Birth with Dr. Zeynep Taşargöl
Your calculated date of birth is approaching, your family is waiting your news to be with you, or maybe, you are sick of hearing ‘did she not give birth yet?’. Unfortunately, neither you nor your doctor will be able to answer this. Only your baby knows the answer and doesn't give a hint either. You went to the examination, everything seems fine, even when you return home, your labor can begin. On average, one month before birth, there are some changes, but this may not be understood in some people.
These are;
As the baby is placed in the birth canal, there is a feeling of your belly coming down… You start to breathe more easily and you feel a lightness. While it is generally experienced in the first births, in the last weeks, it may not occur until the last moment for subsequent births.
Braxton Hicks contractions happen more frequently and are mistaken for a false birth.
Changes begin in the cervix. It may be in the form of softening and sometimes a few centimeters of dilation, but this does not mean that the birth has started or is very close.
Mucus Plug
During pregnancy, the cervix, like the whole genital system, undergoes some changes. The cervical tissue, normally consisting of a hard connective tissue and a small number of secretory channels, softens as pregnancy progresses, connective tissue decreases, fluid content and blood supply increases, and glands proliferate. The thick, viscous, sticky liquid formed by the glands increasing both in number and size forms the mucus plug right after fertilization, closes the cervix and helps the baby. This mucus plug is thrown away just before birth and is a sign that labor will begin. Expectant mothers describe the disposal of this plug as a pink, slimy bleeding. This situation is a sign that the birth is approaching.
It can be observed that water comes out and the membranes surrounding the baby come open, resulting in abundant or less water coming. This is definitely a reason to call your doctor. Even if the contractions have not started, you should go to the hospital and be monitored. After waiting for a while for your pain to start spontaneously, if not, your doctor will initiate the birth to prevent your baby from getting an infection from the open membranes.
Types of Birth:
1)Normal Vaginal Childbirth
Normal Birth is the involuntary contraction of the uterus between the 38th and 42nd weeks, and the birth of a baby through the uterus with its placenta without harming the mother. The uterus, which has been standing comfortable for 9 months, receives various signals and begins to contract towards the end of pregnancy. Although it is not entirely clear why and how this origin comes from, various ideas have been put forward. Most of the pregnant women enter into labor about 1 week before the expected date of birth. Contractions may occur at regular intervals in order for the birth to take place and the uterus to open, and with these contractions, there is no obstacle to the opening of the cervix. In the period after the uterus is opened, these contractions push the baby out of the uterus and bring the baby to the appropriate position, without any obstacle. If we divide the birth into 3 parts, the first stage starts with the contractions of the uterus. It is the longest lasting phase. It may take 14-16 hours. It lasts until the cervix is opened. Contractions first begin to come every 10-15 minutes. Then it begins to come in shorter periods and increase in intensity. It decreases to 1 in every 3 minutes and may decrease to 1 minute. Stage 2 is the time between the opening of the uterus and the delivery of the baby. It can take from a few minutes to a few hours.
The third stage ends with the emergence of the placenta, which is called the wife of the baby, after the baby comes out. It takes about 10 minutes to half an hour. Contractions may continue during this period as well. The purpose of contractions at this stage is to reduce bleeding by closing the blood vessels caused by rupture of the placenta.
ADVANTAGES OF NORMAL DELIVERY:
DISADVANTAGES OF NORMAL BIRTH:
WHEN TO APPLY TO A HOSPITAL DURING NORMAL DELIVERY?
When the real labor pains begin, the pregnant woman should understand that it is different from the others, and should apply to a health institution immediately with the start of pain, especially with the arrival of a snot-like discharge. This could be a harbinger of birth.
Again, in cases where you feel a decrease in your baby's movements, it is useful to apply to the hospital. This is very important so that the baby does not get bored. In particular, this is usually evaluated by your doctor with NST and ultrasound. Also, the coming of water is an indication that labor pains are starting. Bleeding is a very risky situation during pregnancy. Small or heavy bleeding is a sign of birth or that there will be some problems in your pregnancy that do not go right.
WHAT SHOULD BE DONE TO MAKE A NORMAL DELIVERY EASY
2)Painless birth
Epidural anesthesia, which is approached by pregnant women with a lot of worry and questions such as' how its done? how it applied? or will we face any problems? ', is actually a great convenience nowadays. As in every job, if you are in front of an experienced physician, you will immediately notice that there is no need for this much concern. It is less risky not to feel the pain of normal birth, but it is no longer a luxury to be more comfortable or to hold the baby in your arms immediately after cesarean section.
Pain is an unpleasant sensation that originates anywhere on the body. Headache, toothache, abdominal pain, the most severe of these, is labor pain. The cause of the pain here is the baby's descent and the uterus contracting. Epidural anesthesia is a type of regional anesthesia that prevents the transmission of pain in a specific area of the body below the waist.
One of the most beautiful emotions in life is motherhood. Of course, it is necessary to give birth to the baby first in order to hold the baby, to breastfeed it, to feel it and to spend time with it and to live with it. But most women are afraid of labor pains, wondering how to overcome it, or even just choose a different method for this.
