What are the signs before childbirth. Independent occurrence of generic activity. Symptoms of clinical and biological death

Physiology of childbirth

How to understand that childbirth has begun?

Childbirth is a natural psychophysiological unconscious process that occurs reflex way and is regulated by the nervous and endocrine systems. The mechanisms that ensure the onset of childbirth are extremely complex and in many respects insufficiently elucidated. By the end of pregnancy, a woman's body accumulates numerous changes regulated by the nervous and endocrine systems, which together contribute to the onset of childbirth.

Development labor activity is not a one-time process. It is significantly extended over time. All the changes that occur in the body of the mother and child in preparation for childbirth are cumulative in nature and for this you need real time. However, every woman wants to know the timing of her birth, and even better, the date when everything will be done.

When are you expected?

IN modern obstetrics pregnancy is considered full-term at 38 weeks. Carrying a child for more than 41.5 weeks is considered overbearing. Thus, urgent, that is, on-time births fit into the interval from 270 to 290 days. However, there are women who give birth to completely normal, healthy and full-term babies at 36 or 42 weeks.

Moreover, these weeks can be counted in different ways, from the immediate date of conception or from the first day last menstrual period. Taking into account individual features every woman would be fairer to talk not about real time childbirth, but about the most likely interval when they can occur. This interval usually varies from 2 to 5 weeks, i.e. in terms of 38 to 42 weeks.

Obstetricians of the late 19th and early 20th centuries believed that a mature baby could be born within 240 to 320 days after the last period, and that in exceptional cases it can take more than 300 days from the day of conception to delivery. The German law of the early 20th century determined the maximum duration of pregnancy at 302 days from the date of conception. Only after this period it was supposed medical intervention during pregnancy, such as induction of labor or caesarean section.

As soon as the first day of the expected period arrives, the woman in excitement begins to monitor her condition very carefully and can interpret any ailment as a sign of the onset of childbirth. Going to the hospital with unsteady labor activity, a woman in labor runs the risk of being “stuck” in the pathology department for several days or being subjected to immediate stimulation.

Therefore, it is necessary to go to the maternity hospital with already established labor activity. And in order to be able to navigate this, it is not always necessary to call a specialist. For example, there are a number of phenomena that accompany the last weeks of pregnancy, which are called harbingers of childbirth. The presence of one or more harbingers suggests that the birth is coming soon, and it’s not worth it, for example, to go on a visit to the country, but it’s too early to go to the maternity hospital.

dress rehearsal

Pain in the lower abdomen and lower back

In the last 3-4 weeks before delivery, periodic drawing pains in the lower abdomen and lower back. They may be spasmodic. The appearance of such pain is a consequence of increased excitability of the NS, as well as displacement of the vertebrae in the sacrum, which can lead to nerve infringement. Sometimes as a result of such infringement on recent weeks pregnancy, the leg can be periodically taken away and immobilized. This phenomenon has a physiological basis and after childbirth disappears without a trace.

In addition, there may be a feeling of fullness, tingling and pain in the pubic area, which is associated with an increase in pressure of the presenting part of the fetus on the symphysis ( pubic bone). Wearing a bandage helps to alleviate this condition, as well as frequent rest in a prone position. This phenomenon also disappears after childbirth.

Lowering of the abdomen

2-4 weeks before delivery, the pregnant woman's belly drops ("slips"). As the abdomen lowers, the woman notes that it has clearly changed its shape and seems to have become smaller. This makes it much easier to breathe and eat. This occurs as a result of the lowering of the presenting part of the fetus, due to which the diaphragm, stomach and lungs are released.

Excitability of the uterus

Due to the increase in the excitability of the uterus, it begins to respond more and more to any stimuli. Very often, even 5-6 weeks before birth, tonic tension of the uterus occurs. First 1-2, then 3-4 times a week, and closer to childbirth and 1-2 times a day, the uterus can become very tense. At the same time, it becomes solid and this tension is present for quite a long time.

false contractions

In addition to tonic tension of the uterus, 3-4 weeks before delivery, its periodic contractions may occur, which are called the harbingers of childbirth or false contractions. Harbingers do not lead to the development of labor activity.

False contractions are also called Braxton Hicks contractions. Apparently, this pundit quite often felt false contractions, which did not lead to the development of labor activity in him, so he entered the history of obstetrics.

False contractions can appear after 7-10 minutes (and sometimes after 4-5 minutes) and last for 2-3 hours, and then fade away. They are non-systematic, but can be accompanied by quite severe pain in the sacrum, lower back, lower abdomen. Sometimes women experience much more discomfort and anxiety from false contractions than from labor. False contractions in most cases are noticed by multiparous women, who are much more wary of everything that happens to them. A primiparous woman notices them only if she has hypersensitivity.

A warm bath helps to cope with the discomfort that occurs during false contractions. If you immerse yourself in water at a comfortable temperature for 20 minutes - 1 hour, false contractions either subside completely, or go much less often, and at the same time their intensity becomes noticeably less.

