There is, perhaps, nothing worse for pregnant women than the upcoming labor pains. They are expected and feared at the same time. They are credited with terrible pains, women in childbirth tell each other about them in gloomy tones. Are contractions so scary, what they can be, how to distinguish one species from another, how to behave in order to relieve pain and speed up the birth of the long-awaited toddler, we will tell in this article.
What it is?
Contractions are a word that came into medical terminology from the people. Women have long noticed that having a baby is accompanied by a feeling of compression and relaxation inside the abdomen. Having described this phenomenon with the verbs "grasps", "grabs", women gave rise to the official name of the beginning of active labor. The description stuck and was included in all textbooks on obstetrics.
A contraction is a tension in the muscles of the uterus. The body of the uterus is a smooth muscle, and its neck is round. The voltage can be synchronous, or it can be completely autonomous. Pregnant women usually have a lot of questions not only about labor contractions, which bring the moment of childbirth closer, but also other uterine contractions, which, according to reviews, can occur in the middle of pregnancy and before childbirth - at 37 weeks and later.
When contractions begin, it depends on their type, the number of births that a woman previously had, on her individual susceptibility to pain, on the child's readiness for his own birth, on a host of other factors and reasons. Let's take a look at what uterine cramps, called contractions, are.
Types and differences
Knowing the description of each type of uterine cramps, a woman can easily distinguish one from the other. It should be noted that not only primiparous women sometimes find it difficult to determine what is happening to them, but also those who already have generic experience, because with each subsequent pregnancy, the sensations can differ significantly. There are three types of uterine contractions that are not considered pathology and do not need treatment: false, precursor (preliminary) and true (generic).
Training
The female half of humanity owes the description of this phenomenon to the English doctor John Braxton-Hicks, who in the 19th century, while practicing in one of the London hospitals, observed and described them in women during pregnancy. In honor of him, false contractions were called Brexton-Hicks contractions, and women often simply call them "sweatshirts" or "braxtons".
Such contractions are short, episodic and very irregular, intermittent tension of the walls of the uterus. The woman simply feels that "her stomach is turning to stone." It happens suddenly. Likewise, tension spontaneously subsides. There is no need to talk about any intensity, regularity of repetition of false contractions.
This phenomenon defies logical explanation, therefore it is believed that such bouts of tension in the uterus are a kind of preparation of the female body for childbirth. Other experts believe that they are the result of overexcitation of the cerebral cortex inherent in pregnant women. Not everyone has such spasms, not always and at different times. It is noticed that during the first pregnancy, they can appear already in the middle of the gestation period, after the twentieth week. And in multiparous, training contractions of the muscles of the uterus are usually indicated only by the end of pregnancy, shortly before childbirth.
Such cuts look pretty harmless and, in fact, are completely harmless. They do not accelerate the onset of labor, do not affect the opening of the uterus, and do not interfere with the development of the fetus. And the discomfort that a woman can feel when the uterus suddenly comes to tone is easily eliminated: No-shpy pills, candles with papaverine, a warm shower, a leisurely walk in the fresh air, a change in body position, posture, calm and even breathing allow you to stop the spasm and return the muscles of the uterus to a relaxed state.
Forerunners
Such contractions of the uterus already have a well-founded origin: they symbolize the beginning of a woman's active preparation for childbirth. Most often, sipping sensations appear before childbirth, combined with episodic tension of the uterus. The nature of the discharge changes: they become more abundant. Sometimes, against the background of precursor contractions, a mucous plug leaves, which closed the cervical canal throughout the entire period of pregnancy.
Such contractions are more worthy of being called training contractions, since they really are a kind of rehearsal: the cervix begins to smooth out, soften. During the birth process, she will need to open from 0 to 11-12 centimeters, and therefore the tissue of this round muscle must prepare for this in advance.
The structural cells of the uterus, of which it consists, begin to accumulate a special protein substance - actomyosin. It will give the myocytes the ability to contract when labor begins. And the placenta and pituitary gland together begin to produce oxytocin, a hormone that triggers the process of uterine contraction.
The preparatory process in the body usually takes from several days to several weeks. If a woman is expecting her first child, precursor short-term contractions may appear a couple of weeks before childbirth. If the pregnancy is not the first, sometimes precursors occur immediately before the onset of childbirth and are often quite naturally regarded as prenatal.
Do I need to run to the doctor? Most likely not, unless there are other complaints. At a scheduled appointment, it is imperative to mention the appearance of precursors so that the doctor can assess the degree of maturity of the cervix. In addition to periodic cramps in the uterus and tingling sensations in her cervix, a woman may pay attention to other symptoms of approaching labor, which begin (but not always) shortly before the baby is born: diarrhea, insomnia, nausea, sometimes even vomiting after eating (the body "Cleared" before a responsible test), expressed anxiety, anxiety, mood swings. If the nausea is severe, you need to consult a doctor.
