Pregnancy and childbirth are not an easy topic of conversation. Like any taboo, this question has managed to acquire an abundance of myths and misconceptions. It would seem that the abundance of information on the Internet should help women, but often only multiplies fears. How to deal with pain, fear and responsibility, and after all, stay in harmony with yourself? We decided to ask the experts important questions about pregnancy, childbirth and life after them. The physiological side of the issue was helped by the doctor-gynecologist, candidate of medical sciences Tatyana Rumyantseva. We talked about the risk of postpartum depression with clinical psychologist Marina Filonenko, and psychotherapist Olga Miloradova talked about the manifestation of personality traits during pregnancy and the return to sex life after childbirth.
What is the reason for mood swings in pregnant women and is it worth fighting with?
It is no secret that many women find it more difficult to deal with their emotions during pregnancy, and it is known that a lot of this is 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. Moreover, such violations are noted quite often, especially in the last trimester of pregnancy and in the first time after childbirth.
Nevertheless, it is not entirely logical to explain the excessive vulnerability of pregnant women solely by physiology. The fact is that anti-stress hormonal mechanisms are triggered during pregnancy: increased activity of oxytocin systems and suppression of the hypothalamic-pituitary system reduce anxiety. Mood swings and uncontrollable emotions of pregnant women are much more clearly explained in terms of psychology, and sometimes psychopathology. Despite the fact that pregnancy is an absolutely normal physiological process, in a psychological sense it is a period of crisis, and especially when it comes to the first pregnancy.
Every woman has her own personality traits that are exacerbated when you find yourself in a situation that, in the long run, will completely change your life. Changes appear in behavior, due to which the very "inadequacy" is attributed to pregnant women. Someone's mood changes, someone begins to suspect violations in themselves or the fetus, someone is too nervous, and someone has unresolved conflicts with their own mother. If it is not worth fighting the influence of hormones, since they are necessary for the normal development of the fetus, then it is worth working with psychological difficulties before pregnancy.
Is it true that vision decreases during pregnancy?
Changes in eye function are detected in about 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 functioning of the eyes. The sensitivity of the cornea may change - then a feeling of dryness comes, it is more difficult to wear contact lenses. There are changes in intraocular pressure, which can lead to a feeling of eye fatigue and decreased visual acuity, as well as hyperpigmentation of the eyelids. After pregnancy, vision usually returns to normal. Pathological changes can be associated with complications of pregnancy (eclampsia, thrombosis) or be the result of previous problems.It is impossible to understand whether the changes are physiological or pathological without special research methods, therefore consultation of an ophthalmologist, and often a neurologist, is required.
Why are infectious diseases dangerous during pregnancy?
There is a separate group of TORCH infections that can potentially have consequences for the fetus. These include, for example, the notorious herpes and toxoplasmosis. The severity of the consequences depends on the time of infection. With toxoplasmosis, the risk of fetal infection is lowest if a pregnant woman becomes ill in the first trimester (10–25%), in the second, the risk increases to 30%, and in the third, it is 60–90%. At the same time, if the infection occurred 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 an extremely rare occurrence during pregnancy.
As for herpes, labial, with rashes on the face, in most cases it does not affect the course of pregnancy and is not dangerous for the fetus. The danger is genital herpes, especially with primary infection during pregnancy. True, under his condition, fetal infection occurs extremely rarely - in 85% of cases, the child becomes infected during childbirth. Unfortunately, so far there is no treatment method that would guarantee that there is no harm to toxoplasmosis or herpes for the fetus.
How painful is it to give birth?
Childbirth is really very painful, but the degree and nature of the pain depends on the course of childbirth, the woman's pain threshold, and the psychological mood. On the other hand, it doesn't hurt all the time. The first stage of labor, contractions, can last an average of six to 11 hours and is accompanied by painful sensations from a few seconds to a minute. But there is also "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.
With attempts, that is, immediately at the birth of a child, the contractions continue, but the woman herself is included in the work - she strains the muscles of the anterior abdominal wall. This makes it easier for many patients: firstly, they are finally allowed to push, and secondly, the normal duration of pushing is up to an hour, so it is clear that the end is near. True, some at the moment of attempts become unbearably painful, and the inability to push extends the time of childbirth. After the birth of the child, the third stage of childbirth begins - the expulsion of the placenta, that is, the "birth" of the placenta. This usually happens in two to three contractions, which are much less painful than before the baby is born. The placenta is quite soft, and after the passage of the child through the birth canal, its birth is most 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 woman's desire. In some countries (USA, Canada) 60% of women give birth using this method of pain relief. There are also medical indications: preeclampsia, prolonged labor, multiple pregnancies, diseases of the cardiovascular or respiratory systems in the patient, obesity. In accordance with international recommendations, anesthesia can be started at any time of childbirth, in Russia it is most often used starting from three to four centimeters of cervical dilatation. It used to be thought that it made sense to “turn off” pain relief during labor, but it has been proven that pain relief can continue until the end of labor.
