Tears during childbirth

The birth process itself is divided into several stages: from preparatory contractions to the release of the placenta. Most often, it is their preliminary stage that is delayed, when a pregnant woman at the 38th to 42nd week begins to feel very weak, inconsistent contractions and urgently comes to the maternity hospital, and there it turns out that her cervix is ​​not yet ready for childbirth.

Childbirth is an absolutely natural process, but at the same time a serious test for both the mother and the child, who can no longer wait to be born. Since ancient times, it was believed that prolonged labor often leads to the birth of weak and sick children. All known medical practices since the time of Hippocrates formulated in different words one law for obstetrics and the course of this act: “The sun should rise over the head of a woman in labor only once,” that is, the duration of labor should not ultimately exceed 24 hours. And modern obstetricians-gynecologists have further reduced these limits, and in our time labor is considered normal for no more than 18 hours for women giving birth for the first time, and no more than 12 hours for already experienced mothers. But the level of knowledge about the physiology of labor is constantly increasing, and the fruits of this knowledge are a constant decrease in the time allotted for modern childbirth. Currently, the duration of the entire process already tends to be reduced to 8-10 hours, no more.

What's wrong with prolonged labor?

As you know, doctors do not like protracted labor and there is an explanation for this. The fact is that the course of labor extended over time greatly increases the likelihood of complications for both the mother and the fetus - this is the possibility of both injuries and infectious complications.

But this is not even the most important thing - during too long a labor, a pregnant woman becomes very tired, and the baby’s head, which is delayed and cannot appear outside, is subjected to pressure from all sides by the walls of the pelvis, and this is very dangerous and can lead to cerebral circulation disorders.

So why does it happen that contractions that started on time (between the 38th and 42nd weeks) and at first proceeded quite normally, later become less and less frequent, weaker, and sometimes even stop altogether? There can be a huge number of reasons for such weak labor activity:

• if you initially have endocrine and metabolic disorders in the body, for example, excess weight;
• if you are at too early or, conversely, late reproductive age;
• have thyroid disease;
• overstretching of the uterine muscles due to polyhydramnios;
• previous inflammatory diseases of the genital organs and abortions;
• a history of a large fetus or multiple pregnancy, as well as many other reasons.

Each of these reasons contributes to the destruction of the energy balance of contractile activity of the uterus and a decrease in the level of the hormone that stimulates uterine contractions - oxytocin.

Weakness of labor is not only secondary, which we have already talked about - if the contractions had satisfactory initial characteristics, and then weakened, but also primary - this is when they turn out to be rare and weak initially.

It happens when the water breaks, but contractions do not begin after that - this pathological condition has the same reasons, only the measures taken by doctors in this case will be called labor induction, and not labor stimulation.

How does natural childbirth work?

The process of childbirth has a certain scenario from a medical point of view, but the feelings of women in labor can vary significantly. So, some clearly feel every contraction, accompanied by severe pain, and some calmly tolerate minor, in their words, painful sensations and can actively behave right up to the attempts themselves.

Table: stages of the natural childbirth process

The cervix opens gradually, and productive attempts begin only when the dilation is characterized as complete (10 centimeters).
On average, childbirth for a primiparous woman takes 12–14 hours, for a multiparous woman - 6–8, however, if the process proceeds rapidly, then all stages can take up to 4 hours. The main task of a woman is to behave calmly, try to relax during contractions, and set herself up in a positive way. The more a woman in labor is aware of the birth process, the more comfortable she is with her doctor and birth partner, the easier everything will be, both physically and mentally. The main task is not to panic, not to be afraid and to carefully follow the instructions of doctors.

Pain relief during childbirth

During childbirth, various methods of pain relief can be used to relieve the severity of painful sensations, but doctors resort to this action only when absolutely necessary. Thus, drugs are administered in situations where without them it is impossible to ensure the normal course of labor: a woman loses consciousness, vomits, panic and fixation on painful sensations are noted, which does not allow her to concentrate on labor. Two types of pain relief can be used:

• drug pain relief. The drugs are administered once, intravenously or intramuscularly to relieve the severity of pain. Typically, the method is used during strong contractions, when the dilation does not exceed 6 cm, to give the woman the opportunity to rest a little;
• Epidural anesthesia is the injection of anesthetics into the area between the lumbar vertebrae in front of the membrane surrounding the spinal cord. This procedure allows you to block the nerve roots of the lower body and, if necessary, adjust the degree of pain relief.

