Childbirth is a difficult and dangerous process that requires a woman to follow certain rules. If you act as doctors advise, pain can be significantly reduced. Everything is important: from a comfortable position of the body, arms and legs to rhythmic breathing. You need to start working even before the pressure appears. What does this concept mean and how do pushing differ from contractions?

Attempts: what is it?

The medical term “pushing” means a reflex contraction of the abdominal and uterine muscles, supported by the work of the diaphragm, with the help of which the body pushes the fetus out. The woman is not able to influence the course of this stage of childbirth, since everything happens completely automatically. Attempts begin after the fetal head has turned in the desired direction and puts pressure on the cervix, which must be prepared and dilated as much as possible.

Reflex muscle contractions begin involuntarily; their arrival cannot be delayed or stopped at will, but they can still be controlled. When describing pushing, women often use the term “pushing”, since they are to a certain extent reminiscent of the process of defecation.

Pregnant women are often afraid that they will not be able to give birth to a child on their own. Fears are in vain; nature arranges it in such a way that all processes during childbirth follow one after another in the correct order and occur automatically. In case of unforeseen complications, doctors from the operating team and an obstetrician receiving the baby are on duty next to the woman in labor.

How are pushing different from contractions?

Women giving birth for the first time do not always understand the difference between pushing and contractions. Both processes are aimed at helping the baby to be born, complement each other and occur sequentially.

During contractions, a woman cannot control her muscles. The woman in labor needs to take a comfortable position and try to catch the rhythm, helping her body. Proper breathing will help reduce pain. Between contractions, you should try to relax and give your body a little rest.

At the stage of preparatory contractions, the pain is not very strong and develops progressively. At this time, the cervix dilates.

When the uterus is prepared for childbirth, the fetus begins to push through the birth canal. This is the second stage of labor, during which contractions become much stronger and more painful. This is followed by attempts, which can be restrained or intensified, following the instructions of the midwife. It monitors the movement of the fetus and helps the process by determining whether the baby is being born normally.

When does pushing begin and how long does it last?

There is no need to be afraid that during the first contractions labor will immediately begin and the fetus will appear. The process of childbirth is quite long (rapid labor in primiparous women is extremely rare). Attempts appear immediately before its final stage.

The duration of the attempts themselves varies among all women in labor, but they are always shorter than contractions. How long the process will last depends not only on the intensity of labor, but also on the woman’s ability to control herself and relax. During the first pregnancy, which passes without complications, they last about 2 hours. Subsequent labor for most women goes a little faster, and the duration of pushing can be reduced to 30 minutes.

One push lasts about 15 seconds. The break between attempts is about 3 minutes, during which time you must try to restore your breathing. You should not resist the body’s reactions or restrain yourself when pushing, this will only prolong the process. To prevent involuntary bowel movements from straining during childbirth, women are given an enema first, so there is nothing to fear.

Actions of a woman in labor during pushing

During pushing, the woman in labor needs to listen to the obstetrician and follow his advice. It is important to study the breathing technique in advance, and if this is not done, try to breathe as the doctor recommends. Sometimes the birth process needs to be slowed down, then you will need to relax as much as possible and breathe short and often. This shallow breathing will help you get some rest. Complete relaxation is the key to successful childbirth.

Efforts must be made at the moment at which the peak of the effort occurs (that is, it becomes as strong as possible). Breathing should remain even and smooth. Screaming during childbirth is harmful for a woman in labor - it wastes a lot of energy.

Types of pushing behavior

A woman can choose the type of behavior during childbirth herself in a preliminary consultation with her doctor. It is worth doing this in advance so that you have time to prepare and practice proper breathing. There are two types of behavior when pushing:

• natural;
• controlled.

With the natural type, a woman trusts her own body and does not control her attempts. The doctor monitors the process and helps you adapt to the situation. The main task of a woman in labor is to relax and help her body do everything as required, without holding back labor efforts.

This type of behavior is suitable for those who have given birth for more than the first time and tolerate pregnancy well. In this case, the fetus must be correctly positioned, that is, turned head down.

The controlled type of behavior is more suitable for those who are giving birth for the first time and are very afraid of doing something wrong. In this case, it is better to completely trust the doctor and follow his recommendations. During pushing, the woman in labor is given a signal when to push. In this way, the obstetrician can synchronize the woman’s actions with the progress of the fetus.

Correct breathing

The most important thing in the process of trying is to control your breathing. Sharp breaths are unacceptable; the diaphragm should move smoothly. The period of deep breathing alternates with superficial, so-called canine breathing. The algorithm of actions is as follows:

1. at the beginning of the attempt, take a deep, slow breath and hold your breath;
2. at this moment the hips, buttocks and face are as relaxed as possible;
3. The abdominal muscles at this moment must be tensed as much as possible;
4. during pushing, the pressure in the abdominal muscles should be directed to the lower abdomen towards the perineum;
5. After a few seconds, at the doctor’s sign, you can relax.

With proper rhythmic breathing during pushing, a woman helps her baby pass through the birth canal. The exhalation should be strong and smooth, since it is at this moment that the fetus is moving forward, and sharp shocks are harmful to it. It is important to relax in between attempts so that the woman has enough strength to complete labor.

Possibility of complications

Childbirth in women lasts several hours, in difficult cases up to a day. One of the common complications of this process is weak labor. It can manifest itself both during contractions and during pushing. In this case, only the abdominal muscles are involved in the process of pushing the child out.

This pathology is typical for those who are overweight or women who have given birth many times. Those who suffer from various diseases of the abdominal organs have a predisposition to weak labor. In case of weak labor, the obstetrician may prescribe medications that can increase the effort.

Due to improper breathing of a woman during childbirth, the baby can suffer a traumatic brain injury. With a sharp active inhalation, the child is pulled back into the birth canal, and the risk of injury is high. That is why women in labor are strongly advised not to scream while pushing.

If a woman in labor pushes at the wrong time, there is a danger of damaging her own muscles, ligaments and bones. In this case, the baby in the stomach is deprived of oxygen and may also suffer. Early onset of pushing with insufficient dilation of the cervix leads to ruptures in the woman and prolongation of the entire birth process.

Quick labor is no less dangerous than prolonged labor. If a woman begins to push before the cervix has dilated, this leads to uterine rupture, which complicates the entire birth process. The rapid advancement of the fetus along the birth canal is fraught with numerous ruptures in the vagina and perineum, leading to dangerous bleeding in the woman and various sprains and injuries in the child.

Many pregnant women are terrified of pushing, considering them the most terrible moment of childbirth. It is important for a woman to get rid of this fear, because it will prevent her from relaxing and calmly following the doctor’s recommendations, which is extremely necessary during childbirth. That is why it is necessary to prepare for the birth process, for example, by attending special courses for pregnant women.

Of course, the statement that preparing for childbirth is useless is incorrect. This is how those who are lazy or are simply afraid to find out something about childbirth in advance justify themselves. And yet, there is some truth in this statement: no matter how you prepare for childbirth, the beginning of this process will still be associated with natural excitement, during which all acquired knowledge can become confused in the head.

To meet this process fully armed, many women, long before the end of pregnancy, begin to seriously prepare for childbirth: they take courses, read magazines and search for information on the vast expanses of the Internet. After all, in order to feel confident from the very beginning, you need to firmly understand how not to miss the onset of labor, when you need to go to the maternity hospital, what documents and things will be required for hospitalization, what needs to be done before leaving for the maternity hospital.

