A Lesson in Labor.

I thought I would write this so you guys knew what your Wife or partner would be going through during labour. Most of us have no idea and will obviously never feel what labour will be like. Some guys will say stupid things like, it can’t possibly be as bad as being kicked in the nuts! And well, while technically accurate. Being kicked in the balls is an acute pain that’s extremely painful followed by stomach, bowel and chest pain thanks to our vagus nerve going crazy…and then its over in a few minutes.

After speaking to many women, the consensus is that in the beginning of labour, the physical feeling is quite similar to a Braxton hicks (which is your wife’s body’s way of preparing for childbirth. She may have felt these from the second trimester), period pain and pressure around her pelvis or lower back.

Braxton hicks can be minor, mild or intense cramps where the muscles of the uterus contract for around a minute. In later stages of pregnancy you will be able to feel and see braxton hicks contractions for yourself, the front of your wife or partners abdomen will go hard and and sometimes contorted.

Dehydration can bring on braxton hicks as well as a full bladder, but there can’t be enough said about making sure your wife or partner is hydrated properly throughout pregnancy.

Contractions (or surges) are more prominent than Braxton hicks because they are more regular. Labor contractions happen when your Wife or partner produces a surge of oxytocin (which is why around due dates, a quiet night in with a happy film, good food and a quick fumble can bring on labor).

Labor surges are more feel more intense and there can be a sense of pressure in the back and a tightening sensation around the uterus. Each surge lasts around a minute and during that time what would feel like a wave of pressure gets stronger, once the surge ends, the pressure ends and your wife is able to relax a little.

to put that in perspective for you, imagine doing a weighted squat and holding the squat for a minute while engaging your abs for the full minute. do it if you want. Then relax for Three minutes, then do again for the minute. Then rest for three. And repeat, except every 20 minutes add 2kg. And do that for eight hours.

basically your wife’s body it contracting a huge set of muscles for a very long time. The upper part of the uterus contracts to push baby down whilst the muscles around the baby essentially ripple down and the muscles around the cervix loosen to allow baby to move through the birth canal. (just a note, all this can be done without pushing. Pushing may make labor more uncomfortable but it may move quicker)

generally the closer the baby gets to being born, the more uncomfortable each surge will be.

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If you remember back on the blog about pain, we learnt about how pain is subjecting, and the production of cortisol in the body can cause psychological pain to be experienced physically. So how you speak and act around your Wife or partner during surges is very important. Calmness is the way forward. Slower, deeper speech and slow, full, deep breaths are important for reducing stress.

The next piece will talk your the the physiology of labor and the uterus in detail. You can skip if you want. But its pretty awesome.

 

Physiology of the Uterus and Labor

The uterine wall is composed of 3 layers:
internal – myometrium (2 muscle layers) – endometrium – next inner layer
external – epithelial (skin)
The 2 muscle layers of the myometrium are fibers going in different directions and forming a protective web.
The INNER layer is circular and is perpendicular to the long axis. Spirals UP around the body of the uterus.
The OUTER layer runs parallel to the longitudinal axis.
Most of the muscle cells in the (skeletal) body are striated muscle cells.
The uterus and heart are smooth muscle cells. They are arranged in bundles of 10-15 cells in a matrix of connective tissue and collagen – NOT piled upon each other, but rather are in a wash of elastic-type tissue. This matrix transmits the forces of the contractions.
The myometrial cell contains myocin & actin. The myocin heads must attach to the actin, which is spiraled. Once attached, as the actin spirals, it pulls the myocin. Then releases, relaxes, until the next contraction.
Each myometrial cell makes a change (during labor) – EACH CELL contracts & becomes progressively tenser & shorter. The shape of the uterus eventually changes, bunching up on top.
If the uterus stayed a spherical object, the pressures of contractions would be distributed evenly; instead the fundus elongates > ovoid shape > heavier pressure to midpoint; the lower segment actually has very little pressure. The cervix itself is not conducting any contractions, it is reacting to them. The fundus (top segment of the uterus) has the heavier distribution of myometrium & smooth muscle cells, vs. the cervix, which is more connective tissue and collagen.
A normal contraction spreads downward within 15 seconds from the fundus to the cervix – she feels it AFTER the initiation. The actual contraction lasts longer than her subjective experience of it (or palpation or TOCO), and the interval space is shorter (which is why 2 min. apart contractions are hyperstimulation). Contractions exert slow pull, without rebound – they do not return to full resting tonus. The myometrial cells STAY FORESHORTENED in teeny increments. They never go back, they get shorter & shorter.

What causes Labor?
Connective tissue and collagen are easily influenced by hormones
Chemicals ATP & ADP increase at term & are causative to contractions.
The cervix is 85-90% connective tissue covered by a thin layer of smooth muscle. Collagen fibers keep the cervix firm; they decrease at the end of pregnancy, known as softening. Myometrial contractions (labor) have little effect on cervical ripening. Ripening takes place BEFORE contractions occur. Most women will begin labor with a ripe cervix due to hormonal changes – estradial, relaxin, prostaglandins, etc. No one really knows what starts/causes labor. Just theories, measurements.
We don’t know what makes labor start but for labor to occur we need the myocin and actin within the myometrial cells to start up, pull, slide over, shorten the cell, then relax it, never going back to its exact original size. Picture little heads attaching to a spiraling receptor site. Thousands of these produce an increase in bulk- like a bunching-up zipper.
In labor, we also need an increase in “gap junctions” – a nerve-conducted impulse. When the walls of 2 cells touch each other, the result is depolarization. The positive ions (sodium, calcium, potassium) are shoved inside & push the negative out. There must be positive & negative ions in the myometrial tissue at term (pre-term pregnancy has premature gap junctions).
Hormonal influences on initiation of labor must also be in place. The fetus, the membrane and the placenta all participate in producing hormones. Progesterone, which suppresses uterine responses in pregnancy, drops during labor. Even the fetal membranes hold less progesterone during labor. Of 16 prostaglandins (we don’t know all their functions), one of them increases calcium binding. Estrogen, which increases oxytocin receptors, rises at 34-35 weeks to a peak that remains though labor and aids in making gap junctions. The increase in estrogen also increases oxytocin receptors.
All these systems need to interplay for it to work.

Uterine Physiology & Second Stage
Once the uterus is drawn up & the cervix is gone, pressure is directly on the sacrum. Uterus is higher & denser at the fundus, pressure comes straight DOWN, not funneling to sides. A uterus can have enough force to deliver a baby. In second stage, the uterus exerts the primary effort; Mom the secondary effort. At full dilation all the power is concentrated in the fundus. Each muscle cell is shorter, but thick & strong. The pressure of contractions is only going DOWN = expulsive contractions. The fundus has no more cervix to work on.

The uterus may have a pacemaker (like the heart), capable of creating rhythmic contractions. We don’t know where yet but speculation is logical because to coordinate the upper pull of the uterus w/the lower, you must have a pacemaker.

(Adapted from a lecture by Virginia Jackson CNM)

The female body is amazing. And as the nurturer of your baby it should be literally worshipped by you.

Hopefully this has given you a short insight into what a woman and her body go through during labour, how it may feel and how communication can help her.

next up is our birth story….

 

 

 

 

 

 

 

 

 

 

 

 

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