Normal Delivery Pain - Criteria, Causes, and Treatment

Introduction:

Labor is described as the sequence of activities in the genital organs to flush out the materials of the conception, that is, the fetus, placenta, and the membranes from the womb and exit from the vagina. If the labor pain occurs before the entire term of 42 weeks or midway between 37 to 41 weeks is mentioned as preterm labor. Delivery of the fetus can be associated or not associated with labor pain. Cesarean delivery is without the onset of labor. The baby's delivery is either through the vagina, a natural process that requires assistance, or through a cesarean section. Instrumentation delivery is by the usage of a vacuum or forceps.

What Are the Criteria for Normal Delivery Pain?

There is a difference between labor pain. They are real labor pain and false labor pain.

• Real Labor Pain:

  • The pain is constant and expected.

  • It is first detected in the lower back and then radiates toward the lower abdomen.

  • The pain does not stop by taking rest.

  • There is a rise in pain intensity, duration, and frequency.

  • Mucus discharges with blood.

  • Co-occur with cervical changes.

  • Formation of the bag of water.

• False Labor Pain:

  • The pain is not regular.

  • Pain only occurs in the lower abdomen.

  • The pain stops after taking a rest.

  • There is no change in pain intensity, duration, and frequency.

  • Absence of mucus discharge with blood.

  • No cervical changes.

What Are the Stages of Normal Delivery Pain?

In the first stage, there are two phases.

Latent Phase:

• Cervix opening less than four centimeters.
• Contractions are feeble.
• There are only two contractions per 10 minutes.

Active Phase:

• First Stage: The cervical opening is more significant than four centimeters. Contractions are more than three per ten minutes, and the duration is 45 to 50 seconds. Descent of the fetus.

• Second Stage: The second stage starts from cervix dilatation until baby delivery. There is maximum cervical dilatation. The perineum, which is very thin, is bulged out. Widening of anus and vagina. Head visibility at the perineum.

• Third Stage: Starts after the expulsion of the fetus and ends with the removal of the placenta and other membranes. The duration of this stage, on average, is fifteen minutes.

• Fourth Stage: This stage is after the delivery of the fetus. The maternal vital signs, uterus retraction, and vaginal bleeding are examined during this phase. This stage is critical to make sure the health of the mother and child is good.

What Are the Causes of Normal Delivery Pain?

• Uterine Distension: Pressure on the myometrium (muscular outer layer of the uterus) by the developing fetus can cause uterus distensionleading to labor pain.

• Fetoplacental Activity:

  • The sequence of activities occurs.

  • An increase in corticotropin-releasing hormone leads to an early onset of labor.

  • Adreno- corticotropic hormone leads to increased cortisol production leading to the onset of labor.

• Estrogen Hormone - Increases in myometrial cell activation lead to the onset of labor.

• Progesterone - This hormone initiates labor pain.

• Prostaglandins - These lipids have hormone-like effects.

• Oxytocin Receptors - A protein that functions as a receptor for the hormone oxytocin.

What Is the Treatment at Each Stage of Labor Pain?

In the Latent Phase of the First Stage:

• Record all the actions.

• Contractions of the uterus-frequency of the contractions.

• The duration of the contractions.

• Fetal heart rate using cardiotocography.

• Check all the vital signs like temperature, pulse, and blood pressure.

• Note the time when there is membrane breakage and the amniotic fluid's color.

• See for any emergencies like uncontrolled bleeding from the vagina.

• Shock, seizures, and loss of consciousness.

In the Latent Phase, after Eight Hours:

• The contractions are more intense than referring to the first referral unit.

• No membrane rupture or increase in intensity; the woman is asked to relax.

In the Active Phase:

• This is the first stage.

• Record the fetus's pulse, uterine contractions, and heart rate every 30 minutes.

• The cervical dilatation, the mother's temperature, and blood pressure must be recorded every four hours.

Partograph-

To record the labor progress and maternal and fetal condition graphically, ensure maximum hydration to the mother, and avoid including hard food substances in the diet. The woman is encouraged to walk upright.

In the Second Stage of Labor:

• Record the frequency and duration of the contractions every half an hour.

• Every fifteen minutes, record the fetal heart rate using cardiotocography (a technique used to monitor fetal heart rate and contractions during gestation).

• Check for abnormal symptoms like uncontrolled bleeding and convulsions.

Look for the Following Actions:

• Widening of the vulva.

• Swelling of the perineum.

• Descent of the fetus and head at the cervix.

• The woman is suggested to push during the contractions for easy movement.

For the Head of the Fetus:

• The hand can be placed gently on the head of the fetus, and the other hand to support the perineum.

• The umbilical cord must be checked by pressing along the fetus's neck.

• If the umbilical cord is hanging along the neck, then deliver the fetus with the umbilical cord.

• If the cord is rigid around the neck, then from both ends, clamp the umbilical cord and divide in between.

For Shoulders and Rest of the Body:

• Gentle application of pressure to free the top shoulder of the baby.

• Then hold the baby upwards to release the posterior shoulder of the baby.

• The remaining of the baby's body is delivered hassle-free.

What Is the Mechanism of Normal Labor Pain?

• Engagement - This is the gestation stage, when the fetus's head moves into the pelvis in preparation for birth.

• Descent - The head of the fetus moves down further through the pelvis.

• Flexion - While descending through the pelvis, the fetal head flexes so that the fetal chin touches the fetal head.

• Internal Rotation - The head of the fetus further descends. The head will most often rotate, so the back of the head is below the pubic bone of the mother.

• Crowning - When the top of the head of the baby is visible through the opening of the vagina.

• Extension - At the delivery time, the combined effects of uterine contractions and the pelvic floor result in cardinal movement.

• Restitution - The head externally rotates to face the right or left medial thigh of the mother.

• External Rotation - The baby rotates from face down to ninety degrees to face one of the thighs of the mother after delivery.

• The expulsion of the body of the fetus outside.

Conclusion:

The onset of the normal delivery pain before childbirth is a warning symptom that must be noticed carefully, followed by immediate medical intervention. The pain intensity and progression are crucial steps taken for further procedures. The use of a partograph and specific criteria for the correct diagnosis of the actual active labor pain.

Proper management and experienced medical staff for the third stage of the labor and delivery of the baby at the right time are necessary. Ultimately the health of the mother and the child is of utmost importance. Avoid the usage of any interventions that are not important. The position of the woman during the delivery process is of her choice. Provide support to the mother during the whole process.