Natal Period

                                  

                          

                                                  "Delivery, Birth without Fear, (प्रसव)"

Pregnancy lasts for about 280 days or 40 weeks. A preterm or premature baby is delivered before 37 weeks of your pregnancy. The medical term for the due date is estimated date of confinement (EDC). However, only about four per cent of women actually give birth on their DUE DATE.

                                           

Premature Delivery

Normal Delivery

Post term Delivery 

The New Born Child

              "You simply equip yourself with some knowledge, relaxation and breathing techniques."

The Body's design for birth

A woman's body is designed for giving birth. To begin with, a woman's pelvis bones are broader than men's. A woman's pelvis is heart shaped, where as a male pelvis is apple shaped.. There are three joints in the female pelvis that spread apart at birth. Two are at the back, on either side of sacrum,i.e. the lower portion of the back bone where it join the iliac bones or the basin like bones of pelvis. These are called the two sacroiliac joints.Then there is one joint in front of the pelvis , called the symphysis pubis. These three joints spread apart  to make way for the baby's exit.

After the baby has passed through the cervix  or mouth of the uterus, it makes its way through  the vagina. The vagina is made up of folds and is therefore capable of unfolding, just as the pleats in front of the saree can unfold.  As the baby passes through the vagina, it opens up to make way for the baby.. The more relaxed the woman keeps  the muscles of the vagina passage, the less tension of the baby's head encounters during birth

The cranial or head bones of the baby are not fused. As the baby's head negotiates the birth canal, these bones can mould to the size of the vaginal passage. They can also override each other, if necessary.  At birth the bones come back to their original shape. It is because these moulding of the baby's head sometimes takes place, that some babies are born with funny bumps on the head, which smoth out in a few days.

The body releases hormones to control the process of birth and make it pain free.

An interesting fact is that  uterine contractions and their associated 'pain' form a very short part. of the total labour. For instance, if you have one minute contractions every five minutes,  it will mean that  in one hour you will have  twelve minutes of contractions  and forty eights minutes of relaxation. At the start, contractions can be every fifteen minutes and last for thirty seconds. So in one hour one would have only two minutes of contractions.

                    

Normal delivery

Labour Preludes

There are three signs that could herald the onset of labour. These may appear by themselves or two may appear together.

Duration : 24 hours in first delivery and 18 hours in second delivery.

Children that are born  between the 36th and 39th weeks after the Last menstrual period (LMP) are considered as normal deliveries.Giving birth proceeds in three periods:

1 . Mucus Discharge or show

You may notice a thick mucus discharge tinged with pink or brown. Discharge occurs from the mouth of the womb or cervix plugged with mucus to prevent infection from entering the womb.

A week or more before labour begins, the cervix can thin out and flattened. As this happens, the mucus plug escapes and you notice  a thick lumpy mucus discharge. This discharge is a sign that your body is getting ready for the birth process. It is no cause for alarm.

The doctor would say that your cervix is ripe, ready or effaced.

Contractions

The muscular contractions of the uterus are felt  as periodic discomfort, and often referred to as labour pains. Initially contractions are mild. They may feel like mild discomfort at the beginning of a menstrual period. Or one may mistake them for discomfort that accompanies an upset stomach, since it is not uncommon to have diarrhoea before labour begins. On some occasions women feel it is discomfort arrive from tight clothings around the waist. However, even when you switch to more comfortable clothing or lighter food, the discomfort persists. It comes  and goes periodically.

When you realize this, begin to make a note of the time  whenever the discomfort occurs. If you find it occurs half - hourly, you know it is real labour. It could also occur more frequently, for example, every 15 minutes. So when it occurs at fixed intervals, you know it is real labour.

Sometimes before labour begins  you feel practice contractions or false contractions. These are contractions of the uterus in preparation for birth. Practice contractions feel similar to real contractions, but they occurs at irregular intervals.

