Future mother 

What are the feelings when the water breaks in pregnant women. The waters have broken, but there are no contractions, or how long can the waterless period be? What to do when amniotic fluid passes

Many pregnant women recent weeks before childbirth, they carefully listen to their body, waiting for the first harbingers of childbirth. The most indisputable evidence of the onset of active labor activity is the discharge (or, as they say, outpouring) amniotic fluid. It is difficult to miss such an event for a future mother, since the amount of fluid can be significant. The very process of outpouring surrounding the baby fluid leads to increased contractions and activation birth process. But sometimes the waters can only leak , which is why they are confused with mucus plug discharge or urinary incontinence. How to understand this issue, and what volume of fluid should be expected during contractions?

Table of contents:

Amniotic fluid: functions

Throughout pregnancy, the amniotic fluid fills the entire uterine cavity inside the membranes, and it is in it that the baby swims. Its main function is to protect against negative factors external environment, moisturizing the skin and maintaining its functioning, nourishing the crumbs, help in training respiratory system and digestion. In addition, amniotic fluid helps in the implementation of metabolism, eliminating metabolic products during its renewal. They constantly support optimal temperature the bodies of the crumbs, create space for him to move, do not allow the umbilical cord to be pinched, due to them the fetus occupies the most correct and comfortable position for childbirth.

Amniotic fluid is no less important during childbirth. When the fetal head is lowered into the mother's small pelvis, the waters are divided into anterior and posterior. The anterior waters are located behind the head of the fetus in the cervical region; at the beginning of labor, they are in contractions along with fetal bladder perform a peculiar function - they make up a "hydraulic wedge" that helps to smoothly and slowly open the cervix. This allows you to experience contractions easier, they are less painful and the cervix opens smoothly.

Descent (outflow) of amniotic fluid


In normal physiological childbirth the discharge of amniotic water is carried out closer to the opening of 6-7 cm, in a situation where amniotic sac already loses its purpose and is torn apart. The contents can move away at once, in one big stream, or gradually the waters leak for several minutes. Women describe such sensations as spontaneous emptying Bladder(many mistake this for incontinence).

note

The waters are usually transparent, slightly yellowish in color and have a sweet smell, and may have small blood impurities due to microcracks in the cervix. Sometimes women describe the feeling of popping or clicking, bursting the package before pouring out the water. This is an opening of the amniotic membranes, where the anterior waters are located.

As the fluid drains, the fetal head is firmly inserted into the small pelvis, the birth process is activated, the contractions become painful and strong. Often for the purpose of stimulation labor activity with sluggish contractions, doctors open the fetal bladder with water diversion (amniotomy). This revives contractions and allows you to complete the birth process faster.

How to determine the discharge of amniotic fluid?

In some cases, it is important to distinguish between leaks amniotic fluid in terms of 38-40 weeks from urinary incontinence and vaginal discharge. This can be done visually: amniotic fluid is clear and liquid, while vaginal discharge mucous and thick, heterogeneous. Urine usually has a specific smell and color. But it is not always visually possible to distinguish these fluids for the woman herself, then relatively simple tests are carried out.

You need to take a shower and dry yourself thoroughly, put an absorbent sheet or diaper on the bed, lie down and stay in horizontal position about 30 minutes. The appearance of a watery stain on the bed without smell and color is most likely a sign of leaking water. It's worth going to the hospital.

Also A test for amniotic fluid using a pharmacy pad with a reagent can help. After washing and thoroughly drying the crotch, it should be worn on panties for a couple of hours. The appearance of reagent staining in the gasket area indicates water leakage, it is urgent to go to the maternity hospital.

At the appointment, the doctor can also conduct tests for amniotic fluid using special reagents., as well as visually assess the condition amniotic sac and cervix, their readiness for childbirth and the stage of the process (preparation for childbirth or already the beginning of labor).

Amniotomy in childbirth

If the amniotic fluid does not drain during childbirth, while the doctor considers it appropriate to hasten the birth process, he may recommend the process of amniotomy - opening the fetal bladder with a special tool.

This is a painless procedure, it is performed during one of the contractions, when the woman lies on the gynecological chair. After this procedure, contractions usually intensify, and childbirth is faster, the weakness of the tribal forces is eliminated.

Before the procedure, the doctor explains all the conditions and the need for an amniotomy to the expectant mother and receives from her written agreement on it, having previously indicated all the pros and cons, possible complications and sensations.

