Pain before delivery

Pain before delivery is a precursor to the onset of labor. It is believed that the pain in the process of delivery is inevitable, accompanying every appearance of a new inhabitant of the planet. However, as well as pregnancy - this is a fairly common physiological condition of millions of women, and not the disease, and pain before delivery - this is more a psychological attitude and fear of the process by the future mother.

The idea of giving birth to many pregnant women consists of stories of "eyewitnesses", that is, giving birth to women, emotional responses of relatives or girlfriends. Often this information is subjective, since every member of the fair sex has her own pain threshold, and the anatomical features are also individual. And objectivity is this:

• From the physiological point of view, a healthy woman is capable of normal labor without intensive pains, deformities and ruptures of the genital organs. The nature itself provides that the body of the future mother was prepared for the appearance of the baby, it is no accident that the fetus is nurtured for 9 months. During this period, the tissues of the birth canal become more elastic, stretchable, so as not to create a risk of injury for the infant moving along them. 
• Undoubtedly, Homo sapiens, a man of intelligence higher in development than fauna, but also strives to continue his species, giving birth to babies. Note that no animal in the world suffers from terrible pain during childbirth, because it perceives generic activity as a natural, normal part of existence. 
• Everyone knows that there are still corners on the planet, far from the notorious benefits of civilization. It is there that the lucky ones live, who, in principle, lack knowledge about prenatal pains, of course, we are talking about healthy women who do not have pathologies. Perhaps therefore, despite all the wild living conditions from the point of view of modern man, these peoples do not die out. 
• Physiologists more than 200 years ago found that mainly pain is accompanied by pathological processes associated with dangerous diseases, severe stress or fear. Obviously, neither pregnancy nor delivery itself is pathology, therefore, there should not be any reasons for pain, except fear and tension.

Summarizing the arguments, it should be noted that the pains before delivery are affected by the following factors: 

• Age and state of health of the woman in childbirth.
• Anatomical features of the structure of the pelvis, hormonal, muscular system and other parameters of the female body.
• Presence of pre-pregnancy disorders of the menstrual cycle.
• The peculiarity of labor is premature birth.
• Fetal position, its size.
• Individual psychoemotional features of the parturient woman, level of pain threshold.
• Preparation for childbirth, both psychoemotional and physiological.

An important factor that affects the pain before delivery is the woman's psychological attitude, the ability to cope with fear and tension, since pain before giving birth is usually not intensive and is associated with the preparation of the cervix, the uterus itself for the birth of the baby.

[1], [2]

Causes of pain before delivery

The first typical cause of pain before labor is the so-called false fights. The process of the first fights can be called "training", during which the muscles of the uterus contract, come into tonus literally for a minute, preparing, softening the cervix for childbirth. These sensations may appear after the 20th week and, as a rule, do not cause severe pain. Every day, these muscle strains become more tangible, but irregular, irregular, which distinguishes them from true bouts. In addition, false bouts are similar to menstruation pains, that is, they are felt only in the lower abdomen and pelvis, while pain with a true contraction of the uterus carries a rhythmic, shingling character and begins most often from the waist. 

Causes of pain before delivery are labor pains, which are called expulsive, that is, helping the fetus get out of the mother's womb. Actually, contractions are the first stage of labor activity, accompanied by rhythmic contractions of the uterus (uterus) and stretching of the cervix uteri (cervix uteri). The pain is widespread in the back and sacrum character, not localized in a specific place and quite intense, increasing, albeit with interruptions. 

The psychoemotional condition of the woman in labor is the third and, perhaps, the most important reason for the pain in prenatal activities. . The injury causes muscle clamps, which in turn provoke even more soreness. 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 preparing for childbirth, the more painful it becomes. 

There are other causes of pain before labor, which have pathological etiology, that is, are associated with chronic diseases of internal organs, including pelvic organs.

Summarizing the etiological factors of prenatal pain, we can make the following list: 

• Individual psychoemotional condition associated with poor preparation for childbirth, lack of information or objective reasons (chronic diseases, family problems, etc.).
• For a few days (weeks) before childbirth, an increased anxiety condition develops, a constant release of adrenaline into the bloodstream begins.
• The natural adaptive response of the body to the adrenaline rush is tension, muscle contraction, an increase in the tone of the vessel walls.
• Stress leads to muscle clamps, disruption of normal circulatory activity, as a result - deterioration of the general condition, increased pain symptoms.