It is possible that after starting at periodic intervals, contractions might stop for a day or so,only to restart later.There is no harm if  contractions stop.There is at times a slowly unfolding labour  that starts and stops on  and off, until it gets properly established.. So you can safely stay at home until your contraction go to be ten minutes apart.Once they are coming every ten minutes, they are properly established, and less likely to stop.

In a second delivery , labour is generally shorter, so you can go to the hospital when contractions are fifteen minute apart. Do not panic if contraction start at ten or five minutes intervals.

Contractions may stop for a while when you check into the strange atmosphere of the hospital or nursing home. If that happens, just walk around and get familiar with the place. See where is the toilet is, where the nursing station is, the position of your room on the floor where you are. Stroll in the corridor and your contractions will start again as you get familiar with your environment. You could also go and have a look at the nursing home  or hospital earlier, while pregnant.

After ten minutes intervals the contraction will shift to five minute intervals and for a short while before birth, to every two minutes.

3. Fluid Leak

The baby is encased in the amniotic sac. Sometimes the amniotic sac burst and all the amniotic water gushes out, as though a tap were opened inside you at full blast. The amniotic sac may burst before labour begins. It could happen at any time  in the ninth month, but it mostly happen at night. So you could spread a rubber sheet or a rubber cloth  across the middle of your bed. It can be bought from  a chemist or a cloth shop.(It is called momjama in hindi)

                        

When this happens, the amniotic fluid also sweeps out the mucus plug on its way out. The protection of the plug and of the amniotic fluid  is now absent. For this reason, the women is now more susceptible to infection each time an interval examination is given..

So once a water bag bursts, doctor like to deliver the baby in four hours. The common practice is to put a women whose water bag has burst, on a drip of glucose to which a synthetic hormone called syntocinon has been added in order to trigger off  contractions artificially.

However, if you wait for 4-5 hours before fixing a drip, it is possible that contractions may start spontaneously, on their own and thus eliminate the need of a drip.. It would be more pleasant if this happens, since spontaneous contractions are gentler than contractions that are artificially induced.

So if the water bag burst, you check into the hospital, but request for the drip to be delayed by 4-5 hours. It is a simple request. Keeping in mind that the baby should arrive  in twenty four  hours, waiting 4-5 hours still leaves an ample period of nineteen to twenty hours for the birth.

On some occasions amniotic fluid may not burst, but might just trickle instead, The trickle will be clear  and uncomfortable. Wear a sanitary pad and take rest at home. After some time the amniotic sac might seal itself and the trickle might stop. It might recur after some time, or might be followed by contractions.

Go to the hospital when the contractions are ten minutes apart. Or if the trickle gets out of control and cannot be contained by a sanitary pad. The sanitary pad should be changed often to avoid infection.

When urgent medical attention is needed

A coloured trickle

The trickle that appears from the amniotic sac is usually clear. if the trickle appears muddy or greenish and has a foul smell, you must get in touch with your doctor immediately. The colour of the amniotic fluid comes if the baby passes a stool inside the womb, which it normally does after birth.

So, once you have what is called meconium staining of the amniotic fluid you need to be under medical observation. If along, with meconium staining, there is an adverse effect on a baby's heart rate (the normal heart rate  is 120 to 160 beats per minute), it would indicate a need for Caesarean section. If the fetal heart rate is not affected labour can progress normally.

Bright  red  Bleeding

If you experience bright, fresh, red bleeding like when you cut your finger, or at the height of a period, you should be in touch with your doctor immediately. Bright, fresh, red bleeding occurs if there is placenta previa, a condition in which the placenta lies between the baby's head and the mouth of the uterus, blocking the baby's exit.

Or, it could occur if the placenta, the organ that nourishes  the baby, detaches or peels away from the wall of the uterus. If a small portion has peeled away, it may be quite harmless, but nevertheless you will have to be under observation, to make sure it does not adversely affect the heartbeat of the baby. The normal heart beat of the baby in labour would fluctuate between 120 and 160 beats per minute. Below 120 or above 160 are both considered fetal distress.

