Photo: UGC When the 38th week of pregnancy arrives, the expectant mother is already in full swing preparing for childbirth. By this time, the baby is already completely ready for life outside the mother’s body, so the birth process can begin any day. In order not to miss the moment when it’s time to get ready for the maternity hospital, it is important to be able to recognize the signs of an approaching birth. The information in this article will help with this. Read and be fully prepared.
Signs of labor by week
- The first sign noted by many women is prolapse of the abdomen. The baby's head is directed downward and located in the pelvic area. As a result of this position of the child, the pressure on the diaphragm and lungs is reduced. It becomes “easier for the mother to breathe,” and this is one of the most pleasant harbingers of childbirth.
- Another important symptom is a decrease in the motor activity of the fetus: the fact is that the size of the baby no longer allows him to move freely in the uterine cavity. It is important for the expectant mother to know that if the baby becomes quiet, this is normal. Don't worry about this.
- At the 37th week of pregnancy, the center of gravity shifts, as a result of which the woman’s posture changes. The gait of the expectant mother at this time can be called a “proud gait”: her head is slightly thrown back, her shoulders are straightened.
- At 39-40 weeks of pregnancy, a mucous plug is released, which is also a sign of impending labor. The mucus plug is much denser than normal secretions, transparent, with small streaks of blood. The volume of the mucus plug in primigravidas is 2-3 mm. For second-time mothers, these values may be higher.
- At 39 weeks of pregnancy, women notice frequent urination and softening of the stool, which is caused by increased fetal pressure on the pelvic organs.
- At 40 weeks, a few days before birth, the first irregular contractions appear and weight loss occurs by 1 - 1.5 kg. This is due to a decrease in tissue swelling. A decrease in swelling should also be interpreted as a sign of impending labor.
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.
Precursors of childbirth in primiparous and secondparous women
They have a smooth and increasing character and appear long before birth. Due to a lack of experience, it is difficult for a woman to diagnose the first signs of impending labor; most often she perceives them as an ailment or does not pay attention to them.
All of the above signs in second-bearing women are more pronounced and appear at a later date. The mucus plug has a larger volume.
Symptoms of impending labor may appear 1-2 days before the birth, as well as immediately before it. Therefore, second-time mothers should be especially careful in the last weeks of pregnancy: the body no longer perceives childbirth as a global restructuring of all systems and is completely ready for it.
Often in second-time mothers, labor begins quickly and unexpectedly.
Pay attention to the psychological state of your family: often husbands immediately before childbirth become more affectionate and reach out to the woman more than usual. Moreover, the woman herself discovers the “nesting effect”: it suddenly seems to her that the house is completely unprepared for the arrival of the baby, she begins to arrange a place for the unborn child, and may start renovations.
These folk signs, although not scientifically confirmed, are passed down from generation to generation as sure harbingers of an imminent birth.
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.
Specialists
Kuznetsova Tatyana Vladimirovna
Obstetrician-gynecologist with 35 years of experience, chief physician of the center.
Tatyana Vladimirovna’s specialty is the diagnosis and treatment of infertility. Performs surgical interventions and pregnancy monitoring. Recipient of the state award "Order of Honor".
Makatsaria Alexander Davidovich
Obstetrician-gynecologist, famous scientist, founder of clinical hemostasiology.
It will help you plan and maintain your pregnancy if you have had cases of fetal loss, thrombosis, obstetric complications or blood coagulation disorders. You can also contact your doctor for a transcript of hemostasis tests.
Egorova Elena Borisovna
Obstetrician-gynecologist of the highest qualification category.
Specializes in peritoneal factor of infertility in women and management of problematic pregnancies.
It will provide effective help if, before conception, you were diagnosed with adhesions, endometriosis, erosion or other pathologies of the cervix.
Akinshina Svetlana Vladimirovna
Obstetrician-gynecologist, hemostasiologist with an academic degree.
Pregnancy management S.V. Akinshina will help avoid severe complications: gestosis, placental insufficiency, fetal loss syndrome.
The doctor's expertise includes hemostasis disorders and immunological infertility.
Bitsadze Victoria Omarovna
Gynecologist-hemostasiologist, professor, doctor of medical sciences.
The doctor's profile is management of high-risk pregnancies, including in women with genetic thrombophilia and a tendency to spontaneous bleeding. Develops effective treatment regimens for infertility associated with autoimmune pathologies and hemostasis disorders.
What should I do in early labor?
If you have only a few early symptoms of approaching labor, it may be too early for you to go to the hospital. The latent phase of the first stage of labor may last long enough that you will probably be more comfortable staying at home. Your doctor will be able to guide you when you need to go to the hospital, taking into account your signs of labor and your individual situation. Realizing that you're going into labor can bring up a variety of feelings, from excitement to anxiety. Try to remain calm and not panic. Agree in advance with your partner or one of your friends that when labor begins, they will keep you company at home, and when the time comes, they will take you to the maternity hospital. Several ways to ease discomfort during the latent phase of labor:
- take a walk;
- try relaxation or breathing techniques that were taught to you in childbirth preparation courses;
- change position;
- take a shower or bath.
