Preparing for childbirth: how it begins, the phases of labor, how to help yourself

We are waiting for the birth to begin

Are you expecting a baby? Congratulations! One of the most important events in life is already close, and many mothers worry in vain, expecting severe pain or worrying about the process itself. Your body is specially created for childbirth and is completely ready for it. And experienced doctors will take care of you, their knowledge, skills and attention will help the baby be born.

But I still wonder on what day there will be one more person on our planet. How to calculate the due date? The approximate date of the expected birth is known to every expectant mother from the very beginning, from the moment the doctor calculates it. But you need to know that childbirth can occur from the full 37th to the end of the 42nd week, that is, on average, pregnancy lasts from 260 to 293 days, so for sure “that very” day cannot be known to anyone, except perhaps the baby himself.

How do you know when labor is approaching? You can identify indirect signs, but remember that everything is individual.

Abdominal prolapse. For those expecting their first child, the belly drops 2 to 4 weeks before giving birth; for mothers who are not giving birth for the first time - the day before. This happens because the baby feels ready to be born and changes position in the abdomen, occupying the presenting part (that is, the one that is now located at the bottom of the uterus) in the pelvis. At the same time, the navel protrudes.
Heartburn goes away. Thanks to this, the feeling of pressure on the diaphragm goes away, breathing becomes easier, and the symptoms of heartburn and belching go away.
Increased urge and change in stool. At the same time, the urge to go to the toilet becomes more frequent, and about a week before birth, the stool becomes liquid - due to the pressure of the fetus on the rectum and the effect of activated hormones on the intestines.
Pain in the lower back. There may be nagging, painful, sometimes cramp-like sensations in the perineum and pelvis due to pressure and stretching of the tissues of the sacrum. During this period, the expectant mother may find it uncomfortable to walk and sit, and it may be difficult to find a comfortable position during sleep. “False” contractions may be felt, but if they are irregular and the interval between them does not decrease, then it is too early to talk about the onset of labor.
Lack of appetite. Most often, before giving birth, expectant mothers do not even want their favorite food. As a rule, 1–2 weeks before the birth of a child, pregnant women lose up to 2 kg due to excess fluid. This is how the body prepares for childbirth, when the mother will need additional flexibility and lightness.
Changeable mood. More and more hormones are released, and the pregnant woman’s mood changes hour by hour. The periods when the expectant mother is active and cheerful are replaced by a desire to retire and be in silence.
The baby moves less. His new position—usually head down—makes him uncomfortable to move.
Mucous discharge. During pregnancy, the cervix is closed by a mucus plug, and shortly before the baby is born, it comes off. This can happen right before childbirth, at the beginning of labor, and 1 - 2 weeks before it. It is thick, transparent, slightly yellowish, often mixed with blood. This is normal, however, if the discharge is bloody, you need to go to the doctor as soon as possible to make sure that there are no complications, or to deal with them quickly.

Not everyone knows that water can leak or break before birth.

Some unpleasant sensations can cause discomfort and ruin your mood, but try to concentrate on the joyful anticipation: all these are temporary phenomena, and besides, very soon you will meet your baby for the first time!

Contractions: false or real / “Waiting for a baby”

February

Shortly before giving birth, the expectant mother may be disturbed by training contractions, rhythmic contractions of the uterus, which quickly pass and appear sporadically. We will try to find out how to distinguish them from real contractions, and what they are needed for.

The phenomenon of temporary contractions was first described by the English doctor John Braxton Hicks. That’s why they are called Braxton Hicks contractions or false contractions, training contractions, precursor contractions. In his scientific work of 1872, he argued that these contractions are short-term (from half a minute to 2 minutes) contractions of the muscles of the uterus, which are felt by the pregnant woman as an increase in the tone of the uterus. They appear after the 20th week of pregnancy. And they happen often during the day, but the expectant mother may not even notice them during the daytime. However, as the period increases, they intensify, becoming more and more obvious. WHY ARE FALSE CONTRACTIONS NEEDED?

The uterus is a muscular organ. And like any muscle that must perform the work assigned to it in the body, it needs training. After all, if she hangs like a bag for the entire forty weeks, she will not be able to cope with the load during childbirth. Thus, the purpose of training or false contractions is to prepare the uterus and cervix for childbirth. That is why one of the names of training contractions is harbinger contractions - harbingers of an approaching birth.

ARE FALSE CONTRACTIONS PAINFUL?

As a rule, false contractions are painless, but as the period increases they become more noticeable and bring more discomfort. However, in all women they manifest themselves differently, some do not feel them at all, and some do not sleep at night, tossing and turning and trying to find a comfortable position to sleep. It all depends on the threshold of pain sensitivity. The main thing in this situation is to stop being nervous about this and calm yourself with the thought that such training is necessary for the most important upcoming event - the birth of your baby. And to calm down a little and sleep better, ask your doctor to prescribe a sedative for you and get a special pillow for expectant and nursing mothers. With her, falling asleep and surviving the discomfort of the last weeks of pregnancy will be much easier!

