What sensations during childbirth and contractions. Last contraction: contractions of the postpartum period. Description and functions of contractions

What sensations indicate the approach of childbirth

From the grip before childbirth - periodic spasms of the muscles of the uterus, characterized by increasing dynamics and intensity. Understanding the mechanism of this process and its purpose will help overcome fear and act consciously during childbirth.

IN contemporary practice obstetrics, childbirth begins precisely with the appearance of rhythmic uterine contractions increasing intensity. It is important to know the difference between true contractions in order to be in the hospital in a timely manner.

As obstetricians note, the behavior and mood of the woman in labor has a noticeable effect on the course of childbirth. The right attitude gives a woman an understanding of the processes taking place in her body. Contractions are indeed one of the most difficult periods in childbirth, but they are the force that contributes to the birth of a child. Therefore, they should be taken as a natural state.

Training, precursor or prenatal contractions

From the fifth month of pregnancy, expectant mothers may feel episodic tension in the abdomen. The uterus contracts for 1-2 minutes and relaxes. If at this moment you put your hand on your stomach, you can feel that it has become hard. Often this condition is described by pregnant women as "petrification" of the uterus ( stone belly). These are training contractions or Braxton Hicks contractions: they can occur constantly until the end of pregnancy. Their characteristic features are irregular, short duration, painless.

The nature of their appearance is associated with the process of gradual preparation of the body for childbirth, but the exact causes of occurrence have not yet been clarified. In addition, there is an opinion that “training” is provoked by increased physical and emotional activity, stress, fatigue, and they can also be a response of the muscles of the uterus to fetal movements or sexual intercourse. The frequency is individual - from once every few days to several times per hour. Some women do not feel them at all.

The inconvenience caused by false contractions is easily eliminated. You need to lie down or change your position. Braxton Hicks contractions do not open the cervix and do not cause any harm to the fetus, so they should be considered only as one of the natural moments of pregnancy.

Approximately from the 38th week of pregnancy, the period of precursors begins. Along with the omission of the bottom of the uterus, weight loss, an increase in the amount of discharge and other processes noticeable for a pregnant woman, it is distinguished by the appearance of precursor or false contractions.

Also, like training ones, they do not open the cervix of the uterus and do not threaten pregnancy, although they are more vivid in terms of the strength of sensations and may well inspire excitement in primiparous women. Precursor contractions have intervals that do not decrease over time, and the strength of the spasms that compress the uterus does not increase. A warm bath, sleep, or snack can help relieve these contractions.

It is impossible to stop real or labor pains with the help of rest or change of position. Contractions appear involuntarily, under the influence of complex hormonal processes in the body, and are not amenable to any control on the part of the woman in labor. Their frequency and intensity is increasing. In the initial phase of labor, contractions are short, lasting about 20 seconds, and repeating every 15-20 minutes. By the time of perfect opening of the neck, the interval decreases to 2-3 minutes, and the duration of contractions increases to 60 seconds.

In order to make sure that real contractions begin, it is worth correctly calculating the interval between them. As a rule, false contractions are chaotic, the interval between the first and second can be 40 minutes, between the second and third - 30 minutes, etc. While in the process of real contractions, the interval becomes stable, and the length of contractions increases.

Description and functions of contractions

The contraction is a wave-like movement of the muscles of the uterus in the direction from the bottom to the pharynx. With each spasm, the neck softens, stretches, becomes less convex, and, thinning, gradually opens. Having reached a disclosure of 10-12 cm, it is completely smoothed out, forming a birth canal that is one with the walls of the vagina.

Visualizing labor pains can help you cope with pain and uncontrollable emotions.

In each period of childbirth, the spastic movements of the organ are aimed at achieving a certain physiological result.

1. In the first period, contractions provide disclosure.
2. In the second, along with attempts, the function of contractions is to expel the fetus from the uterine cavity and move it along the birth canal.
3. In the early postpartum period, the pulsation of the uterine muscles promotes separation of the placenta and prevents bleeding.
4. In the late postpartum period, spasms of the muscles of the uterus return the organ to its previous size.

After that, there are attempts - an active contraction of the muscles of the press and the diaphragm (duration 10-15 s.). Arising reflexively, attempts contribute to the advancement of the child through the birth canal.

Phases and duration of contractions before childbirth

There are several types: latent, active and deceleration phase. Each of them differs in the duration of the period, intervals and the contractions themselves.

The given parameters can be considered averaged and applicable to the normal course of labor activity. real time contractions strongly depends on whether the woman is giving birth for the first time or is it repeated births, her physical and psychological readiness, anatomical features of the body and other factors.

Contractions before the first and subsequent births

However, a common factor affecting the duration of contractions is the experience of previous births. This refers to a kind of "memory" of the body, which determines the differences in the course of certain processes. In the second and subsequent births, the birth canal opens on average 4 hours faster than in the first. This is due to the fact that in women giving birth to a second or third child, the internal and external os open at the same time. At the first birth, the opening occurs sequentially - from the inside to the outside, which increases the time of contractions.

The nature of contractions before repeated births may also differ: women in labor note their intensity and more active dynamics.

The factor smoothing out the differences between the first and subsequent births is the time interval separating them. The probability of long-term disclosure is higher if more than 8-10 years have passed since the birth of the first child.

In articles on the topics of motherhood and pregnancy, there is information that contractions before the second birth often come not before, but after the water has broken, and this happens not at 40, but at 38 weeks. Such options are not excluded, but there is no scientifically confirmed data indicating a direct connection between the serial number of childbirth and the nature of their onset.

It must be understood that the described scenarios are only options, and by no means an axiom. Each birth is very individual, and their course is a multifactorial process.

