How does the birth process take place in the maternity hospital? Birth of a child

By having an understanding of what happens during each stage of the process, a woman will be able to cope more easily with labor and be an active participant in it.

We will try to give a consistent description of what physiological processes occur during childbirth, what a woman feels at this time and what medical manipulations can be carried out at different stages of labor.

Childbirth is a process expulsion of the fetus from the uterine cavity, its direct birth and release of the placenta and membranes. There are three periods of labor: the period of opening, the period of expulsion and the afterbirth period.

Cervical dilatation

During this period, a gradual expansion of the cervical canal occurs, that is, the opening of the cervix. As a result, a hole of sufficient diameter is formed through which the fetus can penetrate from the uterine cavity into the birth canal, formed by bones And soft tissues small pelvis.

The opening of the cervix occurs due to the fact that the uterus begins to contract, and due to these contractions the lower part of the uterus, i.e. its lower segment stretches and becomes thinner. Dilation is conventionally measured in centimeters and determined during a special obstetric vaginal examination. As the degree of dilatation of the cervix increases, muscle contractions intensify, become longer and more frequent. These contractions are contractions - painful sensations in the lower abdomen or lumbar region that the woman in labor feels.

The first stage of labor begins with the appearance of regular contractions, which gradually become more intense, frequent and prolonged. Typically, the cervix begins to dilate with the onset of contractions that last 15–20 seconds and are spaced 15–20 minutes apart.

During the first stage of labor, there are two phases - latent and active.

Latent phase continues until approximately 4–5 cm of dilation; during this phase, labor is not intense enough, contractions are not painful.

Active phase the first stage of labor begins after 5 cm of dilation and continues until full dilation, that is, up to 10 cm. At this stage, contractions become frequent, and pain -
more intense and pronounced.

In addition to uterine contractions, an important part of the first stage of labor is effusion amniotic fluid. The time of rupture of water in relation to the degree of cervical dilatation is of great importance, as this can affect the course of birth process.

Normally, amniotic fluid flows out during the active phase of labor, since due to intense uterine contractions, pressure on amniotic sac increases, and its opening occurs. Usually, after opening the amniotic sac, labor intensifies and contractions become more frequent and painful.
When the amniotic fluid ruptures before the cervix is ​​dilated by 5 cm, they speak of early rupture. It is most favorable if the rupture of water occurs after the dilation has reached 5 cm. The fact is that at the beginning of labor, before the cervix is ​​dilated by 5 cm, there is an increased risk of developing weakness labor activity, that is, weakening of contractions or their complete cessation. As a result, the course of labor slows down and may drag on indefinitely. If the amniotic fluid has already poured out, then the fetus is not isolated and not protected by the amniotic sac and amniotic fluid. In this case, the risk of developing intrauterine infection. To avoid intrauterine infection, labor should be completed within 12–14 hours from the moment of rupture of amniotic fluid.

If the waters break before regular labor begins and the cervix begins to dilate, they speak of premature rupture of water.

How to behave

If you experience regular painful or pulling sensations in your lower abdomen, begin to note the start and end times of these sensations, as well as their duration. If they do not stop within 1–2 hours, last approximately 15 seconds every 20 minutes and gradually intensify, this indicates that the cervix has begun to gradually open, that is, the first stage of labor has begun and you can get ready for the maternity hospital. At the same time, there is no need to rush - you can observe your condition for 2-3 hours and go to the maternity hospital with more or less intense labor, that is, with contractions every 7-10 minutes.

If your amniotic fluid has broken, then it is better not to delay the trip to the maternity hospital, regardless of whether contractions appear or not, since premature or early rupture of amniotic fluid can affect the choice of labor management tactics.

In addition, remember the time when regular contractions began, and also record when the amniotic fluid was released. Place a clean diaper between your legs so that the emergency room doctor can assess the amount of water and their nature, which can be used to indirectly assess the condition of the unborn baby. If the waters have a greenish tint, this means that original feces - meconium - have entered the amniotic fluid. This may indicate fetal hypoxia, that is, that the baby is experiencing a lack of oxygen. If the waters have a yellowish tint, this may indirectly indicate a Rh conflict. Therefore, even if the water leaks just a little or, conversely, pours into large quantities, you should save the diaper or cotton pad with the spilled amniotic fluid.

To relieve pain during uterine contractions, try to take deep breaths through your nose and exhale slowly through your mouth during contractions. During contractions, you should behave actively, try not to lie down, but, on the contrary, move more, walk around the ward.

During a contraction, try different positions that make the pain easier to bear, such as resting your hands on the bed and leaning slightly forward with your feet shoulder-width apart. If your husband is present at the birth, you can lean on him or squat down, and ask your husband to support you.

A fitball, a special large inflatable ball, will help ease the sensations during contractions.

If possible, contractions can be endured in the shower, directing a warm stream of water to the stomach, or immerse yourself in a warm bath.

What does a doctor do?

During the first stage of labor, special obstetric manipulations are required from time to time to help choose the right tactics for labor and assess the risk of possible complications.

An external obstetric examination is performed upon admission of the expectant mother to the maternity hospital. During this procedure, the approximate weight of the fetus is assessed, the external dimensions of the expectant mother's pelvis are measured, the location of the fetus, the standing height of the presenting part are determined, that is, at what level in the birth canal is the presenting part of the fetus - the head or buttocks.

During a vaginal examination, the condition of the cervix, the degree of its dilation, and the integrity of the amniotic sac are assessed. The presenting part is determined: the head, legs or buttocks of the fetus - and the nature of its insertion, that is, which part - the back of the head, forehead or face - the head was inserted into the small pelvis. The nature of the amniotic fluid, its color and quantity are also assessed.

During the normal course of the first stage of labor vaginal examination carried out every 4 hours to assess the dynamics of cervical dilatation. If complications occur, more frequent of this study.

Every hour during the dilatation period, the mother's blood pressure is measured and auscultation is performed - listening to the fetal heartbeat. It is performed before contraction, during contraction and after it - this is necessary in order to assess how the unborn baby reacts to uterine contractions.

To more accurately assess the nature of the fetal heartbeat and indirectly study its condition during childbirth, each woman in labor undergoes a cardiotocographic study - CTG. Two sensors are installed on the surface of the uterus, one of them records the fetal heart rate, and the other - the frequency and intensity of uterine contractions.

The result is two parallel curves, after studying which the obstetrician-gynecologist can objectively assess the well-being of the unborn baby, notice signs of possible complications in time and take measures to prevent them. During normal labor, CTG is performed once and lasts for 20–30 minutes. If necessary, this study is performed more often; Sometimes, when the birth is high-risk, a continuous recording of a cardiotocogram is performed. This happens, for example, if there is a postoperative scar on the uterus or with gestosis - a complication of pregnancy, which is manifested by high blood pressure, swelling and the appearance of protein in the urine.

Period of expulsion of the fetus

After the cervix has fully dilated, the second stage of labor begins, that is, the expulsion of the fetus from the uterine cavity, its passage through the birth canal and, ultimately, its birth. This period lasts for primiparous women from 40 minutes to 2 hours, and for multiparous women it can end in 15–30 minutes.

After leaving the uterine cavity, the presenting part of the fetus, most often the head, performing certain rotational movements with its smallest size, gradually lowers to pelvic floor and emerges from the genital slit. After this, the birth of the head occurs, then the shoulders, and finally the baby is born entirely.

During the expulsion period, uterine contractions are called pushing. This is due to the fact that, descending to the pelvic floor, the fetus exerts significant pressure on nearby organs, including the rectum, as a result of which the woman experiences involuntary desire push.

How to behave?

The second stage of labor requires a lot of energy expenditure from both the expectant mother and the fetus, as well as the well-coordinated work of the woman in labor and the obstetrics-gynecology team. Therefore, in order to make the course of this period as easy as possible and avoid various complications, you should listen carefully to what the doctor or midwife says and try to follow their advice exactly.

During the second stage of labor obstetric tactics is largely determined by the level at which the presenting part of the fetus is located. Depending on this, you may be advised to push as hard as you can, or, conversely, try to hold back.

The desire to push may be accompanied by unpleasant painful sensations. However, if pushing is not recommended at this time, every effort should be made to restrain the pushing, as otherwise cervical rupture may occur. The doctor may ask you to “breathe” through the pushing. In this case, you need to take frequent sharp breaths and exhales through your mouth - this is called breathing “doggy”. This breathing technique will help you control the urge to push.

If you are already in the delivery chair and your baby is about to be born, you will be asked to push as hard as possible while pushing. At this moment, you should concentrate as much as possible on what the midwife says, since she sees what stage the fetus is at and knows what needs to be done to facilitate its birth.

When you start pushing, you should take a deep breath and start pushing, trying to push the baby out. Typically, you may be asked to push 2-3 times during one push. Try not to scream or release air under any circumstances, as this will only weaken the pushing and it will be ineffective. Between attempts you should lie quietly, try to even out your breathing and rest before the next attempt. When the fetal head erupts, i.e. is established in the genital slit, the midwife may ask you not to push again, since the force of uterine contraction is already sufficient for further advancement of the head and its removal as carefully as possible.

What does a doctor do?

During the expulsion period, the mother and fetus are exposed to maximum stress. Therefore, monitoring the condition of both mother and baby is carried out throughout the entire second stage of labor.

The mother's blood pressure is measured every half hour. Listening to the fetal heartbeat is carried out with each push, both during uterine contractions and after it, to assess how the baby reacts to the push.

External obstetric examination is also regularly performed to determine where the presenting part is located. If necessary, a vaginal examination is performed.

When the head erupts, it is possible to perform an episiotomy - a surgical dissection of the perineum, which is used to shorten and facilitate the birth of the head. When giving birth in a breech position, an episiotomy is mandatory. The decision to use an episiotomy is made in cases where there is a threat of perineal rupture. After all, an incision made by a surgical instrument is easier to stitch up, and it heals faster than a lacerated wound with crushed edges due to a spontaneous rupture of the perineum. In addition, an episiotomy is performed when the condition of the fetus worsens in order to speed up its birth and, if necessary, immediately carry out resuscitation measures.

