Whether contractions without relief. Contractions before childbirth: how to distinguish from false ones, sensations during contractions

Even during pregnancy, a woman is told that the contractions that await her during childbirth should lead to the dilatation of the cervix so that the baby, when the time comes, can leave the uterus into the reproductive tract and ultimately be born. But do contractions always lead to dilation of the cervix? In this material we will try to understand this in detail.

Process and stages

Normally, labor begins with the appearance of contractions. There may be other options, for example, the water will break first, but they are not considered the norm at all. The first contractions are very rare: they last no more than 20 seconds and repeat approximately once every 30–40 minutes. Then the duration of the spasm increases, and the time between contractions decreases. With each contraction, the walls of this reproductive organ are involved, as well as the circular circular muscle, which is essentially the cervix.

During the first stage of labor, which is called latent, the cervix dilates up to 3 centimeters (or about 2 fingers, in the language of obstetricians). Unfolding during the 8–12 hour latency period proceeds at a rather slow pace. But already at the stage of active contractions, the uterus opens by about a centimeter per hour.

The active period lasts about 4–5 hours, contractions repeat every 4–6 minutes, spasms last about a minute. During this time, the uterus dilates to approximately 7 centimeters. Then, for half an hour to an hour and a half, the period of transitional contractions lasts, the strongest ones, which last more than a minute and are repeated every 2–3 minutes. But the dilation at the end of the period is 10-12 centimeters, which is quite enough to pass the baby’s head. Attempts begin.

Thus, normal labor contractions are always associated with dilatation of the cervix.

If there are contractions, but there is no dilatation, they speak of labor weakness, and the birth is considered abnormal.

Causes of weakness

If there is no dilation or it proceeds at a very slow pace and clearly does not correspond to the periods of labor, the reason usually lies in the weak contractility of the uterus. If the contractions are weak, then the cervix cannot open. In this case, usually the periods of relaxation between contractions exceed the norm in time, the woman “rests” more, and the contractions themselves lag behind the required values ​​in duration. This complication occurs in approximately 7% of women giving birth; primigravidas most often experience it.

Primary weakness of labor forces most often develops in women:

• with a large number of abortions in the past;
• with a history of endometritis, fibroids;
• with the presence of scars on the cervix after inflammation or erosion;
• with hormonal imbalance;

• in case of premature birth;
• in post-term pregnancy;
• with polyhydramnios;
• for obesity;
• during childbirth against the background of gestosis;
• in the presence of pathological conditions of the fetus: hypoxia, Rh conflict, placenta previa, etc.

A reason that deserves special attention is a woman’s psychological unpreparedness for childbirth. Doctors are often surprised to encounter the weakness of labor forces when contractions occur and the cervix does not dilate in a healthy woman without pregnancy pathologies. Wide pelvis, normal weight of the fetus, all tests are in order, but the cervix does not want to dilate. This may be the result of a woman in labor’s strong fear of childbirth, reluctance to give birth (an unwanted child), if the woman has been subjected to psychological pressure, conflicts in the family, she is tired, does not get enough sleep, is very nervous or worried. Sometimes weakness becomes a consequence of an excessive amount of painkillers that were used to ease contractions.

How does the uterus open in this case? The excitability of the female reproductive organ is reduced. Periods of uterine tension are followed by periods of “rest”, which are 1.5–2 times higher than normal for a particular stage of labor.

What are they doing?

In order to speed up the dilation of the cervix, sometimes it is enough to simply perform an amniotomy - puncture the amniotic sac and ensure the outflow of amniotic fluid. To replenish lost energy, a woman may be prescribed a short medicated sleep. If within 3-4 hours after amniotomy the contractions do not intensify and the cervix does not open or the opening continues to proceed slowly, labor-inducing therapy is performed.

The woman is given hormones (oxytocin, dinoprost) that stimulate uterine contractions. At the same time, monitoring of the fetal condition using CTG is established.

If contractions become faster under the influence of drugs and dilatation begins, childbirth is then carried out as usual. If stimulation does not bring the desired effect, the woman undergoes an emergency caesarean section.

About pain

Painful sensations due to weakness of labor can be different. Contractions can be both painful and less painful. The weaker the smooth muscles of the female reproductive organ contract, the less pain the woman will feel, although here everything is very individual.

