home All hormones Whether contractions without relief. How to distinguish false contractions from real ones? Symptoms and signs of false and real contractions during pregnancy. How can a husband help?

Whether contractions without relief. How to distinguish false contractions from real ones? Symptoms and signs of false and real contractions during pregnancy. How can a husband help?

It is believed that the process of contractions is irreversible. If they started during childbirth, then it is not possible to stop or weaken them.

If we talk about external influences, then contractions are really almost impossible to control. But for a variety of reasons they can stop and weaken. In this article we will talk about why labor weakness develops and what to do if this happens.

Causes

During normal childbirth, contractions increase in time and duration, in strength and intensity. This is necessary to open the cervix so that the baby can leave the mother's womb. A situation in which contractions are not strong enough or were regular and then stopped is considered a complication of the birth process. If contractions slow down, they speak of primary labor weakness. If the attempts stop, they speak of secondary weakness of the labor forces.

Cessation of uterine contractions during childbirth is not normal. And the reason for this is hypotension of the smooth muscles of the uterus. Reduced uterine tone can result from:

uterine hypoplasia;
myoma;
endometritis;
uterine anomalies – saddle-shaped or bicornuate uterus;
failure of the uterine tissue due to previous abortions or diagnostic curettages;
scars on the cervix in nulliparous women caused by treatment for erosion;
high level of progesterone in a woman’s body, reduced level of oxytocin;
hypothyroidism, obesity;
the age of the woman giving birth is under 20 years or over 36 years;
gestosis.

Most often, this complication occurs in women who give birth to their first child; during the second or subsequent births, the likelihood of developing weakness of labor forces is minimal, although not completely excluded.

According to statistics, up to 7% of all primiparous women experience weakening contractions or pushing; among multiparous women this occurs in 1.5% of cases. Most often, contractions suddenly stop during premature birth or post-term pregnancy. At risk for sudden weakness of labor forces are women who are carrying a large baby or several babies at the same time, since the walls of the uterus in this case are overstretched.

Stopping labor threatens both women with polyhydramnios and those whose pelvic size does not correspond to the size of the fetal head. Too early release of amniotic fluid is also the cause of weak contractions. In addition, factors such as placenta previa, fetal hypoxia, and malformations of the baby may also affect the condition.

Quite often, doctors cannot determine the reasons for the sudden stop of contractions or their slowdown. With good tests and ideal health, a woman’s labor may slow down for psychogenic reasons.

If the child is unwanted, if there is a strong fear of childbirth, if the woman was very nervous in the last days before giving birth, was in the midst of family conflicts, did not get enough sleep, did not eat well, the development of so-called idiopathic weakness of labor is possible.

Sometimes the cause is too many painkillers, which the woman took on her own initiative, fearing pain during contractions, or administered in the hospital, but the latter is the least likely.

Consequences

If you do nothing and adhere to a wait-and-see approach, the likelihood of negative consequences will increase every hour.

The baby can become infected, because the uterus is already partially open. A long period without water is dangerous due to hypoxia and the death of the child. If weakness occurs in the second half of labor, severe bleeding in the mother may begin, and asphyxia and injuries to the baby are possible.

What to do?

The woman herself just needs to monitor the duration and frequency of contractions in order to notice the lag in time. With pathological weak contractions, the rest intervals between uterine spasms are approximately 2 times longer than normal, and the contraction lags behind the norm in duration.

Everything else should be decided by doctors. First of all, they must understand how far behind the norm the dilation of the cervix during primary contractions is. A decision will then be made on further action. So, sometimes it is enough to insert a catheter into the bladder of a woman in labor or puncture the amniotic sac during polyhydramnios, and labor resumes and then proceeds normally.

If a woman is very tired, she is exhausted, and the baby has no signs of trouble or hypoxia, then the woman in labor can be given sleeping pills so that she gets some sleep, after which labor can resume on its own.

If these measures do not help, the woman can be induced to give birth by injecting oxytocin intravenously, which increases uterine contractility. If stimulation turns out to be useless, then the woman undergoes a caesarean section.

Initially, without stimulation of labor, signs such as fetal hypoxia, a long anhydrous period, and the appearance of blood discharge from the genital tract, indicating possible early placental abruption, will speak in favor of an emergency cesarean section.

How to prevent it?

There is no way to prevent weakness of the labor force. But doctors can do everything that is necessary if a woman turns to the maternity hospital for help in time.

You can learn more about contractions in the following video.

Good afternoon and good mood to everyone reading my blog! One of the most significant events in a woman’s life is the birth of her child. Holiday, birthday! Cake, candles, gifts. But, unfortunately, many women remember their childbirth not as a holiday at all, but as “horror, a nightmare, endless torture.” Why does this depend, and how to survive childbirth and labor without receiving psychological trauma for life?

Knowledge is power!

Despite the fact that childbirth seems to be a natural and programmed process by nature, knowing how it happens makes these few hours much easier.

For example, my friend Alena was sincerely sure that the entire time of labor a woman was exclusively screaming and pushing. She didn’t have the slightest idea about contractions, how they grew, how long they lasted, and other “little things.” At the same time, she was terrified of giving birth (well, that’s right, given such ideas!) and did not want to learn anything about this topic. As a result, during childbirth I was confused, did not listen to the midwife, screamed, clenched and completely exhausted both myself and the child. With good introductory instructions, I had a very difficult birth.

My advice to you: Be sure to study the theoretical material already at the beginning of pregnancy, or better yet before it (while prolactin has not yet chewed out the painted cradle from your brain, and it is able to critically perceive and remember information). Take courses, watch videos, read books. From books I can recommend William and Martha Sears "Waiting for Baby" And Grently Dick-Read "Childbirth without fear".

Breathing and movement

Whatever source of information you choose, the main emphasis there will be on learning proper breathing and postures during childbirth. These are the two most effective ways to get through contractions easier.

The main task of a woman during labor is to relax as much as possible. The harder we squeeze, the worse, longer and more painful the cervix will open. Maximum relaxation, a relaxed mouth, free breathing - these are the main components of pain-free childbirth.

Special courses

If you have never practiced breathing before pregnancy, either separately or during yoga or stretching, be sure to take a class where you will be taught how to control your breathing. These could be specialized courses for pregnant women, or simply training, for example, in body-oriented therapy.

