Background information
Yay, we're pregnant or help our world is upside down?
by Norina Wartmann
Oh, my waters have broken!
2.6.2017
Translation: machine translated
I, Norina Wartmann, am a midwife and I'm going to tell you the story of Fabienne and Peter. They are expecting their first child soon. I got to know the couple last time. This time it's all about antenatal classes, the sugar test and premature labour. And what the hell is a macronome child?
In my first report "Yay, we're pregnant or help our world is upside down?" I introduced you to Fabienne and Peter. They are now expecting their first child in around 2 months. The couple have decided to give birth in hospital. I am their attending midwife and have been accompanying them on this fantastic adventure since the start of their pregnancy. You can find out how the story began here:
It's been four weeks since I last visited Fabienne and Peter. Since we last met, the two of them have attended a birth preparation course for parents-to-be.
"Simply super. You know Norina, I was expecting everything, including sitting on a mat panting and having to do some weird contortions. But far from it. Above all, the midwife explained very precisely in which phase of labour what was happening and how I could support Fabienne. The dialogue with the other men was also helpful. I really appreciated that. Does a birth really take that long?" Peter asks me.
"Every birth is unique, no two are the same Peter, but normally the first children take their time, which can sometimes take 24 hours. However, time generally passes incredibly quickly during a birth, I'm always amazed at how quickly the hours fly by. So don't worry! The labour breaks provide relaxation in between. Because these breaks happen again and again until the end. The mother, the baby, the man and the midwife can recover a little during this phase and gather new energy for the next labour. Focus on these breaks during labour," I replied.
Fabienne adds with a smile: "It was very helpful for me to simply hear what happens during a birth and what options there are for dealing with the contractions. I now listen to the hypnosis regularly and I have the feeling that it's good for me. I have respect for the birth, but I'm really looking forward to it."
Birth preparation courses
There are a number of antenatal classes on sale. As a rule, a course is attended between the 28th and 32nd week of pregnancy. Hospitals, midwives and the Migros Club School are just three of the many suppliers that offer specialised antenatal courses. It is up to the woman whether she attends the course alone or with a companion. You can also decide for yourself whether to take an evening course or a weekend course. But panting and contortions are hardly to be found today as they used to be. However, hypnosis for deep relaxation is always a topic these days. It's also worth starting at an earlier stage.
No matter which course you end up attending. Giving birth is a natural process. Mother and child are well equipped for it and nature has made private pension provisions. The body intuitively knows what to do, but it is certainly an advantage if you as a mother know what happens to your body during a birth. Which phases of birth you go through and which possibilities there are to deal with the contractions/pain. Good courses will show you how you can prepare for the birth and the time afterwards. And after every course, you should realise that no two births are the same. Jumping waters and screaming taxi rides from Hollywood films may be funny, but they have little to do with reality.
When things suddenly turn out differently
One day before our actual appointment for the next pregnancy check-up, Fabienne calls me. She is unsettled.
"Hello Norina, do you have a minute?"
"Of course, what can I do for you?"
"I've had downward pressure and a stinging sensation in my vagina for a few days now. Is that normal?"
"Does your tummy get hard more often?"
"Yes, all the time."
"Sounds like premature labour. It's best if you go to the hospital for a check-up so that we can see whether the hard belly and the stitching are affecting the cervix or not. If the cervix is stable and has not shortened, you can rest assured. If it has shortened, we know that you need to take it a little easier and it's best to take a sick note."
As a woman, you know your body best. You know when something hurts, when something is not normal, when you no longer feel well. Take time for yourself and your child. Listen to your inner voice and if you are unsure, it is better to call your midwife or doctor once more and have yourself checked if necessary.
Preterm labour
Fabienne is now 33 weeks pregnant. If the baby were to be born now, it would most likely still need help with breathing, regulating its heat balance and feeding. By the 35th week of pregnancy, it can be assumed that the lungs are fully developed. As the due date approaches, the uterine muscles become more active and prepare for labour. This is harmless from the 36th week of pregnancy onwards. However, if a woman has a hard belly more than 5-10 times a day, feels downward pressure, or the contractions are painful or regular, the length of the cervix should be measured to rule out premature labour. In premature labour, rest, magnesium and bryophyllum (herbal medication to inhibit contractions, among other things) can help. In addition, Ingeborg Stadelmann's toko oil or lavender oil can be gently applied to the abdomen. If these measures do not help or if the cervix is severely shortened, a stronger labour-inhibiting medication or possibly an inpatient stay in hospital may be necessary.
Macrosome child
Fabienne contacts me after the examination and is quite shaken.
"You were right with your assumption. My cervix is shortened, I'm now on sick leave and have to take it easy for the next 2-3 weeks. Tomorrow I have to see a specialist because my doctor saw an irregular heartbeat on the ultrasound."
I try to calm Fabienne down a little, but quickly realise that there's not much left of the stable, calm pregnant woman at the moment. Which is understandable. As soon as it comes to our children, we are much more worried and insecure. But Fabienne was given the all-clear after the heart ultrasound.