What is the volume of amniotic fluid?

The normal volume of amniotic fluid for childbirth is up to 1500 ml, but how much it leaves during childbirth depends on the presentation of the fetus, in each case it is individual. The waters in cephalic presentation are divided into anterior, those that are in front of the head of the fetus in the cervical region, and posterior, located around the body of the crumbs in the uterine cavity. When the fetus is lowered and the head is inserted into the small pelvis, a separation of waters is formed due to the contact zone, around the circumference of the head, and when the fetal bladder is opened, usually no more than 300 ml of liquid is discharged. The rest of the volume of water departs at the birth of the shoulders and the whole body of the child.

Departure of water: timely, premature and belated

However, the discharge of water in expectant mothers can occur in different time, in view of which they share both physiological and pathological conditions associated with amniotic fluid.

Timely outpouring- this is the discharge of amniotic fluid during regular and fairly intense contractions, with the opening of the cervix more than 4-5 cm.

It is also possible for the water to break before the onset of contractions, during contractions during the first stage of labor, towards the end of labor, and then the fetus is born “in a shirt”, with a whole fetal bladder:

Each of the states of untimely outpouring has its own risks and dangers. So, early or premature discharge threatens the risk of infection of the fetus if labor is delayed.

According to doctors, if the waters have receded, no more than 10-12 hours are allotted for the birth of a child, then there is a high probability of infection. In the state of a long anhydrous period in childbirth, the mother is administered intravenously or intramuscularly to prevent complications in her and the fetus.

In some cases, doctors decide to artificially open the bladder to enhance labor and intensify contractions. In this state of affairs, the cervix begins to open more actively.

Discoloration of outgoing waters

Normal amniotic fluid is colorless and odorless, but if the water is colored in various colors, it requires special attention doctors and indicates possible complications and pathologies. Most often, amniotic fluid stains green, dark or bloody shades indicating various complications.

green waters become evidence, due to which his muscles relax, including in the anus, which leads to the discharge of meconium into the amniotic fluid. It is the impurities of feces that color the water in a similar color.

Greenery in the waters can form during the aging process of the placenta, which is typical for. By the end of gestation, this organ can no longer fully perform all its functions of supplying nutrition and oxygen, which affects metabolic processes in the water area.

Premature rupture of the amniotic membrane is a serious complication of pregnancy, which is accompanied by a violation of the integrity of the bladder and is characterized by leakage or massive outflow of amniotic fluid at any stage of pregnancy.

Causes of premature discharge of water

Risk factors and causes of early discharge of water, they are not fully understood and it is impossible to answer with accuracy which of them is provoking. The following are the confirmed and most common risk factors:

  • the presence in the past of one or more pregnancies ending in premature discharge of amniotic fluid. The most telling factor, the likelihood that another pregnancy will end the same, is approximately 23%;
  • inflammatory and infectious processes of the genital tract. The focus of inflammation forms a kind of “weak spot” on the wall of the bladder; over time, a rupture or crack may occur in its place;
  • isthmic-cervical insufficiency. Bubble protrusion into the lumen of the dilated cervix can lead to easy infection of its walls, and as a result, rupture;
  • instrumental medical interventions. Chorionic biopsy and amniocentesis. Contrary to myths, examination with a mirror, sexual intercourse and vaginal examination are not able to provoke a rupture of the amniotic sac ahead of time;
  • a strong change in the volume of amniotic fluid - oligohydramnios, polyhydramnios;
  • injury. This includes both a fall and a direct injury to the abdomen;
  • multiple pregnancy.

Diagnosis of premature bladder rupture

There are many diagnostic methods aimed at determining the rupture of the shell. These include a smear for amniotic fluid, and gynecological examination, and all kinds of tests to determine the acidity of the vagina, but they are all uninformative an hour after the rupture of the bladder. Impurities of blood, urine, semen can affect their result, and they show a high percentage of errors from 20 to 40, both false negatives and false positives, which is extremely high and fraught. In the second case, this leads to unnecessary hospitalization, labor stimulation and drug therapy, and in the first all the listed complications that are characteristic of premature release of amniotic fluid, which can lead to serious consequences.

The closer the due date for women who are expecting their firstborn, the more excitement they experience: will everything be fine, how to understand that the waters have broken, what should be done after the amniotic fluid is poured out, and how long after that the birth will begin?

