The delivery begins - every delivery in its own way

The end date is getting closer. There are few women who give birth on the due date of their child. A normal delivery takes place at a gestational age between the 38th and 42nd week. A child is usually viable from a gestational age of 26 weeks. But if your baby is already born, he is still very vulnerable and he will have to spend a considerable time in an incubator.

The due date is approaching

Okay, your due date is approaching, but when does it start exactly? You obviously do not want to take a risk, but you do not want to call too much too soon.
Speak to your midwife or gynecologist during your pregnancy. She can tell you exactly when and at what time you can best call the bell.

Pre-contractions

The uterus regularly contracts during the entire pregnancy. These are also called hard bellies. These contractions slowly turn into pre-contractions.
Pre-contractions are very irregular. Sometimes there is a few minutes between them, then another hour, the strength of the contractions also varies. They can be annoying and especially at night you can suffer from it. At night, the uterus is the most irritable.

No disclosure

Pre-labor can also come every three minutes for a longer period of time. It looks like the birth has begun, but pre-contractions do not gradually become more powerful and take much shorter (30 - 40 seconds). In that they differ from real contractions, which last for at least one minute and become more powerful.
You will not get access from the pre-contractions, but they will ensure that the head drops deeper and the cervix becomes better.

Different announcements

Exciting: it is now almost there! You have been waiting for nine months, but your baby is now coming. Several announcements are possible and this will vary per person.

First signals (longer in advance)

A few weeks before delivery your child can already descend into the pelvis. This can give a feeling of pressure on the vagina and sometimes even exude a sharp pain. A nice extra is that your uterus will be lower again, so that you can breathe better.
Slimy discharge, mixed with some blood (due to the changes in the cervix).
Diarrhea: The production of prostaglandins (substances that cause the uterus to contract) can also cause diarrhea.

It really starts!

Break the membranes

Usually your membranes do not break until the end of the first phase, but sometimes the delivery is also started. This happens in 10% of women. The breaking of your membranes can go with a big tidal wave, or drip quietly.
If you break membranes, try to absorb some amniotic fluid. The amniotic fluid tells a lot about the condition of your baby. It should be clear in color with flakes in it. By mixing a little blood, the amniotic fluid can also be pink. But if the water is brown or green in color, you should call your midwife immediately. There is a chance that your child has pooped into the amniotic fluid (mecconium-containing amniotic fluid) and in that case your child should be monitored carefully.

Do not panic

Do not panic, because it is more common, but be alert. If your membranes are broken, the mucus plug (which closed your cervix) will usually disappear. You are therefore more prone to infections. Usually (70%) the birth starts within 24 hours.

No more in the bath

If your membranes are broken, it is not advisable (because of infection risk) to have sexual intercourse or to take a bath. Also pay attention to hygiene (when you go to the toilet from front to back, so you prevent bacteria from the anus in the direction of vagina), keep an eye on your temperature (increase can be a first sign of an infection). You can possibly stimulate the contractions activity by stimulating your nipples. By sucking on the nipple, the body is stimulated to produce oxytocin. Instead of sucking, you can also grab the nipple between thumb and index finger and squeeze it gently.

The contractions begin

In the beginning you may not be sure yet if it has started. But if it really started, your contractions will increase in intensity and frequency. They feel like an elastic band around your lower abdomen, which is tightly tightened. The pain is a bit similar to menstrual pain. The pain radiates from the top, all the way across your stomach to your pelvis and lower back. In the beginning, a woe lasts about 30 to 40 seconds and can take half an hour. But they can also come every five minutes. If they come every five minutes and last a minute and you really need to concentrate on it, it might be time to call your midwife. Probably you have already heard from her exactly when you should call her.

Loss of the mucus plug

During your pregnancy, the cervix is ​​filled with a mucus plug that protects your baby against infection. Due to the stretching (and softening) of the cervix, the mucus plug comes loose at a given moment. The mucus is slimy and rosy and the loss of this clot can be accompanied by a little blood. When you lose more blood, you have to call your midwife. Sometimes you do not notice anything at all.

Can take a few days

In losing this gag it does not at all mean that the birth starts right away, sometimes there may still be a few days, but it is in any case a sign that your child is coming. You do not have to call your midwife when you lose the mucus plug.
If you have any doubts and are unsure whether the birth has started, always call your gynecologist or midwife. She can give you the best advice.

