Childbirth (1)
When Do We Deliver?
WHEN SHOULD YOU GO TO THE MATERNITY?
HOW IS THE FETUS MONITORED DURING LABOR?
WHAT ABOUT MATERNAL MONITORING?
Dr. Claude Allouche, Gynecologist
Ahuza Clinic, Raanana
Call: 058 726 02 64 (or send a stork with a message)
When Do We Deliver?
- So, childbirth is considered "at term" when it happens between 37 and 41 weeks of pretending you're not pregnant.
- In the magical land of Hebrew, the due date is pronounced as "taarikh leïda meshouar" (feel free to practice your tongue twisters).
- Your doctor, armed with a crystal ball and a handy pregnancy calculator, will provide you with a due date based on your last period or the mystical ultrasound readings.
- The accuracy goes up a notch if the ultrasound was performed during the enchanted first trimester (give or take a few magical days).
- In Israel, they mark the calendar at 40 weeks of belly occupancy (GA), while in France, they hold on for 41 weeks.
- But hey, it's all just a guesstimate because Mother Nature likes to keep us on our toes, doesn't she?
So, get ready to deliver around that ballpark.
- If your little one decides to make a surprise appearance before 37 weeks of pregnancy, it's deemed a premature entrance, and the tiny adventurer will receive VIP care in the neonatal world (in Hebrew, it's "paguia," which sounds like a secret baby language).
- Now, if your bun is still in the oven beyond the expected due date of 40 or 41 weeks, depending on your chosen country, it's time for repeated visits at the Hotel Hospital.
- Think of it as a pregnancy vacation, complete with regular check-ups, fetal entertainment via monitoring, and ultrasound sightseeing every few days until showtime.
WHEN SHOULD YOU GO TO THE MATERNITY?
This is a question that many parents ask themselves with the fear of arriving too late and having to live at home or on the way, or the apprehension of arriving too early and losing hours of waiting at the Maternity, which could have been spent at home!
There are several things to consider when deciding whether or not to go to hospital:
- the travel time to reach the hospital, taking into account possible circulation difficulties depending on the time at which the contractions began.
- the duration of labor is generally faster than during the first delivery.
- The duration of your previous deliveries can be a clue as to the duration of your future deliveries.
- Some patients find it difficult to identify labor contractions, which can manifest as pain in the back.
WHAT ARE THE WARNING SIGNS THAT WILL TRIGGER DEPARTURE TO MATERNITY?
1/ Uterine labor contractions,
(In Hebrew tsirim צירים)
During pregnancy, you experienced Braxton-Hicks contractions, which are irregular, undeveloped and painless.
The term approaching, the phenomenon will be accentuated and, for you, reside in the fact of differentiating these contractions of maturation to the uterine contractions of work.
“True labor” (Hebrew Leïda peïla לידה פעילה) is characterized by uterine contractions, felt as a sensation of the uterus shrinking gradually intense, slackening, regular and repetitive for over an hour and increasing in intensity sore.
Therefore, you find that these contractions are:
- Involuntary,
- Intermittent and rhythmic: between contractions, the uterus relaxes,
- Progressive in duration and intensity.
* At the start of labour, every 15 to 20 minutes and for 15 to 20 seconds.
* At the end of the 1st phase of labor, they get closer and their duration increases.
* During work, their intensity will increase.
- Painful: the intensity of pain is perceived differently from one woman to another.
The pain is most often abdominal and pelvic but can also be felt in the lumbar region
If labor begins with uterine contractions, there is no need to rush to the maternity ward as this 1st stage of labor can last for some time that you can spend at home.
By staying at home, you will be able to:
- Take a bath: hot water promotes muscle relaxation and acts as a painkiller,
- Stroll: walking promotes the progress of labor,
- Mobilize the pelvis by performing rotational movements,
- Change positions: sitting, standing with your back against the wall, lying on your side, on all fours,
- If your partner is close to you, he can massage your lower back or apply a hot water bottle to you.
2/ The loss of the waters (in Hebrew yeridat mayim, ירידת מים)
Two situations can arise:
- A crack in the bag of waters can be observed by some loss of amniotic fluid which can stop spontaneously. It is often difficult to distinguish with leaking urine.
If in doubt, a test can be done at the maternity ward to determine whether it is amniotic fluid or not.
- A frank rupture of the bag of waters which is characterized by a frank flow of amniotic fluid, leaves no room for doubt.