Mood

Before childbirth, about 3-4 weeks before them, the pregnant woman has a change of mood. Even if during pregnancy a woman was afraid of childbirth and tried in every possible way to delay their onset, then before childbirth she spends every day in their painful expectation. “Well, when will I give birth? Well, it would be better to give birth! When will these births begin? Rather, rather, would rather give birth! she thinks all the time. The whole being of a woman is focused on this desire, and rarely anyone manages to bypass these quivering, sweet and painful expectations of childbirth.

Sometimes these thoughts can go so far that a woman begins to seriously consider how she could speed up the onset of labor. However, it is best to be patient and avoid rash acts: there is a time for everything!

Such a change of mood is associated with neuroendocrine processes occurring in the body of a pregnant woman before childbirth. The main reason for the change in her moods are the inconveniences that she begins to experience as the birth approaches: a feeling of heaviness, shortness of breath, heartburn, an uncomfortable position during sleep, etc. This discomfort accumulates and increases gradually, and 2 weeks before delivery reaches its climax. It is at this time that a change in the mood of the pregnant woman occurs.

appetite and weight

1-2 weeks before giving birth, a woman may become worse appetite and the abyss of that debilitating feeling of acute hunger, which was observed throughout the pregnancy. She begins to treat food more calmly. Such indifference and even refusal to eat are especially evident in the last 3-4 days before childbirth. Sometimes a woman stops wanting to eat only a day before giving birth, and in some cases her appetite does not suffer at all before giving birth.

Approximately 7-10 days before childbirth, a woman's weight may drop by 1-2 kg. Weight loss does not always occur, but, in any case, there is a stop in weight gain. 1-2 weeks before delivery, the woman's weight stabilizes and its increase is no longer observed. Reducing or stabilizing the weight of a pregnant woman before childbirth is associated with an increase in the release of fluid from her body.

It is time?

By the end of pregnancy, all the conditions for the development of labor activity are created in the woman's body. The excitability of the uterus increases and the level of hormones and substances that contribute to its contractile activity increases, a number of mechanical stimuli appear that contribute to its excitability: the lowering of the fetal head, its movements, provoking tonic tension of the uterus.

Thus, by the end of pregnancy, conditions are created for a very unstable balance, which is about ready to be disturbed in the direction of the development of labor activity, but childbirth occurs only at a certain point in time. It is possible to reliably determine that labor has already begun by observing the dynamics of the opening of the cervix by vaginal examination. This can only be done by a specialist.

But the woman in labor herself is able to note the symptoms that it is time to contact such a specialist - to go to the family or call him at home.

By what signs can you understand that childbirth has already begun?

Mucus plug

For 1 - 3 days or a few hours before childbirth, brownish mucus, similar to the beginning of menstruation, may begin to stand out from the genitals of a woman. It can come out with a pop (indeed, as if a “cork” popped out, which is associated with the strength of intrauterine pressure due, for example, to the large weight of the fetus: over 4.5 kg), or it can flow out gradually, in small portions. The appearance of a mucous plug indicates the beginning of the opening of the cervix. This is a definite sign of the onset of childbirth.

The abundance of secretions and the features of their appearance are individual. In pretty rare cases the secretions of the glands of the cervix are so meager that the mucous plug does not appear at all before childbirth. In this case, it may not appear during them either. In other cases, on the contrary, the maturation of the cervix is ​​very slow, and the secretion of its glands is very intense. In this case, the mucous plug may begin to stand out 7-14 days before the onset of labor. However, in the vast majority of cases, the mucous plug appears with the onset of labor or a few hours before it begins.

Contractions

Undoubted evidence of the onset of labor is regular contractions, i.e. periodic contractions of the uterine muscles, going with a steady rhythm. Labor pains are always accompanied by dilatation of the cervix, and they cannot be neutralized by relaxing procedures, such as taking a warm bath. But if a woman has had false contractions several times the day before, it can be difficult for her to orient herself in her feelings and distinguish between labor pains. If contractions are accompanied brown secretions from the genitals, then we can speak with full confidence about the onset of childbirth.

Digestive system

On the eve of childbirth, as a rule, there is a bowel movement. A woman can repeatedly go to the toilet, and at the same time the stool comes out in a slightly larger volume than is usually the case. Immediately before the onset of childbirth, i.e. a few hours before the onset of labor pains, nausea, vomiting, total loss appetite or indigestion. Such a reaction digestive system associated with the action of hormones that stimulate labor activity. These phenomena can occur both together and separately and accompany the appearance of the first weak contractions. In addition, the first contractions may be felt as abdominal pain, increased peristalsis, and frequent empty urination.

pain

Sometimes childbirth begins with the appearance of unclear dull pains in the lower abdomen and lower back or girdle pain (lower abdomen and lower back). They can be of a periodic nature, or they can serve as a painful background, i.e. continue without stopping.

Chills

Quite often, all these phenomena are accompanied by a feeling of cold and chills. Labor chills may accompany the onset of labor.

When a pregnant woman carefully analyzes the symptoms that the body gives, she understands that the onset of childbirth has come. And this means that soon there will be a meeting with the baby.

In women, a few weeks before childbirth, the hormonal profile begins to change smoothly. The placenta gradually ages. The amount of progesterone that she produces decreases, and the level of estrogen begins to rise. Progesterone ensures the safe bearing of the child, and estrogen prepares the body for the onset of childbirth. Before the onset of labor, estrogen reaches maximum number in blood. Therefore, the brain sends signals to the body, and childbirth begins.

