Roots to life - Having your baby!
Marianne Theuma follows the course of labour of expectant mothers
In our last article we saw how the muscles in the uterus work. Like all other muscles in the body they harden, they expand and they shorten or contract. Hence we refer to "contractions" as opposed to "labour pains" when we refer to the work of the uterine muscles involved in childbirth. In everyday life, each movement in the body involves exactly this kind of work performed by other muscles used in the different tasks we choose to do as we go along with our daily chores. Muscles, wherever they are, are designed to be able to do just that, and we normally accept it as a matter-of-fact without questioning.
The same applies to the numerous muscles in the uterus. They work throughout a woman's life, but definitely work their hardest during the birth of a baby. Their mission is to open the way for the baby's entry into the world, when both the mother and the baby are ready. When the time is ripe, hormones start preparing the cervix, the mother's doorway, by softening the muscles, often without the mother's knowledge. This may start several days before the actual birth. Softening the muscles before they start to work is highly practical and useful, as in due time, work on the cervical muscles will be much more effective and the muscles will give way much more easily when they are soft, rather than hard. Labour, in fact, may be much easier on the mother if she waits for this to happen slowly but surely in the natural way. Her reward for waiting is usually a labour and a birth experience which is relatively shorter and easier, certainly a gift given by nature. Some mothers become impatient by the end of the pregnancy and may be tempted to be saved the last couple of weeks by asking to be induced, accelerating the last weeks' final work into a shorter time frame. If this is done without an acceptable reason for the mother or her baby's safety, it may not be a particularly good idea, as it only causes unnecessary pain and a prolonged labour due to a still hard cervix, which often results in complications needing even more intervention.
'The show'
At a point in time, the slow ripening and softening of the cervix causes the mucous plug in the cervix to fall. This pinkish jelly-like plug has been in the cervix throughout the pregnancy to provide more protection to the baby. The mother may be surprised to see it, and make take it as a sign that she will be having her baby in a few hours. Nothing is further from the truth, as the "show", as it is popularly known, only tells the mother that the hormones, now present in her system, have started to soften the cervix, which is certainly good news, but is not a sign of imminent labour. It is quite common for the contractions of real labour to start even a week or more after this happens. The mother needs to wait for more signs from her body before she decides that this is it! In normal circumstances, the show is not a sign for the mother to go to hospital, but is a sure sign that the waiting game has started! The virtue of patience is certainly an asset to own, at this point in time.
The next step to be expected is that work on the uterine muscles may start at any time. Most mothers feel tightenings in the lower belly, often mistaking them for gas pains. Others feel them in the lower back. Some mothers feel both, usually starting at the back and radiating to the front. Soon enough, in real labour, the mother starts noticing a pattern in the frequency and strength of the contractions. Usually the pattern is in proportion: the closer together they get, the longer and stronger they become. This is real, established labour.
Timing contractions
When the mother is still at home, the strength of the contraction, which is the best indication of established labour, may only be measured by the mother's perception of pain. The pain threshold is very different from one mother to another. Though certainly not a definite indication, timing contractions is useful as it gives the mother and her partner a rough idea of what is happening, and may help them decide whether it is time to go to hospital or not. Strictly speaking, the strength of the contraction is considered a better indication to go by, though first time mothers, unlike the experienced ones, may not have an idea what strength to expect, and may welcome the more tangible help of a stopwatch or clock. At first, contractions only last a few seconds, while hours later, the "good" strong ones may be as long as one minute, which could seem quite long. Daddies please note! At first contractions are far apart, then as labour gets established, they may become as close together as five minutes or even less.
Usually, waiting till the contractions are one minute long, five minutes apart, and strong - whatever that means to the first-time or multiparous mother - is a good time to go to hospital. More detail will be given in future articles.
Rupture of membranes
The "breaking of waters" may happen naturally at any time during labour or even before the real contractions start. Some mothers in late pregnancy may be going along their usual way, only to be surprised with a gush of water streaming down their legs! It is useful for the mother to know what to do when this happens. The basic thing is to notice the colour of the water. It is usually clear and pinkish. Though not necessarily so, green waters may be a sign of distress in the baby. Whether pink, and more so if green, the mother is advised to go to hospital immediately for checking. Some birthing methods advise checking by a midwife for could-be complications, while other methods advise no vaginal checks at all to prevent infection, while using other ways to monitor the baby and the mother. It is good to know also, that contrary to a well-known old-wives tale, rupture of the membrane does not mean that the birth will be "dry" and so more painful. The baby's surrounding water, or amniotic fluid, is constantly being manufactured by the placenta.
A vaginal check tells the midwife whether the bag of waters has ruptured. Some midwives choose to rupture the membranes artificially during a check, though the latest trend is to avoid this. It is known that the intact membranes give the baby protection in many ways. The longer this protection is kept up, especially in a hospital environment, the better. Management and procedures differ from one hospital to another. After vital checks are performed, some prefer to send the mother home and let nature take its course, while others prefer to keep the mother in hospital, requiring that the baby be born within twenty-four hours. It is a good idea for the mother to discuss the path that will be taken in her case, with her attending midwife.