Fetal distress and placenta previa would indicate the need of a surgical removal of the baby.

Position to Adopt in Labour

Once labour begins, it is best to be upright rather than lying down flat on your back. Up right mean walking /  kneeling / standing and other positions we shall discuss shortly. Being upright in labour gives the following advantages :

1 . The force of gravity helps in the descent of the baby. (The force of gravity is constantly pulling down things). The baby with its own weight  will descent through the birth canal sooner when the mother is upright, rather than when she is lying down.

2 . When the mother lies flat on her back, blood vessels get compressed by the weight of the uterus and the baby on the one hand and the backbone on the other. This hampers the blood flow to and from the heart, and increases the chances of distress in the mother and the baby.

Being upright lifts the compression on the blood vessels so that the blood flow to the mother and the baby is more efficient and both are therefore more alert and awake during birth.

3 . When the mother is lying down, the vagina is at an upward slant, so the baby has an uphill task before it.

When the mother is upright, e.g.standing, it becomes a downward descent for the baby.

4 . During birth the head of the baby passes first the top brim of the pelvis basin and then the bottom outlet of the pelvic basin.

Forming part of the outlet at the bottom of the pelvis is the tailbone.The tailbone is a flexible bone. If you do not lie or sit on it while in labour, it moves away as the baby comes through the outlet of the pelvis, and the space for the baby's exit increases by as much as thirty percent.

5 . The women who walked during labour:

a . the duration of labour was shorter.

b . there was less need for painkillers.

c . the incidence of fetal heart abnormalities was markedly smaller and

women experienced less pain.

6 .  a . The strength or intensity of contractions is greater  when women are moving about in labour and

      b. There is greater regularity and frequency of contractions.

Precautions :

There is just  just one instance when it is better for you to lie down rather than be upright.

At about 36 weeks, the head of the baby fixes in the brim of the pelvic basin. In some instances, the head does not lower and fix in the pelvic basin, but remain floating above the pelvic inlet. This is called a floating head, fairly often, a floating head fixes in the pelvic basin after labour begins.

In the last month of pregnancy when you go for weekly check ups to your doctor, ask if baby's head has fixed or engaged. If you have a floating head , and the water bag bursts, it is possible that as all the water drains out, the umbilical chord may also be swept downwards with the water and  come to lie between the baby's head and the brim of the bony pelvic basin. In this case, if you remain upright, you may cause the chord to be squashed between the baby's head and the pelvis, a most undesirable situation, medically called cord prolapse. It is through the chord  that the baby receives oxygen and nourishment.

So when there is a rare combination of floating of the baby's head and the bursting of the water bag, you must remain lying down or adopt the knee-chest position.

Upright Position for labour

Walking

Walking is the best position for labour. You can walk about your room, at a relaxed leisurely pace. Avoid brisk walking; it will tire you out. Stroll about, and when your contractions is felt.

1 . Stop walking, stand where you are , with your feet nicely apart, to take the even distribution of your weight. Place both palms on your lower abdomen. Make a circulatory rotatory movement with your hips, during the duration of your contraction.When the contraction is over, you can resume walking.

2 . If you happen  to be near a wall when a contraction is felt, stop walking.Stand facing the wall.Place your feet nicely apart, about 6 inches away  from the wall. Place your palms on the wall at shoulder level. Keeping your body straight, bring it slightly forward by bending elbows, then push back with your palms. Keep up this gentle forward and backward movement while the contraction lasts. Avoid jutting the stomach forward and increasing the curve of your back, as this can lead to backache. If you do not find the forward and backward movement comfortable, you can instead make circles with your hips.

                                        

3 . Alternatively, while you stand facing the wall, place your feet a little away from the wall, place raised arms bent at the elbow on the wall, and use them to rest your forehead on .This position helps to make the contraction stronger, specially beneficial if contractions are week.

