How is the process of childbirth in the hospital completely. Birth of a child

Having an idea of ​​what happens during each stage of this process, a woman will be able to more easily endure childbirth and actively participate in them.

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 periods of childbirth.

Childbirth is a process expulsion of the fetus from the uterine cavity, its immediate birth and excretion of the placenta and fetal membranes. There are three periods of childbirth: the period of disclosure, the period of exile and the subsequent period.

Opening of the cervix

During this period, there is a gradual expansion of the cervical canal, that is, the opening of the cervix. As a result, a hole of sufficient diameter is formed through which the fetus can penetrate the birth canal from the uterine cavity, osseous 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 is stretched and thinned. Disclosure is conditionally measured in centimeters and is determined during a special obstetric vaginal examination. As the degree of cervical dilatation increases, muscle contractions intensify, become longer and more frequent. These contractions are contractions - painful sensations in the lower abdomen or in the 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. As a rule, the cervix begins to open with the appearance of contractions lasting 15-20 seconds with an interval of 15-20 minutes.

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

Latent phase continues until about 4–5 cm of dilatation, in this phase labor activity is not intense enough, contractions are not painful.

active phase the first stage of labor begins after 5 cm of disclosure and continues until full disclosure, 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 the effusion amniotic fluid. Of great importance is the time of outflow of water in relation to the degree of cervical dilatation, as this can affect the course birth process.

Normally, amniotic fluid is poured out in the active phase of labor, since due to intense uterine contractions, pressure on amniotic sac rises and opens up. Usually, after opening the fetal bladder, labor activity intensifies, contractions become more frequent and painful.
With the outflow of amniotic fluid before the opening of the cervix by 5 cm, they speak of their early outflow. It is most favorable if the outflow of water occurs after the dilatation has reached 5 cm. The fact is that at the beginning of labor, before the cervix dilates by 5 cm, there is an increased risk of developing weakness labor activity, that is, the weakening of contractions or their complete cessation. As a result, the course of childbirth slows down and can drag on for an indefinite time. If the amniotic fluid has already poured out, then the fetus is not isolated and not protected by the fetal bladder and amniotic fluid. In this case, the risk of developing intrauterine infection. To avoid intrauterine infection, labor must be completed within 12 to 14 hours of amniotic fluid discharge.

If the waters have departed before the onset of regular labor and the beginning of the opening of the cervix, they speak of premature outflow of waters.

How to behave

If you experience regular painful or pulling sensations in the lower abdomen, begin to note the time of the beginning and end 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 increase, this indicates that the cervix has begun to gradually open, that is, the first stage of labor has begun and you can go to the maternity hospital. At the same time, it is not necessary to rush - you can observe your condition for 2-3 hours and go to the hospital with more or less intense labor activity, 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 have appeared or not, since premature or early discharge of amniotic fluid can affect the choice of labor management tactics.

In addition, remember the time when regular contractions began, and record when the amniotic fluid occurred. Put a clean diaper between your legs so that the emergency room doctor can assess the amount of water and their nature, by which you can indirectly assess the condition of the unborn baby. If the waters have a greenish tint, this means that the original feces, meconium, got into 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 an Rhesus conflict. Therefore, even if the waters leak quite a bit or, conversely, pour into in large numbers, you should save the diaper or cotton pad with the amniotic fluid that has poured out.

To relieve pain during uterine contractions, try to take deep breaths through your nose and slow exhalations through your mouth during a contraction. During contractions, you should be active, try not to lie down, but, on the contrary, move more, walk around the ward.

During the contraction, try different positions that make the pain easier to bear, such as resting your hands on the bed and leaning forward slightly with your feet shoulder-width apart. If a husband is present at the birth, then 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 carried under the shower, directing a warm stream of water on the stomach, or immersed in a warm bath.

What does a doctor do?

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

An external obstetric examination is performed when the expectant mother enters the maternity hospital. During this procedure, the approximate weight of the fetus is estimated, the external dimensions of the pelvis of the expectant mother are measured, the location of the fetus, the height of the presenting part, 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 disclosure, the integrity of the fetal bladder 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, their color and quantity are also evaluated.

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 this study.

Every hour during the opening period, the blood pressure of the woman in labor is measured and auscultation is performed - listening to the fetal heartbeat. It is performed before the contraction, during the contraction and after it - this is necessary in order to assess how the future baby reacts to uterine contractions.

For a more accurate assessment of the nature of the fetal heartbeat and an indirect study of 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 captures the fetal heart rate, and the other - the frequency and intensity of uterine contractions.

As a result, two parallel curves are obtained, having studied 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. In normal labor, CTG is performed once and lasts for 20–30 minutes. If necessary, this study is performed more often; sometimes, when childbirth is at high risk, a permanent cardiotocogram is recorded. This happens, for example, in the presence of a postoperative scar on the uterus or in preeclampsia - a complication of pregnancy, which is manifested by increased pressure, edema and the appearance of protein in the urine.

Fetal expulsion period

After the cervix is ​​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 primiparas from 40 minutes to 2 hours, and for multiparous ones it can end in 15–30 minutes.

After leaving the uterine cavity, the presenting part of the fetus, most often this is the head, making certain rotational movements with its smallest size, with each contraction gradually descends to pelvic floor and emerges from the genital slit. After that, the head is born, then the shoulders, and finally the whole baby is born.

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

How to behave?

The second stage of childbirth requires high energy costs from both the expectant mother and the fetus, as well as the well-coordinated work of the woman in labor and the obstetric-gynecological team. Therefore, in order to facilitate this period as much as possible and avoid various complications, you should carefully listen to what the doctor or midwife says, and try to follow their advice accurately.

During the second stage of labor obstetric tactics largely determined by the level at which the presenting part of the fetus is located. Depending on this, you may be advised to push during an attempt, making every effort, or, conversely, try to restrain yourself.

The desire to push may be accompanied by unpleasant painful sensations. However, if pushing is not recommended at this point, every effort should be made to contain the push, as otherwise cervical tears may occur. The doctor may ask you to "breathe" the push. In this case, you need to take frequent sharp breaths and exhale through your mouth - this is called "doggie" breathing. This breathing technique will help you resist the urge to push.