• Ms Theuma is a qualified childbirth educator and school teacher. A mother of three children and a grandparent, she directs a school for parents, In the Family Way, based at Marsascala.
The school offers courses and support for parents, covering various related subjects, from pregnancy to primary and early secondary school age.
The same applies to the numerous muscles in the uterus. They work throughout a woman's life, but definitely work their hardest during the birth of a baby. Their mission is to open the way for the baby's entry into the world, when both the mother and the baby are ready. When the time is ripe, hormones start preparing the cervix, the mother's doorway, by softening the muscles, often without the mother's knowledge. This may start several days before the actual birth. Softening the muscles before they start to work is highly practical and useful, as in due time, work on the cervical muscles will be much more effective and the muscles will give way much more easily when they are soft, rather than hard. Labour, in fact, may be much easier on the mother if she waits for this to happen slowly but surely in the natural way. Her reward for waiting is usually a labour and a birth experience which is relatively shorter and easier, certainly a gift given by nature. Some mothers become impatient by the end of the pregnancy and may be tempted to be saved the last couple of weeks by asking to be induced, accelerating the last weeks' final work into a shorter time frame. If this is done without an acceptable reason for the mother or her baby's safety, it may not be a particularly good idea, as it only causes unnecessary pain and a prolonged labour due to a still hard cervix, which often results in complications needing even more intervention.
'The show'
At a point in time, the slow ripening and softening of the cervix causes the mucous plug in the cervix to fall. This pinkish jelly-like plug has been in the cervix throughout the pregnancy to provide more protection to the baby. The mother may be surprised to see it, and make take it as a sign that she will be having her baby in a few hours. Nothing is further from the truth, as the "show", as it is popularly known, only tells the mother that the hormones, now present in her system, have started to soften the cervix, which is certainly good news, but is not a sign of imminent labour. It is quite common for the contractions of real labour to start even a week or more after this happens. The mother needs to wait for more signs from her body before she decides that this is it! In normal circumstances, the show is not a sign for the mother to go to hospital, but is a sure sign that the waiting game has started! The virtue of patience is certainly an asset to own, at this point in time.
The next step to be expected is that work on the uterine muscles may start at any time. Most mothers feel tightenings in the lower belly, often mistaking them for gas pains. Others feel them in the lower back. Some mothers feel both, usually starting at the back and radiating to the front. Soon enough, in real labour, the mother starts noticing a pattern in the frequency and strength of the contractions. Usually the pattern is in proportion: the closer together they get, the longer and stronger they become. This is real, established labour.
Timing contractions
When the mother is still at home, the strength of the contraction, which is the best indication of established labour, may only be measured by the mother's perception of pain. The pain threshold is very different from one mother to another. Though certainly not a definite indication, timing contractions is useful as it gives the mother and her partner a rough idea of what is happening, and may help them decide whether it is time to go to hospital or not. Strictly speaking, the strength of the contraction is considered a better indication to go by, though first time mothers, unlike the experienced ones, may not have an idea what strength to expect, and may welcome the more tangible help of a stopwatch or clock. At first, contractions only last a few seconds, while hours later, the "good" strong ones may be as long as one minute, which could seem quite long. Daddies please note! At first contractions are far apart, then as labour gets established, they may become as close together as five minutes or even less.
Usually, waiting till the contractions are one minute long, five minutes apart, and strong - whatever that means to the first-time or multiparous mother - is a good time to go to hospital. More detail will be given in future articles.
Rupture of membranes
The "breaking of waters" may happen naturally at any time during labour or even before the real contractions start. Some mothers in late pregnancy may be going along their usual way, only to be surprised with a gush of water streaming down their legs! It is useful for the mother to know what to do when this happens. The basic thing is to notice the colour of the water. It is usually clear and pinkish. Though not necessarily so, green waters may be a sign of distress in the baby. Whether pink, and more so if green, the mother is advised to go to hospital immediately for checking. Some birthing methods advise checking by a midwife for could-be complications, while other methods advise no vaginal checks at all to prevent infection, while using other ways to monitor the baby and the mother. It is good to know also, that contrary to a well-known old-wives tale, rupture of the membrane does not mean that the birth will be "dry" and so more painful. The baby's surrounding water, or amniotic fluid, is constantly being manufactured by the placenta.
A vaginal check tells the midwife whether the bag of waters has ruptured. Some midwives choose to rupture the membranes artificially during a check, though the latest trend is to avoid this. It is known that the intact membranes give the baby protection in many ways. The longer this protection is kept up, especially in a hospital environment, the better. Management and procedures differ from one hospital to another. After vital checks are performed, some prefer to send the mother home and let nature take its course, while others prefer to keep the mother in hospital, requiring that the baby be born within twenty-four hours. It is a good idea for the mother to discuss the path that will be taken in her case, with her attending midwife.
• Ms Theuma is a qualified childbirth educator and school teacher. A mother of three children and a grandparent, she directs a school for parents, In the Family Way, based at Marsascala.
The school offers courses and support for parents, covering various related subjects, from pregnancy to primary and early secondary school age.