Home practice

In addition to special activities, conduct yourself daily breathing rituals. The easiest way to organize them is in bed in the morning and evening. Set yourself a task to practice a certain type of breathing and try to complete it. For example:

Inhale for 3 counts through your nose, exhale for 4 counts through your mouth. After 20 cycles, lengthen your breathing - inhale through your nose for 5 counts, exhale through your mouth for 7 counts. After another 10 cycles, start breathing very often - inhale through your nose for 1 count, exhale through your mouth for 1 count.
Changes in the depth and duration of breathing. We start with deep and frequent inhalations and exhalations; at this time, you can imagine the sea surf, how the waves powerfully and quickly roll onto the shore. After a minute, we switch to deep and slow inhalations and exhalations - this breathing is similar to ocean waves. Then we breathe “dog” for another minute - very frequent shallow breathing. After this, very slow shallow breathing almost naturally occurs - a feeling as if you are almost not breathing.

During any comfortable breathing, consciously relax individual parts of the body. We lie down and dictate to ourselves “forehead... nasolabial folds... lips... tongue... lower jaw... neck... shoulders...” and so on down to the toes. We try to feel and relax exactly what we pay attention to.
Let's learn to sing. We take a deep breath, and as we exhale we sing the sound “a-a-a” or “mm-mm.” At the same time, both lips and throat should be relaxed. This type of singing helps a lot during strong contractions. The main thing is not to break into a scream, but to sing relaxed and deeply.
Surprisingly, laughter helps you relax. Although, if you understand the mechanics of the process, then laughter is a deep breath and several sharp exhalations. Learn to laugh and relax!

Learning to move

And again - if before pregnancy you were engaged in dancing, or any activity that teaches you to feel and control your body, then you already have an excellent bonus. Listen to your body and move as it tells you.

If there is no such practice, then it is worth finding out how you can and should move during childbirth.

"Kitty." Starting position – rest on your knees and palms. Controlling your breathing, swing your hips to the right and left, then bend your lower back up and down. During childbirth, many people want to lean not on their palms, but on their elbows or forehead, with their arms stretched out in front of them. Helps to relax the stomach, promotes better opening. Another option is to stand on the floor and lean your elbows on the windowsill/bedside table/headboard, while you can sway your hips.

Jumping on a fitball. If there is a large ball in the delivery room, it can significantly facilitate the flow of contractions. We sit down on it fully, our heels rest on the floor. During a contraction, we actively spring, or sway from side to side, monitoring our breathing, then rest. You can rest by leaning back or forward, resting your hands on the bed.

For some women giving birth, the pain is relieved squatting in a fight with knees wide apart. In this case, you need to hold on to the edge of the bed with your hands (that is, do not raise your hands high). Ideally, your husband or midwife should hold your back.

What other ways are there to relieve pain?

In fact, there are a lot of different options. Which one is right for you is unknown. But the more ways you know, the higher the likelihood that the right way will be found.

If the fear of childbirth is strong, and thoughts about death, injury, and the unbearability of the process are stuck in your head, then it is best to go for a consultation with a psychologist. A good psychologist will help you identify the causes of your fears, work through them and set yourself in a positive mood.
If you are very afraid of pain and have negative experience of inappropriate behavior during severe pain, perhaps the best solution would be to pay for epidural anesthesia in advance.
If you believe in God, pray. I experienced this powerful prayer myself. I share with you, dear girls, and then in the comments I expect stories from you whether it helped you or not.

If it is unbearable to endure the long agony of childbirth, let the woman in labor turn in the direction where the sun is in the sky, and if it is night, then the moon. She needs to cross herself three times and say this:
Oh my God,
I, slave (name), stand in front of you.
There are two thrones before me,
On those thrones sit Jesus and the Mother of God,
They look at my tears.
Blessed Mother Theotokos
Holds golden keys
she opens meat caskets,
releases the baby from the womb:
from my flesh, from my hot blood.
Lord, take away the aches,
pinches, visceral pain!
How the Mother of God gave birth without torment, without pain,
open the bone gates.
In the name of the Father and the Son and the Holy Spirit.

Massage (self-massage) of the lower back and sacrum helps most women.
You can think about - husband, mother, sister, close friend.

Watch the video, they describe in detail about breathing, and about poses, and about massage:

I wish all pregnant women an easy birth, healthy babies and good nights!
Subscribe to updates, leave comments, share your favorite articles with friends - there is still a lot of interesting things to come!

However, sometimes the safety of mother and baby can only be ensured with the help of medical intervention.

Changes may occur in your body indicating that a crucial moment is approaching. Women feel them several weeks before giving birth - with varying degrees of intensity - or do not feel them at all.

The duration of the difficult process of bringing a baby into the world can vary greatly. For the first birth, it averages 13 hours, for repeated births - about eight. Doctors consider the beginning of labor to be the dilatation of the cervix with regularly recurring contractions.

Over the past 50 years, the average duration of this process has been halved, asin severe cases, a caesarean section is now performed in a timely manner. Spontaneous contractions often begin at night when the body relaxes. Many children prefer to look at this world for the first time in the dark. According to statistics, most births occur at night.

What exactly causes labor pains is a question to which the answer is not yet known. What is clear is that the child himself plays an important role in this process. But exactly what mechanisms provide the decisive impetus remains a mystery.

Recent studies suggest that contractions begin under the influence of a protein substance produced by the child, the so-called SP-A protein, which is also responsible for the maturation of the lungs.

Consultation with a gynecologist. Braxton Hicks contractions are usually difficult to distinguish from real labor contractions. During the third trimester, false labor contractions become more intense and frequent if you are active or dehydrated. If you feel them, sit in a cool place, elevate your feet, drink something and rest. If the intervals between contractions increase and their intensity decreases, then they are false. If they become more frequent or severe (especially if they occur every 5 minutes), call your doctor. I always tell patients that no one has ever described their sensations as “spastic” while giving birth to a child. As a rule, the intensity of labor contractions, during which the child passes through the birth canal, is described as follows: “I can’t walk or talk.”

You've seen it in countless movies. Sudden realization: the woman in labor needs to be taken to the hospital URGENTLY! The woman becomes a real fury, spewing curses (“You did this to me!”). Doubled over in terrible pain, she stops moaning only to unleash another round of curses at her poor, panic-stricken husband, who suddenly forgets everything he learned in the Lamaze course, loses his bag prepared for the trip to the maternity hospital, and inevitably sends car straight into a traffic jam, where he ends up having to deliver the baby himself.

