Pain before labor

Pain before childbirth is a harbinger of the onset of labor. It is believed that pain during childbirth is inevitable, accompanying every appearance of a new inhabitant of the planet. However, just as pregnancy is a fairly common physiological state of millions of women, and not a disease, so pain before childbirth is rather a psychological attitude and fear of the process itself on the part of the expectant mother.

Many pregnant women have an idea of childbirth based on the stories of "eyewitnesses", that is, women who have given birth, and emotional responses from relatives or friends. Often this information is subjective, since each representative of the fair sex has her own pain threshold, and anatomical features are also individual. And objectivity consists of the following:

• From a physiological point of view, a healthy woman is capable of normal labor without intense pain, deformations and ruptures of the genitals. Nature itself provides for the body of the expectant mother to be prepared for the appearance of the baby, it is no coincidence that the fetus is carried for as long as 9 months. During this period, the tissues of the birth canal become more elastic, stretchable, so as not to create a risk of injury to the baby moving along them.
• Of course, Homo sapiens, a reasonable person, is more developed than representatives of the fauna, but also strives to continue his species by giving birth to babies. Note that no animal in the world suffers terrible pain during childbirth, because it perceives labor as a natural, normal part of existence.
• Everyone knows that there are still corners of the planet far from the notorious benefits of civilization. It is there that the lucky ones live, who, in principle, are deprived of knowledge about prenatal pains, of course, we are talking about healthy women without pathologies. Perhaps that is why, despite all the wild living conditions from the point of view of a modern person, these peoples do not die out.
• Physiologists established more than 200 years ago that pain mainly accompanies pathological processes associated with dangerous diseases, severe stress or fear. It is obvious that neither pregnancy nor childbirth itself is a pathology, therefore, there should be no reasons for pain other than fear and stress.

To summarize the arguments, it should be noted that the following factors influence pain before childbirth:

• Age and health status of the mother in labor.
• Anatomical features of the pelvic structure, hormonal, muscular system and other parameters of the female body.
• Presence of menstrual cycle disorders prior to pregnancy.
• A characteristic feature of labor is premature birth.
• The position of the fetus, its size.
• Individual psycho-emotional characteristics of the woman in labor, pain threshold level.
• Preparation for childbirth, both psycho-emotional and physiological.

An important factor influencing pain before childbirth is the woman’s psychological state, the ability to cope with fear and stress, since pain before childbirth is usually not intense and is associated with the preparation of the cervix and the uterus itself for the birth of the baby.

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Causes of pain before childbirth

The first typical cause of pain before labor is the so-called false contractions. The process of the first contractions can be called "training", during which the muscles of the uterus contract, come into tone literally for a minute, preparing, softening the cervix for labor. These sensations can appear after the 20th week and, as a rule, do not cause severe pain. With each passing day, such muscle tension becomes more noticeable, but arrhythmic, irregular, which distinguishes them from true contractions. In addition, false contractions are similar to pain during menstruation, that is, they are felt only in the lower abdomen and pelvis, while the pain during a true contraction of the uterus is rhythmic, encircling in nature and begins most often from the lower back.

The causes of pain before childbirth are labor contractions, which are called expulsive, that is, helping the fetus to leave the mother's womb. Actually, contractions are the first stage of labor, accompanied by rhythmic contractions of the uterus (uterus) and stretching of the cervix uteri (cervix). The pain is widespread in the lower back and sacrum, is not localized in a specific place and is quite intense, increasing, although with interruptions.

The psycho-emotional state of the woman in labor is the third and perhaps the most important reason for pain in prenatal activity. Fear causes muscle clamps, which in turn provoke even greater pain. These pains are called visceral, they are explained by the stretching of ligaments and muscles. The more a woman strains, that is, interferes with the natural process of preparation for childbirth, the more intense the pain becomes.

There are other causes of pain before childbirth that have a pathological etiology, that is, they are associated with chronic diseases of the internal organs, including the pelvic organs.