"Fortunately, everything is fine with our baby's heart. But there is a new problem. According to the professor, our baby is much too big. A "macrosomic child" that is so huge that it doesn't even fit into the birth canal. He advised us to have a sugar test done again, as he suspects unrecognised diabetes."
"I don't think you have diabetes Fabienne. And I'm sure your child will fit you perfectly, these ultrasound measurements should always be treated with caution."
One day later, I visit Fabienne. On her doorstep, I take a deep breath, knowing that there won't be much left of the relaxed, healthy, pregnant woman I met a few weeks ago. Fabienne is nervous and hands me the report from the professor, everything is unremarkable, except for the "macrosomic child" and the recommendation of another sugar test to rule out diabetes.
"I was so confident and I was doing well.... And now I always see this huge, larger than average child inside me and wonder how it's going to get out of there! In my mind it's really huge and it's getting heavier every day! Do I need a caesarean section? Would you notice if it doesn't fit through or will it burst my pelvis? I was looking forward to the birth and now I just have these images of this much too big child in my head."
Fabienne is a small and petite woman. I want her to tell me how her mother gave birth and how difficult it was for her to give birth. It turned out that her mother was also a small woman and that she fitted through the birth canal perfectly as a baby despite her heavy weight. It also depends on when the baby chooses to be born. This is because all children born between three weeks before and two weeks after their due date are considered term babies. Only around 4% of all children are born on the exact day of their due date.
I feel Fabienne's belly and reassure her that her child fits her and her body perfectly and that it is simply a long child with long legs. Fabienne really wants to stop taking all the labour-inhibiting medication such as bryophyllum (herbal) and magnesium. I hesitate for a moment, but I sense that it is important for her to get moving again in order to promote her well-being and the healthy side of her. She now wants to give the baby the freedom to decide when to start the journey out of the warm "home". She just hopes it doesn't get any bigger.
Sugar test / diabetes
A fasting blood glucose level is measured in every pregnant woman between the 24th and 28th week of pregnancy in order to rule out or treat gestational diabetes
. If the fasting value is elevated, a sugar solution is drunk and after one or two hours it is checked to see how the body can break down the sugar. If diabetes is diagnosed, the first step is to try to stabilise the blood sugar levels with an appropriate diet. If this is not successful, insulin must also be injected. If diabetes is not recognised or is treated incorrectly, the child tries to help the mother to break down the excess sugar. The consequences are that the child grows large and excretes a lot, which subsequently leads to a lot of amniotic fluid. After birth, the child cannot maintain its blood sugar level because its body produces too much insulin. It is therefore important to recognise any diabetes at an early stage.
Fabienne took another blood glucose test to be on the safe side. The value was so low that diabetes could be ruled out. I asked the doctor at the hospital to speak to Fabienne again and reassure her that although her child wasn't small, it would fit her perfectly.
Back to normality
"A week ago, I went into hospital healthy and came out sick. Today I went in sick and came out half-healthy. I'm slowly finding my way back to myself and my child," says Fabienne. She has overcome the crisis, listens diligently to her hypnosis and prepares her perineum for the birth with massage and the EPI-NO. She drinks raspberry leaf tea, which softens and loosens the tissue, and eats linseed, which is popularly known to make the children "slip". At her check-up in week 38 of pregnancy, Fabienne opens the door to me beaming with joy and with red cheeks. My first thought is that the birth will probably not be long in coming. Because the red cheeks, the soft face and her full lips are signs that things are about to start.
"I'm fine again, the baby can come when it wants. It will know when the time is right!"
"Everything is fine Fabienne and your child has slipped into the pool and taken up their starting position. Have you packed your bags?"
"Yes of course Norina, I packed two weeks ago. The warm grandmother's socks, a loose, comfortable T-shirt from Peter, my favourite music, a few clothes for the baby, glucose, dates and a few other little things to keep me going. Peter took the 24-hour labour very seriously and packed lots of food and drink for himself. At least we won't have to deal with a hungry man."
"Great, you're well organised as always. I wouldn't have expected anything else from you. Just don't forget your blood group card and the documents for the registry office."
I say goodbye to Fabienne, with the feeling that this baby will probably want to be born soon. My phone rings just five minutes later. Have I forgotten something? No, it was Fabienne - her waters have broken. The baby's birth is imminent. I'll tell you how Fabienne and Peter's story continues and whether it really was a Macrosome baby in the next part.
Header image: Meditation provides sufficient relaxation in the last trimester of pregnancy.
Midwife for 10 years and this with absolute passion. It is close to my heart that women are allowed to give birth in dignity, self-determined, protected and in their own rhythm. Creating a space where parents can welcome their children into this world undisturbed and lovingly is one of my greatest concerns. This requires a lot of flexibility. Births cannot be planned and neither can my life. The phone rings and I'm off... for how long, nobody knows exactly. Even a mother of two wonderful children, married to an understanding man and surrounded by many loving people. Without this fantastic environment and reliable help, my life would be different. <br><a href="http://hebammen-begleitung.ch/" target="_blank">www.hebammen-begleitung.ch</a>
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