                    

Using a foot Stool or low stool

You can sit on a foot stool, with your knees apart, Since the foot stool is rather low, it will be similar to squatting. As you sit in this fashion, the weight of the upper part of the body is supported by the footstool and it leaves the pelvic floor relaxed.. Spreading the knees apart open up  the joints of the pelvis, thus opening of the passage  for the baby's birth.

                  

This position helps to speed up the progress of labour and can be used at any time during its course. It can also be used with the drip.

Using the dining chair to sit

                   

If you have labour at night when you are bit sleepy, or if you are tired and do not want to walk  or stand , this position can be used.

A dinning chair is used, since it narrows on the back  and has no arms. Sit facing the back of the chair with legs on either side  (as you would sit when ridding a horse). Use the back to rest your head upon, with your arms or a cushion, to cushion you head.

As you sit like this , someone can massage you back. As you lean forward to rest  your head on the back of your chair , your tail bone lifts off and moves away from the pelvic outlet , making room for the baby.

Kneeling

                        

                            

When you are tired of walking , you can switch to kneeling. Kneel in front of a sofa or bed. At the hospital, it could be the bed. You can buy a three feet by two feet  foam mat to kneel upon, or use a cushion or a folded quilt.Your legs from a knee up to the toes . should be on it.

Place a soft thick pillow on the back of your legs, that is  on the calves.Sit on a thick pillow  when you are not having contractions. When a contractions is felt, rise up on your knees, hold the piece of furniture in front of you and either rock forward  and backward or make rotatory circles with your hips.

Resume sitting when contraction passes.

Backache in labour

                  

If you feel most of the discomfort of your contraction in your lower back , you are experiencing back labour. Back labour  would mean that the baby is posterior that is, instead of facing the mother's  backbone   abdomen, it is facing the mother's  abdomen, causing a low backache. Counter pressure on the lower back will relieve the discomfort.

It will feel comfortable  if you stand with your back to the wall, and press the part of the  back that hurts,against the wall.To get maximum pressure on the lower back, you can hunch your shoulders forward and bend your knees.

All four Positions

                     

1 . In case of a backache and posterior baby, this position helps relieve the backache and guide the baby to an anterior position.

2 . It also slows down fast labour.

First kneel with your knees one foot apart. Place your hands in front of you on the floor  and go into the all four position. Rotate the hips in circles.

When on the Drip

The drip implies that glucose drip from a bottle through the tube, straight into your vein, through a needle that is inserted into your arms. The bottle of glucose is attached sometimes to a rod at the side of the bed ; and some times to a rod attached to a stand with wheels.

Sitting on the Bed

                        

If the drip is sticked to the side of your bed, you have to remain in bed. Instead of lying down, you can adjust your bed in a sitting position.

Place the hospital table on which you eat your food in front of you, with a pillow on it.. When you are not having a contraction lie back comfortably supported with pillows.When a contraction occur, lean forward on a table , supporting your weight on the arm that is free of the drip.You can rock backwards and forwards as you do your breathing. Spreading your thighs apart will facilitate the backward and forward motion. Sink back into your pillows when the contraction is gone., and close your eyes and relax until the next contraction appear.

Alternatively , while on bed you can turn to a side and sit with your legs hanging down and your feet on the footstool or floor. Your partner can stand in front of you, and you can lean forward  on him or her when the contraction comes. This position will make you feel less 'trapped'.

Sitting on a chair

       If you have a drip that is attached  to a stand  that has roller at the base, you can wheel your drip to  near the wall. Sit on a chair facing the wall.When a contraction occurs, stand up and lean against the wall. Your feet should be well apart and away from the wall by about six inches. Then

1 . You can place one palm on the wall in front of you and make circles with your hip or a forward or backward movement or

2 . You can move your feet back a little and place an arm bent at the elbow on the wall, and place your head on it.

Stand leaning forward as long as the contraction lasts. Resume sitting when the contraction is gone.