Suppose the expectant mother has the first “suspicious” sensations: her back hurts, her stomach tenses, and unusual discharge from the genital tract appears. At this moment, many thoughts simultaneously appear in your head based on the information received about childbirth. However, these thoughts are sometimes very contradictory, because different options for the onset of labor were discussed in courses and in specialized literature. So, where to start: call the doctor, your husband or an ambulance? What if this is it? What is the best way to behave now during “sensations”: try to relax or immediately use pain relief techniques? What is better now: lie down, sit down or walk? Looking for an answer to these questions during contractions, rummaging through a stack of magazines or thick course notes, is extremely inconvenient. To make this task easier, we have compiled a guide to action on the most important points in the beginning of labor.

Maternity hospital bag: what to take with you

Considering that labor often begins suddenly, it is better in the last weeks of pregnancy to constantly carry medical documents with you - a passport, exchange card, policy, after 30 weeks - or a birth contract - after 36 weeks. It is necessary to know or have with you the telephone numbers of emergency services, a doctor, the address of the obstetric departments or other medical institutions closest to your home and work.

The expectant mother should not rely only on herself - if an emergency arises, she must turn to others for help, warning her about her condition. It should be remembered that police officers, metro officers, flight attendants and train conductors undergo medical assistance courses and can urgently contact doctors.

How to pack things correctly?

To the maternity ward of the maternity hospital you need to take washable slippers, clean socks, toilet paper, disposable toilet seats, wet wipes or disposable handkerchiefs (for the face and hands), a bottle of still water), thermal water spray (for irrigating the face and body), chapstick or lip balm, moisturizing drops or nasal spray, earplugs (the maternity ward can be noisy), a phone with charger and headphones. If you are allowed to take your own clothes to the hospital block, you can take a couple of T-shirts or short nighties and a robe.

The postpartum bag should include clothing for you and your baby, daily hygiene products, postpartum pads, disposable panties, bra and nursing pads, nipple cream, breast pump, a pack of diapers and baby wipes.

Advice

When packing things for the maternity hospital, it is more convenient to distribute them into two bags: in one, put everything you will need in the maternity ward, and in the other, the most necessary things for the postpartum ward. Many maternity hospitals do not allow you to carry things in textile bags, so it is better to use plastic bags. If you are having a partner birth, don't forget clothes, a change of shoes and food for your spouse!

How do you know if you can have a snack?

Food is a source of energy that is so necessary for the expectant mother during the long and labor-intensive process of childbirth. Today, even in the maternity ward, the staff offers sweet tea, a lollipop, and a piece of chocolate to a tired woman in labor. True, it is better that it is just a snack, something light and quickly digestible - fruit salad, yogurt, cottage cheese, nuts, dried fruits, juice or sweet tea. It is better to abstain from rich, heavy food at this moment, as it can provoke vomiting with a subsequent increase in contractions.

Advice

Contrary to popular belief, at the beginning of labor you can and even need to have a snack - of course, if you have an appetite. It is necessary to completely abstain from eating from the very beginning of labor only in the case of a planned surgical delivery (that is, before a cesarean section) or in case of any symptoms of deterioration in the health of the woman in labor (bleeding, increased blood pressure, severe pain).

Take a warm shower. In addition to its hygienic function, a shower during contractions is used as a relaxing and pain reliever. Streams of warm water directed at the abdomen and lower back reduce the feeling of tension during contractions and help improve blood circulation in the pelvic area, on which the dynamic development of labor and the baby's breathing depend. At the beginning of labor, it is better to get into the shower completely, with your head - a water massage will help you relax and calm down, control your emotions and have a positive attitude towards the upcoming birth.

Get a manicure and pedicure. First, remove the polish from your fingernails and toenails. By the color of the nail plates, the doctor during the birth process determines the level of microcirculation (blood flow in small vessels) in you, and therefore in the baby! Secondly, trim your nails short. Immediately after birth, the baby will be placed on your tummy and allowed to hold it with your hands. The skin of a newborn is very delicate and vulnerable, almost like the mucous membrane of an adult. Protruding nails can easily damage the baby’s skin, and the resulting scratch can become an entry point for infection.

Perform intimate waxing. Hair removal in the perineal area is a standard “preparatory” procedure upon admission to the maternity hospital. Many women do not understand the purpose of this manipulation: it is obvious that the presence or absence of hair does not in any way affect the course of labor. Why is it necessary to shave the pubic hair and between the legs before giving birth? Hair around the vagina traps intimate secretions. During childbirth and especially in the postpartum period, this discharge becomes much more abundant than usual, accumulates at the entrance to the vagina on the hair of the perineum and serves as an ideal breeding ground for the proliferation of various bacteria, which can cause serious infectious complications for mother and baby. Use a razor to completely remove hair from the perineum. If independent depilation turns out to be too complicated a procedure for you or there is no time left for it, it will be done in the emergency department of the maternity hospital.

When to go to the maternity hospital?

If contractions begin, interspersed with uniform and gradually shortening intervals, the expectant mother feels well, no water has been poured out - we go to the maternity hospital no later than a 10-minute interval between contractions.

If the contractions that begin are irregular, the mother feels well, the water has not been poured out - we rest and wait for further developments.

If water has leaked or is leaking in any quantity, or there is even a suspicion that water has broken, we go to the maternity hospital immediately.

In doubtful cases, a special test will be performed in the emergency room of the maternity hospital - a smear for water. The result will be ready in 15–30 minutes and will allow you to confirm or refute the fact of rupture of the amniotic sac, regardless of its size and location.

Documents to the maternity hospital: what to take with you?

When going to the maternity hospital, you must take a passport, exchange card, birth certificate, insurance policy and/or birth contract. If you have a copy of your passport and insurance policy, also take them with you - this will significantly speed up the procedure for obtaining a card in the emergency room of the maternity hospital.

The scarier the more painful it is!

It is important to understand that the level of pain during contractions directly depends on fear and tension. If a woman in labor is not mentally prepared for childbirth and is very afraid, even in cases where the birth proceeds without complications, the contractions are felt much more painful than usual. This is easily explained: the sensation of pain directly depends on the ratio of various hormones in the blood of a woman in labor. The most important of these are endorphins and adrenaline. Endorphins have an analgesic effect; an increase in adrenaline in the blood, on the contrary, leads to a decrease in the pain threshold and increased pain. Fear is known to stimulate the release of adrenaline in huge doses. Therefore, when you panic, the amount of adrenaline in the blood goes through the roof, it displaces painkillers endorphins, and as a result, the pain during a contraction is felt much stronger.

Labor begins: how to stop panicking?

At the beginning of childbirth, every expectant mother experiences excitement - a completely natural feeling before such a responsible and difficult process. However, at this moment it is very important not to give free rein to your emotions and quickly try to calm down in order to prevent panic from occurring.

Panic fear of childbirth can serve the expectant mother very badly: after all, it is the state of panic that leads to the development of most labor disorders. With significant emotional arousal, which is associated with a feeling of fear, the functioning of the nervous system is disrupted. As a result of “nerve failures,” signals coordinating labor activity arrive unevenly and may weaken or, on the contrary, sharply increase. Due to disruption of the nervous regulation of labor, contractions become painful, weak and unproductive.