After birth, the baby is placed on the mother's stomach to ensure the first skin-to-skin contact. The doctor evaluates the condition of the newborn using special criteria - the Apgar scale. At the same time, such indicators as heartbeat, breathing, skin color, reflexes and muscle tone newborn at 1 and 5 minutes after birth.

Succession period

During the third stage of labor, the placenta, the remainder of the umbilical cord, and the membranes are separated and released. This should happen within 30–40 minutes after the baby is born. In order for the placenta to separate, weak uterine contractions appear after childbirth, due to which the placenta gradually separates from the wall of the uterus. Once separated, the placenta is born; from this moment it is considered that childbirth is over and the postpartum period begins.

How to behave and what does the doctor do?

This period is the shortest and most painless, and practically no effort is required from the postpartum woman. The midwife monitors whether the placenta has separated. To do this, she may ask you to push slightly. If the remainder of the umbilical cord is retracted back into the vagina, then the placenta has not yet separated from the placental site. And if the umbilical cord remains in the same position, the placenta has separated. The midwife will again ask you to push and gently pull the umbilical cord to bring the placenta out.

After this, a thorough examination of the placenta and fetal membranes is performed. If there is any suspicion or indication that part of the placenta or membranes remains in the uterine cavity, a manual examination of the uterine cavity should be performed to remove any remaining parts of the placenta. This is necessary to prevent the development of postpartum hemorrhage and infectious process. Under intravenous anesthesia, the doctor inserts his hand into the uterine cavity, carefully examines its walls from the inside and, if retained lobes of the placenta or membranes are detected, removes them out. If spontaneous separation of the placenta does not occur within 30–40 minutes, this manipulation is performed manually under intravenous anesthesia.

After childbirth

After the birth of the placenta, a thorough examination of the soft tissues of the birth canal and perineum is performed. If ruptures of the cervix or vagina are detected, they are sutured, as well as surgical restoration of the perineum if an episiotomy has been performed or ruptures have occurred.

Surgical correction is performed under local anesthesia; in case of significant damage, it may be necessary intravenous anesthesia. Urine is released with a catheter so that during the next few hours the postpartum woman does not have to worry about the overflow. Bladder. Then, in order to prevent postpartum bleeding, women are placed on the lower abdomen. special bag with ice, which remains there for 30–40 minutes.

While doctors examine the mother, the midwife and pediatrician perform the first toilet of the newborn, measure his height and weight, head and chest circumference, and treat the umbilical wound.

Then the baby is placed on the mother's breast, and for 2 hours after birth they remain in the maternity ward, where doctors monitor the woman's condition. Blood pressure and pulse are monitored, uterine contractions and the nature of vaginal bleeding are assessed. This is necessary so that if postpartum hemorrhage occurs, timely treatment can be provided. necessary help in full.

If the condition of the mother and the newborn is satisfactory, 2 hours after birth they are transferred to the postpartum ward.

The birth of a baby is a happy event for every family. However, many women have to recover for quite a long time due to the healing of stitches, and the joy is overshadowed by poor health, discomfort and pain. Those who have already given birth to one or more children have an idea about labor, but first-time mothers are especially interested in how to behave during labor and labor in order to give birth easily and without disruption.

A woman's fear of upcoming birth is quite understandable, but we should never forget that this is, first of all, the joy of the birth of a long-awaited child. Therefore, first of all, a woman in labor should push aside negative thoughts and try to think positively. Of course, there is hard work ahead, but the reward will be meeting your baby.

In fact, the mother’s mood is transmitted to the baby in her womb, and when fear goes off scale, the child also begins to get nervous. There is no need to think about pain - this is a transitory phenomenon; it is better to remember those who worry about their mother and are looking forward to her return from the maternity hospital.

You should know how to behave during childbirth and contractions, and then, thanks to the presence of spirit, childbirth will be easier and faster. Typically, labor is divided into three main stages:

1. Preparing the uterus and baby for birth during labor;
2. The birth of a child, through pushing;
3. The final phase with the expulsion of the placenta.

In this regard, when preparing for childbirth, a woman should:

• Master proper breathing techniques;
• Find the most successful position to help give birth and, at the same time, safe for the condition of the fetus;
• Learn to push correctly so as not to injure the child and avoid ruptures.

First-time mothers may not know, but it is not advisable to scream during childbirth, since this may cause the baby to experience oxygen starvation, and it is also difficult for him to move forward. birth canal. Moreover, fear, although it is psychological condition, can intensify real pain.

Correct breathing, pushing and posture

It is better for a woman to learn in advance how to breathe; moreover, she needs to learn how to do this, so she will have to practice during pregnancy.

This can be done by enrolling in special courses that she can attend together with her husband. It is important that certain breathing must correspond to each stage of labor.

Of course, the doctor will tell her how to behave, but the woman must master three basic techniques in advance:

• During the initial contractions, counting breathing should be used - inhale during the spasm, and exhale very slowly literally after a few seconds. Usually, when you inhale, count to four, and when you exhale, count to six.
• When strong and painful contractions are present, you should breathe like a dog - inhalation and exhalation should be fast and rhythmic.
• During the birth of a child, breathing is characterized by deep inhalation and strong exhalation with pressure directed towards bottom part abdomen - uterus and vagina.

Proper breathing provides the fetus with normal access to oxygen, reduces pain, and promotes the rapid completion of the birth process.

When discussing how to behave during labor and labor, this concerns not only breathing, but also the optimal posture of the woman in labor. There is no one-size-fits-all ideal position for the most comfortable expulsion of the fetus, since each woman’s body has its own characteristics, both physiological and anatomical.

But it has been noticed that some women find it more convenient to give birth in a position on all fours, albeit in the same horizontal position - for this, the woman in labor should try to take this position on her back, pulling her knees up as much as possible and tilting her face forward to her chest. Sometimes a woman can intuitively feel how she should turn or lie down. If this does not threaten the baby, the doctor will tell you how best to do this during labor.

It is very important to push correctly. The intensity of the pain and the appearance or absence of ruptures depend on this. In addition, if you push incorrectly, it can result in injury to the baby.

What not to do when pushing:

• When pushing, you should not strain your muscles, as this slows down the passage of the baby through the birth canal - if the muscle tissue is relaxed, the uterus opens much faster, and the pain is not so severe.
• Do not apply pressure to the head or rectum - only to the lower abdomen.
• It is forbidden to push with full force until the uterus opens, as this leads to ruptures of the perineum and damage to the baby.

On average, there should be two or three attempts per contraction. A woman in labor should not rush things - in any case, the baby will be born at the right time, but the mother must unquestioningly listen to the doctor’s instructions.

How to behave during childbirth and contractions in order to give birth easily and without ruptures

So, the very first stage is the actual contractions, the purpose of which is to open the cervix to allow the baby to pass through.

How to behave during contractions

This period can take from 3-4 to 12 or more hours. For women giving birth for the first time, the process can drag on for 24 hours. Typically, at first contractions occur every 15-20 minutes, gradually increasing in time. At the same time, the intervals between them are becoming shorter. A woman needs to monitor their onset, since the doctor can derive a certain birth algorithm from these calculations and help the woman in labor in a timely manner. If contractions occur every 15 minutes, it’s time to go to the hospital.

When uterine contractions are repeated every 5 minutes, this may mean the imminent expulsion of the fetus, that is, the birth of a baby. Usually severe cramps occur in the lower abdomen, as well as in the area lumbar region spine. Expectant mothers should not eat at this moment - they can only drink water.

The third phase of contractions can last up to four hours or more. A woman must rest in short intervals between them. When the pain is especially severe, you can drown it out with frequent breathing.

How to push properly during childbirth to avoid tearing

Pushing is the most important and crucial moment when the baby is born. The contractions accelerate, repeating every minute, and the woman in labor begins to feel powerful pressure on the anus. At this time, a woman needs to get together and make every effort to help her child. To hold on, a woman in labor can grasp the special handrails of the table. Next, she will need to take a deep breath, hold her breath, and press her head to her chest in an elevated state.

It happens that the attempts are weak, in which case the doctor usually allows one or two contractions to be missed. At the same time, the woman should relax as much as possible and breathe frequently. Later she will be able to perform the most fruitful expulsion of the fetus.

Doctors note that during childbirth, the expectant mother should not think about voluntary urination or even bowel movements, since holding back and tension can harm both the baby and herself. We must not forget that childbirth is a difficult natural process and a huge burden on internal organs, including the bladder and intestines. Moreover, during labor, a woman has more important work than wasting extra energy on unnecessary thoughts and embarrassment.

After the birth of a child, it is still too early for a mother to relax, although, of course, the removal of the baby’s place is the most painless stage during childbirth. After some time, contractions begin again, but they are very weak. During the next attempt, ideally the membranes and placenta should separate. This may take varying amounts of time – from several to 30-40 minutes. It happens that the afterbirth does not come out completely, and then the doctor will have to remove its remains. If children's place has receded completely, the birth canal will be examined by a gynecologist. As a rule, this process takes place without complications.

A woman not only needs to know how to behave during childbirth and contractions - in addition, she should follow all the recommendations of the obstetrician, undergo vaginal examinations if they are necessary to determine important points birth process. Often, women in labor refuse to stimulate weak labor with drug therapy, but sometimes such a doctor’s decision is made not without reason. There are cases where appropriate medications helped a child avoid injuries and health complications in the future.

For women who just can't get rid of negative thoughts about upcoming trials, pain and ruptures, it can be recommended to undergo training using special gymnastics, massage and breathing exercises to make her feel more confident. It will also help good psychologist, which can set the expectant mother in a positive mood. In the end, the pain will pass, but the most precious thing in a mother’s life will remain - her beloved child.