Why does water break before childbirth?

The fetus in the womb grows and develops inside a special membrane filled with liquid - amniotic fluid. The volume of amniotic fluid at the fortieth week of pregnancy is approximately one and a half liters. In the first stage of labor, the cervix gradually stretches and begins to open in order to push the baby through the birth canal during labor. When the cervix opens, the membranes of the fetus are torn and the amniotic fluid is poured out. In this way, if the waters have broken, it means that labor has already begun.

Sometimes the fetal membranes rupture before contractions begin; in some cases, contractions begin before the waters break. Often there are before childbirth. Normally, amniotic fluid is clear, almost odorless. Sometimes the departed waters contain small white flakes - this is the original lubricant that covers the body of the child. At different women water can drain in different ways: in some they pour out abundantly - up to 150-200 ml of liquid at a time, in others they leak gradually, in a few drops.

How to understand that the waters have broken

Many debutantes who are expecting their first child worry that they will not be able to understand if their water has broken. If the water leaves abundantly and the liquid gushed in a stream, then the rupture of the amniotic membranes is beyond doubt, although the process of rupture itself is completely painless. However, in the case when the liquid oozes out in a thin stream, a woman may be unsure whether the water is leaving - after all, later dates many pregnant women have urinary incontinence because the baby's head presses on the bladder and then the outpouring of water can be confused with involuntary urination. In order to dispel doubts, you need to use a white cotton napkin or purchase a special test in advance at the pharmacy to diagnose water leakage. If we are talking about the outpouring of water, then the liquid on the napkin will be transparent, without the smell of urine. And yet, only a doctor can say for sure whether the water is leaking, so you still need to call the doctor. If this is not possible, then it is better to go to the maternity hospital without delay.

Urgently need to apply for medical care and in the event that the color of the amniotic fluid is brown, pink or greenish color. A change in the color of the water may indicate oxygen starvation fetus or that feces have entered the amniotic fluid. Both are dangerous for the child - in this case, both the woman in labor and the fetus need emergency assistance doctors.

What to do if the waters broke

The behavior of a woman in a situation where the waters have broken should depend on how pregnant she is, as well as on how much fluid has poured out and what kind of fluid it was.

If the woman is at 37-41 weeks of pregnancy and she has the waters broke transparent color in a small amount, then you can slowly pack up and go to the hospital - the pregnant woman has another 2-3 hours. Under a small amount you should understand the volume of liquid about a glass - 200-250 ml. Sometimes in courses for expectant mothers, pregnant women are advised to “rehearse” the outflow of amniotic fluid in advance so that when the time will come, the woman could understand how much liquid spilled out. To do this, experts advise taking a glass warm water, stand in the bath and pour the liquid on your feet. Remember feelings. Then pour a one and a half to two liter jar of water over yourself. Such a rehearsal will help to understand, when the time comes, how much water has poured out at a time. In case the amniotic fluid literally rushed out, you should hurry to the hospital.

As soon as possible, you should go to the hospital even if the waters are brown or green. In order for the color of the poured waters to be obvious, doctors advise pregnant women to wear light-colored underwear and use white sheets for sleeping in the last weeks before giving birth.

Premature rupture of amniotic fluid is a dangerous situation, and in this case, a woman needs urgent medical attention. When amniotic fluid is poured out for a period of 20-24 weeks, there is a very high chance of miscarriage. If it was prevented, then the pregnant woman is given drugs that protect the fetus from infections and contribute to it. further development. In this case, the expectant mother will have to comply with strict bed rest right up to the birth.

If a waters broke at 24-28 weeks, then, with timely seeking medical help, the chances of preventing premature birth, protect the fetus from infections and stimulate its ripening, are quite high.

For a period of 28-32 weeks in case of rupture of amniotic fluid doctors decide whether to continue the pregnancy or have a premature delivery after examining the pregnant woman. It all depends on the condition of the future mother and the fetus. After the 32nd week of pregnancy, the outflow of amniotic fluid in most cases ends in childbirth or doctors perform delivery through surgery. C-section».

The waters broke - when to give birth

With a full-term pregnancy and a cervix ready for childbirth, contractions begin within two to three hours after the first outpouring of amniotic fluid. During contractions, the cervix opens up in preparation for the birth itself. In women giving birth for the first time, on average, the cervix opens by a centimeter per hour. Accordingly, from the moment of the onset of labor until birth child will pass about 9-12 hours. In women giving birth for the second and third time, the cervix opens faster and childbirth takes about 5-6 hours.