If you are already on 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 point, you should concentrate as much as possible on what the midwife says, as she sees what stage the fetus is at and knows what needs to be done to facilitate its birth.

With the beginning of the attempt, you should take a deep breath and start pushing, trying to push the baby out. As a rule, during one push you may be asked to push 2-3 times. Try not to scream or let out air in any case, as this will only weaken the attempt, 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. will be installed in the genital gap, the midwife may ask you not to push again, since the force of the uterine contraction is already enough to further advance the head and remove it as carefully as possible.

What does a doctor do?

During the period of exile, the woman in labor and the fetus are subject to maximum stress. Therefore, control over the condition of both mother and baby is carried out throughout the second stage of childbirth.

Every half an hour, a woman in labor is measured blood pressure. Listening to the fetal heartbeat is carried out with each attempt, both during uterine contraction and after it, in order to assess how the baby reacts to the attempt.

An external obstetric examination is also performed regularly 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 the breech presentation, an episiotomy is mandatory. The decision to use episiotomy is made in cases where there is a threat of perineal rupture. After all, an incision made with a surgical instrument is easier to sew up, and it heals faster than a lacerated wound with crushed edges with 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.

After the birth, the baby is placed on the mother's stomach to provide the first body contact. The doctor assesses the condition of the newborn according to special criteria - the Apgar scale. At the same time, on a ten-point scale, 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 remnant of the umbilical cord and the fetal membranes are separated and released. This should happen within 30-40 minutes after the baby is born. In order for the placenta to separate, after childbirth, weak uterine contractions appear, due to which the placenta gradually separates from the uterine wall. Having separated, the placenta is born; from that moment on, it is considered that the birth has ended and the postpartum period has begun.

How to behave and what does the doctor do?

This period is the shortest and painless, and practically no effort is required from the puerperal. The midwife watches to see if the placenta has separated. To do this, she may ask you to push slightly. If at the same time the rest of the umbilical cord is drawn 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 with light, gentle pulls on the umbilical cord, gently 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 the 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 placental lobules or fetal membranes are found, removes them outward. If within 30-40 minutes there was no spontaneous separation of the placenta, 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 its ruptures have occurred.

Surgical correction is performed under local anesthesia, with significant damage may require intravenous anesthesia. Urine is released by a catheter so that in the next few hours the woman in childbirth does not worry about overfilled Bladder. Then, in order to prevent postpartum hemorrhage, women are placed on the lower abdomen special bag with ice that stays there for 30-40 minutes.

While the doctors are examining the mother, the midwife and pediatrician carry out the first toilet of the newborn, measure his height and weight, the circumference of the head and chest, and treat the umbilical wound.

Then the baby is applied to the mother's breast, and within 2 hours after the birth they remain in the maternity ward, where doctors monitor the condition of the woman. Blood pressure and pulse are monitored, uterine contraction and the nature of bloody discharge from the vagina are evaluated. This is necessary so that in the event of postpartum hemorrhage, promptly provide needed help in full.

With a satisfactory condition of the puerperal and the newborn, 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 the 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 of ​​labor activity, but primiparous mothers are especially interested in how to behave during childbirth and contractions in order to give birth easily and without breaks.

Woman's fear of upcoming birth is quite understandable, but one should never forget that it is, first of all, the joy of the appearance 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 a meeting with your baby.

In fact, the mood of the mother is transmitted to the baby in her womb, and when fear rolls over, the child also starts to get nervous. There is no need to think about pain - this is a transient phenomenon, it is better to remember those who are worried about their mother and are looking forward to her return from the hospital.

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

1. Preparation of the uterus and baby for birth during labor;
2. The birth of a child, through attempts;
3. The final phase with the departure of the placenta.

In this regard, during the preparation for childbirth, a woman should:

• Master the technique of correct breathing;
• Find the most successful position that helps to give birth, and, at the same time, safe for the condition of the fetus;
• Learn how to push correctly so as not to injure the child and avoid tears.

Primiparous mothers may not know, but it is not advisable to scream during childbirth, since in this case the baby may experience oxygen starvation, and it is also difficult for him to move along birth canal. In addition, fear, although it is psychological condition can exacerbate real pain.

Proper breathing, pushing and posture

It is better for a woman to learn about how to breathe in advance, moreover, you need to learn this, so you will have to practice during pregnancy.

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

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

• In the initial contractions, breathing should be applied with a count - inhalation must be taken during a spasm, and exhaled very slowly in just a few seconds. Usually count up to four when inhaling, and up to six when exhaling.
• When strong and painful contractions are present, one should breathe like a dog - inhalation and exhalation should be quick and rhythmic.
• During the birth of a child, breathing is characterized by a deep inhalation and a strong exhalation with the direction of pressure on lower part abdomen - uterus and vagina.

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

When discussing how to behave during childbirth and contractions, this applies not only to breathing, but also to the optimal posture of the woman in labor. There is no single ideal position for everyone for the most convenient expulsion of the fetus, since the body of each woman has its own characteristics, both physiological and anatomical.

But it has been noticed that it is more convenient for some women to give birth in a position on all fours, though still in the same horizontal position - for this, the woman in labor should try to take this position on her back, pulling her knees 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 child, the doctor during the contractions will tell you how best to do this.

It is very important to make attempts correctly. The intensity of pain, the appearance or absence of gaps depends on this. Also, pushing incorrectly can result in injury to the baby.

What not to do when trying:

• When trying, you can not strain the muscles, as this slows down the passage of the child through the birth canal - if the muscle tissue is relaxed, the uterus opens much faster, and the pain is not so strong.
• Do not put pressure on the head or rectum - only in the lower abdomen.
• It is forbidden to push with all your might until the uterus opens, as this leads to perineal tears and damage to the child.

On average, one contraction should have two or three attempts. A woman in labor should not rush things - in any case, the child 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 to give birth easily and without breaks

So, the very first stage is, in fact, contractions, the purpose of which is to open the cervix in order to let the baby through.