[3]

Symptoms of pain before delivery

Each childbirth feels the approach of childbirth in its own way, despite the existing typical signs. The main thing is that the symptoms of pain before delivery are shown, this is the beginning of the first stage, that is, true birth pains. Unlike them, false contractions of the uterus do not open it and do not end with the birth of the baby, they are designed to prepare the body for labor. False contractions, as a rule, do not differ in intensity and are localized in the lower part of the abdomen. If a woman will give birth in the second time, it is likely that false, "training" cuts will not be felt anymore, since the body has already learned the "lesson". Symptoms of pain before labor of this nature are easy to distinguish, false bouts (Braxton-Hicks syndrome) are characterized by such signs: 

• Appear 21-14 days before the expected date of delivery.
• The pain is localized in the lower abdomen and resembles the menstrual period.
• The pain is blunt, drawing character.
• Uterus tense, well palpable.
• The uterus does not lose its tonus in breaks, which can be prolonged - up to 5-6 hours.
• Contractions last no more than one minute and are irregular.
• Pain can be removed by changing the posture, moving, walking.

Symptoms of pain before delivery, which need to pay more attention, so as not to miss the onset of labor: 

• Regular contractions of the uterus.
• Rhythm of repetition of pain, break 10-20 minutes.
• A steady reduction in the interval between contractions up to 2-3 minutes.
• In between the contractions, the uterus quickly relaxes.
• The pain is oppressive, widespread, surrounding nature.

Also forerunners of true births is the departure of the mucous mass (plug) and amniotic fluid (amniotic fluid).

Pain in the abdomen before childbirth

Periodic Pain in the abdomen before childbirth is an inevitable phenomenon that should not be dramatized, because pain should not exceed the level of pain in the menstrual cycle. This is a fully explainable physiological process of uterine stretching, respectively, accompanied by some displacement of nearby organs. Pain has a pulling, aching character, but it is transient, not permanent. Also, pain in the abdomen before childbirth - this is the harbinger of the birth itself, most often such feelings appear between 20 and 30 weeks in primiparous women. Braxton-Hicks contractions (false uterine contractions) are more a norm than a deviation, since they prepare the female organism for the birth of the baby due to stretching, softening of the muscles and shortening of the cervical canal of the cervix.

If the pain in the abdomen before childbirth is accompanied by drawing, girdling, growing sensations, the pains become regular, with decreasing interruptions, this is direct evidence that the first stage of labor-fights has begun.

Pain in the abdomen before delivery

Pain in the lower abdomen before childbirth is a typical sign of false labor, more accurately the preparatory period, when the uterus comes into tonus, and its neck begins to decrease, to shorten. Thus, the pain in the lower abdomen is a kind of adaptive stage that helps the body to prepare muscles, ligaments, tissues for normal labor. The sensations of pain are not intense, tolerant enough, these symptoms can subside during movement, changes in body posture, even with emotional switching - watching a movie, reading a book.

Since the structure of the body of expectant mothers is not subject to unification, every woman can feel the approach of childbirth differently. For many women in labor, the pain in the lower abdomen is related to the fact that in the last weeks of pregnancy the fetus can turn head down into the pelvic region, which causes quite natural painful sensations in the future mother. It should be noted that in some pregnant women the onset of labor, that is, true contractions, can manifest atypically - not lumbar, girdling pains, but sharp sensations in the perineal region and in the lower abdomen.

In such situations it is better to be safe and refer to an obstetrician treating a gynecologist, in any case, advice, examination, consultation and supervision will not hurt, but will only relieve the anxious state.

Back pain before delivery

As a rule, pain in the back before childbirth is associated with moving the baby to a natural prenatal position (preposition), that is, head down. Lumbar drawing pains are caused by fetal pressure and physiological stretching of the connective tissue of the sacroiliac zone.

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

Back pain before delivery

Lumbar pains are characteristic of the period of labor, but they can be caused by other causes.

• Hormonal dysfunctions that cause relaxation and expansion of pelvic joints, intervertebral ligaments. 
• Stretching of the abdominal muscles, compensatory increase in the load on the lumbar region. 
• Physiological displacement of the center of gravity of the body forward (abdomen), leading to compensatory tension of the muscles of the back. 
• Violation of the body's posture, curvature of the spinal column. 
• A natural increase, a stretching of the uterus, which squeezes the nearby nerve endings in the lumbar region. 
• Increasing body weight, increased mechanical stress on the spine, on the legs. 
• Uncomfortable shoes, clothes. Especially increases the load on the back of shoes with high heels. 
• Osteochondrosis, which developed before pregnancy. Symptomatics can be aggravated by increasing the strain on the deformed vertebrae.