How to breathe correctly during childbirth and labor: video

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Despite the fact that almost every woman is tormented by the fear of such an ancient and sacred event for her, like the birth of a child, yet the main feelings during this period for the expectant mother remain other feelings - trepidation, joyful excitement and anticipation of the coming into the world of the greatest miracle bestowed upon her by fate.

Particularly difficult falls on those who are about to experience the happiness of motherhood for the first time. After all, to the fear of pain and complications, to fears for the child, and for oneself, is added the fear of the unknown, aggravated by a variety of horror stories from relatives and friends who have already gone through this.

Don't panic. Remember that childbirth is the most natural process intended by Mother Nature. And by the end of pregnancy, the necessary changes occur in every woman’s body, which carefully and gradually prepare it for the upcoming tests.

Therefore, instead of imagining the upcoming “torments of hell”, it is much more it is wiser to enroll in prenatal training courses for pregnant women, where you can learn all the most necessary and important things about childbirth, learn proper breathing, correct behavior, correct postures. And meet this day as a calm, balanced and confident expectant mother.

The process of childbirth. Main stages

Despite the fact that the unconditional (unconscious) behavior of any woman during childbirth is determined genetically, information about the process of upcoming childbirth itself will never be superfluous. “Praemonitus, praemunitus” - this is what the ancient Romans said, which means “Forewarned is forearmed.”

And that's true. The more he knows a woman about what will happen to her at each stage of childbirth, the better prepared she is for how she should and should not behave during these stages, the easier and more natural the process itself will be.

Timely birth at a gestational age of 38-41 weeks occurs and is successfully resolved when the generic dominant has already been formed, which is a rather complex complex consisting of a combination of the activities of higher centers of regulation (nervous and hormonal systems) And executive bodies reproduction (uterus, placenta and fetal membranes).

• Due to the fact that the fetal head approaches the entrance to the pelvis and begins to stretch the lower part of the uterus, the pregnant woman’s stomach drops. Due to this, the pressure on the diaphragm is reduced, and breathing becomes easier.
• The center of gravity of the body shifts forward, straightening the shoulders.
• By reducing the concentration of progesterone, excess fluid is removed from the body. And your weight may even decrease by one or two kilograms.
• The child becomes less active.
• The psychological state changes. Future mom may feel apathy or, conversely, feel overexcited.
• A nagging, but not severe, pain occurs in the lower abdomen and lower back, which will turn into contractions with the onset of labor.
• A thick mucous fluid, sometimes streaked with blood, begins to be released from the vagina. This is the so-called plug, which protects the fetus from various infections.

The woman herself notices all this, but only a doctor upon examination will be able to recognize the most main feature readiness for childbirth: cervical maturity. It is its maturation that indicates the approach of this important event.

In general, the entire process of natural childbirth is divided into three main stages.

Stage of contractions and cervical dilatation

The moment when gradually intensifying ones become regular and their frequency increases is considered to be the beginning of the first, longest (10-12 hours, sometimes up to 16 hours in primiparous women and 6-8 hours in those who give birth repeatedly) stage of labor.

At this stage the body conducts natural bowel cleansing. And that's okay. If cleaning does not take place on its own, you should take care to do it. However, it must be remembered that Doctors categorically do not recommend staying on the toilet for a long time, as this can cause premature birth.

Avoiding dehydration at this stage you should drink more fluids, but at the same time, do not forget about regular urination, even if you don’t feel like it. After all, a full bladder will reduce the activity of the uterus.

Proper breathing will definitely help ease the pain, which gets worse every hour. Massaging different parts of the body will also make it easier. You can stroke the lower abdomen with both hands, massage the sacrum with your fingers, or use the technique acupressure for the iliac crest (its inner surface).

At first, contractions last a few seconds with a break of about half an hour. Later, when the uterus opens more and more, contractions become more frequent, and the interval between them is reduced to 10-15 seconds.

When the cervix dilates 8-10 cm, the transition stage to the second stage of labor begins. By the time of dilation, the amniotic sac is partially retracted into the cervix, which then ruptures and releases amniotic fluid.

The stage of pushing and passage of the child through the birth canal

It's different called the stage of expulsion of the fetus, because it is now that the child is born. This stage is already much shorter and takes about 20-40 minutes on average. Its distinctive feature is that the woman actively participates in the process, helping to bring her baby into the world.

Pushing is added to contractions(this is the name for tension in the muscles of the uterus, diaphragm and abdominal cavity, promoting the expulsion of the fetus) and the child, thanks to the combination of intra-abdominal and intrauterine pressure, gradually leaves the birth canal.

At this stage you must listen to your obstetrician and do whatever is told. Breathe correctly and push correctly. It is during this period, more than ever, that you should not rely solely on your own feelings.

After the baby’s head appears, the process goes much faster, is not so painful, and relief comes for the woman in labor. A little more and the baby was born. However, the mother still awaits the last (third) stage of labor.

Stage of placenta rejection

The shortest part of the process is when, a few minutes after the birth of the baby, feeling light contractions, the woman pushes out the umbilical cord, placenta and fetal membranes.

In this case, the doctor must check that nothing remains in the uterus.

As a rule, this stage takes no more than half an hour. Then an ice pack is applied to the abdomen to speed up contraction of the uterus and prevent atonic bleeding, and the woman can be congratulated. She became a mother!

Video about childbirth

From the proposed documentary film For example real story you can find out what happens and at what stage during childbirth and preparation for it in the body of any woman.

Birth of a child- a wonderful event for every woman, which requires a lot of effort and work from the expectant mother. Childbirth is a kind of test for a woman, which is accompanied by labor pain and fear. Being pregnant, I experienced a huge fear of childbirth, but I knew that there was no turning back and I would still have to give birth. I re-read the birth stories of women who gave birth and listened to the impressions of my friends and acquaintances, in the hope of finding something soothing for myself. The closer I got to the birth of the child, the stronger my panic became. But, as it turned out, “fear has big eyes.” Because of our fears and ignorance of the birth process, we women cannot relax and help our body cope with childbirth. It has been proven that fear and anxiety are the culprits of pain and nothing else.

A few days before the birth of the child, the so-called precursors of labor appear, signs by which one can guess that childbirth is just around the corner. Not all women have these signs, because women are different and everything happens individually.

Harbingers of childbirth:

Your baby calms down in your stomach and no longer moves so actively;
- the stomach drops, breathing becomes easier, since the stomach no longer squeezes the diaphragm;
- the navel protrudes;
- weight decreases by 1-2 kg;
- appear nagging pain in the lower abdomen as before menstruation;
- the plug comes off (the plug is thick yellowish mucus that closes the cervix, preventing infections from entering the uterus)

The entire process of childbirth is divided into three stages, they are called - periods of labor.

Periods of childbirth.

1. First stage of labor. The period of opening and formation of the birth canal.
2. Second stage of labor. The period of expulsion of the child.
3.Third stage of labor. Postpartum period (placenta delivery).

First stage of labor.

The longest period can last from 10 to 12 hours, but a significant part of the time passes almost unnoticed. During this period, the cervix opens. Under the influence of hormones, the uterus begins to contract faster and faster. First, preparatory contractions appear, almost painless. The woman in labor feels them like a hardened belly. When the preparatory period ends and the cervix becomes soft, then “real” contractions begin.
At first, contractions are irregular and short-lived, only 15-20 seconds. The uterus gradually starts working.
Contractions gradually become more intense and more frequent. Due to the fact that the uterus contracts, the cervix, like a retractable cup, begins to decrease in height with each new contraction. Since the uterus has multidirectional muscles, as they contract, the cervix not only shortens, but also slowly opens.

These processes occur in parallel, but still this period of childbirth is divided into three subperiods:

The smoothing sub-period lasts from 3 to 7 hours. Contractions are almost painless and last no more than 30-40 seconds every 15-20 minutes.

The second sub-period of disclosure, its duration is 1-5 hours. The contractions are already intense, also lasting 30-40 seconds, but their frequency is increasing, now the contractions are repeated after 5-7 minutes. However, it is a good break for rest or even a light nap.

The process of opening the cervix is ​​actively assisted by the amniotic sac. He puts pressure on the cervical canal and pushes it apart. When the bladder bursts under its own weight, amniotic fluid is released. Sometimes this can happen even before contractions begin (the so-called early rupture of amniotic fluid). There is no need to be afraid that the bubble burst earlier, this does not worsen the child’s well-being at all, since the baby’s life depends on blood circulation in the umbilical cord, but nevertheless, tell the doctor about the time when the bubble burst.
If the bubble does not burst on its own, then the doctor may decide to puncture it at a certain point in labor (usually this happens in the second stage of labor).

Sub-period of transition to expulsion of the fetus. The baby's head descends into the pelvic floor and passes through a section of the uterus that is equipped with a large number of nerve endings. This sub-period is the most painful, as irritation of the nerve endings leads to the longest contractions.
This ends the first period.

What can you feel in the first stage of labor?

Fear, anxiety, uncertainty, loss of appetite or elation, relief, anticipation, desire to speak.
The most unpleasant may be discomfort in the sacral area during contractions, pain similar to pain during menstruation, diarrhea, a burning sensation in the abdomen, bloody issues.

At the end of the first stage of labor, when the cervix is ​​fully dilated, there will be a feeling of strong pressure on the perineal area, or a feeling that you really want to go to the toilet, sometimes there may be dizziness and chills.

Advice for a woman in labor: What to do in the first stage of labor?