HOW TO LIVE WITH FREQUENT CONTRACTS

Some expectant mothers complain that Braxton Hicks contractions occur frequently and cause significant discomfort, even when doing housework or other light physical activity. In such a situation, obstetricians advise lying down or vice versa, taking a light walk, or in any case changing your occupation. If training contractions bother you a lot, it is recommended to drink a glass of water, juice or herbal tea, calm down and rest a little. Ask someone close to you to give you a massage. Lie in silence. And to also benefit from training contractions, try doing breathing exercises: practice breathing techniques during childbirth. HOW TO DISTINGUISH TRAINING CONTRACTIONS FROM LABOR CONTRACTIONS

The most important thing to understand is that real contractions are much more painful than Braxton Hicks contractions. You will understand this immediately. Plus, the contractions that bring you closer to labor are more regular. Contractions begin in the lower back, spreading to the front of the abdomen and occur every 10 minutes (or more than 5 contractions per hour). Then they occur at intervals of about 30-70 seconds and over time the intervals between them become shorter. Some women describe the sensations of labor pains as intense menstrual pain, or the sensations of diarrhea, when the pain comes in waves in the abdomen. These contractions, unlike false ones, continue after a change of position and when walking, constantly intensifying. As soon as you feel all these symptoms, call your obstetrician-gynecologist - hour X has come. If in doubt, also do not be afraid to bother the doctor. The doctor will ask you a few questions that will help him determine the type of contractions and eliminate all your doubts and worries. After all, it is always better to consult a doctor and trust his professional experience.

You should seek help if:

• you have more than four contractions per hour and they occur regularly • the contractions are accompanied by pain in the lower spine • the contractions are accompanied by watery or bloody vaginal discharge • the contractions are so strong that you find them very difficult to bear • there is a noticeable change in the baby’s movement, or less than 10 movements every 2 hours • you think your water has started to break Alla Misyutina, consultant doctor, INVITRO Independent Laboratory

Dear women, during labor the body needs a lot of oxygen, so proper breathing is very important. A large influx of oxygen into the blood of mother and baby alleviates the condition of the baby, who experiences oxygen starvation during childbirth. Special breathing techniques help to properly open the birth canal and make contractions and pushing as effective as possible.

In different stages of labor it is necessary to use different breathing.

•During “false” contractions, breathing should be deep and slow. During the period when contractions become more intense, it is necessary to use “anesthetic breathing”. This breathing is slow, deep, the inhalation is done through the nose, it should be longer than the exhalation through the mouth. More details: inhale at the count of 1-2-3-4, and exhale at the count of 1-2-3-4-5-6. With the help of this breathing: the mother relaxes, is distracted from the pain, focuses on counting; the baby receives as much oxygen as possible. •During breaks from contractions, you need to rest and breathe evenly without any effort, so that you can then easily follow the doctor’s recommendations. •During pushing, you need to exhale all the air from your lungs, then take a deep breath and push for 6-9 seconds. Quickly exhale all the air, quickly take a deep breath and hold your breath again for 6-9 seconds, and so on - about three times per push. •During breaks from pushing, you need to rest and breathe deeply, evenly and relaxed. • It is very important to push only into the perineum and never push into the head. In this case, all efforts are wasted and will manifest themselves in the form of burst blood vessels in the eyes and face. •In the period after the birth of the head, it is necessary to stop pushing and breathing shallowly; some people call this breathing “doggy style”; deep breathing can harm both mother and baby. Then everything goes on as usual, the main thing is to listen to the doctor. •After the baby is born, within half an hour the last stage of labor begins - the birth of the placenta. Special breathing is no longer required, at the doctor’s command, push a little into the perineum and THAT’S ALL! Dear women, pain during childbirth is good, it means that your baby will be born soon. There is no need to resist the pain, this is a mistake that brings nothing to the woman and child except fatigue. On the contrary, you need to concentrate and do your best to help the baby be born healthy.

BIRTH PAINS

So, you have decided that this is no longer a “teaching”, but the beginning of labor. In addition to contractions, the onset of labor may be indicated by the rupture of amniotic fluid and the release of the mucus plug that covers the lumen of the cervix. The mucus plug may come off 2-3 days before birth. However, her departure does not always mean that it is time to go to the maternity hospital. During pregnancy, the cervix is tightly closed. With the onset of labor pains, its opening begins: the cervix of the uterus gradually expands to 10-12 cm in diameter (full opening). The birth canal is preparing to “release” the baby from the womb. Intrauterine pressure increases during contractions as the uterus contracts in volume. And ultimately, this leads to rupture of the membranes and the release of part of the amniotic fluid.

The first, preparatory, period of labor for women giving birth for the first time takes an average of 12 hours, and 2-4 hours less for those who have repeated births. At the beginning of the second stage of labor, contractions are joined by pushing - contractions of the muscles of the abdominal wall and diaphragm. In addition to the fact that different muscle groups are involved in contractions and pushing, they have another important difference: contractions are an involuntary and uncontrollable phenomenon, neither their strength nor frequency depend on the woman in labor, while pushing is to a certain extent subordinate to her will , it can delay or enhance them. Therefore, at this stage of labor, much depends on the expectant mother and her ability to quickly and correctly follow the commands of the obstetrician delivering the baby. And the most important thing is to have the right mindset and not allow yourself to panic or think about something bad. Obstetricians and gynecologists recommend that mothers treat childbirth as a holiday, the baby’s birthday. Then it will be easier to concentrate on the fact that now your main task is to help the baby be born. If the expectant mother panics during childbirth, the concentration of adrenaline in her blood will increase significantly. Which will not have a very good effect on the process of childbirth. Adrenaline affects the synthesis of oxytocin, which significantly weakens contractions and slows down the labor process. In addition, adrenaline completely blocks the production of endorphins, which will increase the feeling of pain during contractions and pushing. That is why it is so important to get in the right mood, concentrate and help the baby to be born as soon as possible.

Liliya Egorova

What are the stages of the birth process?

First stage of labor. The onset of labor occurs as soon as regular contractions begin, with less and less time between them. Many expectant mothers notice the appearance of irregular “false” contractions after the 30th week of pregnancy. If you are worried about this, it is enough to visit a doctor to make sure that they are false. In any case, remember that only the regularity of contractions indicates the onset of labor.

