Stages of contractions before childbirth. Natural childbirth process and stages of the birth of a child

The process and stages of childbirth

The birth of a child is one of the most significant moments for which a woman begins to prepare even during pregnancy. At present, childbearing is carried out naturally or through surgery C-section. From a health point of view, it is most preferable for a woman to give birth on her own (without medical intervention).

In order for the birth to be successful, the expectant mother needs to prepare for them in advance. The moment of the birth of a child is always unpredictable, because everything can start at any time of the day, so the most important rule is not to panic. The expectant mother needs to listen to her body and the recommendations of obstetricians who control childbirth.

Preparing for natural childbirth

The process of preparing for childbirth naturally includes the following:

Physical training.
Packing bags for the hospital.
Psychological preparation (most important: includes theoretical knowledge about how natural childbirth goes, how to breathe properly and help the baby).

How to prepare the body for childbirth

It takes a lot of energy for a woman to have a baby. In order for the body to be ready and trained, the expectant mother can attend special classes in the pregnancy fitness center or prepare yourself at home with light exercises. This helps support physical health during pregnancy and prevents the development of certain diseases characteristic of this period (for example, varicose veins).

It should be borne in mind that if a woman feels unwell during a home workout (dizziness, etc.), you should immediately stop charging.

Rise on socks.
Squats from a standing position, "half" (legs should not form a right angle at the knees).
In a standing position, take the leg as far as possible to the side, controlling the back (perform the exercise for each leg).
In a standing position, take the leg as far back as possible (perform for each leg).
Get on all fours and perform light push-ups (without straining your abdominal muscles).
In the same position, raise the leg bent at the knee.
In the same position, raise a straight leg.
Sit on the floor and stretch your legs: perform circular movements with your feet.
In the same position, work with your feet: pull the socks away from you - towards you.

These exercises help to strengthen the muscles of the pelvis, prevent varicose veins, relieve fatigue and swelling of the legs.

What to bring with you to the hospital

Doctors recommend that a woman prepare a bag in advance with which she will go to the hospital. This is required in order not to waste time during fights and immediately go to medical institution. The list of necessary items should be provided by your attending gynecologist, who controls the course of pregnancy.

Usually the list of things for the mother looks something like this:

documentation;
two nightgowns (in which the woman will give birth (may get dirty) and in which she will be in the postpartum ward);
robe;
comfortable shoes / slippers;
socks (thin and warm);
interchangeable underwear;
adult diapers or night pads;
toothpaste, brush, towel, soap, shampoo, shower gel, sanitary napkins, comb, toilet paper;
mug, plate, spoon (in the hospital they may not be issued);
a bottle of non-carbonated water (during childbirth, a woman drinks a lot);
paper towels (as a rule, they are given to orderlies before childbirth).

diapers (the smallest size);
undershirts-shirts;
sliders;
bodysuit;
socks;
warm jackets;
bonnets (warm and thin);
diapers;
baby soap, powder, baby cream.

All baby clothes must be collected depending on the time of year, it must be washed and ironed from the outside and inside.

You can take a baby blanket with you, and prepare an elegant set of clothes for a newborn or an envelope for discharge.

The bag to the hospital should be collected already at 34-36 weeks of pregnancy. If necessary, if you forgot something, call your loved ones and ask them to transfer the necessary things through the staff.

Psychological preparation for the first birth

Even in the presence of all modern medical devices to determine the exact date childbirth is not possible. Presumably this moment comes after 280 days from the date of last menstrual period, that is, the entire pregnancy takes about 40 weeks (+/- 2 weeks). If there are abnormalities during pregnancy, doctors may prescribe urgent delivery(perform stimulation (provoke the appearance of contractions) or, if the situation does not stabilize, prescribe a caesarean section).

It is better to talk about possible non-standard situations with your doctor, and if you feel serious persistent anxiety, it makes sense to consult a psychologist - he will help you get in the right mood and recommend how to behave in difficult moments.

Also, expectant mothers should not forget about the various schools of future parents that can be attended with the father of the child. This will greatly facilitate the process of accepting the idea of an early birth and systematize knowledge.

All women endure childbirth in different ways - this may depend on body structure, age, heredity and other factors. Natural delivery can last from 6 to 11 hours. In order for the baby to appear normally, the mother must know how childbirth begins, when it is necessary to call an ambulance, how to breathe correctly during contractions and push.

The start of labor is the time when contractions come every 3 minutes - you can pick up a watch and track this moment. At the same time, the amniotic fluid drains. They are a signal that you need to call an ambulance and go to the hospital, unless you have other instructions from the doctor.

How is natural childbirth

Doctors distinguish three stages of childbirth:

Contractions and preparing the body for the birth of a child.
The immediate birth of a baby.
Expulsion of the placenta and blood clots.

First stage

At the first, longest stage, the cervix opens from 2 to 10 cm. The woman should not push yet: at this moment, the fetus changes its position and prepares for birth.

During all childbirth, the expectant mother should in no case be nervous and constantly scream: this will prevent her from concentrating on contractions and will not allow her to hear what the doctors say. Each subsequent fight is longer in time compared to the previous one, the time between them is constantly decreasing.