Relax! Try to do normal household chores or take a nap. I tried to sleep during both small contractions and the most intense ones. And time passed faster, and there was more strength left. You can take a warm shower, directing the water stream to your lower back; the water is very relaxing. Ask your husband to massage your lower back. During contractions, you need to go to the maternity hospital every 7-10 minutes.
Now fear and anxiety are the worst enemies for you and for your baby, so do not be afraid of the impending contractions - but rather be glad that you will soon see your long-awaited baby, especially since most of the contractions are already behind you.
In between contractions, try to relax and rest as much as possible; if you are relaxed, the uterus will be well saturated with blood and will carry oxygen to the baby, and will restore its ability to contract intensively during the next contraction.
And if you are constantly tense in anticipation of a new contraction, then the uterus will not relax and the blood flow to it will worsen, and metabolic products will begin to be produced. They cause spasm of the uterine vessels and lower the pain threshold, therefore the pain will become more intense. Then a vicious circle arises - contraction - pain, break - fear of pain, contraction - even more pain.
Therefore, relax during the breaks and the birth will go well. By the way, you can learn to relax and breathe properly during pregnancy.

Second stage of labor.

This stage of labor is painful, but not long. In a normal course, the second stage of labor lasts no more than 30 minutes.
When the baby's head drops into the pelvic floor, a strong desire to push will appear, and labor itself begins. The contractile force of the abdominal press and diaphragm also joins the work of the uterus. All these joint efforts help the baby squeeze through the mother's birth canal. First the head is born, then one shoulder, another, and then the whole body.
Now your baby is free!

What can you feel in the second stage of labor?

Tension, not calmness, concentration, or vice versa, the feeling that labor will never end (although there is no more than an hour left before its end), as well as confidence, elation and even euphoria.
You may experience increasing pain in the lower back and hips, fatigue, thirst, and even nausea. Not all phenomena may appear, but only some of them.

Advice for a woman in labor: What to do in the second stage of labor?

Third stage of labor.

This period is almost invisible to the woman; after the birth of the baby, the woman directs all her attention towards the child. Although you will have to work quite a bit more. Moreover, the third period is the most painless and short-lasting, no more than 30 minutes. And it even seemed to me that no more than 5 minutes had passed, since my thoughts were only about my baby.
During this period, the placenta separates after several almost imperceptible contractions, and comes out along with the fetal membranes and the remains of the umbilical cord. This completes the birth process. After the birth of the placenta, a heating pad with ice will be placed on the lower abdomen so that there is no bleeding and the uterus contracts well.

What can you feel in the third period?

Exhaustion or surge of strength, irritability or universal love, hunger, thirst and desire to relax. And most importantly, a feeling of boundless happiness from the fact that your child was born.

Advice for a woman in labor: What to do in the third stage of labor?

Gain a little more strength and follow the midwife's instructions so that the placenta comes out and your perineum is stitched up if there were any tears. Be sure to ask the baby to be placed on your chest and feed him; the first drops of colostrum are the most valuable for the baby.
Thank everyone who helped you. And finally, call your husband and family.

Dear women, do not be afraid of childbirth and labor pain, be sure of their successful resolution. Believe me labor pain is quickly forgotten, but the miracle of the birth of a child remains with you forever!
The morning after giving birth, I was ready to go through everything again if it was necessary for my baby!

The question of how childbirth occurs is of concern to absolutely everyone: pregnant women, women who plan to become mothers, and even those women who do not want children yet, and this question is also interesting to men. And all because childbirth is not only a miracle of birth, but also a huge amount of work. We will try to explain to you how childbirth occurs, what needs to be done during contractions, and what you should or should not be afraid of. After all, knowing what will happen to a woman during childbirth can make her work much easier; there will be no surprises or incomprehensible situations.

What is childbirth

It’s worth starting with the fact that the process of childbirth is the process of the baby leaving the uterus through the mother’s reproductive tract. One of the most important roles Contractions play a role in this process. They are the main driving force, which first opens the cervix, and then helps the child overcome his difficult path formed by the ring of pelvic bones, soft tissues, perineum and external genitalia.

What is a uterus? The uterus, in fact, is an ordinary muscle, only it has one distinctive feature - it is hollow. This is a kind of case that the child fits inside. Like any other muscle, the uterus has the ability to contract. But unlike other muscles, contractions of the uterus occur regardless of the will of the woman giving birth; she can neither weaken nor strengthen them. How then does this process actually happen?

Well, firstly, as pregnancy progresses, or, more precisely, towards its end, the uterus begins to open on its own, due to the tension that appears due to the already large size of the fetus. The cervix is ​​affected, so by the end of pregnancy it is usually already dilated by 1-3 cm.

Secondly, it’s worth remembering about hormones. Towards the end of pregnancy, the pituitary gland begins to secrete the hormone oxytocin, which actually causes and maintains uterine contractions. Its synthetic analogue is used in maternity hospitals and during childbirth, administered to women with weak or insufficient labor in order to cause more intense contractions of the uterus.

These two factors are not self-sufficient, that is, the presence of one of them cannot by itself cause the onset of labor. But when their one-time “assistance” occurs, the process of childbirth begins. For the normal course of labor, regular and strong contractions of the uterus are necessary; otherwise, doctors will definitely correct this process.

Periods of labor

Childbirth consists of three obligatory consecutive periods, which have completely different durations for each woman.

1. Dilatation of the cervix due to contractions. This period is the longest and often the most painful.
2. Expulsion of the fetus. This is the very miracle of birth, the birth of a baby.
3. Birth of the placenta, children's place.

During the first birth, their normal duration is on average 8-18 hours. With repeated births, their length is usually much shorter - 5-6 hours, on average. This can be explained by the fact that the cervix and genital slit have already opened, so they have acquired the necessary elasticity, so this process goes faster than the first time.

But we hasten to clarify that the duration of labor is influenced by many different factors that can both speed up the process and slow it down.

Factors that influence the duration of labor:

• Child's body weight. According to statistics, the greater the baby's weight, the longer the labor takes. It is more difficult for a large baby to overcome his path;
• Fetal presentation. With a breech presentation, labor lasts longer than with a normal breech birth;
• Contractions. The different intensity and frequency of contractions directly affects both the course of labor as a whole and its length.

As soon as any symptoms occur that indicate the onset of labor (this could be rupture of amniotic fluid or regular contractions), the woman is transferred to the maternity ward. There, the midwife measures the blood pressure and body temperature of the laboring woman, the size of the small pelvis, and some hygiene procedures– shaving excess hair on the pubis, cleansing enema. Some maternity hospitals do not do enemas, but general practice has the following opinion: cleansing the intestines helps increase the space for the birth of a child, so it is easier for him to be born. After all this, the woman is sent to the birthing unit, from this moment until the birth of the child she is called a woman in labor.

How does childbirth occur - First stage of labor: dilation of the cervix

This period has three phases:

1. Latent phase. This phase begins from the moment regular contractions begin until the cervix opens by approximately 3-4 cm. The duration of this phase in the first birth is 6.4 hours, in subsequent labors it is 4.8 hours. The rate of cervical dilatation is approximately 0.35 cm per hour.
2. Active phase. This phase is characterized by much more active opening cervix from 3-4 cm to 8 cm, now the cervix opens at a speed of approximately 1.5 - 2 cm per hour during the first birth, 2-2.5 cm per hour during repeated births.
3. Deceleration phase. In the last phase, the opening occurs a little slower, from 8 to 10 cm, at a speed of approximately 1-1.5 cm per hour.

This period of labor begins with the appearance of strong contractions, which give you a signal that it is time to go to the hospital.

Many women face the problem of so-called “false contractions.” So how can you tell “false” or “practice” contractions from real ones?

False, training contractions are characterized by the following parameters:

• Irregularity;
• The contraction “disappears” when you change your body position, take a warm shower, or take an antispasmodic;
• The frequency of contractions is not reduced;
• The interval between contractions does not shorten.

Contractions of the uterus are directed from top to bottom, that is, from the bottom of the uterus to its cervix. With each contraction, the uterine wall seems to pull the cervix upward. As a result of these contractions, the cervix opens. Its opening is also facilitated by the fact that during pregnancy the cervix becomes softer. Dilation of the cervix is ​​necessary so that the baby can leave the uterus. Fully dilated cervix corresponds to a diameter of 10-12 cm.

Through contractions, the uterus acts not only on the cervix, but also on the fetus, pushing it little by little forward. These actions happen simultaneously. Once the cervix is ​​fully dilated, the membranes usually rupture. And after that the fetus will be able to leave the uterus. But if the bubble does not burst, a doctor or midwife can artificially disrupt its integrity.

During each contraction, the volume of the uterus decreases, intrauterine pressure increases, the force of which is transmitted to the amniotic fluid. As a result of this, the amniotic sac wedges into the cervical canal and thereby helps to smooth and dilate the cervix. When it is fully dilated at the height of the contraction at maximum tension, the amniotic sac ruptures and amniotic fluid flows out - such an outpouring of amniotic fluid is called timely. If the waters pour out when the cervix is ​​not fully opened, then the discharge is called early. If the water pours out before the onset of contractions, then such an outpouring is called premature (prenatal). Sometimes a baby is born “with a shirt on.” This means that the amniotic sac has not ruptured. Such children are called lucky, because in such a situation there is a danger of acute oxygen starvation(asphyxia), which poses a danger to the baby’s life.

A full bladder has a weakening effect on the labor activity of the uterus and interferes with the normal course of labor, so you need to go to the toilet every 2-3 hours.

It is impossible to say with certainty how long this period will last, but it is the longest during the birth process, taking up 90% of the total time. So, during the first pregnancy, cervical dilatation lasts approximately 7-8 hours, and during subsequent births - 4-5 hours.

During the period of cervical dilatation, the midwife or doctor will observe the intensity of uterine contractions, the nature of cervical dilatation, the degree of advancement of the baby's head in the pelvic tunnel, and the condition of the baby. Once your uterus is fully dilated, you will be moved to the delivery room where the next phase of labor will begin, during which your baby will be born. By this time, that is, at the height of labor, contractions repeat every 5-7 minutes and last 40-60 seconds.

Although contractions occur involuntarily, they cannot be weakened or their rhythm changed, but this does not mean that you should remain passive. At this stage, you can walk around the room, sit or stand. When you are standing or walking, contractions feel less painful, lower back pain decreases, and the baby adapts to the size of the pelvis.

