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Many maternity hospitals, such as the Diaconesses in Paris, are now trying to reconcile technique, safety and the wishes of future mothers. No more having to give birth on your back, immobilized on a bed, feet wedged in the stirrups. Even under an epidural, we leave you free to adopt more spontaneous postures, on your side, squatting, on all fours… Step by step, here is how childbirth takes place.
The preparation
Nine o’clock in the morning. That’s it. Clarisse is installed in the birth room, on the 3rd floor of the maternity ward. A large window opens onto the garden and the light filtered by a blind diffuses a soft shadow in the room. Sitting next to her, Cyril, her husband, looks rather relaxed. It must be said that this is their second baby: a girl, whom they will call Lili. The midwife, Nathalie, has already come for a blood test and a blood pressure test. She now feels Clarisse’s belly to make sure that the baby is properly presented, upside down. Everything is fine. To confirm this first clinical examination, she carefully fixes the monitoring on the belly of the future mother. Two sensors that continuously record the activity of the fetal heart and the contractions of the uterus. This allows for better monitoring of the baby. To see how he reacts to the contractions. For her part, Denise, the nurse, is also busy. She sets up the infusions. Glucose serum to give the mother strength and salty serum to reduce the drops in blood pressure sometimes associated with epidural analgesics. These infusions can also be used to pass oxytocics. These synthetic molecules mimicking the action of oxytocins, naturally secreted by the body, help regulate the rate of contractions and speed up labor. But their use is not systematic.
The installation of the epidural
It is already eleven o’clock. Clarisse is starting to have a lot of pain. The contractions came together, about three every 10 minutes. Now is the time to put on the epidural. The nurse makes the mother sit on the edge of the bed. To have a well rounded back, she comfortably wedges a pillow under her chin. The anesthetist can now brush her back with a strong antiseptic before giving local anesthesia. In a few minutes, Clarisse no longer feels anything. The doctor then inserts the hollow, bevelled needle into the epidural space, between the 3rd and 4th lumbar region, and slowly injects the analgesic cocktail. Before withdrawing the needle, he slides a thin catheter like a hair which will remain in place and will allow, thanks to an electric syringe, to constantly diffuse the product in small quantities. Properly dosed, the epidural effectively removes pain and no longer prevents sensations from being retained., as was the case a few years ago. The proof, some maternities offer an outpatient epidural, allowing if desired to walk in the room or in the corridors.
Work continues calmly
Midday. All the medical device has been put in place. Nathalie came to break the bag of amniotic fluid using a membrane piercer. This painless gesture allows the baby to press more firmly on the cervix and accelerates dilation. In the birth room, Clarisse and Cyril can still enjoy moments of privacy and freedom. A CD player is even available in the room if they wish to listen to music.
Today, the mother-to-be no longer necessarily has to stay nailed to her bed. She can sit up, stand up and adopt the position that suits her best. In some maternities, such as the Deaconesses, she can even take a bath to relax. Throughout this phase, the midwife regularly visits the mother-to-be to check the progress of labor. She does a vaginal examination to control the dilation of the cervix. And look at the monitoring curves to ensure the effectiveness of the contractions and the state of health of the baby. If necessary, she can also adjust the dose of the epidural so that working conditions are as comfortable as possible.
The cervix is dilated
XNUMX:XNUMX p.m. This time the collar is at full dilation: 10 cm. Under the effect of the contractions, the baby is already well engaged in the pelvis. But to reach the exit, he still has to go through a long and narrow tunnel of about 9 cm. On monitoring, all the lights are green. Clarisse remains free of her movements. Lying on her side, she pushes, exhaling with each contraction. “Like when you blow into a balloon”, explains the midwife. Then get back onto his back and grab his legs to give more strength to his thrusts. New look at monitoring. Everything is fine. The baby continues its descent. Kneeling on the bed, a large ball installed under her arms, Clarisse still continues to push, while swaying. The baby has now reached the maternal perineum with his head. We can see her hair. This is the last step before going out into the open.
Expulsion
For the expulsion, Clarisse finally chooses to come back on her back. One last effort and the head sticks out, then the rest of the body that comes on its own. The mother, helped by the midwife, grabs her little daughter, Lili, to place her delicately on her stomach. It is four o’clock. Cyril, the father, approached the bed. Moved, he looks at his little girl coiled skin to skin against her mother. Full of vitality, she now cries out loud. To their delight, the parents do not even see the midwife who has just cut the umbilical cord. A perfectly painless gesture, because this gelatinous tube does not contain any nerves. Lili spat a bit. It’s okay, his nose and throat are just a little congested with phlegm. The midwife takes her for first aid and promises to bring her back very quickly. Clarisse, smiling and relaxed, feels a few contractions again, but much lighter. A final push to expel the placenta, and it is finally deliverance. Lili, who passed her first check-up with flying colors, has already found the warmth of her mother’s belly for tender skin to skin.