Therefore, it is very important for the mother to relieve birth pain. The goal is to reduce this pain without affecting the labor, without harming the baby and the mother, and in a healthy way. This can be done in a variety of ways. The most preferred method among these is epidural analgesia. It is called as such because the epidural area is anesthetized. In this method, the pregnant woman gets rid of these pains. On the other hand, the traffic required for birth flows, the baby progresses over time, the contractions continue, but the mother does not feel pain. Here is an effective, safe, healthy and easy method. "Can I push?" is the frequently asked question about the epidural technique by pregnant women who are curious and want to prefer this method. They can also strain whenever their doctors want.
How its done?
This anesthesia is performed by an experienced and competent anesthesiologist. Whether it is in normal birth or cesarean section, the mother is placed on her side. The knees are pulled towards the mother's abdomen. The aim is to clearly show the doctor the area to be anesthetized with the needle and to create a space. In the meantime, while the end point of the chin is pressed towards the chest, the knees are pulled further to the abdomen, the back is maximally hunched, the waist is cleared.
The area to be anesthetized is first wiped and cleaned to protect against infection, because this area is an important place to be considered. The doctor wears his sterile glove, and a sterile cloth with a hole in the middle is spread over that area. First of all, that area is numbed with the help of a very thin needle. While doing this, it is very important for the patient not to move. This is the maximum pain the patient will ever feel. After that area is numbed and the epidural area can be entered for real anesthesia. In order to enter here, a catheter, which we call a path finder with a thin needle inside is inserted, then the needle is removed and the catheter remains inside. When the catheter moves, it is taped to the patient's waist by the doctor so that it does not come out. Medicines are given through this catheter. When the procedure is said to be over, the patient can return to the original position, that is, on her back.
When Is It Applied?
In the vaginal examination of the mother, if the cervix reaches 4 cm or if the cervical thickness is 60%, this procedure can be performed. After either normal delivery or cesarean epidural anesthesia, a catheter in the waist is used for pain control and painkillers can be injected from here. Usually this is done with the help of a pump system. A button is given to the mother's hand. One end of this rudder is connected to the pump while one end of the pump is connected to the catheter. When the mother presses the button, the pump works and pain relief is given from the waist. In other words, the pain and pain relief scheme is under the hand of the mother. About 15 minutes after pressing, the pain subsides and passes. This mechanism can continue as long as there is pain. Withdrawal of the catheter is also painless. In just 5 seconds, the doctor pulls this catheter from the waist and puts a small tape on that area. The tape comes off automatically after 1 day.
Which Patients Cannot Have Epidural Anesthesia?
What Are The Side Effects?
The most common side effect is low blood pressure. In order to prevent this, the patient is given enough liquid supplements before surgery.
Nausea, vomiting, dizziness, tingling in the head, weakness and headache may be seen. However, this situation is rare if an experienced anesthesiologist does this. The reason is that the spinal fluid leaks out a little too much when the drug is injected. It is temporary, so anesthesiologists recommend drinking plenty of fluids and even drinking caffeinated liquids.
After the operation, sometimes there may be numbness or incontinence in the knees or feet. This situation worries patients a little. But this is a temporary situation. The important thing is that this numbness decreases over time and it opens slowly. If this situation does not change after 1 day, the patient should re-evaluate.
In very rare cases, there may be an infection or allergic reactions.
If the anesthesia does not hold or is unilateral, the catheter is reinserted.
Sometimes there may be difficulty urinating.
3)Cesarean section
Cesarean section is performed in cases where it is not possible to complete the vaginal delivery safely, if there is a risk that the vaginal delivery will cause problems for the mother, the baby or both, if the delivery cannot be initiated or continued despite the vaginal delivery.
What are the situations to be done cesarean section:
1. Situations related to the baby:
• If the baby is in distress
• If the baby is coming backwards (breech, lateral, forehead, face)
• Multiple pregnancy
• If the baby has an anomaly (such as hydrocephalus, teratoma)
2. Situations related to the mother:
• Previous cesarean section
• Hypertension, diabetes
• Viral infections (HIV, HCV, HSV) en geçirilmiş sezaryen
3. Birth-related situations:
• If there is an incompatibility between the bones of the mother and the head
• If the labor is prolonged and does not progress
• If the baby is bigger than 4000gr
4. Situations related to the placenta:
• Placenta previa (placenta being in front of the baby and blocking the exit)
• Placental detachment (premature separation of the placenta)
• Early exit of the cord and blocking of the canal
Advantages of Cesarean Section:
No pain is felt
It is very rare to have problems with the baby.
If tubal ligation is desired, both can be done together.
Disadvantages of Cesarean Section:
Anesthesia is required.
The abdominal folds are opened and stitched again. This is also a big issue to be cared about.
Ultimately it is an operation. All risks in operations are also valid for cesarean section.
There is a possibility of infection
Duration of hospital stay is long.
The recovery period is long.