At the initial stage, the cervix gradually opens; at the end it should be opened by 10 - 12 cm.

The initial stage consists of two phases:

Latent phase - first, the cervix opens by 2 - 3 cm at a speed of 0.35 - 0.5 cm per hour;
Active phase - the speed of cervical dilatation increases to 1 - 2 cm per hour, but at the end, when the cervix is almost completely dilated, it drops slightly: the body is preparing for the second stage of labor.

On average, disclosure takes 9 – 12 hours.

The second stage of labor is contractions from the moment the uterus opens until the baby is born.

The third stage of labor is the time between the birth of the baby and the birth of the “afterbirth” - the placenta and membranes.

Both pregnancy and childbirth always proceed individually. On average, the birth process takes from 10 to 20 hours. But some women give birth much longer, while others, on the contrary, faster. For expectant mothers who give birth vaginally for the first time, labor is thought to take longer.

Is it important not to miss the main point?

The date of birth can be guessed based on parameters such as fetal movements in a pregnant woman. We have already found out that about a week before birth, the baby in the mother’s tummy begins to behave more calmly. This is due to the fact that there is not enough space for him, and the head sinks into the pelvis. To track the dynamics of movements, a woman is recommended to keep a special diary in which she could record the time and number of kicks of the child. If the baby pushes several times, it is recorded as one movement.

Such a diary will help track the moment when movements become less active. After about a week, labor can be expected.

How labor begins

Childbirth begins with contractions: regular contractions of the uterus lead to the dilatation of the cervix and the birth of the baby. The sensations can be described as follows: the stomach seems to turn to stone, shrinking into a lump, and after a few seconds it relaxes.

The very first contractions can be missed without noticing them: most often they are almost not felt; then they become stronger, and at the moment when they occur, nagging pain appears in the lower abdomen or lower back. Afterwards, these sensations go away until another contraction occurs.

As a rule, early contractions are not too painful, but it can be different. In this case, tell your doctor about your discomfort so that he can help you cope with it.

How long do contractions last?

The interval between contractions at the beginning of labor is 10–12 minutes (sometimes 5–6), and they last for several seconds. Gradually they begin to appear every 3 - 5 minutes, their duration also increases to 40 - 60 seconds.

Typically, this period lasts from 6 to 12 hours. Sometimes prenatal contractions last a long time, more than a day, and the expectant mother may get tired of them, which is not very conducive to a normal birth. In this case, you need to consult a doctor who, if necessary, will help in this situation.

When does your water break?

Labor may begin with the rupture of amniotic fluid. They can immediately go away completely, or pour out in small portions. In any case, after this you need to see a doctor so that, after assessing your condition, he can decide whether you are ready for childbirth or whether you need to wait a little longer. Most often, the water is colorless, with small white flakes - this is the lubricant of the fruit. If they are green or yellow, you should consult a doctor.

As a rule, water is poured out in large quantities (about 250 - 300 ml) or - in another case - constantly, from the moment the process begins, and it is difficult not to notice.

It is impossible to confuse water with discharge, which also becomes more noticeable and watery towards the end of pregnancy: discharge may appear in the morning, and then disappear during the day, unlike water, which flows constantly. If in doubt, do not hesitate to consult your doctor.

When to go to the maternity hospital?

This is a question that worries many expectant mothers. The general recommendation is to go there when not only contractions have become regular, but the intervals between them are 7–8 minutes.

Until this time, you can walk around, take a warm bath, or sleep a little between contractions.

But if you wish, you can go to the maternity hospital earlier. The first stage of labor is considered complete when the cervix has dilated to 4–6 cm and continues to dilate. If this “indicator” is less than 3 cm, you may not be admitted to the maternity hospital and sent back home.

How to behave during the onset of labor

Don't nervously count down time with a stopwatch, this will only tire you. It doesn't matter how long the initial labor process lasts. Make sure that the birth lasts as long as necessary. It is enough to pay attention to the duration of contractions and intervals from time to time. As a rule, the contractions themselves will tell you when the labor process has intensified.

The most important thing for you is to save energy and rest more. Try to sleep between contractions.
Drink enough fluids and go to the toilet more often, even if you don't really want to: a full bladder prevents the uterus from contracting, and the baby has less room to move around.
If you are worried, the best thing to do is do relaxation exercises, watch a movie or read a book.

Baby activity before birth

The closer the birth is, the less room for movement remains in the abdomen. The fruit is already quite large, and its movement is not swimming, as before, but kicking with its limbs. Women who have given birth remember for a long time the tangible blows of small feet on the liver and other internal organs. Peak activity occurs in the first half of the third trimester - from 28 to 36 weeks. The child gets comfortable before the pregnant uterus descends and the head is fixed, which will limit its movements even more than its own size.

One of the signs that labor is approaching is the prolapse of the abdomen, or rather, the displacement of the uterus with the fetus inside into the pelvic region. This can happen a month or a few hours before the baby is born. The expectant mother understands that this has happened by the reflection in the mirror and internal sensations. Usually, with the prolapse of the abdomen, heartburn and difficulty breathing go away, since the fundus of the uterus no longer supports the diaphragm and stomach of the pregnant woman.

To wake up a sleeping baby in the womb if you are worried about his suspiciously long lull, drink a cup of sweet tea or lie down on your back. An uncomfortable position or the arrival of tasty food will set the baby in motion. But do not lie on your back for more than 10 minutes, this position leads to oxygen starvation of the fetus. If your stomach is still quiet, try again after an hour, and if unsuccessful, immediately call the emergency team.