When do women start showing signs of labor?

When, under the influence of hormones, the body of pregnant women begins to change and prepare the birth path for the birth of a baby, this phenomenon is called signs of childbirth. This is the last stage of pregnancy, during which the soft progress of the fetus (with minimal trauma) is ensured. birth canal.

Usually, before childbirth, signs appear in the final two weeks of pregnancy (with its normal course). Some women feel signs of incipient labor a few days before they begin. With a second pregnancy, symptoms usually appear just before the birth of the baby. Signs can be overt or covert.

What are the symptoms of a pregnant woman before childbirth

If future mom experiences changes in the state of the body, similar to obvious signs before the birth of a child, which means it's time to call an ambulance.

Contractions

First, women experience pain (similar to menstruation). The pain can be endured, and the expectant mother is quite capable of doing everyday household chores, even before childbirth. Then in lumbar there are sensations of a pulling and unpleasant character. Contractions are of two types: real, in which the cervix opens, and false.

During false contractions, there is no pain, although the ligaments are tense. Such fights are called training / preliminary.

They occur a week before the birth of the baby to prepare the uterus. But the birth doesn't start. Real contractions become more frequent and lengthen when labor begins. At first, the duration of the contraction is up to 15 seconds with a rest interval of 20 minutes. Before the birth of the baby, the duration of the contraction and the break for rest are 90 seconds each. You need to count to determine if they are real. Contractions at the beginning of childbirth appear with a certain period of time.

Another way to find out if labor will begin or not. You need to take a No-Shpa pill, lie down and relax. With real fights discomfort will intensify, with false ones, they will pass, and childbirth will not begin. It is advisable to give more time to rest during the period of false contractions.

With real contractions, the sensation of pain in women is characterized by wave-like manifestations. The onset of pain occurs in the back, then moves to the hip area, then to the abdomen. When the fight begins, the stomach tenses up, the uterus is in good shape.

It is advisable to record the time before the start, end and interval between contractions, so that later you can inform the doctor who will take delivery.

You need to urgently go to the department of the maternity hospital with a respite between contractions of 5 minutes. When contractions begin, it is advisable not to panic. You need to remain calm, try to relax, slowly and deeply breathe. Be sure to talk with the baby, as he experiences a lot of stress during this period.

You need to listen to the prompts of your body, as the body knows better what it needs in such a situation. important point. Walking helps many women ease the flow of contractions before labor begins.

A similar process is considered the first sign of the onset of childbirth. If the waters have broken at home, you should immediately go to the maternity hospital. After the discharge of water, the interval should not exceed 12 hours. It is necessary to inform the doctor about the time of discharge of water, their smell and color.

IN ideal beginning childbirth, there should first be contractions, and before the onset of attempts (when the cervix is ​​\u200b\u200balmost fully opened), the water should drain. But they can pour out different time. Sometimes doctors open the bubble to stimulate the onset of labor.

The waters depart in different ways: they leak or immediately pour out. It is also possible for the water to drain in case of oligohydramnios in the early stages of pregnancy, and the woman may not notice them.

Changes in the body that indirectly indicate the approach of childbirth

Lowering of the abdomen

The abdomen descends when the baby begins to descend into the mother's pelvis and prepare for the birth. It occurs after the 35th week of pregnancy. At the same time, the pregnant woman ceases to experience discomfort, since the uterus exerts less pressure on the diaphragm every day.

Now sitting and breathing is much more comfortable. Sometimes the navel protrudes, and the skin of the abdomen is even more stretched.

As the baby grows, there is less and less free space in the uterus. A few days before the birth, the baby practically does not move. But a woman needs to monitor the movements at this time especially carefully. If the movements of the baby are felt less than 10 times a day, you need to inform the doctor.

Weight loss

The expectant mother can lose up to 2 kg. In addition, swelling may pass. The body is thus freed from excess fluid. With daily weight control, a pregnant woman will notice changes in weight.

Increased activity

A woman becomes more lively the day before the onset of childbirth. She starts doing a lot homework(cooking, washing, cleaning, etc.), although before that she had more rest. From a psychological point of view, future mother trying to finish unfinished and important things. They even suggest that labor activity will not begin until she redoes all the planned affairs.

Cork performs protective function for the uterus, so that all kinds of infections do not penetrate into it. It consists of a lump of mucus streaked with blood. Departure, as well as discharge, is possible when contractions have begun, a few weeks before them. Sometimes the cork leaves during the birth itself.

Softening of the cervix

This process warns of the readiness of the body for the onset of childbirth. Only a doctor can fix this feature during vaginal examination.

Vomiting, nausea, diarrhea

Before contractions and at the beginning of the opening of the cervix, women in labor may experience similar symptoms. Doctors comment on this phenomenon by the presence of food in the stomach, which is trying to get rid of excess. It is believed that in this way the body saves strength for childbirth, so as not to expend energy on digesting food. When contractions begin, it is best to avoid eating.

Frequent urination

A few days before birth, the hormone prostaglandin is released. This hormone prepares the birth canal for the birth process and softens them. It intensively gets rid of fluid in the body, and cleanses the intestines. A similar process takes from a week and a little more before the upcoming birth.