Advice

In order not to succumb to panic, it is important to control your emotions from the very first sensations. There is no need to fuss and try to solve several problems at once. There is no need to immediately call your relatives, rush to get ready or call an ambulance: first, sit or lie down, find the most comfortable and relaxed position, close your eyes and take several long deep breaths through your nose and exhale through your mouth. This will help calm your emotions and only takes a couple of minutes. Then open your eyes and try to assess your well-being as objectively as possible: what exactly has changed in it?

How do your waters break at the beginning of labor?

This is probably the most common cause for concern: most expectant parents are afraid of not noticing the breaking of water, confusing it with urination, the passing of a mucus plug, or normal female discharge. In fact, fetal fluid is fundamentally different from all other types of discharge from the genital tract, and it is extremely difficult to confuse it with anything. Normally, this should happen during contractions, but often the water breaks before labor begins.

There are two “scenarios” for water breaking. In the first version, they pour out unexpectedly, all at once and in large quantities. As a result, the liquid will flow down the legs, all clothes below the waist will instantly become wet - it is simply impossible to miss such a phenomenon! The rupture of the membranes itself, due to which the water begins to leak, is not accompanied by any subjective sensations - it occurs without pain, spasm or the urge to urinate.

The water drains completely differently if the resulting hole in the amniotic sac is located high and is covered by the wall of the uterus: in this case, the liquid may periodically be released in drops or tiny streams, in small quantities, wetting the sanitary pad and underwear. However, even with slight leakage of water, they can easily be distinguished from ordinary vaginal discharge: the water is absorbed into the fabric of the underwear and wets them without leaving mucus on the surface. Fetal fluid is also completely different from urine: it does not have a specific color or smell, like urine, and spontaneous urine discharge without the urge to urinate does not occur in a healthy woman.

Advice

In doubtful cases, you need to see a doctor: a special water test, carried out in the emergency department of any maternity hospital, will dispel all doubts!

The onset of labor: is it possible to confuse the release of the mucus plug with the rupture of water?

It is not at all similar to the leakage of water that the mucous plug, or cervical mucus, is discharged - a special secretion that closes the cervical canal during pregnancy. Usually the cork is released gradually, in parts, leaving brownish marks on the underwear for 1–3 days. Much less often it appears entirely at once. In this case, it can be compared to a lump of gel up to 1.5 cm in diameter, yellowish-pinkish-brown in color. The removal of the plug may be accompanied by slight aching sensations in the lower abdomen, similar to malaise before the start of the next menstruation.

As can be seen from this table, unlike the mucus plug, the water is clear, warm and constantly leaking. The rupture of water before the onset of labor, i.e., before contractions, is considered prenatal or premature, and if it is discharged during regular contractions, but with insufficient dilatation of the cervix, they speak of early rupture of water. Before contractions begin, water often breaks in multiparous women. In the case of premature rupture of water, the fetal bladder may rupture high above the cervix, then the water flows out slowly, or maybe directly above the opening of the cervix, then the water will immediately drain in large quantities. Labor after the rupture of water develops over the next few hours.

The placenta and fetal membranes are a barrier that is usually completely impenetrable to bacterial (purulent) infection. Throughout pregnancy, the fetus develops in a sterile environment. The key to this sterility, and therefore the intrauterine well-being of the fetus, is the integrity of the amniotic membranes. Immediately after the rupture of amniotic fluid, bacteria begin to flow from the vagina and cervix into the uterine cavity; the child is no longer protected from possible infections, so childbirth should occur no later than 12 hours after the rupture of the membranes. For this reason, in the event of rupture of water, it is necessary to go to the maternity hospital without delay, even if there are no contractions yet. You should remember the exact time the water broke and its color: this will help the doctor decide on the tactics of labor management. In case of premature rupture of amniotic fluid in the maternity hospital, fetal infection is prevented.

It is necessary to pay attention to the color of the waste water. Normally they are transparent or light pink, odorless. The greenish, brown or black color of the amniotic fluid indicates that meconium - original feces - has been released from the baby's intestines, which happens when the fetus is oxygen starved. If the waters are colored with bright blood, then there is a high probability of placental abruption. In this case, immediate hospitalization is necessary.

Before the ambulance arrives or before leaving the house on another transport, the expectant mother needs to take a horizontal position and put a diaper under her, since from the moment the water leaves the water will continue to flow out. After the rupture of water, the fetal head is inserted into the uterine cavity and in some cases can press the umbilical cord. The standing and sitting position of the woman in labor speeds up the process of inserting the head.

If you are not sure that the water has broken, it is necessary to perform a cough test: when you cough and strain the abdominal wall, the water will flow more strongly, but the amount of mucus plug will not change. If doubts remain, you should consult a doctor at the maternity hospital.

Advice

When water appears, regardless of its quantity and the presence of other signs of the onset of labor (contractions, pain in the lower abdomen), you should immediately go to the maternity hospital: from the moment the membranes rupture, the risk of infection of the uterus and fetus increases, and it is better for the expectant mother to be in the sterile conditions of the obstetric department.

Remember that it is impossible to confuse the mucus plug with fetal fluid: it is a very thick, jelly-like, viscous and elastic mucus, not at all like a liquid. Cervical mucus may begin to appear about two weeks before your due date. This is a normal option and, unlike water leakage, does not require seeing a doctor.

How are contractions going?

The classic onset of labor is the onset of contractions. Contractions are regular contractions of the uterine muscles. The first contractions are usually not associated with pain or significant discomfort. Describing their feelings at this moment, expectant mothers say that the stomach itself is very tense, as if it “turns to stone” for 5–10 seconds, and then completely relaxes until the next one. This is similar to the increase in tone during pregnancy, but stronger and short-term. Contractions occur periodically, at certain intervals. In the intervals between contractions, the expectant mother’s well-being is no different from usual - absolutely no new sensations! However, the appearance of the first contractions of labor does not necessarily mean the beginning of labor: they may turn out to be just a rehearsal, a false alarm and end as unexpectedly as they began. Such contractions are called training contractions, or false contractions, and can normally appear as early as the 36th week of pregnancy.

False contractions- This is a kind of training of the uterine muscles before childbirth. With them, the expectant mother, in response to the movement of the fetus or physical activity, periodically feels tension in the abdomen, it seems to “cramp”, it becomes harder to the touch than usual, and a pulling sensation may occur in the lower abdomen or lower back. They do not cause any particular discomfort; more often these sensations are painless, irregular, and quickly pass with rest and when taking antispasmodics - NO-SHPA, PAPAVERINE, MAGNE B6.

The purpose of precursor contractions is to prepare the muscles of the uterus and birth canal for childbirth: they contribute to the ripening of the cervix.

True contractions- This is a contraction of the uterine muscle, which causes shortening and dilatation of the cervix by stretching its circular muscles. With each contraction, the cervix shortens and then flattens. The canal, or opening, of the cervix stretches - opens. The amniotic sac is inserted into it, expanding the pharynx like a hydraulic wedge. True contractions increase in frequency, strength, and duration over time. They occur regardless of body position, taking antispasmodics, without connection with physical activity, at any time of the day or night.

Is the pain severe during contractions?

Due to contraction of the uterine muscles during contractions and pressure on the cervix of the fetal bladder or the presenting part of the fetus after the discharge of amniotic fluid, the cervix shortens until smoothing. This continues for 4–6 hours and is called the latent phase of labor.