If the cervix is ​​not yet mature by the time the waters have broken and is not ready for childbirth, then labor may not begin even after many hours. In this case, doctors use special drugs that allow short time improve the condition of the cervix, and then either wait for the natural onset of labor, or stimulate the onset of labor with the help of drugs.

The decision on whether to stimulate labor or wait for their natural onset, doctors make, depending on the condition of the child and the woman in labor. The point is that the long anhydrous period can be dangerous to the life and health of the baby. It used to be thought that the safe waterless period for a baby was 12 hours, after which doctors would typically induce labor or perform a "caesarean section." Critical time for the fetus was determined by twenty-four hours. Now there is modern facilities diagnosing the condition of the fetus, so doctors are not so categorical and they decide whether to wait for the onset of natural childbirth or conduct stimulation based on the results of the diagnosis. Of course, all this time, the expectant mother should be under the vigilant supervision of doctors. If the cervix has been prepared for childbirth and there is a need for an early delivery, then doctors can begin to stimulate labor. Labor is usually stimulated by a drip of the hormone oxytocin. If the cervix is ​​not ready for childbirth, and the baby needs to be born as soon as possible, then a "caesarean section" is performed.

What to do if the water has broken, but there are no contractions

Exemplary childbirth occurs as follows: in their first period, contractions begin, which become regular and intensify. During contractions, the cervical canal is stretched, the amniotic membranes are torn and water is drained. In the second stage of labor, the cervix fully opens and attempts begin. After several attempts in the third stage of labor, a child is born, and then the placenta completely departs. But such exemplary births do not happen often, there are, as they say, “variations”. What to do if the waters have broken, but there are still no contractions? Doctors recommend going to the maternity hospital after the waters have broken in any case, in order to be under the supervision of specialists.

It should be noted that the absence of contractions within a few hours after the outflow of amniotic fluid is also a variant of the norm. Contractions can begin both 12 and 20 hours after the waters have broken and the woman in this case will also give birth safely. So why do doctors worry and insist on the arrival of a pregnant woman to the hospital?

Firstly, violation of the amniotic membranes makes the child vulnerable to infections. In the maternity hospital, doctors will be able to control the situation and wait for the start of natural childbirth without risk to mother and child.

Secondly, a pregnant woman may have weak labor and an immature cervix. But even in this case, a woman can safely give birth naturally if you start preparing the cervix for childbirth in time and at the same time monitor the condition of the child. And only if natural childbirth will pose a danger to the woman and the fetus, doctors will do a "caesarean section."

Thirdly, in some women, the opening of the cervix is ​​so gentle and painless that she may not even realize that she is giving birth until attempts come. Of course, there are few such lucky ones, but it happens. Therefore, if the future mother's plans do not include home birth, then after the waters have broken, it is better to go to the hospital.

If a water broke at 32-34 weeks of gestation, but there are no contractions, then after examining the expectant mother, the doctors will have to decide whether to take measures to continue the pregnancy or go for a premature birth. As a rule, in both cases, the woman is given drugs that stimulate the maturation of the fetal respiratory system in case preterm labor cannot be prevented.

The more the expectant mother knows about pregnancy and childbirth, the better she is prepared for the upcoming event and the more safely she will give birth. However, friends and relatives this case not a very suitable source of information - they certainly love you, but they are not competent specialists. It will be much more useful if the expectant mother starts attending good courses for pregnant women, reading special publications and asking her doctor questions. The doctor is obliged to explain to the woman her condition, because knowledge reduces anxiety and allows you to behave calmly and correctly both during pregnancy and during childbirth.

In this article:

Some women who have not given birth may not know what it is - "the waters have broken." amniotic fluid departs after the rupture of the membranes, so the anhydrous period begins, which lasts until the birth of the child. At this time, the woman is under stress, tension and may be frightened. She listens to herself and asks questions when the contractions will begin and after how many hours she will have to give birth if the waters have broken.

Primarily, expectant mother you need to calm down and slowly gather in the hospital. The outflow of amniotic fluid is one of the stages of normally occurring.

How long does it take for labor to start after water breaks?