Emotional condition

1-2 weeks before the onset of labor, the mood changes dramatically. If a pregnant woman laughs, then after a couple of minutes she may suddenly burst into tears. At times like these, support state of mind future mother.

Change in posture

The center of gravity shifts because the uterus has sunk. The gait of a pregnant woman becomes similar to that of a duck.

What are the signs on the eve of childbirth in nulliparous women

Often, primiparous women explain birth rates as disease state. Of distinctive importance is the fact that in women without the experience of childbirth, the symptoms proceed smoothly. They can appear up to 2 weeks before delivery. The abdomen drops in nulliparous women a week or two before delivery. The allocations are not very large.

The main thing is to learn to distinguish training contractions from real ones. After all, if a woman gives birth for the first time, she can take a false fight for a real one. It is important to note that signs before labor in nulliparous women may be asymptomatic, or may not be manifested by all, but by several symptoms.

What are the signs on the eve of childbirth in multiparous women

The second birth is different from the first. At the anatomical level, the multiparous cervix responds faster to hormonal stimuli and has a wider lumen. Signs of re-birth may appear for more early term, and flow more pronounced.

In multiparous women, the mucous plug and discharge are more voluminous, which increase more and more towards the end of pregnancy. Training contractions appear earlier than in primiparas.

The second and subsequent births proceed much more rapidly than the first. It should also be mentioned that the time between symptoms and delivery is significantly reduced. It happens that signs in multiparous people appear 1-2 days before delivery.

The abdomen drops, almost immediately before childbirth (about 2 days), and not like in those who give birth for the first time (a couple of weeks before the onset of labor). Also, the cervix repeated births opens faster and contractions are more painful. You need to listen carefully to your body. And if signs appear, it is advisable to set yourself up for a trip to the hospital and wait for the onset of contractions.

The term "harbingers of childbirth" in obstetrics is usually denoted clinical changes occurring with the cervix. Under the influence of hormones, it softens, shortens, opens slightly. Let us consider the phenomenon in detail, naming its visual signs, the sensations that the pregnant woman herself experiences at the same time.

Harbingers of childbirth in primiparas

The period of delivery is the most exciting for women who are expecting their first child. This fact is explained by the fact that most pregnant women about the signs early delivery in primiparous nothing is known. Talking with doctors, they learn about such a phenomenon as the harbingers of childbirth in first-borns, including:

1. Dropping of the abdomen. The expectant mother herself notes how it becomes easier for her to breathe, heartburn disappears. At the same time, she fixes that the gait has become more difficult, it becomes difficult to move.
2. Removal of the mucous plug. During the period of childbearing reproductive system(cervix) forms a clot of mucus, which it produces. It directly acts as a barrier to pathogenic microorganisms, protecting the fetus and uterus from their harmful effects. Shortly before the moment of delivery, the woman fixes her discharge from the vaginal cavity.
3. Decreased fetal activity. Many pregnant women fix that before the birth, in a few days, the child calms down. This is due to the lack of free space and big size baby.
4. Contractions of the uterus. Periodic voltage front abdominal wall with simultaneous tingling in the lower abdomen indicates an increase in contractility muscle fibers. Such contractions are called training, as they do not lead to the development of labor.
5. Posture change. Due to the shift in the center of gravity, a change in gait occurs, the head deviates slightly back.
6. Increase in the number of urination. strong pressure rendered on bladder fruit, requires frequent emptying organ.
7. Appearance discomfort in the lower abdomen, in the back. Woman fixes pulling, aching pain weak intensity. Pulls the lower abdomen before childbirth, mainly in primiparous.

Feelings before childbirth in primiparous

Each pregnant woman can describe her feelings before childbirth in different ways. But most women who already have children say that it all started with the appearance of a dull, unclear origin of pain in the lower abdomen and in the lumbar region. Often they act as a painful background - they continue for a long time, subsiding for a short time. At the same time, there may be an increase in defecation acts.

Doctors say that such harbingers of childbirth are associated with the efforts of the body to cleanse the intestines. At the same time, the chair was not changed. In addition, nausea and vomiting may occur several hours before delivery. This is predetermined by an increase in the concentration of the hormone oxytocin in the blood, which stimulates labor activity. Under its influence, there is an increase in the activity of the uterine myometrium.

When does the abdomen drop before childbirth in primiparas?

A sign associated with a change in the visual location of the abdomen is one of the well-known precursors of childbirth. It is due to the process of lowering the fetal head into the small pelvis, a change in the position of his body. At the same time, the expectant mother fixes relief, improvement in well-being. But primiparous, because of their inexperience, do not imagine given state. Because of this, often at a gynecologist's appointment, they ask a question about how to understand that the stomach has dropped before childbirth. Doctors indicate the presence of the following phenomena:

• increased frequency of urination;
• disappearance of recent shortness of breath;
• decrease in fetal activity.

There is an easy way to find out what happened. To do this, you need to conduct a test: place the hand in the space between the chest and the upper part of the abdomen. If almost the entire palm fits in it, this one indicates the approach of the delivery process. According to medical supervision, a similar phenomenon is recorded in women giving birth for the first time, 2-3 weeks before the onset of the birth process. This time interval has an average value. Due to the fact that each pregnancy has its own characteristics, it can change up or down.