From this moment on, the mother most often feels not even kicks, but the baby’s spasms—his hiccups. This is considered a good sign of sufficient maturity of the fetal central nervous system. A baby may hiccup several times a day, for about 20 minutes on average.

Video: broadcast of intrauterine hiccups using a Doppler device

A harbinger of imminent delivery is a change in the child’s motor activity. But whether it decreases or increases depends on the baby’s temperament. Sometimes excessive activity is caused by oxygen starvation, but most often it is a common reaction to the fact that the mother has recently eaten or taken a position that is uncomfortable for the baby.

A decrease in the intensity of movements is felt for several reasons:

lack of space for active movements;
preparation for childbirth. The child has to accumulate strength to be born;
blows with children's legs on the bottom of the uterus, which has practically no nerve endings. Because of this, the impression of a lack of movement is created.

It would be wrong to say that all children become less active before birth, but in most cases there is a decrease in the number of movements. Note, not complete freezing, but alternating rest with motor activity. A table drawn by hand or downloaded from the Internet will help you track the movements. Here's a simple paper helper you can make with your own hands:

Take a sheet of A4 paper (landscape) and draw a table on it. Columns - according to the number of days in the week - seven. Lines - every half hour while awake in the morning. For example, from 8 am to 8 pm - 25 lines. Don't forget to leave room for a table header to indicate the days of the week and time, as in the example below.
Listen to the baby's movements starting from the 28th week of pregnancy. Several movements in a row with an interval of less than a minute are counted as one movement.
Mark each movement in the table at the intersection of the day of the week and the time when it occurred (rounded to the nearest half hour).
As soon as the tenth mark appears on the daily movement chart, the table can be postponed until tomorrow.

Having created such a table, do not forget to note the tenth movement daily, at first it may be the first half hour, but gradually the schedule will shift down to lunchtime.
Regular monitoring of the baby will allow you to immediately notice when the intensity begins to decline. The norm in recent weeks is 1-3 movements per hour, but if the child does not give signals for more than four hours in a row, this is a reason to consult a doctor. Medical consultation is also needed if the baby is too active to exclude possible hypoxia. Using cardiotocography (CTG), the doctor will determine whether there is reason to worry, or whether suspicions, fortunately, are unfounded.

If your baby begins to bother you with kicks less often, but does not forget to remind you of himself from time to time, it means that he is preparing to be born.

In my maternity hospital, fetal movement tests were mandatory. Several times I met expectant mothers filling out a weekly form right outside the doctor’s office. I would not recommend repeating such actions. Observing the movements of the child inside is necessary, first of all, for the birth of a healthy baby, and not for the sake of “the doctor said so, I’ll do it.”

Active phase of onset of labor

Contractions become stronger, longer and more frequent, making it difficult for you to talk when they occur. The cervix is actively dilating. If contractions become painful and occur every 5 minutes for an hour, you need to go to the hospital without delay. This phase of labor lasts on average 5 – 8 hours. If you are giving birth for the first time or the baby is large, it will take longer, but if you have taken oxytocin or have had a vaginal birth before, the process will be faster and is unlikely to take more than an hour.

What to do at this moment

It's okay to walk during this time, but you'll likely want to lean on something during contractions. If you are tired, you can rest by lying on your left side. You can take a shower, a warm bath, or ask for a light massage.

When the cervix has dilated to 8–10 cm, the most active part of labor begins. The contractions are getting stronger, coming every 2 - 3 minutes and lasting a minute or longer.
You may feel shivering and chills between contractions, and feel hot during contractions.
The baby moves to the pelvic area, if he has not done so before, and there is a feeling of pressure on the rectum and the desire to push.
Most often, bleeding appears at this moment - don’t worry, this is normal.
There is often a feeling of nausea.

Before labor begins, many (but not all) doctors ask the woman to give her an enema. This is a voluntary procedure, but expectant mothers often agree because then they won't have to worry about having a bowel movement during labor, although this is completely normal. This means they will be able to feel more comfortable while pushing. It is better to consult your doctor in advance and choose a plan of action that is more suitable for you.

Many women in this phase of labor turn to pain relief, such as an epidural.

However, there are many ways to relax and relieve pain, since much of the pain is caused by fear, and not by a real physical process.

Here are a few tricks:

Ask for a light massage;
Look for a more comfortable body position;
Apply a cool or warm compress to your forehead;
You may want silence and no need to communicate, since contractions take all your attention; but maybe you will want to get support from a doula - your assistant during childbirth, about whom we will talk in more detail below - as well as from the child’s father or another loved one;
Focus on the fact that with each contraction you are helping the baby to be born.

What changes in the intensity of movements can be expected before childbirth?

It cannot be said that there is a certain pattern in the intensity of movements before childbirth, which takes place 100% and confirms the success of pregnancy and the birth process. There are only a few factors that contribute to a stiff baby, and in most cases these factors lead to some lull in the weeks or days before delivery. Among them:

Large size of the child, tightness, decreased amount of water. By the last weeks of pregnancy, the fetus reaches its maximum size and occupies the entire space of the uterus, grouped in such a way that movements can only be made by the limbs.
Insertion of the head into the small pelvis - by about the 35th week, the fetus takes a “head down” position, thus preparing to leave the uterus. At some point, the stretched ligaments and tissues of the small pelvis allow the fetal head to descend into the small pelvis - there it will be literally fixed, which also takes away the opportunity for maneuvers.
Features of sensitive zones - the main flow of movements of the baby, who has already turned his head “towards the exit”, occurs in the area of the fundus of the uterus (under the woman’s ribs), where his legs are located. It’s not for nothing that in newborns you can observe the reflex of “pushing away” with their legs - all this is conceived by nature so that during a fight the child will help the mother to push him forward. At the same time, the area of the fundus of a woman’s uterus is the most insensitive in comparison with the lateral and lower areas.