In other cases, you need to make sure that everything you need and useful is folded into a bag that you have to take with you to the maternity hospital, and be patient - there is very little left to wait.
Generic
Such fights are a real gift from nature to a woman. They cause the cervix to dilate. The process of its opening begins with the first true contraction, which is very important for the baby to be able to leave the uterine cavity in which he grew and developed during nine calendar months. A distinctive feature of such fights is clear order and consistency. They occur at a certain time and at intervals that are also approximately equal to each other. This is the main distinguishing feature of real fights from all others.
At first, the true contractions of the uterus are short and repeated infrequently, gradually the spasms become more protracted and prolonged, and the rest intervals between them become shorter. Throughout the contractions phase, the cervix gradually opens. The stronger the contractions at the end of the period, the greater the opening becomes.
Labor pains end after the disclosure becomes complete, the baby's head, under the pressure of the uterine walls, can pass through the cervix and the birth of the fetus begins.
The purpose of contractions is quite obvious: rhythmic contractions increase the pressure inside the uterus, which leads to the opening of the cervix, to the discharge of amniotic fluid, to the beginning of the expulsion of the baby.
It should be noted that only about 5% of children are born on the date indicated in the exchange card. All others appear either earlier or later than the estimated day of birth (PDD).
Real contractions will begin when the painstaking and multi-stage process of internal preparation (from the physiological level to the hormonal background) is completed - and not a day earlier. The preparation process is very individual. Exactly because of this reason women who become pregnant on the same day may give birth two weeks apart.
How do they start and how long do they last?
The beginning of labor is the moment that pregnant women are so afraid to miss. The obstetricians have a professional joke on this score, which says: "If you are in doubt whether you are giving birth, then you definitely do not give birth, since labor pains cannot be confused with others." Indeed, in addition to the fact that the real uterine contractions, indicating the start of the labor mechanism, have a certain temporal pattern, they differ in completely different sensations.
If the precursor and false episodes of tone are manifested only by stretching in the lower abdomen and a slight feeling of aches, then the true ones are more reminiscent of ebbs and flows: pain arises somewhere in the middle of the back, passes to the lower back, girdles, passes to the stomach. Then, in the reverse order, the uterus relaxes.
The onset of labor and its duration will largely depend on the type of pregnancy.
First birth
The expectant mother, expecting the appearance of the first child, needs to prepare for the fact that the period of contractions will be longer for her: the muscles of the uterus and birth canal do not differ in increased elasticity - the cervix opens more slowly.
As soon as a woman notices her cramping seizures and realizes that they occur every 30–40 minutes and last within 15–20 seconds each, we can safely say that labor has begun. These first contractions will be called latent, since labor has begun, but so far they are latent in nature.
This stage at the first birth can last up to 10 hours, until the cervix opens up to about 3-4 centimeters. The contractions themselves will grow very smoothly, gradually, they will become longer, the relaxation intervals between them will be shorter. Then the stage of active contractions will begin. The duration of the contractions will reach 50 seconds, and they will be repeated every 4-6 minutes. The uterus will open another 3-4 centimeters, and by the end of the stage, the dilation will already be about 7 centimeters. Active contractions should be more painful than latent ones, and this is quite natural. But this stage also lasts less than the previous one - from 3 to 5 hours.
The last stage of contractions is transitional. He is the borderline between contractions and struggles. It lasts from half an hour to an hour and a half during the first birth. The contractions are the longest: each one lasts about a minute, such spasms are repeated every 1-2 minutes. At the end of the period, the woman begins to feel a strong desire to visit the toilet in a big way. This symbolizes the beginning of the strenuous period, when the obstetrician will lead everything.
In total, the period of labor for the first time can take from 10 to 19 hours.
Second and subsequent childbirth
The peculiarity of repeated childbirth is that all processes (from preparation of the body to the expulsion of the fetus from the womb) last a little faster. After the first birth, the musculature of the uterus and cervix is not fully restored - it always remains a little more stretched and elastic than that of the firstborn giving birth. In addition, women already have an idea of the birth process, and therefore they panic less, rush and fear, which definitely contributes to a faster and less painful labor activity.
Latent contractions in such women can generally go unnoticed until they reach a certain intensity and strength. The entire first latent period of labor can take no more than 8 hours, after which active contractions begin, which usually last no more than 3 hours. The most painful transitional contractions during repeated childbirth do not last more than 30–45 minutes, and, according to doctors, most often the period lasts 15–20 minutes and immediately turns into attempts.