Pain in the lower back before birth increases, starting with the fifth month of pregnancy, when the process of bearing the fetus goes to the stage of the third trimester. In addition, the pain symptom in the lumbar region at the end of the 9th month is a direct evidence of labor activity, fights, when uterine pharynx opens, the cervix is significantly reduced, compressed to facilitate passage of the fetus along the birth canal.

[4], [5]

Headache before childbirth

Pregnancy is accompanied not only by joyful expectations and hopes, but also by anxieties with which the headache before childbirth is associated. Most often, future mothers suffer from tension headaches, less often migraines. Sensations of pain in the head are typical for the second half of pregnancy, when the birth of the baby is already close, and the psychoemotional state of the mother is aggravated by fears. It is extremely rare in obstetric, gynecological practice, there is a headache before childbirth, caused by impaired cerebral circulation or other pathologies of the brain. Typically, these problems are diagnosed before registration for pregnancy and are monitored throughout the period of gestation. It should be noted that headaches can indicate severe forms of gestosis, nephropathy, hypertension. Such pathologies are supervised only in a hospital setting, as they can lead to complications during childbirth. All other manifestations of discomfort on the side of the head are typical for the prenatal period, when a woman is elementary afraid of childbirth and pain associated with them. The higher the level of anxiety, the greater the strain of the muscular system, with the muscles of the cervico-brachial region reacting first, which leads to a natural narrowing of the large and small vessels that feed the brain.

Drawing pain before delivery

Drawing pain before delivery is a signal that the baby will soon be born. As a rule, sensations of aching pain begin with 33-34 weeks and are caused by the stretching of ligaments, muscles, that is preparation for labor. The pain can be localized in the lower abdomen, which is associated with false contractions, and the pain symptom is felt in the back, in the lumbar region, the sacrum, this indicates a normal presentation of the fetus head down. The pelvis during this period gradually expands, moves apart, causing pulling pains in the perineal region, this is how the bony bones adapt to the forthcoming birth. During this period, the woman needs the recommendations of the treating gynecologist more than ever before to prepare for an important process. Now it is not difficult to read specialized literature, attend courses of future mothers and parturient women, under the guidance of a coach or independently master breathing exercises or do water procedures (swimming). Such training will not only alleviate pain symptoms, but will help to pass the generic process relatively painlessly.

[6], [7], [8]

Pain in the perineum before childbirth

Causes of pain 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 such factors: 

• The increase in weight leads to a load on the lumbosacral section, provoking pain in the perineum.
• Increases the production of relaxin, a hormone that controls the elasticity of the interosseous joints.
• Gradually, the pelvic bones (lone articulations) move apart, preparing for labor.
• The fetus takes a position that causes pressure on the nearby nerve endings, including the sciatic nerve.
• In the process of pregnancy there is a risk of developing varicose veins - small pelvis, perineum, which can also provoke pain in this area.

Pain in the perineum before birth can be associated with the approach of the fetus to the birth canal, which is obviously the most positive reason, as any pain symptom is quickly forgotten, giving way to the joy of motherhood.

Pain in the chest before childbirth

Painful sensations in the chest - this is 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 a pregnant woman. The mammary glands undergo changes during all nine months, the glandular tissue begins to expand, especially the breast enlargement after the 30th week. Pain in the chest before childbirth is due to the fact that the capsules of the mammary glands strongly stretch in the same way as the skin. Breast like swells, becomes more dense, often the skin covers itch, which indicates possible stretch marks. In addition, the pain in the chest before birth is due to the formation, growth of the milk ducts, the increase in nipples. Symptoms and the nature of pain in the mammary glands in women can be different: for someone the chest hurts only in the first trimester, in some breast glands begin to increase intensively immediately before childbirth. This is due to the peculiarities of the hormonal system and the general state of the body. Pain sensations in the mammary glands, as a rule, are not sharp, acute and tolerable enough. In addition, the expectant mother should understand that the pain in the chest before giving birth is a sign of the formation of colostrum and the evidence that the body is already completing the stage of gestation and is preparing for the process of nursing the baby, that is, feeding

