Preparation for childbirth is a very complex and multi-stage process that starts in the body of a pregnant woman almost immediately after the onset of an "interesting situation". And it depends on how timely certain processes will take place when the birth begins. Basically, these processes are natural, which are regulated by the female body independently. But sometimes there is a need to stimulate labor.
Changes in the body
Childbirth is a very complex physiological process that requires all-round preparedness from the female body. In order for the birth to go well, and a healthy, full-term baby was born, the reproductive organs and the central nervous system must be ready for labor. A woman's uterus grows during the entire period of gestation, but in the third trimester, growth slows down and the accumulation of myocyte cells (of which the organ consists) of a special protein, actomyosin, begins. It is he who, when the time comes, will enable the uterus to contract rhythmically and intensively. These contractions will lead to the opening of the cervix during childbirth, which will open the way for the baby to exit from the mother's womb into our world.
The endocrine system must work in accordance with the gestational age, because by the end of the pregnancy, a sufficient amount of the hormone oxytocin must accumulate in the blood plasma of the expectant mother. It is he who excites the receptors of myocytes and makes the uterus begin to contract (this is how labor contractions begin). Before the onset of labor, the level of progesterone decreases, the level of estrogen and oxytocin increases.
If the hormonal background does not meet these requirements, labor does not begin.
The kid is trying to help his mother. In the last weeks, the stomach sinks, the baby is pressed by the head against the internal throat of the neck, pressing on it with the whole mass. This contributes to the gradual smoothing and shortening of the neck, which is considered an important indicator of the preparedness of the female body for childbirth. The cervical canal begins to produce some enzymes that gradually thin the membranes. It is important for the bubble to burst at the right time and release the amniotic fluid.
When all conditions are the same, natural childbirth begins. The neck gradually opens, and when the opening becomes full, attempts begin. As a result of attempts, the baby leaves the uterus, passes through the birth canal and is born. In the final stage of labor, the placenta is born.
Preparation for childbirth is very individual and depends on many factors, including the health status of the expectant mother, her age and the characteristics of the current pregnancy. You should not expect that labor will necessarily begin during the period specified in the PDD. The estimated date is only the end of the 40th obstetric week. And normal childbirth, in which there is nothing pathological, is considered to be childbirth that occurs from week 38 to week 42 on any day. During this period, there is no need to stimulate labor, if there is no special medical indication.
When is induction needed?
Stimulation of labor (induction of labor) are measures that are aimed at labor induction. Such methods are carried out only in a hospital, and only according to indications and under the supervision of doctors. When, to whom and why rhodostimulation should be performed, a special document explains - the clinical guidelines of the Ministry of Health of Russia. They, in particular, indicate that the basis for making a decision to stimulate a woman's labor activity is considered to be a gestation period of 42 full obstetric weeks of pregnancy.
Overturning harms the child, because the placenta after 42 weeks is already old, therefore, the baby lacks nutrients and oxygen. Until 42 weeks, the tactic of waiting prevails, and after that the time for active medical actions comes. But this is true only if a woman's pregnancy proceeds without complications, her condition and the condition of the baby does not raise any questions.
If not, induction of labor may be considered.
Induction is recommended if fetal distress is suspected. Stimulation is also indicated if women have chronic diseases that can complicate the last weeks of pregnancy - diabetes mellitus, glomerulonephritis, gestosis. Stimulation is also indicated if the child died in utero, but the expulsion of the fetus from the uterus does not begin. Medical indications also include Rh-conflict and any other complications of pregnancy that may threaten the life and health of a woman or child.
In some cases, stimulation is used for social and geographic reasons. For example, a woman lives at such a distant point from the nearest maternity hospital that she cannot get to it if labor begins at home. There are social indications if a pregnant woman ends up in a remand prison or a colony, in this case she is hospitalized and delivered with induction at 39-40 weeks of pregnancy, since it may also not be possible to send an inmate to a maternity hospital after the onset of labor on her own.
In every case the decision is made individually. But doctors must always take into account a very important point - it makes sense to stimulate labor only if when the risk from prolongation of pregnancy significantly exceeds the risk of stimulation.
Potential risks
To induce childbirth is always against the laws of nature, when actions are contrary to the natural course of events. And for this reason alone, induction is always associated with the risks of possible complications. The doctor tells about them in detail both to the woman in labor and to her relatives, if required. For stimulation, a woman must give written informed consent, otherwise labor will not be stimulated.
Can I refuse? Yes it is possible. But only after you carefully listen to what dangers the continuation of pregnancy can be associated with for you and your baby, as well as familiarize yourself with the list of possible risks during induction. In other words, the decision must be balanced, thoughtful. When you refuse stimulation recommended by your doctor, you must understand that from now on, you take on the entire burden of responsibility for the outcome of pregnancy.
Stimulation of labor is always unpredictable. Not a single doctor will tell you exactly how this or that remedy, this or that drug, technique will work on a particular woman.
Whether the effect will be the same as described in obstetric textbooks, too, no one can say in advance.
