Dr Girija Wagh, Obstetrician, Gynecologist, IVF expertMD, FICOG, DIP ENDO, FICS
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Every expectant mother is eagerly looking forward to the time when she will now deliver and have her boney baby. The biggest question is “how will I know, I am in labour ? “.Many feel tired and bored and want to deliver soon but there is always a concern about preterm birth. It is best to be delivered at the completion of 38 weeks but some women may deliver before 37 weeks / aka preterm delivery, and some may get delayed beyond 40 weeks / aka post term delivery. Preterm delivery is associated with issues such as breathing difficulties, infections and need of NICU care in the newborns, while postmaturity is associated with the demise of the baby or increased possibilities of compromise of the baby.
Every mum-to-be wants to know whether she is in labour and the delivery has begun or not. This is of much importance, especially if the mother is still to complete 37 weeks of the pregnancy. In case of a preterm delivery, it is important that help is sought earlier, to help prevent pre-term delivery with help of medications. Many a time, delay in seeking care can result in delivering a premature baby.
There is a recent terminology which has been evolved “tocophobia” in context with birth. This means fear of pain. Many women are scared of delivery pains and opt for operative or cesarean delivery. This fear usually is a result of some misinformation derived either from the media or some friendly counsels among colleagues, friends or family. Caesarean delivery has become safe and families have become nuclear with women opting for childbirth later in life leading to such decisions.
We need to understand the pain aspect associated with delivery and therefore this article.
Painful hardening of the womb which usually starts at the lower back and radiates forward towards the lower part of the tummy and the inner part of thighs are typically labour pains. These are usually of a duration of 20-30 seconds to begin with and increase in frequency and intensity. If such a painful tightening of the womb is perceived every one hour or after half an hour it is labour pain.
There are three components to this pain . One is due to the shortening of the fibres of the womb. The womb consists of special muscle called a myometrium which is sensitive to the delivery hormone released from the pituitary ( a special gland situated under the brain ). This hormone is called as oxytocin and causes contraction of the myometrium to help open the mouth (cervix) of the womb and push the baby towards the delivery passage to help it negotiate the soft tissues of the mothers lower delivery tract and the bony pelvis. This negotiation of the baby needs to be done with a little force but this force is gradual and allows the tract to open to make passage safe for the passenger.
Second component is the pain, as a result of the dilation or opening of the cervix. The cervix is made up of special tissue which has the capability of remodelling to turn the passage into a wide opening to allow the baby to come out of the womb and this process of dilation causes the pain related to the back
Third component is due to the increased pressure inside the womb, due to the contraction of the muscle fibres.
Towards the end of pregnancy, such tightening is felt on and off but it is not associated with pain and they are not progressive either. These are a sign of the preparation that the muscle is undergoing to aid labour which is shortly to begin. These are also called as Braxton Hick’s Contractions (BHC) as described by these obstetricians first. They are painless, non-progressive, non-aggravating and not associated with any change in the vaginal secretions and are therefore only BHCs and not labour pains.
Many times women report to the emergency with such kind of a presentation and the doctor tells them that they are false labour pains. Gaseous distension, colic due to indigestion is many times is perceived as pain and mums may feel it to be a labour pain. The doctor examines and diagnoses that it is not a labour pain.
Sit on a chair with a back rest with a timer or a watch in sight. Gently put your palm on your tummy and feel. If it tightens count the duration. Compare the tightening to the tip of your nose or your forehead. Normally the womb is tense even without contraction and feels similar to the tip of the nose. If it is harder and similar to the hard forehead, then measure the duration. If the duration is 20 seconds or more and recurs after half an hour or one hour it may be a labour pain. Relax and try to perceive your baby’s movements and do not panic. All is fine.
Throughout pregnancy you have experienced a little more secretions and which are normal as are internal cleansing mechanisms to keep the womb protected from ascending infections. These secretions if found to be increased, watery or sticky you must seek consultation. Excessive secretions can be a precursor to labour pains. Sticky voluminous secretions are a sign that the cervical canal mucus plug is released, is called as ‘show’ as the cervix has started opening. Watery discharge, which is similar to urine is a sign of water break and is called as ‘leaking’. In any of these situations it’s better to seek doctors consultation and be assured.
Many times first timers called as ‘Primis’ are inexperienced and not sure of their symptoms. Many times they may report for checkup and find that it was a false alarm. But it Is always better to be careful than careless and be assured. Also delays sometimes can be harmful leading to unnecessary interventions.
Shilpi was pregnant the second time and was expecting her baby anytime. Her first was normal vaginal delivery three years prior and she was expecting everything to be normal this time around. She had gone for a long walk and trip to grocers to replenish her kitchen for the imminent birth. She did feel little tired and experienced some sticky vaginal discharge But she was busy with work and ignored the tightening that she perceived thinking she must be feeling so as she was tired. The delivery was scheduled couple of days ahead.The household went off to sleep and she was feeling uneasy but decided not to bother anyone. In the midnight she felt a serious urge to go to the loo and she tiptoed and felt excruciating pain and woke up her husband before rushing to the washroom. He followed and low and behold the baby slipped out and it was a situation where he couldn’t do anything but to help her deliver. The baby was delivered, the placenta was then delivered under the guidance of the doctor on phone and she had to be rushed to the hospital .Luckily everything went well and she dint suffer grave consequences. She was at risk of bleeding, injury and the baby could have suffered asphyxia and even death.
Lessons learnt : Shilpi should have paid some attention to her symptoms and visited the hospital.
Shona was 36 weeks pregnant and experienced a watery discharge which she shared with her mother in law who told her not to worry as it is a sign of labour and advised her to take rest. The watery leaking continued and she felt a little uneasy but decided to bear it and wait for pain. Nearly 10-12 hours passed and she also thought the doctor may not be available as it was in the midnight. She decide to go to the hospital in mid-morning after all her chores were done and she continued to leak but now it had reduced. She felt the baby movements and assured herself. The doctor diagnosed her to have premature rupture of membranes leading to a dry womb with no liquor around and this was confirmed by sonography. She had to wheeled for an emergency cesarean section. If she would have reported in time, vaginal delivery could have been possible.
So be smart, be wise and be strong and be cool. Deliveries are a wonderful experience and face them with a positive attitude. Be confident and don’t have fear. Be conscious of your self and cautious about your self and your baby. Happy birthing !!!
Dr. Girija Wagh, MD (Obstetrics & Gynaecology), FICOG, FICP, Diploma (Endoscopy, Infertility), Fellowship of Indian College of Ob-Gynec, Women health care specialist, Academician, Acclaimed Orator & Researcher, B. J. Medical 1990-1992, Topper University Of Pune 1992
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