At first, true contractions are weak and painless, the intervals between them are about half an hour, although longer or shorter intervals are possible. The uterine contractions themselves last 5–10 seconds. Gradually the intensity and duration increase, and the intervals between them decrease. During the period between contractions, the stomach is relaxed.

Pain during contractions is caused by dilation of the cervix, compression of nerve endings, and tension of the uterine ligaments. Sometimes the first tremors are felt in the lumbar region, then spread to the abdomen and become encircling. Pulling sensations may also occur in the uterus itself, and not in the lumbar region. Pain during contractions when a woman cannot relax or find a comfortable position resembles pain during menstruation. Its strength depends on the individual characteristics of the threshold of pain sensitivity, the emotional state of the woman and her attitude towards the birth of the child. It is important not to be afraid of childbirth, because this whole process takes only a few hours, and the pain of childbirth is quickly forgotten.

You can often hear from women who have given birth that their contractions were either completely painless, or the pain was quite tolerable. The fact is that during contractions the body releases its own painkillers. In addition, relaxation and proper breathing techniques learned during pregnancy can help relieve pain.

If contractions start...

A woman has a little time to take a shower, put on clean underwear, trim her nails and wash off the polish. For many expectant mothers, shaving the perineum upon admission to the maternity hospital is a very unpleasant moment. However, this procedure is necessary, as it allows you to control the degree of stretching of the perineum during childbirth, prevent its rupture, and in case of injury, it is better to compare the tissues when suturing. You can avoid the feeling of embarrassment by shaving yourself at home. To do this, you need to take a completely new razor and thoroughly treat the skin with an antiseptic solution - CHLORHEXIDINE, CITEAL, MIRAMISTIN - or antibacterial soap. If it is difficult for a woman to do this herself, you can ask your husband for help.

You should go to the maternity hospital when contractions become regular and occur every 10–15 minutes. If a clear interval between contractions has not yet been established, but they are accompanied by severe pain, it is also necessary to go to the maternity hospital. If the birth is repeated, then with the onset of regular contractions it is better to go to the maternity hospital immediately: repeated births are often characterized by rapidity, so it is better not to delay.

Is it possible to move during contractions?

During contractions, you can choose a comfortable body position: you can lie on your side, walk, stand on all fours or knees, or swing on a large ball - a fitball. It is necessary to monitor the duration of contractions and the intervals between them. It is recommended to remember, write down or note on your phone the time when contractions begin.

During contractions, you need to slowly, deeply and rhythmically inhale air through your nose and exhale it through your mouth. If contractions become very strong, frequent shallow breathing will help, in which you also inhale through the nose and exhale through the mouth.

From the very beginning of the contraction, stroking the lower half of the abdomen should be performed. fists or open palm on both sides of the spine, up and down, to the base of the tailbone. After a contraction there is always a period of time when there is no pain, you can relax and rest. It is necessary to empty the bladder regularly - this stimulates contractions.

What should you not do during contractions?

During contractions, you should not sit or lie on your back. Lying on your back, the pregnant uterus compresses large vessels, in particular the aorta and inferior vena cava, which leads to a deterioration in the return of blood to the heart and a drop in blood pressure. This is accompanied by a disruption of the blood supply to all organs of the pregnant woman, including the placenta and, as a consequence, oxygen starvation of the fetus. This is what the so-called inferior vena cava syndrome consists of. In the sitting position, the relationship of the pelvic bones changes, which makes it difficult for the fetal head to move along the birth canal, and at the end of the first stage of labor can lead to fetal injuries.

You can’t eat during childbirth: this is due to two points. Firstly, in the first stage of labor - during contractions - the gag reflex is activated in many women, and a full stomach provokes repeated vomiting. Secondly, during childbirth a situation may arise when the expectant mother needs surgery using general anesthesia. If the patient's stomach is full during anesthesia, gastric contents may be refluxed into the respiratory tract, which leads to very serious, sometimes fatal complications.

It is forbidden to take painkillers on your own: they will not relieve normal labor pain, but can mask important symptoms.

Advice

The first task of the expectant mother when a periodic feeling of tension appears in the abdomen is to detect the intervals between contractions in order to understand whether they are real or training. Real contractions occur regularly - there are equal intervals between them, not exceeding 20 minutes, and the neighboring contractions themselves are the same in duration and strength of sensations. Another sign of real contractions is an increase: over the period of observation they should gradually become longer, stronger and more frequent. With this option for the onset of labor, you should go to the maternity hospital as soon as the interval between contractions is reduced to 10 minutes. Until this moment, provided you feel well, you can stay at home, under the supervision of loved ones, calmly gather and watch the development of contractions.

Training contractions, on the contrary, are irregular: the intervals between several neighboring contractions are unequal, sometimes more often, sometimes less often - and the contractions themselves occur at random, sometimes longer and stronger, sometimes shorter and weaker. There will be no increase in false contractions either - even if the intervals between them are more or less the same, they do not change in any way for several hours. It should be noted that the intervals between false contractions can be either very large (more than 20 minutes) or very small (3–5 minutes), so it is necessary to evaluate first of all not the frequency of contractions, but rather the regularity and increase.

What is the best way to behave during contractions at the beginning of labor?

At the beginning of labor, when the first contractions just begin, they are practically painless. At this stage, you can behave freely: there are no restrictions in actions, movements, just as there is no need to use special pain-relieving techniques - poses, massage, breathing techniques - they will be needed later, when the contractions become stronger and more painful.

Advice

The only special recommendation during the first contractions is “belly breathing”, practiced in psychology and yoga. At the beginning of the contraction, the expectant mother takes a relaxed, slow breath in through her nose, and then exhales the air through her mouth for as long as possible (as if blowing on water). With this technique, in addition to the intercostal muscles, the respiratory act involves the diaphragm and abdominal muscles - hence the name of this breathing. As a result of abdominal breathing, intra-abdominal pressure changes during each inhalation and exhalation. This ensures good blood flow, helps prevent hypoxia (lack of oxygen) of the fetus and weakness of labor, and also helps cope with anxiety.

Why do attempts occur?

At the beginning of the second stage of labor, when the cervix is ​​fully opened, the fetal head, thanks to uterine contractions, begins to move down, squeezing the walls of the rectum. In response to irritation of rectal receptors, the muscles of the anterior abdominal wall and diaphragm reflexively contract: this is how pushing begins. The fetal head presses on the woman's pelvic floor and rectum, causing her to want to empty her bowels - the urge to defecate. This is an effort.

When can you push?

Before you start pushing, you need to call a doctor so that he can determine where the baby's head is. It is necessary to push only if she has passed almost the entire birth canal and is already lying on the pelvic floor. Premature pushing leads to rapid exhaustion of the woman’s strength, weakness of pushing, disruption of the uteroplacental circulation and lack of oxygen for the baby.

All women experience the desire to push at different times. If it appears when the head is already quite low, but the cervix has not yet fully dilated, then by pushing the head forward with force, the woman in labor can provoke a rupture of the cervix. To control premature labor, a woman in labor is recommended to use a special breathing pattern.