A woman needs to find a body position that makes it easier to endure contractions. It is believed that while standing, the body “cooks” faster. birth canal for the birth of a baby, so it is recommended to keep as straight as possible. You can try to walk, stand, leaning on the back of a chair and shaking your pelvis, kneel and rest against the bed.

Breathing plays a major role. In between contractions, a woman should breathe deeply and evenly, gaining strength. During the fight, shallow breathing through the mouth is necessary.

At the first time, when the contractions began, the woman in labor, if she wants, can eat a little (light food: a cracker, a bun, a banana). It takes a lot of strength to give birth to a baby, because childbirth can drag on for several hours.

IN Lately doctors are less likely to use a cleansing enema before childbirth. This is explained by this procedure greatly relaxes the muscles abdominal cavity than prevents a woman from pushing. If, during the birth of a baby, a woman in labor wants to go to the toilet "by and large", this is natural: the fetus presses on the intestines, which leads to its involuntary emptying. Obstetricians will take care of everything, while the mother needs to fully concentrate on the process of giving birth to a baby.

Second phase

When the cervix dilates to 10 cm, the second stage of labor begins - you can already push to help the baby be born faster. This stage can take up to 2.5 hours, during which doctors carefully monitor the progress of the baby.

If necessary (if the mother cannot cope and the child does not move), they can make an incision in the perineum - this happens when the child's head is too large and there is a danger of soft tissue rupture. After the birth of the baby, the doctor will give an anesthetic injection and put stitches on the incision.

Many mothers who give birth for the first time make a gross mistake during attempts: when they push, they tighten the press, which is why the child does not move forward, and forces are wasted. If a woman pushes incorrectly, soft tissue ruptures may occur.

It will be correct to strain the muscles during attempts rear wall abdominal cavity (it is these muscles that tense up when a person goes to the toilet "by and large"). You need to strain only during contractions, during breaks - rest and breathe deeply.

Third stage

This period can take from 5 to 30 minutes, during which the placenta is rejected and the placenta is born, and the woman may feel weak contractions.

Finally, doctors will examine the birth canal for internal tears, and, if necessary, stitch them with anesthesia. A few hours after the birth, the mother rests in the ward, then the baby is brought to her for the first feeding. By this time, the doctors will have examined the newborn, made the necessary measurements and recorded all the data.

In the postpartum ward, a woman is recommended to lie down on her stomach for 1-2 hours: this will improve blood circulation and uterine contraction, and will contribute to the rapid release of blood clots. If the birth was successful, and the mother and child feel well, then after 3-5 days they will be discharged from the hospital and sent home.

What does the baby feel during childbirth?

It's not just the mother who experiences the pain of childbirth: for the child, having a natural birth is also stressful and hard work. In the last months of pregnancy, the fetus, as a rule, assumes a head-down position. During contractions and cervical dilatation, the baby's head must enter the pelvic bones mother - thus the child descends closer to the birth canal.

Next action what he does is a tuck: the child presses his chin to his chest in order to squeeze further. Then the baby turns from a position facing the side of the body of the woman in labor to a position facing her spine.

If the baby turns to face her stomach, the woman experiences strong and painful spinal contractions. Doctors advise at the same time to move more and change position until the child lies down correctly.

At the next stage (with attempts), the child unbends the neck (the head can already be seen when the mother is pushing). When the head is born, the baby rotates outward facing sideways - as a rule, this happens with the help of a doctor. The last stage is pushing the baby out entirely.

Childbirth with a husband - pros and cons

are births that take place in the presence of loved one. It is believed that psychological support, which is provided by the partner, has a positive effect on the woman in labor. At the same time, he can accompany a woman to the toilet, massage the lower back, supply water and do other useful things.

Some psychologists do not recommend taking your husband with you to the delivery room. This is due to the fact that it is hard for a man to look at the suffering of his beloved wife, which can lead to subsequent psychological problems in bed, but each case is individual. If a woman is afraid to give birth alone, she can invite her mother, sister or friend.

When a man insists or a woman in labor herself wants her husband to go with her, it is advisable to mentally prepare him for what is happening. People behave differently in stressful situations, and if a man is able to cope with his emotions, you can safely rely on him.

Contraindications for natural childbirth

If the pregnancy went well and the fetus developed correctly, the birth should go well. Doctors prescribe a caesarean section in cases where a natural birth threatens the life of the mother and child.

Indications for planned surgical intervention:

narrow pelvis, tumors and deformities in this part of the body;
the threat of rupture of the uterus, the insolvency of the scar after the previous operation;
Not correct position placenta;
pathology in the vagina or uterus;
severe form of preeclampsia;
chronic diseases (diabetes, disorders in the work of the cardiovascular system and others);
transverse position of the fetus;
fetal hypoxia;
exacerbation of genital herpes.

Doctors may perform emergency surgery during childbirth if the following factors are present:

early departure amniotic fluid(in this case, mothers can provide stimulation to induce contractions);
fetal hypoxia in the acute stage;
placental abruption;
prolapse of umbilical cord loops;
wrong position fetal heads.

