Experts answer the main questions about pregnancy and childbirth
Pregnancy and childbirth is a difficult topic to talk about. Like any taboo, this question managed to acquire an abundance of myths and errors. It would seem that the abundance of information on the Web should help women, but often only multiplies the fears. How to cope with pain, fear and responsibility, and after all stay in trouble with yourself? We decided to ask the experts important questions about pregnancy, childbirth and life after them. The gynecologist, Candidate of Medical Sciences Tatyana Rumyantseva helped us understand the physiological side of the issue. We talked with clinical psychologist Marina Filonenko about the risk of postpartum depression, and the psychotherapist Olga Miloradova told about the manifestation of personality traits during pregnancy and returning to sex life after giving birth.
What is the reason for mood swings in pregnant women and is it worth fighting against it?
It is no secret that many women during pregnancy become more difficult to cope with their emotions, and it is known that this is largely due to hormones. During pregnancy, the level of production of estrogen, prolactin, progesterone and a number of other sex (steroid) hormones increases. With regard to memory loss, impaired concentration and some other changes in cognitive functions, scientists have not yet associated them with the effects of sex or peptide hormones. However, such violations are often noted, especially in the last trimester of pregnancy and during the first time after birth.
Nevertheless, explaining the excessive vulnerability of pregnant women solely by physiology is not entirely logical. The fact is that during pregnancy anti-stress hormonal mechanisms are triggered: the increased activity of the oxytocin systems and the suppression of the hypothalamic-pituitary system reduce anxiety. Mood swings and uncontrollable emotions of pregnant women are much more clearly explained from the point of view of psychology, and sometimes psychopathology. Despite the fact that pregnancy is an absolutely normal physiological process, in a psychological sense this is a crisis period, and especially when it comes to the first pregnancy.
Every woman has her own personality traits, which become aggravated when you find yourself in a situation that in the future will completely change life. There are changes in behavior, for which pregnant women are credited with the very "inadequacy". Someone's mood changes, someone begins to suspect a violation in himself or the fetus, someone is too nervous, and someone has unresolved conflicts with his own mother. If it is not worth fighting against the effects of hormones, since they are necessary for the normal development of the fetus, then it is worth working with psychological difficulties before the onset of pregnancy.
Is it true that vision drops during pregnancy?
Changes in the work of the eyes are detected in approximately 15% of pregnant women, but in the vast majority they are insignificant and reversible. New processes in the body of a pregnant woman affect the metabolism, hormonal and circulatory systems, and all these changes can affect the work of the eyes. The sensitivity of the cornea can change - then comes a feeling of dryness, it is more difficult to wear contact lenses. There are drops in intraocular pressure, which can lead to a feeling of eye fatigue and a decrease in visual acuity, as well as hyperpigmentation of the eyelids. After pregnancy, vision, as a rule, returns to normal. Pathological changes may be associated with pregnancy complications (eclampsia, thrombosis) or be a consequence of previously existing problems. It is impossible to understand whether changes are physiological or pathological, without special methods of research, therefore consultation of an ophthalmologist, and often a neurologist, is required.
What are dangerous infectious diseases during pregnancy?
There is a separate group of TORCH infections that can potentially have consequences for the fetus. These include, for example, the well-known herpes and toxoplasmosis. The severity of the consequences depends on the duration of the infection. With toxoplasmosis, the risk of infection of the fetus is the lowest if the pregnant woman falls ill in the first trimester (10-25%), in the second the risk increases to 30%, and in the third is 60-90%. At the same time, if the infection occurs in the first trimester, the consequences for the fetus will be more severe. It is important to know that it is dangerous not to detect class G antibodies in the blood of a pregnant woman, namely, primary infection is extremely rare during pregnancy.
As for herpes, labial, with rashes on the face, in most cases does not affect the course of pregnancy and is not dangerous for the fetus. The danger is genital herpes, especially during the initial infection during pregnancy. However, under his condition, infection of the fetus is extremely rare - in 85% of cases the child becomes infected during childbirth. Unfortunately, there is not yet a treatment method that would guarantee the absence of harm toxoplasmosis or herpes for the fetus.
How painful is it to give birth?
Childbirth - it is really very painful, but the degree and nature of pain depends on the course of childbirth, the pain threshold of the woman, psychological attitude. On the other hand, it does not hurt all the time. The first stage of labor, labor, can last on average from six to 11 hours and is accompanied by painful sensations from several seconds to a minute. But there is also a “rest” between contractions: at the beginning of labor, these intervals are about 15 minutes, closer to the second period (attempts) are shortened to two minutes or less.
During attempts, that is, directly at the birth of a child, contractions continue, but the woman herself joins in the work - she strains the muscles of the anterior abdominal wall. This makes it easier for many patients: first, they finally allow them to push, and secondly, the normal length of the attempt is up to an hour, so it is clear that the end is near. However, at some moment the attempt becomes unbearably painful, and the impossibility of pushing prolongs the time of delivery. After the birth of the child, the third stage of labor begins - the expulsion of the afterbirth, that is, the "birth" of the placenta. This usually happens in two or three contractions that are much less painful than before the birth of the child. The placenta is quite soft, and after passing the child through the birth canal, its birth is often not difficult.