How to breathe during childbirth

1. Take a full, deep breath.
2. Hold your breath, as if swallowing air, tense your abdominal muscles (the muscles of your thighs, buttocks and face are completely relaxed). Gently increase the pressure on the bottom. Tighten your abdominal muscles more and more, helping the baby move through the birth canal.
3. Exhale smoothly.
4. Next, when you feel that you are short of breath, exhale smoothly, but in no case with a jerk. During a sharp exhalation, intra-abdominal pressure quickly decreases and the baby's head also quickly moves back, which can lead to traumatic brain injury. After this, immediately, without relaxation or rest, take a breath - and push.

During the full push, repeat all these steps three times.

After pushing, take a full breath and restore calm, even breathing with complete relaxation. This way you can quickly regain strength for the next push.

Attention! At the moment of removing the head, the midwife will ask you not to push - breathe like a dog.

How to push correctly during childbirth?

While pushing, press your chin tightly to your chest, clasp your knees with your hands, spread them apart and pull them towards the armpit. The force of pushing should be directed to the point of maximum pain. Increased pain after pushing means that you are doing everything right and the baby is moving along the birth canal.

How long does the pushing last?

In primiparous women, this period lasts on average 2 hours, in multiparous women - 1 hour. Its duration can be influenced by various factors. Thus, the use of one of the methods of pain relief - epidural analgesia - leads to an extension of the second stage of labor by an average of up to 3 hours in primiparous women and up to 2 hours in multiparous women. A large fetus, a narrowed pelvis, weak labor, and overstretching of the anterior abdominal wall can also increase this stage of labor. Conversely, in women with well-developed abdominal muscles, the duration of the expulsion period is reduced.

How to avoid ruptures during childbirth?

Protection of the perineum begins from the moment the head erupts, i.e. from the time when the child’s head does not go back between attempts. The midwife uses three fingers of her right hand to prevent rapid advancement of the head during pushing, which leads to gradual stretching of the skin of the perineum and prevents ruptures. Normally, the fetal head passes through the entire birth canal with its smallest diameter - in a bent state (the chin is pressed to the chest). To prevent ruptures, the midwife clasps the baby's head with two fingers of her left hand and monitors its correct progression.

The occipital region of the head erupts first, then the crown, then the head expands and the face is born. From the moment the fetal head begins to unbend until the full birth of the face, the woman in labor is prohibited from pushing. It should be remembered that the integrity of the perineum depends not only on the actions of doctors, but also on the behavior of the woman herself during childbirth. Breathing through the mouth "dog" can significantly weaken the efforts. The born head is facing backward in 96% of cases; then the child's face turns to the mother's right or left thigh. Simultaneously with the external rotation of the head, an internal rotation of the shoulders occurs, then the anterior shoulder (located at the pubic symphysis) and the posterior shoulder (located at the sacrum) are born. Further birth of the baby's body and legs occurs without difficulty.

Expulsion of the placenta

10-15 minutes after the birth of the child, a woman experiences mild contractions, during which the placenta is separated from the wall of the uterus, and then the placenta, membranes and umbilical cord (all of this together is called the placenta) are expelled from the uterine cavity with a slight effort. At the same time, up to 300 ml of blood is released from the genital tract - this is physiological (harmless) blood loss during childbirth. The doctor carefully examines the afterbirth, because if parts of it remain in the uterine cavity, this is fraught with the development of infectious inflammation of the uterus (endometritis) or bleeding in the postpartum period. After the birth of the placenta, the external genitalia, perineum and inner thighs are washed with a disinfectant solution. The birth canal is examined to exclude soft tissue injuries (cervical rupture, vaginal rupture).

After separation of the placenta, the child is examined by a pediatrician. The baby is wiped with sterile gauze or washed with soap, and a 30% solution of sodium sulfacyl is instilled into the eyes to prevent blennorrhea. 3 , then clamps are placed on the umbilical cord at a distance of 2 and 10 cm from the umbilical ring and, after wiping it with a 5% alcohol solution of iodine or 96% ethyl alcohol, cut between the clamps.

After this, the baby is placed on the mother's breast. It is very important that the newborn receives colostrum from the mother’s breast within the first hour after birth. The fact is that colostrum - unripe milk - contains vitamins, enzymes, antibodies that will help the baby avoid many infections and quickly adapt to new conditions.

For two hours, the woman remains in the maternity ward under observation, because... During this period, there is a possibility of developing early postpartum hemorrhage.

Pregnancy is a wonderful time, and in most cases ends with childbirth. Natural childbirth is an activity intended by nature itself. As the baby passes through the birth canal, it gains strength.

What are pushing

The duration of labor varies from 2 to 14 hours, depending on the age of the patient and the history of childbirth (usually in primiparous women, labor lasts 10-12 hours, in contrast to multiparous women - no more than 3 hours).

Labor process:

• the first, an interval of 30 minutes;
• increased frequency of contractions - the interval is 5 minutes;
• contractions merge - a constant contraction flowing into attempts;
• development of labor;
• birth of a child;
• postpartum stage.

Pushing is a contraction of the abdominal and uterine muscles, including the diaphragmatic reflex to push the baby out of the womb. In other words, this is the process of pushing the child out.

There is no pain when pushing: the cervix is ​​sufficiently dilated and softened. Unlike contractions, pushing lasts only a short time.

To properly push the baby out, a woman needs to listen to the midwife and push correctly.

The difference between contractions and pushing

Contractions are muscle tension and contractions of the uterus. It is impossible for a woman to control the contractive process. For relief, nurses use a jet that relaxes the smooth muscles of the uterus.

In the second stage of contractions, pushing occurs - this is a process controlled by the woman in labor. She is able to stop pushing the baby out for a very short period in order to catch her breath and again help the baby to be born.

When they appear during childbirth

Pushing is a condition comparable to defecation, so before transferring the pregnant woman to the maternity ward, a cleansing enema is given.

The appearance of labor pains is individual for each pregnant woman. On average, the pushing period lasts no more than 2 hours; for multiparous women it is about 30 minutes.

If a woman in labor knows how to breathe correctly, listens to the doctor and pushes correctly, the baby will be born faster. Contractions precede pushing. They are the ones who take away the pregnant woman’s strength, but to give birth to a child, a little more patience is needed.

The main thing when pushing is to know that the woman’s health depends on the child’s health. So, for example, if a woman holds back while pushing for fear of spontaneously emptying her bowels, then the baby cannot breathe due to the lack of water and oxygen.

At this moment, she may swallow the remaining mucus, amniotic fluid or maternal blood, which will lead to irreversible consequences.

The number of attempts to give birth to a baby is set by nature individually for each pregnant woman, so it is difficult to answer the question “How many attempts can it take to give birth?”

According to statistics, on average, firstborns push the baby out in 8-10 attempts.

Feelings of a woman in labor during pushing

The pushing period is characterized by the presence of minor pain. A state of feeling like you really want to go to the toilet.

During labor, contractions are painful because the uterus stretches and contracts. During childbirth, contractions turn into pushing.

The pain may be due to the child being large or the woman behaving incorrectly.

The occurrence of pain syndrome depends on the mother’s pain threshold; the higher it is, the more painful the sensation.

Breathing is the key to successful childbirth

Breathing plays one of the main roles at the time of childbirth. The right tactics allow the woman in labor to remain calm, speed up the process of the birth of the child and help to accumulate all her strength.

1. Breathing between attempts should be shallow, not deep. It resembles the breathing of a dog;
2. Inhale through the nose, exhale through the mouth. You should push while exhaling.

