Preparation for childbirth
How does childbirth begin? True signs
Each pregnant woman with excitement and joy awaits the forthcoming birth. Let's talk about what a contraction is during childbirth?
Elizaveta Novoselova obstetrician-gynecologist, Moscow
Harbinger of birth is called external, really tangible for the future mother manifestations of those changes in the body, which are a direct preparation for the beginning of labor. It is necessary that the birth began on time, lasted not too little time and not too long, so that the process of opening the cervix, moving the fetus through the birth canal and its birth was minimally traumatic for the baby and his mother. For optimal achievement of these goals before the birth in the body of a pregnant woman there must be certain changes.
Tissue of the birth canal - cervix, vagina, vulva, perineum - should become sufficiently elastic, expandable, but at the same time - very strong and resistant to tears. The cervix should be located in the center of the vaginal vault, shortened almost twice with its usual length and significantly softened. The cervical canal - the lumen of the cervix, connecting the uterus cavity with the vagina - should be opened slightly and easily passable for two fingers of an adult person (as a result, the diameter of the cervical canal is approximately 2-2.5 cm). The head of the fetus should descend as low as possible and firmly press against the entrance to the small pelvis. Of course, such a significant "reorganization" will take more than a day!
What are precursors of childbirth?
For the preparation for childbirth in the body of the mother is responsible for female sex hormones. In fact, before the birth, the woman's hormonal background changes. During the previous nine months, progesterone, the hormone supporting pregnancy, "reigned supreme in the body of the future mother". He provided a normal tone of the uterus (relaxed muscles), the production of cervical mucus - a mucous plug in the cervix, protecting the fetus from infection. The normal development and growth of the fetus, the necessary concentration of nutrients and oxygen in the mother's blood, and also their timely and uninterrupted delivery to the baby, largely depended on the amount of progesterone during pregnancy.
Shortly before birth, the production of progesterone is markedly reduced, and estrogens are replaced by female sex hormones. This time, the increase in estrogen in the blood of a future mother is caused by the need to prepare her body for the forthcoming birth. After all, these hormones are responsible for the elasticity and patency of the birth canal. Dependence depends on them, and hence - the rate of opening of the cervix in the first stage of labor. In the second period, when the cervix has completely opened and the fetus passes through the birth canal, it is also very important how elastic and stretchy the vaginal walls are, which will largely determine the duration of the excruciating period. Finally, the very beginning of labor activity depends on the level of estrogens in the mother's body: contractions during labor arise as a result of a nerve impulse, which is caused by a certain level ("peak") of the accumulation of estrogens.
Before talking about each of these phenomena separately, we draw the reader's attention to several important points common to all harbingers of birth:
- All the phenomena discussed in this article are the norm. None of the precursors requires an unscheduled visit to the doctor, call for emergency medical care or hospitalization. Harbinger of birth - just a manifestation of planned adjustment in the body of the future mother, the "finishing touches" of preparation for the upcoming joyful event.
- The absence of predictive sensations closer to the expected date of birth is not a pathology. Not all future mothers mark the changes on the eve of birth, which are usually called precursors. This does not mean that someone does not prepare for childbirth. Simply "last preparations" sometimes pass absolutely imperceptibly for the pregnant woman. Thus, the subjective (that is, associated with the sensations of a pregnant woman) lack of precursors of childbirth should not cause excitement of the future mother and overtime appeal to specialists.
- The appearance of any of the predictive events indicates the probability of the development of regular labor in the next two hours - two weeks. Contrary to popular belief, none of the described feelings gives you a one hundred percent guarantee that within the next 24 hours you will become a mother. Hormonal restructuring before childbirth, thanks to which precursor phenomena appear, begins about two weeks before the expected delivery. Theoretically, during these two weeks, on any given day, at any time, a pregnant woman can observe certain changes in her state of health. Consequently, the absence of labor activity in an hour, a day and even a week after the first marked predictive events is not a pathology and does not require special consultation of a doctor.
Changes in the state of health of a future mother on the eve of delivery, requiring immediate medical attention:
- Scarlet discharge from the genital tract in any amount.
- Severe pain in the abdomen.
- The rise in blood pressure is higher than 130/80 mm Hg. Art.
- Body temperature rise above 37.5 ° С.
- The palpitation rate is more than 100 beats per minute.
- Severe headache, vomiting, impaired vision.
- Significant increase in edema.
- Absence, a sharp decrease, a sharp increase in fetal movements.
- Suspicion of leakage of amniotic fluid.
Decreased body weight. Shortly before the expected term of childbirth, the future mother can happily note a "slimming". Weight loss during this period of pregnancy is associated with the removal of excess fluid from the body, that is, a general decrease in edema. The more pronounced was the fluid retention during pregnancy, the more kilograms the pregnant woman will lose on the eve of childbirth. In the period of expectation of the baby in the body of all expectant mothers, water to a greater or lesser extent is retained. The culprit of this diuresis is progesterone, the hormone whose main function is the maintenance of pregnancy processes. Before childbirth, the effect of progesterone decreases, estrogens replace it. It is estrogens that remove excess fluid from the body of a pregnant woman. Since in this case, weight loss is associated with the elimination of edema, the first results will be felt on the hands, feet and legs. Usually the future mother pays attention to the facilitation of the process of shoes, putting on gloves and rings. Depending on the severity of swelling, weight loss before childbirth varies from 0.5 to 2.5 kg.
