Childbirth: a trigger, how does it happen?
For personal or medical reasons, some cases necessitate the onset of childbirth. How’s it going? The answers with Emmanuel Peigné, gynecologist-obstetrician at Polyclinique Beaujolais (Rhône-Alpes) and the member of the National Union of Gynecologists Obstetricians of France.
The medical reasons that cause the doctor to trigger are:
– Breaking the water pocket: if the mother has cut the pocket of the waters but has no contraction. In 80% of the cases, the work will begin without the intervention of doctors. In the remaining 20%, it is necessary to trigger the mother because the infectious risk is too important. The baby must be born within 48 hours of breaking the water pocket.
– Maternal and fetal pathology, such as, for example, gestational diabetes. If it is unbalanced, that the mother takes insulin, doctors prefer to induce labor from the 39 th week, especially because of the often large size of the baby.
Fetal growth retardation may also be a triggering cause. ” We think that the child is worse in that than outside and we will trigger the delivery, ” says Dr. Peigne.
Contrary to popular belief, multiple pregnancies are not systematically unleashed. The risk of uterine rupture is greater on a distended uterus. However, the uterus of a mother expecting several children is, of course, more distended than that of a woman pregnant with only one child.
The triggering of convenience
For some reasons, women want to be triggered. It is possible to do this but under certain conditions. The trigger can not take place until the 39 th week of gestation, and if local conditions are right: baby down, mature neck (a little open, shortcut, soft enough). This can be quantified with what is known as the Bishop score, which nevertheless remains an indicator.
The triggers of convenience must remain exceptions because all these conditions must be met to practice it. If this is not the case, and a doctor decides to trigger the patient, there is a good chance that this will result in a caesarean section. As Dr. Peigné reminds us: ” It should not be that the too light acceptance of this type of trigger increases the rate of the first caesarean section .”
The patient who wants a trigger of convenience is usually seen the day before the scheduled date or the same morning. If its collar is not mature, it can not be triggered. The doctor then gives him another date. However, it is possible that the cervix has not yet matured.
On the other hand, maternity hospitals may have to deal with many spontaneous deliveries simultaneously, and then you can push back your “comfort” trigger for organizational reasons.
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How does a triggering happen?
We first analyze the obstetrical situation of the woman, and we are interested in the neck. Medicine knows how to give contractions but does not know how to open a collar that refuses to do so.
If the cervix is not mature enough, the doctor will give prostaglandins to the patient, in gel or capsules. In 70% to 80%, this product works. If the cervix does not mature, it is restored the next day. Prostaglandins are administered once a day (sometimes two). If the birth can take another day or two, as in the case of well-balanced gestational diabetes, this is done. On the other hand, as part of a rupture of the water pocket, one can not wait. If the cervix does not ripen fast enough, or there are abnormalities in the child’s heart rhythm, a Caesarean section will be performed.
Namely: in the context of a convenience trigger, prostaglandins do not have to be used since this can only be achieved by definition if the neck is ready.
6 hours after giving prostaglandins to the patient, and if the doctor believes that the cervix has matured enough, she is given an oxytocin infusion that will cause contractions. It is little dosed at the start. The regularity and intensity of the contractions are observed. If they are not regular enough, the dose of oxytocin is increased.
There is a major contraindication to the onset of childbirth: the cicatricial uterus, that is, a woman who has already undergone a caesarean section. There is a high risk of rupture of the uterus during labor. Indeed, the contractions given by a trigger are less harmonious than those that come naturally. They are therefore stronger. The mother can then tear the scar from her first Caesarean section, which can result in a child’s death and major bleeding in the woman.
Three tricks to trigger “naturally” her childbirth
– Grandmothers (and naturopaths) advise infusions of raspberry leaves at 2-3 cups a day. The wild raspberry contains a chemical agent that would have the property of relaxing the uterus and thus facilitate the passage of the baby …
“Italian childbirth, does not that tell you?” It is just making love with your spouse. The sperm would indeed contain prostaglandins, ideal for helping the cervix to mature. Also, oxytocin is secreted during hugs. What trigger the contractions!
– The stimulation of certain points of acupuncture would favor the secretion of oxytocin, would accelerate the work and open the cervix. It is necessary to stimulate areas such as the sacrum, the upper part of the hand, the “soft” zone between the thumb and forefinger (intersection of the joints), the ankle top (inner side of the legs) and the small toe.
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