Anticipating D-Day (Delivery day)
As their estimated delivery date draws near, many expectant mothers eagerly anticipate the arrival of their bundle of joy while dreading labour pains. Knowing what to expect in the final weeks of pregnancy, the various methods of pain relief available and some mothers have experienced during labour can help you to approach D-day (delivery day) with greater confidence.
1. SIGNS OF IMPENDING DELIVERY
Baby engages with pelvic bone
Towards the end of most pregnancies, the baby’s head engages with the mother’s pelvic bone in preparation for birth. This can occur as early as the 36th week in a first-time pregnancy, or just shortly before labour in subsequent pregnancies. Mrs B.C. Goh, a 33-year old consultant, describes what she believes may have been that moment, “I was 37 weeks pregnant when I felt a sharp pain at my right hip while walking. It felt as though my pubic bone was being forced apart. My son was born a week later.”
Braxton-Hicks contractions and false labour
As the body “practices” for labour, you may experience painless and irregular Braxton-Hicks contractions as early as the 30th week of pregnancy. Closer to the delivery date, you may experience “false labour”. This is characterised by strong and painful contractions lasting less than 45 seconds each. However, unlike during real labour, where contractions increase in frequency and magnitude of pain, false labour contractions are irregular, and there are usually less than two per hour.
Towards the end of pregnancy, you may pass out a “mucus plug”— a mucus-like substance mixed with some old, brown blood. However, this does not indicate impending labour yet. A clearer indication that labour has begun is the “show” of a small amount of fresh blood, caused by the stretching and dilating of the cervix. The fresh blood may also be mixed with the mucus plug, if it had not been discharged earlier.
Breaking of water bag
One sure sign that baby is on the way is when the water bag protecting the baby bursts. In 15 per cent of women, this occurs before labour has begun, but for most women, the water bag ruptures towards the end of the first stage of labour. When this happens, you may either feel a gush of amniotic fluid, or just a continuous trickle. If contractions do not begin within 24 hours of the waters breaking, do consult your gynaecologist, as your baby will be exposed to a greater risk of infection.
In preparation for delivery, the uterus contracts with increasing intensity as the cervix thins and begins to dilate. These contractions feel like strong menstrual cramps, and the interval between the start of each contraction will reduce from 10 minutes to five, and then two minutes. Unlike false labour, which causes pain in your lower abdomen, you may also feel pain in your lower back when you are truly in labour.
2. INDUCING LABOUR
After reaching the 40th week of pregnancy, some mothers who are anxious to “pop” may attempt to trigger the onset of labour by eating very spicy food or pineapple. However, these methods are not medically proven and are best tried in moderation. Taking long walks may help your baby to move lower into the pelvis, exert greater pressure on the cervix, and stimulate contractions.
As the pregnancy approaches or passes the 40th week, the placenta does not function as effectively as before. As this can adversely affect the transfer of oxygen and nutrients to the baby, Ms. M. S. Ang, 37, induced labour for her first two pregnancies at 37 and 38 weeks, respectively. This involved inserting prostaglandin tablets into the vagina to stimulate contractions. The homemaker shared, “My water bag burst naturally after the contractions started. I was relieved that the gynae did not have to artificially rupture the bag as I heard from friends that this can be painful.” Ms. Ang went on to deliver her first two children through natural birth.
3. PAIN RELIEF DURING LABOUR
Having experienced the pain of two labours, Ms. S. Phua, 34, described it “like a jackhammer ramming down my pubic bone till it opened”. Fortunately, there are pain relief techniques which can help you to manage or block the pain.
Non-Pharmacological methods of pain relief
In the early stage of labour, some mothers have found a back massage or using a TENS (Transcutaneous Electrical Nerve Stimulation) machine helpful in releasing tension as both stimulate the production of endorphins, which are the body’s natural painkillers. Using deep breathing techniques and correct positioning taught at antenatal classes can also help you to manage the pain during the first stage of labour, while short, rhythmic breaths coupled with pushing during each contraction helps the second stage of labour to progress.
Sitting in a warm bath can also help to relax muscles. In addition, water buoyancy helps to support the heavy tummy and relieve some of the pressure on the pelvis. However, this method should only be attempted if your water bag has not burst, and with medical personnel monitoring the mother’s temperature to ensure that the baby is not exposed to overly high temperatures.
Pharmacological methods of pain relief
As the labour progresses, most women feel the need for some form of analgesic drugs. Mothers are usually first given Entonox (nitrous oxide) to dull the pain. This gas is inhaled through a mask at the start of a contraction and it does not result in any side effects to the baby. The mother can also control the amount of gas she inhales. However, nitrous oxide, which is also known as “laughing gas”, can make one feel light-headed. Mrs B. C. Goh recalls “I started to laugh till I cried after every breath of gas. After several attempts with little relief to my pain, I decided that I could not laugh through my entire labour and opted for epidural.”
Ms S. Phua, who delivered her elder child in Brunei, was offered Pethidine, which is administered via an injection in the thigh. She found this drug ineffective as “it made me sleepy, but the pain still shot up during each contraction”. Unlike Entonox, Pethidine can cross the placenta into the baby, causing him or her to become sedated and making it difficult to monitor the baby’s well-being.
Having an epidural block is probably the most effective method of pain relief. However many mothers hesitate to try this because the anaesthetic is injected into the epidural space found within the spine. Fear of the needle accidentally piercing the spinal cord, or the possible side effects such as headaches, backaches and nausea are common reasons why some mothers consider epidural only when all else fails. Mrs B. C. Goh’s anaesthetist assured her that damage to the spinal cord is an extremely rare occurrence.
She shared, “a friend also advised me to get an epidural early before the labour pains become unbearable, as I would not be able to stay still for the injection to be administered then. It also takes time for the drug to take effect. I took her advice and had an almost painless labour. However, I vomited seven times during and after the labour. The numbing of my lower body also resulted in me being unable to push my baby out effectively, and the nurses had to press my tummy during each contraction.”
4. ASSISTED DELIVERIES
While most mothers would ideally like to have a natural birth, certain deliveries may require medical assistance. It is important to trust your gynaecologist’s professional judgement and not resist medical intervention if it is required. Two mothers share their experiences.
Ms. M. S. Ang, 37, mother of four children aged 13, 10 and 5 (twins)
“I was expecting twins during my 3rd pregnancy. I opted for a caesarean section since one of my twins was in a breeched position, and I was unsure of what to expect if I delivered them naturally. I experienced labour pains in the 34th week of pregnancy, before the selected delivery date. A C-section was performed immediately under general anaesthesia and my twins were delivered safely.”
Ms S. Phua, 34, mother of two children, aged 5 and 1½
“The day before delivering my second child, I already felt the baby’s pressure going downwards and had a show the same morning. Sure enough the following night, I had regular contractions initially at 20 minutes apart and then at 10 minutes apart with bleeding—a sure sign that I needed to get to the hospital. Towards the end of my 4-hour labour, I was told that my baby’s heartbeat had stopped momentarily. A vacuum extractor was applied to my son’s head to help him out more quickly. I didn’t panic as I trusted the medical team and thank God that my son is alive and well today.”
Whatever your delivery experience may be, stay positive, knowing that each stage brings your little one closer to your loving arms!