Thus, most women before giving birth - a few weeks or days - experience a decrease in the activity of movements. However, the absence of this phenomenon does not indicate any problems. It is only important not to miss excessive, completely uncharacteristic activity, which may indicate hypoxia, and complete inaction (up to 3 episodes of movement per day) is an alarming sign that the baby is not feeling well.

Particularly restless expectant mothers, in the absence of movements, use the following effective ways to “stir up” the baby (and therefore make sure that everything is fine with him - he is just sleeping): eat something sweet; take a position that is not the most comfortable for him, for example, lying on his left side; change the type of activity (take a walk if you were resting, rest if you were active).

A portion of sweets will definitely wake up the intrauterine baby - even doctors advise eating chocolate before CTG

Epidural anesthesia

If you have an epidural, either for medical reasons or because you want it, you will feel less pressure. This process takes from several minutes to several hours.

This procedure is widespread and is considered safe; complications occur very rarely, only in 1 case out of 80,000.
This anesthesia is done in the lumbar region using a special needle and a thin catheter into which medication is injected approximately every 30 minutes.
As a rule, after this the expectant mother is able to walk, but sometimes her legs may lose sensitivity for a while, and then she will have to lie down.

What are the benefits of anesthesia? Thanks to her, the expectant mother, as a rule, does not feel pain.

The disadvantages are that labor is slower, in 1 in 20 cases the anesthesia does not work, and complications are possible. It is believed that the effect of anesthesia on the baby is minimal if no complications arise.

As a rule, doctors recommend against epidural anesthesia, but each woman's sensitivity threshold is different, and if severe fear and pain increase and you cannot cope with it, your doctor will prescribe this procedure for you.

When should you be concerned?

Childbirth, although natural, is a very complex and dynamic process. It occurs differently for every woman. Disturbances can occur both during labor and directly during childbirth.

What situations should cause concern:

hyperactivity before contractions;
lack of movement before and during childbirth.

Important! Before giving birth, the doctor should monitor the child’s behavior, asking how hard and at what time he pushes. Readings are taken 12 weeks before and immediately before birth. Thanks to this, the doctor will be able to see the full picture and assess the health of the fetus.

The development of hyperactivity before contractions should alert a woman.

Excessive activity

If a child actively beats his arms and legs before birth, this is very bad. With no exceptions. Hyperactivity is most often caused by compensated hypoxia. It can be determined by listening to the fetal heartbeat or by the results of a cardiotocogram.

Listening to the heartbeat should be done every 30 minutes during labor. The causes of hypoxia can be:

large fruit size;
severe or moderate anemia;
discrepancy between the Rh factors of mother and baby;
placenta previa;
abruption of the placenta ahead of time (provided that it is located normally).

If a child is born hyperactive, then parents will have to put a little more effort into raising them.

Pushing, childbirth and placenta

Once the cervix is fully dilated, the baby begins to move through the birth canal. At this point, contractions occur less frequently so that you have time to rest between them. Many mothers believe that this period, despite the fact that it is the main one - right now the baby will be born - is easier to bear. For others, having to push may not be the most pleasant thing to do.

The uterus contracts and the baby feels pressure. With each attempt, he moves along the birth canal. Now you don’t need to do anything special, you just push with each contraction, trying to relax as much as possible during the breaks. However, in many hospitals, doctors ask the expectant mother to push specifically: everything is individual, so you should discuss with the doctor in advance how best to behave and choose the method that is closer to you.

If you have had an epidural anesthesia, you do not feel the contractions of the uterus so clearly, then you should trust your doctor who will tell you when to push.

The birth of the baby itself can be fast, especially if this is not your first vaginal birth, or slow. With each contraction, the baby will get closer to exiting the birth canal.
At this moment, a woman often wants to change her position to find the most comfortable one, but the hospital does not always have this opportunity.
Finally, when the next contraction ends, the baby’s head (as a rule, the baby is born with the head forward, although this is not at all necessary) will gradually appear and will be born very soon.
Now the expectant mother wants to push even harder, and with each contraction the head is visible more and more clearly, and the muscles of the perineum are stretched and a burning sensation may be felt in this area (between the anus and vagina).
At this time, your doctor will tell you when to push less or stop so that the baby's head can come out of the vagina. It is important to try to allow the head to pass through slowly and smoothly to avoid tearing the perineum.
As soon as the head is born, the doctor checks whether the umbilical cord is entangled in the baby’s neck. If this happens, they will try to remove the umbilical cord from the neck or cut it if necessary.
Then the doctor will tell you when to push so that the baby moves smoothly out of the birth canal.

As soon as the baby is born, he will be dried with a towel and excess mucus will be removed from the mouth and nose. If possible, the doctor will place your son or daughter on your chest so that you can admire your treasure. They will cover you with a blanket: now the newborn needs warmth.

The doctor will cut the umbilical cord, and you will be overwhelmed with emotions and great relief that labor is over. And although you will be very tired, you may not even want to sleep at this moment.

How long does the second stage of labor last? From several minutes to several hours. Without an epidural, this stage usually takes about an hour for a woman giving birth for the first time, and about 20 minutes if this is not her first labor.

There is very little left. Just a few minutes after the baby is born, contractions begin again. The first few contractions separate the placenta from the walls of the uterus. The doctor will tell you when to push. As a rule, the placenta is born after one contraction, it is not painful and takes 5 – 10 minutes.