Summarizing the etiological factors of prenatal pain, the following list can be compiled:

• An individual psycho-emotional state associated with poor preparation for childbirth, lack of awareness or objective reasons (chronic diseases, family problems, etc.).
• A few days (weeks) before childbirth, an increased state of anxiety develops, and a constant release of adrenaline into the bloodstream begins.
• The body's natural adaptive response to an adrenaline surge is tension, muscle contraction, and increased tone of the vascular walls.
• Tension leads to muscle clamps, disruption of normal blood circulation, and as a consequence – deterioration of the general condition, increased pain symptoms.

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Symptoms of pain before childbirth

Each woman in labor feels the approach of labor in her own way, despite the existing typical signs. The main thing that the symptoms of pain before labor show is the beginning of the first stage, that is, true labor contractions. In contrast, false contractions of the uterus do not open it and do not end with the birth of the baby, they are intended to prepare the body for labor. False contractions, as a rule, are not intense and are localized in the lower abdomen. If a woman gives birth for the second time, it is likely that she will no longer feel false, "training" contractions, since the body has already learned the "lesson". Symptoms of pain before labor of this nature are easy to distinguish, false contractions (Braxton-Hicks syndrome) are characterized by the following signs:

• They appear 21-14 days before the expected date of birth.
• The pain is localized in the lower abdomen and resembles menstrual pain.
• The pain is dull and aching in nature.
• The uterus is tense and easily palpated.
• The uterus does not lose its tone during breaks, which can be long – up to 5-6 hours.
• The contractions last no more than one minute and are not rhythmic.
• Pain can be relieved by changing position, movement, and walking.

Symptoms of pain before labor that you need to pay closer attention to in order not to miss the onset of labor:

• Regular contractions of the uterus.
• Rhythmic repetition of pain, break 10-20 minutes.
• Steadily reducing the interval between contractions to 2-3 minutes.
• Between contractions, the uterus relaxes rapidly.
• The pain is pressing, widespread, and encircling in nature.

Also, the discharge of mucous mass (plug) and amniotic fluid (amniotic fluid) is considered to be a harbinger of true labor.

Abdominal pain before childbirth

Periodic abdominal pain before childbirth is an inevitable phenomenon that should not be dramatized, since the pain should not exceed the level of pain during the menstrual cycle. This is a completely understandable physiological process of stretching the uterus, respectively, accompanied by some displacement of nearby organs. The pain is pulling, aching in nature, but it is transient, not constant. Also, abdominal pain before childbirth is a harbinger of the birth itself, most often such sensations appear between 20 and 30 weeks in primiparous women. Braxton Hicks contractions (false contractions of the uterus) are more the norm than an abnormality, since they prepare the female body for the birth of the baby by stretching, softening the muscles and shortening the cervical canal of the cervix.

If the pain in the abdomen before childbirth is accompanied by pulling, encircling, increasing sensations, the pain becomes regular, with decreasing intervals, this is direct evidence that the first stage of labor has begun - contractions.

Lower abdominal pain before childbirth

Pain in the lower abdomen before labor is a typical sign of false contractions, or rather the preparatory period, when the uterus comes into tone, and its cervix begins to decrease, shorten. Thus, pain in the lower abdomen is a kind of adaptation stage that helps the body prepare muscles, ligaments, tissues for normal labor. The sensations of pain are not intense, quite tolerable, these symptoms can subside with movement, a change in body position, even with an emotional switch - watching a movie, reading a book.

Since the body structure of expectant mothers is not subject to unification, each woman can feel the approach of labor differently. Many women in labor experience pain in the lower abdomen due to the fact that in the last weeks of pregnancy, the fetus can turn head down, into the pelvic area, which causes quite natural pulling pain in the expectant mother. It should be noted that in some pregnant women, the onset of labor, that is, true contractions, can manifest themselves atypically - not with lumbar, girdle pain, but with sharp sensations in the perineum and lower abdomen.

In such situations, it is better to play it safe and contact your obstetrician or gynecologist; in any case, advice, examination, consultation and observation will not hurt, but will only relieve anxiety.