Harbingers of preterm birth in primiparas

Pro premature appearance a baby is said to be born at his birth in the period from 28 to 37 weeks of gestation. The phenomenon does not happen suddenly. For some time before the onset, harbingers are fixed premature birth. Among those:

• soreness in the lower abdomen, which resembles the one that is fixed during menstruation;
• bleeding from the vagina;
• lack of fetal movements;
• leakage amniotic fluid.

Harbingers of childbirth in multiparous

The signs of an early birth in multiparous women are practically no different from those that are present when expecting the first child. hallmark they must be named by the fact that they are less pronounced and may appear later. This makes them harder to identify. But a woman giving birth forever remembers those harbingers of childbirth that she had before the birth of her first baby. She will know in advance about the imminent departure to the hospital.

Feelings before childbirth in multiparous

Women who give birth to a second and subsequent children know almost all the harbingers of an early birth. For a long time, a pregnant woman will know about the approaching hour "X" by her well-being, a change in activity. Many note that suddenly at the end of the gestational period there is a sharp relief, a surge of strength, there is a desire to do all the unfinished business, to prepare a room for the baby. This phenomenon is often compared to the nesting instinct.

When does the abdomen drop before childbirth in multiparous?

It is worth noting that women giving birth again are characterized by a relatively early prolapse of the abdomen before childbirth. Connected this phenomenon with muscle weakness abdominals And pelvic floor- a consequence of the first pregnancy. IN individual cases, the omission can be fixed at , when the process of the appearance of the child immediately begins.

Harbingers of preterm birth in multiparous

Early delivery is often due to complications of the gestation process. Among those central position occupies uterine hypertonicity. With this phenomenon, there is an increase in the contractile activity of the muscle fibers of the myometrium. Doctors record signs of imminent childbirth, including:

• opening of the uterine cervix;
• appearance;
• breach of integrity amniotic sac.

Diarrhea before childbirth

Often, expecting a second birth, the harbingers of which are described above, a woman fixes sharp violation late stools. This phenomenon is caused by a change in the position of the baby and an increase in the concentration of hormones that stimulate the birth process. Doctors say that this is how the body empties the intestines, increasing the space for the genital tract, along which the baby will move.

pregnant women on last dates pregnancies, as a rule, look forward to approaching the date of delivery. For many, the question of what is still considered signs of the onset of childbirth has not yet been finally resolved.

One experienced friend says one thing, the other - another, and in the special literature - the third information. You get confused here ... And it becomes scary: “What if I don’t understand that this is childbirth, that it’s time to go to the hospital? No matter what happens."

Such thoughts appear because, due to scattered reviews of experienced friends or after reading special literature, the difference between the preparatory stages (harbingers) of childbirth and true signs their start.

In this article about the signs of the onset of labor, an answer will be given to the maximum questions that a pregnant woman has about the onset birth process. In order for all issues to be resolved, fears dissipated without a trace, and only the expectation of the happiness of motherhood remains.

Causes and mechanisms of the onset of labor

From about 37-38 weeks of pregnancy, the female body begins to prepare for childbirth.

The main triggers for the onset of labor are:

• Hormonal changes in the body of a woman in labor. The production of progesterone, the hormone that maintains pregnancy, decreases. There is a stimulation of the production of a complex of estrogens - female sex hormones that stimulate labor activity;
• Contractile readiness of the uterus. The muscle fibers of the uterus (myometrium) fully mature. Increases the sensitivity of the muscles of the uterus to oxytocin - a hormone that is the main stimulator of uterine contraction and all labor activity. In the last stages of pregnancy, the uterus loses its ability to stretch freely. As a result of mechanical irritation of the uterus by the lowered head of the baby and an increase in the concentration of hormones in the blood that stimulate labor activity, an increased contractile readiness of the uterus is formed and it begins to contract;
• Maturity of the placenta. The placenta is the so-called children's place in the uterus. Through the placenta, the organisms of the mother and child are connected, the nutrition of the fetus is carried out. The body already “knows” that the placenta has fulfilled its function and will soon become unnecessary. There are natural processes of aging and destruction (degeneration) in a fully mature placenta;
• Fruit maturity. The limiting accumulation of metabolic products in the fetal body, a decrease in the volume and a decrease in the rate of formation of amniotic fluid does not allow maintaining metabolic processes at the same level.

All of the above reasons and factors are closely interrelated. It is their implementation in the complex that triggers the mechanism for the onset of labor.

Possible signs of childbirth (harbingers)

Harbingers of childbirth are a number of signs that are observed in a pregnant woman in advance, a few weeks or days before the cherished event. They show willingness female body to the process of childbearing. Depending on the characteristics of the woman's body, the combination of these signs will be strictly individual in each case.

So, first things first. One of the first signs of approaching labor is decreased fetal activity. Already a few weeks before giving birth, a woman may notice that the number has decreased and they have become less intense. Since the baby has grown enough, and there is little free space left in the uterus, his motor activity is difficult.