How to behave during fights

This period can take from 3-4 to 12 or more hours. In women giving birth for the first time, the process can drag on for 24 hours. Usually, in the beginning, contractions occur every 15-20 minutes, gradually increasing in time. At the same time, the intervals between them are shrinking. A woman needs to control their onset, since the doctor can derive a certain algorithm of childbirth from these calculations and help the woman in labor in time. If the contractions are repeated every 15 minutes, it's time to go to the hospital.

When uterine contractions are repeated every 5 minutes, this may mean an early 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 spine. Expectant mothers at this moment should not eat - you can only drink water.

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

How to properly push during childbirth so that there are no tears

Attempts are the most important and crucial moment when the baby is born. 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, the woman in labor can take hold of the special handrails of the table. Next, she will need to take a deep breath, hold her breath, and press her head in an elevated state to her chest.

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, a woman should relax as much as possible and breathe often. Later, she will be able to perform the most fruitful expulsion of the fetus.

Doctors say that during childbirth, the expectant mother should not take into account voluntary urination or even bowel movements, as holding back and straining 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 departure of a child'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 fetal membranes and placenta should separate. This may take a different 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 remnants. If a children's place has departed completely, an examination by a gynecologist of the birth canal will follow. As a rule, this process passes without complications.

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

Women who can't get rid of negative thoughts about upcoming trials, pain and ruptures, it can be advised to get trained using special gymnastics, massage and breathing exercises to make her feel more confident. Will help and good psychologist who will be able to set the expectant mother in a positive way. 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 properly during childbirth and contractions: 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, nevertheless, other feelings remain the main ones in this period for the expectant mother - awe, joyful excitement and expectation of the coming into the world of the greatest miracle bestowed on her by fate.

Especially difficult accounts for those who will experience the happiness of motherhood for the first time. After all, fear of the unknown is added to the fear of pain and complications, to fears for the child, and for herself, aggravated by a variety of horror stories of relatives and friends who have already gone through this.

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

Therefore, instead of imagining the coming "torments of hell", much it is wiser to sign up for prenatal preparation courses for pregnant women, where you can learn all the most necessary and important about childbirth, learn correct breathing, correct behavior, correct postures. And meet this day with a calm, balanced and self-confident expectant mother.

Childbirth process. Main steps

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

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

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

• Due to the fact that the head of the fetus approaches the entrance to the small pelvis and begins to stretch the lower part of the uterus, the pregnant woman's stomach drops. This reduces pressure on the diaphragm and makes breathing easier.
• The center of gravity of the body shifts forward, straightening the shoulders.
• By reducing the concentration of progesterone, excess fluid is excreted from the body. And maybe even one or two kilograms to decrease weight.
• The child becomes less active.
• The psychological state is changing. Future mom may feel apathy or, conversely, feel overexcited.
• In the lower abdomen and in the lower back, there are pulling, but not severe pains, which, with the onset of childbirth, will turn into contractions.
• A thick mucous liquid begins to stand out from the vagina, sometimes with streaks of blood. This is the so-called cork, which protected 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 childbirth readiness: maturity of the cervix. It is her maturation that speaks of the approach of this important event.

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

Stage of contractions and cervical dilatation

The moment when gradually increasing ones become regular and their frequency grows is considered to be the beginning of the first, longest (10-12 hours, sometimes up to 16 hours for nulliparous women and 6-8 hours for those who give birth again) stage of childbirth.

The body at this stage natural bowel cleansing. And that's okay. If cleaning does not go away on its own, care should be taken to carry it out. However, it must be remembered that Doctors categorically do not recommend staying on the toilet for a long time, because it can provoke premature birth.

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

Competent breathing will definitely help ease the pain, which is getting worse every hour. Facilitate them and massaging different parts of the body. 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, the contractions last a few seconds with a break of about half an hour. In the future, 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 opens by 8-10 cm, the stage of transition to the second stage of labor begins. By the time of opening, the amniotic membrane is partially retracted into the cervix, which at the same time breaks and pours out the amniotic fluid.

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

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

Attempts are added to fights(the so-called tension of the muscles of the uterus, diaphragm and abdominal cavity, contributing to the expulsion of the fetus) and the child, due to the combination of intra-abdominal and intrauterine pressure, gradually leaves the birth canal.

At this stage it is necessary to obey the obstetrician and do whatever is said. Breathe properly and push properly. It is during this period, more than ever, that you should not rely solely on your own feelings.

After the appearance of the baby's head, 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 is still waiting for the last (third) stage of childbirth.

Placenta rejection stage

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

In this case, the doctor must check that nothing is left 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 the contraction of the uterus and prevent atonic bleeding, and the woman can be congratulated. She became a mother!

Childbirth video

From the proposed documentary film For example real history you can find out what and at what stage occurs during childbirth and preparation for them 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 future 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 reread the stories about the birth of women who gave birth and listened to the impressions of my friends and acquaintances, hoping to find something soothing for myself. The closer I got to the birth of my child, the stronger my panic became. But, as it turned out, "fear has big eyes." We, women, because of our fears and ignorance of the process of childbirth, 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 a child, the so-called harbingers of childbirth appear, signs by which you 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 in the stomach calms down and no longer moves so actively;
- the stomach drops, it becomes easier to breathe, since the stomach no longer squeezes the diaphragm;
- the navel protrudes;
- weight is reduced by 1-2 kg;
- appear drawing pains in the lower abdomen as before menstruation;
- cork leaves (cork is a thick yellowish mucus that closes the cervix, preventing infections from entering the uterus)

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

childbirth periods.

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

First stage of childbirth.

The longest period can last from 10 to 12 hours, but most of the time passes almost imperceptibly. 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 stomach. When the preparatory period is over and the cervix has become soft, then "real" contractions begin.
At first, the contractions are not regular and short, only 15-20 seconds. The uterus is gradually starting to work.
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 run in parallel, but still this period of childbirth is divided into three sub-periods:

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 for 30-40 seconds, but their frequency increases, now the contractions are repeated after 5-7 minutes. Nevertheless, it is a good break for rest or even a light nap.

The process of opening the cervix actively helps the fetal bladder. It presses on the cervical canal and pushes it apart. When the bubble bursts under its own weight, amniotic fluid is poured out. Sometimes this can happen even before labor starts (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 life of the crumbs depends on the blood circulation in the umbilical cord, but nevertheless tell the doctor about the time when the bubble burst.
If the bubble does not burst itself, then the doctor may decide to pierce 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 the uterus, which is equipped with a large number of nerve endings. This sub-period is the most painful, since irritation of the nerve endings leads to the longest contractions.
Thus ends the first period.

