts and disconnect from everything that happens around you. Emotions of a woman in childbirth, if she listens to them, are usually ahead of the uterus.This is a signal that the active phase of labor may soon begin and intense contractions will fall on you. The desire to close oneself and immerse oneself in one’s thoughts and feelings is the most reliable signal that one will soon need to pack on the road or at least warn a hospital, maternity center or midwife. Some women in labor arrive at the hospital too early, strictly following the recommendations of books, courses for preparing for childbirth, or a doctor. Childbirth can occur in different ways: it is possible that contractions follow with an interval of three minutes, but if they are short and very weak, this is not the active phase of childbirth. An emotional state is sometimes the best indicator of a physical state.
In the early phase of childbirth, it is recommended not only to psychologically and physically rest before the upcoming difficult work, but also to walk more. If during this period the discomfort is concentrated mainly in the back, this may indicate the back position of the child, the back of which is facing the sacrum of the mother. To relieve pain, rest on all fours or while standing - resting on your spouse or on a stable piece of furniture. This will help the child in the back position to roll over before continuing the descent, and you - to avoid a difficult birth.
If the baby is in the back position, childbirth usually progresses more slowly because the fetal head has a harder time getting into the pelvic aperture and lowering becomes less effective. Childbirth can slow down due to the fact that the baby's head does not fall into the cervix. In this case, pain medications are often used, followed by pitocin (due to the slow progress of childbirth), the use of instruments or a cesarean section if the baby is stuck in the pelvic opening. By the end of the first stage of labor, most babies in the back position roll over on their own; about 5 percent need a turn with their hands or forceps, and in rare cases a baby is born face up.
Food and drink during childbirth
In the past, women were not recommended to eat during childbirth - not for dietary reasons, but in case general emergency anesthesia is needed during emergency surgery. If a patient under general anesthesia experiences vomiting, food from the stomach during inspiration can enter the lungs - this is a life-threatening situation. Currently - with the exception of really urgent cases - most women who need a caesarean section do not choose general, but epidural anesthesia. If you have a special case that increases the likelihood of using general anesthesia, you will be given intravenous fluids and essential nutrients.
Any work requires replenishment of the consumed reserves of fluid and calories, and in this regard, the hard work of pushing the child out is no exception. Eating and drinking during childbirth is not only safe, but also necessary. Try to follow these guidelines.
• Frequent small “snacks” are better perceived by the tightened intestines than plentiful food. Childbirth slows down the process of digesting food.
• Give preference to proven foods that you consumed during pregnancy and are easy to digest. For most women in labor, these are crackers, jellies, and liquid soups.
• The richest and most energy-efficient foods are carbohydrates: fruits and juices for quick recovery, cereals and pasta for an even supply of energy. Honey allows you to restore strength in the most difficult moments - especially if you do not feel hunger.
• Avoid dehydration - it disrupts the physiological processes in the body, leads to a breakdown and slows down childbirth. As parturition progresses, part of the blood and energy is taken from the digestive system and sent to the organ that works with maximum load - that is, to the uterus.
Therefore, when overeating, even if it is only a liquid, the stomach tends to free itself from its contents.Take a few sips of fluid after each bout. Here is a time-tested recipe for a drink that a spouse can prepare in childbirth:
cups of lemon juice;
cups of honey;
¼-½ teaspoon of salt;
¼ teaspoon drinking soda;
1-2 ground calcium tablets.
Add water, up to one quart. Another 8 ounces of water can be added to soften the taste. In addition, you can flavor your drink with your favorite juice.
When to go to the hospital
If this is the first birth and the first fight, you may want to immediately go to the hospital, but such a rush will not necessarily be useful to you and your child. In the ninth month of pregnancy, during a planned visit to the doctor, be sure to ask him the question: "When?" Perhaps your condition requires you to come to the hospital as early as possible.
For most women, the best chance of securing a safe and satisfying birth is to stay at home as long as possible. Getting to the hospital prematurely may make you want to do something. As soon as you are in the hospital, you feel the need for progress in childbirth. Arriving at the hospital prematurely opens the door to optional interventions that can undermine your self-confidence and slow your delivery. In addition, you cease to be a "queen in your own castle", and turn into a "patient", who is in other people's possessions. Here, other orders reign. Very often, a woman who comes to the hospital during the early phase of childbirth, labor is slowed down or stopped. Therefore, you should understand that you always have the right to return home if you arrived at the hospital and found that the opening of the cervix is only 2 centimeters.
For most nulliparous women, it is necessary to go to the hospital when labor pains:
• follow with a frequency of 12-15 per hour;
• occur regularly with an interval of less than five minutes;
• last at least one minute;
• strong enough to interrupt your classes, demand all your attention and force you to resort to a relaxation technique.
The practical rule is that you need to go to the hospital when the contractions can be described by the formula 1-4-1, that is, they last at least a minute with an interval of 4 minutes for at least an hour.
The following symptoms indicate that you must go to the hospital as soon as possible:
• sudden severe bleeding (more blood flows than during normal menstruation);
• sudden sharp pain in the uterus, not like pain during contractions;
• constant dizziness;
• An inner voice tells you that something is wrong.