When the baby is ready to be born

According to statistics, four out of five babies are born between 37 and 42 weeks of pregnancy. By this time, they are usually ready for independent life, the body systems work as they should for newborns. Already at 37 weeks, children weigh about three kilograms, and their height reaches 49 centimeters. Further, the crumbs develop individually, as is genetically determined, so weight and body length indicators do not have clear restrictions. In addition to heredity, the size is influenced by the mother’s lifestyle and the gender of the child.

Before birth, all the baby’s senses are already functioning, except for smell. Newborns are able to hear smells as soon as they begin to breathe through their nose.

Having done a three-dimensional ultrasound examination of the child, you can notice how the baby has changed in appearance compared to earlier stages of pregnancy:

subcutaneous fat gave him roundness and he looks cute and chubby;
children's skin smoothed out everywhere, with the exception of the palms and heels;
due to the fact that the same fat has separated large blood vessels from the skin, it is now pinkish in appearance, and not red as before;
lanugo - the fluff that covers the fetus during pregnancy - disappears shortly before birth, and the skin becomes even;
the original white lubricant, which previously covered the baby’s entire body, is grouped in the groin and on the bend of all four limbs. It performs the function of protecting delicate skin from chafing;
Even in the mother's womb, children's heads are covered with hair; in some cases, the hair is very thick. Some children have sparse hair, but this does not affect their hairstyle in the future. Both options are not a deviation from the norm, but rather an individual feature. Hair and nail growth continues.

Hormones synthesized by the female body prepare the expectant mother for childbirth. But the baby is influenced only externally. Under the influence of estrogen, the genital organs—the boy's scrotum or the girl's labia—swell. After birth, this swelling subsides almost immediately.

The bones of the skull and skeleton are very elastic for easy passage through the birth canal; after birth they will become stronger.

The position in the uterus that the fetus occupies several weeks before birth is called breech. In 95% of cases, the baby is presented correctly, head down towards the exit of the uterus, but there are deviations from the norm:

breech presentation, in which the baby “sits” in the mother’s belly with his legs and buttocks moving towards the vagina. This longitudinal position is considered a pathology, although natural childbirth is possible according to indications. The fact is that not every doctor, even in favorable circumstances, will decide to take such a risk;
transverse presentation, when the fetus lies perpendicular to the os of the uterus and in no way can get out on its own. Surgeons help him to be born;
oblique presentation is, in fact, an option between longitudinal and transverse, but in the case of the baby’s position in the uterus diagonally, there can be no talk of natural childbirth. Only a caesarean section can protect the baby from birth injuries.

Presentation is diagnosed by ultrasound and, to the extent possible, doctors try to avoid an abnormal position by prescribing procedures when it is detected. Mothers can independently assume that the baby is malpresented by his movements. The baby, positioned head down, actively moves in the upper abdomen, in the area of the ribs. Movement at the bottom of the mother's belly or on the sides should alert the woman, but do not panic. The child sometimes rolls over into the desired position on his own, but the doctor will try to help with the rest.

Video: Doctor turns fetus in the womb

Ultrasound examination often records the entanglement of the fetus with the umbilical cord, most often single. But in 9 out of 10 cases, births with entanglement occur without consequences for the mother and newborn. Without an ultrasound, it is difficult to know whether the baby is entwined with the umbilical cord or not. An indirect confirmation of the umbilical cord being wound is the child’s excessive activity or, conversely, complete calmness.

Photo gallery: variants of fetal presentation and anomalies

Head presentation is considered correct; childbirth in this position usually occurs without injury

Longitudinal presentation is very rare, but is always an indication for cesarean section

Only a highly qualified obstetrician can perform a natural birth of a baby with a breech presentation, but if it is possible to perform a caesarean section, do not neglect it

A child entwined with an umbilical cord can be born without incident, but repeated entanglement reduces the chance of a successful outcome because the baby will simply suffocate, and medicine is currently unable to help unravel

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!

Should a baby move during contractions?

Many expectant mothers have no idea whether the baby is moving during contractions, although this is important information, because contractions are a major part of childbirth. They represent a synchronous process of contraction of the smooth muscles of the uterus. Thanks to this, the cervix opens and the baby comes out through the birth canal.

How does a child behave when contractions begin? The fetus begins to feel pressure from all sides of the uterus. As a result, the child moves a lot. The expectant mother may not feel this, since her body is experiencing severe stress caused by the painful shock due to childbirth.

But what happens to the child, why does he start kicking intensely? The onset of contractions leads to changes in the comfortable living conditions in the stomach. The fetus is trying to find a comfortable position again. And the contracting uterus directs it to the exit, which it actually opens. When the baby finds this path, he pushes with all his strength from the bottom of the muscular organ with his limbs.

Another reason why a baby kicks during contractions is lack of oxygen. The blood flow from the placenta slows down. This puts the child in a state of panic, because before contractions he is in the most comfortable and calm position. Immediately after birth, all indicators return to normal.

Episiotomy: when and why it is done

This is the name given to a small incision in the perineum and back wall of the vagina so that the baby's head can be born. This is a fairly common procedure, and the doctor cannot tell before delivery whether it will be needed. We list the cases when the doctor may decide that it needs to be done:

If there are signs that the perineal ligaments are not elastic enough and there is a risk of rupture. Then a 2-3 cm incision is the lesser of evils, because the gap may be longer and heal less quickly.
If there is a fear that the baby's head may be injured. This may happen if the baby’s head is much larger than the opening of the vagina or if the baby moves his pelvis forward during childbirth.
If childbirth occurs quickly.
If swelling of the perineum is noticeable, this happens when contractions are not strong enough or if they last much longer than expected.
When a woman is unable to wait out the attempts and the tissues are forced to expand too quickly.
If a woman’s condition requires a faster birth of the baby (for example, high blood pressure, severe myopia or other factors).
When the doctor needs to apply special instruments to help the baby be born: these can be obstetric forceps or a vacuum extractor. An experienced specialist will be able to assess whether this is really necessary, whether it is safe for the child and which method is correct.