The truth is that most couples have plenty of time to realize that labor has actually begun. No one knows exactly what triggers this mechanism, but they are approaching quite quickly. Here are some signs that will tell you it's time to grab your bag and the baby in labor - and get in the car.

Labor begins - signs of labor

Most women give birth to their children earlier or later than the estimated date indicated on the exchange card.

Moreover, most often the deviation in both directions does not exceed ten days. Ultimately, the expected date of birth only plays the role of a guideline. Only 3% to 5% of children are born exactly on this day. If the doctor said that your baby will be born on December 31st, you can be sure that you will not give birth on New Year's Eve.

Loose stool

This is due to hormonal changes caused by prostaglandins.

And this makes sense: your body begins to cleanse the intestines to free up more space inside the body for the baby.

Estimated date of birth (EDD)

This is the day on which your baby is statistically likely to be born. Most give birth somewhere between 37 and 42 weeks. Although many women don't give birth exactly on their expected date, you should definitely know it so you can be prepared. The closer it is, the more attention you need to pay to your bodily sensations and possible signals of the onset of labor. When you turn over the calendar and see the month in which the birth is due, you will feel excitement (and mild panic). Soon!

Contractions - first signs of approaching labor

In 70-80% of cases, the onset of labor announces itself with the appearance of real labor pains. They cannot be immediately distinguished from training ones, which you may have noticed for the first time a few weeks ago. At these moments, the abdomen hardens and the uterus contracts for 30-45 seconds.

The pain caused by contractions is well tolerated at first: you can even walk a little if you want. As soon as a certain regularity is established in the contractions, you will, without any prompting, put everything aside and listen to what is happening inside you.

As contractions gradually intensify, it is recommended to perform the breathing exercises that you were taught in childbirth preparation courses. Try to breathe as deeply as possible, inhale from your stomach. Your baby also has to do hard work during birth. And oxygen will be very useful to him for this.

Braxton Hicks contractions (preparatory). These contractions of the uterine muscles begin early, although you may not notice them. You will feel tension in the uterus. Such contractions are brief and painless. Sometimes there are several of them, they follow each other, but usually they stop quickly. Closer to labor, Braxton Hicks contractions help prepare the cervix for the process.

Go to the clinic immediately!

Regardless of the onset of contractions, if the baby stops moving, the membranes are ruptured, or there is vaginal bleeding, you should immediately go to the clinic.

Braxton Hicks contractions are a “warm-up” before the real contractions begin. They can start and stop several times and often stop when you are active (for example, while walking). Early labor contractions will be uneven in intensity and frequency: some will be so strong that you will lose your breath, others will simply resemble spasms. The intervals between them will be either 3-5 or 10-15 minutes. If you talked to your doctor for 15 minutes discussing whether labor had started or not, and never stopped, it was most likely a false alarm.

Learn to recognize contractions

During the early stages of labor, contractions lasting about 30 seconds may occur every 20 minutes.

The first contractions are similar to spasmodic menstrual pain (radiating pain). The muscles of the uterus begin to contract so that the cervix opens to the full 10 cm.
Late contractions feel like severe menstrual pain or reach an intensity you never imagined.
When contractions become very strong and the rhythm of contractions becomes regular, it means it has begun for real!

There are no mandatory standards for when you can come to the maternity hospital. But if contractions occur every 5 minutes for an hour and make you freeze in pain, no one will prevent you from appearing in the maternity ward. Make an action plan with your doctor, taking into account the time it takes to travel.

If you live near a maternity hospital, wait until the contraction rhythm is 1 every 5 minutes for an hour, and then call and tell your doctor that you are going.
If the maternity hospital is 45 minutes away from you, then most likely you should leave when the contractions are less frequent.

Discuss this with your doctor in advance so you don't panic during labor. Remember that with the onset of the active stage, the cervix in most women dilates by 1-2 cm per hour. So do the math: 6-8 hours before you start pushing. (But if at your last doctor’s appointment you were told that your dilation was 4 cm, it is better to come to the maternity hospital early.)

Consultation with a gynecologist. I caution expectant parents, especially if this is their first pregnancy, that there may be a few “false alarms.” My wife is an OB/GYN and she made me take her to the hospital 3-4 times while pregnant with each of our three children! If she couldn't tell for sure, who could? I always tell patients: it is better for them to come and be checked (if it is premature, they will simply be sent home) than to give birth on the side of the road.

Timing is everything

How to calculate the time and rhythm of contractions? There are two ways. Just pick one and stick with it and watch things unfold.

Method 1

Note the moment when one contraction begins and its duration (for example, from 30 seconds to 1 minute).
Then note when the next contraction begins. If it is not felt within 9 minutes, then the regularity of contractions is 10 minutes.
It can become confusing if contractions occur more frequently. Always note the time from the start of one contraction to the start of the next.
If a contraction lasts a whole minute, and the next one begins 3 minutes after the end of the previous one, then contractions occur once every 4 minutes. When their frequency increases, it is difficult to concentrate on counting. Ask someone close to you to count the contractions for you.

Method 2

Almost the same, but here you start counting the time from the end of one contraction to the end of the next.

Opening and effacement of the cervix

Imagine your cervix as a big, plump donut. Before childbirth, it begins to thin and stretch. Expansion (opening) and thinning (flattening) can occur over a period of weeks, a day, or a few hours. There is no standard for the time frame and nature of the process. As the due date approaches, your doctor will make conclusions about the condition of the cervix as follows: “Dilatation 2 cm, shortening 1 cm.”

Abdominal prolapse

This happens when the fetus descends to the entrance to the pelvis and, as it were, “gets stuck” there, i.e. no longer moves inside. During Braxton Hicks contractions, it moves even further into the lower pelvic region. Imagine the child moving into the “start” position. This process begins for all women at different times, for some - only before childbirth. For many, the news of fetal descent is both good and bad news. It’s now becoming easier to breathe and eat, but the pressure on the bladder and pelvic ligaments makes you run to the toilet more and more often. Some expectant mothers even begin to think that the baby might simply fall out, because it is now so low. During the exam, your doctor will determine how low in the pelvis your baby is, or what his “position” is.