In order for the trip to the hospital to be calm and safe, rehearse it in anticipation of childbirth. Without haste, find a parking place, find out which of the hospital entrances you need to use (different entrances can be opened at night and day), and explore the shortest way to the maternity ward. To make the trip comfortable and safe, lay the back seat cushions, but do not forget to fasten your seat belt, which should cover your hips below the uterus. In case your water drains on the way, cover your "mobile bed" with plastic wrap - a special sheet, a bath curtain or a trash bag. Choose the shortest and least shaky route and don't forget to grab a cassette of your favorite music on the road. If you live far from the place you have chosen for childbirth, it is better not to wait for the active phase and not take risks, shaking in a frantically racing car and trying to restrain contractions, and move to the hotel closest to the place of birth or to your girlfriend. Once ready, make a short visit to the hospital or maternity center. Do not forget to register in advance. In the midst of fights, neither you nor your spouse will have the desire to mess around with forms.
Arriving at the hospital, it is best to indifferently jump past the notice board and, accompanied by your spouse, go straight to the ward for women in labor. The ceremonial appearance in the hospital lobby or in the emergency room, most likely, will lead to the fact that you will be treated like an invalid of royal blood - you will find shaking in a narrow and uncomfortable wheelchair. If such a trip is a standard procedure, take it between contractions or ask for a stop so that you can move during the contractions. A deliberately leisurely walk from car to ward is an excellent way to kill time and relax at the same time. Do not hesitate to lean against the wall or lean on your spouse if necessary. Smile to the caring "saviors" and tell them that everything is in order and that you want to go at your own pace.
Active phase of labor
This work is waiting for you in the active phase, when the process of opening the uterus begins. The active phase is also called the phase acceleration, because during this period the contractions become stronger, longer and more frequent, and the cervix opens up to 8 centimeters. During the previous phase, the contractions do not cause any particular inconvenience, but as soon as you think that “in the end, everything is not so bad” as you will encounter completely different sensations. Now the intensity of the fights can catch you by surprise, and you will no longer be able to forget about them, taking yourself into some kind of business. They require your full attention, and you will need to apply the anesthetic technique that you mastered during pregnancy. If the contractions make you fall silent in the middle of the phrase, it is likely that you are in the active phase of childbirth. During this phase, you will go to a hospital or maternity center - or call a midwife to your home.
After arriving at the hospital, the doctor or nurse of the maternity ward will check the degree of cervical dilatation and the level of lowering of the child. Shortly after the onset of the active phase of labor, in most women the cervix was already half open (5 centimeters). At this moment, you can feel the joy that everything is going well, and feel confident that you can withstand further. Perhaps, on the contrary, you will be upset and disappointed, because this progress took you twelve hours. In addition, your feelings will be strengthened along with increased fights. Will you survive another twelve hours? Take heart: the rest of the birth can be more intense, but it is more productive and less prolonged. Now, contractions occur every 3-5 minutes, and their duration increases and is 45-60 seconds.
In the active phase of labor, it takes three to four hours to fully open the cervix. Nevertheless, you should not spend a lot of time comparing the progress of your birth with "average" indicators. Very often, there are breaks and pauses in childbirth, when the opening of the uterus is suspended, and you should not worry about it. Each uterus has its own internal “clock”, and its schedule becomes known to you only after the end of the next stage of labor.
Recommendations for the "back position"
The most common cause of back pain is the child’s back position. Women often ask: "How do I know if a child is in the back position?" This position is often determined by the experienced hands of a doctor or midwife, palpating the mother’s belly or probing the baby’s head during vaginal examination after rupture of the fetal bladder. More often, however, this conclusion is suggested by Roger herself, saying: "All pain is concentrated in the back" or "Contractions are so strong in the back that I can hardly feel anything in front." If this is exactly what you experienced during childbirth, try the following guidelines to relieve back pain.
• Do not lie on your back.The supine position, and especially on the back, will only increase the pain from the pressure of the child’s head on the sacrum and will deprive mobility of the tailbone, which should be able to bend.
• Spend most of your time on all fours, on your knees, or in your knees to chest position. This will not only reduce pressure on the back, but will also contribute to the child’s upheaval, since gravity will pull the heaviest parts of his body (back of the head and body) down.
• Perform exercises such as rocking your pelvis. With your hands on all fours or knees to the chest, swing or rotate your pelvis to make your baby roll over.
• Get moving! Walking provides freedom of movement of the pelvic bones, and this helps the child to bend and turn, finding the path of least resistance through the aperture of the pelvis. Think twice before turning to epidural anesthesia. Forced horizontal position and limited mobility reduces the chances that the child will turn to the optimal position, and increases the likelihood of using forceps, as well as cesarean section.
• Sit in a bath of water. (For the benefits of labor using water, see Chapter 9). The more water in the bath, the more you - and the child - have freedom of movement.
• Other useful remedies - back pressure and back massage, hot or cold compresses, transdermal electrical stimulation and a shower stream directed to the corresponding zone (see Ch. 9).
Do you need a dropper?