The calmer and more relaxed you are, the faster the birth will go. Therefore, during the first phase of labor, you are faced with two tasks: to breathe correctly and relax as much as possible.

Why breathe correctly during a contraction?

The uterus does hard, intense work; during contractions, the muscles absorb oxygen. Our body is designed in such a way that lack of oxygen causes pain. Therefore, the uterus must be constantly saturated with oxygen, as well as supply oxygen to the baby. And this is only possible with deep and complete breathing.

Proper breathing in the second phase of labor ensures pressure from the diaphragm on the uterus, which makes pushing effective and helps the baby to be born gently, without injuring the mother’s birth canal.

Relaxation leads to the release of tension in the muscles, and in weakened muscles less oxygen is consumed, that is, both the uterus and the child will use the saved oxygen.

In addition, your general tension leads to more tension on the cervix during dilatation, which leads to severe pain. Therefore, at the first stage of labor, you need to strive to completely relax and not make any attempts: now you will not be able to intensify labor, but will only make it painful. Do not try to overcome or somehow distance yourself from what is happening during the fight, but completely accept, open up and surrender to what is happening. Relax when pain occurs, both physically and psychologically, perceive pain as a natural sensation.

How to breathe during a contraction:

• The fight is approaching. At this moment, the woman begins to feel increasing tension in the uterus.
  You need to breathe deeply, taking full inhalations and exhalations.
• The fight has begun. At this moment, the woman feels increasing pain.
  Begin to inhale and exhale quickly and rhythmically. Inhale through your nose, exhale through your mouth.
• The fight ends. The woman felt the peak of the contraction and its decline.
  Start breathing more deeply, gradually calming down. Between contractions, we recommend that you rest with eyes closed, it is quite possible that you will even be able to fall asleep. You need to save your energy for the most important event, the next stage of childbirth.

During childbirth, the pain of contractions always increases slowly, so there is time to get used to them and adapt, and there is time to rest between contractions. Besides, childbirth doesn't last forever, which means this pain won't last forever either. This banal thought in the delivery room can provide you with very real support. Do not forget that each contraction helps the baby move forward and ultimately leads to its birth.

What position is best to choose during cervical dilatation? The one that is most convenient and comfortable for you. Some women prefer to walk and massage their backs during contractions, while others prefer to lie down; in some maternity hospitals, women are allowed to use a fitball. Try it and you will definitely find “your” pose.

It was noticed that during childbirth a woman seems to plunge into herself. She forgets hers social status, loses control of himself. But in this state, the woman is far from helpless and lost, but on the contrary, she acts leisurely, spontaneously finding a position that suits her the best way, which is why the physiology of childbirth depends.

Most women in the early stages of labor will instinctively bend over, hold onto something, or kneel or squat. These poses are very effective in reducing pain, especially in the lower back, and also allow you to ignore external stimuli. Outwardly, they resemble a praying pose and, probably, somehow help to move into other states of consciousness.

As your cervix dilates and as your baby's head moves through the birth canal, you may feel the urge to help and push your baby, as well as the urge to push. But this should not be done without the advice of a midwife, since pushing until the cervix is ​​fully dilated will only interfere with the process and thereby increase the duration of labor. In addition, it is better for you not to waste energy on unnecessary early attempts, but to save them until the second stage of labor, when all your muscle efforts will be required from you. Therefore, try to relax, giving your body a comfortable position.

The decisive factors for the normal course of labor in the first stage are warmth, peace, free choice of positions, relaxation and the help of a midwife.

How childbirth occurs - First period: cervical dilatation in pictures

In this picture we see the cervix before dilation begins:

And at this point the cervix is ​​almost completely dilated:

How childbirth occurs - Second stage of labor: birth of a child

During this period, the moment occurs that you and your family have been waiting for 9 months with trepidation and impatience. During the second stage of labor, the baby is born. This period lasts on average 20-30 minutes. in the first birth and even less in subsequent ones.

After the cervix is ​​fully dilated, the woman, who until now has been a rather passive participant in childbirth, as they say, “enters the game.” It will take a lot of effort from her to help the fetus pass through the birth canal and be born.

What distinguishes this stage from others most of all is the strong urge to have a bowel movement; some may feel incredibly tired, while other women in labor suddenly experience a “second wind.” The second stage of labor can last up to 50 minutes for those who are not becoming mothers for the first time, and up to 2.5 hours for “newbies”. Its duration depends on many factors: the intensity of labor, the strength of the mother’s attempts, the size of the fetus and the mother’s pelvis, and the location of the head in relation to the mother’s pelvis.

Contractions at this stage are very different from the previous ones, since at this stage there is active muscle contraction chest, abdominals and uterus. The urge to stool is felt several times during the contraction, and it is thanks to them that the child moves “towards the exit”. Now, as indeed at all stages of labor, it is very important to follow the instructions of the midwife and doctor.

The expulsion ends with the appearance of the baby's head from the birth canal. At this moment, painful sensations in the perineal area and a “burning sensation” may appear. Then the whole body is born quite quickly. So be patient and trust your doctor.

By the end of pregnancy, the fetus takes the position of “coming into the light” - vertical cephalic presentation

Types of fetal presentations:
The presenting part is the part of the baby that first enters the pelvic area.

• Occipital.
  Most common, approximately 95% of cases. In this case, the head enters the pelvic area somewhat bent, the chin is pressed to the chest, the back of the head is turned forward;
• Facial
  The head is thrown back. Childbirth in this case can be difficult, a caesarean section is indicated;
• Frontal presentation.
  Intermediate position between facial and occipital presentation. The head is turned so that it will not fit into the pelvis, its diameter is too large, so natural childbirth caesarean section is not possible and is necessary;
• Transverse presentation(or shoulder presentation).
  The fruit is positioned horizontally up or down with its back. A caesarean section is also necessary.
• Gluteal(breech) presentation.
  The fetus is positioned with the buttocks down, and the head is located deep in the uterus. In case of breech presentation, the doctor will take maximum precautions and carefully determine the size of the pelvis. You need to find out in advance whether the maternity hospital where you will give birth has the equipment necessary for such cases.

Fetal presentation in pictures

Head presentation

Breech presentation

Options breech presentation:

Transverse presentation

How does the second stage of labor begin for a woman? She has a great desire to push. This is called pushing. The woman also has an irresistible desire to sit down, she has the need to grab onto someone or something. The position when a woman gives birth with support under the armpits from her partner is very effective: gravity is used to the maximum with minimal muscular effort - the muscles in this position relax as much as possible.

But no matter what position a woman chooses, understanding from others is no less important for her at this moment. Experienced and responsive assistants are able to make a woman feel warmth and joy. The midwife uses only in simple words, but this does not exclude firmness on her part in certain situations when you need to support the activity of a woman giving birth.

During this period, contractions are joined by pushing - muscle contractions. abdominal wall and diaphragm. The main difference between pushing and contractions is that these are voluntary contractions, that is, they depend on your will: you can delay or intensify them.

In order to be born, the child must pass through the birth canal, overcoming various obstacles. During labor, the baby must enter, cross, and exit the pelvis. And in order to overcome all the obstacles encountered, he needs to adapt to the shapes and sizes of the tunnel. The entry of the baby's head into the pelvic cavity (especially at the birth of the first child) can occur at the end of pregnancy, and the expectant mother may experience pain and a feeling that the fetus is descending. When entering the upper hole, the child turns his head to the right or left - this way it is easier for him to overcome the first obstacle. Then the child lowers into the pelvic area, turning in a different way. Having overcome the exit, the child encounters a new obstacle - the muscles of the perineum, into which he will rest his head for some time. Under pressure from the head, the perineum and vagina gradually expand, and the birth of the child begins.

During childbirth, the passage of the baby's head is most important, since it is the largest part of the fetus. If the head has overcome the obstacle, then the body will pass without difficulty.

Certain circumstances may make it easier for the baby to pass through the birth canal:

• the pelvic bones are connected to each other by joints, which by the end of pregnancy slightly relax, causing the pelvis to expand by several millimeters;
• The bones of the baby’s skull will finally fuse only a few months after birth. Therefore, the skull is malleable and can change shape in a narrow passage;
• the elasticity of the soft tissues of the perineum and vagina facilitates the passage of the fetus through the birth canal.

In the second stage of labor, contractions become more frequent and prolonged. The pressure of the baby's head on the perineal area causes the desire to push. While pushing, listen to the advice of an experienced midwife. You must actively participate in the birth process, helping the uterus push the baby forward.

What to do during contractions in the second stage of labor

1. The fight is approaching.
   Take the position in which you will give birth, relax your perineum and breathe deeply.
2. The start of the fight.
   Inhale deeply through your nose, this will lower the diaphragm as much as possible, which will increase the pressure of the uterus on the fetus. When you finish inhaling, hold your breath and then tighten your abdominal muscles, starting from the stomach area, to press as hard as possible on the fetus and push it forward. If you cannot hold your breath for the entire duration of the contraction, exhale through your mouth (but not sharply), inhale again and hold your breath. Continue pushing until the contraction ends, leaving the perineum relaxed. In one push, you need to push three times.
3. The fight is over.
   Breathe deeply, inhaling and exhaling deeply.

Between contractions, do not push, restore your strength and breathing. Your doctor or midwife will help you determine when to push. With each contraction, the baby's head appears larger and larger, and at a certain point you will be asked not to push, but to breathe quickly and shallowly, since one extra push can now sharply push the baby's head out and cause a rupture of the perineum. After the head comes out of the genital slit, the midwife releases the baby’s shoulders one by one, and the rest of the body comes out without difficulty.