Feelings in contractions

In order to determine the onset of contractions, you should pay attention to the nature of the pain: before childbirth, they are similar to menstrual. Pulls the lower abdomen and lower back. There may be pressure, a feeling of fullness, heaviness. Here it is more appropriate to talk about discomfort, not pain. Soreness occurs later, with an increase in contractions. It causes the tension of the uterine ligaments and the opening of the neck.

The localization of sensations is quite subjective: in some women in labor, the spasm has a girdle character, its spread can be clearly associated with a wave that rolls from the bottom of the uterus or from one of the sides and covers the entire abdomen, in others the pain originates in the lumbar region, in others - directly in the uterus .

However, in the vast majority of cases, women experience the peak of spasm as a contraction, strong contraction, "grasping", which follows from the very name of the fight.

Is it possible to miss contractions?

Not all women in labor have uterine muscle tension that causes unbearable pain. How a woman tolerates it depends on the threshold of sensitivity, emotional maturity and special preparation for childbirth. Someone endures contractions, for someone they are too painful to hold back a cry. But it is impossible not to feel contractions. If they are not there, then there is no labor activity, which is an essential condition physiological childbirth.

Some uncertainty in the expectations of expectant mothers can be introduced by the stories of women who have already given birth, in whom childbirth did not begin with contractions, but with a discharge of water. It must be understood that such a scenario in obstetrics is considered a deviation. Normally, at the peak of one of the contractions, intrauterine pressure pulls and tears the membrane of the fetal bladder, pouring occurs amniotic fluid.

Spontaneous discharge of water is called premature. This situation requires the immediate intervention of a doctor; it is unacceptable to wait for contractions at home.

Mechanism of action at the onset of contractions

It is important to understand what to do at home in the event of contractions and an approaching birth. A few recommendations:

• First, don't panic. Lack of concentration and unconstructive emotions interfere with concentration, lead to unreasonable actions.
• Feeling the onset of contractions, you need to determine their type: are they really contractions before childbirth or harbingers. To do this, you need to use a stopwatch or special applications in mobile phone note the time and calculate the duration of intervals and contractions. If the frequency and duration do not increase, then there is nothing to worry about. Harbingers usually subside completely within two hours.
• If spasms have become regular, the time of pauses between them is clearly defined, you can start going to the hospital. Departure should be planned in such a way as to be examined by a doctor by the time when the frequency of contractions reaches 10 minutes. At normal course childbirth, this will happen approximately no earlier than after 7 hours. Therefore, if the contractions began at night, you should try to get at least a little rest.
• You can take a shower hygiene procedures.
• In case of repeated births, you should go to the hospital immediately after the contractions become regular, without waiting for the contraction of their interval.

The pregnant woman waits for the appearance of contractions and at the same time experiences animal fear in front of them. Popular rumor ascribes to this stage of childbirth the most powerful pain. If experienced mothers go to repeated or third births and already have a good idea of ​​​​what awaits them, then women who are looking forward to the appearance of their first child are at a loss. We will talk about the features and sensations, the timing and duration of contractions in women giving birth for the first time in this article.

How does it all start?

Childbirth is the natural process of completing childbearing. Nature gave him exactly 10 lunar months in order to become a real man from one crushing cell, just still very small. Childbirth can begin both on time and earlier or later. According to statistics, the onset of labor in nulliparous women usually occurs either at 39-40 weeks or at 40-42 weeks of pregnancy. The date indicated in exchange card- only a guideline for a doctor and a pregnant woman, only 5% of pregnant women give birth strictly in the PDR.

Childbirth can start in different ways. From the discharge of water, from the exit of the mucous plug, from the beginning of rhythmic contractions of the uterus - contractions. The latter option is considered the most preferable, since premature effusion water always complicates childbirth, even if they occur right on time. It is from contractions that the process of childbirth manifests itself in the vast majority of expectant mothers. Only 10% of women start giving birth when the water breaks.

Contractions are called contractions of the muscles of the uterus. Labor pains occur simultaneously with the opening of the cervix. This dense muscle ring was tightly closed throughout the pregnancy, and the cervical canal inside it was closed with a mucous plug. The beginning of the opening of the neck is accompanied by contractions that grow and become stronger as it expands.

Contractions begin suddenly, but develop gradually. True labor pains may be preceded by false, training ones. They can be observed as early as the 20th week of pregnancy, or appear later, or not appear at all. But before giving birth - a couple of weeks or less - almost all women can feel a short-term uterine tension from time to time. That's what it is preparatory work female body before childbirth.

The purpose of labor contractions is obvious - at the first stage, they are needed in order for the cervix to open and free the passage for the child, who will have to go through the birth canal and be born. They compress the space inside the uterus, leading to rupture of the fetal bladder; in the stage of active contractions, the waters depart and this is considered quite timely. Rhythmic contractions of the uterus slightly "push" the baby to the exit. His time has come, there is no need to remain in the mother's womb any longer.

How to understand that childbirth has begun?

The first birth is always a lot of questions, the main one of which is how to recognize whether the birth has begun and whether it is time to go to the hospital. On this subject, experienced obstetricians have an old joke that says that if a woman has doubts whether she is giving birth, then she does not give birth, since it is impossible to confuse childbirth and training uterine contractions. But mostly women who are pregnant for the second or third time agree with obstetricians in this, they know for sure that the doctors are not disingenuous.