The question, after how many hours will labor begin, if the waters have already departed, is quite natural. Normally, the rupture of the fetal bladder occurs just in the process of childbirth. In the first bubble plays the role of a shock absorber, protecting the child from injury. Its wedging promotes the opening of the cervix. But there comes a time when it is already superfluous and prevents the child from passing through the narrow birth canal. Then the bubble bursts and the waters pour out.

If the waters of the pregnant woman have broken, they will begin at any time (if they have not already begun), after how many hours or minutes this will happen, no one will say for sure. The first contractions are weak and painless, with long intervals. Intense normally can begin both after 2 hours and after 6. More often they proceed faster, therefore, the contractions begin earlier.

When the waters break

Normally, this occurs at the end of the first period of labor, with the opening of the cervix by about 6 cm, before intense contractions.

Another development is also possible:

  • If the waters have receded before the normal opening of the cervix, but in the presence of contractions and labor, this is considered an early discharge.
  • It is also possible that the water may have already broken, but there are no contractions. E If this happened before the onset of labor, we are talking about premature outflow.

What will happen if contractions begin, but the waters do not break, how will this affect childbirth? There is nothing terrible in this. You need to see a gynecologist. If this is the beginning of labor, if necessary, the bubble is pierced in maternity hospital. If it is, it will be left intact, but the obstetrician must differentiate these conditions.

How does this happen

How to understand that the waters have broken? This usually happens after the first contractions appear and after. They can pour out profusely, in amounts from 200 ml to 1 liter. A woman has a feeling of urinary incontinence, while she cannot stop the flow of flowing fluid by contracting the muscles of the sphincter of the bladder. Waters can depart in 2 or even 3 stages. Some women may have a "popping" sensation when their membranes rupture before the water breaks.

Is it possible for the water to break, but there were no contractions? This happens when premature discharge amniotic fluid through microcracks in the fetal membranes. A woman can take them for urinary incontinence or increased profusion of vaginal secretions, since water can come out sparingly, literally drop by drop.

How to understand that the waters have broken?

A woman will not miss an abundant outpouring of water. However, it is not uncommon for the waters to break while the woman was sleeping at home. In a dream, she may not feel it. If after waking up on a wet sheet there is no smell and color of urine, and even more so if there is a mucous plug, this speaks in favor of water. The plug is a mucus clot that forms in the cervix during pregnancy.

You can skip the moment of outpouring when a woman takes a bath or shower. In this case, the presence of a mucous plug in the bath may indicate that the waters have departed without contractions.

In such situations, a woman often doubts and asks questions: did the waters break and when did it happen, and if the waters really broke, then what to do? There can be only one answer - urgently go to the gynecologist.

When to be concerned

Premature discharge of water is common and poses a great threat to both the baby and the woman.

Therefore, you must always be on your guard, especially:

  • with increased incidence of urinary incontinence;
  • when vaginal discharge becomes more abundant and watery;
  • when the discharge becomes more abundant with a change in body position;
  • when available bad smell vaginal discharge;
  • when the stomach decreases in size;
  • when down;
  • with abdominal pain.

What waters are normal?

At normal course pregnancy in healthy woman amniotic waters light, transparent, colorless and odorless. The volume of water by the end of pregnancy ranges from 600 ml to 1500 ml. A deviation from these figures up or down is considered oligohydramnios or.

In the presence of water pathology, the following may change:

  • with oxygen starvation of the fetus, they have greenish tint;
  • with the threat of miscarriage and premature detachment of the placenta, they may have a brown or brown color;
  • at bacterial infection water will be cloudy, yellow-green in color, with an unpleasant odor.

Why are the waters breaking?

This happens when the volume of the fetal bladder under external pressure from contractions decreases - as a result, it increases internal pressure amniotic fluid on its walls, and they burst.

However, rupture of the membranes can occur long before the birth process. One of the reasons is the infectious melting of the walls of the fetal bladder. Where it is thin, microcracks form. Also one of the obvious causes of bladder rupture is trauma.

Factors contributing to premature or early outflow of water:

  • narrow pelvis of a pregnant woman;
  • violation of the cervix of a woman - rigidity, cicatricial changes after abortions or previous births;
  • abnormal position of the fetus and;
  • polyhydramnios;
  • exacerbation of chronic bacterial infection in the vagina and uterus;
  • serious chronic diseases mothers - diabetes, lupus erythematosus and others.