Most women don’t need a drip, but there are situations when you can’t do without it. The reason for the intravenous administration of fluid to the mother in childbirth is the desire to ensure the supply of sufficient water to her body, since dehydration negatively affects all physiological processes and can slow down childbirth. If your stomach is so irritated that it does not hold the liquid, or if the excitement does not allow you to eat or drink, intravenous infusions will provide you with the energy and water you need to give birth. But even in this case, crushed ice and small portions of liquid are a more preferable way of supplying the mother’s body with water. A catheter in your hand turns you into a "sick person", limits mobility and causes fear. Experiments have shown that excess sugar in an intravenous fluid can stimulate the production of insulin, which will lower the blood sugar level of the newborn. Some doctors feel more comfortable if the woman in labor is pre-connected to the dropper - in case of unforeseen complications - such as a drop in blood pressure or bleeding, as well as the need for the introduction of stimulating drugs. Women object: if they are not at high risk and such events are unlikely, then why do they need a dropper? Consider the following options. If for medical reasons you need a dropper or if there is a high probability of complications during childbirth, it is wise to put it in advance. If the birth is normal, you are not at high risk, and you can also eat and drink to satisfy hunger and thirst, there is no need for a dropper. If you can’t do without a dropper, or if the doctor insists on it, ask for a salt or heparin lock. (The needle is inserted into the hand, but does not connect to the tube. Periodically, it is washed with saline to keep it open.) Do not forget that if you choose epidural anesthesia, then a dropper is required - for safety reasons. If you think that a dropper is bothering you, be sure to tell about it. The medical staff is committed to providing you with a safe and as satisfying birth as possible. It is possible that you will be able to fulfill these two requirements.
Between the first and second stages of labor there is a phase that most women would prefer to skip.Indeed, one of the most reliable signals about the onset of this phase is the exclamation of the woman in childbirth: "I can no longer!" For most women, this is the most difficult part of childbirth. But after it ends, the "descent" begins.
What is going on in your body. You are preparing for the second stage of childbirth, during which the baby is pushed out. The cervix expands by the last few centimeters, and the baby begins to sink into the vagina. The reason that the transition phase is so painful is that the muscles involved in childbirth switch from one job (opening the cervix) to another (pushing the baby out). This double task leads to the fact that your body receives two signals: pull the cervix on the baby and push the baby through it. In both cases, this is a very intensive work that must be carried out simultaneously, which can lead to disorientation.
Possible sensations. The transition phase is often characterized by the maximum tension of the muscles surrounding the cervix, and strong sensations prevent you from maintaining a relaxed state of muscles. Therefore, during this period the pain may be the most severe. In the active phase, the contractions can be compared with gradually increasing waves, on which you swing, while maintaining the ability to stay afloat. Now it is more like a tidal wave, and you begin to doubt whether you can withstand this storm. Contractions can occur every two minutes and last from one minute to one and a half. You do not have time to take a break from one fight, as the next one already begins. They can have several peaks, between which there is almost no gap. By the time you recall the anesthetic technique and try to apply it, the contractions can become unbearable. At this moment, doubt and confusion is the norm. You may ask: "Is everything all right?" or insist: "I can no longer."
When the baby crosses the border between the uterus and the vagina, you may feel increased back pain, as well as strong pressure in the rectum. In addition, in parturient women at this moment sometimes a diaphragm tension occurs, causing hiccups and heartburn. In some women, during the transition phase, nausea (and even vomiting), cramps in the throat (a harbinger of an urge to try), flushing of heat and cold, trembling throughout the body, and especially in the legs. Irritability, discontent, and pickiness are also frequent. Some women give free rein to their feelings (it’s more useful not to restrain themselves), others become quiet and thoughtful, trying with the help of consciousness to defeat matter. During the transition phase, a woman can be both very cute and completely unbearable.
Get ready that during childbirth you will learn a lot about yourself and about your relationship with your spouse. One woman described her feelings this way during the transition phase.
After giving birth, I felt a little awkward, remembering how verbose I was in the transition phase. It seemed to me that I could remain calm even in the most difficult moments of childbirth. Therefore, I was shocked and disappointed that I expressed my feelings in words and screamed in pain. Later, my husband changed my point of view, noting: "Sherry, you are a rather emotional and talkative person. Why did you suddenly think that at the time of the highest tension in your life, you will change yourself?" These words reassured me, and I proudly thought that I had coped with difficult moments in the most suitable and effective way.
Fortunately, the transition phase is the shortest period of childbirth, which takes only ten to twenty contractions and rarely lasts more than an hour. Extremely intense contractions are a sign of progress. The transition phase is the moment of the highest voltage, breaking which you begin the "descent". If you feel that you are no longer able to endure, it means that you have reached the end of the transition phase.
What a spouse can feel. A sudden change in the mood of a woman, and often not characteristic of her, can be a shock to a spouse who is not prepared for the difficulties of the transition phase. It is during this period of childbirth that many men take the usual feelings for childbirth as a sign of trouble and panic. A gentle touch can cause irritation: "Leave my hair alone!" Accusations: “It’s your fault” or “You are doing everything wrong” - can shock even the most devoted spouse. In the transition phase, it makes no sense to expect from a woman logic in words and deeds. A man should not take it personally. Of course, it is quite natural to feel fear, seeing that the giving birth to the wife is "not in herself". The feeling of helplessness from the fact that you cannot change anything can be considered just as natural. The transitional phase involves changes - changes that a woman has never experienced in her life and, perhaps, will never experience again. Even if she persecutes you, stay close - cheer and praise her, help to stay on. This is your chance to prove yourself from the best side. The pain of the transition phase will soon pass, and the memory of your support will remain for life.
What can you do. The transition phase is a period when even the most staunch supporter of a “pure” birth can ask for mercy. The request to administer painkillers is understandable and natural, but before you put your hand under the needle, think about this: the introduction of analgesics during the transition phase is not the best option for the child, because the peak of the drug may occur at the time of delivery and adversely affect on the breath of a newborn. We believe that by the time the pain medication is effective, the transition phase is already over, and the medicine will prevent you from fully participating in the stage of pushing the baby out. Remember: the feeling that you are no longer able to endure is a sign that you are ready for attempts. All of the above is true for epidural anesthesia. By the time the catheter is installed and the drug begins to act, you will be ready to push the baby out, and epidural anesthesia can turn into an obstruction from help. In most cases, it is desirable that by this time the action of epidural anesthesia is already over (or at least weakened) and the woman in labor could effectively push. Do not forget that during the transition phase, you may despair and be willing to accept any proposal that can alleviate your suffering.