You know, there is life situation when it is crowded in a room or, for example, in a trolley bus. We then say: "It's so crowded here that you can't turn around." Or don't move. This is the situation with the baby. He, too, does not turn around, does not move.

The abdomen drops, the pelvic bones diverge.

This happens when the baby goes down, preparing to pass through the birth canal. At this time, his head is pressed against the entrance to the small pelvis. The bottom of the uterus (its highest part) is shifted downwards. In primiparous this probable sign may appear 2 weeks before the onset of labor. For mothers who have already experienced the joy of motherhood - a few days before the cherished event, but more often immediately before childbirth.

The pregnant uterus, having fallen down, no longer presses so hard on the diaphragm. At the same time, women say that it becomes easier for them to breathe, heartburn practically does not bother. Although outwardly lowered belly, not everyone notices on their own.

Since the baby's head descends and puts pressure on the pelvic bones, a pregnant woman gait changes. In gynecology, this is called "proud gait." The woman takes her shoulders and shoulder blades backwards, the center of gravity shifts, and the pregnant woman begins to walk, swaying slightly.

Due to excessive pressure on the fetal head pelvic organs(intestine, bladder) the frequency of urination and the urge to defecate changes. A woman feels more often the urge to urinate, less often, but there is even urinary incontinence. Due to mechanical irritation of the intestinal walls, constipation occurs a few days before childbirth. And sometimes it may not be constipation, but diarrhea.

Before childbirth volume increases vaginal discharge due to hormonal changes. They become less sticky. Sometimes women may confuse this discharge with amniotic fluid leakage. To differentiate discharges in the hospital, special tests are carried out.

What do you need to know about this? If the gestational age is more than 37 weeks or there are prerequisites for premature or rapid delivery, then if you find abundant vaginal discharge, you need to urgently go to the hospital.

Test with a sterile gauze cut

If the discharge is not very much, but more than usual, a simple test can be performed at home using a sterile gauze cut folded in several layers. Amniotic fluid is usually clear and quickly absorbed without leaving any residue. Allocations are absorbed poorly, often staining gauze.

This test is simple, but involves a subjective assessment of the results. And here, not every woman can figure it out on her own. Therefore, it is better to contact the hospital for timely diagnosis.

If the doctor confirms that it is just a discharge, you will be safely sent home. But if it turns out that amniotic fluid is leaking, then you did the right thing by contacting the hospital as soon as possible. A long waterless period is very dangerous for the health of the baby.

Before childbirth future mommy may mark weight loss(from 1 to 2 kg). Due to the influence of the changed hormonal background the body gets rid of excess fluid. This happens a few days before delivery.

false contractions

False (training, preparatory) contractions can begin from 36-37 weeks of pregnancy and periodically occur until childbirth. The closer to the date of birth, the more often the uterus comes to increased tone. Expectant mothers describe this as a “hardening” uterus. At the same time, pulling pains appear in the lower abdomen, less often in the lower back, sometimes girdle pain bothers (from the sacrum to the pubis). The intensity of the pain can be compared with the sensations during menstruation.

False contractions, unlike true contractions, are short (40-60 seconds) and do not have a clear regularity. One more distinctive feature false contractions is their disappearance after a change in the position of the pregnant woman or a short rest.

Training contractions do not lead to the opening of the cervix of the uterus, but accelerate its maturation and prepare the muscles of the uterus for the forthcoming active contractile activity during childbirth. Be sure to inform your doctor about the occurrence of such a harbinger as training contractions.

Due to all the above factors, change in the cervix. Mainly under the influence of estrogens, the cervical canal shortens by the time labor begins. The cervix itself softens and opens about one centimeter (“misses one finger,” as OB/GYNs say). Despite the fact that only a doctor can fix this sign during examination, a woman needs to know this important harbinger.

Because the cervix opens up a little, mucus plug comes out, which throughout the pregnancy performed a protective function. That is, this cork prevented the penetration of infections into the uterus. Mucus plug is a thick light mucous secret, sometimes with the inclusion of blood streaks. Sometimes the cork is light brown. The cork may come off entirely. In some cases, it departs in portions.

When exactly does the mucus plug come off?

The timing of the onset of this symptom can vary from 2 weeks or several hours before the onset of labor. If you notice that the mucous plug has come off, you should inform the gynecologist observing you about this.

Very often I encounter the fact that women on later dates they are tired of pregnancy, it is hard for them, they are looking forward to the term of childbirth. But at the same time, many expectant mothers have emotional lift on the eve of childbirth. Women actively prepare their home for the arrival of a new family member (laundry, cleaning, furniture rearrangement and even minor repairs).

By analogy with the animal world, this strangeness is explained by the instinct of "nesting". And if you suddenly feel any of the manifestations of this “nesting instinct”, for example, you urgently want to rearrange something in the apartment, then consider this also a harbinger of the imminent start of the cherished event.

Reliable signs of childbirth

These include the appearance of regular contractions (true) and the outflow of amniotic fluid. It is impossible to establish a causal relationship between them. What is primary and what is secondary cannot be clearly stated. In each case, the onset of labor activity proceeds individually.

