Pregnancy is one of the most wonderful periods in life. Nine months of waiting, joy, preparing a dowry for a newborn. But at the same time you have to sacrifice something, plus anxiety and uncertainty. All this will soon move into a new dimension. Your baby will be born and you will be able to touch him, cuddle him and feed him. However, first of all, you need to give birth to him, and for this you will have to make a lot of effort. However, there is no need to worry in advance. Remember that millions of women before you have gone through this process, and you can do it too.
The birth process is divided into three stages:
- Stage I - from the onset of contractions until the cervix is fully dilated by 10 cm.
- Stage II - birth of the child.
- Stage III - removal of the placenta, i.e. placenta, umbilical cord and fetal membranes.
Preparing for the birth of a child
2-3 weeks before giving birth, your stomach drops significantly. The baby prepares himself for exit by pointing his head towards the birth canal. It will become easier for you to breathe, but your visits to the toilet will become more frequent. At this time, many women feel a strong instinct to prepare a place for the baby. They enjoy decorating their children's room and dreaming about the future. Concentrating on the upcoming birth often causes mild euphoria or irritability. During this period, difficulties arise when performing intellectual work. That is, this is not the best time to defend a doctoral dissertation. You need to focus on your body and the signals it sends.
Remember: Once a day, in a horizontal position, count the baby’s movements: there should be at least 10 of them per hour. Remember that the baby can also sleep and rest, so choose a time when you know for sure that he is active.
First stage of labor
In the case of the first-born, the chances that the birth will take place on the way to the hospital are close to zero. The same goes for other children. After all, now you are an experienced mother who knows what to do and can recognize the signals of her body. Remember that the given time limit is actually an estimate. The child has his own path and will be born when he is ready. In general, the absolute norm is to give birth within two weeks before or two weeks after your due date. How to recognize the approach of labor?
- One of the symptoms is the appearance of a large amount of gelatinous brown, pink or red mucus in your underwear, that is, a mucus plug that covers the cervix.
- Discharge of water - water may pour out immediately, or it may leak in small quantities. Most women go into labor within 72 hours of their water breaking.
- You may experience nausea, diarrhea, or chills.
- Back pain, aching and pulling, is also possible, as during menstruation.
- Contractions intensify with changes in position, become regular, their frequency and intensity increase, and they last more than 30 seconds.
Remember that all women have different bodies. You may not experience all of the above symptoms, or all of the symptoms at the same time.
The birth is over - what next?
Congratulations to mom and her baby! After the placenta has left the uterus, you will feel that your stomach has become hard: this is the uterus contracting. The doctor will check to make sure she remains in this position. This is important so that the blood vessels that connect the placenta and uterus can narrow and the bleeding stops.
- The doctor will check to see if all of the placenta has been delivered and will do an exam to make sure there are no stitches needed in the perineum. If necessary, you will be given local anesthesia. If you had an epidural, the anesthesiologist will come to you to remove the catheter from your back. It takes one second and doesn't hurt at all.
- If you are planning to breastfeed, now is the time to make your first try. True, both you and your baby should be prepared for this. Not all newborns have this desire in the first minutes after birth, but try holding the baby at the nipple. Most babies begin to breastfeed within the first hour after birth. Breastfeeding early helps your newborn, and it's good for mom, too: Breastfeeding releases oxytocin, the same hormone that causes contractions and now helps your uterus stay in a contracted position. If this does not happen, the doctor will give you oxytocin and everything will work out in any case.
- At this time, contractions continue, but almost imperceptibly. If this is your first baby, you may only feel a few contractions. If you already have children, then contractions may continue from time to time for 1 to 2 days. They feel like menstrual pain, and if it is too severe, ask your doctor for a safe pain reliever. You may feel weak or chilly - this is completely normal and will pass soon.
If the birth went without problems and the baby does not need special care, ask the doctor to leave you with the child, now is your time!
The onset of contractions - the first symptoms
The appearance of contractions does not mean that you need to immediately go to the hospital. From the moment of contractions to the full dilatation of the cervix (10 cm) it takes about 12 hours, in the case of repeated births - a little less. It is best to spend this time at home, rest and relax. They go to the maternity hospital when:
- The contractions have become very strong and are repeated at intervals of less than 5-7 minutes.