And it seems to a primiparous woman that at any moment she can miss something important and be late for the hospital. As already mentioned, a few days before giving birth female body begins to prepare for the upcoming event. In the cells of the uterus, the amount of a special protein, actomyosin, begins to increase. It is responsible for the ability of cells to contract. At the same time, the placenta and pituitary gland of a woman begin to produce oxytocin and relaxin. The first hormone increases the contractility of the female reproductive organ, and the second is responsible for softening the ligamentous apparatus, because during childbirth the uterus will change shape.

With these changes, the final preparatory stage, during which women are anxiously trying to find some “harbingers” in themselves, about which she read on women's forums, and which can make it clear that childbirth is just around the corner. Harbingers include anxiety, mild depression, mood swings, sleep disturbance, insomnia, more active training contractions. They appear like this: the stomach turns to stone, slightly “sips” in the sides and lower abdomen (due to the tension of the ligaments), and then they pass and can be repeated after half an hour, and after 5 hours, and after a day.

Contractions-harbingers do not differ in regularity, they come on their own and disappear in the same way. A woman can easily take off discomfort, just taking a shower, drinking a glass of milk or a No-Shpy tablet, or even changing the position of the body. With a training bout, a pregnant woman can go to bed and doze off quite successfully.

Is it possible to skip the moment of the onset of real contractions? Obviously not. After all, true contractions are rhythmic from the very beginning, they are repeated at regular intervals, the pain is no longer pulling, but light girdle in nature, the back and lower back are drawn into it, the pain increases with each contraction. You won’t be able to fall asleep, the No-Shpy tablet or the shower won’t have any effect. If labor pains have begun, it is unlikely that it will be possible to stop them or weaken them. The duration of the fight will be the same each time. And this is the main difference between "harbingers" and real fights.

Latent stage - sensations

As soon as a woman notices that the tension of the uterus becomes regular and obeys a certain rhythm, we can say that the first stage of childbirth is already underway. It is called latent (hidden).

If not spotting, the waters have not broken, there is no need to rush to call an ambulance and urgently rush to the maternity hospital with special signals. The latent period at the first birth is usually the longest. It lasts up to 10-12 hours, on average, about 7-8 hours, and therefore there is plenty of time to put your nerves and feelings in order, psychologically tune in to a positive outcome of events and check things and documents collected in the maternity hospital in advance.

During this period, the pain is moderate, increasing gradually. At the very beginning, they are felt as habitual pains during menstruation, then they intensify, but the character remains the same. During pregnancy, women are taught proper breathing in childbirth. The latent period - it's time to start applying theoretical knowledge in practice - breathing correctly, doing deep breaths and exhale to relax as much as possible. You can walk, sing, chat. Lying in one position horizontally is not worth it.

Feelings are undulating in nature. The fight usually "originates" in the back, covers the lower back and goes first to the bottom, and then to the top of the abdomen. Then the tension subsides, the woman gets the opportunity to rest a bit until the next fight.

During the latent phase, the contractions become longer. The very first signs of labor pains can be determined by measuring the duration of the spasm and the interval between episodes of spasms. In this first period, the average duration of one contraction from the moment of tension to the moment of relaxation is 20-25 seconds. Spasms are repeated at first once every half an hour, then once every 20 minutes.

By the end of the latent stage of labor, contractions last 25 seconds and repeat every 10-15 minutes. It is on this optimistic note that you should arrive at the hospital. The cervix at this point reaches a dilatation of 3 centimeters. The next phase of contractions is active, it should take place in the conditions of the maternity home. This will make everyone safer.

active phase

After opening the cervix by 3 centimeters, the contractions become quite painful, and in time they begin to occur more often. The duration of the contraction is 25-60 seconds, between contractions takes place within 3 minutes.

If you breathe correctly, keep calm, massage the sacral zone, the second stage of contractions can be experienced more easily.

Contractions at this stage look like a protracted spasm, the peak of the contraction becomes long. Usually at this stage, normal delivery the waters come off.

The duration of such a period is 3-5 hours. At this time, it is desirable for a woman to be under the supervision of a doctor. Usually at this stage, they begin to monitor the condition of the fetus with the help of CTG, the woman is already in the antenatal ward.

Behind active period contractions, the uterus opens up to an average of 7 centimeters. This is already quite a lot, but not yet enough for the baby's head to pass.

Transition period

This period is final. After him, attempts start - the shortest period of childbirth. Transitional contractions are also called the deceleration phase. The spasms themselves reach their maximum value for the entire period of childbirth. Each contraction lasts at least a minute and spasms are repeated every 2-3 minutes.

In general, the transitional period lasts from half an hour to an hour and a half. During this time, the cervix opens up to 10-12 centimeters (depending on the size of the pelvis). This dilation is considered complete as it allows the baby's head to pass through.

IN transition period a woman begins to feel a pronounced pressure on the bottom, as it is usually felt if you really want to empty your intestines.

But you can't push yet. The obstetrician will give the appropriate command already in the second phase of childbirth - in attempts.

If a woman in labor is not under the constant control of a doctor, then a feeling of pressure and a great desire to go to the toilet in a big way is a signal to call the medical staff and go to the delivery room.

What will happen next?

Next, the pushing starts. A woman needs to remain calm, breathe correctly, do not exhale sharply until the end of the attempt, push only at the command of the obstetrician. During attempts, the baby will turn, bend his head, he also tries very hard to be born as soon as possible. Wrong behavior of a woman in this situation can lead to a child getting birth injury, the emergence acute hypoxia extremely dangerous for him.

If you push on command, do not scream, do not bring your legs together, do not pinch your perineum, breathe deeply, holding your breath at the time of the attempt and making a long smooth exhalation at the end of the attempt, then the child can be born in the very near future.

