In the last episode of my DPP series, I tried to briefly illustrate the typical experiences of women in their early reproductive years, especially during menstruation, pregnancy and delivery; also not leaving out the harsh treatment a young woman may receive from some health care givers during delivery.You May Later Refer here
On this episode…
I was already going to have my snooze, around 3.30am, when I was called to attend to a patient that was said to be in labour pain. She was a young primigravida woman—primigravida is the word medical practitioners use for women getting pregnant for the first time. As she came in with her mother, the first thing she said was,
‘doctor, I have started seeing signs of labour, I’m in labour,’
Yeah, this woman was obviously in pain, holding her back so tightly and squeezing her face in discomfort. I asked her for those signs she was seeing and she said she was feeling low back pain that wasn’t allowing her sleep; also feeling great pain on her low abdomen and started noticing some unusual discharge from her private part for the past three days. The next thing anyone would want to find out is, if this woman was termed, ‘yes!’, again, I didn’t complete my question before she said her pregnancy was nine months already. Although doctors are trained to query a patient’s dating of pregnancy until we calculate it from the first day of her Last Normal Menstrual Period and or from few early obstetric ultrasounds! Quite alright, I think she got a good antenatal counselling on how to anticipate labour. After taking few more history, I discovered she had just completed her 8months and was in the first week of her 9th month. She was around 35weeks and few days. Even more precisely, the discharge she was seeing was whitish discharge which was sign of yeast infection, this is common in pregnancy. Holla! I felt a little relief, at least I would go to bed sooner than I thought.
A pregnancy is said to be termed right from 37weeks… In that sweet cosy womb, there is whole lot maturation process that occurs between the period of 35 and 37week. The sleep soon vanished from my eyes and I became fully alert. After examining her thoroughly, I discovered she was not in labour. Because I didn’t want to break her heart too abruptly – there is usually this labour anxiety that is common to first time pregnant women, I said to her,
‘Ma’am, if indeed you are in labour right now, there is a problem, would you want a problem?’ she said, ‘no o. But what could that problem be?’ still thinking she was in labour.
‘Hmm. If you are in labour now, it is a premature one…’
she was dumbfounded but before she could utter another word, I immediately added,
‘But, the good news is, you are not yet in labour.’ She became relieved.
Well, you would rightly guess the next question she asked, so I had to explain what she was feeling and why she was feeling those pains…
How Would You Then Tell If You Are Truly Having A Labour Pain?
1. Severe ‘low’ pain that seems to keep increasing in grade and duration
When your baby is preparing for its first ever exploration of the outside environment, the uterus (mother’s womb) starts contracting under hormonal regulation. These contractions manifest as pains around the low back and low abdomen, but they won’t stop, they would keep building up, getting stronger until the discomfort becomes unbearable for the pregnant woman. What my patient had was false labour, and she was most likely witnessing what is called Braxton Hicks contractions—small contractions of the womb that usually occur around 35weeks (around 8 completed months) and build up to form stronger contractions of labour.
A woman who hasn’t experienced labour pain before may confuse this as true labour pain, but it’s always advisable to have a close-to-accurate dating of your pregnancy. May be you are not sure of the date? Have an ultrasound scan done, it would give a good prediction of your date of delivery.
It’s funny to realize that while some first time pregnant women would rush to hospital before going into true labour, some stay at home until they are in true labour and almost delivering at home, this is not because they want to deliberately deliver at home but because they probably have high pain threshold. They still think,
no no no, this is not yet the labour pain my friend spoke about, it’s still coming,
until they are close to delivering at home. This tends to be a gift common amongst Fulani women of northern Nigeria.
What would you then do to avoid allowing the baby’s head come out before you start seeking for ways to get to the hospital?
It’s generally accepted that, when you are fully in labour and your contractions are adequate, you would experience not less than three powerful and painful contractions in ten terrifying minutes. Yes, ten agonizing minutes! Each of these contractions would last not less than forty seconds or there about. With adequate contractions, delivery should be expected in just few hours.
Please Do Not Wait To Have Adequate Contractions Before Knocking On The Hospital Gate o!
Anyways, most pregnant women would have developed a great deal of discomfort with a single contraction in ten minutes.
2. Breaking The water
As these contractions increase in strength and duration, there become tendencies that the thin membrane covering the baby would break and let out those waters you see when you are in labour. It’s termed drainage of liquor! And that is it, the baby is ready to investigate the outer world, and any longer period of hindrance may cause it to commit suicide in a waterless bag. Some women may not witness this until when the doctor pricks the bulging membrane with his forceps during delivery.
3.Passage of bloody show
You may also experience some blood stained mucous-like fluid coming out of your private part right before or even when you start feeling labour pain. Once you see this, even if you haven’t started having serious labour pain, it means it’s time you dashed to your doctor’s consulting room. Earlier, my patient had confused the whitish discharge she saw with ‘show’.
4. Have an accurate dating of your pregnancy
Even if you are counting months, as most women do, try to record a full month for a month and not a half month or ¾ of a month. Like I noted earlier, there is a whole lot that could happen to a baby in terms of maturation within a week in a woman’s womb.
Now, the frank talk is, once you are in labour, the pain would continue to get stronger, under normal circumstances, until that pretty cutie accomplishes his or her aim of seeing the light, indeed your baby must see the light to survive! But many patients sympathetically seek for pain killer and anaesthesia. This will not allow them bear down. However, during the period of false labour and initial onset of labour, the following are ways you can reduce the discomfort that comes with contraction.
I. Use of mild painkillers that would not affect your pregnancy adversely, example is paracetamol.
II. Taking of warm bath, this has also been shown to reduce pain of menstruation.
III. Soft and gentle massage on the back and low tummy. Your spouse is in the best position to help you out here. It not only reduces the physiologic pain, it may also bring about a sensual feeling that tends to alleviate the pains. Perhaps, the body’s natural pain killer, endorphins, plays a role here.
IV. Mild exercise like walking and dancing around. Most patients with moderate pain of labour tend to feel better when they walk around and dance. Please do not ask me to explain in details. Smiles.
V. It is generally believed that when you breathe in slowly during contractions, it helps to reduce the level of pain of contractions. Many midwives encourage women in labour to breathe in with the mouth, by hyperventilating in this way, you also tend to minimize the pain of contraction.
I know you have few other things going through your mind concerning labour pain, please ask, I would be very willing to answer to the best of my knowledge. Thanks for reading today’s piece.