Back pain before childbirth

As a rule, back pain before childbirth is associated with the baby moving into a natural prenatal position (presentation), i.e. head down. Lumbar pulling pains are caused by the pressure of the fetus and physiological stretching of the connective tissue of the sacroiliac region.

In addition, the back hurts during the contraction stage, and the pain intensifies when the uterus is almost ready to "release" the baby. Such muscle stretching cannot but affect the nerve endings of the lumbosacral region. At these moments, it is very important for a woman not to give in to panic, fear, that is, not to activate tension, but on the contrary, to help the body rest, relax during breaks between contractions. Also, the expectant mother should know that back pain before childbirth associated with the contraction period usually subsides when labor gradually moves to the second important stage - pushing.

Back pain before childbirth

Lumbar pain is typical during labor, but it can also be caused by other reasons.

• Hormonal dysfunctions that provoke relaxation and expansion of the pelvic joints and intervertebral ligaments.
• Stretching of the abdominal muscles, compensatory increase in load on the lumbar region.
• Physiological shift of the body's center of gravity forward (stomach), leading to compensatory tension in the back muscles.
• Poor body posture, curvature of the spine.
• Natural enlargement and stretching of the uterus, which compresses nearby nerve endings in the lumbar region.
• Increasing body weight, increasing mechanical load on the spine and legs.
• Uncomfortable shoes, clothes. High-heeled shoes especially increase the load on the back.
• Osteochondrosis that developed before pregnancy. Symptoms may worsen due to increased load on deformed vertebrae.

Back pain before childbirth increases, starting from the fifth month of pregnancy, when the process of bearing the fetus moves to the stage of the third trimester. In addition, a pain symptom in the lumbar region at the end of the 9th month is direct evidence of the onset of labor, contractions, when the cervix opens, the cervix significantly decreases, contracts to facilitate the passage of the fetus through the birth canal.

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Headache before childbirth

Pregnancy is accompanied not only by joyful expectations and hopes, but also by worries, which are associated with headaches before childbirth. Most often, expectant mothers suffer from tension headaches, less often from migraines. The sensation of pain in the head is typical for the second half of pregnancy, when the birth of the baby is already close, and the psycho-emotional state of the mother is aggravated by fears. Extremely rarely in obstetric, gynecological practice, headaches before childbirth caused by cerebrovascular accident or other pathologies of the brain are encountered. As a rule, these problems are diagnosed before registering for pregnancy and are monitored throughout the entire period of gestation. It should be taken into account that headaches can indicate severe forms of gestosis, nephropathy, hypertension. Such pathologies are monitored only in hospital conditions, as they can lead to complications during childbirth. All other manifestations of discomfort from the head are typical for the prenatal period, when a woman is simply afraid of childbirth and the pain associated with it. The higher the level of anxiety, the greater the tension in the muscular system, and the first to react are the muscles of the cervical-shoulder region, which leads to a natural narrowing of the large and small vessels that feed the brain.

Nagging pains before childbirth

Nagging pains before childbirth are a signal that the baby will soon be born. As a rule, the sensation of aching pains begins at 33-34 weeks and is caused by the stage of stretching of the ligaments, muscles, that is, preparation for labor. The pain can be localized in the lower abdomen, which is associated with false contractions, the pain symptom is also felt in the back, in the lumbar region, sacrum, this indicates a normal presentation of the fetus head down. During this period, the pelvis gradually expands, moves apart, causing nagging pain in the perineum, this is how the pubic bones adapt to the upcoming birth. During this period, a woman needs more than ever the recommendations of the attending gynecologist on issues of preparation for an important process. Nowadays, it is not difficult to read specialized literature, attend courses for expectant mothers and women in labor, under the guidance of a trainer or independently master breathing exercises or engage in water procedures (swimming). Such preparation will not only alleviate pain symptoms, but will also help the birth process to be relatively painless.

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Pain in the perineum before childbirth

The causes of painful symptoms in the perineum can be both hormonal and physiological, structural changes in the body of a pregnant woman.