The period of attempts under a favorable set of circumstances and the impeccable behavior of the woman in labor can last 20-30 minutes. Less often, primiparas push for an hour and a half, and it is very rare that the period of attempts is extended to 2 hours.

As soon as the baby is born, the woman can relax. Ahead is still the birth of the placenta, but it will no longer be so painful and unpleasant, especially since the baby is being applied to the breast and the mother can already examine the baby, hug, so for many, the birth of the placenta is relatively easy. This period takes from 20 to 40 minutes.

This completes the birth. The woman is sent to the postpartum ward for rest, the baby is sent to the children's department in order to be processed, washed, and examined by neonatologists. They will meet in a few hours, if there are no contraindications either from obstetricians or from children's doctors.

Features of the first birth

Very often you can hear the opinion that the first birth is always harder and more painful than the next. To some extent, it is true, but not in terms of pain, but rather because of the fear that a woman in labor experiences during her first birth. Lack of birth experience makes it difficult for a woman to choose comfortable posture during contractions, from time to time she forgets what she was taught in preparatory courses in antenatal clinic. At times like these, some people start to panic. From the point of view of psychological readiness, women who have given birth earlier behave more disciplined in subsequent births.

The birth canal of a primiparous woman is narrower and less elastic. They are more difficult to stretch, and therefore even attempts are felt differently and last longer. The cervix also takes longer to open, and with that physiological aspect nothing can be done.

The first births are more often accompanied by complications. It cannot be said that during the second birth, unforeseen difficulties will not appear, there are always chances, but it is the primiparas who most often face such a phenomenon as primary or secondary weakness of the birth forces, when contractions do not lead to the opening of the cervix, and attempts do not move the baby forward . In primiparas, ruptures or tears of the perineum and cervix are more common.

Complications to a lesser extent depend on the physiology of the primogeniture, to a greater extent - this is a consequence of the erroneous actions of the woman in labor, disobedience to the commands of the midwife or doctor leading the birth.

Women who are preparing to become mothers for the first time need to prepare for childbirth in advance. Preparation must be consistent and constructive. It is a clear understanding of the upcoming process without unnecessary fear and emotions, as well as understanding the order of their own actions on different stages childbirth will be the key to a successful delivery.

You need to start preparing from the middle of pregnancy. Already at week 20, it makes sense to enroll in a school for expectant mothers who work in any antenatal clinic. Practicing gynecologists, children's doctors, psychologists will help prepare for the most important event in a woman's life as best as possible. Preparation includes the following information.

Expansion of the theoretical knowledge base about the physiological processes and biomechanism of childbirth.

• Technique training correct breathing during fights and in attempts. To practice breathing exercises during pregnancy, you need to be careful, half-heartedly, but it is recommended to devote at least 10-15 minutes a day to this. Then proper breathing will be natural and when childbirth begins, the woman will not have to remember how and when to inhale and exhale in order to relieve pain and help herself and the child. Breathing techniques help to feel the period of contractions less painfully, because due to the saturation of the body with oxygen, there is an increased production of endorphins, which have an analgesic effect.

• Training in the technique of massage and self-massage. Starting from the latency period and up to the very attempts to relieve tension and pain, massage of the sacral zone will help, acupressure hands and faces. All techniques will be shown and told during the preparation by experienced obstetricians.
• Psychological consultations. They will help shape right attitude to childbirth and labor pain. It has long been noted that the stronger a woman's fear of contractions, the more painful and longer they last. The psychologist will talk about some techniques that allow a woman to be more confident in her strengths and abilities.
• Learning postures that make it easier to survive contractions. IN real childbirth before the period of attempts, a woman will be able to change the position of her body, adjusting to her own feelings.

• Legal and domestic assistance. During the courses, the expectant mother will be told about what benefits and payments she can count on after the birth of the baby, how to apply maternity leave, as well as tell you what things you need to collect in the hospital, when to do it, what documents in without fail will need to be provided during hospitalization in a maternity facility.

If there are no prejudices against partner childbirth, and you want to give birth in the presence of your husband or close relative, you need to take care of this in advance. The spouse or other accompanying person must pass all the necessary tests.

Contractions before childbirth, which are training or false and real labor - how to learn to distinguish between them? At what point should you understand that it's time to go to the hospital or call ambulance? Do I need to have a special education or use any programs to understand what is happening with the body?

Labor pains are something that all expectant mothers are waiting for and at the same time afraid of. It is bad if labor activity begins earlier than 37-38 weeks. For this reason, among other things, you can and should know when you need to urgently see a doctor. Indeed, in many cases, if labor pains have begun, there is time and opportunity to stop them and carry them out if necessary. drug therapy to accelerate the maturation of the lungs of the fetus. It is carried out up to 34-35 weeks. A woman is pricked hormonal drug- dexamethasone. If such preventive measure carried out - the chances of survival and good health the child increases dramatically. And it is likely that after birth there will be no need to keep it on the machine. artificial ventilation lungs, which means there will be no risk of developing pneumonia.

Many women are very afraid of premature birth and a little something - they immediately rush to the doctor. On the one hand, this is correct. But the excitement is not good either. Such anxious expectant mothers often ask why they dream of labor pains, miscarriages, caesarean sections - psychologists answer this that it's all about psychological mood, subconscious fear. Perhaps it makes sense to drink valerian or another natural sedative allowed during pregnancy.

What do labor pains look like, what do women who have already given birth usually write about them? They are usually described as severe menstrual pain. And with the opening of the cervix, it grows more and more. And closer to the attempts appears very desire push. By the way, it is undesirable to do this while the cervical dilatation is less than 10 cm, since tears can form on the cervix and capillaries in the eyes burst. In this case, the midwife should talk about how to breathe properly to relieve discomfort.