If there are no contractions

If the waters of the woman in labor have already departed, she is naturally interested in how much the child can do without this water. Ideally, the anhydrous period lasts from 4 to 6 hours and ends with the birth of a child. When it exceeds 6 hours, it is already considered long-term, but this is not yet a pathology. Danger arises, this period lasts more than 72 hours.

Inexperienced expectant mothers sometimes ask the gynecologist what to do when the water broke, for example, 12 hours ago, but there are no contractions. But why wait so long? Immediately after the outpouring of water, you need to go to the hospital. During the day, doctors can begin to stimulate labor or proceed to.

Outflow of water - important feature beginning of the birth process. Premature start process is often subtle and gradual, but it can provoke spontaneous abortion or cause serious pregnancy complications. If a woman notices that her water is breaking, she should urgently apply for professional help obstetrician-gynecologist.

Useful video about the end of pregnancy and the beginning of childbirth

How to understand that the waters have broken? How does the baby feel during childbirth? Can gaps be avoided or are they inevitable? These and other questions worry pregnant women, especially as the due date approaches.

1. How to understand that labor has begun?

You have seen the classic onset of labor even in the movies: a pregnant woman feels contractions (i.e. regular uterine contractions). They can be expressed in sipping in the lower abdomen. The main difference between their training bouts is regularity and increasing pain. First contractions are repeated every 20 minutes, then every 15 minutes. In some cases, almost immediately after (and sometimes even before) the onset of contractions, a pregnant woman's water breaks. The bladder with amniotic fluid "bursts" painlessly, sometimes it looks like involuntary urination. In some cases, the water may not pour out completely, but gradually leak.

2. What should I pay attention to when the water breaks?

First of all, the color of amniotic fluid. Clear waters are the norm. However, during a post-term pregnancy, they may acquire a greenish tint due to an excess of meconium (original feces) in them. It is also possible that small dark flakes appear in them. All this must be reported to the doctor who will take care of your childbirth, since such water is often accompanied by fetal hypoxia.

3. Why are there contractions, but the water does not break?

Normally, water is poured out when the cervix is ​​opened by 7 cm. In some cases, with sufficient opening of the cervix and the whole fetal bladder, an amniotomy is performed (i.e., a puncture of the amnion - the fetal bladder). Such manipulation is performed to improve labor activity and is carried out, according to statistics, in 10-15% of women in labor. After the amnion is punctured, the baby's head begins to press harder on the cervix, contributing to its natural opening. Does it hurt to pierce the fetal bladder? Amnion does not have nerve endings; therefore, the procedure is absolutely painless.

4. How do I know how my baby is feeling during labor?

During childbirth, the condition of the fetus is monitored as carefully as the health of the mother. There are several ways to make sure that the child is all right:

  • Using a heart monitor or stethoscope, the fetal heartbeat is heard. Normally, a baby's heart beats at a frequency of 140-160 beats per minute. With the onset of a contraction, the heartbeat quickens to 180 beats per minute.
  • Close attention is paid to the color and nature of amniotic fluid. Normally, they are transparent, when stained in a greenish color, as we have already said, fetal hypoxia can be suspected.

4. When is an emergency caesarean section performed?

Indications for emergency caesarean section are: bleeding with placenta previa, premature detachment normally located placenta, weakness of labor activity. One of the common reasons is acute hypoxia fetus. In these cases, the fetus must be urgently removed, since the health of the mother and child cannot be put at risk. A caesarean section is performed under spinal anesthesia, less often under general anesthesia.

5. Is natural childbirth possible after a caesarean section?

It depends on the type of caesarean section performed during the first birth. If a woman had a classic caesarean section (longitudinal scar), then natural childbirth is unacceptable. If the scar is transverse, healing is complete, there is no indication for a caesarean section, then natural childbirth is allowed and even desirable, because a repeat caesarean section in a pregnant woman is not the safest alternative.

6. How to avoid vaginal tears during childbirth?

Breaks are one of the most common birth trauma women. They are of three types:

  • Cervical ruptures(if the laboring reflex manifested itself ahead of time in a woman in labor, and the cervix still covered the fetal head during attempts).
  • Vaginal tears(they occur if the fetal head is in one place for a long time, as well as with premature attempts).
  • perineal tears ( occurs with insufficient extensibility of the soft tissues of the perineum).

How to avoid? Main advice- listen to your doctor and midwife. Start pushing when it's time full disclosure, and this was confirmed by the doctor during the examination. Do exercises during pregnancy to help