It is also important to remain calm during contractions. When the time between contractions decreases, you need to breathe through your nose while in an upright position.

At the moment of a fight, it is difficult to control emotions, but screaming will only worsen the situation: the capillaries in the eyes will burst, and a headache will appear.

How to push correctly

The first thing you need to do is listen to your midwife and medical staff.

For the easiest birth, you must follow the following rules:

1. A cleansing enema allows you to alleviate the condition of a pregnant woman and avoid having a bowel movement at an inconvenient moment. An enema is a prerequisite for transfer to the maternity ward.
2. Childbirth takes place in an obstetric (gynecological) chair. For convenience, a special loop is hung above the chair, allowing the woman in labor to lie down comfortably.
3. Before starting to push, you should inhale through your nose, tuck your knees, rest your feet, or hold your legs with your hands.
4. As you exhale, as you begin to push, begin to push down. The emphasis should be placed not on the stomach, but on the vagina, trying to “blow” the baby out of it.
5. You need to push until the air runs out. The child tries no less than the mother, and with double strength the birth will be successful.
6. As soon as the push is released, you have a few seconds to gain strength and inhale again.

After the birth of the baby, labor does not end - the woman “gives birth” to the baby’s place – the placenta. To do this, you should inhale again and push it out.

Attempts stop from the moment the placenta is removed. The birth is completed.

The effect of pushing on a child

With each new attempt, the child penetrates more and more into the environment. That is, with each pushing movement, the baby gradually overcomes the birth canal to meet the mother.

During the period of pushing, it is important to listen to the doctor so as not to harm the child.

• Advancing the baby's head

The fetal head penetrates through the genital slit during the first push, and when it disappears, the head also hides. Pushing during this period is very important, because the child is in a state of temporary hypoxia.

• Birth of the baby's head

The vulvar ring becomes wider with each pushing exercise, and the emerging forehead prevents the gap from closing. The entire head (forehead, nose, face, chin) is born. In 1-2 attempts, the baby's head is born.

• Birth of the torso and legs

When the baby is presented correctly, labor proceeds fairly quickly. After the head appears, the body is born. Doctors and midwives help the baby. The shoulders are born in turn: first one, then the other. When they are born, it is important not to overdo it from the outside, as you can damage the brachial plexuses and cervical vertebrae. After the birth of the fetus's arms, they are placed on the chest and the baby is brought out completely. The child is born.

The child’s condition is assessed using a 10-point Apgar scale, which takes into account: muscle tone, heart rate, presence of reflexes, skin color and depth of breathing.

The period of pushing has its effect on the born baby. Long and difficult labor rates the baby’s condition at 6-8 points.

When the child is removed from the mother by special means. If you do not use forceps, there is a high probability of the baby being born still, or with low scores on the rating scale.

The end of pushing and the postpartum period

As soon as the baby took his first breath. It is placed on the mother's stomach to create mother-baby contact, then applied to the breast to produce progesterone and prolactin.

These hormones promote the rejection of the placenta.

The child is processed and taken to the children's department. The mother is in the postpartum room under the close supervision of doctors for at least an hour and a half.

All this time, the uterus is cold, and substances that prevent the development of bleeding enter the vein. The uterus contracts, and accumulated blood clots come out of its cavity.

• After transfer to the obstetric department, try to fall asleep lying on your stomach, but be sure to go to the toilet before that;
• At the time of birth, do not clamp down and listen carefully to the midwife;
• Try to avoid pain relief during labor;
• Don’t rush to pick up your child from the children’s ward - you should gain strength;
• Eat porridge or soup without bread;
• If an episiotomy was performed during childbirth, it is necessary to visit a physiotherapy room and go to the sutures.

In the postpartum period, monitor the process of urination and defecation.

Lack of stool and urine negatively affects the health of the mother.

Limit physical exercise.

Video: pushing during childbirth

The logical conclusion of every pregnancy is childbirth. This is a rather complex process that requires not only the qualifications of the obstetrician delivering the baby, but also the literacy and concentration of the woman. An important moment in childbirth is the appearance of labor. But many women do not always understand how they differ from contractions and what their role is in the process of childbirth. Therefore, let's figure out what attempts are and how they manifest themselves. We will also consider how to behave correctly when pushing has already begun.

Pushing is a reflex contraction of the abdominal and uterine muscles, as well as the diaphragm, aimed at pushing the fetus out of the uterus. In obstetric practice, this process is often called “complete expulsion of the fetus.” This physiological phenomenon in the female body is the final stage of childbirth, thanks to which the baby is born.

Attempts occur involuntarily in a woman in labor, and the woman cannot influence their appearance in any way. They arise independently when the baby’s pressure on the cervix reaches its apogee. As a rule, attempts appear at the moment of full dilatation of the cervix and the strongest and most prolonged contractions. But unlike the latter, pushing can be controlled, helping the baby to be born faster and more safely.

It is, of course, difficult to describe in detail the sensation of pushing, and each woman perceives this process differently. But in general, you can compare pushing with the state during defecation, as if the intestines are emptying, and after this an indomitable desire to push arises, which contributes to the expulsion of the fetus.

The attempts were laid down by nature for a reason. Their appearance allows the baby to be born under any conditions, because women did not always give birth in modern clinics, take prenatal training courses and understand what pushing is. That is why you should not be afraid that you will not be able to give birth on your own. When the time comes, the body itself will begin to contract and push out the fetus.

What is the difference between contractions and pushing?

Quite often, expectant mothers do not fully understand the difference between contractions and pushing. These two concepts are aimed at expelling the baby from the mother’s womb, and during the birth process they act as one whole, complementing each other perfectly. But there are still significant differences between them. So what is the difference between contractions and pushing?

Contractions are muscle contractions of the uterus that cannot be reduced or stopped, that is, they are completely beyond the woman’s control. The only thing a woman in labor can do is breathe properly and take comfortable positions to ease the pain a little.

Contractions occur in two stages. The first contractions before pushing are aimed at fully dilating the cervix. This can last from 8 to 12 hours until the cervix opens.

The second stage is the direct pushing of the fetus through the birth canal. At this moment, attempts occur during contractions. Together they expel the fetus and direct it in the right direction.

A woman is unable to control contractions, but she can stop the efforts, restrain them a little, or, conversely, intensify them if her obstetrician-gynecologist advises her to do so. Therefore, after the appearance of attempts, the woman in labor should carefully follow the doctor’s instructions in order to facilitate the process of the fetus passing through the birth canal. Otherwise, it can not only delay this process, but also harm the child.

Only the woman herself can answer the question of what is more painful than contractions or pushing. The pain that is provoked by contractions arises and subsides independently, and its intensity depends on the pain threshold of the woman in labor. And a woman can partially regulate pain during pushing by controlling her pushing.

When does pushing begin and how long does it last?

Attempts appear during the final push, when the baby is about to be born and the body is completely ready for this event. There is no exact time for the appearance of pushing, and for each woman in labor this happens at different times. But you shouldn’t worry about the unknown, because you definitely won’t miss their appearance. And even if, in confusion, you cannot understand that the moment has come, the obstetrician-gynecologist will definitely tell you that pushing has begun and what to do next.

With a normal first pregnancy without complications, pushing can last about two hours. If this is the second or third pregnancy, then the duration of labor is reduced to half an hour. How long the pushing lasts depends on the specific case, but on average they last up to 15 seconds with an interval of three minutes.