The perineal muscles may not be flexible enough in the following cases:

If this is the first birth of a woman over 35 years old;
If the perineum is located high, that is, the distance between the anus and the vagina is more than 7 - 8 cm;
If there are scars on the perineum;
When the obstetrician did not sufficiently protect the perineum when removing the baby's head and shoulders.

How is an episiotomy done?

Anesthesia is not usually used for this procedure, but the woman does not feel pain because there is currently insufficient blood supply and sensitivity in these tissues.

The incision is most often made when the head is exposed; do it with scissors.

After your baby is born, your doctor will stitch you with anesthesia using surgical suture, which dissolves on its own so there is no need to remove stitches.

The suture usually heals within 4 to 5 weeks if you follow the doctor’s recommendations (bed rest, breastfeeding while lying down, a light diet) and take care of the suture. After the lochia (discharge after childbirth) has stopped and the stitch has healed, if you are ready, you can engage in sports and sex. There may be some discomfort at first, but it will go away over time.

What you can do to reduce the risk of an episiotomy:

You should massage the perineum 2 - 3 times a week, starting from about the 36th week of pregnancy - preferably using special oil. The technique is simple: you need to insert your fingers shallowly into the vagina and press towards the anus.
Kegel exercises are also useful - contraction of the intimate muscles and muscles of the anus at different rates. Read about them in a special material (https://agulife.ru/calendopedia/kak-vosstanovitsya-posle-rodov).
Try to be as calm and patient as possible during childbirth.

Child activity

A couple of weeks before birth, the baby descends into the mother's pelvis, and the head is located between the thigh bones. At the same time, the woman feels that the uterus and fetus no longer put pressure on the ribs, and the volume of intrauterine fluid causes less discomfort. It becomes easier for her to breathe, and her stomach visually drops. Based on these signs, you can understand that the body is preparing for childbirth.

Before taking this position, the baby's movements may increase. Despite the relief in breathing, the pregnant woman feels discomfort from the bladder. Sharp shocks can cause pain to the mother and cause frequent urination. After the fetus descends into the pelvic area, the baby becomes cramped and movements decrease. If this does not happen, it is better to consult a doctor for examination. Most likely, the baby is indignant and tries to take the most comfortable position. Excessive activity may be a sign of, for example, hypoxia, but the likelihood of this is low. The greatest activity of the fetus is usually recorded at 36-37 weeks of pregnancy.

When is a caesarean section performed?

Statistics from recent decades show that caesarean sections are being performed more and more often all over the world. According to WHO, this operation for medical reasons should be prescribed no more than 15% of cases. But in reality this number is much higher (in a number of European countries - almost half of all births).

A caesarean section is a medical operation in which childbirth occurs surgically through an incision in the uterus. This method has been known since the times of Ancient Rome. But the conditions under which the operation is carried out have, of course, changed markedly since then. Everything goes quite quickly and, as a rule, only takes an hour. It is the latter fact that is often decisive when women opt for a cesarean section “at will”: some are afraid of hours of contractions, others are afraid of ruptures and stretching of the uterus, etc.

However, a caesarean section is not a cosmetic procedure. For medical reasons, it is prescribed only if there is a threat to the life and health of the mother or baby. Compared to natural childbirth, the risks for both the woman and the baby in the case of a cesarean section are many times higher.

When is a caesarean section performed electively, as prescribed by a doctor?

The woman’s pelvis is too narrow and/or the fetus is too large;
Placenta previa (the placenta covers the entrance to the uterus);
Scars on the uterus from previous operations, threat of rupture;
Multiple pregnancy;
A number of diseases not related to pregnancy (cardiovascular diseases, risk of retinal detachment, varicose veins, viral diseases of the urinary tract, etc.).

When is a caesarean section performed urgently after contractions have started?

When labor takes too long or labor activity suddenly stops;
In case of acute oxygen deficiency and problems with the child’s heartbeat;
With premature placental abruption;
If there is a risk of uterine rupture.

What should you know if you are scheduled for a caesarean section?

The doctor monitoring your pregnancy will most likely report the need for surgery during the first examinations. Especially if you already have a history of uterine surgery or have chronic diseases.
The operation itself is most often scheduled for the end of the third trimester of pregnancy—at 38–39 weeks. Most caesarean sections are performed under local anesthesia (epidural or spinal anesthesia). This way, you will most likely have the opportunity to put your baby to your breast immediately after birth.
The work of surgeons is hidden from the woman in labor using a small curtain. And only after the doctor removes the baby through an incision in the uterus (in most cases horizontal), you will be able to see your baby.

What should you consider if you are considering having a caesarean section without a compelling medical reason?

The likelihood of complications developing in both mother and baby is much higher. You will have a longer recovery after childbirth: while the stitch is healing, your mother will need constant help.
There may be difficulties establishing breastfeeding.
Negative effects of anesthesia and antibiotics received during surgery for the baby.
Difficulty regaining fertility: Research shows that a cesarean section may make it more difficult for you to become pregnant again.

If you are having a caesarean section for medical reasons, remember that this is a vital necessity for your baby, and you are doing everything right. If you are choosing surgery out of uncertainty and fear, you may want to reconsider the situation.