Pain in the perineum before childbirth is associated with the following factors:

• Increased weight puts stress on the lumbosacral region, causing pain in the perineum.
• The production of relaxin, a hormone that controls the elasticity of interosseous joints, increases.
• The pelvic bones (pubic symphysis) gradually move apart, preparing for labor.
• The fetus assumes a position that puts pressure on nearby nerve endings, including the sciatic nerve.
• During pregnancy, there is a risk of developing varicose veins - pelvic, perineum, which can also provoke pain in this area.

Pain in the perineum before childbirth may be associated with the fetus approaching the birth canal, which will obviously be the most positive reason, since any pain symptom is quickly forgotten, replaced by the joy of motherhood.

Chest pain before labor

Painful sensations in the chest are a normal phenomenon that accompanies almost the entire period of pregnancy. Moreover, for an experienced obstetrician-gynecologist, the absence of discomfort in the mammary glands of the expectant mother is a sign of hidden pathologies, diseases and a reason for prescribing additional examinations of the pregnant woman. The mammary glands undergo changes during all nine months, the glandular tissue begins to grow, the breast enlargement is especially noticeable after the 30th week. Pain in the chest before childbirth is associated with the fact that the capsules of the mammary glands are greatly stretched in the same way as the skin. The breast seems to swell, becomes denser, often the skin itches, which indicates possible stretch marks. In addition, pain in the chest before childbirth is caused by the formation, growth of milk ducts, enlargement of the nipples. Symptoms and nature of pain in the mammary glands in women can be different: someone's chest hurts only in the first trimester, in others the mammary glands begin to increase intensively immediately before childbirth. This is due to the peculiarities of the hormonal system and the general condition of the body. Pain in the mammary glands, as a rule, is not sharp, acute and is quite tolerable. In addition, the expectant mother should understand that pain in the chest before childbirth is a sign of the formation of colostrum and evidence that the body is already completing the stage of bearing and preparing for the process of nursing the baby, that is, feeding

Pelvic pain before childbirth

Pain in the pelvis before childbirth is explained by the fact that all nearby organs and systems, including the pelvic bones, are affected by the enlarging uterus. On the other hand, the uterus also depends on the pelvis, since it is located inside the bone bed, the pelvic ring. The pelvic bed includes paired pelvic bones, which in turn consist of the pubic, ilium and ischium bones fused together. Thus, together with the sacrum, the pelvic bed contains and protects not only the abdominal organs, but also the uterus, which is attached to it by specific ligaments. Pain in the pelvis before childbirth is caused by an increase in the tone of the uterine, spiral ligaments, such sensations are especially characteristic of pregnant women with a history of pelvic muscle distortion, a twisted pelvis. As a result of sacroiliac displacement, the ligaments that attach the uterus to the pelvis are stretched unevenly, causing nagging pain in the lumbar and pelvic region. In addition, pelvic pain before childbirth is associated with natural causes characteristic of the second half of pregnancy: •

• Lack of calcium and magnesium in the body.
• Increased body weight, abdominal weight, leading to increased stress on the pelvic girdle.
• Enlargement of the uterus, causing stretching of the ligamentous apparatus and pain in the pelvis.

Increased production of relaxin, responsible for elasticity, stretching of tissues, ligaments. Active production of relaxin can lead to pain in the pubic symphysis and symphysitis. Symphysiopathy is not a pathology, rather it is a common syndrome characteristic of the third trimester. Symphysitis is caused by inflammation of the pubic symphysis and pubic bone, their abnormal mobility due to hormonal changes in the body, which manifests itself as pain in the pelvis before childbirth.