But often the onset of labor pains is not so intense. Many women cannot understand that this is possibly uterine hypertonicity, which many expectant mothers are familiar with. Labor pains provoke different sensations, usually it all starts with a petrification of the abdomen and slight pulling sensations below the navel and in the lumbar region. And this is repeated every 15-20 minutes - this is the standard interval between labor pains. There are tangible pain, which only grow and become longer in waves. Pain during labor pains is very individual in its intensity. Of course, a lot depends on the pain threshold of a woman, on her ability to relax, apply some non-drug painkillers, and breathe correctly. The pain and duration of labor pains are drastically reduced in women who experience the majority of labors under epidural anesthesia. Often this type of anesthesia is done not just at the request of a woman for her comfort, but in medical purposes. For example, when it is harmful for a woman to strain, strain, experience severe pain. When a woman is in her first stage of labor, labor pains may not be felt at all, which is a big breakthrough in obstetrics and gynecology.

But not always, even when the expected date of birth of a child comes into the world, a woman immediately begins real labor activity. Labor or true contractions are uterine contractions that cause the cervix to dilate and then pass amniotic fluid. If the doctor states that the opening of the cervix is ​​too slow, it can be either a weakness of labor activity or that these are training contractions (Brexton-Hicks contractions), that is, not childbirth at all.

This feature of the pregnant uterus can manifest itself both at long periods and in the middle of pregnancy. And on small terms such contractions, in some cases, can contribute to premature opening of the cervix and even provoke premature birth. If a woman often has uterine contractions, even painless ones, the doctor does not try to recognize labor or training contractions from the description, but simply conducts gynecological examination for an approximate determination of the consistency and length of the cervix. If necessary, directs to determine these parameters using a vaginal ultrasound probe. There are no signs of labor pains, and this phenomenon It is considered simply a "workout" if the cervix does not react to it in any way. And the neck usually reacts only in those women who have isthmic-cervical insufficiency. With it, there may be excess muscle tissue in the cervical region.

It is actually not difficult to distinguish false contractions from labor, even on your own, if the time for the birth of the baby has already come or is very close.
During childbirth, uterine contractions always:

• regular;
• with increasing pain
• do not pass when using antispasmodics;
• are constantly increasing.

And for Internet users, there is how to determine that labor pains have begun with special programs - contraction counters. The interface is very simple. Press the button when the fight began, again - when it ended. The program will calculate the duration of contractions and their frequency. And based on the data received, he will suggest whether this is a description of labor pains or not, whether it is time to go to the hospital. Doctors directly advise women to go to the hospital if the contractions are regular and the intervals between them are at least 5-7 minutes. But this applies to women who were not planned to have a caesarean section. And if the amniotic fluid has not departed.

What most often scares a young woman preparing to become a mother for the first time (or what scares her most often)? The answer suggests itself - contractions. The anticipation of pain can cause more panic than the pain itself. And the closer the cherished date, the more obtrusively this fear haunts. Most the right remedy get rid of fear - stop hiding from it and hide it from yourself, meet it face to face, "talk" with it. Are you afraid of contractions? So let's figure out what it is.

What are contractions?

In medical terms, birth pains- these are involuntary regular contractions of the uterus, along with attempts related to the birth forces that expel the fetus. Contractions indicate the onset of labor. (In addition to contractions, the onset of labor may be indicated by symptoms such as the rupture of amniotic fluid and the passage of a mucous plug that closes the lumen of the cervix 1; the mucous plug may also come off 2-3 days before birth, so its discharge does not always mean that it is time to go to the hospital). Many works have been written about what, in fact, provokes the onset of childbirth. Diverging in particulars, all researchers agree on the main thing: the organisms of the mother and child, being in close interaction, seem to “agree”, transmit the necessary impulses to each other. Shortly before the onset of labor, the woman's placenta and the baby's pituitary gland begin to produce specific substances (in particular prostaglandins and the hormone oxytocin) that cause uterine muscle contractions, called contractions. During pregnancy, the cervix is ​​tightly closed. With the onset of labor pains, its opening begins: the pharynx of the uterus gradually expands to 10-12 cm in diameter (full disclosure). birth canal preparing to "release" the child from the mother's womb. Intrauterine pressure increases during contractions as the uterus itself shrinks. Ultimately, this leads to rupture of the fetal bladder and the outflow of part of the amniotic fluid. If this coincides in time with the full opening of the uterine pharynx, they speak of a timely outflow of water, but if the uterine pharynx did not open enough at the time of the rupture of the fetal bladder, such an outpouring is called early. The first, preparatory, period of childbirth takes, on average, 12 hours if a woman gives birth for the first time, and 2-4 hours less for those who have not given birth for the first time. At the beginning of the second stage of labor (the period of expulsion of the fetus), attempts are added to the contractions - contractions of the muscles of the abdominal wall and diaphragm. In addition to the fact that they participate in fights and attempts different groups muscles, they have another important difference: contractions are an involuntary and uncontrolled phenomenon, neither their strength nor frequency depend on the woman in labor, while attempts to a certain extent obey her will, she can delay or intensify them.

What to expect from fights?