Contractions

The occurrence of regular contractions underlies the onset of labor. True contractions determine the first stage of labor, when the cervix opens. The strength of the contraction the woman in labor cannot control. Thanks to contractions, the cervix softens, smoothes, and the cervix opens up to 10 cm (full dilation). The uterus and vagina are connected, forming a single birth canal, through which the baby passes, being born (II stage of labor).

It is sometimes difficult for primiparas to distinguish between false and true contractions. There has already been a description of false contractions above. Now let's talk in more detail about true contractions.

There are pulling pains in the lower abdomen. In primiparas, these pains often begin in the lower back. Their duration and intensity increases. And most importantly, there is a clear regularity of their occurrence.

Many people ask the question: “How often do contractions need to go to the hospital?” Only the doctor who observes you can clearly give an answer. In multiparous women, childbirth is faster. They should not stay at home with contractions. As you felt the contractions - rather in the hospital.

In primiparas, the first stage of labor is longer (12 hours on average). In principle, they can wait at home for a while with contractions, but first you need to consult with your gynecologist on this issue. But it's better to go to the hospital as soon as you make sure that these are real and not false contractions.

I will provide a table (more clearly) of the average duration and frequency of contractions.

Temporal characteristics of labor activity

Outflow of amniotic fluid

First, the anterior amniotic fluid drains. The anterior amniotic fluid is that part of the water that, at the entrance to the dense ring pelvic bones remain in the amniotic sac along with the fetal head. The volume of anterior amniotic fluid may be different. And they can pour out at once or in small portions.

In a normal pregnancy, the amniotic fluid is colorless, odorless, may have white inclusions (particles of cheese-like lubrication of the fetus). Greenish, fetid, with an admixture of meconium (fetal feces), amniotic fluid occurs during pathological pregnancy.

As a rule, the membrane of the fetal bladder ruptures with the outflow of anterior amniotic fluid in the first stage of labor when the cervix is ​​dilated by 3-7 cm.

It happens that the amniotic fluid leaves before the appearance of regular contractions and the necessary opening of the cervix. In any case, with the outflow of amniotic fluid, a woman should immediately go to the maternity hospital under the supervision of specialists. A long waterless period (more than 6 hours) is a threat of infection of the child.

Advice for moms-to-be in late pregnancy

Better in advance. Wherever you go or don’t go, always have your pregnancy documents (exchange card) with you. It's more reliable. It is impossible to accurately predict the moment of the onset of labor. But, having an exchange card with you, wherever you find signs of the onset of childbirth, you will always be ready to urgently contact the maternity hospital and avoid unnecessary worries.

Already at 38 weeks, the prenatal period begins, when the first harbingers of childbirth and the first, as yet irregular (training) contractions, appear. Such contractions appear irregularly, and they pass after a change in body position or a short rest. In nulliparous women, such training uterine contractions can last five, and in some cases even more days before giving birth. When they appear, you do not need to worry and urgently go to the hospital, but the expectant mother should inform her doctor, relatives and friends about such changes in her body.

When the first signs of leakage or outflow of amniotic fluid appear, which may indicate the onset of labor or premature labor, the woman should immediately notify the doctor or contact the medical institution to decide on further hospitalization.

If a woman has learned to recognize training contractions, then she will be able to distinguish them from the onset of labor, or true contractions. These sensations are difficult to confuse with any other symptom, since they are characterized by periodicity and rhythm. For example, a fight lasts 20-30 seconds, and then there is a 20-minute pause - this is repeated many times in a row, and the time intervals hardly change.

At the beginning of the onset of labor pains, the woman in labor or her relatives should notify the doctor about the onset of labor, call " ambulance or head to the maternity hospital on your own.

Reasons for the onset of labor

The main reason for the onset of labor is the readiness of the uterus for the birth of the unborn child and the maturity of the fetus.

Ready for childbirth uterus:

• gaining sufficient weight and size;
• her neuromuscular apparatus is ready for contractile activity;
• fully mature placenta.

Several factors influence the onset of labor:

• neuro-reflex - as a result of a decrease in the excitability of the brain, an increase in excitability spinal cord and increasing the sensitivity of the muscle fibers of the uterus to oxytocin, an increased contractile activity of the uterus is produced;
• hormonal- at the end pregnancy the production of progesterone decreases and the production of a complex of estrogens increases, which stimulate the onset of labor;
• neurohumoral - at the end of pregnancy in the body of a woman, the synthesis of oxytocin, prostaglandins, serotonin and other bioactive substances increases, which increase the sensitivity of the uterus to substances that cause active contraction of its muscles;
• bioenergy - a sufficient amount of substances (glycogen, ATP, phosphorus compounds, electrolytes and trace elements) accumulate in the mother's body, which make the uterus capable of increased contractile activity;
• mechanical - the ripened uterus loses its ability to stretch, and in response to motor activity fetus and an increase in the level of hormones of oxytocin-like action, begins to actively decrease;
• trophic and metabolic - the accumulation in the body of a mature fetus of some waste products leads to its active movement, and degenerative processes in the mature placenta and the full maturation of the muscle fibers of the uterus contribute to the onset of labor.

The main value in the formation of all mechanisms of the onset of labor is nervous system women in labor, because it is she who ensures the readiness of the uterus for natural childbirth.