The sounds that a woman in labor makes
Some women feel better with a scream, a long moan or a growl when the pain becomes very strong. These often uncontrollable sounds help reduce pain and can serve as a powerful means of mobilizing internal energy. You are free not to make a sound or scream - do something that will bring you relief. You should not be embarrassed or apologize for the sounds you make during childbirth. Just prepare your husband for the fact that during the birth you will make strange sounds - otherwise, he may misinterpret them, thinking that you are losing control of yourself, and try to take something to calm you. The muscles in your throat and mouth should be relaxed, as their tension can be transmitted to the muscles that are involved in childbirth. You are free to express your feelings in any way, but there are certain types of sounds that can make birth difficult. When a moan goes into a sharp cry, you may notice that the body tenses and resists the process of childbirth; in addition, with this scream you can scare yourself (as well as the women in the next room). Low lingering moans bring relief and strength.
To illustrate the energy that emotions give birth to, we recall the famous "growl" of tennis star Monica Seles, with which she enhanced her feed. In 1992, the organizers of the Wimbledon tournament forbade her to scream their blows, claiming that these were inappropriate sounds for the competition. Seles lost the tournament.
SECOND STAGE OF DELIVERY
The transition to the second stage of childbirth can be compared with reaching the finish line in a marathon. You may feel joy that it will all be over soon, as well as anxiety - will you have enough strength for the last stage. You are already on the verge of getting out of the race, but here you have new strengths and a second wind opens. You are relieved that the most difficult and painful part of childbirth is left behind, and joyful excitement is anticipated that you will soon pick up your baby. The cervix at this point has fully opened, and the baby is ready for the finish spurt - passing through the birth canal.
Second stage birth statistics
Contractions can last from sixty to ninety seconds at intervals of two to four minutes, stretching a little every three to four minutes after the start of the attempt. During prolonged labor, the intensity of uterine contractions may decrease. The average duration of the second stage in primiparous women is from one to one and a half hours; in women giving birth, it is much shorter. However, this time may be different. In some women, the second stage of labor lasts three or even four hours. Epidural anesthesia can also lengthen this stage, especially during the first vaginal birth, and the reason for this is the weakening or disappearance of the desire to push, which negatively affects the effectiveness of attempts.
In order to give the mother a chance to relax, between the full opening of the cervix and the beginning of the expulsion of the child, many women have a break in labor activity, called "peacetime". This pause, lasting from ten to twenty minutes, can be compared with a pit stop in car racing, which makes it possible to refuel the car before the last lap. Use this break to rest before the “finishing spurt." After a short rest, the woman in labor usually experiences a surge of enthusiasm and a surge of energy - something like a second wind before pushing the baby out.
The cervix at this point has already fully opened and erased, and therefore the sensations associated with this process disappear. In addition, if you are actively “working” with contractions and pushing (instead of “obeying” them, as in the previous stages of childbirth), you have the opportunity to “push out” the remaining unpleasant sensations. The nurse who helped with the birth of our first grandson taught our daughter-in-law effective attempts: "Get angry with the pain and squeeze through it." This helped Sherry imagine the attempts and understand that they are her ally in the fight against pain. She found that, "squeezing" through pain during attempts to push the baby out, the pain is weaker than when she tries to restrain them. During the first stage of labor, uterine contractions do almost all the work of lowering the baby. Your task is to submit to these fights, rely on the wisdom of the body and allow it to act in the most effective way. In the second stage of labor, uterine contractions still help give birth, but your other muscles must finish the job. The uterus seems to be telling them: "I lowered the baby for you, and now help push it out."
What women say about childbirth
Early and active phases
"Like strong menstrual contractions."
"Like severe pain from gas in the intestines." *
"A pulling sensation directly above the pubic bone."
“The lower back hurts so much that I didn’t even feel anything in the front.” *
“During the contractions, I literally bent in half from severe pain in the lower abdomen, and everything was in order between contractions. It was strange.” *
"Weak contractions - almost no pain."
"A wave starting in the upper part of the uterus and spreading down."
"An unpleasant but tolerable pain."
"I walked normally, and then the pain made me freeze, and my breath caught."
"Strong contractions extending from one pelvic bone to another." *
"Terrible pressure somewhere deep in the pelvis."
"I had to do my best to focus on deep breathing in order to maintain clarity of thought and cope with almost unbearable fights."
"As if someone was spreading my legs, tearing me apart." *
"I was sure my spine was breaking." *
"In the transition phase, I had only two fights, but they turned out to be incredibly strong. I was glad that after that I could push and at least do something with pain."
"About the same as strong contractions, but also pressure from a falling child."
“I didn’t get any respite. Pressure and pain didn’t disappear between contractions.” *
"Continuous pain - without beginning and end" *.
“No one told me that it would hurt so much.” *
"It was terrible - but I did it!"
"Wonderful - compared to the transition phase."
“It’s as if a tractor is trying to get out of you” *.
"Unbearable pain in the rectum" *.
"It seems like the strongest urge to go to the toilet."
"An irresistible, stunning sensation."
"I thought I'd explode, but it worked out."