In general, the period of contractions is considered the most painful in childbirth. This statement sometimes frightens women so much that they cannot cope with fear even after the first contractions begin.

The period of contractions cannot be painless. Neither anesthetic drugs nor natural pain relief techniques using breathing and acupressure can guarantee that there will be no pain at all. But both medications and alternative pain relief help reduce the intensity of pain, which allows a woman to give birth more easily.

In order for dilatation to proceed at the desired pace and reach 10–12 centimeters (at which attempts begin), a woman needs to know from the very beginning how to behave, how to relate to what is happening. Proper breathing from the very beginning of contractions is deep and slow inhalations and exhalations, allowing you to relax as much as possible. At the stage of active contractions, a series of short and quick inhalations and exhalations at the peak of the contraction helps.

When the body is saturated with oxygen, the release of endorphins increases. These hormones have a certain analgesic effect. In addition, proper breathing helps saturate all organs with oxygen, improves blood circulation, and prevents fetal hypoxia during childbirth.

Regarding drug pain relief, a woman has the right to decide for herself whether she needs it and wants to refuse the proposed epidural anesthesia if she considers it unnecessary.

The very mechanism of pain during childbirth is difficult to explain, because there are no nerve receptors in the uterus. Therefore, experts tend to consider pain psychogenic, which means it will be possible to cope with it.

Prevention

To avoid non-dilatation of the cervix during childbirth, doctors recommend that pregnant women calm down, not be nervous, and, if necessary, visit a psychologist if there are problems or a strong fear of labor pain. In the later stages of pregnancy, a woman is recommended to have moderate, but still physical activity. Lying on the sofa can be of little use for the upcoming labor.

There is a popular belief that having sex increases the likelihood of successful disclosure. This is partly true: semen contains prostaglandins, which soften the cervix, but they do not affect contractility.

For more information about cervical dilatation, watch the following video.

• Pain as during intestinal upset
• Lower back pain
• Pain in unexpected places
• Contractions without pain

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KEANA: The beds in the pregnancy pathology department were so hard that every morning I thought that contractions had started (I definitely had back pain like during menstruation), but when real contractions started, I realized that they couldn’t be confused with anything, that’s for sure!

mama_Levika: About two weeks before giving birth, a slight tingling sensation begins in the lower abdomen, it seems like contractions, but, girls! You can’t confuse contractions with anything, don’t rush to call an ambulance...

What are contractions

So, there comes a time when your baby is ready to be born. Labor begins, which many expectant mothers recognize by painful contractions. But what is a “confrontation” and what happens at this moment?

” A contraction is an involuntary contraction of the smooth muscles of the uterus of a wave-like nature. They allow the cervix to open - the only “way out” for the child.

To imagine how the muscles of the uterus move, think of a crawling snail: a wave passes along its sole from the tail to the head, and tense muscles push it forward. The same thing happens with the uterus: not all of it tenses at the same time.

The upper part of the uterus is more “muscular”. It is she who compresses the amniotic sac. As you remember from your school physics course, a liquid easily changes shape, but practically does not change volume. So the fertilized egg begins to put all its might on the lower part of the uterus - there are fewer muscle fibers here, so it does not shrink, but, on the contrary, stretches. The main pressure falls on the cervix - the “weak link” of the muscle sac. The amniotic sac literally wedges there: the anterior fluid (amniotic fluid located in front of the baby) presses the amniotic sac into the birth canal and pushes it apart.

” It is believed that in the uterus there is a dominant focus of excitation, most often localized in the right corner of it (“pacemaker”), from here the wave of contractions spreads to the entire musculature and goes in a downward direction.

A woman cannot control contractions, unlike pushing, which involves the muscles of the perineum, the muscles of the abdominal wall, and the diaphragm. That is why, in the last stage of labor, the midwife asks the woman to push or, on the contrary, hold back for a few seconds. Indeed, we can all tense our abdominal muscles, but it is absolutely impossible to strain, for example, the muscles of the stomach through willpower.

When the uterus is tense and stretched, the blood flow to its muscles is blocked (if you clench your fist with all your might, you will see certain areas of the skin turn white), and the nerve endings leading to the uterus are also compressed. This is what determines the sensations that arise: the pain is dull, periodic (“it will grab you, then it will let go”), and most importantly, it is perceived differently by all women (depending on the location of the child, the uterus, and also on where the nerve endings are most compressed ). But the pain during pushing, which is caused by the movement of the child along the birth canal, is perceived by all mothers in the same way: the unpleasant sensations are concentrated in the vagina, rectum, perineum, and the pain is quite acute.

