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    Labour & Delivery

    Finally, you are approaching close to a very special day of your pregnancy period. 

    You must be excited to see your baby and feel the warmth of your baby touch, but little nervous too as you don’t know the exact date and time of delivery. 

    It is very unpredictable to foretell precisely the exact date of delivery. It not only varies from mother to mother but even in different pregnancies of the same mother.

    Therefore, it is important to prepare yourself in advance by gaining knowledge on labour procedure you will undergo and accordingly preparing your delivery checklist and activities.

    Delivery is the process of giving birth which occurs by series of uterine contractions, leading to cervical dilation and extraction of the fetus out of the womb. To ensure the proper care of the baby, KMC i.e. kangaroo mother care is recommended for infant and mother affection.


    Types of Delivery:


    It may occur through a vaginal route called Normal delivery or may be abdominal via Caesarean section surgical procedure. 


    Normal vaginal delivery is the process of giving natural birth that does not require any medication or surgery. Nowadays, the process is speeded by medications that alleviate the pain and shorten the whole procedure. The process starts with softening and stretching of the cervix to allow delivery. As the cervix becomes fully dilated and mother experiences regular and strong contractions, the baby is pushed outside through the birth canal. 


    The mother experiences intense pain around the vagina and pelvis due to protruding of the baby's head through the vaginal opening. After the birth of the baby, the contractions continue to push out the placenta. This can take from a few minutes to a half hour after the baby is born. 


    Caesarean delivery or C-section is the surgical process of delivery in which an incision is made over the lower abdominal wall and the uterus for the delivery. 

    C-section is usually indicated when the possibility of vaginal delivery is either difficult or risky for mother and baby’s health. 

    Emergency C-section may be done in the following conditions: 

    • Maternal conditions like preeclampsia, eclampsia, uterine rupture, placenta previa, etc. 
    • Fetal conditions like poor heart rate, distress, or umbilical cord derangement, etc. 


    Stages of Labour 


    The events of Labour are divided into 3 stages:


    The first stage: It starts from the onset of true labour pain and ends with full dilatation of the cervix. Its average duration is 8-16 hours in primigravidae and 4-8 hours in multiparous mother. 

    The second stage: It starts with full dilatation of the cervix and ends with the delivery of the baby. Its average duration is 1-2 hours in primigravidae and 10-15min in multiparous mother. 

    The third stage: It begins after delivery and ends with the expulsion of the placenta and membranes. Its duration is usually reduced by active management of the OT staff. 

    The mother is under observation for at least one hour to carefully monitor the general condition and the behaviour of the uterus. (especially to check any postpartum bleeding). 


    Labour pains


    In the final phase of the pregnancy, the mother faces a series of labour pains which are the strong indications to estimate the time of the delivery. Sometimes the normal abdominal discomfort and mild pain episodes are misunderstood as true labour pains. To experience a painless or less painful natural birth, an expectant mother can go for hypnobirthing classes to get aware of the instinctive birthing capability of their bodies.


    Therefore, we should understand the basic difference between these two types of following pains:


    False labour pain: False labour pains are usually common in first time pregnant mother (primigravidae). It occurs before the onset of true labour pain by one or two weeks in primigravidae and by few days in multipara mother. The false pain can easily be mistaken as true labour because the mother feels pain and discomfort in the lower abdomen. Therefore, the mother should know the key distinguishing features of false labour pain:

    • Dull pain is confined to the lower abdomen and groin area. 
    • Continuous and unrelated with hardening of the uterus
    • No dilatation of the cervix


    If the mother is still confused or unable to distinguish it from true labour pain, then it is advisable to immediately consult with your doctor. 


    True Labour pain: During pregnancy, there are continuous episodes of painless Braxton Hicks contractions together with stiffening of the uterus happen. In the initiation of true labour pain, these contractions become robust, irregular and connect with the pain. The pain is more often felt in front of the abdomen and radiates towards the thighs. The key features of true labour pain are:

    • Painful uterine contractions 
    • Profuse cervical secretion with the discharge of cervical mucus plug (mixed with blood) 
    • Dilatation of cervix and lower part of the uterus 
    • Formation of “bag of waters” by a lower pole of the fetal membranes, tends to bulge out from the cervix. 

     

    Position of a baby before delivery 


    As the due date is getting closer the position of the baby in the womb becomes important. Your doctor will assess you many times and might use the following words while explaining the baby’s position to you. 


    Anterior lie (cephalic position): When the baby head is facing downward and the spine is facing towards the front part of the mother’s stomach. This position is called cephalic presentation (normal presentation) and is the most preferred position for delivery. 

    Posterior lie: When the baby head is facing downward and the spine is facing towards the mother’s spine. In these cases, usually in last moment the baby rotates themselves and come into the cephalic presentation. In this position the chances of prolonging delivery and pain increases.

    Breech lie: When the baby’s buttock or feet are facing towards the birth canal and head towards the mother’s stomach. It is not the ideal position for labour induction and increases the chances of trauma and complications during delivery.

    Transverse lie: When the baby is lying horizontally within the uterus. In these cases, the risk of cord prolapse is high, therefore the doctors suggest opting for caesarean section.


    Considering the completion of the pregnancy weeks, the delivery is subdivided into:


    Preterm delivery (or premature birth): When the delivery takes place before the completion of the 37th week of pregnancy (i.e. 259 days). In about 50% of cases, the cause of the onset of labour is unknown. But in rest, the decision to induce preterm delivery is taken by identifying the risk factors involve (considering both for mother and baby) in continuing the complicated pregnancy. In premature birth, the baby needs special medical assessment and might need a longer hospital stay under the supervision of a paediatrician.