A child who has just been born lets out a cry, possibly in pain, as air rushes into his lungs for the first time and sharply expands them. Your baby breathes for the first time. His nostrils flare, his face wrinkles, his chest rises, and his mouth opens slightly. Not so long ago, the absence of a child’s cry at birth was a cause for concern: it was believed that the cry indicated the viability of the child, and the medical staff did everything to cause this cry. But in fact, the first cry is completely unrelated to the child’s health. In this case, it is important that after the first breaths the baby’s skin color turns pink. So don't worry or worry if your baby doesn't cry at birth.

How childbirth occurs - The second stage of labor: the birth of a child in pictures

The cervix is ​​fully dilated, and under the influence of contractions and efforts of the woman in labor, the head appears:

The head is almost completely out:

After its release, the rest of the body comes out without problems and effort:

How does a baby feel immediately after birth?

According to many psychologists, the first cry of a child is the cry of horror that he experiences when he is born.

For the child, life in his mother’s belly was paradise: he did not experience any discomfort - it was always warm, calm, comfortable, satisfying, all his needs were satisfied by themselves, there was no need to make any effort. But suddenly everything changes: it becomes a little cramped, stuffy and hungry. To cope with the situation, the child goes on a journey without knowing how it will end. After all the hardships of this dangerous path, a child from a cozy, perfect world finds himself in a cold and indifferent world, where he must do everything himself. Such impressions can easily be compared to a real life catastrophe. That’s why psychologists call birth a “birth trauma.” The horror that a child experiences during birth is not retained in his consciousness, since it has not yet been formed. But he experiences everything that happens around him with his whole being - body and soul.

Coming into the world is a natural process, and a person is quite adapted to withstand it. Just like physiologically healthy child can be born without harm to bodily health, he is able to survive psychological trauma associated with birth, without any harm to mental health.

Compared to the enormous shock that childbirth is, some medical difficulties are experienced by the child quite easily. Therefore, the physiological consequences of difficult childbirth are compensated proper care. It is almost impossible to describe the feeling that a mother experiences when her baby appears. Probably, this is the simultaneous experience of several feelings and sensations at once: satisfaction of pride and sudden fatigue. It’s great if in the maternity hospital where you give birth, the baby is immediately placed on your chest. Then you will feel a connection with the child, realize the reality of his existence.

The first hour after birth is one of the important moments in the life of mother and newborn. This moment can become decisive in how the child will relate to the mother and, through her, to other people.

For some time after the birth of your baby, you can take a break from the hard work done and prepare for the final stage of labor - the birth of the placenta.

Mother and child are still connected by the umbilical cord, and the correct behavior of the mother makes this connection rich and perfect, from that moment a dialogue begins between them. This is the first meeting between mother and child, getting to know each other, so try not to miss it.

Continued skin-to-skin contact (with the baby lying on the mother's stomach) of mother and baby stimulates female hormonal secretion, which is necessary to induce contractions for spontaneous expulsion of the placenta. The less rush at this point, the less risk for subsequent bleeding. Use this moment to put your baby to the breast for the first time and squeeze colostrum into his mouth, which is an excellent immune defense.

At this time, the doctor ties the umbilical cord and cuts it. This procedure is absolutely painless since there are no nerves in the umbilical cord. In a healthy child at the time of birth, the width of the umbilical cord is 1.5 - 2 cm, and the length is approximately 55 cm. From this moment, a new independent life for your baby begins: the baby establishes independent blood circulation, and with the first independent breath, oxygen begins to flow into the body. Therefore, we can assume that the umbilical cord, which becomes flat and pale after childbirth, has fulfilled its function. The remaining root will fall off in a week, and in its place a wound will form that will heal within a few days. After one or two weeks, it will tighten, forming a fold that we all call the “navel.”

After birth, the midwife or doctor performs the first examination of the baby. His airways are cleared, since during childbirth he could have swallowed mucus, and the skin with which he is covered is also cleared of mucus. Then it is washed, weighed and measured. A bracelet with a surname is put on the child’s hand so as not to be confused. The doctor also pays attention to the color of the child’s skin, heart rate, breathing, patency of the nose, esophagus, anus, general mobility of the child.

In the following days, a more thorough and detailed examination is carried out, including a neurological examination of the newborn’s unconditioned reflexes: the automatic walking reflex, grasping and sucking reflexes. The presence of these reflexes indicates the good condition of the newborn’s nervous system.

How childbirth occurs - Third stage of labor: expulsion of placenta

Once your baby is born, labor is not over for you. After a few minutes, you will again feel uterine contractions, but less strong than before. As a result of these contractions, the placenta will separate from the uterus and come out. This process is called separation of the placenta. Sometimes after labor is completed, an injection is given to make the uterus contract better. Contraction of the uterine muscles compresses the vessels that connected the uterus to the placenta and remained open after the placenta was delivered, thereby preventing bleeding. When the placenta begins to separate, you should lie on your left side so as not to squeeze the vein.

Contractions are intensified by lightly pinching the nipples of the mammary glands or applying the baby to the breast, which promotes the release of oxytocin, the hormone responsible for contractions of the uterus. Afterbirth contractions cause separation of the placenta from the walls of the uterus, the connection between the placenta and the uterine wall is disrupted, and under the influence of pushing, the afterbirth is born.

After the birth of the placenta, the uterus contracts strongly, causing bleeding to stop.

After the birth of the placenta, the woman is already called a puerpera.

After the birth of the placenta, it is carefully examined by a doctor, then the birth canal is examined in a small operating room, and if ruptures are detected, they are sutured.

For the first two hours after birth, the woman remains in the maternity ward under the close supervision of the doctor on duty, then, in the absence of concerns and pathologies on both sides, she and the newborn are transferred to the postpartum ward.

Childbirth is not only a physical test, but also a strong emotional shock. That is why it is impossible to convey in words “what is what.” Literally everything affects the course of labor. And how they go depends on a lot of factors: the degree pain threshold, physical and psychological preparation and even your desire to have this child. The only thing that cannot be denied is that those women who attended special prenatal courses go through childbirth, if no less painful, then more calmly and confidently.

How do pathological births occur?

Pathological are those births whose scenario differs from the course of classical births. Pathological childbirth poses a threat to the health or even life of the mother and child.

Pathological childbirth occurs for the following reasons:

• Narrow pelvis of a woman in labor;
• Large fruit;
• Weak labor (anomaly of uterine contractility);
• Extensor presentation of the fetal head;
• Asynclitic insertion of the fetal head (in this case, one of the parietal bones is lower than the other (extra-axial insertion of the head);
• Breech presentation;
• Delay of the anterior shoulder behind the symphysis pubis;
• Malposition;
• Multiple pregnancy;
• Umbilical cord prolapse;
• Scar on the uterus.

Let's consider options for the course of labor for the most common pathologies.

How pathological childbirth occurs - Large fetus

A fruit is considered large if its weight exceeds 4000 g; a fruit over 5000 g is considered gigantic. Both large and gigantic fruits are developed proportionally, differing from the “classic” ones only in their much greater weight and size and, accordingly, length - up to 70 cm.

Some sources claim that the frequency of occurrence of large fruits in Lately increased, but this opinion is subject to doubt. According to the literature, the occurrence of large fruits is subject to significant fluctuations. In the middle of the twentieth century. Large fetuses occurred in 8.8% of all births, and giant fetuses occurred in 1:3000 births. Today, the frequency of encountering large fruits is approximately 10%.

Why does “large fruit” happen?

There is no clear opinion on this matter. There are suggestions that this pathology occurs in women whose pregnancy continues longer than usual. This occurs when late start and long duration of the menstrual cycle.

But there is also a risk group of women who may have a large fetus:

• Women with more than 2 births over 30 years of age;
• Overweight women;
• Pregnant women with large weight gain (more than 15 kg);
• Pregnant women with post-term pregnancy;
• Women who have already given birth large fruit.

It is believed that the main reason for the development of a large fetus is poor nutrition of the mother. Most large babies at birth are born to mothers who are prediabetic, obese, and have given birth multiple times. It is known that with obesity of the first degree, a large fetus is diagnosed in 28.5% of women, with degree II - in 32.9%, with III degree- 35.5%.

Also, a large fetus may be associated with the height, body weight of the father, or other relatives.

Ultrasound is considered the most accurate method for diagnosing a large fetus, which allows you to accurately determine the size and calculate the estimated body weight of the fetus. The most important indicators of fetometry are the biparietal size of the head, abdominal circumference, fetal femur length, ratio of femur length to abdominal circumference.

The course of pregnancy with a large fetus

The course of pregnancy with a large fetus may be almost no different from the course of a normal pregnancy.

How does childbirth occur with a large fetus?

In such births, with a large fetus, there are often various complications. These complications often include: weakness of labor, premature or early rupture of water, long duration of labor. During childbirth, a situation is possible when a discrepancy occurs between the fetal head and the size of the mother's pelvis. After the birth of the head, difficulties often arise with the removal of the baby's shoulders. In such childbirth there is a very high frequency of injuries to both mother and child, therefore in most cases or in the case of a combination of other pathologies, childbirth naturally replaced by childbirth emergency surgery caesarean section.

How pathological childbirth occurs - Childbirth with a narrow pelvis

The size of the pelvis is determined by a special device. The pelvis of a woman in labor is considered narrow if at least one of the parameters is reduced by 2 cm or more compared to the norm.

But there is also such a thing as a functional narrow pelvis. This pathology can only be seen during childbirth, when the size of the head does not correspond to the size of the mother’s pelvis, regardless of the size of the pelvis.

Reasons for the development of a narrow pelvis

A narrow pelvis is a pathology, and accordingly it has corresponding causes. The causes of a narrow pelvis are very, very diverse: environmental influences, disrupted periods intrauterine development, childhood and puberty.

Due to metabolic disorders between mother and child during pregnancy, the child’s pelvis may not form correctly, just like any other pathology. During intrauterine life, the mother's diet has a great influence on the fetus; vitamin deficiency can lead to dire consequences.