What can you feel in the first stage of labor?

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

At the end of the first stage of labor, with the full opening of the cervix, there will be a feeling of strong pressure on the perineal area, or a feeling that you want to go to the toilet for the most part, sometimes there may be dizziness and chills.

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

To relax! Try to do your normal household chores or take a nap. I tried to doze off both in small contractions and in the most intense ones. And time ran faster, and more strength remained. You can take a warm shower, directing jets of water to the lower back, the water is very relaxing. Ask your husband to massage your lower back. With contractions every 7-10 minutes you need to go to the hospital.
Now fear and anxiety are the worst enemies for you and your baby, so do not be afraid of impending contractions - but rather rejoice that you will soon see your long-awaited baby, especially since most of the contractions are over.
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 child, and will restore its ability to contract intensively at 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, metabolic products will begin to be produced. They cause spasm of the vessels of the uterus and lower the pain threshold, so the pain will become more intense. Then a vicious circle arises - a fight - pain, a break - fear of pain, a fight - even more pain.
Therefore, relax during breaks and childbirth will be normal. By the way, you can learn relaxation and proper breathing even during pregnancy.

Second stage of childbirth.

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 descends into the pelvic floor, there will be a strong desire to push, and the birth itself begins. The contractile force of the abdominal press and diaphragm also joins the work of the uterus. All these joint efforts help the child to squeeze through the mother's birth canal. First, a head is born, then one shoulder, another, and then the whole body.
Here is your baby and on the loose!

What can be felt in the second stage of labor?

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

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

Third stage of childbirth.

This period is almost not noticeable for a woman, after the baby is born, the woman directs all her attention towards the child. Although it will take quite a bit of work. Moreover, the third period is the most painless and short, 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.
In 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 be felt in the third period?

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

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

Get a little more strength and follow the instructions of the midwife so that the placenta comes out and your perineum is sewn up if there were tears. Be sure to ask to put the baby on your chest and feed him, the first drops of colostrum are the most valuable for the baby.
Thank everyone who helped you. 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 quickly forgotten, and the miracle of the birth of a child remains with you forever!
Already on the morning after the birth, I was ready to go through everything again, if it was required for my crumbs!

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 of interest to men. And all because childbirth is not only a miracle of birth, but also a huge work. About how childbirth occurs, what needs to be done during labor and what you should or should not be afraid of, we will try to explain to you in as much detail as possible. After all, knowing what will happen to a woman during childbirth can greatly facilitate her work, there will be no surprises or incomprehensible situations.

What is childbirth

It is worth starting with the fact that the process of childbirth is the process of the child leaving the uterus through the mother's genital tract. one of the most important roles contractions play 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, inside which the child is placed. Like any other muscle, the uterus has the ability to contract. But unlike other muscles, uterine contractions occur independently of the will of the woman giving birth, she can neither weaken them nor strengthen them. How then does this process take place?

Well, firstly, with the course of pregnancy, and, to be more precise, towards its end, the uterus begins to open itself, due to the tension that appears due to the already large size of the fetus. There is an effect on the cervix, so by the end of pregnancy, it is usually already open by 1-3 cm.

Secondly, it is 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, introducing it to women with weak or insufficient labor activity to cause more intense uterine contractions.

These two factors are not self-sufficient, that is, the presence of one of them cannot in itself cause the onset of labor. But when their one-time "assistance" occurs, the process of childbirth begins. Regular and strong uterine contractions are necessary for the normal course of childbirth, otherwise doctors will definitely correct this process.

Periods of childbirth

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

1. Opening of the cervix under the influence of contractions. This period is the longest and often the most painful.
2. Fetal expulsion. This is the very miracle of birth, the birth of a baby.
3. Birth of the placenta, children's place.

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

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

Factors that affect the duration of labor:

• The body weight of the child. According to statistics, the greater the weight of the baby, the longer the birth lasts. It is more difficult for a large baby to overcome its path;
• Presentation of the fetus. With a breech presentation, childbirth lasts longer than with a normal, head;
• contractions. Different intensity and frequency of contractions directly affects both the course of labor in general and their length.

As soon as any symptoms occur that can be used to judge the onset of the birth process (this may be an outpouring 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 woman giving birth, the size of the small pelvis, some hygiene procedures– shaving extra hair on the pubis, cleansing enema. Some maternity hospitals don't do enemas, but general practice has the following opinion: cleansing the intestines helps to 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 birth unit, from that moment until the birth of the child she is called a woman in labor.

How labor happens - 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 neck opens by about 3-4 cm. The duration of this phase in the first birth is 6.4 hours, in the next - 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 disclosure cervix from 3-4 cm to 8 cm, now the cervix opens at a speed of about 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 is a little slower, from 8 to 10 cm, at a rate of about 1-1.5 cm per hour.

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

Many women face such a problem as the so-called "false contractions". So how can you tell "false" or "training" contractions from real contractions?

False, training bouts are characterized by the following parameters:

• Irregularity;
• The fight "disappears" when changing the position of the body, taking a warm shower, taking an antispasmodic;
• The frequency of contractions is not reduced;
• The interval between contractions is not reduced.

The contractions of the uterus are directed from top to bottom, that is, from the bottom of the uterus to its cervix. With each contraction of the uterine wall, as it were, the cervix is ​​pulled up. As a result of these contractions, the cervix opens. Its disclosure also facilitates the fact that during pregnancy the neck becomes softer. The opening of the cervix is ​​necessary so that the baby can exit the uterus. Fully open neck corresponds to a diameter of 10-12 cm.