All these are absolute indications for a caesarean section. Relative readings:

the age of the mother is more than 35 years (the fact of the first birth at this age complicates the situation);
too big or small fruit;
previous caesarean section;
pathology of pregnancy.

With a planned caesarean section, the mother will take a written consent to the operation.

Thus, in order for the birth to go well, a woman needs:

do not panic,
prepare things for the hospital in advance,
breathe properly during contractions,
search comfortable position bodies during fights
proper pushing during childbirth,
listen to your body and the recommendations of doctors,
have positive attitude to the outcome of the situation.

And most importantly: suffering and pain are quickly forgotten when the mother returns home with the baby and devotes herself to caring for him.

The process of childbirth is not something supernatural, and from beginning to end depends on the preparation of the woman. Constant monitoring by a gynecologist will help to avoid hormonal problems, which means birth anomalies. During childbirth, it is worth listening to the obstetrician, remembering proper breathing and inner peace.

All women, expectant mothers, are different. If for one woman childbirth is like physiological process, will an unforgettable trip to the hospital, then for the other it is a difficult test. This is due to the lack of an adequate description of the normal process of childbirth.

Part of the experience of women expecting their first child is associated with ignorance of the symptoms indicating the preparation of the body for childbirth, and how the birth process goes during normal course pregnancy. On last month or a little earlier, mom has training contractions.

False contractions are not intense, painless, periodic, pass on their own due to a warm shower or the effects of antispasmodics. If the last two measures have ceased to help, it means that there is not much time left before the start.

Obvious signs may be pain in the lower abdomen and in the last 3 weeks of the term. lumbar, frequent urination. This is typical for those giving birth for the first time, which indicates psychological state women.

Moms, during the first pregnancy from conception to childbirth, listen to every change in the body. Feelings of tingling, stretching, pain in the pubic area. After the prolapse of the abdomen, the fetus moves to the small pelvis, the center of gravity shifts, changing the posture. cervical canal closed, filled with a mucus-like secret.

closer to two last weeks the abdomen sinks lower, which causes a feeling of general reduction in the body. Eating and breathing becomes much easier. At the same time, the uterus is strongly compressed, hardening is felt in the lower abdomen, caused by muscle tension, and this state persists for a certain time. The psychological background of a woman undergoes changes, the nesting syndrome manifests itself.

The first sign of the onset of labor will be the discharge of the mucous plug. Recognizing the cork is very simple. Looking at underwear or sanitary napkins, you will find a lot of thick mucus that has no color. Cork is different from the usual discharge during pregnancy.

3 stages of childbirth

By about 38 weeks, the birth dominant is already formed - a complex set created by the centers of regulation (nervous and hormonal system) and reproductive organs (fetal membrane, placenta, uterus).

Conditionally from the 37th week, the amount of progesterone, the main hormone of pregnancy, decreases in the body, and the production of estrogen and prostaglandin increases. Changes in the hormonal background provoke the tone of the uterus and the sensitivity of the myometrium to the effects of compounds: oxytocin, acetylcholine, serotonin.

How is the whole process of childbirth in a woman:

dilatation of the cervix;
birth of a child;
afterbirth exit.

risk of premature or early delivery occurs before the thirty-eighth week of pregnancy. The reasons may be inflammation or infection in the uterus, which, affecting the muscle tissue, prevent the organ from stretching. This leads to the impossibility of bearing and rejection of the fetus.

At 27 weeks premature birth occur due to isthmic-church insufficiency. This is a pathology that causes a weakening of the cervix, due to which the organ opens ahead of time under the pressure of the fetus.

An early birth takes 4 to 6 hours for primiparas, and 2 to 4 for multiparous ones. The reasons may be increased excitability caused by the pathology of muscle cells, a loosened nervous system, impaired metabolism, gynecological diseases. If the child in the womb lies sideways to the exit from the vagina, or is located to him with his feet, then natural option birth is not possible without a caesarean section.

Opening of the cervix

The longest process for expectant mothers has two ways: hidden and active. The latent type is characterized by changes in the cervix, which lead to softening, shortening. Compared to the state during pregnancy, the neck is reduced from five centimeters to complete smoothing. This leads to contractions that are not strong at first, appear at intervals of up to 20 minutes.

The period of contractions lasts up to 10 hours in women giving birth for the first time and about 6 in multiparous women. In the maternity hospital, continuous monitoring of the process is carried out, as the limit of cervical dilatation is exceeded in time. This indicates an obstacle to the birth of a child on the part of the mother's body or the condition of the fetus.

During contractions, the baby begins to put more and more pressure on the bladder and intestines. To avoid problems with the gastrointestinal tract, between contractions, the hospital staff gives the woman in labor a cleansing enema. The procedure also stimulates the intestines, which causes strong uterine contractions.

In the latent phase, a pregnant woman should not lie down, she should be moderately active: hiking, fitball exercises. You need to breathe measuredly, deeply, so as not to cause premature fatigue. This helps the opening of the cervix, the formation of the birth pharynx and the transition to the active phase.