    Term delivery: When the delivery takes place between 37 weeks to 41 weeks (i.e. 260-294 days).

    Post-term delivery: When the pregnancy has extended to 42 weeks (295 days) or more. 


    A pregnant woman will experience following signs and symptoms that tell the baby is on the way:

    • Baby will typically start to drop down into the pelvis
    • Cervix dilates
    • Back pain and cramps increase
    • Loose-feeling joints
    • Diarrhea
    • No more weight gain 
    • Fatigue and "nesting instinct"
    • Loss of mucus plug with clear, pink, or blood-tinged discharge
    • Vaginal discharge changes colour and consistency
    • Stronger, more frequent contractions
    • Water breaks


    Look for these signs and get ready for the delivery.


    Mother emotions and relationship: A first-timer mother will be very excited as well as exhausted after the delivery phase. Baby is also very receptive, and an immediate bond is made between the baby and mother as soon as the baby is put on the mother’s chest soon after the delivery. Start great motherhood by adopting the following steps: 


    • At the hospital, try to sleep with your baby or if he is in NICU, visit often to see your baby
    • Once you arrive home, spend as much of the time with your baby by rocking her on your lap or by wearing her in sling or carrier
    • Do exclusive breastfeeding
    • Try to give a gentle massage to your baby
    • Sing for you so that your baby can connect with your voice.
    • Have some skin-to-skin contact with your new-born



    Reference:


    Textbook DC Dutta “Normal Labor, Caesarean Delivery, Early Labour, Stages of Labour, position of baby during delivery, birth defects”

    www.womenshealth.gov/breastfeeding “exclusive breastfeeding”

    https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/implementing-standards-resources/skin-to-skin-contact/ “Mother emotions and relationship”

    Frequently Asked Questions

    Once your pregnancy is around 34 weeks, it's time to start preparing for your delivery. Following is the checklist: DELIVERY CHECKLIST

    For Mother: 

    ● Dressing gown

    ● Loose clothes

    ● Backless slip-on slippers

    ● Footwear

    ● Sanitary pads

    ● Breastfeeding clothes

    ● Socks

    ● Hairbands or a clip and a hairbrush

    ● Shower essentials

    ● Toothbrush and paste

    ● Warm clothes

    ● Underwear

    For baby

    ● Baby nappies

    ● Baby blanket

    ● Baby clothes

    ● Baby wipes

    ● Onesies

    ● Cap, booties or socks

    ● Feeding essentials


    Yes, it is possible. You can plan a vaginal birth in your second pregnancy after first caesarean delivery. But factors like your medical history, the reason for your first C-section, incision type, etc. determine if you can proceed with safe vaginal delivery. 

    Common birth defects are: 

    ● Heart defects, like deformed valves

    ● Cleft lip, splitting in the lip

    ● Clubfoot, the inward pointing of foot instead of outward

    ● Spina bifida, underdeveloped spinal cord 

    ● Down syndrome

    ● Blindness or deafness etc. 

    Although the exact cause of many birth defects is not known but following precautions should be taken by a pregnant woman to reduce the risk:

    - Avoid alcohol and drugs

    - Maintain a healthy diet and weight

    - Visit your doctor frequently

    - Take preventions from being infected

    - Take all the supplements as prescribed

    - Get enough iodine

    - Stay in the sun for some time every day

    How to manage the labour pains?

    ● Take deep breaths

    ● Stay in a comfortable position

    ● Take a warm shower

    ● Apply a lukewarm water bottle (not on the abdomen)

    ● Try massage

    ● Stay calm

    ● Keep moving 


    There are no as such side-effects of a caesarean delivery but it is a surgery, there are several risks associated with it like a formation of blood clots, haemorrhaging, surgery site infection, injury to adjoining organs like bladder or intestine, reaction to the anaesthesia and risk to future pregnancy etc.  You should take proper rest, follow medication and stay calm to avoid these risks. Your doctor will take every precaution to keep you and your baby safe during C-section. 

    Following symptoms denote early labour: 

    ● Pinkish/red mucus discharge from the vagina

    ● Dull aching pain in the lower back

    ● Water breaks

    ● Diarrhea-like bowel movements

    ● Contractions that are longer, stronger and more frequent


    Cord blood banking is a facility that allows the storage of umbilical cord blood (is a rich source of haematopoietic stem cells (HSC)) in proper shape and form so that it can be used in the future for treatment of over 80 different diseases like Cancers, Blood Disorders, Metabolic Disorders, and Immune Disorders etc.

    It is a better source of HSC as compared to other sources because: 

    ● Cord blood cells multiply very quickly.

    ● HSCs from cord blood naturally move to damaged areas

    ● Umbilical cord cells are more adaptable than other types of HSCs


    • Use pads and not tampons
    • Use warm water to cleanse yourself
    • Take sitz bath
    • Use ice packs for pain around the vagina
    • Rest properly
    • Take a nutritious diet
    • Stay hydrated
    • Do light exercise
    • Take help from a husband or anyone else


    • Take deep breaths 
    • Stay in a comfortable position 
    • Take a warm shower 
    • Apply a lukewarm water bottle (not on the abdomen) 
    • Try massage 
    • Stay calm 
    • Keep moving  

    Like any surgery, there are few complication associated with caesarean delivery like a formation of blood clots, haemorrhaging, surgery site infection, injury to adjoining organs like bladder or 

    intestine, reaction to the anaesthesia and risk to future pregnancy etc.  You should take proper rest, follow medication and stay calm to avoid these risks. Your doctor will take every precaution to keep you and your baby safe during C-section.