This is why the sensations during contractions raise so many questions - are these really contractions or, for example, osteochondrosis? Let's look at the most typical examples of pain!

Pain “like menstruation”

Unpleasant sensations are localized in the lower abdomen and resemble pain during the onset of menstruation.

Lyalechka: The pain is like menstruation, only worse.

SV1980: The contractions were similar to menstruation at the beginning.

As a rule, women in labor who perceive contractions as “pain during menstruation” also feel the occurrence of - “petrification” of the abdomen.

Pain as during intestinal upset

Abdominal pain during contractions reminds many expectant mothers of the discomfort of an intestinal disorder, cramping attacks that accompany diarrhea.

ANelli: at the beginning it didn’t hurt, it was just a feeling that you really needed to go to the toilet, but when you go to the toilet early in the morning with an interval of 20-30 minutes, but there is no result, you understand that the intestines have nothing to do with it!

Zuleyka: I thought I had been poisoned by something the day before, my stomach was churning...

By the way, immediately before childbirth, intestinal function actually becomes more active, and bowel movements may occur more than once.

Lower back pain

Quite often, the source of pain is the lumbar region: “pulls”, “grabs”.

vedetta: I had such pain - it seized my lower back and the pain rose from the bottom up my back and stomach. And then she also went down and passed through. To be honest, it doesn’t look much like menstruation...

Tanyusha_I'll be a mother: suddenly my lower back began to hurt every 15 minutes and then decrease a little bit... I didn’t wait right away and went to the maternity hospital.

The phenomenon of back pain has two explanations: the pain can radiate to the lower back, or it can be felt lower, in the tailbone area - most likely it is caused by the divergence of the pelvic bones.

Pain in unexpected places

Sometimes pain can radiate to the most unexpected places, so that a woman in labor complains that, for example, her hips or ribs hurt.

Alma: contractions started - it hurts in my side and radiates to my kidney and leg!

Most often, women identify radiating pain as “kidney pain,” especially if they have experienced it before. Pain in the hips, knees, numbness in the legs can be a result of compression of large blood vessels in the lower abdomen.

Contractions without pain

This also happens, especially at the very beginning of labor. The sensations, however, are quite unpleasant. Expectant mothers usually feel how the uterus becomes toned for a few seconds - the stomach “turns to stone”, then relaxes again. Similar sensations arise if during contractions you do .

Ksyusha_SD: I kept walking and thinking, how will I understand that this has begun? I felt good and there were no changes in my appetite either. I really understood only when the contractions started - the tone of the tummy just began periodically.

Of course, not everyone is so lucky, but it happens that a woman is not very susceptible to pain. So at the beginning of labor, while the pressure on the cervix is ​​low (or, for example, she has a flat membrane in which ), the sensations may be unpleasant, but not painful.

As you can see, descriptions of contractions vary greatly. How to recognize them?

Periodicity. Contractions, no matter how they feel, occur at regular intervals. This is how labor contractions differ from “training” ones - .

Increasing frequency. During childbirth, contractions occur more and more frequently.

Gain. The intensity of pain increases.

Lack of response to your actions. The unpleasant sensations do not disappear if you change your body position, walk, lie down, or take a shower.

Displacement of painful sensations. Gradually, the pain shifts to the perineal area, on which the baby’s head begins to press.

Did everything coincide? It's definitely time for you to go to the maternity hospital!

This question is of more interest to those representatives of the fairer sex who are expecting their first child.

They are very worried about not missing out, so at the first signal they begin to rush to the maternity hospital. So can labor begin without contractions? What should a woman know about the potential start of labor?

Usually, all of which begin to intensify in waves. Then contractions begin to occur more often, the interval between them becomes shorter. But in some cases, the onset of labor may be non-standard.

Very often, the expectant mother initially experiences an outpouring of amniotic fluid. This is the liquid within which the fetus develops in the mother's womb. These waters are found in the membranes of the fetus, which, together with the placenta, act as a kind of barrier that protects the unborn baby.

During the entire gestation period, amniotic fluid allows the baby to develop in a sterile environment.