During the neonatal period and early childhood, the cause pathological formation pelvis can be caused by inadequate artificial feeding, living conditions, inadequate nutrition, rickets, heavy child labor, suffered infectious diseases(bone tuberculosis, poliomyelitis), injuries of the pelvis, spine, lower extremities.

During puberty, changes in the structure of the pelvis can be caused by significant emotional and physical stress, stressful situations, intense sports, exposure to the acceleration factor, hormonal imbalance and even wearing tight trousers made of thick, non-elastic fabric (the so-called “denim” pant).

Currently, such pathological forms of a narrow pelvis as rachitic, kyphotic, oblique, and sharp degrees of narrowing have disappeared, which is associated with acceleration and improvement of living conditions of the population.

How pathological childbirth occurs - Narrow pelvis

In most cases, when diagnosing a narrow pelvis or a functionally narrow pelvis, the doctor sends the woman for delivery by cesarean section.

Women with this pathology very often experience abnormal fetal position. It can be positioned in the womb any way you like: transversely, obliquely, in a breech position, etc. Also, with a narrow pelvis, premature rupture of amniotic fluid is common.

With a small degree of narrowing of the pelvis, spontaneous childbirth is quite possible. But with sufficiently large narrowings, natural childbirth poses a threat to the health and life of both mother and child, therefore II and III degree of narrowing of the pelvis - direct reading for a caesarean section.

In the picture below we see the baby's head and the woman's pelvic bones. In the first one there is no reason for alarm - the size of the head is proportional to the size of the pelvis, but in the last two the size of the head is clearly disproportionate to the size of the pelvis.

If the child was born naturally when the mother was diagnosed with a narrow pelvis, then he has a very high risk birth trauma Therefore, such newborns in most cases require resuscitation, intensive treatment and medical supervision after birth.

Prevention of development of a narrow pelvis

Such prevention should be carried out in childhood. The program of such prevention includes: a rational diet and rest; moderate physical activity; physical education and sports; compliance with hygiene rules; labor protection for teenage girls.

Doctors antenatal clinics should include pregnant women with a narrow pelvis or suspected narrow pelvis in the group high risk on perinatal and obstetric complications. When managing pregnancy, it is necessary to provide for a balanced diet to prevent a large fetus, additional measurements of the pelvis, ultrasound in the second and third trimester to clarify the position and estimated weight of the fetus, X-ray pelvimetry according to indications, hospitalization in maternity ward a few days before birth, timely diagnosis of the form and degree of pelvic narrowing, selection of a rational method of delivery.

Childbirth with extension presentation of the fetal head

Extensor presentation of the fetal head is an obstetric situation in which the fetal head in the first stage of labor is firmly established in one degree or another of extension.

According to the degree of extension of the head, the following variants of extension presentation are distinguished:

• anterior cephalic presentation;
• frontal presentation;
• facial presentation.

Reasons for the development of extension presentations:

• decreased tone and uncoordinated contractions of the uterus;
• narrow pelvis;
• decreased tone of the pelvic floor muscles;
• small or excessively large fetus size;
• decreased tone of the muscles of the anterior abdominal wall;
• lateral displacement of the uterus;
• tumor thyroid gland fetus;
• insufficient umbilical cord length.

How does childbirth occur with an extensor presentation of the fetal head?

It all depends on the degree and type of presentation. Doctors can wait for a while to see how the birth progresses. But the likelihood that the fetus can be inserted into the pelvis correctly and the birth will take place without complications is extremely small. In most cases, this kind of presentation is a direct indicator for an emergency cesarean section.

Birth with breech presentation

Breech presentation is a presentation in which the buttocks or legs of the fetus are located above the entrance to the small pelvis.

There are pure breech presentations, mixed breech presentations, and leg presentations (complete and incomplete). In rare cases, a type of leg presentation occurs - knee presentation.

The most common among breech presentations is a purely breech presentation.

Pure breech presentation

Often during childbirth there is a transition from one presentation to another. Complete and incomplete pelvic can turn into complete leg in a third of cases, which worsens the prognosis and serves as an indication for cesarean section.

The causes of breech presentation are quite vague. However, among all cases of birth with breech presentation, most cases of the cause of such presentation are prematurity, multiple pregnancy, big number childbirth and narrow pelvis.

The significant frequency of breech presentations during premature birth is explained by the disproportion of the size of the fetus and the capacity of the uterine cavity. As the fetal weight increases, the frequency of breech presentations decreases.

How does childbirth occur with a breech presentation of the fetus?

Childbirth with a breech presentation of the fetus differs significantly from those with a cephalic presentation. The main difference is the high intrauterine mortality rate, which exceeds the mortality rate of children during birth in cephalic presentation by 4–5 times. When delivering vaginally in first-time mothers with a breech presentation, the mortality rate is 9 times higher.

With breech presentation, as in most cases pathological childbirth, premature rupture of amniotic fluid, weakness of labor, prolapse of the umbilical cord, and fetal hypoxia often occur. The risk of umbilical cord prolapse during breech presentation is very high.

Also, breech birth is the most traumatic for mother and child.

The period of expulsion during breech presentation may begin earlier than expected, since the size of the baby’s pelvis is much larger. less head. In this regard, special complications during childbirth are possible, since problems may arise with the expulsion of the head from the uterus.

In most cases, this pathology is accompanied by such a feature as a large fetus. In such cases, a caesarean section is indicated.

Indications for performing a planned CS in primiparous women are:

• age over 30 years;
• extragenital diseases that require switching off pushing;
• severe disturbance of fat metabolism;
• pregnancy after IVF;
• post-term pregnancy;
• malformations of the internal genital organs;
• narrowing of the pelvis;
• scar on the uterus;
• estimated fetal weight less than 2000 g or more than 3600 g.

The frequency of CS in breech presentation reaches 80% or more.

Childbirth with abnormal fetal positions

Abnormal fetal position is a clinical situation when the axis of the fetus crosses the axis of the uterus.

Incorrect fetal positions include transverse and oblique positions. The transverse position is the situation in which the axis of the fetus intersects the axis of the uterus at a right angle, and large parts of the fetus are located above the crests of the iliac bones.

An oblique position is a situation in which the axis of the fetus intersects the axis of the uterus at an acute angle, and the underlying large part of the fetus is located in one of the iliac fossa of the large pelvis. The oblique position is considered a transitional state: during childbirth it turns into longitudinal or transverse.

The causes of transverse or oblique position of the fetus are varied. This includes decreased tone of the uterus and sagging muscles of the anterior abdominal wall. Other reasons incorrect positions fetus: polyhydramnios, in which the fetus is excessively mobile, multiple pregnancy, bicornuate uterus, placenta previa, tumors of the uterus and appendages located at the level of the entrance to the pelvis or in its cavity, narrow pelvis.

Childbirth in a transverse position cannot complete spontaneously (self-rotation and self-inversion are observed very rarely. In a transverse position of the fetus, only abdominal CS in a planned manner should be considered a reasonable method of delivery.

If a woman in labor enters the maternity hospital with a neglected transverse position, a CS is performed, regardless of the condition of the fetus.

How does childbirth occur in women with a uterine scar?

What is, in principle, a uterine scar? This is a dense formation that consists of rich collagen fibers connective tissue. Such a scar occurs when the integrity of the uterus is damaged, for example, after a previous birth by cesarean section.

By the way, the concept of “scar on the uterus after a caesarean section”, adopted in our country, is not entirely successful, since it is often reoperation no scar is found. Foreign authors usually use the terms “previous caesarean section”

The prevalence of caesarean section in Russia over the last decade has increased 3 times and is 16%, and according to foreign authors, about 20% of all births in developed countries end in caesarean section.

A woman who has a scar on the uterus is actively monitored during pregnancy, and during childbirth - extremely carefully.

During pregnancy, a woman with this pathology must monitor her well-being quite critically. Because the scar on the uterus can disperse, both during childbirth and during pregnancy.

Symptoms of uterine rupture along a scar during pregnancy:

• nausea;
• vomit;
• pain, not necessarily at the site of the scar, pain can also radiate to the back.

Also, signs of the beginning of uterine rupture along the scar during pregnancy are:

• hypertonicity of the uterus;
• signs of acute fetal hypoxia;
• possible bleeding from the genital tract.

If you have a scar on the uterus, do not rush to panic. Rupture of the uterus along a scar during pregnancy and with sufficient medical supervision is quite rare. But those women who are carrying multiple pregnancies especially need to take care of themselves. Such women in later stages need permanent medical supervision or self-control. If in any doubt, seek medical advice immediately.

How does childbirth occur with a uterine scar?

Most obstetricians have a basic postulate when delivering a pregnant woman with a uterine scar after a cesarean section: one cesarean section is always a cesarean section. However, both in our country and abroad, it has been proven that in 50–80% of pregnant women with an operated uterus, childbirth through the birth canal is not only possible, but also preferable. The risk of a repeat cesarean section, especially for the mother, is higher than the risk of spontaneous labor.

In most cases, a pregnant woman's word carries its own weight, so if you are determined to give birth naturally, you should discuss this in advance with the doctor who will deliver you. Since such cases have their own risks, not every doctor will welcome natural childbirth, which is why a woman with a uterine scar should address this issue in advance.

Childbirth with a uterine scar proceeds according to the usual birth pattern. Only in this case, as in the case of any other pathology, there is a high risk of premature rupture of amniotic fluid, weakness of labor, clinical discrepancy between the sizes of the child’s head and the mother’s pelvis, and the appearance of signs of impending uterine rupture. Such births are usually carried out with a full operating room. Doctors will constantly monitor the condition of the child, mother and uterine scar using CHT or ultrasound.

If a woman has a scar on the uterus, then during childbirth there is a possibility of its divergence, so such women are not given any anesthesia, since in case of suture divergence and loss of sensitivity, the moment can be missed. If such a situation occurs, the woman is urgently sent for surgery. Incomplete uterine rupture can occur at any stage of labor, even during the last push. Therefore, if there is a scar on the uterus, all women should undergo a manual examination of the uterus or an ultrasound.