Contractions begin to occur more often, more intensely, causing severe pain, pushing the baby to the small pelvis. The medical staff relieves the pain of the woman in labor with painkillers and monitors the opening of the cervix, the condition of the fetus.

Contractions are repeated at intervals of 3-5 minutes and last about 10 seconds. At this stage, most of the amniotic fluid comes out, otherwise the doctor opens the bladder on his own. By the color and amount of fluid, the state of the fetus is diagnosed in the process of physiological childbirth. If the amniotic discharge looks greenish, then the baby is suffering from hypoxia in the womb.

Birth

Hormonal balance is a factor in the course of the birth process. Per launch labor activity the hormone prostaglandin, which affects the beginning and duration of the preparatory period, the rate of maturation of the cervix, respond. With a low content of prostaglandin in the patient, the disclosure is delayed, the medical staff injects a gel containing this hormone into the uterus, which allows you to start the process of contractions and childbirth.

How the proper birth process starts:

with the help of a gel;
intravenous administration of the drug;
natural.

Oxytocin affects childbirth itself. With a low content of the hormone, a dropper is placed intravenously. After a dose of oxytocin, opening is faster, contractions intensify. Epidural anesthesia is used to alleviate the condition. At this stage, the water leaves, if this does not happen, the fetal bladder is opened using amniotomy.

At the same time, the obstetrician continues to monitor the activity of the child during childbirth using a heart monitor, and if the condition of the fetus worsens, an urgent caesarean section is used. In the case of a normal content of hormones, the process of labor activity begins itself.

After opening the cervix and getting rid of the amniotic fluid, the body enters the phase of expulsion of the fetus. First, a part of the head appears, the back of the child's head, after, with each attempt, muscle relaxation intensifies, the head comes out. It takes an average of 5 attempts to get the head and shoulders out. The duration of the stage takes from half an hour to an hour and depends on the activity of the woman in labor.

Why is childbirth painful? Normal childbirth is painful, there are two reasons for the appearance of pain. The first, dull, aching, is associated with uterine contractions and cervical sprains at the first stage. The second, somatic, pain during attempts at the birth of a baby is caused by stretching of the lower zone of the birth canal.

Placenta exit

The afterbirth is the embryonic organ of bearing a child, responsible for the normal development of the fetus, providing it with nutrition and oxygen. It serves as a biological protection of the baby from the effects of microorganisms and viruses. Has a flat appearance with a membrane inside, which just connects circulatory system child with mother. The chorionic villi located on the surface of the uterus form the placenta, which, together with the membranes, forms the afterbirth.

While obstetricians are studying the condition of the child, weighing, swaddling, the mother will have the last stage of childbirth - the birth of the placenta. A few minutes after cutting the cord, the obstetrician checks to see if the placenta is ready to come out. To do this, he puts his hand with an edge in the area of \u200b\u200bthe lower part of the peritoneum and slightly presses. If the remainder of the umbilical cord is not attracted back, then the procedure for removing the placenta can be started.

The woman in labor at this moment feels weak uterine contractions with low intensity. The obstetrician, observing the frequency of contractions, tells the patient when to push. A minute later, the fetal sac comes out, which is sent for histology to make sure its integrity. Even a small remainder female body can cause inflammation.

Histological examination can reveal the presentation of the placenta. In case of detection incomplete exit bag, the medical staff is obliged to clean the uterus. The procedure is carried out manually using a special spoon - a curette.

If there is a delay in the release of the fetal membranes, cleaning is not performed, the membranes will leave the body along with the lochia. The examination ends with the weighing of the placenta. The data is recorded in the patient's card, and the conclusion is issued to the woman in labor, then the afterbirth is disposed of.

anomalies

Discoordination of labor is an abnormal disorder caused by a shift in the rhythm. Several defining rhythms may occur, which disrupts the synchrony of uterine muscle contractions and changes their direction. As a result, painful contractions become more frequent, their effectiveness decreases. This affects the discharge of waters, causing them to prematurely.

Cervical dilation progresses slowly or stops at four to five centimeter opening. Nausea, vomiting, difficulty urinating, and restlessness may occur. There is uterine hypoxia of the fetus, placental abruption and heavy bleeding. Method of struggle - anesthetic and antispasmodic drugs, sedatives or caesarean section.

Abnormal uterine tetanus is a phenomenon caused by the prolonged development of discoordination of labor. It causes tetanic contractions of the muscles of the uterus, which are not coordinated with each other and occur in different zones of the myometrium. Contractions are sharp and painful, followed by a stop in labor. The general condition of the patient worsens, the skin turns pale, tachycardia begins. The further process of childbirth with bronchial asthma or other diseases of the cardiovascular and respiratory systems becomes impossible.