Abdominal prolapse occurs when the child seems to “fall” and descends towards the entrance to the pelvis. Head first, the baby moves into the pelvis, thereby preparing to travel through the birth canal. However, for women who experience abdominal prolapse a few days or weeks before giving birth, this symptom is a “false clue”, and for some it does not happen at all until the start of active labor. Braxton Hicks contractions become stronger, the baby gradually moves lower into the pelvis, the pressure on the cervix increases, and it softens and thins.

Rupture of membranes

In 10-15% of cases, the onset of labor is heralded by premature rupture of the membranes, which occurs before the first contractions appear.

If the baby's head is firmly established in the pelvis, then the loss of amniotic fluid will not be so large-scale.

You will know that the amniotic sac has ruptured by copious discharge of clear, warm fluid from the vagina.

Rupture of the amniotic sac does not cause any pain, since there are no nerve fibers in its membrane. Sometimes the amniotic fluid may be green in color: this means that the baby has already passed his first stool. Record the time of rupture of the membranes and the color of the discharged fluid, and inform the midwife or the maternity ward of the clinic. Here you will receive instructions on your next steps.

It is very rare that the amniotic sac ruptures in its upper part, with amniotic fluid draining out only drop by drop. Then they can easily be mistaken for urine or vaginal discharge, especially if the bladder is slightly weak. If you suspect that amniotic fluid is breaking, call your doctor immediately or go to the maternity hospital. A short inspection will clarify the situation.

As a rule, rupture of the membranes does not lead to dramatic consequences. Usually, contractions occur spontaneously within the next 12-18 hours, and childbirth occurs naturally. In the absence of contractions, they are artificially stimulated with appropriate medications to reduce the risk of infection for mother and child.

Breaking of water

Sometimes the amniotic sac is referred to by the strange, biblical-sounding term “fetal sac.” When it bursts (either naturally or by a doctor), it means that labor will occur within 24-48 hours. As a rule, the doctor decides not to take risks and not wait more than 24 hours after opening the bladder, especially if the baby is born at term, because there is a danger of infection.

If your water breaks

When the amniotic sac bursts, it's like a small flood, and it's impossible to predict exactly when or where it will happen. In the third trimester, the amniotic sac, a soft and comfortable “place of stay” for the baby, already contains about a liter of amniotic fluid. (Pour a liter of water on the floor - this is what it might look like.) But remember:

For some women, the “leakage” is very small.
Fluid will continue to leak from the sac even after your water breaks because your body will continue to produce it.
Some women's water does not break spontaneously, and to stimulate labor, the doctor performs an amniotomy by piercing the sac with a long plastic hook.
The liquid should be colorless. If it is dark (greenish, brownish, yellowish), this may mean that the baby has defecated directly in the uterus (this type of stool is called meconium). This may be a sign of severe stress in the fetus. Call your doctor immediately.

Consultation with a gynecologist. Heavy vaginal discharge during late pregnancy is completely normal. V 10-20% of women at this stage are so significant that they have to wear pads all the time. Blood flow to the vagina and cervix increases in the third trimester, so vaginal secretion also increases. You may not immediately understand whether this is discharge or your water has broken. If you feel “wet,” dry yourself and walk around a little. If fluid continues to leak, call your doctor.

Signal bleeding is a symptom of the onset of labor

Usually, throughout pregnancy, the uterine os remains closed with viscous mucus, which protects the fetal bladder from inflammation. When the cervix shortens and the uterine pharynx opens, the so-called mucus plug comes out. This is also a sign of impending labor. However, labor pains do not necessarily occur on the same day. Sometimes it takes several more days or even weeks before real contractions appear.

Closer to childbirth, mucus may lose its viscosity and come out as a clear liquid. In most cases, this is accompanied by a small, so-called signal, bleeding. It is much weaker than menstrual and completely harmless. However, to be sure, you should talk to your doctor or midwife about this - you should make sure that the bleeding is not caused by other reasons that could threaten you and your baby. Very often, a woman does not notice the separation of the mucus plug at all.

Light spotting or spotting

They may appear due to changes occurring in the cervix as it prepares to open. Contractions soften the cervix and the capillaries begin to bleed. Contractions intensify and spotting occurs. Any pressure on the cervix may cause slight bleeding (due to exercise, sex, straining during bowel movements, or straining the bladder muscles). If you are unsure whether this bleeding is normal, call your doctor.

Removal of the mucus plug

The cervix softens and begins to open, releasing a mucus plug. Sometimes the mucus flows out slowly or the plug may come out in the form of a knotty thick flagellum. Until this moment, mucus acts as a protective barrier in the cervix and is constantly produced by the body, especially a lot closer to childbirth. It's not a sign of impending labor—some women produce mucus for weeks beforehand—but it's definitely a sign that something is starting to change.

Backache

Pain may occur if the baby is positioned facing forward rather than toward your back. If the baby does not turn to his back, they may get worse. Pain may also occur due to the pressure of his head on your spine when contractions begin.

Cozy nest: not only for birds

Pregnant women often have a strong desire to build a cozy nest even before the onset of labor. The surge of “nesting” energy, which contrasts so strongly with the debilitating fatigue of the last trimester, forces expectant mothers to arrange their habitat, turning it into a nice and clean “incubator”. Another sign that you have begun the “nesting” period is the speed with which you try to get everything done, and how demanding you make requests to your family. "Nesting" is usually expressed as:

painting, cleaning, arranging furniture in the nursery;
throwing away trash;
organizing things of the same type (food in the buffet, books and photographs on the shelves, tools in the garage);
deep cleaning the home or completing “renovation projects”;
purchasing and organizing children's clothing;
baking, preparing food and stuffing it around the refrigerator;
packing a bag for a trip to the hospital.

An important caveat: for some pregnant women, “nesting” never occurs, and if such impulses appear, the expectant mother feels too lethargic to do anything.

Symptoms of labor

False contractions are a nagging pain in the lower abdomen, similar to pain during menstruation. If such contractions are not strong and not regular, there is no need to do anything special: this is only preparing the uterus for childbirth. The uterus seems to be testing its strength before the important work ahead, gathering itself and relaxing its muscles. At the same time, you can feel the tone of the uterus - sometimes it seems to gather in a lump and become harder. The uterus can become toned without pain, since the closer the birth gets, the more sensitive and irritable it becomes. This is fine.