Prevention of uterine rupture along the scar

Prevention of uterine rupture along a scar involves the following measures:

• Creating optimal conditions for the formation of a healthy scar on the uterus during the first caesarean section or other operations on the uterus;
• Forecasting, prevention, timely diagnosis And adequate therapy postoperative complications;
• Objective assessment of the condition of the uterine scar before pregnancy and during pregnancy;
• Screening examination during pregnancy;
• Careful selection of pregnant women for vaginal delivery;
• ·Careful cardiotocographic and ultrasound monitoring during spontaneous labor;
• Adequate pain relief during spontaneous labor;
• Timely diagnosis of threatening and/or incipient uterine rupture.

How does childbirth occur by caesarean section?

Caesarean section (CS) is a delivery operation in which the fetus and placenta are removed through an incision made in the uterus.

In modern obstetrics, CS is of great importance, since during complicated pregnancy and childbirth it allows preserving the health and life of the mother and child. However, every woman must understand that every surgery may have serious adverse consequences both in the immediate postoperative period and during subsequent pregnancy.

The most “popular” indication for caesarean section today there is an existing scar on the uterus after a previous operation.

Despite the possible complications of CS, the frequency of this operation is steadily increasing throughout the world, which causes reasonable concern for obstetricians in all countries.

The increase in the frequency of CS in modern obstetrics is due to objective reasons:

• An increase in the number of primigravidas over 35 years of age;
• Intensive implementation of IVF (often repeated);
• Increased incidence of CS in previous pregnancies of women;
• Increased incidence of cicatricial changes in the uterus after myomectomy performed through laparoscopic access;
• Expanding indications for CS in the interests of the fetus.

Indications for planned caesarean section during pregnancy:

• Complete placenta previa;
• Incompetence of the uterine scar (after CS surgery, myomectomy, uterine perforation, removal of a rudimentary horn, excision of the angle of the uterus during tubal pregnancy);
• Two or more scars on the uterus;
• Obstruction from the birth canal to the birth of a child (anatomically narrow pelvis, deformation of the pelvic bones, tumors of the uterus, ovaries, pelvic organs);
• Severe symphysitis;
• Presumably large fetus (fetal body weight more than 4500 g);
• Severe cicatricial narrowing of the cervix and vagina;
• Presence in the woman's medical history plastic surgery on the cervix, vagina, suturing genitourinary and enterogenital fistulas, third degree perineal rupture;
• Breech presentation, with a fetal body weight of more than 3600–3800 g (depending on the size of the patient’s pelvis) or less than 2000 g, III degree extension of the head according to ultrasound, mixed breech presentation;
• In multiple pregnancies: breech presentation of the first fetus with twins in first-time mothers, triplets (or more fetuses), conjoined twins;
• Monochorionic, monoamniotic twins;
• Malignant neoplasm;
• Multiple uterine fibroids with the presence of large nodes, especially in the lower segment of the uterus, malnutrition of the nodes;
• Stable transverse position of the fetus;
• Severe forms of gestosis;
• FGR III degree, if its treatment is effective;
• High myopia with changes in the fundus;
• Acute genital herpes (rashes in the external genital area);
• Kidney transplant;
• Death or disability of a child during a previous birth;
• IVF, especially repeated IVF, in the presence of additional complications;
• Indications for emergency CS during pregnancy;
• Any type of placenta previa, bleeding;
• Threatening, begun, accomplished uterine rupture along the scar;
• Acute fetal hypoxia;
• Extragenital diseases, deterioration of the pregnant woman’s condition;

Indications for emergency CS during childbirth are the same as during pregnancy. In addition, a CS may be necessary if the following complications childbirth

• Weak labor;
• Clinically narrow pelvis;
• Prolapse of the umbilical cord or small parts of the fetus with cephalic presentation of the fetus;
• Threatened, started or completed uterine rupture;
• Foot presentation of the fetus.

Keep in mind that if there are indicated indications for a CS, the doctor may decide to perform the birth through the vaginal birth canal, but at the same time he bears moral and sometimes legal responsibility in the event of an unfavorable outcome for the mother and fetus. But in any case, the woman must give informed consent to the operation.

Repeated CS is performed on the old scar with its excision.

If indications for a CS are identified during pregnancy, it is preferable to carry out the operation as planned, since it has been proven that the frequency of complications for the mother and child is significantly less than with emergency intervention.

CS is also performed according to combined indications, i.e. in the presence of a combination of several complications of pregnancy and childbirth, each of which individually is not considered a reason for performing a CS, but together they are considered as a real threat to the life of the fetus in the case of vaginal delivery (post-term pregnancy, births in first-time mothers over the age of 30 years, stillbirth or history of miscarriage, previous long-term infertility, large fetus, breech presentation, etc.).

If the operation is performed using epidural anesthesia, then the child is placed on the mother’s chest for 5–10 minutes immediately after primary processing. Contraindications to this are extreme prematurity and birth with asphyxia.

If there are no contraindications on the part of the mother and child, then breastfeeding is allowed on the 1st–2nd day after surgery.

Doctors clean the postoperative wound daily with a 95% solution ethyl alcohol with application of an aseptic sticker. In order to determine the condition of the wound and possible inflammatory and other changes in the uterus in the postoperative period, an ultrasound is prescribed on the 5th day. Sutures or staples from the anterior abdominal wall are removed 6–7 days after the operation, and 7–8 days after the operation the postpartum woman is discharged home under the supervision of a doctor at the antenatal clinic.

How does childbirth occur during multiple pregnancy?

A multiple pregnancy is a pregnancy in which two or more fetuses develop simultaneously in a woman’s body. Childbirth with two fetuses and a large number of fetuses is called multiple births.

If we make an analogy with the animal world, we can see that in it multiple pregnancies are the norm. In humans, multiple pregnancy is a pathology. Therefore, in the case of a multiple pregnancy, more control is exercised over the pregnant woman than in the case of a single pregnancy. And this is done because in the case of a multiple pregnancy, the various risks for mother and child are many times higher than in a singleton pregnancy.

The causes of multiple pregnancies are not yet fully understood. Numerous observations have been published in the literature indicating the role of hereditary predisposition. Among the causes of multiple pregnancies, the age of the mother is of known importance; It is more often observed in older women. There is data on the frequency of twins with anomalies in the development of the uterus, characterized by its bifurcation (bicornuate uterus, having a septum in the cavity, etc.). The cause of polyembryony may be the separation of blastomeres (in the early stages of fragmentation), resulting from hypoxia, cooling, disturbances in the acidity and ionic composition of the environment, exposure to toxic and other factors.

Multiple pregnancy can occur: as a result of fertilization of two or more simultaneously matured eggs (polyovulia), as well as the development of two or more embryos from one fertilized egg (polyembryony).

1 - each fetus has its own amniotic sac and its own placenta; 2 - both babies share the placenta, but each has its own amniotic sac; 3 - both have one common amniotic sac, but they are separated by membranes, both placentas are fused; 4 - both fetuses have one common amniotic sac and one common placenta.

All this, of course, is not a direct sentence to the fact that during pregnancy or childbirth with twins or triplets, you need to tune in to problems. Not at all! Such a pregnancy, like any other, may well pass without complications at all.

During a multiple pregnancy, increased demands are placed on a woman’s body: the cardiovascular system, lungs, liver, kidneys and other organs function under great strain. In this regard, multiple pregnancies, as a rule, are more severe than singleton pregnancies.

In multiple pregnancies, toxicoses occur more often than in singleton pregnancies: vomiting, drooling, edema, nephropathy, eclampsia.

Premature termination of multiple pregnancies often occurs. With twins, premature birth occurs in at least 25% of women. With triplets, premature termination of pregnancy occurs more often than with twins. The greater the number of fetuses gestated, the more often premature births are observed.

The development of twins born at term is normal in most cases. However, their body weight is usually less than that of single fruits. There is often a difference in the body weight of twins by 200-300 g, and sometimes more.

Uneven development of twins is associated with unequal intake nutrients from a single placental circulation. There is often a difference not only in weight, but also in the body length of twins. In this regard, the theory of supergeneration (superfoetatio) was put forward. Proponents of this hypothesis believe that it is possible to fertilize eggs of different ovulation periods, i.e. offensive new pregnancy in the presence of an existing, previously occurring pregnancy.

In case of multiple pregnancy during childbirth, more precisely in the first period, weakness of labor is more common than in normal pregnancy.

Managing childbirth requires a lot of attention and patience. It is necessary to carefully monitor the condition of the mother and fetus, the dynamics of labor, feed the woman in labor on time with nutritious, easily digestible food, monitor the function of the bladder and intestines, and systematically clean the external genitalia.

After the birth of the first child, contractions stop for a while. Since the volume of the uterus is reduced by half and it takes some time for it to regain the tone necessary for contraction. At this time, the doctor continuously monitors the second fetus, its well-being, and heartbeat. If the second fetus is not born within 30 minutes, the amniotic sac of the second fetus is opened. With multiple pregnancies, the children are most often slightly smaller than with a single pregnancy, so even in the case of a breech presentation, the second child comes out without problems. And the road to the exit has already been “trodden” by his older brother or sister.

The third stage of labor requires special attention. It is necessary to carefully monitor the condition of the woman in labor and the amount of blood lost. At the beginning of the afterbirth period, the woman in labor is injected intramuscularly with 1 ml of pituitrin or intravenously (by drip) oxytocin to prevent heavy bleeding.

IN postpartum period during multiple pregnancies, uterine contractions occur more slowly than after childbirth with one fetus. Therefore, it is necessary to monitor the nature of the discharge (lochia), uterine contractions and general condition postpartum women. If necessary, doctors prescribe drugs that contract the uterus. Such postpartum women benefit from gymnastic exercises that strengthen the muscles of the abdominal wall and pelvic floor.