Difficulty urinating independently. Women in labor with such an anomaly are prescribed a caesarean section. In case of pathology, the patient needs rehabilitation and nursing care at birth trauma. Self hygiene possible after the transfer of the mother from intensive care to postpartum department.

pathological preliminary period- a deviation that occurs before the start of the active stage of labor. It is characterized by a long preparatory period with painful contractions. The cervix is dense, long, not located along the axis of the pelvis. The cervical canal does not pass a finger. The tone of the uterus increases, the presentation of the fetus changes. There is a possibility of premature discharge of water. As a method of struggle, drugs are used to eliminate pain and excessive spasms, stimulate the maturation of the cervix to restore normal labor activity.

After childbirth

The woman will be in maternity ward a couple more hours. An obstetrician monitors the condition and discharge from the vagina. If all is well, then the mother and child are transferred to the postpartum ward, where the woman can rest and prepare for the first feeding. From this moment, the body of the woman in labor will begin to recover.

The first change will be in cardiovascular system and respiratory tract. The uterus no longer displaces the diaphragm, it becomes easier to breathe, and the heart load decreases. Breathlessness passes. Increased blood volume during pregnancy manifests itself in the form of changes in skin tones and edema.

Recovery of the uterus will take 6 to 8 weeks, and will be accompanied by lochia. The first few days of lochia look like menstruation, then the blood content in them drops, and after a few days the discharge brightens. Involution of the uterus causes painful contractions, which indicates a gradual decrease in volume. After a period of rehabilitation, the organ acquires a pear-shaped shape and slightly more weight than before childbirth - from 60 to 80 grams.

The recovery process is accelerated by the release of the hormone oxytocin into the blood. When a newborn is attached to the breast, the natural production of the hormone occurs, as a result, painful uterine contractions occur in the first days of feeding.

The menstrual cycle is restored after one and a half or 2 months in the absence of breastfeeding. When feeding mixed type uterine contraction will last up to 6 months, and in full mode from six months to 2 years.

Contractions before active phase- the longest and most monotonous process. The very same birth of a child takes less time and basically all the difficulty lies in the appearance of the head and shoulders. The latter will come out very easily. Recovery will take time, which depends on the woman's body and the way the baby is fed.

This is the time of "pushing" to help the baby move through the birth canal. After the birth of the child, the birth of the placenta will follow.

Stage of labor - Cervical dilatation

Now in the delivery room, you are experiencing the longest part of labor: the dilatation of the cervix. Its duration depends on the number of previous births, the intensity of contractions, the size of the pelvis, the size of the child and its position. On average, during the first birth, the rate of cervical dilatation is 1 cm per hour, during subsequent births - 2 cm per hour. Until the moment it opens up to 10 cm, an average of 12 hours will pass. But sometimes this stage of labor can take less time, and sometimes it can take longer (up to 24 hours). In addition, for primiparas, cervical dilatation occurs before the baby's head descends into the small pelvis. During repeated births it happens almost at the same time and therefore takes less time.

You are not alone! You will be under the supervision of a midwife at all times. She will have regular vaginal examinations. The nurse will take your temperature and blood pressure.

An anesthetist will also be there in case you need an epidural. Sometimes it causes inhibition of labor activity. Then you will be prescribed additional administration of stimulant drugs.

What to do at this time? In order for contractions to be effective and disclosure to occur quickly, it is important to monitor the position of the body at this time. Do not bend and keep your back straight. In the delivery room, you will be in a lying or semi-lying position. It is best to lie on your side, stretching lower leg and bending the top. You can also sit with your legs crossed in front of you or with your legs up on a step.

To make it easier to endure contractions, use the breathing techniques that you were taught during preparatory courses or yoga sessions. If you were engaged in sophrology, you will try to find a way to relax, which will also have a positive effect on labor activity. Usually, during contractions, pain occurs in the lower abdomen. Do not be afraid of this pain and do not strain, try to overcome it, thinking that it helps your child to be born into the world Millimeter by millimeter, he is advancing towards life. Do not push until the cervix is fully dilated.

Stage of childbirth - expulsion of the fetus

When the cervix is fully dilated and the baby's head is down, it's time to push. The exile phase lasts approximately 20-30 minutes. At this point, lie on your back, spread your legs and put your shins on special ledges on the sides. Some of the hair around the vulva is shaved off and a catheter is inserted into the ureter (if you were unable to urinate on your own).

Pushing during contractions. The doctor next to you will tell you when to push. It will set the rhythm to some extent. You need to push during contractions, and rest between them. Everything you learned while preparing for childbirth will be useful to you at this moment. At each contraction, you push, first inhaling while blocking your breath, and then breathing often on the exhale. In this case, the abdominal muscles are strongly reduced, and it is desirable to relax the muscles of the perineum. Attempts should be long, so that the child moves forward.

For more pushing, you can hold on to the rails or the edge of the bed, or better still, press your hips together and lift them towards your shoulders. At the same time, you can bend your elbows, like a rower on a boat, and press your head to your chin. When the baby's head appears in the perineum, everything will go very quickly. The obstetrician will ask you to stop pushing so that the head erupts gradually. One more effort will be required to deliver the shoulders, the rest of the body will come out easily. In a few minutes, the baby will be lying on your stomach, and the long-awaited meeting will take place.