The third important harbinger of labor may be the release of the mucus plug. This is a mucous content that “lives” in the cervix, as if clogging the baby’s “house”. The mucus plug may come off in the form of a thick and sticky discharge of a transparent pinkish color.

A woman may not feel the warning signs of labor, although most often the expectant mother still feels preparatory contractions.

A normal first labor lasts approximately 10-15 hours. Subsequent births usually proceed somewhat faster than the first, but this does not always happen. I am an example of this exception, as my second labor lasted 12 hours longer (20 hours) than my first (8 hours).

If a woman’s amniotic fluid has broken, she must go to the clinic immediately. Amniotic fluid protects the baby, and he should not be left without it for a long time. Therefore, if you feel lukewarm, clear water leaking out, call your doctor and get ready to go to the maternity hospital.

Usually, after your water breaks, contractions begin (or they suddenly intensify if you have been in labor before). If contractions have not started, most likely in the maternity hospital they will try to induce labor (with the cervix ready) so as not to leave the baby unprotected for a long time.

Labor usually begins with contractions. Typically, women often begin to feel pain in the lower abdomen and aches in the lower back about a couple of weeks before giving birth. But how then do you understand what it is: preparatory Braxton-Hicks contractions or the beginning of labor?! Such questions and concerns almost always arise among women who are faced, theoretically or practically, with the precursors of childbirth.

It is not at all difficult to distinguish preparatory contractions from the onset of labor! When your stomach begins to swell, be a little more attentive to yourself: is it the same pain as usual, perhaps the painful sensations have lingered a little, or does something else intuitively seem unusual to you?

If you feel that these painful sensations are regular (appear and disappear with little frequency), it makes sense to start timing, counting contractions and writing them down.

Let's say that at about 5 o'clock in the morning you decide that your stomach hurts a little in a special way or for quite a long time. Get a stopwatch (you have it in your phone) and start counting.

At 5 o'clock in the morning pain appeared, a contraction began, it lasted 50 seconds, then there was no pain for 30 minutes.

At 5:30 the stomach begins to pull again, the pain lasts 30 seconds, then nothing bothers you for 10 minutes, etc.

When you see that the pain regularly repeats, intensifies, the duration of contractions increases, and the interval between them decreases - congratulations, you have begun labor.

Update: October 2018

Not all births proceed “as expected” and without complications. One of these problems during childbirth is the formation of weakness of labor, which can occur in both primiparous and multiparous women. Weak contractions during childbirth are anomalies of labor forces and are observed in 10% of cases of all unfavorable births, and in the first birth they are diagnosed more often than in repeated ones.

Weakness of generic forces: what is the essence

We speak about the weakness of labor forces when the contractile activity of the uterus is of insufficient strength, duration and frequency. As a result, contractions become rare, short and ineffective, which leads to a slowdown in the opening of the cervix and the movement of the fetus along the birth canal.

Classification of weak labor

Depending on the time of occurrence, weak labor can be primary or secondary. If contractions from the very beginning of the labor process are ineffective, short, and the period of relaxation of the uterus is long, then they speak of primary weakness. In the case of weakening and shortening of contractions after a certain period of time of sufficient intensity and duration, a diagnosis of secondary weakness is made.

Secondary weakness, as a rule, is noted at the end of the period of dilatation or during the process of expulsion of the fetus. Primary weakness is more common and its incidence is 8 – 10%. Secondary weakness is observed in only 2.5% of cases of all births.

Also identified are weakness of pushing, which develops in multiparous women or in obese women in labor, and convulsive and segmental contractions. Convulsive contractions are indicated by prolonged contractions of the uterus (more than 2 minutes), and with segmental contractions, the uterus does not contract entirely, but only in separate segments.

Causes of weak contractions

Certain reasons are necessary for the formation of weakness of labor. Factors that contribute to this pathology are divided into a number of groups:

Obstetric complications

This group includes:

prenatal rupture of water;
disproportion between the sizes of the fetal head (large) and the mother’s pelvis (narrow);
changes in the walls of the uterus caused by dystrophic and structural processes (multiple abortions and uterine curettage, fibroids and uterine surgeries);
rigidity (inextensibility) of the cervix that occurs after surgical treatment of cervical diseases or damage to the cervix during childbirth or abortion;
and multiple births;
large size of the fetus, which overstretches the uterus;
incorrect location of the placenta (previa);
presentation of the fetus with the pelvic end;

In addition, the functionality of the amniotic sac plays a great role in the occurrence of weakness (with a flat amniotic sac, for example, with, it does not act as a hydraulic wedge, which inhibits cervical dilatation). We should not forget about the woman’s fatigue, asthenic body type, fear of childbirth and mental and physical stress during gestation.

Pathology of the reproductive system

Sexual infantilism and congenital anomalies of the uterus (for example, saddle-shaped or bicornuate), chronic inflammation of the uterus contribute to the development of pathology. In addition, a woman’s age (over 30 and under 18) affects the production of hormones that stimulate uterine contractions.

This group also includes menstrual cycle disorders and endocrine diseases (hormonal imbalance), recurrent miscarriage and disturbances in the formation of the menstrual cycle (early and late menarche).

Extragenital diseases of the mother

This group includes various chronic diseases of women (pathology of the liver, kidneys, heart), endocrine disorders (obesity), numerous infections and intoxications, including bad habits and occupational hazards.

Factors due to the fetus

Intrauterine infection of the fetus and developmental delay, fetal malformations (anencephaly and others), post-term pregnancy (overripe fetus), as well as premature birth can contribute to weakness. In addition, Rh conflict during pregnancy, fetoplacental insufficiency, etc. are important.

Iatrogenic causes

This group includes “hobby” with birth-stimulating drugs that tire a woman and disrupt uterine contractile function, neglect of labor pain relief, unjustified amniotomy, as well as rough vaginal examinations.

As a rule, not one factor, but a combination of them, plays a role in the development of weakness of contractions.

How does pathology manifest itself?

Depending on the type of weakness of the generic forces, the clinical manifestations differ somewhat:

Primary weakness

Contractions in the case of primary weakness are initially characterized by a short duration and poor efficiency, little or no pain, periods of diastole (relaxation are quite long) and practically do not lead to the opening of the uterine pharynx.