Types of contractions

A woe is the powerful and regular contraction of the uterine muscles. Because of this contraction the space for the baby becomes smaller and the baby is pushed down. Nobody can explain to you how a woe feels. A woe has a run, a highlight and a run. On average, a strong wee lasts from the beginning to the end about one and a half minutes.
There are different types of contractions:

Hard bellies

Your uterus regularly contracts during your pregnancy. From the fourth to fifth month, these exercise contractions increase. This is very normal: your uterine muscles also have to train for the big job later ... Your belly feels like a hard ball. A 'hard belly' can occur if you suddenly get up, bend or tilt, but also if you have been busy. Also a full bladder or an orgasm can stimulate the uterus enough to contract. Sometimes a 'hard belly' can be a bit painful, but usually you notice very little of it.

Braxton-Hicks contractions

Braxton-Hicks contractions are painless, irregular contractions of your uterus. They occur fairly early in the pregnancy. If you often rub your belly (and thereby massaging your uterus) you can get them more often and stronger.

Pre-contractions

Painful contractions that occur irregularly and are short-lived (30 - 40 seconds). Then there is 5 minutes between then another hour. It can suddenly stop again. They occur at the end of your pregnancy. These contractions are also called exercise or softening contractions. There are strong indications that the baby's brains are given the start signal for the delivery. Prostaglandins are produced in the placenta; these substances stimulate the uterine muscle to contract. This contracting can be experienced as painful. Pre-contractions continue to feel the same and do not increase in intensity and duration. These contractions usually do not lead to access, but they prepare the cervix for delivery.

Real contractions

A woe is caused by hormones (oxytocin) and prostaglandins. Feel like an elastic band around your lower abdomen that is tightly tightened. These contractions recur regularly and last longer than the pre-contractions (about 1 minute).

Accessions

The contractions of your uterus last long and violently, causing your cervix to become thinner and start to open up. At 10 cm there is full access.

Perspee

If you have full access, (usually) the dislocation contractions automatically turn into contractions (similar to the pressure when visiting the toilet). This urge is so fierce that you can not help but express yourself.

Nawee

Some cramp and they serve to drive the placenta and membranes out. Usually a few minutes after the baby is born. If you press gently, the 'afterbirth' is expelled from the uterus.

Real contractions versus false contractions

CharacteristicFalse contractionsReal contractions
Frequency of contractionsIrregular, do not occur more and more oftenRegularly, contractions are getting closer together
Duration of the contractionsIrregularly40 to 60 seconds
Intensity of the contractionsDoes not increase, not really painfulBecoming more and more painful
If you change attitudeContractions go awayNo difference, or even more often contractions
Place of contractionsUnderbellyUpper abdomen or lower back, pain in the lower abdomen

Source: The big pregnancy and upbringing for Dummies 9789043016407

Time for action!

Once you think the birth has started, you can call the midwife or the hospital. If you do not trust it, you can also contact us before!
It is also no problem at all if it appears that you have called too soon and the birth has not started yet. Before you call you can watch the contractions for a while and see if they will follow each other more quickly.

Every 5 to 10 minutes

If your contractions occur every 5 to 10 minutes and are painful, then it is certainly high time to call your midwife. However, if you are not already 37 weeks pregnant then it is always necessary that you call the midwife (or doctor) at contractions! Do not waste time unnecessarily by making a schedule of how the contractions come and go, but come into action immediately!

Call your midwife or doctor if you:

  • the contractions follow each other faster and become more painful;
  • (almost) no more movements of your baby;
  • continuously feels a severe pain in the lower abdomen, without it disappearing;
  • child (or umbilical cord) in your vagina (stay there!);
  • membranes are broken (inform your doctor if the fluid is green, brown or red);
  • suffer a lot of blood loss (or lose blood clots);
  • not familiar! Doubts = calling!

Location of the fetus

The location of your child in the womb is decisive for the course of the birth and determines whether your child can be born in a natural way. Approximately 95% of the babies are in the correct position, the main position. His head is then at the bottom of the uterus against the cervix. It can also happen that your child is in a breech position. Instead of his head, the trunk of your child is in the womb. This occurs at 3 to 4%. You have a breech where the legs are pushed up and next to the body and a breech with one or both feet in front.

Stripping

If you are almost 2 weeks late, it can sometimes help to strip.
In order to strip, the midwife must do an internal examination and feel whether the cervix is ​​already open. If your cervix is ​​already softening and passing and you have 1 cm of access, then your midwife can go into the cervix with a finger and loosen the membranes (not broken). By this loosening the uterus is stimulated and oxytocin is released. Sometimes this is just enough to put your body on until the birth. It offers no guarantee but sometimes this push can help just a little bit.
Stripping can cause a bit of blood loss.

Childbirth

Childbirth is the process whereby the baby, the placenta, the membranes and the amniotic fluid are driven out of the uterus. Every birth is unique but every (natural) birth can be divided into three different phases.
The duration of the delivery is mainly determined by the duration of the access.