Stage of labor - Birth of the placenta

The child is born, the moment you have been waiting for has come. Exhausted but full of emotions, you and your father experience the first moments alone with each other. If everything is in order with the child, you can rest the three of us, if Airways clogged, the doctor will clear them of mucus.

After a while (20-30 minutes) contractions will resume. You will need to push again for the placenta and membranes to come out.

Examination of the placenta. When the placenta is delivered, doctors will carefully examine it to make sure it has passed completely. At the slightest doubt, a uterine examination can be carried out. The birth of the placenta should not be spontaneous. This painless procedure because you are still under local or general anesthesia.

In case of severe bleeding. During the birth of the placenta, a woman can lose a lot of blood. This loss is incomparable to normal blood loss during minor skin wounds. In this case, the doctor needs to remove the placenta from the uterus as soon as possible (artificial birth of the placenta).

Suturing in the perineum. If you have had an episiotomy, doctors will put in stitches right after the placenta is delivered. Sutures will also be applied if there are minor tears.

From the moment of birth, the child reacts to the voice, bodily contact, the views of those around him: he needs attention. Talk to him gently, rock him. Do not forget that you felt your baby for all 9 months, but his father did not. Maybe he wants to take it in his arms too. He will wear it, holding it from below and showing it to the outside world.

Truth or lie? Is it true that water can break during childbirth?

Is it true. Most often, the water breaks before the start of contractions. This is the signal to go to the hospital. But sometimes it can happen on the delivery table.

When the child has sank to the bottom of the pelvis and the moment of birth is already close, the woman most often lies on her back with her legs apart. From now on everything will go very fast...

Stages of child advancement

Entrance to the pelvis

At the beginning of labor, the baby's head enters the small pelvis. The obstetrician can feel it by palpation abdominal region and by vaginal examination.
The entrance to the upper pelvic inlet is very narrow, but the child must adapt to this passage. His head must pass at a 45° angle to enter the widest part of the pelvis.

The child, in turn, tries to enter with that part of the head where the diameter will be the smallest ( back skull, bowing the head and pressing the chin to the chest).

Descent and advance

The descent begins as soon as the head enters the small pelvis. Under the action of contractions and attempts, the head moves down, it makes another turn of 45 ° to exit into vertical position. Then, in the groin area, it bends and rests on the elastic muscles of the perineum, which gradually release it outward.

In front of the vulva, the head straightens and pulls it under pressure. Appears top part skulls.

The birth of the head and the exit of the child

Slowly, millimeter by millimeter, the head comes out, thanks to the efforts of the mother and the help of the obstetrician. Then the obstetrician will help to release the shoulders; the rest of the body will come out very easily.

Immediately after childbirth

After giving birth, you will spend about two more hours in the delivery room. The child will be brought to you after it has been taken care of and bathed. A nurse will take your blood pressure and temperature regularly. The doctor monitors the state of the uterus: the bleeding should be less abundant, and the uterus should continue to contract. You will leave the delivery room and return to the room when you are ready.

Childbirth is a physiological process that occurs naturally and ends with the birth of a child. It is normal that every woman is worried on the eve of such important event. But fears and worries should not prevent her from safely resolving the burden. Going through all the stages of childbirth is not an easy test, but at the end of this path a miracle awaits a woman.

The initial stage (harbingers) is practically painless, so pregnant women often doubt the sensations experienced. Let's try to figure out what signs indicate the onset of childbirth, how to distinguish between their periods and facilitate the process of the birth of a child.

Harbingers of childbirth, what are they?

Harbingers of childbirth are changes in a woman's body that begin at about 37 weeks of pregnancy. On later dates the following changes occur:

Sudden weight loss. A weight loss of 1-2 kg at the end of the third trimester of pregnancy is absolutely normal. Excess liquid during this period, it is gradually excreted from the body, which signals the beginning of its preparation for childbirth.
Frequent urination and diarrhea. The increased urge to go to the toilet indicates that labor can begin at any time. The child is gaining weight intensively and by the end of pregnancy, the enlarged uterus presses on the intestines and bladder of the woman.
. A pregnant woman who is closely monitoring her health may notice changes in daily secretions from the genital tract. An increase in their number and the presence of a small lump or streaks of mucus are the result of preparing the cervix for childbirth. But if the discharge is copious, with bad smell and an admixture of blood, you need to urgently contact a local gynecologist, or call an ambulance.
Aching pain in the lower abdomen or back. Such discomfort is usually associated with. They do not have a clear periodicity, do not become more frequent and eventually stop. So the muscle tissue is preparing for the upcoming work in childbirth. Training contractions usually subside with a change in body position.
. This is a sign that the baby is preparing for childbirth. If he has taken the correct position, then his head is already inserted into the small pelvis. During this period, pregnant women note ease, despite big belly. This happens because the uterus sinks down with the baby and makes more room for the lungs, stomach and other internal organs future mother. If a woman was worried, after the prolapse of the abdomen, she usually passes.
Changes in the cervix (smoothing, softening). A woman does not feel them, an obstetrician-gynecologist can judge the readiness of the cervix for childbirth during the examination.
Decreased fetal activity. At the end of pregnancy, a woman notices that the baby has become less moving. This is normal, because it is growing rapidly and there is less and less room for movement. But you can't ignore too active behavior child during this period. Often it signals that the baby does not have enough oxygen.