As a rule, primary weakness develops after a pathological preliminary period. Often, women in labor complain that their waters have broken and the contractions are weak, which indicates either premature or early rupture of water.

As you know, the role of the amniotic sac in childbirth is enormous, it is it that puts pressure on the cervix, causing it to stretch and shorten; untimely release of water disrupts this process, uterine contractions become insignificant and short-lived. The frequency of contractions does not exceed one to two during a 10-minute period (and normally should be at least 3), and the duration of uterine contractions reaches 15 to 20 seconds. If the amniotic sac has retained its integrity, then it is diagnosed as non-functional, it is sluggish and does not flow well into contractions. There is also a slowdown in the advancement of the fetal head; it remains in the same plane for up to 8–12 hours, which not only causes swelling of the cervix, vagina and perineum, but also contributes to the formation of a “birth tumor” of the fetus. The long course of labor exhausts the woman in labor, she gets tired, which only worsens the birth process.

Secondary weakness

Secondary weakness is less common and is characterized by a weakening of contractions after a period of effective labor and dilatation of the cervix. It is observed more often at the end of the active phase, when the uterine pharynx has already reached an opening of 5–6 cm or during the period of pushing. Contractions are initially intense and frequent, but gradually lose strength and become shorter, and the movement of the presenting part of the fetus slows down.

Weakness of pushing

This pathology (pushing is a controlled contraction of the abdominal muscles) is more often diagnosed in women who have had frequent and multiple births, who are overweight or have discrepancies in the abdominal muscles. Also, weak pushing may be a natural consequence of weak contractions due to physical and nervous exhaustion and fatigue of the woman in labor. It manifests itself as ineffective and weak contractions and attempts, which slows down the progress of the fetus and leads to its hypoxia.

Diagnostics

To make a diagnosis of weak contractions, consider:

the nature of uterine contractions (strength, duration of contractions and relaxation time between them);
the process of opening the cervix (slowing down);
advancement of the presenting part (no forward movements, the head stands for a long time in each plane of the small pelvis).

An important role in diagnosing pathology is played by maintaining a partogram of labor, which clearly shows the process and its speed. During the latent phase in primiparous women in the first period, the uterine os opens by approximately 0.4 - 0.5 cm/h (in multiparous women it is 0.6 - 0.8 cm/h). Thus, the latent phase normally lasts about 7 hours in primiparous women, and up to 5 hours in multiparous women. Weakness is indicated by a delay in the opening of the cervix (about 1 - 1.2 cm per hour).

Contractions are also assessed. If in the first period their duration is less than 30 seconds, and the intervals between them are 5 or more minutes, they speak of primary weakness. Secondary weakness is indicated by a shortening of contractions of less than 40 seconds at the end of the first period and during the period of fetal expulsion.

It is equally important to assess the condition of the fetus (listening to the heartbeat, performing CTG), since with weakness, labor becomes protracted, which leads to the development of hypoxia of the child.

Management of childbirth: tactics

What to do if labor is weak. First of all, the doctor should determine the contraindications for conservative treatment of the pathology:

there is a scar on the uterus (after myomectomy, suturing of the perforation hole and other operations);
narrow pelvis (anatomically narrowed and clinically);
large fruit;
true post-term pregnancy;
intrauterine fetal hypoxia;
allergy to uterotonic drugs;
breech presentation;
burdened obstetric and gynecological history (placenta previa and abruption, scars on the cervix and vagina, their stenosis and other indications);
first birth in women over 30.

In such situations, the birth ends with an emergency caesarean section.

What should a woman in labor do if contractions are weak?

Undoubtedly, a lot depends on the woman when contractions are weak. First of all, it all depends on her attitude towards a successful outcome of the birth. Fears, fatigue and pain negatively affect the birth process, and, of course, the child.

The woman should calm down and use non-drug methods of labor pain relief (massage, proper breathing, special positions during contractions).
In addition, active behavior of a woman - walking, jumping on a special ball - has a positive effect on childbirth.
If she is forced to be in a horizontal position (“there is an IV”), then she should lie on the side where the back of the fetus is located (the doctor will tell you). The baby's back puts pressure on the uterus, which increases its contractions.
In addition, it is necessary to monitor the condition of the bladder (empty approximately every 2 hours, even if there is no desire).
An empty bladder helps strengthen contractions. If you cannot urinate on your own, the urine is removed with a catheter.

What can doctors do?

Medical tactics for managing labor with this pathology depend on the cause, period of labor, type of weakness of contractions, and the condition of the mother and fetus. In the latent phase, when the opening of the cervix has not yet reached 3–4 cm, and the woman experiences significant fatigue, medicinal sleep-rest is prescribed.

Medication-induced sleep is carried out by an anesthesiologist by administering sodium hydroxybutyrate diluted with 40% glucose.
In the absence of an anesthesiologist, the obstetrician prescribes a complex of the following drugs: promedol (narcotic analgesic), relanium (sedative), atropine (increases the effect of the drug) and diphenhydramine (sleeping pill). Such a dream allows a woman to rest for 2-3 hours, restore strength and helps intensify contractions.
But medicinal rest is not prescribed if there are indications for an emergency cesarean section (fetal hypoxia, abnormal position, etc.).

After the woman in labor rests, the condition of the fetus, the degree of cervical dilatation, and the functionality of the amniotic sac are assessed. A hormonal-energy background is created using the following drugs:

ATP, cocarboxylase, riboxin (energy support for the woman in labor);
glucose 40% - solution;
intravenous calcium preparations (chloride or gluconate) – increase uterine contractions;
vitamins B1, E, B6, ascorbic acid;
piracetam (improves uterine circulation);
estrogens on ether intrauterinely (into the myometrium).

If there is a flat amniotic sac or polyhydramnios, early amniotomy is indicated, which is performed when the cervix is dilated by 3–4 cm, which is a prerequisite. Opening the amniotic sac is an absolutely painless procedure, but it promotes the release of prostaglandins (intensifies contractions) and intensifies labor. 2 - 3 hours after the amniotomy, a vaginal examination is performed again to determine the degree of cervical dilatation and decide on the issue of labor stimulation with contracting drugs (uterotonics).