Pain in the pelvis before childbirth

Pain in the pelvis before birth is explained by the fact that the influence of the increasing uterus is amenable to all nearby organs, systems, including pelvic bones. On the other hand, the uterus also depends on the pelvis, because it is located inside the bone bed, the pelvic ring. The pelvic bed includes paired bones of the pelvis, which in turn consist of the pubic, iliac and ischium bone, fused together. Thus, together with the sacrum, the pelvic bed accommodates and protects not only the organs of the abdominal cavity, but also the uterus, which is attached to it with specific ligaments. Pain in the pelvis before birth is due to increased tonus of uterine, spiral ligaments, especially those that are characteristic of pregnant women who have a history of dystrophy of the pelvic muscles, a twisted pelvis. As a result of the sacroiliac displacement, the ligaments that attach the uterus to the basin are stretched unevenly, causing pain in the lumbar and pelvic region. In addition, pain in the pelvis before childbirth is associated with natural causes, characteristic of the second half of pregnancy: •

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

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

Pain in the vagina before childbirth

Before the birth of pain in the vagina is normal should not be, because most often the pain manifests itself in the pelvic region, in the lower back, in the hips, in the lower abdomen. If there is pain in the vagina before childbirth, this may indicate a varicose veins of the vulva, the perineum that occurs in every fourth pregnant woman. Varicose veins are provoked by the compression factor of the enlarged uterus when it compresses the main vessels (iliac, inferior vena cava) in the retroperitoneal zone. Pain in the vagina before childbirth can manifest as accruing, burgeoning painful sensations, itching, swelling of the labia. This symptom is most dangerous in the sense of the development of acute varicothrombophlebitis and a vein rupture. Possible spontaneous bleeding from the vagina before childbirth poses a threat of abortion due to its intensity, and also because it is difficult to stop the blood - the pressure in the veins is very high, and their walls are extremely fragile. That is why if a future mother feels discomfort in the vaginal area, a feeling of heaviness or bursting, you should immediately go to a gynecologist to get timely symptomatic therapy.

Diagnosis of pain before delivery

Ideally, the prenatal period should be controlled by the woman herself and her treating obstetrician-gynecologist. Painful sensations, diagnosis of pain before delivery are so individual that, for all information awareness, the future mother can mix up the symptoms and aggravate her already worrisome condition.

• Pain before delivery has two main objective reasons: 
• The contracting activity of the uterus, that is, visceral pain.
• Pain during the attempts, that is, physical pain.

However, the most common cause of prenatal pains is anxiety, fear and the fully understandable muscle tension of the parturient woman. As you know, a person is afraid of what he does not understand, what he does not know, so knowing the symptoms of pain, stages and options for their development - this means to remove unnecessary anxiety and prepare for normal, natural childbirth.

Diagnosis of pain before delivery includes the following prenatal stages, which ideally should be controlled by a doctor in a hospital: 1.

Prenatal stage, classical course: 

• Contractions, contraction of the uterus, opening of the cervix, which are felt as intense pressure, surrounding the pain in the pelvic region, radiating into the rectum.
• Spastic pain in the groin, which is typical for women who have given birth.
• Pain of a trailing nature in the lumbosacral region.
• Changing the structure and color of vaginal discharge.
• Perhaps the passage of the mucous plug, which is often released during false labor. This symptom is not specific.
• Growing spasms, fights, characteristic rhythm and a decrease in the time between them.
• Dyspeptic phenomena, diarrhea are possible.

Diagnosis of pain before delivery, symptoms of false labor: 

• Spastic pains are irregular, irregular. Breaks between them can reach 5-6 hours. The nature of painful sensations is not obvious, the pain is not intense, often transient due to a change in body posture.
• The pain is not localized in the sacrum, but in the ileum, and does not have a shingling character, rather it is pulling, giving down the abdomen.
• The fetus manifests activity during false encounters, strenuously moves, whereas during true fights the fetus often freezes.

Signs of the onset of labor: 

• Spasms are worse, especially when you change your posture, movements.
• Pain begins in the sacrum and spreads up and down, often radiating to the leg (legs).
• Painful symptoms are accompanied by a digestive tract disorder, diarrhea.
• Contractions intensify, become more prolonged, and the time between them steadily decreases.
• Appear vaginal discharge with blood.
• Perhaps the allocation of amniotic fluid (amniotic fluid), although this characteristic is not standard for all women, it is not specific.

How is the examination in the last month of pregnancy, how is the diagnosis of pain before labor?