To dispel doubts, it is necessary to undergo an examination (ultrasound, CTG, dopplerography) and consult a doctor.

Periods of childbirth: their duration and characteristics

Childbirth consists of certain stages of labor activity. There are three of them, and each woman has to make certain efforts to help a new person be born.

Normally, the first birth lasts 8-12 hours, the second and subsequent ones pass faster. But there are cases of prolonged (more than 18 hours) or rapid delivery when about an hour passes from the start of contractions to the appearance of the baby.

First stage of labor

This is one of the most long periods childbirth in obstetrics. It begins with aching sips in the lower abdomen or back. There are three active phases:

latent phase. The contractions of the uterus become regular, the interval between them decreases, they are repeated at intervals of 15-20 minutes. Usually, after 5-6 hours of such contractions, the cervix opens by 4 cm.
active phase. The intensity and soreness of contractions increases. The woman has 5-6 minutes to try to rest between contractions. At this stage, the outflow of amniotic fluid may occur. If necessary, this process is assisted by a doctor. Thanks to frequent painful contractions, which follow each other with increasing frequency, after a few hours the opening of the uterine os is already 8 cm.
transitional phase. Pain is slightly reduced. A woman in labor may have a desire to push. But until the uterus has fully opened, this cannot be done, otherwise there is a risk of injuring the child and harming one's own health. The phases of the first period end when the obstetrician-gynecologist ascertains a full disclosure of 10 cm.

It also happens that childbirth does not begin with contractions, but with the outpouring of amniotic fluid or spotting. That is why a woman should especially carefully monitor her health during pregnancy.

The slightest suspicion or doubt is a reason to go to the hospital and make sure that everything is in order with the child. Timely examination by a specialist helps to prevent possible complications and accurately determine whether labor has begun.

Second stage of labor

As you know, the periods of childbirth and their duration are individual for each woman and proceed differently for everyone. At the second stage, a difficult, but very important work awaits the woman in labor. Its result will depend on the joint efforts of the woman and the medical staff of the maternity hospital.

So, the opening of the neck of the T-shirt by 10 cm and attempts is a sign fully prepared body for the birth of a child.

During this period, the woman in labor should listen to the obstetrician, who will tell her how to push and breathe properly. Usually, the doctor recommends that at the beginning of the fight, take a full chest of air, hold your breath and push the baby out. Then, exhale and start all over again. During one fight, it is desirable to do three such approaches.

During the second stage of labor, it may be necessary to make an incision in the perineum (episiotomy) to avoid multiple tears. This is required if the child has a large head or big weight. After the end of childbirth, a woman under local or general anesthesia suturing the incisions.

The head of the child is not born immediately, at first it appears and disappears several times in the perineum, then, finally, it is fixed in the pelvis of the woman in labor. If a woman follows the advice of an obstetrician, then at the next attempt the baby will be fully born.

After his birth, the umbilical cord is clamped with special sterile instruments, then it is cut and the baby is placed on the mother's chest. After hard and hard work in the body of a woman, endorphin is produced (“hormone of happiness”), due to which pain and fatigue are forgotten.

third stage of labor

The stages of labor activity are coming to their logical conclusion, it remains only to give birth to the placenta. The uterus begins to contract again, but the intensity pain decreases significantly and, after several attempts, the woman gets rid of the placenta.

Then, the gynecologist carefully examines the birth canal for cracks and tears. If the placenta came out entirely, and the woman in labor has no injuries, then after all the necessary manipulations, the woman is left to rest.

When the placenta does not come out completely, doctors have to perform a manual examination of the uterus. The procedure is carried out under anesthesia and the condition of the woman is monitored for the next few hours.

The third period for a happy mother goes almost unnoticed. The baby is taken from her to be weighed and assessed. general condition. She no longer feels pain, all attention is focused on the newborn, which is applied to the breast for the first time.

Methods to facilitate the birth process

The stages of childbirth differ from each other in the nature and frequency of pain.

But there are several ways and techniques that can facilitate the process. These include:

Walking and changing body position during contractions. Many doctors recommend that a woman move as much as possible during intensive opening of the cervix and choose the most comfortable postures. The rate of opening of the uterine os depends on how much the woman in labor can relax. During the contraction, the uterus is tense and the expectant mother herself involuntarily shrinks from pain. muscle tissue in such conditions it is difficult to shrink quickly. Therefore, a woman should study the process of childbirth in stages in order to know what is happening to her body. The faster she can relax the abdominal muscles, the rather baby will come to light.
Massage of painful areas. Since a woman in labor cannot always make the necessary efforts on her own, in such a case one cannot do without outside help(husband, mother, sister or girlfriend). Massaging sacral area and acting on painful points during the fight, the partner thereby switches the attention of the woman and helps her relax.
Breathing exercises. As you know, during a period of strong contractions, a woman in labor is periodically disturbed respiratory rhythm. This leads to an insufficient supply of oxygen to the child and threatens his health. Therefore, you need to choose the appropriate technique that will help the expectant mother cope with the problem.
Positive attitude and self-confidence. Oddly enough, but this approach to childbirth is quite effective. When a woman is afraid of pain and allows herself to panic, she loses control over the process. Conversely, as soon as she manages to pull herself together, contractions are easier to bear.
. This method of anesthesia is used in childbirth when the cervix is opened by 4-5 cm. A special catheter is inserted into the epidural space, which is located in the lower back. Through it, a drug that blocks pain sensations enters the body of the woman in labor. After some time, its action weakens or stops completely so that the woman can feel contractions and fully participate in birth process. Anesthesia is performed by an anesthesiologist only with the written consent of the woman in labor.

