GYN CHRONICLES
Labor And Delivery
Dr. Maureen Owiti
I
t looks like I have been very
gynaecological, yet my degree makes
me an obstetrician and gynaecologist.
The first word tends to be a mouthful and
my colleague insists everyone understands
a gynaecologist but a good number can’t
wrap their tongues round obstetrician.
Obstetrics is the field of medicine that is
concerned with the health of the woman
from the moment she is pregnant till 42
days or 6 weeks after delivery. I love my
Muslim brothers and sisters they call that
postnatal period “arubaini” and in that
period the new mum is usually at her
parents’ house.
Nine months have ticked away: combated
fatigue morning sickness, breast tenderness
and so hopefully enjoyed your second
trimester went back to fatigue sleepless
nights and finally the D day has come
are you ready? Asked a thousand times
nothing can prepare you 100% for what
you are about to go through.
Labor I explain to my clients is exactly
what the word means. The good Lord
wasn’t joking when he said we would
labor during child birth. Except a few
individuals who appear to have it easy the
rest of us look like were “dragged to hell
and came back”.
Notwithstanding I believe God gave
women grace and strength to endure and
overcome and modern medicine is also
helping in that regard. If you can afford it
one can actually have pain free labor!
As I have the privilege of teaching I love the
definition our students regurgitate for us:
labor is the process whereby an expectant
mother gets contractions that increase in
frequency, intensity, and duration leading
to cervical effacement and dilatation with
final expulsion of the fetus and products of
conception.
Epidural anaesthesia has revolutionized
the labor process. It involves insertion
of catheter (very slim tube) in a certain
space called the epidural space that sur-
rounds the spinal column. This allows
for the women to have adequate pain re-
lief but still maintain movement unlike
spinal anaesthesia where the limbs can’t
move for the duration of the anaesthe-
sia.
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MAL33/19 ISSUE
Quite a mouthful, but yes basically that
is what labor is. Now contractions are
perceived by the soon to be mums as
abdominal pain usually arising at the top
of the womb and the closest I can describe
them is like period cramps (for those who
experience them), but more intense.
The contraction is usually short lived and
disappears after a while. So if you are
experiencing continuous pain that most
likely is something else and not labor.
During the initial stages it may just be a
few seconds and then the pain disappears
for a long time. In the preceding months
most women may have experienced
Braxton Hicks contractions. These are
similar to labor pains but the difference
is when they disappear it may come back
after a very long time like after a few days.
In terms of the frequency it can initially be
every hour and the frequency will increase
over time so the pain starts coming every
10 minutes. By the time contractions are
coming every 3 minutes or the woman is
having 3-4 contraction in 10 minutes if
you are nowhere near the hospital plan
how you are getting delivered.
For duration the contraction may last 5
seconds in early labor increase to 20 seconds
and when near delivery contractions can
last between 40-60seconds.
I normally advise my clients that if they
feel they are having contractions that
last at least 20 seconds coming every 10
minutes they can come in for an evaluation
so a determination is made whether they
can continue walking about at home or
get admitted. Of note is that some women
don’t feel the contraction on the abdomen