The total duration of the period of contractions for those giving birth again is on average 8–12 hours, and pain sensations, compared to the first birth, are significantly reduced.
In the hospital - when is it time?
Do I need to go to the maternity hospital with the onset of regular and repeated contractions? No, it is not necessary if the woman's condition is generally normal and there are no complications. Arriving too early at the maternity hospital will not benefit the woman in labor, because in the hospital ward it is much more difficult to maintain the Spartan calm necessary for an easy and almost painless birth.
Obstetricians recommend coming to the hospital when the cervix is 2–3 centimeters wide. It is clear that a woman cannot measure it on her own at home. Therefore, it is recommended to focus on the frequency of contractions. It is about this or approximately this opening of the cervix that contractions, which are repeated every 5-10 minutes, speak.
Primiparous women should come to the hospital when contractions are repeated every 5-10 minutes. Not for the first time giving birth should remember that their disclosure is faster, and therefore it is better to call an ambulance when the break between uterine spasms is 10-15 minutes.
You can catch the time of the interval (interval) using the most ordinary stopwatch, or you can use the achievement of science and technology - a contraction counter. This application can be installed on a smartphone completely free of charge. There are separate metering applications for different operating systems and platforms. If you suspect a contraction, you just need to press a button in the application and repeat this for several subsequent spasms. The program will help to calculate correctly not only the interval, but also the duration of each contraction, and will also choose the most suitable time for sending to the hospital.
When should a woman not detect, count and analyze anything in order to go to a maternity hospital? Only if medical attention is required immediately, urgently. These situations include:
- discharge of water (with contractions, against the background of spasms or without contractions);
- the appearance of bleeding (before contractions, during or without them);
- the beginning of contractions with an obstetric pessary established for cervical weakness or surgical sutures imposed on the cervix;
- normal initial contractions, but against the background of a general deterioration in health (unstable blood pressure, very dizzy, sweating, severe vomiting opened, the woman fainted, and so on).
From the moment the cyclical and rhythmic contractions of the uterus appear and before being sent to the hospital, try not to eat, drink a very limited amount of liquid, do not take any medications.
Possible complications
Childbirth that begins with the onset of contractions is the classic and preferred option. They are called ordinary, uncomplicated. In almost 85–90% of women in labor, labor begins precisely with uterine contractions. But you can never be sure that complications will not arise. These include premature or early discharge of amniotic fluid, untimely detachment of the "baby's place", as well as too weak contractions that do not lead to the opening of the neck at the pace at which it is necessary for the normal birth process.
Weakness of birth forces
They talk about such a phenomenon if regular contractions do not increase, do not lead to neck opening, or the spasms have stopped altogether. Depending on when this happened, primary and secondary weakness are distinguished.In the first case, we are talking directly about weak contractions, in the second - about weak attempts, when, with full disclosure, the expulsion of the fetus does not occur.
The cause of this complication in all cases is the hypotonia of the uterine muscles. It can develop due to hypoplasia of the reproductive organ, in the presence of fibroids or other neoplasms in the cavity or outside it, endometritis, congenital anomalies in the structure of the uterus. A large number of abortions in the past, the presence of scars on the uterus due to previous operations, treatment of erosion with cauterization in the past - all these are reasons to assume that a woman may develop primary weakness.
Imbalance of hormones (oxytocin and progesterone, estrogens), obesity in a woman in labor, gestosis, too young age or late first birth (after 36 years), the very fact of the first birth, post-term or premature pregnancy, large fetus, pregnancy against the background of polyhydramnios - all this increases the likelihood that the contractions will not be strong enough or the labor will suddenly stop.
Separately, doctors distinguish psychogenic primary weakness. With a normal state of health, good tests and the absence of pathologies of pregnancy, a woman, for inexplicable reasons, does not have a normal contraction of the uterus, and childbirth does not develop. Experts are inclined to believe that this happens in women who are terrified of childbirth, and therefore, at the psychosomatic level, they themselves unconsciously “inhibit” their own childbirth.
Psychogenic weakness occurs in women in labor who do not want to give birth (the child is unwanted, unnecessary, the woman became a victim of rape and became pregnant, abandoned her husband, and so on).
Without the help of doctors, a woman cannot cope with the weakness of labor. The risk is that the child and mother may die, the baby may experience irreversible changes in the cerebral cortex due to hypoxia, and a systemic infection may also begin. If the contractions are weak, the doctors will do everything to strengthen them: they will inject a dose of oxytocin, puncture the fetal bladder, if the water has not left on its own, they will stimulate childbirth.