"The most earthly sensation of all that I had to experience."
* These sensations can not be considered "normal", and they serve as a signal for action for a woman in labor - to change her position, use methods of relaxation and relieve unpleasant sensations.
Desire to push
After the cervix has fully opened, you can feel an irresistible urge to push. This is an involuntary reaction - you find that you begin to push in response to the fight, before you have time to realize it.
Women describe this as an “irresistible” and “overwhelming sensation”, “like a strong urge to go to the toilet”. Some express their feelings like this: “Miraculously - compared to the transition phase” or “The most earthly sensation of all that I have experienced.” The time of occurrence of this desire in different women may be different, and for some it does not appear at all. In part of women in labor, the urge to try is even before the cervix is fully opened. Premature attempts are not beneficial, and sometimes harmful - if the cervix does not give in to pressure. Your doctor or midwife will advise you to restrain your attempts by prolonged exhalation - as if you were blowing out a candle - and also take a knee-to-chest position to relieve pressure on the cervix. Pressure on the baby’s head against stubborn tissue can injure the cervix, causing swelling that will prevent it from opening further. However, if the attempts do not cause pain, then they, apparently, do not injure the cervix, and the doctor will allow you to obey the desire to push. However, it should be noted that the urge to try to open with less than 6 centimeters is extremely rare. If such a premature desire nevertheless arose and, despite all efforts, the cervix begins to swell and does not open, this is one of those cases when epidural anesthesia will bring undoubted benefit. Epidural anesthesia will suppress the urge to squeeze, allow the pelvic muscles to relax and reduce pressure on the cervix, as a result of which the edema subsides, and the opening of the cervix resumes.
The desire to push is as follows. As the baby’s head stretches the muscles of the vagina and pelvic floor, microscopic receptors of these tissues give signals that make you want to push, as well as increase the production of the hormone oxytocin, which stimulates contractions. These two reflexes, which make you push and instruct the uterus to contract, work together, and therefore their synchronization is very important. Why push? Contraction of the abdominal muscles and attempts to create pressure on the upper uterus, causing it to push the baby.
Here are some guidelines Marta followed during childbirth and experienced mothers told us about.
When to push. Push when you feel the desire, and not when you are ordered. Artificial attempts are an unreasonable waste of energy; natural attempts are more effective because you act in sync with the uterus while pushing the baby out. Push as soon as you feel an irresistible need to push. Sometimes this desire will be long and constant, and sometimes you will feel several such attacks during one fight. A call to attempts can arise at the very beginning of a fight, and sometimes as it intensifies. Listen to your body. Do not give in to the commands of your assistants: “Push, Push!”, “Stronger!”, “Hold your breath!”, “You will succeed - try!”. These best-motivated teams are counterproductive - they take strength away from the woman in childbirth and lead to perineal tears. These so-called guided attempts we inherited from those times when women in childbirth were motionless and were under the influence of drugs, not feeling a desire or not being able to properly push.
Nevertheless, controlled attempts may be necessary during childbirth, when a woman does not feel the urge to push - either due to the characteristics of the nervous system or due to the action of epidural anesthesia, which suppresses the natural reflex. In this case, the nurse or assistant will tell you when to push: “As soon as the fight begins” (you will feel this moment yourself, it will be shown by a fetal monitor or a palm pressed against your stomach), take a deep breath, tighten your abdominal muscles, relax your pelvic muscles and push five to six seconds, either holding his breath or exhaling slowly. Repeat these movements three or four times during the contractions and rest with the uterus. "If during guided attempts you feel that synchronization with contractions has broken, ask to weaken epidural anesthesia and take upright position.
If the birth is fast (this means that the baby is moving so fast that no effort is required on your part), it is best to lie on your side, while the assistant will lift and support your leg. Then you need to hold your breath or try to deeply and often breathe in order to restrain attempts and slow down the progress of the child - as much as possible in the given circumstances. In this case, a palm pressed to the crotch will help you. Rapid childbirth is most often observed in women who have already given birth to one or more children with a short stage of fetal expulsion. You will recognize this situation by a burning sensation in the perineum after the first attempts. Burning is a signal to stop pushing.
How to push. Push yourself to help push the baby out. There is no need (and this is harmful) to push "until the blue", "until the eyes come out of their sockets." No need to exert excessive effort. Short (from five to six seconds) and frequent (from three to four during one fight) attempts are less tiring for the mother and do not limit the supply of oxygen to the child. After five to six seconds of exhalation, exhale all the air from the lungs, and then take a new breath and push for another five or six seconds. At first glance, it seems that the voltage does not last long, but in fact this is not so - given the intensity of the load. If the doctor believes that at some point longer attempts are needed, he will warn you about it. However, in the majority you will manage your attempts. To avoid unnecessary stress, do not press your chin to your chest - but do not lean back too much so as not to bend your back and not strain your neck, as this will reduce effectiveness and increase pain in attempts.
Long, unnatural and untimely attempts are harmful not only to the mother, but also to the child. Long attempts, accompanied by a delay in breathing, not only tire the mother, but also limit the flow of oxygen to the child. Studies confirm the effectiveness of natural instincts, and therefore instructors for preparing for childbirth, doctors and midwives no longer recommend guided attempts, but encourage natural ones.
Short, frequent, instinctive attempts
• save the labor of a woman in labor;
• protect facial capillaries;
• increase uterine contractions;
• gently stretch perineal tissue;
• stabilize the biochemistry of maternal blood;
• provide the child with sufficient oxygen;
• reduce the likelihood of episiotomy.