It takes time (about twenty to thirty minutes) to call the team of anesthesiologists and insert the catheter, and therefore, if you decide on epidural anesthesia at the time of attempts, it may be too late: the labor may end sooner than the pain relief can begin.If there is no medical staff trained in the procedure, or it is not possible to monitor the fetal heart rate, epidural anesthesia should not be given. In addition to the woman's reluctance, absolute contraindications are circulatory and blood clotting disorders, increased intracranial pressure, and infection of the puncture area.
When using epidural anesthesia, there may be a pulling sensation in the lower abdomen (as with menstruation), but there should be no severe pain. One of the side effects is numbness in the legs: this is normal and will go away after the drug stops working Most often, the spinal root is compressed, rather than damaged, since soft catheters are used for this procedure. If sensitivity in the legs does not return, it is important to pay the doctor's attention to this: this may indeed be the result of an injury to the spinal cord root, however, the incidence of such a complication is only 0.6 per 100 thousand women.
When is a cesarean section done?
Indications for caesarean section differ in different guidelines, but there are many. Caesarean section is mandatory if there is a danger to the life of the fetus (irregularities in the heartbeat, prolapse of the umbilical cord) or to the life of the mother (profuse bleeding, a sharp increase in pressure), as well as in the case of mechanical obstacles to the birth of a child: the narrowness of the birth canal of the mother or especially large sizes fetus. Caesarean is also carried out in some cases of weak labor - when the strength of the contractions does not increase and the child cannot move along the birth canal. In another group of indications, in which caesarean is not always carried out, but most often, very different conditions - from placenta previa or mother's diseases (diabetes, arterial hypertension) to exacerbation of genital herpes or genital warts, HIV infection.
In Russia, in some maternity hospitals there is an unofficial indication of "a woman's desire." It is possible to agree in advance with the doctor about a planned operation, but this is not considered completely ethical and expedient. The concept of “not suffering” is also not entirely applicable here: after the operation, a woman finds herself with a newborn baby and with a seam on her abdomen, which creates noticeable discomfort and interferes with standing up or taking the baby in her arms. In order not to "suffer", an epidural anesthesia was created: this is the most gentle delivery option for mother and child.
Is it really more difficult to give birth to petite women and those with a narrow pelvis?
A narrow pelvis can really be an indication for a cesarean section. However, this is not determined "by eye": it is possible to speak about a narrow pelvis only after measuring it with a special instrument. This is done when the mother is registered at the clinic. If a woman has any of the types of narrowing of the pelvis, during pregnancy, careful monitoring of the possible size of the fetus is carried out, and the tactics of labor management are based on the correspondence of the size of the birth canal of the mother and the head of the fetus. Before childbirth, if in doubt, roentgenopelviometry is possible - an additional study to assess these ratios.
There is no pattern “the greater the height or weight, the easier it is to give birth”. One can only note the connection between physical fitness and ease of childbirth. For women who did not have physical activity before pregnancy, it is often more difficult to give birth: the muscles of the anterior abdominal wall also take part in childbirth, and if they are not trained at all, this complicates the process. However, weight and physical activity are often unrelated.
How often do perineal ruptures occur during childbirth and why are they dangerous?
Fortunately, in modern practice, birth ruptures occur quite rarely due to the use of episiotomy (less often - perineotomy). Episiotomy - an incision diagonally from the vagina to the ischial tubercles, perineotomy - an incision towards the anus. The threat of perineal rupture is just one of the indications for an episiotomy.Ruptures are dangerous mainly by damage to the muscles of the anal sphincter, since the rupture most often occurs precisely in the direction of the anus. Such serious injuries lead to fecal incontinence in the future, therefore, if the 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 delivery. Unfortunately, this cannot always be achieved due to contraction of the vaginal muscles, bleeding from the wound, making it difficult to see, or sudden movements of the patient. As a result, the innervation of the gap region may be disrupted. However, more often this leads to the appearance of pain points, and not to loss of sensitivity in the area of the 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 way of treatment. A properly sutured incision or tear later looks like a thin scar, almost invisible to the inexperienced eye. With the proper technique of intervention, the appearance of the genitals does not change in any way.
Does the vagina lose sensitivity after childbirth and is it true that it stretches?