What is epidural anesthesia and can everyone use it?
The most common indication for the use of epidural anesthesia, in which the drug is injected into the spine through a catheter, is the desire of the woman. In some countries (USA, Canada) 60% of women give birth using this method of anesthesia. There are also medical indications: pre-eclampsia, prolonged delivery, multiple pregnancy, diseases of the cardiovascular or respiratory systems in a patient, obesity. In accordance with international recommendations, pain relief can begin at any time of labor, in Russia it is most often used from three to four centimeters to open the cervix. It used to be thought that it makes sense to “turn off” pain relief during attempts, but it has already been proven that pain relief can continue until the end of labor.
It takes time (about twenty to thirty minutes) to call the anesthesiology team and install the catheter, and therefore, if you decide to undergo epidural anesthesia by the time of the attempts, it may be late: it is possible that the birth will end sooner than you can start the anesthesia. If there are no medical personnel trained in the procedure, or there is no possibility to monitor the fetal heartbeat, epidural anesthesia cannot be performed. In addition to the reluctance of the woman, the absolute contraindications are circulatory disorders and blood clotting, increased intracranial pressure, infection of the puncture area.
When using epidural anesthesia, there may be a pulling sensation in the lower abdomen (as during menstruation), but there should not be any strong pain. One of the side effects is numbness in the legs: this is normal and will pass after the end of the action of the drug. The most common occurrence of compression of the spinal root, and not damage, since this procedure uses soft catheters. If the sensitivity in the legs does not return, it is important to pay attention to the doctor: this can actually be the result of spinal cord injury, although the frequency of this complication is only 0.6 per 100 thousand women.
When do cesarean section?
Indications for cesarean section vary in different manuals, but they are many. A caesarean section is required if there is a danger to the fetus’s life (heartbeat malfunctions, loss of the umbilical cord) or for the mother’s life (heavy bleeding, sharp pressure increase), and also in case of mechanical obstacles to the birth of the child: narrowness of the mother’s birth canal or large fetus. Caesarean conduct and in some cases weak labor activity - when the strength of contractions does not increase and the child can not move through the birth canal. In another group, indications in which caesarean is not always carried out, but most often, very different conditions - from placenta previa or maternal diseases (diabetes, hypertension) to acute genital herpes or condyloma, HIV infection.
In Russia, in some maternity hospitals there is an unofficial indication of the "desire of a woman." You can agree in advance with your doctor about a planned operation, but this is not considered to be quite ethical and expedient. The concept of “not suffering” here is also not entirely applicable: after the operation, a woman finds herself with a newborn child and with a seam on her stomach, which creates significant discomfort and prevents her from getting up or taking the child in her arms. In order to "not suffer", an epidural anesthesia was created: this is the most benign delivery option for mother and child.
Is it more difficult to give birth to miniature women and those who have a narrow pelvis?
A narrow pelvis can really become an indication for cesarean section. However, “by eye” this is not defined: it is possible to speak of a narrow pelvis only after measuring it with a special instrument. This is done when the mother registers in the clinic. If any type of pelvic contraction is found in a woman, during pregnancy a careful monitoring of the possible size of the fetus is carried out, and the tactics of childbirth is based on the size of the birth canal of the mother and the head of the fetus. Before birth, if there is any doubt, X-ray epiometry is possible - an additional study to evaluate these ratios.
Patterns "the more height or weight, the easier it is to give birth" no. One can only note the connection of physical training and ease of childbirth. Women who have not had physical activity before pregnancy often have more difficulty giving birth: the anterior abdominal wall muscles also take part in labor, and if they are not trained at all, this complicates the process. However, weight and level of physical activity are often not related.
How often during childbirth occur breaks perineum and what they are dangerous?
Fortunately, in modern practice, gaps in childbirth are quite rare due to the use of episiotomy (less often - perineotomy). Episiotomy - incision diagonally from the vagina to the ischial tubercles, perineotomy - incision in the side of the anus. The threat of perineal rupture is one of the indications for episiotomy. Breaks are mainly dangerous to the muscles of the anal sphincter, since the break often occurs in the direction of the anus. Such serious damage leads to fecal incontinence in the future, so if an obstetrician believes that an episiotomy is needed, it is better to trust him.
When suturing incisions or tears, the edges of the tissue should be connected as they were before birth. Unfortunately, this is not always possible due to contraction of the vaginal muscles, bleeding from a wound that makes it difficult to see, or sudden movements of the patient. As a result, the innervation of the area of the gap may be disturbed. However, more often this leads to the appearance of pain points, and not to loss of sensitivity in the area of rupture. Painful sensations, of course, worsen the quality of life in general and sex life in particular, but almost always it is possible to find a method of treatment. Properly sutured incision or gap then looks like a thin scar, almost imperceptible to an inexperienced eye. With proper intervention technique, the appearance of the genitals does not change.