When the first signs of labor appear, there is no need to hold back. At first, a woman may be afraid that involuntary bowel cleansing will occur during pushing, so she tries to reduce contractions. But this is an absolutely normal process, so there is no need to be embarrassed or worry, and besides, an enema is specially given before childbirth.

Effective pushing: how to push correctly

During the period of pushing, a lot depends on the woman. And if during contractions a woman’s efforts were only aimed at relieving pain, then during pushing she takes a commanding position. At this moment, the woman in labor is positioned on the birthing chair, and her knees and hip joints are slightly bent. At the moment of contractions, the woman reflexively rises, which increases the pressure on the fetus. Although “vertical” childbirth is often practiced, which is also a physiological position.

As already mentioned, a woman in labor can change the intensity of pushing, but this is prohibited without instructions from the medical staff. Therefore, you need to unquestioningly follow all the advice of your obstetrician-gynecologist, regardless of pain, fear or powerlessness. You need to pull yourself together as much as possible and make every effort to expel the fetus.

Important! Only correct attempts can save strength, prevent ruptures and prevent hypoxia of the baby.

The first thing you need to pay attention to is proper breathing. At this point, the fetus will experience a severe oxygen deficiency, so you need to breathe correctly. In addition, knowing how to breathe while pushing, you will be able to direct your strength to pushing and push correctly.

It is better to master the technique of proper breathing before the moment of birth. Then you will be able to use oxygen more productively and control the intensity of pushing. You also need to learn in advance to relax and be able to overcome the feeling of tightness. For these purposes, women are recommended to attend courses for pregnant women.

Breathing during pushing needs to be well controlled, and in conditions of stress, pain and fear, this is quite difficult to do. Therefore, read the following recommendations in advance so as not to get confused during childbirth:

• In anticipation of the increase in attempts, exhale as much air as possible, and then slowly inhale through your belly, trying to draw in air as deeply as possible.
• Now hold your breath for a while, bend your upper body forward, pressing your chin to your chest. Place your knees near your armpits, clasp them with your hands.
• Accompany the beginning of pushing with an exhalation and begin to push.
• The pushing urge should be directed downwards so that the diaphragm is tensed, not the face.
• If the pushing is directed correctly, a burning sensation and soreness will be felt in the vaginal and cervical areas.
• You have to push until you have enough air. But if during pushing there is a need for another breath, exhale completely, inhale deeply, hold your breath and start all over again.
• After pushing, restore your breathing, inhale the air slowly and deeply. This will help you gain strength before your next push.

After the baby is born, the woman will have to endure the final push. It will be less intense and not as painful, but its role is also important, because as a result the placenta will be released.

Important! Breathing during labor should be calm, without jerks or long delays. The way you breathe will affect both your condition and the well-being of the fetus.

Despite the arguments of obstetricians and gynecologists, in the modern world there are many supporters of natural behavior during pushing without the participation of doctors. Therefore, in obstetric practice, two options for behavior during the period of pushing are used:

1. Natural - the woman has absolutely no influence on the attempts, completely relying on the naturalness of this process. Also, the progress of labor is not corrected by doctors, but only observed from the outside. It is generally accepted that nature itself will take care of the safe birth of the baby.
2. Controlled - the woman controls the intensity of pushing under the guidance of a doctor. She pushes only at the indicated time, and the doctor monitors the progress of the fetus.

Note! Which method to choose depends on the woman’s wishes, her condition, and how the pregnancy is progressing. Therefore, the remaining choice should be made after consultation with a doctor.

Attempts in first-time mothers: how to facilitate the birth process

When a woman has not given birth for the first time, she already knows how best to behave and what to do during pushing. But if this is your first pregnancy, then these few tips will be very useful:

• There should be three attempts per contraction. The optimal time for one push is 5-7 seconds. Therefore, it is a big mistake to do one long push; it is more effective to do several short ones.
• If you don't know how to tell when pushing is starting, ask your doctor to remind you when to push.
• You don’t need to give it your all, otherwise you won’t have enough strength by the end of labor. Therefore, try to distribute the forces evenly.
• Never inhale or exhale sharply, this will have the opposite effect and the child will be pulled back.
• Do not waste your energy screaming; if the pain during pushing is very strong, it is better to groan. In addition, screaming provokes the release of adrenaline, which causes an outflow of oxygen and, as a result, fetal hypoxia.
• Don’t give in to panic attacks, pull yourself together and endure these couple of hours with dignity, because there’s still very little left and you’ll meet your baby.

Weak attempts and a way out of this situation

In isolated cases, attempts may not appear or may not be strong enough. This is a very undesirable option for the development of childbirth, since the child may not survive. In this case, the obstetrician-gynecologist must get his bearings in time and help the baby be born. To do this, special instruments are used to grab the head or limbs of the fetus and pull it out of the birth canal.

This happens for several reasons. So, in a very exhausted woman, pushing may stop until the baby is born. And a multiparous woman may not have them at all, due to very flabby and stretched abdominal muscles.

At first, pushing seems like a very scary moment in childbirth, but if you mentally prepare for it and know how to behave, everything turns out to be much easier. You shouldn’t be afraid of labor pains, because doctors will always tell you what to do and when to do it. Just tune in to a positive outcome and wait for the baby to arrive with peace of mind.

Proper breathing and pushing. Video

So, you give birth. You are having contractions, the intervals between them have become very short, and the strength has increased. After another examination, the doctor reported that the cervix had dilated. What's next?

In the first stage of labor, contractions contributed to the dilatation of the cervix; they could conventionally be called dilating. Now, when “the path is open,” the task of contractions is to help the fetus leave the cozy mother’s womb in which it lived for 9 months.

The second stage of labor begins, which is called the period of expulsion, and contractions in this period are called expelling. It’s a little dissonant, we’re not actually expelling the baby from his shelter, but we’re helping the most beloved creature in the world to be born, but, you must admit, the wording “the period of birth of the most beloved creature in the world” is a little too long for official documents.

It lasts for primiparous women 1-2 hours, and for multiparous women - depending on the number of births and individual characteristics - from 5-10 minutes to 1 hour (on average 30 minutes). During this period, contractions become stronger, their duration increases, and the intervals between them decrease. Soon the contractions are joined by pushing.

Pushing is a contraction of the abdominal muscles and the diaphragm (the muscular septum separating the chest and abdominal cavities). The average duration of pushing is 10-15 seconds. Thanks to pushing, intra-abdominal pressure increases, which, coupled with increased intrauterine pressure (due to contractions), allows the baby to move through the birth canal. Attempts occur reflexively, since the newborn fetus with its presenting part (head or pelvic end - depending on the type of presentation 1) irritates the corresponding nerve endings in the cervix, vagina and pelvic floor muscles. Attempts occur involuntarily, but, unlike contractions, a woman can control them.

What to expect from labor pains?

Most often, pushing is felt as an unusually strong, uncontrollable desire to empty the intestines, pronounced unpleasant pressure on the rectum and involuntary contractions of the abdominal muscles. However, if you do not experience such sensations, you should not think that there is something wrong with you. This is an individual feature of the body. In this case, your doctor will tell you that it is time to push. Contractions during this period are the strongest and longest, but most women claim that after pushing, the pain decreases. Currently, pushing does not provide pain relief, since any anesthesia, by reducing sensitivity, reduces the effectiveness of pushing. Currently, drugs are being developed that, while eliminating pain, would not “turn off” pushing. Most often (though not always), after the start of pushing, the woman’s mental state improves, as she turns from a “passive observer” into an active participant in the birth process.

