Pregnancy and childbirth are usually considered a blessing in modern times. Off the grid, however, we will be thrown back to the 19th century from a medical standpoint. Back then, childbirth was associated with a much higher rate of complications than today. It was thought that each pregnancy carried a one- to two-percent death rate. This may not sound like a huge number but, given that the average woman would become pregnant an average of ten times, it added up to a very real risk. A family stood a significant chance of losing its mother.
Even if a group has no women of childbearing age at present, the family caregiver may be called upon to attend a delivery without the benefits of a modern medical system. Therefore, they must be ready to deal with a pregnancy at term, classically defined as one that has reached 37-42 weeks from the first day of the last menstrual period. In this part of our series, we’ll discuss what happens and the terms used.
(Note: In addition to being a retired Fellow of the American College of Surgeons, I am an actively-licensed Life Fellow of the American College of Ob/Gyn and Nurse Amy is an actively licensed Certified Nurse Midwife.)
APPROACHING THE DUE DATE
As a woman approaches her due date, several things happen. The fetus begins to “drop”, assuming a position deep in the pelvis. Her abdomen may look different, or the top of the uterus, also called the “fundus,” may appear lower. Heartburn, if experienced, may lessen as pressure on the stomach is relieved. As the neck of the uterus (the cervix) relaxes, she may notice a mucus-like discharge mixed with a little blood. This is referred to as the “bloody show” and is usually a sign that labor will occur soon, anywhere from the next few hours to a week or so. Any bright red bleeding is an immediate emergency and, in modern times, requires a visit to the emergency room ASAP.
To determine the patient’s status, you can perform a vaginal exam. This is done by gently inserting two fingers of a lubricated (use lubricating jelly) gloved hand. You’ll notice the cervix is firm like your nose when it is not ready to begin dilating or becomong “ripe,” but becomes soft like your lips when the due date is approaching. This softening and thinning out (shortening) of the cervix is called “effacement.”
Effacement is measured in percentages. When 50% effaced, the cervix is half its normal thickness and length. At 100% effacement (“completely effaced”), the cervix is paper-thin. Much of the effacement usually occurs before any significant opening of the cervix (also called “dilation”).
Contractions will start becoming more frequent as labor begins. To identify a contraction, feel the skin on the soft area of your cheek, and then touch your forehead. A contraction of the fundus will feel like your forehead. False labor, also called Braxton-Hicks contractions, will be irregular and will go away with bed rest (especially on the left side) and hydration. If contractions are regular, getting closer together and more painful, even with bed rest and hydration, it’s likely the real thing!
A gush of watery fluid from the vagina will often signify “breaking the water”, and is also a sign of impending labor and delivery. The timing will be highly variable, however, and sometimes urine leakage may confuse the situation. A product called “nitrazine paper” will turn a bright blue when it touches amniotic fluid due to its high pH. A bright blue result (nitrazine positive) usually verifies that the bag of water is broken. If you have a microscope in the hospital tent, a little amniotic fluid, when dried, on a slide will reveal fern-like crystals. This is called “ferning” and is more solid proof of membrane rupture than nitrazine positive tests.
There are three stages of labor:
- The first stage, which is broken up into latent (early) and active phases.
- The second stage, which starts when the cervix is fully dilated and the baby is born.
- The third stage, when the placenta is delivered.
We’ll discuss these stages in the next part of this series.
THE DELIVERY KIT
In the meantime, you’ll want to have certain supplies on hand. A typical OB kit used in birthing centers would have the following items:
- Sterile basin with lid
- Baby blanket
- Infant head warming cover
- Umbilical cord clamp
- Under-buttocks drape without pouch
- Curved hemostat forceps
- Straight hemostat Kelly forceps
- Plastic sponge forceps
- Straight mayo scissors
- 12-Ply, 4 x 4″ gauzes
- Large Sterile vinyl gloves
- 18 G x 1.5″ needle
- 7″ serrated needle holder
- 10 mL luer-lock syringe; 2 oz.
- Bulb syringe (to suck out baby’s nose and mouth at birth)
- 50″ x 90″ Table cover
- O.R. towels x4
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