Drug labor stimulation

To intensify contractions, the following methods of drug labor stimulation are used:

Oxytocin

Oxytocin is administered intravenously. It enhances myometrial contraction and promotes the production of prostaglandins (which not only intensify contractions, but also affect structural changes in the cervix). But it should be remembered that exogenously administered (foreign) oxytocin suppresses the synthesis of one’s own oxytocin, and when the drug infusion is discontinued, secondary weakness develops. But long-term administration of oxytocin over several hours is also not advisable, since this delays urination. The drug begins to be administered when the cervical opening is greater than 5 cm and only after the water has broken or an amniotomy has been performed. Oxytocin in an amount of 5 units is diluted in 500 ml of saline and dripped, starting at a speed of 6 - 8 drops per minute. You can add 5 drops every 10 minutes, but exceeding 40 drops per minute. Among the disadvantages of oxytocin, it can be noted that it inhibits the production of surfactant in the lungs of the fetus, which, if it has chronic hypoxia, can cause intrauterine aspiration of water, circulatory disorders in the child and death during childbirth. Oxytocin infusion is carried out with the mandatory (every 3 hours) administration of antispasmodics or with EDA.

Prostaglandin E2 (prostenon)

Prostenon is used in the latent phase, before the cervix opens by 2 fingers, when primary weakness is diagnosed against the background of an “insufficiently mature” cervix. The drug causes coordinated contractions with good relaxation of the uterus, which does not interfere with blood circulation in the fetus-placenta-mother system. In addition, prostenon promotes the production of oxytocin and prostaglandin F2a, and also accelerates the maturation of the cervix and its opening. Unlike oxytocin, prostenon does not cause an increase in blood pressure and does not have an antidiuretic effect, which makes it possible to use it in women with preeclampsia, kidney pathology and hypertension. Contraindications include bronchial asthma and intolerance to the drug. Prostenon is diluted and dripped in the same dosage (1 ml of 0.1% drug) as oxytocin.

Prostaglandin F2a

Prostaglandins of this group (enzaprost or dinoprost) are effectively used in the active phase of cervical dilatation, that is, when the pharynx is opened by 5 cm or more. These drugs are strong stimulants of uterine contractions, constrict blood vessels, which leads to increased pressure, and also thicken the blood and enhance its coagulability. Therefore, they are not recommended for use in cases of gestosis and blood pathology. Side effects (in case of overdose) include nausea and vomiting, hypertonicity of the lower uterine segment. Administration regimen: 5 mg of enzaprost or dinoprost (1 ml) is diluted in 0.5 liters of physiological solution. The drug is started to be administered intravenously with 10 drops per minute. You can increase the number of drops every 15 minutes, adding 8 drops. Maximum speed – 40 drops per minute.

The combined administration of oxytocin and enzaprost is possible, but the dosage of both drugs is halved.

Simultaneously with drug labor stimulation, fetal hypoxia is prevented. To do this, use the triad according to Nikolaev: 40% glucose with ascorbic acid, aminophylline, sigetin or cocarboxylase intravenously, inhalation of humidified oxygen. Prophylaxis is prescribed every 3 hours.

Surgery

If there is no effect from drug stimulation of labor, as well as in the case of deterioration of the fetus’s condition in the first stage, the birth is completed surgically - by caesarean section.

If efforts and contractions are weak during the expulsion period, either obstetric forceps are applied (with obligatory bilateral episiotomy) or a Werbow bandage (a sheet thrown over the mother's stomach, the ends of which are pulled down on both sides by assistants, squeezing out the fetus).

Question answer

I had weak labor during my first birth. Is it necessary for this pathology to develop during the second birth?

No, not at all necessary. Moreover, if the reason that led to the occurrence of this complication in the first birth is absent. For example, if there was a multiple pregnancy or a large fetus, which caused overstretching of the uterus and the development of weakness, then most likely a similar reason will not recur in the next pregnancy.

What threatens the weakness of the generic forces?

This complication contributes to the development of fetal hypoxia, infection (with a long anhydrous interval), swelling and necrosis of the soft tissues of the birth canal with subsequent formation of fistulas, postpartum hemorrhage, uterine subinvolution, and even fetal death.

How to prevent the occurrence of labor weakness?

To prevent this complication, a pregnant woman should attend special courses that teach about methods of independent pain relief during childbirth, the birth process itself, and set the woman up for a favorable outcome of childbirth. She also needs to adhere to proper and balanced nutrition, monitor her weight and perform special physical exercises, which not only prevents the formation of a large fetus and development, but also maintains the tone of the uterus.

During my first birth, I had a caesarean section due to weak contractions; can I give birth on my own during my second birth?

Yes, such a possibility cannot be excluded, but subject to the absence of those indications that led to the operation for the first time (breech presentation, narrow pelvis, etc.) and the consistency of the scar. In this case, the birth will be planned in a special maternity hospital or perinatal center, where there is the necessary equipment and doctors with experience in managing births with a uterine scar.

Each pregnancy proceeds and resolves individually. The gynecologist will not answer for sure whether contractions or water break first, but during labor both processes should begin naturally. If the uterus contracts poorly or the amniotic sac has not burst, medical techniques intervene.

Contractions without water breaking

The uterus prepares for childbirth from 20-21 weeks of pregnancy, the concentration of the hormone progesterone decreases, and the cervical tissue softens. From this time, the woman begins to have contractions that train the uterus - Braxtons, painless, irregular. At the same time, the amniotic sac is intact, the fluid does not leave, protects the baby from infections, supplies oxygen, and removes waste products. Training cramps are a normal physiological phenomenon.

Can contractions occur without the water breaking? Yes, these are either Braxtons, or cervical dilatation, before an imminent delivery. You need to monitor the timing and frequency of contractions.

In half of the cases, contractions begin before birth, without the water breaking. Contractions occur regularly, the interval between them is shortened to 15-20 minutes, the duration increases. Late rupture of the bladder threatens the health and life of the baby.

If contractions are going on, but the water has not broken, you need to calculate the contractions, duration, and frequency in a special way. An Internet calculator or a manual method is used. Take a notebook and pen and draw up a table.

Abbreviations calculator:

the start and end times are recorded;
the period of stress and rest is calculated;
the intensity is recorded (stronger, unchanged, weaker).