All of the above factors, being in close relationship, contribute to the appearance of contractions, which are replaced by attempts and end with the expulsion of the fetus from the uterine cavity and the birth of the placenta.

Harbingers of the onset of labor

Harbingers of childbirth:

• Dropping of the abdomen.
  Such a change, which is determined externally by a slight downward displacement of the abdomen, is individual for each pregnant woman, and may not always be noticed on its own. In nulliparous women, this harbinger may appear 2-4 weeks before the day of delivery, and in multiparous women, a few days or immediately before childbirth.


• Gait changes.
  The nature of the gait changes after the prolapse of the abdomen. The woman begins to walk "waddling" due to the pressure of the baby's head on the pelvic bones and the bottom of the uterus.


• Changes in the nature of urination and defecation.
  The prolapse of the abdomen can cause more frequent urination or urinary incontinence, as the uterus begins to exert more pressure on the bladder. The mechanical impact of the pregnant uterus on the intestinal wall can provoke constipation, and in some cases diarrhea, a few weeks or days before delivery.


• Change in the nature of secretions from the genital tract.
  Vaginal discharge under influence hormonal changes become more plentiful and liquid. In some cases, to exclude the discharge of amniotic fluid, a special test is performed by an obstetrician.


• Removal of the mucous plug.
  This harbinger of labor can occur 2 weeks before the onset of labor, and a few hours before it begins. In some cases, the mucous plug does not come off entirely, but in small portions. In practice, this sign looks like a discharge of vaginal discharge (sometimes with an admixture of a small amount blood). A pregnant woman should inform her obstetrician-gynecologist about the discharge of the mucous plug.


• Decrease in the body weight of the expectant mother.
  A few days before giving birth, a pregnant woman may notice that she weighs 1-2 kg less. This weight loss can be explained by the removal of excess fluid from the body under the influence of changes in the hormonal background.


• Reducing the number of fetal movements.
  The fetus, a few weeks before birth, moves less frequently. This is explained by his rapid growth. The future baby becomes crowded in the uterine cavity, and its movements are difficult.


• Training bouts.
  Closer to the date of birth, the uterus begins to increasingly come into increased tone, which is expressed in the feeling of training contractions. They differ from labor pains in a number of features: short duration, irregularity, weak painful sensations(reminiscent of pain during menstruation), spontaneous disappearance after a change in body position or rest.


• The manifestation of the instinct of "nesting".
  Many women in last days and even the hours before childbirth begin to prepare the home for the forthcoming birth of the child. These actions can be expressed in the fact that a woman begins to diligently clean, wash, and even start repairs.


• Changes in the cervix.
  Only an obstetrician-gynecologist can notice such a harbinger of an approaching birth when examining a woman on a gynecological chair. Under the influence of estrogen hormones, the cervix shortens and becomes more elastic by the 38th week. The external os of the cervix begins to open before the onset of labor pains.

Harbingers of the onset of labor - video

Signs of the onset of labor

These two signs always indicate the onset of labor and every pregnant woman should know how they proceed.

Contractions

The first true contractions are accompanied by minor painful sensations, which most women compare with pain during menstruation. The pain is tolerable and can be given to the lower back or localized in the lower abdomen. Most women in labor begin to feel contractions at night. Some women note that during labor pain the uterus “hardens”, i.e. if during the contraction the woman in labor puts her hand on her stomach, then she can feel a hard, tense uterus.

You can determine the truth of contractions using a stopwatch. Their periodicity and constant occurrence, which is not eliminated by a change in body position, taking a warm bath or rest, indicates the onset of labor.

At first, contractions occur at intervals of half an hour (in some cases more often). With each contraction, the woman in labor begins to feel not only soreness, but also rhythmic contractions of the muscles of the uterus. Gradually, contractions become more noticeable, and their frequency, duration and intensity increase. At every fight amniotic sac and the head of the fetus presses on the fundus of the uterus, causing a gradual opening of the cervix.

Outflow of amniotic fluid

A woman in labor, with a classic outpouring of water, may seem to have involuntarily urinated. In some cases, water is poured out gradually, in small portions. In this case, a woman may notice the appearance of wet spots on her underwear or bedding and experience such sensations as when separating vaginal or menstrual flow.

Sometimes the rupture of amniotic fluid can occur before regular contractions and cervical dilatation, or much later. full disclosure pharynx of the uterus. These conditions do not always mean that there will be a pathology of childbirth or the fetus, but usually gynecologists use various special tactics for the further conduct of such labor to prevent possible complications.

Signs of the onset of labor - video

Contractions at the beginning of labor

Initial (hidden) phase:

• the duration of the fight is 20 seconds;
• the frequency of contractions is 15-30 minutes;
• opening of the cervix - 0 or up to 3 cm.

Active phase:

• the duration of the fight is 20-60 seconds;
• the frequency of contractions is 2-4 minutes;
• opening of the pharynx of the uterus - 3-7 cm.

Transitional (transient) phase:

• the duration of the fight is 60 seconds;
• the frequency of contractions is 2-3 minutes;
• opening of the pharynx of the uterus - 7-10 cm.

Labor pains occur in the first stage of labor (the period of disclosure).

Beginning of labor in primiparas