By contractions, the uterus affects not only the cervix, but also the fetus, pushing it forward a little. These actions happen at the same time. After the cervix is ​​fully dilated, the fetal bladder usually ruptures. 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 violate 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 fetal bladder is wedged into the cervical canal and thereby contributes to the smoothing and opening of the cervix. When it is fully opened at the height of the contraction at maximum tension, the fetal bladder bursts, and amniotic fluid is poured out - such an outpouring of amniotic fluid is called timely. If the waters poured out with an incomplete opening of the cervix, then the outflow is called early. If the waters poured out before the start of contractions, then such an outpouring is called premature (prenatal). Sometimes a baby is born "in a shirt." This means that the fetal bladder did not burst. Such children are called lucky, because in such a situation there is a danger of an acute oxygen starvation(asphyxia), which is a danger to the life of the baby.

An overfilled bladder has a weakening effect on the labor activity of the uterus, prevents the normal course of childbirth, so every 2-3 hours you need to go to the toilet.

It is impossible to say with accuracy how long this period will last, but it is the longest in the process of childbirth, it takes 90% of the time. So, during the first pregnancy, the opening of the cervix lasts about 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, the condition of the child. Once your uterus has fully opened, you will be transferred 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 activity, contractions are repeated every 5-7 minutes and last 40-60 seconds.

Although contractions occur involuntarily, they cannot be weakened, their rhythm cannot be 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 around, contractions are less painful, lower back pain decreases, and the baby adjusts 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 childbirth, you are faced with two tasks: to breathe correctly and to relax as much as possible.

Why breathe correctly during a fight

The uterus performs hard, hard work, during contractions, the muscles absorb oxygen. Our body is so arranged that the lack of oxygen causes pain. Therefore, the uterus must be constantly saturated with oxygen, as well as supply oxygen to the child. And this is possible only with deep and full breathing.

Proper breathing in the second phase of labor provides pressure from the diaphragm on the uterus, which makes the efforts 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 overall tension leads to more tension on the cervix during dilation, which leads to severe pain. Therefore, at the first stage of childbirth, you need to strive to completely relax and not make any attempts: now you will not be able to intensify labor activity, 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 coming. The woman at this moment begins to feel the growing tension of the uterus.
  You need to breathe deeply, taking full breaths and exhalations.
• The fight has begun. At this moment, the woman feels a growing pain.
  Begin to take quick and rhythmic breaths in and out. 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 you may even be able to fall asleep. It is necessary to save energy for the most important event, the next period of childbirth.

During childbirth, pain during contractions always increases slowly, so there is time to get used to them and adapt, and between contractions there is time to rest. In addition, childbirth does not last forever, which means that this pain will not last forever either. This banal thought in the delivery room can give you very real support. And don't forget that each contraction helps the baby move forward and eventually leads to his birth.

What is the best position to choose during the opening of the cervix? The one that is most convenient and comfortable for you. Some women prefer to walk and massage their back 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 a woman during childbirth, as it were, is immersed in herself. She forgets her social status losing control of himself. But in this state, a woman is far from being helpless and lost, but on the contrary, she acts slowly, spontaneously finding a pose that suits her. the best way, from which the physiology of childbirth depends.

Most women in the early stages of labor instinctively bend over, hold on to 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 the pose of a praying person and, probably, in some way help to move into other states of consciousness.

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

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

How childbirth happens - First period: dilatation of the cervix in pictures

In this picture we see the cervix before it begins to dilate:

And on this, the cervix is ​​already almost completely open:

How childbirth happens - Second stage of labor: the birth of a child

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

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

Most of all, this stage is distinguished from others by a strong urge to empty the intestines, someone may experience a feeling of insane fatigue, and other women in labor suddenly have a “second wind”. The second stage of labor can last up to 50 minutes for those who become mothers not 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 efforts, the size of the fetus and the mother's pelvis, the location of the head in relation to the pelvis of the woman in labor.

Contractions in this stage are very different from the previous ones, since at this stage there is an 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 "to the exit." Now, as, indeed, at all stages of childbirth, it is very important to follow the instructions of the midwife and doctor.

The exile ends with the appearance of the baby's head from the birth canal. At this point, there may be pain in the perineum, "burning". 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 world" - vertical head presentation

Types of fetal presentation:
The presenting is that part of the child that first enters the pelvic region.

• Occipital.
  The most common, approximately 95% of cases. At the same time, the head enters the pelvic region 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, therefore natural childbirth caesarean section is impossible and necessary;
• Transverse presentation(or shoulder presentation).
  The fetus is located horizontally up or down with its back. A caesarean section is also necessary.
• Gluteal(breech) presentation.
  The fetus is located with the buttocks down, and the head is in the depths of the uterus. With a breech presentation, the doctor will take maximum precautions, carefully determine the size of the pelvis. You also 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 childbirth begin for a woman? She has a great desire to push. It's called pushing. Also, a woman has an irresistible desire to sit down, she has a 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, it is equally important for her at this moment to understand from others. Experienced and responsive assistants are able to make a woman feel warmth and joy. The midwife uses during childbirth only in simple terms, but this does not exclude her firmness in certain situations when you need to support the activity of a woman in labor.

During this period, attempts are added to contractions - muscle contractions abdominal wall and diaphragms. The main difference between attempts and contractions is that these are arbitrary 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 the pelvis, cross it, and exit. 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, while 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 descends into the pelvic area, while turning in a different way. Having overcome the exit, the child meets a new obstacle - the muscles of the perineum, in which he will rest his head for some time. Under the pressure of the head, the perineum and vagina gradually expand, and the birth of the child begins directly.

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

Some circumstances can make it easier for a baby to pass through the birth canal:

• the bones of the pelvis are interconnected by joints, which by the end of pregnancy slightly relax, causing the pelvis to expand by several millimeters;
• the bones of the child's skull will finally grow together 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 longer. The pressure of the child's head on the perineal area causes a desire to push. While pushing, listen to the advice of an experienced midwife. You must actively participate in the birth process, helping the uterus to push the baby forward.

What to do during a contraction in the second stage of labor

1. The fight is coming.
   Assume the position in which you will give birth, relax your perineum and breathe deeply.
2. The start of the fight.
   Inhale deeply through the nose, this will lower the diaphragm as much as possible, as a result of which the pressure of the uterus on the fetus will increase. When you have finished inhaling, hold your breath, and then strongly tighten the 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 duration of the contraction, exhale through your mouth (but not abruptly), inhale again and hold your breath. Continue pushing until the end of the contraction, leaving the perineum relaxed. For one attempt, you need to push three times.
3. The fight is over.
   Breathe deeply, inhaling and exhaling fully.