Relaxing the stool. The increase and change in the consistency of physiological dispatches on the eve of delivery is also associated with an increase in the level of estrogens and the elimination of fluid from the body of a future mother. Similar changes in the body of non-pregnant women are observed during menstruation. The stool can become frequent up to 2-3 times a day, at the same time some liquefaction of feces can be noted. More frequent urges for defecation, a sharp change in color and smell of feces, combined with nausea and vomiting is an occasion for consultation with a doctor - under such "harbingers" food poisoning can be masked!
Omission of the bottom of the uterus. At the philistine level, this phenomenon is called "abdominal depression". Shortly before childbirth the baby is pressed by the presenting part (most often it is the head) to the lower segment of the uterus and pulls it down, pressing against the entrance to the small pelvis. The fruit is "grouped" as an athlete before the start, taking the most advantageous position at the time of the start contractions during labor. As a result of such "preparations" from the fetus, the uterus "sags", and its upper part - the bottom - ceases to exert pressure on the internal organs. After the lowering of the uterine fundus, the pregnant woman has shortness of breath (it becomes easier to breathe, a feeling of full inspiration appears). If in the last month the expectant mother was burdened with eructations, heartburn, a feeling of heaviness in the stomach after eating, when the uterine fundus falls, these phenomena will disappear - they also were caused by pressure of the uterine fundus on the diaphragm and displacement of the organs of the upper part of the digestive tract. However, lowering down to the pelvic area, the uterus will exert more pressure on the internal organs located there. The organs of the small pelvis, in particular, is the bladder. It is located directly in front of the uterus, in its lower part. Behind the uterus, at a distance of a few centimeters, is the ampulla of the rectum - the exit part of the intestine. It is easy to guess what the result of pressure on the bladder and rectum: the urge to the toilet before childbirth can significantly increase.
Isolation of mucous plug. During pregnancy, the gland of the mucous membrane of the cervical canal (lumen of the cervix) is given a special secret. It is a thick, sticky, jelly-like mass that forms a kind of cork. Mucous plug completely fills the cervical canal, preventing the penetration of the bacterial flora from the vagina into the uterine cavity. Thus, cervical mucus, or mucous cork of the cervix, protects the fetus from an ascending infection. Before childbirth, when the cervix begins to soften under the action of estrogens, the cervical canal is slightly opened and the cervical mucus contained in it can stand out. In this case, the future mother can find on the underwear small clots of mucus yellowish-brownish color, transparent, jelly-like consistency, odorless. Mucous plug can stand out at the same time or go off in parts during the day. In the latter case, there is sometimes a slight discomfort in the form of "sipping" in the lower abdomen, reminiscent of the sensation before or during menstruation. However, most often the isolation of the mucous plug is not accompanied by any tangible changes in the state of health of the future mother. After the passage of the mucous plug is not recommended to visit the pool, swimming in water and in a bath. When immersed in water, it fills the vagina; Thus, in the absence of a mucous plug, the risk of infection of the fetus and membranes through the slightly open cervix of the uterus increases. Hygienic procedures during this period should be limited to a shower.
What is contraction at delivery?
Предвестниковые contractions during labor. Precursors, training or false refer to such fights that appear shortly before the birth and are not actually labor activity, since they do not lead to the opening of the cervix. The contraction is essentially a single contraction of the uterine wall; usually such a reduction lasts a few seconds. At the moment of the struggle, the future mother feels gradually increasing, and then gradually decreasing tension in the abdomen. If at that moment put your hand on your stomach, you can note that the stomach becomes very hard - "like a stone," but after the bout is completely relaxed and again becomes soft. In addition to the involuntary tension of the uterus, other changes in the state of health of the expectant mother during false bouts are usually not noted. Distinguish between training contractions during labor from the real is not difficult. In most cases, predictive fights are weak, painless, irregular, or alternating with a significant interval (30 or more minutes). "Generic" fights, on the contrary, are characterized by regularity and gradual increase in intensity. Unlike false bouts, real contractions lead to a visible result - an increase in the opening of the cervix. Therefore, in doubtful cases, you can see a doctor - a simple obstetric examination will be enough to make an accurate diagnosis. In other cases, training fights, like all forerunners, do not require a doctor or hospitalization. False contractions can be repeated for several hours without delivering any discomfort to the future mother, except, perhaps, unrest, and then cease. Most often such precursory phenomena disturb the pregnant woman in the evening and in the morning, may be for several days.
Discomfortable sensations. The last weeks before childbirth, many pregnant women note uncomfortable sensations in the lower abdomen and in the region of the sacrum (the area is somewhat lower than the waist). Such changes in the state of health of a future mother are caused by stretching of the pelvic ligaments and an increased inflow of blood to the pelvic organs. Usually these are insignificant sensations, described as a feeling of "easy languor" in the lower abdomen. These sensations of a tapering character are comparable with similar phenomena in the period before or during menstruation. Such sensations sometimes accompany the secretion of mucous plugs or false contractions, but may appear independently. Predictive discomfort, like training contractions during labor, more often disturbs the expectant mother in the morning and evening hours. Once again, we emphasize that the level of discomfort is minimal; he should not worry the future mother and does not require medical intervention.
So, all the predictive phenomena can appear during the last two weeks before delivery, their presence, as well as absence, is the norm and does not require a doctor. It is important to learn how to listen to the preparations of your body, not to be afraid of changes in your health associated with prenatal preparation, and most importantly - to have time to prepare morally and physically for the most important event - the birth of a baby.
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