Long, unnatural teamwork • tire a woman in labor;
• lead to rupture of capillaries on the face and eyeballs;
• may weaken contractions;
• may cause tension and rupture of perineal tissues;
• negatively affect the biochemistry of maternal blood;
• limit the flow of oxygen to the child;
• increase the likelihood of episiotomy.
The most convenient position for attempts. We have repeatedly noted that the most effective is the vertical position. Most mothers are pushing in a sitting position, but it’s worth considering the squatting position. In this case, the effectiveness of your efforts is maximum. If you are sitting on the bed during an attempt - this is the doctors' favorite pose, which provides them with a good overview - if possible, do not rely on the tailbone. Reliance on the coccyx often causes pain, and attempts in a sitting position are less effective. What is more important - a good review for the doctor or an easier delivery for you? If you are sitting, then with your weight you press the tailbone (which during childbirth should bend outward), thereby slightly reducing the aperture of the pelvis. The vertical position of the body removes this problem. In any case, try not to lie on your back - otherwise you will have to push the child up. If you want to speed up the delivery, squat down or on the toilet seat. This stimulates the desire to push, and also makes it possible to call for help gravity, which will pull the child down. If the contractions and discomfort increase faster than you have time to react, lie on your side to slow down the process a little. And do not forget to ask the anesthetist to turn off epidural anesthesia if you do not feel the urge to push and the child does not go outside.
Take your time. You may have the feeling that the medical staff is trying to expedite the second stage of labor. The reason for their concern is the outdated notion that the shorter the second stage of childbirth, the better for the baby. Obstetrician-gynecologists are afraid that prolonged squeezing in the birth canal will harm the baby, which may receive less oxygen between contractions; they believe that the fewer fights, the safer the "journey". However, recent research suggests that these concerns are groundless. With proper management and supervision, the second stage of labor does not pose a threat to the baby. Do not be alarmed if the frequency of the fetal monitor signals decreases during contractions - if the rhythm is restored after the end of the contractions. This is a normal and harmless slowdown in the heart of a child during labor.
Do not worry and trust your body. Some women in labor restrain attempts, because they are afraid of pain or strong pressure in the rectum. In both cases, it is necessary to relax the muscles of the pelvic floor. Warm compresses on the crotch help to relax. And don't worry about a possible chair. In the lower intestine, there may not be any feces if you made an enema in the early phase of labor or you had diarrhea that cleansed the intestines on the threshold of childbirth.But even if there are discharges from the rectum during attempts, the assistant will quickly remove them so that the baby is born clean. Even if you have the first birth, it is important to trust your body, which is created for childbirth and knows what needs to be done. After the baby is born, you will recall this process with admiration. Imagine how slowly and gracefully the petals of a tulip open. This is your body giving you a baby.
Protect the crotch. As the baby’s head goes down the birth canal, more attention should be paid to the perineum to prevent tissue rupture. The first few urges to catch you may take you by surprise, and you instinctively strain, instead of relaxing the muscles of the pelvic floor, and this will cause painful sensations. Having become accustomed to the urge, you will begin to relax the muscles of the pelvic floor during exertion (at that moment you will feel the benefit of Kegel exercises. See the section “Kegel Exercises”.). Think of opening, dissolving, relaxing. Spouse will help you relax, smoothing your frowning forehead, getting rid of pursed lips and gritted teeth, as well as cheering and reminding you about the birth of a baby. A bit of humor won't hurt either. This is the most suitable time for massage of the perineum (see section "Massage of the perineum"). Spare your crotch - do not lie on your back with legs fixed in special stirrups. The vertical position and the supine position reduce pressure on the perineum, provide maximum relaxation and stretching of the tissues, as well as accommodation of the child to the birth canal. In these provisions, the likelihood of episiotomy and rupture is reduced.
Teething baby head
The appearance of a wrinkled head is a joy to everyone present in the maternity ward. However, the child has yet to bend and pass under the bones of the pelvis. At the last stage, you can observe the following picture: during attempts, the child’s head appears, and after the end of the bout disappears to reappear during the next. As they say, two steps forward, one back. This gradual reciprocating movement of the child facilitates the stretching of the vaginal tissues, protecting the perineum from tears. After the baby’s head turns and is under the pubic bone, it can no longer be pulled back. The crotch will stick out more and more. You may want to reach out and touch the baby’s head - this is a normal and natural reflex, and a touch will help you gather strength for several final attempts, and will indicate that the long way of giving birth is coming to a happy ending. When the doctor or midwife announces: "The head has cut through," this means that your crotch is fully stretched and put on, like a crown, on the child’s head. You will feel a burning sensation that can scare you if you do not understand what is happening. (Try to grab the corners of the mouth and stretch it. Pay attention to the burning sensation. Strengthen this sensation many times and you will get what the woman in labor is feeling.) At this point, the doctor will advise you not to push hard to protect the cervix and perineum. It is better to carefully release the child. The pressure of the fully stretched perineum leads to numbness of the nerve endings of the skin, and the burning sensation disappears. After the teething head, it can go outside after the next fight. Let the baby decide the moment of his birth. Your doctor will remind you to refrain from trying. Burning is a signal to stop pushing. Listen carefully to the signals your body gives you, as well as the advice of a doctor or midwife. Before the teething ends, the doctor or midwife massages and gently stretches the perineal tissue (this technique is called “ironing”), and will also support them at the time of the birth of the baby,to prevent tears and avoid episiotomy. Perhaps you will feel at what moment the baby's head appeared. Now you can breathe a sigh of relief and imagine that in a few seconds you will hold in your hands a well-deserved reward - your baby. Then the child’s head turns - this is his shoulders around the pubic bone. Last efforts - and the child slips into the hands of an assistant.
