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Worth the labour
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How does an expecting mother overcome anxiety relating to labour?
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USHA AND Ranjith look forward to the birth of their child. It is the culmination of months of hopes and dreams. Finally the time has arrived to go through the process of labour and be rewarded with the birth of a very wanted baby. Usha is beset with mixed feelings. She is excited, but at the same time, she is filled with trepidation. After all, it is a mysterious process and the terms `labour' and `pains' evoke a sense of anxiety. It is important for her to understand the process so that she can undergo labour with the least amount of apprehension.
Labour is the process by which contractions of a pregnant uterus cause birth. During labour, the mouth of the uterus (cervix) thins. This is termed effacement. The gradual opening of the cervix is called dilatation. The dilatation progresses from a closed cervix (0 cm) or a partially open cervix, to full dilatation (10cm) in the first stage of labour. The baby moves down the birth canal and is born, in the second stage of labour. Delivery of the placenta is the last or third stage of labour.
Every labour is different. How long it lasts and how it progresses differs from woman to woman and from birth to birth. There are, however, general guidelines for labour that your obstetrician uses to decide whether it is progressing normally. If it is not progressing normally, you may need medical assistance or a caesarean delivery.
A pregnancy usually lasts 280 days or 40 weeks. Once you reach the 37th week of your pregnancy, you are considered to be at term. If any signs of labour occur before 37 weeks of pregnancy, the labour is considered preterm. You should see your obstetrician immediately if you have any signs or symptoms of labour before 37 weeks.
What triggers labour?
No one knows exactly what starts the labour process. However, we do know that certain hormones, such as oxytocin and prostaglandins, cause uterine contractions and the thinning of the cervix. Hormones from the baby also trigger labour by stimulating the mother's hormone production.
False labour: Sometimes, knowing when labour has begun is difficult. You may be admitted to the hospital and then sent home if your labour does not progress — — that is, if your cervix does not efface (thin out) or dilate. This is called false labour.
True labour: The beginning of labour is defined as the beginning of opening and thinning of the cervix caused by regular uterine contractions. There are some general signs when a woman's body is preparing for labour:
* Passage of a small amount of blood-tinged mucus from the vagina, called "show" or "the mucus plug". This may occur a day to a few days before labour begins.
The two signs that indicate that labour has begun are:
* Regular, strong contractions that last more than 30 seconds and cause the cervix to start to thin and open.
* Breaking of the bag of waters (the amniotic sac).
If either of these happens, contact your obstetrician right away and go to the hospital. Do not eat or drink anything if you think labour has started, until your obstetrician gives you further instructions.
The process of labour
In early labour, or pre-labour, your cervix is 0 to 3 cm dilated. Active labour begins when the cervix is 3 to 4 cm dilated. The contractions usually become stronger and more frequent, and the cervix dilates faster.
Generally, woman in her first labour may dilate about 1 cm per hour during the active phase of labour. If you have had a baby before, you usually progress faster.
After the cervix is fully dilated, you will be encouraged to push the baby down the birth canal. After the baby is delivered, the placenta will be expelled.
Ensuring that your labour is normal requires skill, experience, and careful monitoring by your obstetrician. Your vital signs, your uterine contractions, and your baby's heart rate will be checked throughout labour. They help your obstetrician detect problems and take appropriate action.
GITA ARJUN
(The author is a Chennai-based obstetrician and gynaecologist with a special interest in women's health issues)
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