- The waters have completely receded. Go to the hospital immediately if the water is greenish, which means the baby has passed meconium. The cause may be stress, often caused by fetal hypoxia or inflammation of the genital tract.
How a doula is useful
We have already talked about how a doula can help you cope with emotions during childbirth. This is the name of an assistant who prepares a woman for the birth of a child (sometimes even before conception), accompanies her during childbirth and helps to establish contact with the baby immediately after his birth. Being a doula is a job that requires first of all a calling, and then special training and preparation. Doula schools in different countries are united into a community: they share knowledge, hold meetings and conferences, celebrate International Doula Day and train “newbies.”
And although this profession has existed as long as humanity itself, the current doula movement arose in response to the needs of modern urban women. After all, unfortunately, the process of childbirth in urban conditions is depersonalized.
A doula may not have a medical education (having her own children is also not necessary), since she does not interfere in the birth process itself and does not bring her own experience into the woman’s personal process.
How a doula can help you
- Provide information support. A woman knows at any moment what is happening to her, what stage of the process she is at, what is next, how to prepare for it.
- Support emotionally. During childbirth, it’s easy to get scared and wilt, but the assistant “pours” strength and enthusiasm into the woman giving birth, shares her emotions with her and shares her confidence.
- Ensure that the woman's wishes are respected. If a woman was preparing for a specific birth plan and wanted, for example, to do without stimulation and pain relief, these intentions can be easily forgotten under the pressure of specialists in the clinic. At this moment, the doula can “share” her persistence with the expectant mother and act as her representative in negotiations with doctors, so that they treat the wishes of the woman in labor with greater respect. If a mother wants the baby to be placed on her stomach, to wait until the umbilical cord pulsates, to allow her to put the baby to her breast and stay with him as long as necessary, a doula will come to the rescue. At this moment, the mother may not have enough of her own strength to insist on her own, and the doula reminds her and the doctors that there is no need to rush.
- Take care of the woman. Each doula has her own repertoire of ways to relieve labor pain and cope with contractions and pushing. Some use massage, some use aromatherapy, some “sing” the contractions along with the woman. In addition, there are many movement and breathing techniques that make childbirth somewhat easier. Doulas help women manage labor pain naturally, infusing the process with joy, anticipation, curiosity, and confidence.
Doulas are not doctors, and they do not assist in childbirth themselves. But any of them has the appropriate equipment and is ready to step in if for some reason the doctors don’t have time.
What to expect at the maternity hospital?
Find out in advance the rules adopted in the maternity hospital of your choice. The first stage of labor can be very difficult because it takes a long time. The situation changes extremely slowly, and contractions are quite painful. However, there are ways to reduce discomfort. You may have read or learned about them in a childbirth class.
Find out if you can shower, eat and drink in the maternity hospital and if they have exercise balls. There's no way to know in advance what might ease the pain of this difficult time, so it's good to have several options. You can also ask for a pain-relieving injection. An injection is possible if the cervix is dilated from 2-3 cm to 7-8 cm. However, before resorting to pharmacological methods, try to relieve pain naturally (massage, breathing exercises, changing positions, walking, taking a bath or warm shower).
Don't forget to take your medical documents, insurance policy and passport with you. The maternity hospital can conduct a detailed medical examination, gynecological examination and fetal cardiotocography to monitor the child’s condition.
If contractions do not develop and the cervix does not dilate, your doctor may order oxytocin. This hormone stimulates the start and end of contractions. It is also released in the body during orgasm and when cuddling or breastfeeding a baby. After labor is completed, the uterus begins to contract.
Birth story: “I had no idea what awaited me”
In my opinion, my pregnancy was easy, good and quite safe. I felt great and continued to work without reducing my usual workload. In the evenings, my husband and I tried to go for a walk every day. In general, I tried not to sit still and moved all the time. Despite the fact that pregnant women are usually very anxious, I, on the contrary, felt very calm. I did not experience tearfulness, irritability and mood swings, which are attributed to almost all expectant mothers without exception. I didn’t torment my husband with my whims at all; I was an exemplary wife. On the contrary, I wanted to take care of him even more, feed him more deliciously and be around him more often, because I understood that soon, when our long-awaited baby was born, I would no longer be able to devote so much time to him. And she tried to surround him with tenderness and attention, as if in reserve.