Pouch rupture can occur:
- Before labor: it is said to be premature,
- At the start of labour: it is said to be precocious.
- This rupture is not necessarily accompanied by uterine contractions.
Whether it is a crack or a break, it is recommended to go to the maternity ward as soon as possible.
3/ Other signs imposing the departure to the maternity ward
- Decreased or absence of fetal movements (Hafratat tnouot haoubar הפחתת תנועות העובר)
- Painful and regular uterine contractions, before 37 SA (tsirim koevim צירים כואבים)
- Fever above 38°C
- Presence of intense and abnormal pain
- Red and profuse bleeding
(dimumim hazakim דמדומים החזקים)
HOW IS THE FETUS MONITORED DURING LABOR?
Fetal monitoring is carried out mainly by recording the heart rate and observing the amniotic fluid.
- The recording of the fetal heart rate and uterine activity is done using a device called a CTG cardio-tocograph (monitoring).
- Upon arrival at the obstetric emergency room then in the delivery room, this monitoring device, made up of 2 external sensors, is placed on the patient's stomach: the 1st recording the baby's heart rate and the 2nd recording the frequency of uterine contractions.
- Thanks to this first sensor, the midwife will assess the baby's well-being by analyzing the characteristics of his heart rate.
- During normal work, this heart rate varies between 110 and 150 beats per minute and there may be occasional accelerations.
- This monitoring is carried out throughout the active phase of dilation and expulsion and it is this which, to a large extent, will determine whether an instrumental or surgical procedure is necessary to accelerate the arrival of the baby.
- In general, these sensors are connected by cables to the CTG device which is located right next to the delivery table on which the parturient is lying.
- Nowadays, most maternity wards, both Israeli and French, are also equipped with waterproof wireless sensors which allow patients who wish to walk around during labor, to give birth in water or in a natural room without hindrance (mainly for patients who chose not to use the epidural).
- In certain cases, when it is difficult to record the cardiac or fetal rhythm (significant fetal movements, heavy build, etc.), and after the water has broken, it is possible to place an internal electrode at the level of the scalp of the child, which will ensure this monitoring correctly.
- When the water bag is broken, naturally or artificially, monitoring the color of amniotic fluid is also an element of monitoring: if the fluid is tinted or meconium, instead of being clear, this can also be an element of monitoring Altered fetal well-being to consider when monitoring labor in conjunction with fetal heart rate monitoring.
- You should also know that in all modern maternity wards, the devices in each delivery room are connected to a central system in the labor room from which midwives and doctors can simultaneously monitor all patients in labor in all rooms. delivery rooms.
Thus, even if the medical team is not continuously present alongside the patient in the delivery room, the baby is nevertheless constantly monitored.
WHAT ABOUT MATERNAL MONITORING?
In the delivery room, how will the midwife monitor the labor phase?
On the maternal side, several elements will need to be monitored during this phase:
1/ Uterine contractions
2/ Cervical dilation and head position
3/ Maternal constants
1/ Monitoring uterine contractions
It is carried out electronically, by placing an external pressure sensor on the abdomen which is connected to the cardiotocograph, this device which records the fetal heart rate and uterine contractions.
The uterine contraction sensor makes it possible to measure their frequency and duration. The measurement of intensity is relative because it depends on the position and build of the patient as well as the tightness of the straps.
Abdominal palpation can also be used in addition to electronic monitoring.
Above all, this allows us to assess the relaxation of the uterus between contractions and also gives a good indication of the duration of the contraction.
2/ Monitoring of cervical dilation and head development
The vaginal examination (in Hebrew bdika pnimit, בדיקה פנימית) is the reference examination which allows the midwife or doctor to evaluate the progress of labor.
It allows us to appreciate the dilation of the cervix (in Hebrew ptikha פתיחה) and the progression of the head in the pelvis.
Several elements can thus be evaluated:
the position of the cervix: anterior, centered or posterior,
The length of the pass, expressed in Israel as a percentage of effacement
cervical dilatation, expressed in cm
the consistency of the cervix: softened or intermediate toned
- the height of the head which progresses into the pelvis expressed in figures from -3 to +3 in relation to the sciatic spines
3/ Monitoring the mother’s general condition
Several parameters are evaluated regularly:
- blood pressure (lahats dam, לחץ דם)
- the maternal pulse (dofek, דופק)
- temperature (khom, חום)
- pain (koev כואב)
All this data is transcribed by the midwife or doctor in the patient's file.