Common complications of stimulation include:
- an immature child is born, whose condition requires resuscitation (it is not always possible to draw accurate conclusions about the degree of lung maturity, the exact duration of pregnancy, and so on, according to ultrasound data);
- during stimulated labor, more often than during natural labor, there is a need for the use of surgical assistance (conducting an episiotomy, in an emergency caesarean section);
- childbirth, which was caused artificially, more often proceeds with abnormalities in labor - there is a weakness in the contractions, the cervix opens worse and longer, or, on the contrary, - the contractions are too intense, childbirth proceeds rapidly;
- in the fetus with stimulated labor more often than with natural, there are violations of vital signs - a pathological cardiotocogram occurs, ischemia, hypoxia occurs;
- after induction, the risk of uterine rupture, cervical rupture, vagina rupture increases;
- The risk of prolapse of the umbilical cord or parts of the baby's body from the uterus into the birth canal is assessed as high during induction of labor.
Contraindications are assessed without fail. These primarily include the lack of readiness of the cervix for childbirth. If it remains elongated, rigid in consistency, not ready to open, stimulation is not recommended. Do not induce childbirth even if there is an indication for a caesarean section.
Medical methods
If the cervix is not recognized as mature at 40-41 weeks (sometimes after 39 weeks), then the woman is recommended to go to the hospital so that doctors can contribute to her maturation. This can be done in several ways. The most commonly used drug preparation today. Hormonal agents (prostaglandins) in the form of a gel, ointments are injected into the vagina, inside the cervical canal. Under their action, the muscle tissue of the neck begins to soften, the neck prepares to open at an "accelerated" pace.
Mechanical stimulation is not as popular today as it was 10 years ago. But it is also used in some cases if, for example, there are contraindications to the use of hormonal agents. These methods include Foley catheter - a flexible latex tube with a balloon at the distal end. The doctor inserts a tube into the cervical canal inside the cervix, and the balloon is filled with saline. The enlarged balloon begins to press on the neck, mechanically expanding it.
The procedure has more disadvantages than advantages. The effectiveness of the method does not exceed 50% (that is, in half of the cases, the measure is useless), the installation of the catheter is painful and very unpleasant.
More effective are sticks from dried kelp seaweed. They are introduced into the cervical canal, where the dried algae gradually begins to swell with moisture, expanding the cervical canal. Kelp insertion is less painful than catheter insertion, but the effectiveness, according to doctors, is only slightly more than 54%.
For the purpose of complex action for the ripening of the cervix, doctors recommend candles "Buscopan", "Papaverine", "No-Shpa" technique. These are antispasmodics that have a relaxing effect on smooth muscles.
After the measures for the preparation of the cervix are successful, the main stage of stimulation begins. Most often in maternity hospitals, the induction method is used, when amniotomy is combined with the administration of oxytocin. First, a puncture of the fetal bladder is performed and, under the supervision of an obstetrician, water is released. They are carefully evaluated - how transparent they are, how many they are.
Nothing is done for three hours after the amniotomy. This time is often enough for independent contractions to begin, and this is the most preferable and favorable option.
If there are no contractions, then oxytocin is administered intravenously. Usually they put a dropper, but in modern perinatal centers and maternity hospitals, they often use a special device for infusion, with which it is easy to change the rate of administration, dosage, and so on.
The drug is also used for stimulation. "Mifepristone"... A woman takes pills only under the supervision of a doctor. In some cases, the drug is administered intravaginally.
Medication-assisted stimulation carries risks and therefore It is strictly forbidden to try to induce childbirth on your own at home.
Home use methods
The desire of women who are at a later date to give birth to their baby faster is understandable: it has become difficult to carry the baby, the woman is experiencing physical and emotional fatigue. But it should be remembered that self-activity to induce labor can be very harmful. Fortunately, there are very few truly effective folk methods of self-stimulation to speed up labor. Most of these tips are not proven to be effective, and labor doesn’t come any closer.
Each folk method has its own unconditional pros and cons.
Physical activity
This includes lifting weights and climbing stairs. Much has been said and written about the benefits of walking and exercise for pregnancy. Indeed, activity is a favorable basis. In active women, childbirth is easier, and postpartum recovery is faster. And already these two reasons are a good reason to walk, breathe air, and not lie on the couch in front of the TV in the later stages.
During adequate physical activity, blood circulation improves, muscles are maintained in good shape. But on the cervix or hormones, exercise or walking up the stairs does not particularly affect, and therefore the day of birth is not approaching. The problem is that some women reach fanaticism and their workloads in the later stages are not adequate.
The advice to jump, practice squats, lift weights, and move the closet from one room to another can be harmful. Inadequate exercise is a common cause of placental abruption, and this is a dangerous situation in which both the woman and the child are threatened with death. From inadequate physical activity, water can move ahead of time. If after that the contractions do not begin, you will have to urgently stimulate labor or do a cesarean section.