I myself thought that everything was going just fine, but the doctors did not really agree with me. I regularly received referrals to various specialists, since the obstetrician-gynecologist who took care of my pregnancy believed that I had many health problems. Fortunately, this had virtually no effect on my well-being. With the exception of high blood pressure, which I had before pregnancy, and while expecting the baby also made itself felt. It was because of him that I had to go to the maternity hospital in advance.
The onset of labor: not without problems
The last ultrasound revealed problems. They told me so many things: fetoplacental insufficiency, aging placenta, preeclampsia, gestosis, fetal growth restriction, fibroids... The doctor immediately called an ambulance, and I was hospitalized in the prenatal department. It turned out that I ended up in the maternity hospital at 38 weeks of pregnancy. I thought that I would lie down for a while, they would treat me and I would quickly return home and calmly wait for the birth. It was already a bit difficult for me, everything became uncomfortable: it was difficult not only to walk, climb stairs, but also to just lie down and sit. Everything pressed and caused great discomfort. I managed to take courses on preparing for childbirth, read a lot on this topic and was mentally prepared for different scenarios. However, I couldn’t even think about how the situation would turn out... It so happened that I never knew what training contractions were, how the mucus plug came out, and the first stage of labor passed me by... This is how it happens in life: you plan one thing, but completely different tests are given.
Childbirth: an unexpected turn of events
In the prenatal department, they took tests from me, examined me by a doctor, and suddenly I heard an unexpected verdict: “We will prepare for childbirth!” To be honest, I was in a state of shock; I never expected that I would not be allowed back home, and that I would return there not alone, but with my baby. By the time I was admitted to the maternity hospital, we had already chosen the doctor who would deliver the baby and signed a contract with her. When my doctor came to my room, she didn’t like my appearance at all. I took medications to lower my blood pressure and was also given IV drips, but all these measures did not help very well, and my blood pressure was in no hurry to decrease. I was in a sleepy state almost all the time, and I still looked the same. The doctor said the operation was scheduled for Wednesday. And then it began to dawn on me that we were talking about a caesarean section.
The fact is that I have vision problems - severe myopia. At the beginning of the pregnancy, the issue of a caesarean section was discussed, but then they decided that it was possible to do without surgery, they wrote in the chart “shortening the period of pushing,” that is, they would have to do an episiotomy.
It turned out that in four days I would no longer be pregnant and would see my son.
By that time he weighed a little more than 2 kg, although it was a symmetrical delay. After visiting the chief physician on Monday, the situation began to change again. She suddenly asked me: “Perhaps you can try to give birth yourself?” I was sent for an examination and it was concluded that the cervix was very promising, that there was already a dilation of 2 cm and that in the evening I would be given a drug to help (Mifepristone). The fetal condition was considered stable.
On Wednesday, around 12 noon, my water broke. I was lying down, so it would be logical for the water to flow in and not rush out, as was the case in my case. I think this was the starting point for my sudden onset of labor.
I went to look for a doctor. It was a young doctor, and he said he didn't see anything special. Then I attributed this mistake to his inexperience. After the examination, contractions began. They were painful, but quite tolerable. I knew something was going on and decided to call my doctor. I went to see the midwives and they sent me for a CTG. It’s very strange, but the CTG showed no contractions, but I felt them every 5 minutes! I wrote down the time on a piece of paper. The doctor on the CTG said that I was not giving birth, that there were no contractions, although I even moaned in pain. After the CTG, the midwife gave me a padding diaper and asked me to walk around the corridor with it to make sure that the water had really leaked.
I started wandering along the corridor, it was very painful, periodically I stopped and leaned on the wall, moaning. At some point I thought I had run out of strength. But now I understand that I could have endured it longer.
At 16:00 my doctor came and we went for an examination. Finally, my birth was recognized as valid. While they were doing the enema and filling out the documents for the maternity unit, I became completely unbearable.
In the maternity ward, an anesthesiologist came to see me, we talked, then they gave me epidural anesthesia, and almost immediately I felt like I really wanted to go to the toilet. My doctor came running and after examining me, I was stunned that my head was coming out.
The anesthesiologist lamented why he was bothering with administering the medicine... The situation was a little comical. They transported me and put me on a chair.