The contraction begins when the stomach becomes rigid, tenses, and at the same time the pulse and breathing quicken. Blood circulation increases, so a blush appears on the face. The end of the contraction is recorded at the moment of complete relaxation of the muscles, the heart rhythm is gradually restored, and breathing becomes easier. In the table, the main thing to pay attention to is the duration; if it decreases, then the spasm is false. But there are other important signs.

Table - Differences between true and false contractions

Symptoms	Braxtons	True contractions
Repetitions per day	3-5 r. per day, randomly	From 7 times in two hours
Duration	Short, even, maximum 1.5 minutes	Each next one is longer
Intensity	Does not change, the strength gradually fades away	Every time it gets stronger
Soreness	Absent	Eat
Frequency	Irregular	Increases
Breaks	Up to 30 minutes per attack	Reduced from 20 to 2 minutes
Reaction to an antispasmodic drug	Spasms go away	Do not change the nature of the flow

True contractions at 37 weeks threaten miscarriage, so it is important to control the sensations. If doctors determine that labor has begun without water, an artificial opening of the bladder is required. The procedure is called amniotomy, and is painless and quick. Prescribed only according to indications.

strong walls of the amniotic sac;
weak cervical dilatation;
flat amniotic sac;
malposition;
polyhydramnios.

Releasing the amniotic sac will result in fetal pressure on the birth canal. The procedure performed after the onset of uterine contractions will speed up labor and reduce the risk of complications for the baby.

Contractions and water at the same time

After the woman has analyzed that there are true contractions, it is important to evaluate the interval between them. When the break is 15-20 minutes, you need to go to the maternity hospital, the bubble will burst soon.

What comes first, water or contractions? With the normal development of labor, uterine contractions begin first, followed by the release of water. The more intensely the cervical canal opens, the faster the fluid flows out.

Subsequence:

the cervix is smoothed;
the muscle fibers of the organ contract with each spasm and shorten in length;
the fibers shorten and expand in density;
the thickness of the uterine walls increases;
due to the tension of the body membranes, the lower segment is stretched, the neck expands;
the external pharynx opens under the pressure of the head;
each contraction puts pressure on the amniotic fluid inside the bladder;
it rushes to the cervical canal;
is tightly embedded and presses on the circumference of the passage;
first, the external pharynx opens during contractions;
the fetal sac bursts.

In the intervals, the tension of the shell does not go away, so a rupture occurs in the next few minutes. By the time the water breaks, contractions are repeated every 5 minutes, they are painful and intense.

Normally, water is released when the external cervical os is fully opened; this is called timely effusion. The lower part of the liquid comes forward, about 300 ml, and the remaining part comes out with the fetus. The rupture of the bubble is also facilitated by a change in the structure of the shells - density and elasticity decrease. Therefore, intrauterine pressure is sufficient for tissue divergence.

Feel:

dull pain in the sacral region, spreading around the circumference of the pelvis;
heaviness in the lower abdomen, similar to menstruation, but stronger;
wavy sensations - embrace, smoothly release;
become regular;
a stream of liquid pours out;
attempts begin.

If a woman is at home, when regular contractions begin, it’s time to get ready. To avoid any difficulties in the maternity hospital, you need to pack your bag in advance.

Actions:

collect documents - passport, insurance policy, SNILS, exchange card, birth certificate;
take a shower, shave your crotch;
wear clean underwear;
cut your nails so as not to scratch yourself and the midwife when pushing;
Call an ambulance before your water breaks.

You can sit on a fitball, sway, stroke your lower abdomen, stand on all fours, massage your ankles. If you move and walk when contractions begin, the bubble will burst earlier and labor will begin faster. Therefore, when the road to the maternity hospital is long, it is better to take a bath, lie down and wait for the ambulance to arrive.

If the water breaks during contractions, fetal movement will begin in the next 3-4 hours. The better the cervix is prepared, up to 5 cm, the sooner the baby will be born. If the woman has no signs of complications, obstetricians wait until the woman starts to rupture spontaneously before pushing, and only then perform an amniotomy.

Water broke without contractions

If a woman is constantly on the move, she may not notice the onset of uterine contractions until the amniotic sac bursts. At this moment, a volumetric flow of water is felt pouring out of the vagina. During the normal course of labor, at the same time or with a difference of 20-30 minutes, the spasms become bright and painful.

Can my water break without contractions? Yes, but premature release of amniotic fluid threatens the successful course of labor. Water breaking without contractions before 37 weeks foretells that the baby will be born premature.

The interval between contractions and the release of amniotic fluid should not exceed 12 hours. This is the maximum amount of time a baby has to do without protection from external infections and bacteria.

Why does your water break before contractions?

infectious and bacterial diseases during pregnancy;
isthmic-cervical insufficiency;
polyhydramnios;
multiple pregnancy;
physical overexertion - injury, fall;
physiology – thin membranes.

Infections of the genital tract penetrate deeply and injure the walls of the bladder. Damage will cause corrosion, thinning of the shell, and a rupture will occur at this point. In particular, with ICI, when the amniotic sac flows into the cervical canal, the risk of infection increases.

A harbinger of fluid discharge before the onset of contractions is the release of a mucus plug. Overflow will occur within 8-10 hours, the amount of water will be from 200 ml. up to 1 liter. Sometimes a pop is heard during the rupture.

Premature rupture of amniotic fluid, without contractions, is dangerous because the fetus in the womb may not be ready to be released, especially before 37 weeks. For him, birth will be the first strong stress, this will affect the nervous system and respiratory tract.

Complications:

premature birth;
prolonged labor;
injuries during the fetal movement “dry”;
painful contractions;
child infection;
hypoxia;
endometritis, maternal sepsis.

Infection of the mother or fetus is not associated with uncleanliness of the mother. The internal genital organs contain a special lactic acid environment and conditionally pathogenic microorganisms to which the fetal membranes are not adapted. The sterile environment of the amniotic sac protects the baby from such foreign particles, but when the integrity of the walls is compromised, the bacteria will quickly move upward and penetrate inside. There is more danger if a woman has vaginosis or vaginitis.

According to statistics, 10% of expectant mothers’ water broke before contractions, while only 0.3% experienced complications associated with this. Therefore, attentiveness to sensations, readiness for transportation to the hospital, and the correct behavior of doctors contribute to the positive development of events during childbirth.