Conscious Relaxation of the Lower Abdomen

It is important to keep the lower abdomen and the pelvic floor relaxed while in labour. Most of the action of birth takes place  in this region. If these muscles are relaxed , they will easily give to the baby's head negotiating the birth canal. If they are tight with tension, they will hold up the baby's progress and delay birth.

During pregnancy this relaxation should be practiced at least once a week. During labour this is to be practiced hourly.. You need a partner to help you practice this.

Stand and have your partner  place one hand on your lower abdomen, just above the pubic hairline, and the other hand should  be placed on the lower back, above the hips. No pressure is required to be given with the hands. The hands are to be paced gently on these two places.

When both hands are in place, exhale, then let go of your abdomen. Relax your abdomen towards your hand. Relax your pelvic floor. Leave your pelvic floor relaxed as though you are passing urine. Imagine your pelvis is opening up, and having passed through it , the baby is now coming through your relaxed vagina. Relax your hip and buttocks. Relax your inner thigh and your outer thigh.

Comforters

Palming

Placing the hands on the lower abdomen and on the lower back each time a contraction occurs is very comforting. The lower back is uncomfortable, since it is at this spot that the sacroiliac joints of the pelvis are spreading, apart to let the baby out. The lower abdomen is uncomfortable since it is the area where the uterus is contracting. When palms are placed on these two spots in labour, it brings comfort to the labouring mother.

Head Squeeze

Often a women in labour desires to hold on to  something or someone very tightly. If you have this urge your partner should hold your palm with a firm, tight pressure.. You should avoid gripping your partner's hand, so that you do not waste energy and strength while doing so , and you do not tense your body. Remove rings before trying this, they could hurt.

Your partner's thumb should be placed  at the back of your hand. The remaining four fingers should fold on the back of the hand from the opposite side. The grip should be firm.You should tell your partner if you want to increase the pressure or have it lessened.

Effleurage

The skin and the muscles of the abdomen are very tense during a uterine contraction. A light massage or brushing will lessen this tension.

Effleurage is a light moving of your fingertips on your lower abdomen, that is between the navel and the pubic hair. . Place the fingertips of both hands on either side of the navel. Make circles by moving fingers lightly on a circular motion from the center of the  abdomen, outwards, towards the hips. Then down towards the pubic hairline and up again towards the navel.

If you are on the drip, and one hand is immobilised , you can massage with the fingertips of one hand, from side to side, that is  from one hip to the other, across the lower abdomen.

The fingertips should move in light strokes, rubbing should be avoided. The lighter the stroke, the better. It should be done simultaneously with breathing exercises. Apply talcum powder as needed.

Leg Massage

                             

If you feel that your legs are week or shaky, a massage firmly up from above the ankles, on the sides of your legs, will feel good. You can use talcum powder  so that your fingers run smoothly and are not hampered by perspiration.

If you feel shaky on the thighs, this massage can be done from above the knees, on the inner and outer sides of the thighs.

For a Backache

In labour, a slight discomfort in the back is common. Backache is more pronounced in the case of back labour or a posterior baby. When the discomfort of labour is concentrated more in the lower back than in the lower abdomen.

Back Massage

Lie on your side. Take a pillow under your head  and another pillow between your knees. Your partner should sit facing your back. With one hand he can hold your hip, so that you do not have to brace yourself, and with the other hand, locate the flat, hard surface of your lower back, just above the hips. Once located, he should press the heel of the palm on the spot and once pressed, rotate it clockwise. The massage can be practices during pregnancy too, in case of a backache.

Since a great amount of pressure is applied by a palm, it helps the person massaging, to support the elbow  of the hand on the thigh. However, if tiredness set in , your partner can instead sit back to back with you.

Back to Back

You should continue lying on your side, as for the back massage. Your partner should sit against your lower back as close as he can get with his back straight. That is he should avoid leaning on you, or else you will feel that you might tumble over.

