but in their lower back. If it is behaving
in a similar manner then that is most
probably labor pains.
The intensity and the duration go hand in
hand as the longer the pain/contraction
lasts more likely the perception of the
degree of pain is more.
The next part is cervical effacement and
dilatation. The human body is amazing
and physiological processes are truly
intriguing. The cervix is the entrance to
the uterus and is cylindrical in shape and
generally long; approximately 4 cm in the
non-pregnant woman. During the nine
months of pregnancy all actions by the
body would be to keep the cervix closed.
For delivery to occur the cervix becomes
shorter and practically has no length. The
process where the cervix changes from
being a long cervix to having no length is
called effacement.
We normally request
women to push and
just to aid we explain
that she imagines she
is constipated and
stool refusing to come
out and to try to
push stool out. When
the head crowns we
breathe in and out
and not exert as much
force and usually in a
few seconds or min-
utes the baby’s head
is delivered.
Everyone knows about dilatation as most
movies always depict this. During labor
the woman moves from a closed cervix
to full dilatation which is 10 cm. At full
dilatation you can’t feel any cervix around
the baby’s head or breech if that is what is
presenting.
Vaginal exams will be done to establish
primarily the dilatation, effacement,
position and consistency of the cervix and
station of the presenting part. In this part
of the world we don’t allow for vaginal
breech deliveries unless the woman arrives
in second stage of labor.
Labor can be accompanied with passage
of show or drainage of the amniotic fluid.
Show is mucus like discharge that is
slightly bloody and should not be confused
with bleeding. It signifies that cervical
dilation has started. Spontaneous rupture
of membranes can occur before onset of
labor or during labor and this can also be
established during the vaginal exam with
note on the color of the amniotic fluid.
First stage of labor is the time from the
onset of contractions till full dilation.
It includes both latent phase prior to
4-6cm dilation and active labor which is
beyond 4-6cm dilatation. The midwives
or doctors will have several examinations
from listening to the baby’s heart beat
traditionally done with a fetoscope
or a Doppler sonicaid (intermittent
auscultation).
In more advanced units the mother
can be put on electronic monitoring or
cardiotocograph that can measure and
record the baby’s heart beat and mother’s
contractions. Studies have shown that
there is no difference in terms of picking up
abnormalities whether using intermittent
auscultation or the cardiotocograph so
don’t feel you are getting a raw deal if not
on the monitor.
Based on the findings decisions can be
made whether to hydrate the mother, give
analgesia (pain relief ), augment the labor
or go for a caesarean section.
For pain relief strategies include both non-
medical: presence of birth companion who
can assist with back rubbing, touch and
verbal reassurance, warm bath or water
immersion, aromatherapy and medical,
which includes administration of opioids
(pain relief medication), nitrous oxide gas
(laughing gas) or epidural anaesthesia.
20 MAL33/19 ISSUE