Enfª Patrícia Sancho

Enfº Tito Manuel Félix

Como saber se chegou a hora?
Sinais de trabalho de parto

HPA Magazine 5

Childbirth is a very exciting moment, fraught with expectations and a multitude of feelings. It is since the beginning of time associated with intense pain, many hours of “suffering” and is primarily considered a painful moment. It is for this reason that as the moment of birth approaches the future mother becomes more anxious and fearful. The truth is, that labour and childbirth are real challenges, assuming one of the most important and unique experiences in the life of a woman / couple and family. This experience must thus be lived in a very special and intimate way, culminating in the couple’s most prized possession: their child. This moment should therefore not be trivialized and whenever possible lived as a threesome. We must always remember and respect that just as every pregnancy is unique, the experience of labour and childbirth are equally different from woman to woman, couple and family.

Such as the name implies “labour” means work which in this case is both physically, psychologically and emotionally demanding, but results in an unparalleled outcome. The couple must prepared for the big day and be ready for this very demanding period in their lives. It is therefore essential that they are both informed on the first signs of labour and childbirth so that they both know how the woman’s body will react, what the role of the father will be, how to interact from pre-conception to birth and through the different stages of pregnancy.
Under normal conditions, a pregnancy reaches term at 37 weeks. Unless an elective caesarean section is scheduled or the induction of labour become necessary or justified, the onset of labour is spontaneous. Being spontaneous it may occur at any time of the day or night and in unexpected situations. For this reason expectations are high and with the culmination of pregnancy anxiety increases, as does the bid question: will it be now?
Throughout pregnancy and during the consultations with the obstetrician and specialist nurses in maternal health and obstetrics at the Maternity of the Hospital Particular in Gambelas, couples are provided with information which will permit them to face the moment with serenity. Some of the topics covered are:

THE MUCOUS PLUG?
The mucus plug is a jelly like membrane situated in the cervix. It is normally brownish, contains blood and is eliminated before delivery. It is not a sign of labour. However it is an indication that labour may be close. On its own it is not an alarm signal or indication of a trip to the Maternity.

WHEN SHOULD I MAKE MY WAY TO THE HOSPITAL? 
Certain signs and symptoms although they might not be a sign of imminent labour, may be of the utmost importance and urgency requiring surveillance and observation by a professional. For this reason the team of midwives and nurses of the Maternity Unit are available on a 24H basis to answer any question on – 289 830 040. In addition, there is always an obstetrician on permanent duty at the Maternity Unit of the Gambelas Hospital.
The future mother to be, should make her way to the Maternity Unit of the Hospital Particular in Gambelas when:
1. She realizes that there is a drastic reduction in the baby’s movement pattern or that there is a lack thereof. After the 35th week of pregnancy, every pregnant woman know that there must be at least 10 foetal movements over a 12 hour period. Once the first foetal movements are felt, any alteration of the typical movement pattern she is used , must be reported that same day and monitored by a professional. 
2. If there is blood loss. This should not be confused with the mucous plug which is normally streaked with blood and sometimes noticed after using the toilet. We refer to a considerable loss of blood, similar to the menstrual flow. This is a serious alarm signal and requires an immediate trip to the hospital for medical observation. 
3. If the amniotic sac ruptures or a rupture is suspected. When the “waters break” the traces of amniotic fluid can be more or less evident depending on the quantity lost. In most cases there is no doubt and there is an abundant loss of fluid to the point of soaking clothes. It usually has a crystalline appearance similar to urine and a characteristic smell. If this occurs the future mother should take a back and make her way to the Maternity Unit. The Maternity Unit should also be contacted and informed of the time at which this occurred and the characteristics of the fluid lost. This does not mean that the woman is in labour (there might be no contractions or dilation) but it means a hospital admission. 
4. Constant vomiting. During the 1st trimester this is usual but for the remainder of the pregnancy, constant vomiting is not expected, so it is a situation that requires medical observation. 
5. Feeling bloated. If this sensation does not improve with rest and occurs together with intense headaches, blurred or double vision and stomach ache, medical assistance must be sought. 

HOW WILL I KNOW THAT I AM IN LABOUR? 
Labour is in progress when there are contractions of the womb, capable of effacing the cervix and causing a dilation of over 3 to 4 cm. Contractions are identifies due to abdominal stiffness during a certain period of time. Pelvic, abdominal and even lumbar pain may also occur. 
During pregnancy and especially near the end of pregnancy it is normal to feel some contractions, almost always painless, sporadic, irregular (Braxton Hicks), often detected during a routine CTG. These contractions revert with rest and should not be confused with labour. There is no need to seek medical assistance. 
A couple should make their way to the Maternity Unit when they identify a pattern to the contractions. To identify the pattern the regularity of the contractions must be monitored when the contractions are about 60 to 90 minutes apart. In this active phase of labour contractions do not revert with rest. On the contrary, the regularity and intensity will increase resulting in childbirth. When contractions are 10 minutes apart for 2 hours or every 5 minutes for at least 1 hour, (depending on how far they are form the Maternity) it is time to make their way to the Hospital. During this process it is possible to be in constant contact with the Maternity nurses via the 24H HELP LINE.

PAIN AND CONTRACTIONS.
Contractions mean that the uterus is contracting and this causes discomfort. Depending on each woman’s pain threshold, and often their psychological state (fear / fear of childbirth), these contractions can be very strong and can either be bearable or unbearable.

PAIN RELIEF
Pain and suffering are the fundamental reasons why women fear childbirth. However, nowadays and due to existing pharmaceutical methods (epidural, gas mask, intravenous medication) non-pharmaceutical methods (walks, shower, massage, swiss ball, peanut ball, and others) and the father’s presence or another close member of the family, childbirth can be faced in safety with serenity and comfort. 
Issues concerning pain relief should be discussed with the obstetrician, the specialist nurses in maternal health or the midwife during the pre-natal consultations or even in the pre-natal “Ervilhitas” classes available at the Hospital Particular do Algarve. The couple must be informed on the various options available so that they can make an informed choice on the method or methods of pain relief that best suits them. Together with the maternity staff the couple can devise their own personalized labour and childbirth plan. Pregnancy should be enjoyed as each pregnancy is a once in a lifetime experience. 
Childbirth is an unparalleled moment so it should be lived intensely. Prepare for your most joyful and unforgettable moment, when for the first time you hold your baby in your arms.
The Maternity Unit of the Hospital Particular in Gambelas has exclusive private rooms and suits, in order to provide the mother-to-be with a warm, quiet and private environment. The father or a member of the family of her choice may remain with her throughout labour, relying on the unconditional support of a team of professionals that is working to provide the couple with the most delightful moment of their lives.