During childbirth, the head of the baby passes through the birth canal of a woman, and it is still much larger than anything that was in the vagina of most women until this moment. The vagina, of course, is stretched, which at first can lead to a change in sensations during sex, but, as a rule, within a couple of months after giving birth, the vagina is "collected". The gynecologist will almost always distinguish the vagina of a woman who has given birth from the vagina of a woman who has not given birth, but in most cases it will return to a state where the woman herself will not notice the difference.
If the vagina remains "free" and this does not suit in intimate life, there are modern effective techniques for restoring the vagina. What a woman can do herself is exercises to strengthen the muscles of the pelvic floor (Kegel exercises). They can also help prevent or combat urinary incontinence, prolapse of the vaginal walls. True sensory loss occurs only after a traumatic birth. In addition, there may be a feeling of dryness or soreness in the vagina, which will interfere with sex. All these problems can be solved, so they must be discussed with the attending physician.
How to resume your sex life after childbirth?
There is a myth that sex is prohibited during pregnancy and long after childbirth. It arose from a general lack of information due to the fault of the so-called reinsurers, who like to prohibit everything just in case. During this period, contraindications to sexual intercourse may indeed arise, but they are quite rare: these are spotting of a different nature, leakage of amniotic fluid, the threat of premature birth. A normal pregnancy is not a restriction or contraindication to sexual activity. After giving birth, you can usually return to her after six to eight weeks, ideally after a follow-up examination by a gynecologist.
Another question is whether a woman who has just given birth wants closeness. All women have different experiences: after childbirth, tactile sensations, attraction and self-perception change - for some, even for the better. However, for the majority it is not so simple. The same hormones, in particular prolactin, which are secreted during breastfeeding, cause suppression of libido and vaginal dryness. In addition, at first, the tone of the pelvic floor muscles and the tone of the vagina are disturbed, which can prevent a woman from experiencing an orgasm. The consequences of the mentioned episiotomy or perineal rupture are possible, a freshly healed suture can interfere. However, much more often this causes psychological discomfort: a woman thinks that her vagina is disfigured and this will alienate her partner from her.
The abdomen also does not deflate immediately, and the uterus and abdominal muscles do not return to their previous 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 breast has changed and is constantly flowing from it - not to mention chronic fatigue and other challenges of motherhood. The partner may also not be ready for an active sex life. If the partner shares parenting responsibilities, then he too gets tired. In addition, it is little known that the partners of young mothers have postpartum depression. For someone, the very presence at childbirth can be traumatic: there are cases when fathers then developed erectile dysfunction due to feelings of guilt for the fact that they caused the suffering of the giving birth partner. Of course, it's honest and fair to go through everything together, but if your partner faints from the sight of blood, this should be treated with understanding.
And yet, the mother goes through the most difficult, therefore, first of all, it is she who needs support: it is necessary to help the woman to believe that she is still desirable and sexy, but at the same time not to resort to premature pressure. It is important that both partners are ready to resume sexual relations. At the same time, according to a number of studies, if they are not renewed in a period of up to six months, then it will only be more difficult. Therefore, despite all the novelty and complexity of parenting, it is important to try to pay attention to each other. It is not necessary to immediately move on to active actions: you can start with any comfortable manifestations of tenderness, then gradually move on to foreplay. Focus on new knowledge of your own bodies and needs: often after childbirth, new erogenous zones and new desires open up.
Why can postpartum depression occur?
As mentioned, the relationship with oneself during pregnancy is exacerbated. If a woman was previously not satisfied with her lifestyle or her own body, then during pregnancy the fixation on these issues can be aggravated. At the same time, an unconscious child may be perceived as an enemy and a cause of hardship. Even pregnancy, which is positioned as desirable, can internally be perceived quite differently - with a possible desire to terminate the pregnancy, mixed with a sense of guilt for this desire. In such situations, it is necessary to contact a psychoanalyst, otherwise the woman risks dooming herself and the child to the most difficult traumatic experience. In rare, especially severe cases, psychotherapists may recommend early termination: this 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 manifestations of mental disorders. In other cases, successful and emotionally stable women, after a completely successful birth, refused to accept children or even claimed that it was not their child. Studies of general psychological practice cannot always predict the likelihood of such behavior - in such cases, psychiatrists can be involved.
In the absence of a conscious readiness to have a child, in cases where his birth is the result of the demands of the family or society, the world can be perceived as hostile, and pregnancy and motherhood become a trap. If you have decided to give birth, you should prepare not only for the birth itself, but also for new concerns. It is important to plan your life so that with the arrival of a child you will not be isolated only on feeding and walking with a stroller. Whenever possible, maintain your usual level of social activity - of course, in a comfortable mode.
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