But in the absence of an effect, there will be only one way out - an emergency caesarean section. With secondary weakness, there is always one way out - surgical delivery in an emergency.
Anhydrous childbirth
Every tenth woman is faced with premature rupture of amniotic fluid. The role of waters for a baby is difficult to overestimate: they protect him from infections, shock, acting as a shock absorber. The anhydrous period is a period of risk for the crumbs: it is threatened by numerous bacteria, viruses, fungi that can penetrate the cervical canal, as well as acute oxygen deficiency with a long stay without amniotic fluid.
Most often, the cause of premature discharge of water before the development of contractions is infections of the mother's genital tract, as well as infectious diseases that she suffered during the period of gestation of her baby. Also, provoking factors include a clinically narrow pelvis, improper placement of the baby in the uterine cavity, isthmic-cervical insufficiency, careless rough sexual intercourse shortly before childbirth, multiple pregnancy, severe anemia, preeclampsia and bad habits of a woman with whom she did not want to part during pregnancy , obesity. Falls, abdominal injuries can also cause water to drain ahead of schedule.
If the waters have receded in the period from 29 to 37 weeks of pregnancy, contractions usually begin within a day, but only in half of the women in labor. For the rest, a week may pass before the onset of labor, which needs to be spent under the supervision of doctors. If the amniotic fluid is poured out from week 38, then after 12 hours full-fledged contractions can start in 50% of cases, in the rest, independent labor can begin after 72 hours.
If it turns out that in the day after the passage of water, labor has not begun with a full-term pregnancy, labor is stimulated with medication. Often, the decision to stimulate is made within 6-9 hours after the spontaneous outpouring of water. If there is no result, a caesarean section is done. When the pregnancy is premature, an individual decision can be made to extend it. Doctors will try to give the baby as much time as possible to mature.
Placental abruption
Normally, the placenta should exfoliate and come out after the baby is born, in the so-called successive stage of labor, which is the final stage. But at any stage of contractions or attempts, detachment may occur, which will manifest itself with severe bleeding from the genitals, as well as a change in the condition of the fetus (now you understand why CTG sensors are attached to the abdomen during childbirth).
This complication is considered the most dangerous. A woman can lose a lot of blood, a child can die from acute severe oxygen deficiency and remain disabled due to total changes in the brain and central nervous system caused by hypoxia. Therefore, there are few options - Doctors perform a cesarean section right away.
The sooner a woman is operated on, the more chances of saving the life of both the mother and the fetus are.
How to reduce pain?
The mechanism of the onset of labor pain is largely still not fully understood. But if we take into account that the uterus itself does not possess nervous sensitivity, then the opinion of many experts that pain does not arise in the uterus, but exclusively in the head, looks quite logical: under the influence of increased excitation of the receptors, the pain center is activated. This process is influenced by fears, severe stress, the expectation of something terrible and terrible. In medicine, such pains are called corticogenic.
Since the cause of pain is in the mechanisms of the brain, it is quite possible to avoid it. This statement is the basis for almost all methods of painless childbirth, many of which are used in modern maternity hospitals.
The mastering of some techniques that have received worldwide recognition will help facilitate contractions. So, the delivery technique "According to Lamaze" is a complex method that was described by the French obstetrician Fernand Lamaze in the middle of the last century. It includes breathing exercises, which must be used during contractions, exercises to improve muscle tone, yoga, aromatherapy, meditation, methods of hot and cold contrasting compresses during labor, as well as exercises on fitball during contractions.
The use of knowledge of the Lamaze technique during severe contractions allows to coordinate the work of the cortical and subcortical areas of the cerebral cortex, which can significantly reduce pain or avoid it altogether.
The method of "Hypnotic childbirth", developed by Soviet scientists Platonov, Vel'vovsky, Bekhterev, and also supplemented by Professor Lurie, involves the creation of correct attitudes in the head (from where, as we found out, the main birth pain comes from) of a pregnant woman. Word therapy in the prenatal period allows you to minimize labor pains, to eliminate pathological fear and horror in a woman about the process of giving birth to a baby.
The program, which is based on the development of Soviet scientists, is called "Childbirth without pain and fear." Today, it is carried out by psychotherapists and hypnologists in medical centers, and therefore all pregnant women who wish can visit a psychotherapist about a month before childbirth.
Breath
A woman can learn how to breathe correctly during contractions and struggles in the antenatal clinic at free classes at the school of expectant mothers. Most often, future women in labor are taught the Kobas breathing method. The technique is named after the obstetrician Alexander Cobos, who was a big fan of the scientific work of Fernand Lamaze, whom we talked about above.