Is the sensitivity of the vagina lost after childbirth and is it true that it stretches?
In the process of childbirth, the head of the child passes through the birth canal of a woman, and it is still much more than anything that has been in the vagina of most women until this point. The vagina is undoubtedly stretched, which at first can lead to a change in sensations during sex, but, as a rule, the vagina is “assembled” for a couple of months after delivery. The gynecologist will almost always distinguish the vagina of the woman who has given birth from the vagina of the unborn, but in most cases it will return to the state where the woman herself will not notice the difference.
If the vagina remains "free" and it does not suit in intimate life, there are modern effective techniques for vaginal repair. What a woman can do herself is exercises to strengthen the muscles of the pelvic floor (Kegel exercises). They can also help in the prevention or control of urinary incontinence, omission of the vaginal walls. True loss of sensation occurs only after traumatic labor. In addition, there may be a feeling of dryness or soreness in the vagina, which will interfere during sex. All these problems are solved, so they must be discussed with your doctor.
How to resume sex life after giving birth?
There is a myth that during pregnancy and for a long time after giving birth you cannot engage in sex. It arose from the general lack of information due to the fault of the so-called reinsurance doctors, who like to prohibit everything just in case. During this period, there may indeed be contraindications to sexual contact, but they are quite rare: this is bloody discharge of various nature, leakage of amniotic fluid, the threat of premature birth. Normally proceeding pregnancy is not a restriction or contraindication to sexual activity. After childbirth, it is usually possible to return to it after six to eight weeks, ideally after a follow-up visit by a gynecologist.
Another question is whether the woman who has just given birth wants anything. All women have different experiences: after childbirth, tactile sensations, attraction and self-perception change - for someone even for the better. However, for most things are not so simple. The same hormones, in particular prolactin, which is released during breastfeeding, causes suppression of libido and vaginal dryness. In addition, at first, the tone of the pelvic floor muscles and the vaginal tone are disturbed, which may prevent a woman from experiencing an orgasm. The consequences of the mentioned episiotomy or rupture of the perineum are possible; a newly healed suture may interfere. However, more often it gives psychological discomfort: the woman thinks that her vagina is disfigured and this will alienate her partner.
The abdomen is also blown away at once, and the uterus and abdominal muscles do not return to their former size in a matter of seconds. Because, both outside and inside the body, strange sensations can be observed: as if everything is too soft, the organs are not in place, the chest has changed and is constantly flowing out of it - not to mention chronic fatigue and other challenges to motherhood. The partner may also not be ready for an active sex life. If a partner shares parental responsibilities, then also tired. In addition, the fact that partners of young mothers have postpartum depression is not well known. For some, the very presence at childbirth can be traumatic: there have been cases when fathers developed erectile dysfunction after this because of feelings of guilt for causing suffering of the partner who gave birth. Of course, it’s fair and fair to go through everything together, but if your partner faints from the sight of blood, you should treat this with understanding.
And yet the mother goes through the most difficult, because first of all she needs support: you need to help a woman to believe that she is still desirable and sexy, but at the same time not resort to premature pressure. It is important that both partners are ready for the resumption of sexual relations. However, according to a number of studies, if they do not resume in the period up to six months, then it will only be more difficult. Therefore, despite all the novelty and complexity of parenthood, it is important to try to pay attention to each other. It is not necessary to immediately proceed to action: you can start with any comfortable manifestations of tenderness, then gradually move on to foreplay. Focus on the new knowledge of your own bodies and needs: often after birth, new erogenous zones and new desires open up.
Why can postpartum depression occur?
As was said, relationships with oneself during pregnancy are exacerbated. Если ранее женщину не устраивал её образ жизни или собственное тело, то во время беременности фиксация на этих вопросах может усугубиться. При этом будущий ребёнок может неосознанно восприниматься как враг и причина лишений. Даже беременность, которая позиционируется как желанная, внутренне может восприниматься совсем иначе - с возможным желанием прерывания беременности, смешанным с чувством вины за это желание. В таких ситуациях необходимо обращаться к психоаналитику, в противном случае женщина рискует обречь себя и ребёнка на тяжелейший травматичный опыт.In rare, especially severe cases, psychotherapists may recommend terminating a pregnancy in the early stages: it is a difficult decision that may be the most humane for everyone.
Even during pregnancy and childbirth without physiological and psychological complications, there is a risk of postpartum depression and the manifestation of mental disorders. In other cases, successful and emotionally stable women after quite successful births refused to accept children or even claimed that it was not their child. Studies of general psychological practice can not always predict the likelihood of such behavior - in such cases, psychiatrists can connect.
In the absence of a conscious willingness to have a child, in cases where his birth is the result of the demands of a family or society, the world can be perceived as hostile, and pregnancy and motherhood become a trap. If you have decided to give birth, it is worth preparing not only for the childbirth itself, but also for new concerns. It is important to plan your life so that with the advent of the child does not close only on feeding and walking with a stroller. If possible, keep the usual level of social activity - of course, in a comfortable mode.
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