Latent phase

The contractions at this stage are not very painful and you can just keep quietly busy with your daily activities or a little bit of sleep. Provided your doctor (obstetrician or gynecologist) has not recommended anything else. In the course of this phase, the strength and duration of the contractions increases. Your cervix (cervix) is about 3cm long during most of your pregnancy. Usually your cervix is ​​still closed at the beginning of your delivery. The contractions in this phase ensure that the cervix shortens (passes or becomes thinner) and the cervix starts to open up (digestion).

The first few centimeters last the longest

You can not predict how long this phase will take. With a first delivery it often takes longer than with a second or subsequent delivery. The first few centimeters often take the most time.

Tips for relaxation
Do not fix yourself on the contractions but go as far as possible.
Take something relaxing for the night (glass of warm milk, a nice bath) and put a warm jug against your belly.

Active phase or access stage

The contractions become more sensitive, heavier and more regular and you really have to concentrate on them.
You can always take changing poses to catch your contractions. A hot bath or shower can help to promote access. In this phase, the cervix opens up from 3 cm to 9 cm.

Unlocking speeds up

If the membranes are not broken yet, chances are that it will happen in this phase. As a result, your baby's head will press directly against the cervix, so that the digestion will accelerate. At the end of this phase you have to try to sigh the contractions, which will not always be easy. It is often the most difficult moment of delivery. The access must still be 1 cm further before you are allowed to press. The contractions are getting harder and harder to sigh and you can already have a bit of perspiration that you usually can not admit.

The expulsion

The access is now complete (10 cm) and in an internal examination your midwife can no longer feel the access edge. This is, as it were, taken up by the womb. We then speak of complete or complete disclosure. The point is reached that you can actively press. Choose the most appropriate attitude for you, even if there is no ideal press position. If your doctor has no further instructions, you can just lie down as you feel most comfortable.

Head becomes visible

At a certain moment you can see some hairs during the pressing, which disappear into the depths after the wee. After a while, the head remains visible, even when you are no longer pressing. A little later, the head is born.
Listen carefully to the instructions of your midwife or doctor. She will advise you to prevent the risk of tearing as much as possible. The expulsion for a first child takes about half an hour to an hour and a half.

Check

When your baby is born, he is checked for proper functioning outside the womb. This check is done on the basis of the Apgar Score. Your baby does not have to be taken away from you for this. It is wise to put your baby to the breast as soon as possible after birth. The reflexes of the baby to drink are the strongest in the first hour. The baby imprinted this learning moment, as it were, and then you benefit from it in the rest of the maternity period. It also promotes attachment between mother and child. If you suddenly have to go to the OK, the baby can be placed on the naked belly with your father. Cover the baby warmly.

Placenta or afterbirth

After the birth of your child, the placenta and membranes (afterbirth) must also be born. You have to press a few more times to drive out the afterbirth. A placenta usually weighs between 450 and 800 grams. It is important to know whether the placenta is complete. Sucking the baby to the nipple promotes placental expulsion.

Cut

In the case of a first delivery, the vagina, labia or tissue between the vagina and the anus rupture a few women. Sometimes it is necessary to make the opening larger by means of a cut. After delivery, your midwife will check if you need to be attached. This will be done under local anesthesia.

Apgar score

At birth your baby gets a grade, the Apgar score. This is done using the following scheme:

Sign0 points1 point2 points
aActivity (muscle tension)absentarms and legs movedactive movement
PPulse (heartbeat)absentunder 100 bpmabove 100 bpm
GGrimace (reflexes)no responsegrimacesneezing, coughing, pulling
aApperance (appearance)blue-gray, completely palenormal except extremesnormal over the entire body
RRespirationabsentslowly irregularcry well

Medical indications

The medical indications for which hospital admission is advised can be divided into five categories:

Indications that result from your previous history

For example in neurological diseases (Epilepsy, MS, mental disorders, etc), internal disorders (Asthma, Thrombosis, pneumonia, heart defects, etc), disorders affecting pregnancy (diabetes, nervous disease, congenital pelvic fractures, etc.)

Indications that result from the first study

An earlier miscarriage, a premature birth, bleeding after the delivery of 1000 cc or more, placental exposure, et cetera.

Indications that occur during prenatal monitoring

Strong blood loss, suspicion of deformity of the embryo, ectopic pregnancy, protein loss of more than 100 mg per 24 hours, blood loss, start of the delivery for the 37th week, suspicion of growth retardation of your baby, multiple pregnancy, et cetera.

Indications during (and immediately after) delivery
Indications during the maternity period

Video: How to Deliver Puppies

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