This fluid is normally poured out during the first stage of labor, that is, until the cervix dilates by 4 cm. This happens at the height of one of the contractions. If the waters pour out before the start of labor, then this outflow is called premature or prenatal.

Most often, premature rupture occurs in women who give birth to a baby again, that is, this is not the first child. It doesn’t hurt at all, there is no discomfort, there are no other unpleasant sensations.

If early rupture occurs, the amniotic sac may rupture above the cervix. In this case, water does not flow out quickly. But sometimes the bladder ruptures above the opening of the uterine cervix. In this case, water flows out very quickly and in large quantities.

When the amniotic sac ruptures high enough, it is not easy to identify what it is. It is not easy to differentiate such secretions, because they are quite similar to each other. For a woman giving birth for the first time, it is especially difficult to distinguish between these discharges.

So, it should be noted that the plug comes out approximately 2-5 days before the onset of labor. The color of the cork is single or beige. Sometimes it may contain blood impurities. The cork may come out not in one day, but in several.

When a woman coughs, sneezes, or squats, the discharge increases.

Symptoms of rupture of amniotic fluid

Amniotic fluid has a more watery structure, it is transparent, and sometimes may have a slight yellowish tint. They leak constantly, and when a woman sneezes or coughs, the discharge intensifies.

After this fluid has completely drained out, labor begins in about 2-3 hours.

It must be said that childbirth that begins with the release of water is more unsafe. After all, the baby in the womb remains without protection. Various bacteria from the vagina and cervix can penetrate it.

Delivery should occur within 12 hours of rupture. Under no circumstances later. Such a temporary restriction will help avoid various complications.

If labor begins with the breaking of the waters, then the mother in labor should look at the time so that, when questioned by the doctor, she can answer exactly when this happened. The first thing you should do is call an ambulance and also notify your husband. Don't wait for contractions.

When the water comes out, look if there is a greenish tint in it. If it is, then this directly indicates that it is present. In this situation, you urgently need to call an ambulance without delaying a second. If the waters are clear, then you can reach the maternity hospital on your own.

In order not to slow down labor in the car, a woman should not lie on her back. The optimal position is on your side. Lying on your side minimizes the risk of umbilical cord loops falling out.

This can happen if the water breaks early, it should also be said that it is in this position that the maximum amount of oxygen will flow to the baby.

What not to do when water breaks

• If the water breaks, then in any case you need to go to the maternity hospital. Under no circumstances should you stay at home, as it increases the risk of fetal hypoxia, as well as the risk of infection getting to it. In this case, the baby’s head moves into the uterine cavity and begins to compress the umbilical cord.
• Taking a bath is also prohibited. This increases the risk of infection.
• Enemas are prohibited.
• Shaving is also prohibited.
• You should refuse food, because in cases where the water breaks, the need for surgery under anesthesia greatly increases.

Why are hygiene procedures and eating food still prohibited? Because they will require precious time, and when the amniotic fluid breaks, you cannot hesitate.

You need to pull yourself together, don’t panic, try not to get nervous. You should prepare yourself for a difficult job and try to be in an optimistic mood!

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

Contractions without water breaking

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

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

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

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

Abbreviations calculator:

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

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

Table - Differences between true and false contractions

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

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

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

Contractions and water at the same time

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

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

Subsequence:

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

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

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

Feel:

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

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

Actions:

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

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

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

Water broke without contractions

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

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

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

Why does your water break before contractions?

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

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

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

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

Complications:

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

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

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

Update: October 2018

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

Weakness of generic forces: what is the essence

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

Classification of weak labor

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

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

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

Causes of weak contractions

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

Obstetric complications

This group includes:

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

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

Pathology of the reproductive system

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

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

Extragenital diseases of the mother

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

Factors due to the fetus

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

Iatrogenic causes

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

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

How does pathology manifest itself?

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

Primary weakness

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

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

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

Secondary weakness

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

Weakness of pushing

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

Diagnostics

To make a diagnosis of weak contractions, consider:

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

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

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

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

Management of childbirth: tactics

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

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

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

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

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

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

What can doctors do?

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

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

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

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

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

Drug labor stimulation

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

Oxytocin

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

Prostaglandin E2 (prostenon)

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

Prostaglandin F2a

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

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

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

Surgery

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

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

Question answer

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

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

• What threatens the weakness of the generic forces?

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

• How to prevent the occurrence of labor weakness?

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

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

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