I already felt the pushing, and during the next pushing they made an incision in my perineum. Then I heard a scream. My baby screamed almost immediately after being born. He announced himself loudly and very shrilly. They put him on my stomach, I hugged the small, warm and so familiar little lump, and my heart ached with endless tenderness... I couldn’t resist and burst into tears from the surging feelings.
In conclusion, I would like to say that I completely trusted the doctor and obstetrician, I was confident in them. The midwife helped during the entire birth, telling me how to breathe correctly. Then I pushed and the placenta came out, the doctor examined it carefully, and the neonatologist examined my baby from all sides: 8/9 Apgar, 2500 g, 48 cm. My son turned out to be so tiny.
The most painful thing was when they stitched me up: for some reason it was almost unbearable to endure. It seemed that this was the most painful manipulation during the entire period of childbirth. I would never have thought that I would be left with such impressions from the final and seemingly such a simple procedure.
When I had a little rest, I wanted to tell everyone the good news, and I called my husband, mother and sister. There was so much surprise and delight because I didn’t tell them about the upcoming caesarean section so that they wouldn’t worry while they were operating on me. Of course, everyone was shocked that everything happened so unexpectedly.
My labor was quite fast - I was in labor for only 6 hours. In the end, it seemed to me that giving birth was not very difficult and everything was quite tolerable, although in some places it seemed that my strength was running out. I am sure that for a successful birth it is very important to know how it proceeds, to receive the necessary information about the physiology of childbirth in advance, to properly tune in to it and not to perceive it as something terrible, but to understand that this is a natural process inherent in nature itself. And, of course, you need to choose a doctor in whom you have complete trust, so that there is no doubt about the actions of this specialist during childbirth.
Expert's comments
Elizaveta Novoselova, obstetrician-gynecologist, Moscow
Irina says that even before pregnancy she was prone to arterial hypertension - high blood pressure. This symptom may be a sign of various pathological conditions. High blood pressure may be first registered during pregnancy, or it may be an unpleasant companion for most of our lives, as was the case with our heroine. And the first thing that doctors are afraid of in this case is gestosis (or late toxicosis), the “main blow” of which is directed at the kidneys. Preeclampsia is manifested by the retention of excess fluid in the mother's body - edema, the appearance of protein in the urine and high blood pressure.
Increased mother's blood pressure inevitably leads to changes in the blood vessels of the placenta. As a result, there is a decrease in blood circulation in the placental circulatory network, first at the level of the uterine vessels, then between the placenta and the child. Such changes are called fetoplacental insufficiency (FPI) - it was this complication that was the reason for Irina’s hospitalization in the department of pathology of pregnant women. Due to insufficient supply of oxygen and nutrients (due to reduced blood flow), the baby may experience intrauterine growth retardation, and this is a serious cause for concern.
FGR, or fetal growth retardation syndrome, is a pathological condition of the baby, characterized by a delay in growth and development relative to the gestational age. The main causes of FGR are conditions and diseases of the mother, placenta, and umbilical cord, which make it difficult to supply the baby with oxygen and nutrition. In the case of our heroine, the cause was hypertension. No less important are gestosis and fetoplacental insufficiency, which were also observed in the author of the story. There are two types of fetal growth retardation - symmetrical and asymmetrical. The symmetrical form, identified during the examination of Irina, is characterized by a proportional (uniform) lag in the length and weight of the fetus from the norm corresponding to the gestational age. The asymmetric form of FGR is characterized by uneven development of the fetus, for example, a lag in weight with normal fetal length. The development of a symmetrical form of FGRP in Irina indicates a long-standing problem of the baby’s blood supply: this variant of growth retardation develops already in the early stages of pregnancy against the background of chronic hypertension, while the asymmetric form is a consequence of the development of preeclampsia, a complication of late pregnancy.
When the diagnosis of arterial hypertension in pregnant women or gestosis is confirmed, complex treatment is carried out, aimed at persistently reducing blood pressure to normal and combating the edema that invariably accompanies this complication. In most cases, this requires hospitalization in the pathology department of pregnant women of the maternity hospital, where the expectant mother is examined by gynecologists and therapists. Next, they draw up an individual plan for the upcoming birth, taking into account the expectant mother’s hypertension.