Martha's remark. I liked to participate in the process of laying the baby on my stomach. I wrapped my arms around the baby’s chest after his arms were released. It is impossible to describe my feelings when I felt his body slip out of me and clasped my hands this precious little lump.
The doctor or midwife will suck the mucus out of the baby’s nose and mouth, cut the umbilical cord, and then put it on your stomach with your stomach so that you can hug it.
THIRD STAGE OF DELIVERY
The third stage of labor, the expulsion of the placenta, is usually short and easy compared with the first two stages. The expulsion of the placenta can last from five to thirty minutes - depending on how rushing your assistants are. A few minutes after the birth of the baby, the uterus begins to contract again, trying to get rid of the placenta. Some women feel these contractions as strong contractions. Others do not even notice what is happening.
A surge of maternal feelings from the sight and touch of the baby will enhance the production of the hormone oxytocin, which helps the uterus contract and complete its work. Oxytocin is also produced when the baby is breastfeeding. It is for this reason that you can feel uterine contractions during the first few days after giving birth while breastfeeding.
Despite the relative simplicity of the third stage of labor, there are two opposing methods for its management. With a physiological approach, a doctor or midwife allows nature to calmly do its job. The baby lies on the mother’s stomach about the level of the placenta, the umbilical cord is clamped and cut after it stops pulsating, and the hormones produced by the mother cause the uterus to contract, which pushes the placenta. If the expulsion of the placenta is too long, you can speed up the process with two intense attempts in the squatting position.
The opposite view of the third stage of childbirth is that nature, although it knows what to do, is too slow. In this case, the umbilical cord is pinched immediately after the birth of the baby, and the mother is injected with pitocin and ergot drugs to stimulate uterine contractions. Some women prefer vigorous action because they accelerate the third stage of labor. Some doctors present the case as if without their intervention and the introduction of pitocin, all women would bleed. However, for most women who have given birth without complications, there is no need for the mandatory introduction of this drug. Your body itself will do everything necessary, and you can help him if you give the baby a breast and allow him to suck as much as he wants. The upper part of the uterus, or the bottom (after giving birth it is at the level of the navel), will undergo intensive massage so that the uterus contracts and pushes the placenta. Then they will show you how to do uterine massage on your own, after the danger of bleeding disappears.
If you give birth in a hospital and did not inform in advance about your desire to participate in the decision on the management of the third stage of childbirth, then active actions will be taken automatically. As for the first two stages, intervention in the birth process is a compromise. With active management, there is a higher risk that fragments of the placenta will remain in the uterus, requiring subsequent removal, which is associated with the danger of infection.Active management does not mean haste - it would never occur to anyone to pull on the umbilical cord to remove the placenta, as this can cause bleeding, and fragments of the placenta will remain in the uterus.
The physical process of childbirth is over, but the memories of it and the well-deserved reward - your baby - will remain with you for life.
|Birth stage||Preparatory||First stage|
Early (hidden) phase
|Possible sensations||The instinct of "arrangement of the nest." Abbreviations of Braxton Hicks. The child descends into the pelvic area. Back pain, feeling of heaviness in the pelvic area. Frequent urination. Stomach upset. Menstrual contractions. Anxiety, shallow sleep. Weight loss. Vaginal discharge. Bloody issues.||Fights are slow, regular and do not cause much inconvenience. Mixed feelings - excitement and anxious expectation. "Started!" "As it will be?" "Can I handle it?" The desire to give birth at home. Bloody issues. Amniotic fluid leak or rupture of the fetal bladder (usually in the next phase). Feelings of pride and self-confidence; talkativeness and sociability; contractions every 5-30 minutes lasting 30-45 seconds, gradually intensifying, but bearable. You can do ordinary things.||Desire to be in a place chosen for childbirth. Emotions: "Oh, this is a serious matter!" Contractions intensify: they become more frequent, longer and more intense, require attention. Possible rupture of the fetal bladder - a stream of amniotic fluid. Back pain intensifies; contractions are felt throughout the body; pressure in the depths of the pelvis. Contractions are taken more seriously; the need for solitude and reflection; touchiness, irritability; withdrawal during fights and ignoring the environment. Contraction every 3-5 minutes lasting about 60 seconds; it is impossible to escape from them, and more powerful means of counteracting pain are required.|
|what can you do||Take a rest - the last stage is already close. Pack the things you need during childbirth. Finish everything. Switch to carbohydrate-rich foods for energy. Mentally prepare for childbirth; repeat the relaxation technique. Re-read the second and third parts of this book.||Wander around the house; take a bath or shower. Take a rest; try to sleep; reposition your body with cushions for comfort. Take a walk after relaxing. During fights: hug your spouse, lean against the wall, lean on a chair, get on all fours, lie on your side. Between contractions: rest lying on your side. Have a snack - often and little by little, drink more. Empty the bladder.|
Spouse: Take on the role of an errand boy. Be prepared to prepare a "nest" for the woman in labor or to take her to the hospital. Rub your back, do a massage,
cheer up. Call your doctor or midwife.