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

A newly born child lets out a cry, possibly from pain, as air rushes into his lungs for the first time and expands them dramatically. Your baby is breathing for the first time. His nostrils flare, his face wrinkles, his chest rises, and his mouth opens. Not so long ago, the absence of a baby's cry at birth was a cause for concern: it was believed that the cry indicates 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 health of the child. In this case, it is important that after the first breaths the skin color of the child becomes pink. Therefore, do not worry or worry if your baby does not cry at birth.

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

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

The head is almost completely out:

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

What does the baby feel immediately after birth

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

For a child, life in the mother's stomach was a paradise: he did not experience any discomfort - it was always warm, calm, comfortable, satisfying, all needs were satisfied by themselves, no effort was needed. But suddenly everything changes: it becomes somewhat cramped, stuffy and hungry. To cope with the situation, the child goes on a journey, not imagining 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 everything has to be done by oneself. Such impressions can be easily compared with a real life catastrophe. Therefore, psychologists call the birth of the "trauma of birth." The horror that a child experiences at the time of birth is not stored in his mind, since it has not yet formed. But everything that happens around him, he experiences with his whole being - body and soul.

Birth is a natural process, and man is well equipped to endure 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: the satisfaction of pride and the fatigue that has suddenly piled on. It's great if in the hospital where you give birth, the baby will immediately be placed on your chest. Then you will feel a connection with the child, realize the reality of his existence.

The first hour after childbirth is one of the important moments in the life of the mother and the 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 the baby, you can take a break from the hard work done and prepare for the final stage of labor - the birth of the afterbirth.

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

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

At this time, the doctor bandages the umbilical cord and cuts it. This procedure is completely painless as 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, your baby begins a new independent life: the baby establishes independent blood circulation, and with the first independent breath, oxygen begins to enter 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 a wound will form in its place, healing within a few days. After one or two weeks, it will tighten, forming a fold, which we all call the "navel".

After birth, the midwife or doctor conducts the first examination of the child. His airways are cleaned, since during childbirth he could swallow mucus, and the skin with which he is covered is also cleaned of mucus. Then it is washed, weighed, 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, the rhythm of the heartbeat, breathing, the patency of the nose, esophagus, anus, the general mobility of the child.

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

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

With the birth of a child, childbirth is not over for you. After a few minutes, you will feel the contractions of the uterus again, but already 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 the completion of childbirth, an injection is given so that the uterus contracts better. The contraction of the muscles of the uterus provides compression of the vessels that connected the uterus to the placenta and remained open after the placenta came out, thereby eliminating bleeding. When the separation of the placenta begins, you should lie on your left side so as not to squeeze the vein.

Contractions intensify with a slight pinching of the nipples of the mammary glands or applying to the baby’s chest, which contributes to the release of oxytocin, the hormone responsible for uterine contractions. Subsequent contractions cause separation of the placenta from the walls of the uterus, the connection of the placenta with the wall of the uterus is broken, and under the influence of attempts, the placenta is born.

After the birth of the placenta, the uterus is greatly reduced, as a result of which the bleeding stops.

After the birth of the placenta, the woman is already called the puerperal.

After the birth of the placenta, the doctor carefully examines it, then the birth canal is examined in a small operating room, if tears are found, they are sewn up.

The first two hours after childbirth, the woman remains in the maternity ward under the close supervision of the doctor on duty, then, in the absence of fears 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 shake-up. That is why it is impossible to convey in the words "what is what" - it is impossible. Literally everything affects the course of childbirth. And how they pass 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 have attended special prenatal courses go through childbirth, if not less painfully, then more calmly and confidently.

How does pathological childbirth occur?

Those births are called pathological, whose scenario differs from the flow of the classical kind. Pathological childbirth carries a threat to the health or even the life of the mother and child.

Pathological births are for the following reasons:

• Narrow pelvis of the woman in labor;
• Large fruit;
• Weak labor activity (anomaly of the contractile activity of the uterus);
• extensor presentation of the fetal head;
• Asynclitic insertion of the fetal head (in this case, one of the parietal bones is below the other (off-axial insertion of the head);
• Breech presentation;
• Delay of the anterior shoulder behind the pubic articulation;
• Malposition;
• Multiple pregnancy;
• Prolapse of the umbilical cord;
• Scar on the uterus.

Consider the options for the course of childbirth with the most common pathologies.

How pathological births occur - Large fetus

A fruit is considered large if its mass exceeds 4000 g, a fruit over 5000 g is considered giant. Both large and gigantic fetuses are proportionally developed, differing from the “classic” one only in a much larger weight and size and, accordingly, in length - up to 70 cm.

Some sources claim that the frequency of meeting large fruits in recent times 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. In 8.8% of all births, large fruits were found, and giant ones - 1:3000 births. To date, the frequency of meeting large fetuses is approximately 10%.

Why does the "large fruit" happen

There is no single opinion on this matter. There are suggestions that this pathology occurs in women whose pregnancy continues longer than usual. This occurs at late start and long menstrual cycles.

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

• Women with more than 2 births over 30 years of age;
• overweight women;
• Pregnant women with a large weight gain (more than 15 kg.);
• Pregnant women with overweight;
• Women who have given birth large fruit.

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

Also, a large fetus may be associated with 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 size of the biparietal head size, abdominal circumference, the length of the femur of the fetus, the ratio of the length of the femur to the circumference of the abdomen.

The course of pregnancy with a large fetus

The course of pregnancy with a large fetus may not differ much from the course of a normal pregnancy.

How does childbirth occur with a large fetus

In such childbirth, with a large fetus, there are often various complications. Among these complications are often found: weakness of labor activity, premature or early discharge of water, long duration of labor. During childbirth, a situation is possible when there is a discrepancy between the head of the fetus and the size of the mother's pelvis. After the birth of the head, there are often difficulties with the withdrawal 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 with a combination of other pathologies, childbirth naturally replace childbirth by emergency operation 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 such a thing as a functional narrow pelvis. Such a 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, respectively, it has corresponding causes. The causes of a narrow pelvis are very, very diverse: environmental influences, disturbed periods prenatal development, childhood and puberty.