Vaginal pain before childbirth

Before childbirth, there should not be any vaginal pain, as pain most often occurs in the pelvic area, lower back, hips, and lower abdomen. If vaginal pain occurs before childbirth, it may indicate varicose veins of the vulva and perineum, which occur in every fourth pregnant woman. Varicose veins are caused by the compression factor of the enlarging uterus, when it compresses the main vessels (iliac, inferior vena cava) in the retroperitoneal area. Vaginal pain before childbirth may manifest itself as increasing, bursting painful sensations, itching, and swelling of the labia. This symptom is most dangerous in terms of the development of acute varicothrombophlebitis and rupture of the vein. Possible spontaneous bleeding from the vagina before childbirth poses a threat of termination of pregnancy due to its intensity, and also because it is difficult to stop the bleeding - the pressure in the veins is very high, and their walls are extremely fragile. That is why, if the expectant mother feels discomfort in the vagina, a feeling of heaviness or distension, she should immediately contact a gynecologist to receive timely symptomatic therapy.

Diagnosis of pain before childbirth

Ideally, the prenatal period should be controlled by the woman herself and her attending obstetrician-gynecologist. Painful sensations, diagnostics of pain before childbirth are so individual that, despite all the information awareness, the expectant mother can confuse the symptoms and worsen her already anxious state.

• Pain before childbirth has two main objective causes:
• Contractile activity of the uterus, that is, visceral pain.
• Pain during pushing, that is, somatic pain.

However, the most common cause of prenatal pain is anxiety, fear and quite understandable muscular tension of the woman in labor. As is known, a person is afraid of what he does not understand, what he does not know, therefore, knowing the symptoms of pain, stages and variants of their development means removing unnecessary anxiety and preparing for a normal, natural birth.

Diagnosis of pain before childbirth includes the following prenatal stages, which ideally should be monitored by a physician in a hospital setting: 1.

Prenatal stage, classical course:

• Contractions, contractions of the uterus, dilation of the cervix, which are felt as intense pressure, girdle pain in the pelvic area, radiating to the rectum.
• Spasmodic pain in the groin, which is typical for women who have already given birth.
• A pulling pain in the lumbosacral region.
• Changes in the structure and color of vaginal discharge.
• The mucus plug may come out, which is often released during false contractions. This symptom is not specific.
• Increasing spasms, contractions, characterized by rhythm and a decrease in time between them.
• Dyspeptic symptoms and diarrhea are possible.

Diagnosis of pain before childbirth, symptoms of false contractions:

• Spasmodic pains are irregular, arrhythmic. The intervals between them can reach 5-6 hours. The nature of the painful sensations is not obvious, the pains are not intense, often transient due to a change in body position.
• The pain is localized not in the sacrum, but in the iliac region, and is not encircling in nature; rather, it is pulling, radiating down to the abdomen.
• During false contractions, the fetus is active and moves vigorously, whereas during true contractions, the fetus often freezes.

Signs of the onset of labor:

• The spasms intensify, especially when changing position or movements.
• The pain begins in the sacrum and spreads up and down, often radiating to the leg(s).
• Painful symptoms are accompanied by gastrointestinal upset and diarrhea.
• The contractions become stronger, longer, and the time between them steadily decreases.
• Vaginal discharge with blood appears.
• The release of amniotic fluid (amniotic fluid) is possible, although this symptom is not standard for all women, it is not specific.

How is the examination carried out in the last month of pregnancy, how is the diagnosis of pain before childbirth carried out?

As a rule, the final, last weeks should be devoted to the following activities, which help to clearly differentiate the nature of possible pre-labor pain:

• Weight and blood pressure are measured.
• The last time, urine is given for testing for elevated sugar levels or the presence of protein.
• The fetal heartbeat is checked.
• The height of the uterine fundus is determined.
• The general condition of the fetus is assessed – its size, presentation.
• The woman's vascular system (legs, groin, vagina) is examined for possible varicose veins.
• The cervix is examined to determine its readiness for dilation.
• During contractions, including false ones, the rhythm, frequency and intensity of pain are determined.

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Treatment of pain before childbirth

Physiological painful sensations are usually not subject to drug therapy. Treatment of pain before childbirth is necessary only in cases of pathological conditions of the woman in labor. Indeed, there are reasons that lead to the use of pain relief before childbirth, these include:

• Low pain threshold and increased psycho-emotional excitability of women.
• Pain that occurs as a result of pathological processes in the internal organs and systems of the body.
• Complications during pregnancy (gestosis).
• Hypertension.
• Nephropathy.
• Serious cardiopathologies.
• Intrauterine pathologies of the fetus, which depend on the tone of the mother's muscular system, and are also dependent in terms of oxygen starvation (hypoxia).