At times if your partner is male, just this sitting is adequate. However, if you feel the pressure is less,  your partner should lean forward, cross both palms at the back, place them on your lower back and sit straight again. This will add to the pressure and bring greater comfort. You can guide your partner, as to where exactly you should like  the pressure, higher, lower, or little to the side.

Tennis Ball

A tennis ball can be effectively used to massage your lower back. To use a tennis ball, you must have a foam mattress. It cannot be used on a cotton or coir foam mattress. Lie down on a foam mattress, placing a tennis ball between your lower back and the mattress. The tennis ball will massage your lower back as you lie on it. It will bring comfort for fifteen to twenty minutes, after which it will begin to hurt. When it hurts you get up and try the position of standing with your back to the wall. On and off in labour, you can use the tennis ball to massage your lower back, by lying on it  or by placing it  between your back and the wall, as you stand with your back to the wall.

• Dilatation period
• Expulsion or press periods (subdivided into 4 phases.
• After birth period

Stages of labour : 

      

First Stage

Second Stage

Third Stage

Fourth Stage 

First Stage

• Dilatation period

Second Stage

• Expulsion or press periods (subdivided into 4 phases.)
• The second stage (the period of expulsion) lasts from complete cervical dilatation till the delivery of the infant.

During delivery the infantile head has to confirm to the various pelvic sections. In the expulsion period the first three phases described  the development of the head while phase 4 that of the shoulders, whereby the head rotates 90 degrees back again

                               

Phase 1 of the delivery

The head which is still 'floating' sinks into the minor pelvis, in that the biparietal diameter confirms to the pelvic opening and is there fixated. 

                              

Phase 2 of the delivery

While the baby is pushed further down by the contraction of uterus wall, a forward bending of the head occurs. In this phase only the smaller (rear) frontenel can be felt. The head bends forward so that the baby can pass through the birth canal with the smaller sub-occipito bregma diameter.

                                   

Phase 3 of the delivery

In the third phase baby turns completely with the back towards the front and the baby's neck arrives at the mother's symphysis so it can finally leave the birth canal with a subsequent stretch.

Third Stage

• After birth period
• The third stage (the placental stage) begins immediately after delivery of the infant and ends with the delivery of the placenta.

Expulsion of placenta

Good news is, it is painless. Duration 10 minutes.

Fourth Stage 

The fourth stage is defined as the early postpartum period of approximately 2 hours after delivery of the placenta. During this period patient undergoes significant psychological adjustment and must be under close medical control.

CHILDBIRTH RECOMMENDATIONS

1. It is nor recommended that the pregnant women are placed in the dorsal lithotomy position during labour and delivery. Walking should be encouraged  during labour and each women muct freely decide which position to adopt during delivery.
2. The well being of new mother must be ensured through free access of a chosen member of her family during birth and throughout the post-natal period. In addition the health team must provide emotional support.
3. Immediately breastfeeding should be encouraged even before the mother leaves from the delivery room.
4. The induction of labour should be reserved for specific medical indications.
5. Artificial early rupture of membranes as a routine process, is not justifiable.
6. During delivery, the routine administration of  analgesics or anesthetic drugs should be avoided.

Maternity Panties

You can get underwear that are low riders and high waist one that come up over your belly. During pregnancy, women need sturdy yet comfy panties.

After Delivery

• Harira
• Dashmularisht kada  
• Shatavari dena available in  ayurvedic shop
• Methi ke Laddu
• Meve ke laddu for 3 months.
• light diet
• Thin chapati, raw papita vegetable,lady's finger,masoor dal,
• Avoid : 
• Gobhi, aalu, matar, arbi .

 How long do you bleed for after a c-section? You will have some vaginal bleeding (called lochia) for two to six weeks after the birth. This is normal and natural. This bleeding happens after vaginal or c-section births.

https://madhuchhandacdmo.blogspot.com/2020/11/natal-period.htm