Feelings during contractions are individual. Sometimes the first tremors are felt in the lumbar region, then spread to the stomach, becoming girdle. Pulling sensations can also occur in the uterus itself, and not in the lumbar region. Pain during contractions(in case you cannot relax or find a comfortable position), resembles the pain that often accompanies menstrual bleeding. However, do not be afraid of contractions. You can often hear from women giving birth that the contractions were either completely painless, or the pain was quite tolerable. First, during contractions, the body releases its own painkillers. In addition, relaxation and proper breathing techniques mastered during pregnancy help to get rid of painful sensations. And finally, there are medicinal methods anesthesia, but they are recommended only in extreme cases because they all have an impact on the baby in one way or another. Real (and not false - see below) "exorcising forces" come at regular intervals. Initially, the intervals between contractions are about half an hour, and sometimes more, the contraction of the uterus itself lasts 5-10 seconds. Gradually, the frequency, intensity and duration of contractions increase. The most intense and long (and sometimes - although not always - painful) are the last contractions preceding the attempts. When to go to the hospital? In the case of the first birth (and if it is not far from the maternity hospital), you can wait until the interval between contractions is reduced to 5-7 minutes. If a clear interval between contractions has not yet been established, but the pain intensifies and becomes longer, then it is still time to go to the hospital. If childbirth is repeated, then with the onset of regular contractions, it is better to immediately go to the hospital (often repeated childbirth is swift, so it is better not to hesitate) 2. With the onset of contractions, mucous discharges with a slight admixture of blood may appear - this is the very mucous plug that "clogged" the entrance to the uterus. Blood (in a small amount) enters the mucus due to the smoothing and opening of the cervix. This is a natural process that should not be frightened, however, when profuse bleeding immediate examination is needed.

True or false?

It should be borne in mind that after the 20th week of pregnancy, some (not all) women experience so-called false contractions, or Braxton-Hicks contractions, and 2-3 weeks before giving birth, women begin to feel premonitory contractions. Neither one nor the other, unlike true contractions, do not lead to the opening of the cervix. Arise pulling sensations in the lower abdomen or in the lower back, the uterus seems to turn to stone - if you put your hand to the stomach, you can clearly feel it. The same thing actually happens when labor pains therefore, "Braxton Hicks" and harbingers often confuse women giving birth for the first time. How to understand whether labor is really starting and it's time to go to the hospital, or is it just false contractions?

• Braxton Hicks contractions, unlike true labor pains, are rare and irregular. Contractions last up to a minute, can be repeated after 4-5 hours.
• False contractions are painless. Walking or warm bath most often help to completely relieve discomfort. The role of false contractions has not yet been fully elucidated. Their appearance is associated with an increase in the excitability of the uterus, it is believed that shortly before the birth, precursor contractions contribute to the softening and shortening of its neck.

What to do during contractions?

It has been noticed that the more a pregnant woman is frightened, the less she knows about what is happening to her and what is ahead of her, the more difficult, longer and more painful her birth is. Even in the very recent past, the phrase "preparation for childbirth" seemed to be complete nonsense in Russia. Fortunately, over the past decade there have been qualitative changes in this area - many courses and schools for preparing for childbirth have been opened, where important event not only future mothers are preparing, but also future fathers. Enough books have been published. And most importantly, the psychology has changed. Now, if not all, then most women understand that it is necessary to prepare for childbirth, as for any difficult and important work. And the main goal of such training is to get rid of fear and pain. What do experts usually recommend in order for contractions to be as easy and painless as possible? As already mentioned, you will not be able to control the frequency and strength of contractions, it does not depend on you. But you can quite help yourself and your child survive these contractions.

• At first, when the contractions have just begun, it is better not to lie down, but to move: this will speed up the process of opening the uterine os, which means it will reduce the time of childbirth.
• Calmly focus and try to find the position of the body in which you are most comfortable.
• Don't be shy if you feel like getting on all fours, lying on a big beach ball, or even…dancing. Believe me, it would never occur to anyone to condemn you for extravagance.
• Circular and swaying movements of the pelvis help relieve tension and reduce pain.
• If possible, try sleeping between contractions, or at least "pretending to sleep" (this will help your body relax).
• You can lie down for ten minutes in the bath with warm water- of course, if you are not alone in the apartment and if necessary, they will be able to help you.
• Lightly stroking the skin of the lower abdomen with fingertips facilitates contractions at the beginning of the journey.
• With the start of the fight, you need to take a breath and direct the movement of the hands from middle line to the sides, while exhaling, the arms move in the opposite direction.
• With increased contractions, strong and frequent pressure helps to relieve pain. thumbs hands on points in the region of the anterior-superior iliac spines (these are the most protruding parts of the pelvis).
• Hands are comfortably placed with palms along the hips. Very useful is the massage of the sacral zone of the spine. It is effective not only at the beginning of contractions, but also all the time while expelling forces are operating in your body.
• As the contractions intensify greater value acquires proper breathing 3

But the most important thing is to tune in, listen to own feelings and ... remember the child. Both of you will hard work, but its result will be a meeting!

Tatyana Kipriyanova

First contractions I recognized with difficulty. The fact is that they were very similar to “training” contractions - the so-called “Brexton-Hicks contractions”, which have haunted me since the 7th month almost every evening. And at first I could not understand whether it was still them or already the beginning of childbirth. It feels like the stomach freezes below, then “lets go”. The intervals between contractions were uneven: sometimes after 20 minutes, sometimes after 5; but still they walked regularly (for more than two hours) - this influenced the decision to still go to the maternity hospital. The first contractions were quite tolerable - just a feeling of slight discomfort. There were significant gaps between them, which made it possible to relax, and I even began to doubt that I was really giving birth. Upon arrival at the maternity hospital, the examination showed a dilatation of the cervix of 1 cm. When the bladder was pierced (by the way, it turned out to be completely painless), the contractions became more effective, the pain became quite noticeable, the intervals were about 5-10 minutes (opening 4 cm). I used to have quite painful periods, and this pain seemed to me similar to menstruation. Over the next hours (the child moved towards the exit) the pain got worse and worse. It was hard. I was helped a little by the lower back massage that my husband did, and the breathing that I read about in books (the medical staff also suggested how to breathe better). When the pain became simply unbearable, attempts began (by the way, I have heard from others more than once that when you feel that the limit has come and there is no more urine to endure pain, this means that everything will end soon). It is easy to recognize attempts - you involuntarily start to push (I could compare this process with the urge to go to the toilet). Attempts are also a painful thing, but the cardiographic apparatus began to listen poorly to the heart of the child, and I had to give birth as soon as possible. Therefore, from about the fifth attempt, I already gave birth to my boy (not without an episiotomy). The whole process took us 12 hours (this was my first birth).

