How do contractions turn into dilation contractions, how does the gynaecologist know if you have achieved sufficient dilation and what to do when there is a storm of contractions? And how is the birth of two women different from the birth of one? onen? The pregnancy terms and questions are flying around your ears again. But don't worry, we'll go through them all with you and answer all your questions.
Contraction contractions: now it really starts
You can compare contractions with the waves of the sea. They come on slowly, they reach a peak after which they quietly subside. After a short pause the next contraction appears. Towards the end of your pregnancy you will probably experience preliminary contractions on a regular basis. These - popularly called 'false' contractions - do not say anything about the speed at which the delivery is approaching and can sometimes be quite discouraging. Try to relax and look for distractions. The false contractions eventually turn into 'real' contractions: dilation contractions. These contractions occur more rhythmically than the practice contractions and ensure that the cervix is dilated and opened up.
The first stage of dilation (up to 5 centimetres) often lasts the longest. The dilation contractions are not too intense yet, so try to carry on with your daily activities as much as possible. Are you in bed? Then try to sleep on, because you can make good use of the hours.
In the second phase (5-8 centimetres) the dilation contractions become more intense and the pauses shorter. Try to focus on the contraction and to be in the moment. It stimulates the dilation and the situation does not become hopeless.
The last phase is called the end phase. This is the transition from dilation to expulsion and is perhaps the most difficult phase of all, because you are not fully dilated yet but sometimes you have the urge to push. Giving in to the urge to push can cause the cervix to swell which in turn causes a longer dilation. Hang in there, mama! This phase is the most intense, but lasts the shortest of all (Pregnant Fit).
How long the dilation phase lasts differs per woman and per birth. It may also happen that the dilation stops for a while. No problem, this is perfectly normal. To speed up the dilation you can sit up straight or walk around. This will often help (NVOG). If the last few centimetres really do not want to progress, the midwife or obstetrician may try to massage the last edge away. You may also decide to administer extra oxytocin (a hormone that triggers contractions). Often you will experience more pain and discomfort during the exorcism because it is much faster (NVOG). If mother and baby are doing well, there is often no need to intervene. The contractions often start by themselves. Erection contractions turn into pressure contractions. You can read more about this in this blog.
Contractions, what now?
Contractions are there for a reason: they cause dilation and help you to push. Usually there are a few minutes between two contractions. Those few minutes are very nice to catch your breath, but sometimes the contractions come so fast that you cannot distinguish between them. The one contraction then immediately changes into the other. We call this a storm of contractions. Such an attack of contractions may hurt quite a lot and cost a lot of energy. An advantage of a wave of contractions is faster dilation. So know that the birth will not take long anymore.
With an induced birth, there is a greater chance of a storm of contractions. When oxytocin is administered to provoke contractions, your body can sometimes get a little confused, causing a wave of contractions. The gynaecologist will try to calm down the storm by using anti-pain medication. Your baby may be deprived of oxygen if the contractions continue for too long (Isala). It can sometimes happen that your little one looks a little blue during a rapid exorcism, but this is nothing to worry about. It often clears up soon after the birth.
Also during a labor storm, our tip is: relax. This sounds like an impossible task, but the more tension you hold on to, the more painful the labor storm becomes. Focus on your breathing and try to puff away the contractions. A warm bath or a hot shower can also be nice (Pregnancy Portal).
To determine how much dilation you have and whether dilation has started at all, the midwife will touch you. Touching is another word for internal examination. During this examination the midwife inserts two fingers into your vagina and this way she can measure the progress of the dilation, feel if the cervix has softened and check if your baby has descended. Touching usually does not hurt, but it is often experienced as unpleasant. Touching the baby between contractions is often the most pleasant. Communicate well with your midwife when you feel a contraction coming on (Pregnancy Portal). Try to relax as much as possible. Low abdominal breathing and a little squeezing during touching may alleviate the unpleasant feeling a little (Pregnant Fit).
Giving birth to two
If you are due to give birth to twins, it is likely that delivery will occur around week 37. Twins are more likely to be born prematurely because there is simply limited space in your abdomen and because the uterus stretches, the contractions often start earlier on their own. Your gynaecologist may also advise you to give birth earlier. In both cases you will give birth in hospital, as there is a greater risk of complications when giving birth to twins.
When the first one is born, the second one often comes soon after. When number one is out, number two will start to move. The gynaecologist will use an ultrasound to check whether the second is in a good position to be born. If it is longitudinal, you can often wait for the contractions to start again, but if it is transverse the gynaecologist will first try to turn it. If this fails, the doctor may carefully pull the baby out by both legs (buttress extraction) or perform a Cesarean section to bring the second child into the world. (Thuisarts, 2019). In some cases, the gynaecologist will advise a planned Cesarean section, for instance if your babies are stunted or both are breech. It is then safer for you and your baby to opt for a caesarean section (Radboud UMC).
Hope you've grown a little wiser, mama! Check out our other blogs for another dose of pregnancy terminology, because we'll help you through your pregnancy and delivery with love.
Hentzepeter-Van Ravensberg, H. D. (2008). 9 The beginning of labour. https://link.springer.com/chapter/10.1007/978-90-313-6304-9_14?error=cookies_not_supported&code=e89dc5e6-a8f6-420e-b039-5637190d4ca9
Isala. (2020, March 10). Inducing labour (priming). https://www.isala.nl/patientenfolders/5416-inleiden-bevalling/
NVOG. (s.d.). Spontaneous vaginal birth. https://www.nvog.nl/wp-content/uploads/2018/02/Spontane-vaginale-baring-2.0-14-11-2013.pdf
NVOG & Thuisarts.nl. (2019, November 5). I'm going to give birth to twins. https://www.thuisarts.nl/zwanger-van-tweeling/ik-ga-bevallen-van-tweeling#hoe-gaat-vaginaal-bevallen-van-een-tweeling
Radboud UMC. (s.d.). The delivery. https://www.radboudumc.nl/patientenzorg/aandoeningen/tweeling-of-meerlingzwangerschap/de-bevalling
Pregnancy Portal. (2020a, April 20). Storm of contractions. https://www.zwangerenportaal.nl/bevalling/alles-over-ween/weenstorm
Pregnancy Portal. (2020b, October 5). Touching. https://www.zwangerenportaal.nl/bevalling/toucheren