The Kobas breathing system is based on oxygen saturation of the body and a certain relaxation in various stages of labor pains. When oxygenated, the body begins to produce endorphins, which have an analgesic effect, and the ability to relax certain muscle groups relieves the intensity of pain at the physical level.
During the first contractions and the entire latent period, Alexander Kobas recommends breathing deeply, breathing in slowly and exhaling even more slowly. Active contractions, according to this technique, you need to quickly "breathe", using exercises of short and abrupt breathing ("Locomotive", "Dog", "Candle"). Short repeated exhalations are recommended only at the peak of the spasm; between contractions, breathing remains deep and calm for a long time so that the baby does not experience oxygen deficiency, and the mother's body continues to produce a unique pain reliever - endorphins.
Breathing correctly will help you relax when you need it most, and mobilize strength when the situation calls for it. When pushing, using Kobas breathing, the woman will concentrate inhalation in the chest, and the tension during pushing - at the bottom. This will save you from tears, birth trauma, and help your baby to be born faster.
Poses
Poses that will help a woman get through the period of labor more easily can be both for a "single program" and for joint childbirth, in which the partner of the woman in labor will be assigned a special role of an assistant, and not an outside observer.
It has long been proven and many methods of natural pain relief of childbirth have described that a horizontal position for a woman with contractions is not the best. Yes, it is convenient, but only for obstetricians. It will be much easier for the woman in labor to endure uterine cramps while standing, sitting on the ball, standing on all fours.
The best, according to women, are the "cat pose" and the upright stance. In the first case, during the fight, the woman stands in the knee-elbow position and slightly bends her back in the lower back, not forgetting about correct breathing. In the second case, she stands with support on the wall, headboard of the bed or chair, on a partner, on which, moreover, you can hang if you grab the neck with your hands.
Poses that can facilitate childbirth, as well as the technique of vertical childbirth (when not only contractions, but also attempts do not take place in a horizontal position), can also be taught in courses for pregnant women.
Massage
To improve blood circulation, relieve pain, massage or self-massage of a special zone, which is experiencing special stress during childbirth, helps. This place is the sacrum zone, or the so-called Michaelis Rhombus. It is located in the very center of the lower back, perpendicular to the coccyx. You can make the contractions less painful by rubbing this area, turning the cams - this is a minimum program.
It's good if there is someone nearby who can add to such techniques a light relaxing massage of the back and shoulder girdle between contractions.
Medication
You should not be afraid of contractions already for the reason that doctors are always ready to help the woman in labor. If the techniques and exercises are unfamiliar to her or the effect of pain relief was not achieved, the woman can count on epidural anesthesia from the period of active contractions.
A dose of anesthetic is injected into the epidural space of the spine. The puncture is made in the space between the lumbar vertebrae. The procedure is performed by an experienced anesthesiologist, and the injection itself is practically not felt. After it, the sensitivity of the lower part decreases, contractions occur (they cannot be controlled), but the woman's sensations are dull, smoothed. At the same time, she does not lose the ability to walk, sit, because such anesthesia differs from epidural anesthesia in a lower dose of drugs and the absence of muscle relaxants in the injected mixture.
A woman can ask to anesthetize contractions at any time when it becomes difficult to endure. But you need to be prepared for refusal, because lumbar punctures have their own contraindications. Also, the "epidural" can not count on women in labor with signs of birth weakness, since the contractions can weaken completely.
Can I call it myself?
Women who are tired of carrying a baby, who are in the last days of pregnancy or are overweight, are often interested in how they can provoke labor pains and the onset of labor. Doctors strongly advise against doing this, since contractions always begin in a timely manner, when the woman's body and the child are ready for this.
Folk advice such as sex to stimulate labor, foods to eat for delivery (caraway seed oil, for example), advice to do more homework and “work up labor” as a result, can be dangerous. So, sex is prohibited after the mucous plug comes off and the outpouring of water, as well as when the neck begins to open. Foods have no pronounced effect on childbirth, and physical activity can lead to drainage of water or placental abruption. Also, do not try to increase the dilatation of the cervix or contractions with medications.
The best thing is to be patient and wait for the baby to ask for the light himself. Even if the contractions do not begin at 42 weeks of pregnancy, they will be stimulated in completely different ways - medication, and this will be done under vigilant medical supervision in the hospital.
Fear of labor pains greatly complicates the task of a woman in labor. There is nothing to be afraid of: nature has awarded a woman with a sufficient supply of strength and wisdom to survive the contractions, to behave correctly, and doctors are always ready to help the baby to be born. Trust yourself and the doctor.
For how the contractions begin before childbirth, see the next video.