Call your doctor if you notice that your contractions are getting stronger or more frequent, if your water breaks, or if you are not sure how to interpret the symptoms you are experiencing.
Phases of labor pains
At each phase, the cervix has a different degree of dilation, the duration and pauses between contractions also differ, as do the woman’s sensations.
First: initial, or hidden
The entire phase lasts a maximum of 8 hours. First, the duration is 15 seconds with a pause of 15–30 minutes. Towards the end of the phase, the duration increases to 45 seconds, and the pause is reduced to 5 minutes.
The degree of dilatation of the cervix at this phase is 3 cm. Girls often skip this stage because it occurs without pain. And if it’s also in a dream, then it’s quite possible to “sleep through it.” The phase gives the expectant mother time to complete her chores, take a shower, have a snack and get ready for the treatment facility.
Second: active
If a woman gives birth for the first time, this phase lasts from 3 to 5 hours. Muscle contractions occur more frequently, last longer, and are painful. Their duration is from 40 to 60 seconds, and the pause is 2 to 5 minutes.
By the end of this stage, the cervix dilates by 7 cm. It’s time to hurry to the maternity hospital - there is no time to hesitate.
Third: transitional, or deceleration phase
This is the phase of full dilatation of the cervix. Muscle contractions last 1 minute, and the pause between them is a maximum of 3 minutes. This means that the birth canal is open and the period of pushing is about to begin.
Girls usually feel pressure on the anus and a desire to empty their bowels, but in reality this is the beginning of pushing.
For those who give birth to their first baby, this stage lasts from half an hour to 2 hours, and multiparous women can skip it altogether.
How to count uterine contractions
Step 1. Note the time of the first contraction. This is important information for the doctor who will provide obstetric care.
Step 2: Take a watch or stopwatch, pen and paper.
Step 3. Note each contraction: when it started and when it ended.
If after a while you cannot count on your own, ask your loved ones. In principle, it is enough to simply remember how much time has passed between the previous and subsequent contractions. After all, the point of such a count is not to miss the moment when there is a pause of 5–10 minutes between them. This is the optimal time to go to the hospital.
Another option is to download a free app on your phone. There is now a large selection of these. The application will automatically calculate and record everything. Your task is only to enter the start and end times of each contraction.
What to pay attention to
If you have true contractions but are still far from your expected due date, this is a sign that they have started prematurely. Call an ambulance and go to the hospital.
If you are giving birth to a second or more child, you shouldn’t wait either - it’s better to come to the maternity hospital in advance, because everything can start much faster than you expect.
Admission to the maternity hospital and preparation for childbirth
With regular contractions, come to the selected maternity hospital and go to the emergency department. There, expectant mothers are met by reception staff - the doctor on duty and the midwife. Don’t worry if there is a long line at the department: they will definitely take you in and won’t make you wait long if your contractions are intense. After examining and assessing the degree of dilatation of the cervix, the doctor will decide on the need for hospitalization.
At this stage, have documents at hand, since without them you will not be able to be processed and examined.
Documentation you will need:
- passport;
- exchange card;
- birth certificate;
- SNILS;
- compulsory medical insurance policy or contract for childbirth.
After registration and completion of the birth history, you will need to sign documents for hospitalization - consent to examinations, examinations and surveys.
Don't try to get to the maternity hospital as early as possible. From experience, I can say that it is much calmer and more pleasant to spend time on the eve of giving birth at home with loved ones. For many women, the hospital atmosphere creates anxiety and worsens well-being, and at a time like this, it is more important than ever to remain optimistic. Therefore, when the contractions are still less painful, try to calm down, collect your thoughts and relax as much as possible.
After registration you will need to change clothes. You will have a set of personal belongings that are prepared in advance. My colleague Anastasia Safina described in detail what exactly you need to take in the article “What to take to the maternity hospital?”
Upon admission to the maternity hospital, you will most likely be offered an ultrasound examination, which will show:
- position of the baby in the uterus;
- approximate height and weight of the child, compliance with the gestational age;
- volume of amniotic fluid;
- cervical length;
- whether there is an entanglement of the umbilical cord;
- are there any disturbances in uteroplacental blood flow;
- thickness of the placenta.
Ultrasound is not performed directly during childbirth. When intense contractions begin, cardiotocography (CTG) will help monitor the baby's condition. This test evaluates the baby's heart rate and the force of contraction of the myometrium (the muscle layer of the uterus). It will also prevent oxygen deficiency and, as a consequence, fetal hypoxia (for example, against the background of weak labor).