Anna Goncharova

The contractions were like a very strong and painful menstruation. At first they were very weak, and I did not even feel discomfort. It was like a very mild (not painful) spasm inside the abdomen. Painful contractions became only four hours later. And it reminded me most of all of painful menstruation. But it only hurt for about an hour. It was possible to endure, but with difficulty. My husband helped a lot. Even at the most intense moment, the pain was not constant. Everything went about 5 minutes apart. At first, the pain grew rapidly, reached a maximum, and then disappeared just as quickly. Each contraction took two minutes. For three minutes there was no pain at all! The worst thing for me was at the beginning of a new fight - when it still doesn’t hurt, but you understand that everything started all over again. Unpleasant, but tolerable. And only one hour. As soon as I was allowed to push, the pain stopped. I didn’t have any more pains, which are sometimes written about (in the lower back, or somewhere else). By the time the contractions started, I was already in the hospital, so I immediately went to the doctor, and the doctor confirmed that childbirth started. The doctor and midwife told me when to start pushing. It didn't hurt at all, and giving birth didn't hurt at all. Although they made a cut, but I didn’t notice it at all. In general, I remember childbirth very well, but the pain is forgotten very quickly. I remember rather with pleasure - and first of all all sorts of funny moments. There was no feeling of horror and “never again” at all. Maybe because it was good maternity hospital and I gave birth with my husband!

Elizabeth Samoletova

Unfortunately, to childbirth I was psychologically completely unprepared. Therefore, already being in the delivery room (I was in the hospital for preservation), I felt that my stomach hurts a lot, and I got scared. Of course, “theoretically” I knew that I would have contractions, but I had little idea what it was. Of course, there was no question of any calculation of the intervals between contractions (this was suggested by the midwife who was sitting next to the table and writing something). It seemed to me that I was dying, and in a weakening voice I asked for a caesarean section. The midwife laughed merrily for some reason. I ask: "What are you laughing at?" And she told me: “According to my calculations, every second woman in labor asks for a caesarean section.” I suffered for about an hour. I was very offended that the people who were around (nurses, midwives, head of the department and even some trainees to whom I was shown as an example of an “old primipara with a somewhat narrowed pelvis”) took my suffering for granted and as if nothing sometimes they tried to talk to me about some boring everyday topics (they asked where I work, where I got such a strange surname from and what I would name my unborn child). And when my stomach began to hurt especially badly, the midwife came up and mockingly (as it seemed to me then) told me how I should breathe. When the attempts began, it became easier and even, I would say, more interesting, because the “result of labor” was about to appear. He appeared. It contained 3 kg 600 g. Then I apologized to the doctors, but they laughed again and said that almost everyone behaves the way I do. And I decided that next birth I will prepare long and hard.

1 About the symptoms of the onset of labor, their periodization and course can be read in detail in No. 4/2001: L. Komissarov.
2 We also recommend reading the article by N. Zaretskaya in No. 1/2001 of the 9 MONTHS magazine.
3 About the technique of proper breathing during childbirth, which is recommended to be mastered during pregnancy, see: E. Pechnikova, No. 7-8 / 2001.

Having heard about the rapid delivery in the ambulance and even at home, many girls worry about how not to miss the start of labor and arrive on time at the hospital. To do this, there are certain guidelines, knowing which it is very difficult to miss “hour X”. Attention must be paid to your well-being, the frequency of contractions, vaginal discharge and baby movements. How do contractions begin before childbirth in primiparous and multiparous, how to distinguish true from false?

In a few days and sometimes even weeks, the body of a pregnant woman begins to intensively prepare for childbirth. Everything changes, from the nature of the woman’s breathing and well-being to the size of the abdomen and vaginal discharge. Careful Observations behind them will help the expectant mother understand how soon she will give birth.

Signs that contractions are starting before childbirth

Already a few weeks before childbirth, you can notice changes that indicate that the body begins to prepare. In primiparous, these processes are slower, so they are somewhat easier to notice. With repeated upcoming birth many changes can occur at the same time, quickly, so it is a little more difficult to detect them. The main points are as follows.

• The stomach is decreasing. Gradually, the baby descends deep into the small pelvis. At the same time, the bottom of the uterus also shifts behind it, so it seems that the stomach has become a little smaller.
• It becomes easier to breathe. Due to the fact that the bottom of the uterus and the fetus are shifted down, space is freed up for the lungs, which until this moment are in compressed conditions. Therefore, the woman will notice a decrease in shortness of breath and the appearance of ease when breathing.
• Heartburn is reduced. Due to the decrease in pressure on the stomach, the speed and volume of the reflux of its contents into the esophagus decreases, this causes a decrease in the symptoms of burning and pain behind the sternum.
• There is pain in the lower abdomen. Periodic pulling pain in the lower back, sacrum and lower abdomen is a sign early start"practice bouts"
• Pressing sensation in the perineum. The presenting part of the fetus, which descends into the small pelvis, compresses the nerve endings and tissues, causing bursting sensations in the lower abdomen, on the perineum.
• Mucus plug comes off. Throughout pregnancy, a special mucus is in the woman's cervical canal, which protects against the penetration of microbes to the fetus. On the eve of childbirth, as the cervix opens, it begins to come out. Often women notice it as a thick, clear or slightly grayish mucus in the vaginal discharge.
• Diarrhea appears. Nature has long made sure that a woman's body comes prepared for childbirth. There is a natural loosening of the stool no more than a day before contractions.
• Decreased body weight. Usually, on the eve of childbirth, a woman loses 1-2 kg instead of an increase. This is due to a decrease in appetite, a decrease in fluid in the body.