You should know that, passing through the birth canal, the fetus compresses all internal organs located in the immediate vicinity. It is not surprising that during the birth of the fetus, the intestines and bladder are emptied at the same time. You should not be embarrassed by this circumstance - on the contrary, trying to prevent this and control your bowels only hinders the birth process. Know: (1) it is not your fault; (2) this happens to almost every woman in labor; (3) no one in the delivery room will be surprised by this; (4) all secretions will be immediately removed, so that the child is completely excluded from contact with them.

Somewhere in the middle of the pushing period, you may see that the head (or buttocks) of the baby, which appeared at the vaginal opening during the contraction, disappears again after it ends. Don't be alarmed, this is a normal phenomenon, which is called cutting in the head (or buttocks), and it means that you will soon get to know your child. When the presenting part stops “hiding” outside the contraction (teruption), you will be transferred to the delivery room or, if you have a private room, you will be asked to move from the bed to the delivery table. This is where the culmination and completion of the “period of the birth of the most beloved creature in the world” takes place.

Does anything depend on the woman in labor?

Yes, and a lot. Pushing is an important part of the birth process. If during contractions nothing depended on the woman, then during pushing she becomes the main character. The position in which you will give birth is largely determined by where it will take place. There are maternity hospitals where vertical childbirth is practiced, 2 but most women give birth on the delivery table in the “standard” position. In this case, the woman in labor lies with her legs bent at the knee and hip joints, and during pushing, increasing contractions of the abdominal muscles, she leans forward and takes a semi-sitting position. One should not think that since this position is accepted in all maternity hospitals and the woman did not participate in its choice, then it is absolutely unphysiological. This is not true, and many women who have the opportunity to choose the position in which they will give birth choose just that. At the same time, the mother’s body seems to repeat the shape of the birth canal through which the baby will pass, which facilitates its movement; The baby puts pressure on the birth canal with its weight, which helps to stretch it; in addition, it is convenient to push in this position. This position is also convenient for medical personnel, since it is easier to provide the necessary assistance.

As already mentioned, although attempts occur involuntarily, a woman can, to a certain extent, control them, strengthening or restraining them if necessary. However, unauthorized actions can harm both mother and child. Therefore, during this period it is necessary to get together and strictly follow all the instructions of the doctor and midwife, without reasoning or feeling sorry for yourself. The better you push, the more energy and will you put into it, the faster the baby will pass through the birth canal.

Proper breathing, which is necessary during the entire period of childbirth, does not lose its relevance during pushing. Firstly, at this moment the fetus suffers more than ever from a lack of oxygen. Secondly, it helps to conserve strength and push more effectively.

At the beginning of the push, exhale well - this is necessary in order to immediately follow with a full, deep breath. Hold your breath, and without exhaling (this is very important!), push as hard as you can - as long as you can hold your breath. When you feel that there is not enough air, exhale slowly. (During inhalation, the diaphragm goes down and participates in the birthing act; with a sharp exhalation, the diaphragm quickly rises up, the pressure exerted on the fetus all this time suddenly stops, and the baby can hit its head on the pelvic bones and get injured.) Then do a deep one again. inhale, hold your breath and push.

Usually during one contraction a woman feels the need to push an average of 3 times. It is better to push well several times than to try to do it continuously throughout the entire contraction: in this case, you will only lose strength, and the fetus will suffer from a lack of oxygen. If you can't feel the pushing or it's too weak, your doctor and midwife will guide you.

Where should we focus our efforts?

This is a very important question. It is not only the force applied that matters, but also where it is directed. It just seems that everything is simple: you need to “push” the child out of yourself, making every effort to do this. Some women push, as obstetricians put it, “in the face.” The woman in labor is very tense, but since her efforts have no direction, they do not lead to the advancement of the child; the process is delayed, and the woman’s blood vessels in her eyes and face may burst. In such a situation, if the expectant mother does not change tactics, doctors will have to “push for her”, squeezing the child with their hands through the anterior abdominal wall, and if the child begins to suffer, then apply forceps. You understand that neither one nor the other is desirable.

So “where should we push”? As already mentioned, in most cases, pushing is felt as a strong desire to empty the intestines (the fetal head irritates the nerve endings responsible for this act). Don't resist this urge. Don't be embarrassed, these are natural and correct sensations. Imagine yourself actually having a bowel movement and try as hard as you can to do it. The other leader will be pain. The fetal head stretches the tissues of the birth canal, and you feel severe pain and burning in the vagina. You need to push at the point of maximum pain, intensifying it. Increasing pain indicates that you are doing everything right, and the baby is moving along the birth canal.

Is continuous effort necessary?

During the birth of the fetus, there are times when it is necessary to reduce the force of pushing. Moving along the birth canal, the child puts pressure on the birth canal, stretching it to the width necessary for its passage. The vaginal mucosa and pelvic floor muscles can stretch quite strongly. If this process occurs smoothly, then the soft tissues of the birth canal gradually adapt to the stretching. If the second stage of labor proceeds too quickly, the unprepared soft tissues of the birth canal cannot withstand such a load, and ruptures occur. In cases where doctors see that a perineal rupture is about to occur and it is impossible to prevent it, they resort to an episiotomy during childbirth (perineal incision). They do this in order to avoid complications in the postpartum period, because an incised wound heals better than a lacerated one.

With a rapid birth, the fetus also suffers. It is squeezed out of the birth canal with great speed, its members do not have time to adapt to traveling through such a narrow canal, powerful pressure is exerted on the spine and head, as a result of which the baby can be injured. Therefore, when the midwife tells you that you cannot push, you should stop pushing. Quickly relax and exhale the air smoothly through pursed lips. Sometimes, to help your baby progress or so you can rest and regain strength, your doctor may tell you not to push during one or more contractions. You will not be able to stop the effort, but you can significantly weaken it. It is necessary to relax as much as possible and breathe often, often, with your mouth slightly open, and superficially, “like a dog.”

The birth of a child: a happy ending

If the birth proceeded normally and the baby cried immediately after birth, he is placed on the mother's stomach. The joy of this moment completely overshadows and erases from memory the pain and fear just suffered. After the birth of the baby, there is a short break in pushing (up to 15 minutes), and then, when the separated placenta enters the vagina, the woman again feels the desire to push. But these attempts are much weaker and do not require much physical effort. The woman strains slightly and the placenta (placenta and membranes) is born. The birth is over. Now you are a mother and the owner of the most expensive treasure in the world. Congratulations!

1 The most favorable presentation (i.e., position in the uterus) of the fetus is considered to be cephalic presentation (position with the head down). If the buttocks or legs of the child are palpated in the lower segment of the uterus, they speak of. You can read more about this in the articles by E. Chernukha “Belvic presentation of the fetus” (No. 11/2001) and “Childbirth with breech presentation” (No. 12/2001).

2 See V. Zaborsky, N. Kuznetsova, “Vertical childbirth”, No. 2, 2002.

Anna Koroleva
obstetrician-gynecologist,
doctor of the Medicine 2000 association.

Article from the March issue of the magazine.