At first, Irina’s attending physician insisted on carrying out a planned surgical delivery, without waiting for the expected date of birth. For such a radical decision (our heroine’s pregnancy was barely 37 weeks), the doctor had very good reasons: despite the treatment, the expectant mother’s blood pressure remained high, the blood flow in the placental vessels did not improve, which raised serious concerns for the health of the baby, who was experiencing a long-term lack of nutrition and oxygen. However, later the doctors’ verdict turned out to be more comforting for our heroine: according to the results of the examination, the condition of the fetus was considered stable, and the birth canal of the expectant mother, despite the gestational age, was completely ready for natural childbirth. And Irina was offered to try to give birth herself. To induce labor, the expectant mother was prescribed a hormonal drug that causes uterine contractions. Soon her water broke and contractions began. The expectant mother turned to the doctor on duty, but the examination did not reveal any dilatation. Irina’s water broke at once, after which she went to the toilet and shower, so the doctor did not see any signs of water breaking either. In order to determine whether the water had actually broken out, the midwife on duty gave the expectant mother a sterile padding diaper and recommended walking with it along the corridor - if there was any leakage, there should be traces of amniotic fluid on the diaper, which can be taken for analysis. Despite the doctor’s conclusion, Irina had no doubt that she was starting to give birth, her stomach periodically ached, and the fact of the rupture of water was obvious to the expectant mother herself: the fetal fluid did not leak, but “gushed out,” that is, a lot of it was released at once - no such thing can't be confused with anything.
The fact that CTG (cardiotocography) did not show the development of contractions, in Irina’s case, can only be explained by a malfunction of the sensor - after all, this device registers the slightest contractions of the uterus, sometimes completely imperceptible to the pregnant woman. However, at the time of the study, our heroine was definitely having real productive contractions: this can be judged not only by the described sensations of the woman in labor, but also by the fact that after a couple of hours she was transferred to the maternity ward with a large dilation, and a few more hours later Irina I've already become a mother!
Immediately after transfer to the maternity ward, an anesthesiologist was invited to perform epidural anesthesia. In the case of our heroine, there were special indications for this intervention: anesthesia makes it possible to maintain normal blood pressure levels in women in labor suffering from hypertension throughout the entire birth process. High blood pressure during childbirth is very dangerous: it can lead to rapid labor, premature placental abruption and uterine bleeding.
At the end of the story, Irina makes the absolutely correct conclusion - the happy ending to this difficult pregnancy story is largely due to her! After all, despite all the difficulties, the expectant mother found time to seriously prepare for childbirth, trusted the doctors, followed all their instructions and fully believed in herself!
The second stage of labor is the active phase.
This is the period from full dilation of the cervix to the birth of the fetus. The woman begins to push, which many consider less painful than contractions at the first stage. Finally, you can influence the situation and actively help your child come into the world. Listen carefully to your midwife and try to follow her recommendations. At this stage, most women feel a natural, irresistible urge to push. With each contraction, the baby moves through the birth canal. When the fetus is positioned correctly, the baby's head comes out first. At this stage, maximum effort is required, and there is a high risk of perineal rupture. You may not agree to a perineal incision, but in some cases it is justified, for example, if there is a high risk of a significant perineal rupture (when the baby is large, and the woman in labor has previously encountered a perineal rupture during intercourse).
Now comes the easiest phase. The rest of the baby's body emerges after a single contraction. It is important to immediately place the baby on the mother's stomach for the first close contact, in the absence of medical contraindications. This moment is very important for creating a connection and a sense of safety for the child. The baby will hear a familiar heartbeat and calm down. Try to immediately bring your baby to your breast. Don't worry if your first breastfeeding doesn't happen. The most important thing is the first contact and intimacy. Weighing, measuring height and other procedures can be postponed for a while.
Third stage of labor
After some time, the uterus begins to contract again. The release of the placenta, that is, the placenta and membranes, begins. It is important that all the afterbirth comes out.
In case of a cut or spontaneous rupture of the perineum, it is sutured. The uterus begins to contract. A drop in blood pressure, weakness, and tremors in the limbs are possible. You have come a long and exhausting way. Its effects will affect you for many weeks. Your body will slowly return to its normal state. However, you have received the main prize - a long-awaited, beloved baby whom you can finally hold close to you.