If a woman notices all of these symptoms, or at least some of them, it will be easier for her to recognize contractions before childbirth.

What are "false" abbreviations

"Training contractions" or Bregston-Higs - uterine contractions that are necessary to prepare the birth canal for the baby to enter. Often women confuse them with the onset of labor, especially during the first pregnancy.

Normal

False contractions by their nature do not differ from ordinary ones, but they are less intense, short, irregular. As a result of false contractions, the cervix opens, and the baby descends even more into the pelvic cavity.

The period from the beginning of training contractions to regular labor activity is called preliminary. It can occur in physiological and pathological forms. Normally, a woman may feel the following:

• contractions begin suddenly, more often in the evening or in the morning;
• do not bring general concern to a woman;
• in spite of them future mom can fall asleep;
• decrease after taking antispasmodics;
• irregular - there may be one fight in two minutes, and then one after a 10-20 minute break;
• contractions end as abruptly as they started.

Usually after such training, true contractions begin. The transition can be smooth, but often takes a couple of hours or even days. Also, false contractions can be in several approaches, for example, for two days in the evenings. The way training bouts go before childbirth depends on many factors, for example, on the psychological mood, the presence of diseases.

Pathological

The pathological preliminary period is characterized by the following features:

• the contractions are painful and it seems that they do not go away at all;
• a woman feels pain in the lower abdomen, lower back;
• unpleasant sensations violate the psycho-emotional state;
• unable to sleep or rest;
• pain is not relieved by antispasmodics.

The pathological preliminary period does not lead to structural changes in the cervix, but exhausts the woman and is accompanied by fetal suffering. Therefore, it is important to identify it in time and treat it. Often the pathological preliminary period becomes the reason for caesarean section or bladder puncture without contractions to induce labor.

How to distinguish

An important question is how to identify contractions before childbirth and when to go to the hospital after that.

The intensity of true contractions does not decrease - they only become stronger and more frequent. They can start every 20 minutes, but then they become a multiplicity of ten, five, and then every three to five minutes. At this time, there is often a need for special breath, which will help a woman endure not quite pleasant and even painful sensations. At the peak of the contraction - “like a dog” (frequent shallow breathing), with a decrease in intensity - deeper and calmer. The following table will help distinguish between true and false contractions.

Table - True and false contractions before childbirth

The main difference between true fights and training fights is that the latter come and go again. If the birth has really begun, then the contractions of the uterus become only stronger and more frequent.

Many women wonder how to count contractions. It is customary to determine its duration, and then the number of minutes before a new one. But modern gadgets allow you to use a simple program. Having fixed the time, she presumably gives out whether these are false or true contractions.

When to go to the hospital

Women always have the question of when to go to the hospital if contractions have begun - immediately with the first symptoms or wait some more time.

If the contractions begin, but the water has not yet broken and nothing else worries the pregnant woman, as soon as the contractions of the uterus are every three to five minutes, it is necessary to go to the maternity hospital if it is no more than 30 minutes away. You should immediately go to the hospital in the following cases:

• if water flows- they usually milky, with pathology - yellowish or greenish;
• if vaginal discharge with blood- one of the signs of placental abruption;
• if during contractions there are attempts- a feeling of strong pressure on the perineum, when you want to expel the fetus;
• if the movements have changed dramatically- either became excessively stormy, or stopped altogether;
• if there is a suspicion of pathological "false contractions" - in this case than faster woman apply for medical care, the higher the probability of a favorable outcome;
• if the pressure rises or when other signs of progression of preeclampsia appear (flashing of "flies" before the eyes, severe headache).

What to do when in doubt

Often pregnant women doubt whether they are having contractions or just training. Especially often such situations occur in primiparas. However, you should not be worried or ashamed to seek medical help. When contacting any maternity hospital, the doctor will confirm or deny the onset of labor. It is especially necessary to be vigilant in multiparous women, because often the contractions last for some time inconspicuously, and it is difficult to determine how long the gap is between them. As a result, such mothers barely have time to come to the hospital.

How to relieve pain

Many women are lost and do not know what to do during contractions. In fact, there is nothing special, but the basic rules on how to make childbirth and contractions easier for yourself are as follows:

• learn to breathe correctly in each period of childbirth;
• you can be in a warm shower, directing a stream of water to the sacrum and lower abdomen;
• drink warm tea or water;
• for many, pain at the stage of cervical dilatation decreases when walking;
• you can massage the sacrum - with your hand, with tennis balls;
• exercises in which you need to sit on a gymnastic ball help.

If the contractions are more like false, you can take an antispasmodic drug (for example, No-shpa is safe), after which the pain should become less. Other painkillers should not be taken on their own.

Contractions, like pregnancy itself, are different for every woman. After all, there are no identical organisms. Then the question arises, how to understand that contractions are starting? You should listen to your body, noticing even the slightest changes. With this approach important point it will be difficult to miss, and the woman's reviews confirm this.