Permissible exercises include light exercises, which do not include exercises with bends, squats, and lifting dumbbells. You can do yoga or learn fitball. Homework is allowed, but feasible and not associated with excessive loads. And climbing stairs shouldn't be an ordeal. - if it is hard, there is shortness of breath, sweating, it is better to use an elevator to avoid possible heart rhythm disturbances and increased blood pressure.
With light exercise, the tissues are saturated with oxygen, which is more favorable for the baby and his expectant mother than exhausting physical tests.
Water treatments, hot bath and sauna
Water procedures also contribute to muscle tone, and in addition, they help to relax and reduce the unpleasant sensations that are almost always accompanied by late periods - tension and pain in the back go away, legs hurt less, appetite and sleep improve, and mood improves. But neither the pool nor the bath can in any way affect the endocrine and cellular processes of preparing a woman's body for labor.
Recommendations to take a steam bath or visit a sauna should be treated with caution.
The action of high temperatures in the third trimester of pregnancy is not encouraged, since the heat is dangerous for the expectant mother. In the bath, blood vessels expand, blood flow increases. For this, in fact, the bath itself is valued in folk medicine. But what is good for everyone may be bad for some, such as pregnant women. Increased blood flow can cause placental infarction, detachment, and severe bleeding. In a hot bath or hot bath, a surge in blood pressure may occur.
To keep yourself clean and fit in the later stages, a warm shower is quite enough, and it is better to refuse a bath, a sauna and a hot bathas the consequences can be tragic.
Bath, swimming pool, swimming in ponds are categorically contraindicated after the mucous plug begins to drain. The cervical canal is now open and no longer protects the internal cavity of the uterus from the penetration of viruses and bacteria. Neglect of this prohibition can lead to the development of intrauterine infection.For the same reasons, water procedures (with the exception of a vertical shower) are prohibited after the discharge of amniotic fluid or when it begins to leak.
When labor begins, a warm shower is also helpful. It helps to slightly reduce pain in the first stage of labor - during labor.
Nipple stimulation
A light massage of the nipples of the mammary glands is one of the most effective ways to speed up labor, if their delay is associated with insufficient levels of oxytocin in the body. Stimulation of the nipples contributes to its production, in addition, the woman prepares her breasts for the upcoming breastfeeding.
If childbirth is in no hurry to begin for reasons other than the endocrine background, then the effectiveness of the method will be very low, almost zero. But nipple stimulation with water-based breast treatments and rubbing with a hard towel is a great way to prepare the breasts for lactation, and therefore should not be neglected.
Sex
Active lovemaking can theoretically stimulate the maturation of the cervix. And all thanks to the composition of the semen - it contains prostaglandins, which relax the muscles and allow the neck to mature faster. And certainly muzherapy (as the method was dubbed among the people) positively affects the future dad and the child.
At the moment of orgasm, the blood flow to the uterus increases, the placenta begins to be saturated with blood more actively, the baby receives more oxygen and serotonin (the pleasure hormone is released into the mother's blood and is transmitted to the baby).
Unfortunately, the effectiveness of the method is low. There are not so many prostaglandins in the semen that the effect on the cervix is pronounced. Also there is a large list of contraindications, according to which intimate life and masturbation are prohibited at a later date.
So, it is not recommended to have sex life for women who carry twins or triplets, as well as for women with low placentation, cervical pathologies, genital infections. Sex is also contraindicated in women after the mucous plug comes off, as well as when water leaks, since sexual contact increases the likelihood of intrauterine infection of the baby.
Laxatives
Representatives of the older generation and numerous experts in traditional medicine often advise women to take laxatives in order to speed up the onset of labor. Most often it is advised to drink castor oil, do enemas.
In practice, this method has more disadvantages than advantages. Laxatives do not affect the approach of labor. Different hormonal substances are responsible for the contractions of the intestines and uterus. Neither an enema nor castor oil can stimulate labor. But you can stimulate dehydration, diarrhea, which is completely useless for a woman before giving birth.
Food, diet and folk recipes
Diet is useful for pregnant women at any time. But especially before giving birth. It is considered important not to overload the digestive organs, to prevent constipation. Therefore, they reduce the content of meat and milk, add more vegetables and fruits. Women are often advised to add dates and pineapples. These products, of course, do not directly bring labor activity closer, but contribute to soft and delicate digestion.
From 37-38 weeks it is recommended to drink tea with raspberry leaves, take evening primrose oil, black cumin oil (cumin oil). Herbs and essential oils can be not only useful, but also harmful, and therefore should not be consumed without the knowledge of the doctor. In addition, the effectiveness of folk methods is a very controversial issue.
The advice to use alcohol (red wine, champagne) as a stimulant is harmful and dangerous in all cases.
The well-known pediatrician Dr. Komarovsky (like most other doctors) advises be guided by common sense, and not try to give yourself injections, take dangerous poses, steam in the sauna. This does not help, but only increases the risks of an abnormal course of labor. And the main thing to take care of is the health and well-being of the unborn child.