|During contractions: experiment with positions that help relieve pain. Get on your knees, squat down, hang, accept the position of "knees to chest". Between contractions: rest lying on your side or half-sitting. Sit on the toilet seat, take a bath or shower to relax. Place pillows underneath for your convenience. Use a variety of relaxation tools. Listen to the music. Drink water and have a snack. Empty the bladder. Breathe calmly. Ask for analgesia if necessary.|
Spouse: massage, psychological support, warm compresses on the back and / or lower abdomen.
|What is going on in your body||The cervix is partially erased and slightly opened (1-2 centimeters). Hormones prepare you for your birth: progesterone levels drop, estrogen, oxytocin and prostaglandins levels rise. Pelvic ligaments relax. The tissues of the walls of the vagina become more elastic.||The cervix is almost completely erased. The cervix opens halfway. The child’s head drops even lower into the pelvic area.||The cervix is completely erased.The baby's head drops even lower, bulging and tearing the fetal bladder. The release of endorphins.|
|How long can this go on||From a few hours to several weeks.||From several hours to two days (an average of 8 hours in primiparous women).||3-4 hours|
|How far can it go|
|1-2 centimeters of disclosure, partial erasure of the cervix.||50-90 percent of erasure, 2-5 centimeters of cervical dilatation.||100 percent erasure, 5-8 centimeters of cervical dilatation.|
|What happens in the birth canal||Bloody issues||Protrusion of the fetal bladder; cervical abrasion||Rupture of the fetal bladder; erasing is almost complete|
|Birth stage||Transition phase||The second stage of childbirth||Third stage of labor|
|Possible sensations||The shortest but most intense phase. Doubts: "I can not stand it"; confusion and confusion. Back pain, pressure in the intestines, flushing of heat and cold, trembling, nausea, vomiting, heartburn, pain in the hips. Irritability, hostility towards a spouse and assistants; indifference to the outside world. Need to scream and moan. Contractions with an interval of 1-3 minutes, lasting 60-90 seconds, intense, unbearable, with a double peak, unremitting.||Irresistible desire to push. Short break in the frequency and intensity of contractions. "Second wind" and a surge of strength. Pressure in the rectum and, possibly, the urge to defecate. Sensation of stretching and burning when the child’s head spreads the perineal tissue. Often the frequency (interval 3-5 minutes) and the intensity of contractions are reduced. The desire to reach out and touch the erupted child’s head.||The child completely captures your attention, and you may not notice the expulsion of the placenta. Spasmodic contractions of the uterus. Possible bleeding during separation of the placenta. Irresistible desire to take the child in her arms. Relieved that the birth is over.|
|what can you do||During fights: change position, finding the most convenient; squat down, kneel down, lean forward. Between fights, restore strength. Relax lying on your side; suck on ice cubes, swallow juice; meditate, try to calm down. Use visuals; focus on the short duration of the transition phase; Use the childbirth pool, bath or shower; imagine "disclosure", "relaxation", "submission". Listen to the music. Relax your pelvic muscles. Do not lie on your back. If necessary, slightly increase the dosage of drugs for epidural anesthesia or dropper. Spouse: demonstration of relaxation techniques, encouraging words, back pressure on the back. Offer drinks, recall that the transition phase is the most difficult, but at the same time the shortest.||Short and frequent attempts (3-5 per fight) are more effective than long ones. Do not hurry! Push when you feel the urge, not on command - without epidural anesthesia. Avoid excessive stress - long artificial attempts with breath holding. Have a rest between attempts. Imagine: “opening”, “relaxation” ... Experiment to find the most comfortable position: squatting, on your knees, on the toilet seat. Try to stop the anesthesia by the time you feel the urge to push. Refrain from trying while teething the baby's head - breathe deeply and often or slowly let the air out of the lungs.||Lay the baby on your stomach; press his cheek to his chest while the assistant covers him with a blanket. Let the baby begin to suckle - stimulation of the nipples increases the production of oxytocin, which helps to reduce the uterus, expel the placenta and stop bleeding. Massage the uterus so that it remains firm. Rejoice at the birth of your baby while your doctor or nurse is treating your crotch. Spouse: photographing and filming a replenished family. Rejoice at the child.Keep calm; dim the light; stay warm.|
|What is going on in your body||The cervix is fully revealed; the baby's head squeezes through the cervix and descends into the birth canal, starting to stretch the vagina and putting pressure on the spine, rectum and pelvic organs. The cervix is pulled over the baby’s head. The release of endorphins.||Spouse: remind about the need to relax the muscles of the pelvic floor; exclude “push harder” commands; remind you to touch the erupted head of the child; wipe your forehead, offer an ice cube, moisturize your lips, rub your back, help change your position. The perineal tissues are stretched, preparing for the passage of the child and starting the reflex of attempts. Oxytocin production. The child bends and turns to go through the birth canal. The baby's head is released; the assistant sucks the mucus from his mouth and nose, turns his shoulders and removes the newborn.||The uterus contracts, pushing the placenta and pinching blood vessels to stop the bleeding. The child is placed on the mother’s stomach, wiped dry and the umbilical cord is cut; then the baby is applied to the chest. Maternal hormones produced by the body help to reduce the uterus, stimulate milk production and strengthen communication with the newborn.|
|How long can this go on||15 minutes - 1 hour||½-3 hours||5-30 minutes|
|How far can the process go||Disclosure of the cervix 8-10 centimeters.||The cervix is completely erased and opened; the child advances through the birth canal.||The expulsion of the placenta.|
|What happens in the birth canal||Disclosure completed, stage of attempts||Birth of a child||Expulsion of the placenta|