Due to a metabolic disorder between mother and child during pregnancy, the pelvis may not form properly in the child, as, indeed, any other pathology. During intrauterine life, the mother's diet has a great influence on the fetus, vitamin deficiency can lead to sad consequences.

During the neonatal and early childhood period pathological formation the pelvis can become inadequate artificial feeding, housing conditions, inadequate nutrition, rickets, heavy child labor, transferred infectious diseases(bone tuberculosis, poliomyelitis), injuries of the pelvis, spine, lower extremities.

During puberty, a change in the structure of the pelvis can be caused by significant emotional and physical stress, stressful situations, increased sports, exposure to the acceleration factor, hormonal imbalance and even wearing tight trousers made of dense, inelastic fabric (the so-called "denim" pelvis).

At present, such pathological forms of the narrow pelvis as rachitic, kyphotic, oblique, sharp degrees of narrowing have disappeared, which is associated with acceleration, improvement in the 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 caesarean section.

In women with this pathology, the wrong position of the fetus very often occurs. It can be located in the womb as you like: transversely, obliquely, in a breech presentation, and so on. Also, with a narrow pelvis, there is often a premature outflow of amniotic fluid.

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

In the picture below we see the head of a child and the bones of a woman's pelvis. On the first one, there is no cause for alarm - the size of the head is proportional to the size of the pelvis, but on 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 injury Therefore, such newborns in most cases after birth require resuscitation, intensive treatment and medical supervision.

Prevention of the development of a narrow pelvis

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

Doctors antenatal clinics should include pregnant women with a narrow pelvis or suspected narrow pelvis in the group high risk perinatal and obstetric complications. When managing pregnancy, rational nutrition should be provided for the prevention of a large fetus, additional measurements of the pelvis, ultrasound in the II and III 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 childbirth, timely diagnosis of the form and degree of narrowing of the pelvis, the choice of a rational method of delivery.

Childbirth with extensor presentation of the fetal head

The 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 varying degrees of extension.

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

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

Reasons for the development of extensor presentations:

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

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

It all depends on the degree and type of presentation. For a while, doctors can wait, watching how the birth proceeds. But the likelihood that the fetus can insert 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 caesarean section.

Birth in breech presentation

Pelvic presentation is called, in which the buttocks or legs of the fetus are located above the entrance to the small pelvis.

There are pure breech presentation, mixed breech presentation, as well as foot presentation (full and incomplete). In rare cases, there is a kind of foot presentation - knee presentation.

Most often among the breech presentations, a purely breech presentation occurs.

Pure-year presentation

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

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

A significant frequency of breech presentations in preterm birth is explained by the disproportionate size of the fetus and the capacity of the uterine cavity. As the body weight of the fetus 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, exceeding the mortality of children during childbirth in head presentation by 4–5 times. During delivery through the natural birth canal in primiparous women with breech presentation of the fetus, mortality is increased by 9 times.

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

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

The period of exile in breech presentation may begin earlier than the due time, since the size of the pelvis of the child is much smaller head. In this regard, special complications during childbirth are possible, as there may be problems with the expulsion of the head from the uterus.

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

Indications for elective CS in primiparas are:

• age over 30;
• extragenital diseases requiring the exclusion of attempts;
• pronounced violation of fat metabolism;
• pregnancy after IVF;
• prolongation of 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

The wrong position of the fetus is called the clinical situation when the axis of the fetus crosses the axis of the uterus.

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

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 cavities of the large pelvis. The oblique position is considered a transitional state: during childbirth, it turns into a longitudinal or transverse position.

The causes of the transverse or oblique position of the fetus are varied. These include a decrease in the tone of the uterus and flabbiness of the muscles of the anterior abdominal wall. Other reasons wrong 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 the transverse position cannot end spontaneously (self-rotation and self-torsion are very rare. In the transverse position of the fetus, only the abdominal wall 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, regardless of the condition of the fetus, a CS is performed.

How does childbirth occur in women with a scar on the uterus

What is, in principle, a scar on the uterus? This is a dense formation, which consists of collagen-rich connective tissue. Such a scar occurs when the integrity of the uterus is violated, for example, after a previous birth by caesarean section.

By the way, the concept of “uterine scar after cesarean section”, adopted in our country, is not entirely successful, since often with reoperation the scar is not found. Foreign authors usually use the terms "previous caesarean section"

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

A woman with a scar on the uterus is actively observed during pregnancy, and during childbirth - very carefully.

During pregnancy, a woman with this pathology should 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 the scar during pregnancy:

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

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

• uterine hypertonicity;
• 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 the scar during pregnancy and with sufficient medical supervision is quite rare. But it is especially necessary to take care of those women who are carrying multiple pregnancies. Such women at a later date need a permanent medical supervision or self-control. In case of the slightest doubt, seek medical help immediately.

How does childbirth occur with a scar on the uterus

Most obstetricians have a basic postulate for the delivery of pregnant women with a scar on the uterus after a caesarean section: one caesarean section is always a caesarean 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 natural birth canal is not only possible, but also preferable. The risk of repeat caesarean section, especially for the mother, is higher than the risk of spontaneous delivery.

In most cases, the word pregnant has its weight, so if you are determined to give birth naturally, you should discuss this in advance with the doctor who will take you into labor. Since in such cases there are risks, not every doctor will welcome natural childbirth, which is why a woman with a scar on the uterus should deal with this issue in advance.

Childbirth with a scar on the uterus proceeds according to the usual scheme of childbirth. 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, a clinical discrepancy between the size of the baby's head and the mother's pelvis, and the appearance of signs of a threatening uterine rupture. Such childbirth is usually carried out with a deployed operating room. Doctors will constantly monitor the condition of the child, the mother and the scar on the uterus by means of KGT or an ultrasound machine.

If a woman has a scar on the uterus, then in childbirth there is a possibility of its divergence, therefore, no anesthesia is given to such women, since in case of divergence of the seam and with lost sensitivity, you can miss the moment. If such a situation occurs, then the woman is urgently sent for surgery. Incomplete rupture of the uterus can occur at any stage of labor, even at the last attempt. Therefore, if there is a scar on the uterus, all women will have a manual examination of the uterus or ultrasound.