Many expectant mothers periodically experience anxiety. Once you cope with it, you will probably believe in the strength of your own body. After all, if natural childbirth is available to you, you should definitely take advantage of this chance.

Slowing down movements

Slowing down movements is always considered a greater danger than excessive fetal activity. A long break between movements or the number of tremors of less than 10 in 6 hours are considered dangerous signals and require urgent medical attention. As a rule, such a sign indicates a lack of nutrients or oxygen in the child. Hypoxia can occur for many reasons. It leads to quite serious complications and can be noticed in time precisely by a decrease in the number of movements. After increased activity at 36 weeks, approximately 2 weeks before birth, the baby's movements become less frequent, but remain regular.

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.

Third stage of labor

This period is otherwise called “successive”. The uterus still continues to contract weakly, at which point the membranes gradually come off. A minute after the baby is born, you will be given an intramuscular injection of oxytocin to help your uterus contract better. Afterwards, the midwife will ask you to push a little more so that the placenta comes out. As a rule, this happens painlessly and quickly, in 5-10 minutes. At this stage, the main task of the staff is to make sure that the remnants of the fetal membrane and placenta are completely expelled and the uterus is clean. If there are still fragments of the placenta left in the uterine cavity, they are immediately removed to prevent the development of infection and inflammatory processes.

The doctor will also examine the integrity of the cervix, the presence of perineal ruptures, etc. If necessary, the tears will be sewn up using self-absorbing threads. There is no need to worry - the seam is cosmetic and will not be noticeable in the future.

However, after the baby arrives, all your attention will most likely be focused on him and medical manipulations will not cause much discomfort. The newborn is immediately examined by a pediatrician.

A successful birth means good health for both mother and newborn. Of course, not everything can go according to plan, but there is no need to be afraid of childbirth. Millions of women go through this, each fact of birth is unique in its own way. On average, the duration of the first birth is 10-12 hours; for multiparous women, the entire process from the onset of contractions takes 6-7 hours. Competent preparation and following medical instructions directly during the process of contractions and pushing will help you, and the birth of your baby will be as smooth as possible. And you will have the warmest memories of such an important and solemn event in your life.

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Answers to popular questions

Below are answers to the most popular questions that worry expectant mothers.

Is it normal for a baby to become quiet before birth? Yes, in most cases, this is absolutely normal. The decrease in activity is explained by the lack of free space, the large size of the fetus and its descent into the pelvic area, which limits the possibility of movement. There is no need to worry if the baby still periodically makes itself known by movements.
How to distinguish pathological calm from normal? Even if the child is not active enough or has little space, his movements should be felt. 24 movements in 12 hours (from 9:00 am to 9:00 pm) are considered normal. If you feel your baby more often, that's normal. If the intervals between movements are too long and the movements are less than 24, you should consult a doctor for a more accurate assessment of the fetus’s condition.
Is it normal for the baby to become more active in the last weeks of pregnancy? Yes, this is absolutely normal. Before being lowered into the mother's pelvis, the baby must turn head down and take the correct position, which often feels like increased activity and a lot of kicking. If the baby’s movements bother the mother too much, for example, they are very active or painful and continue for a long time, you can consult a doctor for additional examination. Excessive activity may indicate a lack of nutrients or that something is bothering the child. However, this condition is more often a reaction to sweets. Observe your baby's movements to notice patterns and characteristics of his character - for example, he becomes too active after sleeping or eating candy.
Are baby hiccups dangerous in the last stages of pregnancy? A child may hiccup quite often, about 5 times a day. As the fetus grows, its body weight increases, so the hiccups are felt more strongly. This condition is not dangerous and is completely normal.
Is it dangerous for a baby to push hard? The strength of the shocks, as a rule, depends on the physical development of the fetus and its character traits. Some children are calmer, others demonstrate individuality already at the stage of intrauterine development. If the tremors bother the mother too much, it is best to consult a gynecologist for a more detailed examination of the condition of the fetus. If the child develops normally, you will have to endure the blows or try to calm the baby down with words. A child cannot cause any serious damage to a woman’s internal organs; in most cases, pain is simply a reaction of nerve endings.
How can you be sure that everything is okay with the child if the movements are in doubt (very strong or too weak)? After contacting a doctor with her suspicions, the mother will receive a referral for an ultrasound and CTG. Thanks to these methods, you can look into the uterus and see what is happening with the baby, as well as examine the heart rate. If the umbilical cord is not pinched, no entanglement has occurred, and the heart rate is within normal limits, there is no need to worry.
How to determine that a baby is preparing for birth ? Only a gynecologist can reliably determine that labor will begin soon, but the woman still feels some changes in her body. First, the baby takes a head-down position. This leads to the fact that leg kicks begin to be felt in the upper abdomen. In recent weeks, the mother can even feel where the baby’s back is facing. Such upper pushes indicate that the baby has taken the starting position and is in a breech position. After this, the baby descends into the mother’s pelvis and stops pressing on the fundus of the uterus. This allows the lungs to open more fully and the diaphragm to lower. Mom's breathing improves, becomes fuller, and shortness of breath disappears. Abdominal prolapse can even be visible visually.
Does the baby move during contractions? According to medical data, the baby’s activity does not stop during labor and childbirth. It helps him leave the birth canal faster, squeeze into it correctly and be born. After the cervix dilates, the baby can push off the bottom of the cervix with his feet, while he will turn his head in order to better pass through the winding birth canal. The supply of oxygen during labor and childbirth deteriorates, which can also cause increased activity of the child. At the same time, between contractions the baby usually rests and gains strength, just like the mother.