As a rule, the final, last weeks should be devoted to the following activities that help to clearly differentiate the nature of possible prenatal pains: 

• Weight and blood pressure are measured.
• The last time a urine is given for examination is for an elevated level of sugar or the presence of protein.
• The heartbeat of the fetus is checked.
• The height of the uterine fundus is determined.
• The general condition of the fetus is assessed - its magnitude, previa.
• The vascular system of a woman (legs, groin, vagina) is examined for possible varicose veins.
• The cervix of the uterus is examined, its readiness for opening is determined.
• During fights, including false ones, the rhythm, frequency and intensity of pain sensations are determined.

[9], [10]

Treatment of pain before delivery

Physiological pain is usually not medicated. Treatment of pain before delivery is necessary only in cases of pathological conditions of the mother in childbirth. Indeed, there are reasons that lead to the use of anesthesia before childbirth, they include: 

• Low pain threshold and increased psychoemotional excitability of a woman.
• Pain resulting from pathological processes in the internal organs and body systems.
• Complications during pregnancy (gestosis).
• Hypertonic disease.
• Nephropathy.
• Serious cardiopathology.
• Intrauterine fetal pathologies that depend on the tonus of the mother's muscular system, and are also dependent in the sense of oxygen starvation (hypoxia).

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

• Massage of the lumbosacral region, feet and abdomen. These techniques should be studied beforehand and applied independently, or with the help of a partner, a nurse, a masseur.
• Relaxing effect is possessed by aromatic oils. If a pregnant woman does not have an allergy or a predisposition to it, aromatherapy can create a real miracle. There are known cases confirmed by doctors when a massage with aromatic oil, inhalation of aroma-ester almost completely removed the pain symptom even during mid-bouts. Aroma means should be selected carefully, since many essential oils can cause an allergic reaction. Safe are lavender oil, spruce, roses, thyme, which stimulates generic activity. 
• Breathing exercises are a classic of prenatal and labor activity. To master the technique of proper breathing is not only to reduce pain in childbirth, but also to strengthen the overall health in the future. Breathing helps reduce stress, muscle tone, restores normal blood flow activity, saturates blood vessels and tissues with oxygen, and therefore, prevents fetal hypoxia. 
• There are a lot of special exercises for the maternity body, which can be studied and pre-trained in their performance on the training courses for expectant mothers. Such motor activity helps maintain the normal tone of the skin, helps reduce the pain symptom and significantly reduces the general anxiety of the pregnant woman. Certain poses in bouts, attempts at statistics and reviews of women giving birth at least 50% reduce the severity of pain.

Drug treatment for pain before delivery is only used according to strict indications, when the risk of harm to the fetus is lower than the risk of a threat to the life of the mother. The choice of anesthesia is the prerogative of a doctor, no drug, method or method will be assigned without taking into account all the individual characteristics of the mother. Very rarely in prenatal activities antispasmodics are used, mainly when it is necessary to intensify the process of neck opening. Undoubtedly, the introduction of such medicines facilitates the condition of the mother, but can cause irreparable harm to the child, since any analgesic, spasmolytic easily overcomes the barrier of the placenta and provokes a violation of the respiratory activity of the fetus. It is possible to use inhalation anesthesia in cases where labor is swift, local or epidural (dorsal) anesthesia is also practiced, but they are also used only if there are certain indications. General anesthesia is an extreme measure that does not apply to the topic of "treating pain before delivery", rather, it is a necessary action for serious pathologies during childbirth.

How to prevent pain before delivery?

In order to prepare for childbirth, nature has foreseen a rather long period, when for nine months a woman can combine a pleasant expectation of the baby with useful and necessary actions that will surely come in handy in the future.

Preventing pain before delivery involves such activities: 

• The first and most important is a psychological preparation and a positive attitude, for which information is needed that has been verified and recommended by doctors. As a very simple advice, you can recommend reading books, for example, "Childbirth without fear" by Grentley Dick-Read.
• Before birth, a special diet is needed that will help the digestive system to prepare for labor. Beneficial effect on the process of stretching and contraction of the uterus vegetable oil, 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 to breathe properly, take a comfortable, adaptive posture, perform simple but very effective exercises to reduce pain.
• Prevention of pain before delivery is regular communication with your gynecologist, preferably with those who will take delivery. Detailed counseling, advice and advice from a doctor will give the expectant mother confidence and reduce anxiety.

It is believed that the most effective way to prevent prenatal pains, fears is a positive self-adjustment and support for a loving family. The expectation of the baby in principle should be joyful throughout the period of pregnancy, the end of the third semester in this sense is most important. Therefore, the prevention of pain before delivery is a multivariate, complex action aimed at the most real miracle - the birth of a child.