Prevention of uterine rupture along the scar

Prevention of uterine rupture along the scar is to carry out the following activities:

• Creation of optimal conditions for the formation of a wealthy 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 scar on the uterus before pregnancy and during pregnancy;
• Screening examination during pregnancy;
• Careful selection of pregnant women for vaginal delivery;
• · Careful cardiotocographic and ultrasonic control in the course of spontaneous childbirth;
• Adequate anesthesia in the process of spontaneous childbirth;
• Timely diagnosis of threatening and/or incipient uterine rupture.

How is childbirth by caesarean section

A 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, the CS is of great importance, since in the complicated course of pregnancy and childbirth, it allows you to save the health and life of the mother and child. However, every woman must understand that every surgical intervention may have serious adverse effects both in the immediate postoperative period and in the subsequent onset of pregnancy.

The most popular indication for caesarean section today 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 incidence of CS in modern obstetrics is due to objective reasons:

• An increase in the number of primiparous older than 35;
• Intensive introduction of IVF (often repeated);
• Increased presence of CS in previous pregnancies of women;
• An increase in the frequency of cicatricial changes in the uterus after myomectomy performed through laparoscopic access;
• Expansion of indications for CS in the interests of the fetus.

Indications for a planned caesarean section during pregnancy:

• Complete placenta previa;
• Insolvency of the scar on the uterus (after COP surgery, myomectomy, perforation of the uterus, removal of the rudimentary horn, excision of the uterine angle during tubal pregnancy);
• Two or more scars on the uterus;
• An obstacle from the birth canal for the birth of a child (anatomically narrow pelvis, deformity of the pelvic bones, tumors of the uterus, ovaries, pelvic organs);
• Pronounced symphysitis;
• Presumably large fetus (fetal body weight over 4500 g);
• Severe cicatricial narrowing of the cervix and vagina;
• Presence in the medical history of a woman plastic surgery on the cervix, vagina, suturing of genitourinary and intestinal fistulas, rupture of the perineum III degree;
• 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, extension of the III degree head according to ultrasound, mixed breech presentation;
• With multiple pregnancies: breech presentation of the first fetus with twins in nulliparous, 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 preeclampsia,;
• IGR III degree, with the effectiveness of its treatment;
• Myopia of a high degree with changes in the fundus;
• Acute genital herpes (rash in the vulva);
• kidney transplant;
• Death or disability of a child during a previous birth;
• IVF, especially repeated, in the presence of additional complications;
• Indications for emergency CS during pregnancy;
• Any variant of placenta previa, bleeding;
• Threatening, begun, completed uterine rupture along the scar;
• Acute fetal hypoxia;
• Extragenital diseases, deterioration of the pregnant woman;

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

• Weak generic activity;
• Clinically narrow pelvis;
• Prolapse of the umbilical cord or small parts of the fetus with head presentation of the fetus;
• Threatening, beginning or completed uterine rupture;
• Foot presentation of the fetus.

Keep in mind that if there are indicated indications for CS, the doctor may decide to deliver the child through the natural 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 CS are identified during pregnancy, it is preferable to carry out the operation in a planned manner, since it has been proven that the frequency of complications for the mother and child is much 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 the basis for the production of CS, but together they are considered as a real threat to the life of the fetus in case of delivery through the natural birth canal (postterm pregnancy, childbirth in primiparas over the age of 30 years, stillbirth or miscarriage in history, previous long-term infertility, large fetus, breech presentation, etc.).

If the operation is performed using epidural anesthesia, then the child is applied to the mother's breast for 5-10 minutes immediately after primary processing. A contraindication to this is deep prematurity and birth in asphyxia.

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

Doctors make a toilet of a postoperative wound daily with a 95% solution ethyl alcohol with the application of an aseptic sticker. In order to determine the state of the wound and possible inflammatory and other changes in the uterus in the postoperative period, 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 puerperal is discharged home under the supervision of a antenatal clinic doctor.

How does childbirth occur in multiple pregnancies?

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.

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

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

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

1 - each fetus has its own fetal bladder and its own placenta; 2 - both babies share the placenta, but each has its own fetal bladder; 3 - both have one common fetal bladder, but they are separated by fetal membranes, both placentas have grown together; 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.

With multiple pregnancy, increased demands are made on the woman's body: the cardiovascular system, lungs, liver, kidneys and other organs function with great stress. In this regard, multiple pregnancy, as a rule, is more difficult than singleton.

With multiple pregnancy, more often than with a single pregnancy, toxicosis occurs: vomiting, salivation, edema, nephropathy, eclampsia.

Premature termination of multiple pregnancies often occurs. With twins, preterm 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 gestated fetuses, the more often preterm 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 fetuses. Often there is a difference in body weight of twins by 200-300 g, and sometimes more.

The uneven development of twins is associated with unequal intake nutrients from a single placental circulation. Often there is a difference not only in mass, but also in the length of the body of the twins. In connection with this, the theory of supergenesis (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 already existing, previously occurring, pregnancy.

With multiple pregnancies during childbirth, more precisely in the first period, more often than in the usual, there is a weakness in labor activity.

Birthing requires great attention and patience. It is necessary to carefully monitor the condition of the mother and fetus, the dynamics of childbirth, feed the woman in labor with nutritious, easily digestible food, monitor the function of the bladder and intestines, and systematically toilet the external genital organs.

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 to regain the necessary tone for contraction. At this time, the doctor continuously monitors the second fetus, its well-being, heartbeat. If within 30 minutes the second fetus is not born, open the fetal bladder of the second fetus. With multiple pregnancies, children, most often, are 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 “beaten” 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, a woman in labor is injected intramuscularly with 1 ml of pituitrin or intravenously (by drip) oxytocin in order to prevent heavy bleeding.

AT postpartum period in multiple pregnancy, uterine contraction is slower than after delivery with one fetus. Therefore, it is necessary to observe the nature of the discharge (lochia), contraction of the uterus and general condition puerperas. If necessary, doctors prescribe drugs that reduce the uterus. Such postpartum women benefit from gymnastic exercises that strengthen the muscles of the abdominal wall and pelvic floor.