In other situations, treatment of pain before childbirth is the use of natural methods, methods of reducing pain, which include:

• Massage of the lumbosacral region, feet, abdomen. These techniques should be studied in advance and applied independently or with the help of a partner, nurse, or massage therapist.
• Essential oils have a relaxing effect. If a pregnant woman does not have an allergy or a predisposition to it, aromatherapy can work a real miracle. There are cases confirmed by doctors when massage with essential oils, inhalation of essential oils almost completely relieved the pain symptom even during the middle of contractions. The aromatherapy product should be chosen carefully, since many essential oils can cause an allergic reaction. Lavender, spruce, rose, thyme oil, which stimulates labor, are considered safe.
• Breathing exercises are a classic of prenatal and labor activities. It is worth mastering the technique of correct breathing not only to reduce pain during labor, but also to strengthen the general health in the future. Breathing helps to reduce tension, muscle tone, restores normal blood flow activity, saturation of blood vessels and tissues with oxygen, and therefore prevents fetal hypoxia.
• There are many special exercises for the body of a woman in labor, which can be studied and practiced in advance in their implementation in courses for the preparation of expectant mothers. Such motor activity helps to maintain normal skin tone, helps to reduce pain symptoms and significantly reduces the overall anxiety of the pregnant woman. Certain positions during contractions, pushing, according to statistics and reviews of women in labor, reduce the severity of painful sensations by at least 50%.

Drug treatment of pain before childbirth is used only for strict indications, when the risk of harm to the fetus is lower than the risk of threat to the life of the mother. The choice of anesthesia is the prerogative of the doctor, no drug, method or method will be prescribed without taking into account all the individual characteristics of the woman in labor. Antispasmodics are extremely rarely used in prenatal activities, mainly when it is necessary to activate the process of opening the cervix. Of course, the introduction of such drugs alleviates the mother's condition, but can cause irreparable harm to the child, since any analgesic, antispasmodic easily overcomes the placental barrier and provokes a violation of the respiratory activity of the fetus. It is possible to use inhalation anesthesia if labor is rapid, local or epidural (spinal) anesthesia is also practiced, but they are used only if there are certain indications. General anesthesia is an extreme measure that does not relate to the topic of "treatment of pain before childbirth", rather, it is a necessary action in case of serious pathologies during childbirth.

How to prevent pain before labor?

In order to prepare for childbirth, nature has provided a fairly long period, when for nine months a woman can combine the pleasant anticipation of a baby with useful and necessary actions that will certainly be useful to her in the future.

Prevention of pain before childbirth involves the following measures:

• The first and most important thing is psychological preparation and a positive attitude, which requires information verified and recommended by doctors. As a very simple piece of advice, we can recommend reading books, for example, "Childbirth without fear" by Grantley Dick-Read.
• Before childbirth, a special diet is needed to help the digestive system prepare for labor. Vegetable oil has a beneficial effect on the process of stretching and contracting the uterus, in addition, dishes with vegetable oils saturate the body with vitamin E, prevent possible ruptures and hemorrhoids.
• It is mandatory to attend preparatory classes, where pregnant women are taught how to breathe correctly, take a comfortable, adaptive position, and perform simple but very effective exercises to reduce pain.
• Preventing pain before childbirth is regular communication with your attending gynecologist, preferably with the one who will deliver the baby. Detailed advice, tips and recommendations from the doctor will give the expectant mother confidence and reduce anxiety.

It is believed that the most effective way to prevent prenatal pain and fears is a positive self-set and support from a loving family. The expectation of a baby should, in principle, be joyful throughout the entire period of pregnancy, the end of the third trimester in this sense is most important. Therefore, the prevention of pain before childbirth is a multi-variant, complex action aimed at a real miracle - the birth of a child.