Epidural anesthesia involves inserting a catheter into the surrounding spinal cord to directly deliver an anesthetic drug.
It is worth understanding that pain relief during childbirth is a controversial thing, since no one will give a woman in labor a dose that will completely remove the pain. The sensations will remain, they just won’t be as intense, because the woman should feel what is happening and be able to understand when the pushing began.

Any anesthesia procedure has its own risks, so they resort to this only when absolutely necessary. When a woman is properly prepared for childbirth, a natural mechanism of psychological pain relief is triggered - if the woman in labor can calm down and relax, then the sensations will become less acute, because the body itself produces hormones to suppress pain during labor.

In my case, the contractions were quite tolerable, I was in the mood to joke and laugh with my husband until the end. But about an hour before the birth itself, it became difficult - the contractions were frequent and long, and did not allow me to rest. The doctors administered intravenous pain relief - I can’t say that it didn’t hurt at all, but the sensations were significantly dulled for a while and gave me the opportunity to gain strength.

Help for a woman in labor

When does an expectant mother need help? The doctor makes a diagnosis of primary weakness if the contractions are short, rare and weak after 6 hours from the onset of labor in those giving birth for the first time, and after 3 hours in multiparous women (the cervix has not dilated by 2-3 cm) . We can talk about secondary weakness when contractions weaken and the cervix stops opening completely.

What is stimulation? Stimulation is necessary when the duration of either the first stage of labor (dilation of the cervix) or the second (appearance of the child) is excessively prolonged in time and then it is absolutely clear that this is a protracted labor. The doctor needs to pay attention to some points:

• Are there contractions, and what is their strength and frequency;
• Required uterine dilation (measured in cm, maximum dilation is 10 cm);
• How the presenting part of the fetus advances is determined by vaginal examination or by palpation of the abdomen.

If necessary, the doctor decides on stimulation.

Primary and secondary weakness

Already at the very beginning of labor, contractions should be regular, gradually increasing in strength and duration. As the intensity of contractions increases, the interval between them usually shortens, the cervix dilates by about a centimeter per hour, and the presenting part of the fetus (usually the head) gradually descends into the pelvis. When processes slow down and the time of the first stage of labor increases, doctors talk about primary weakness of labor. This state of affairs leads to the fact that the expectant mother approaches the second stage of labor very tired, and it is difficult for her to work as a team with doctors, listening to their instructions. In addition, the attempts may turn out to be very weak, which is also bad.

The second version of events can proceed like this: the first stage of labor proceeds normally, and the cervix dilates well - up to 5-6 cm, after which the contractions weaken. In this situation, doctors talk about secondary weakness of labor. This situation exhausts not only the mother, but is also dangerous for the baby - being pinned for a long time, the baby begins to experience hypoxia, intracranial pressure increases, which is fraught with complications in the future.

In this case, the woman in labor is given oxytocin and the amniotic sac is punctured to stimulate contractions. Between contractions, a woman is allowed and even recommended to walk, as this speeds up the process of dilation of the cervix. If all medical measures do not help, the maternity hospital medical staff decides on a caesarean section.

When managing a protracted labor, a lot of attention is paid to the expectant mother, and even more to the baby: his heartbeat and movement are monitored, as well as the minutes spent in the tummy are counted - this is important to exclude pathologies in the baby, because prolonged compression of the head is fraught with increased intracranial pressure and hypoxia.

Complications during childbirth

The process of natural childbirth is long and complex, and complications can arise at any stage. So, the following problems may occur:

• no changes in the cervix, it remains long and does not open, despite contractions;
• contractions remain monotonous and do not intensify;
• prenatal rupture of amniotic fluid;
• weakness of labor;
• increased contractile activity of the uterus;
• premature placental abruption.

There is no way to completely eliminate the possibility that something will go wrong during childbirth. A woman can minimize the risks of complications only by her behavior before childbirth: a healthy lifestyle, timely treatment of emerging diseases, performing all studies during pregnancy, regular moderate physical activity and a stable psycho-emotional state. During labor, doctors constantly monitor the condition of the mother and fetus, and if the slightest suspicion of complications arises, they take appropriate action.