A woman preparing to become a mother can get all the information she needs directly from her doctor. However, in addition to theory, practical skills are also needed. For this, there are courses for future parents.

By attending such classes, pregnant women learn how to behave during childbirth, get acquainted with various breathing techniques and massage techniques. Instructors not only tell, but also demonstrate all the techniques and ways to facilitate the birth process.

Answers

Periods of childbirth

childbirth- an unconditional reflex act aimed at expelling gestational sac from the uterine cavity when the latter reaches a certain degree of maturity. The gestation period must be at least 28 weeks, the body weight of the fetus should be at least 1000 g, height - at least 35 cm. With the onset of labor, a woman is called a woman in labor, after the end of childbirth - a puerperal.

There are three periods of childbirth: the first is the period of disclosure, the second is the period of exile, the third is the subsequent period.

Disclosure period begins with the first regular contractions and ends with the complete opening of the external os of the cervix.

Period of exile begins with the moment of full disclosure of the cervix and ends with the birth of the child.

succession period begins from the moment the child is born and ends with the expulsion of the placenta.

Let us dwell in more detail on the description of the clinical course and management of labor in each of these periods.

Disclosure period

The course of the disclosure period

This period of childbirth is the longest. In primiparous, it lasts 10-11 hours, and in multiparous - 6-7 hours. In some women, the onset of labor is preceded by a preliminary period ("false birth"), which lasts no more than 6 hours and is characterized by the appearance of contractions that are irregular in frequency, duration and intensity uterus, not accompanied by severe pain and not causing discomfort in the well-being of the pregnant woman.

In the first stage of labor, there is a gradual smoothing of the cervix, opening of the external pharynx of the cervical canal to a degree sufficient to expel the fetus from the uterine cavity, and establish the head in the pelvic inlet. Smoothing the cervix and opening the external pharynx are carried out under the influence of labor pains. During contractions in the muscles of the body of the uterus, the following occurs: a) contractions of muscle fibers - contraction; b) displacement of contracting muscle fibers, changing their relative position- retraction. The essence of retraction is as follows. With each contraction of the uterus, a temporary movement and interlacing of muscle fibers is noted; as a result, the muscle fibers that lie one after the other along the length before contractions shorten, move into the layer of neighboring fibers, and lie next to each other. In the intervals between contractions, the displacement of muscle fibers is preserved. With subsequent contractions of the uterus, the retraction of the muscle fibers increases, which leads to an increasing thickening of the walls of the body of the uterus. In addition, retraction causes stretching of the lower uterine segment, smoothing of the cervix, and opening of the external os of the cervical canal. This happens because the contracting muscle fibers of the body of the uterus pull the circular (circular) muscles of the cervix to the sides and up - distraction of the cervix; at the same time, shortening and expansion of the cervical canal, increasing with each contraction, are noted.

At the beginning of the opening period, the contractions become regular, although still relatively rare (after 15 minutes), weak and short (15-20 s according to palpation). The regular nature of contractions, combined with structural changes in the cervix, makes it possible to distinguish the beginning of the first stage of labor from the preliminary period.

Based on the assessment of the duration, frequency, intensity of contractions, uterine activity, the rate of cervical opening and head advancement during the first stage of labor, three phases are distinguished:

Iphase (latent) begins with regular contractions and lasts up to 4 cm of the opening of the uterine os. It lasts from 5 hours in multiparous to 6.5 hours in nulliparous. Opening speed 0.35 cm/h.

II phase (active) characterized by increased labor activity. It lasts 1.5-3 hours. The opening of the uterine os progresses from 4 to 8 cm. The opening rate is 1.5-2 cm / h in primiparous and 2-2.5 cm / h in multiparous.

IIIphase characterized by some slowdown, lasts 1-2 hours and ends with full opening of the uterine os. Opening speed 1-1.5 cm/h.

Contractions are usually accompanied by pain, the degree of which is different and depends on functional and typological features. nervous system women in labor. Pain during contractions is felt in the abdomen, lower back, sacrum, inguinal regions. Sometimes in the first stage of labor, reflex nausea and vomiting may occur, in rare cases- semi-conscious state. For some women, the period of disclosure can be almost or completely painless.

The opening of the cervix is facilitated by the movement of amniotic fluid towards the cervical canal. With each contraction, the muscles of the uterus exert pressure on the contents of the fetal egg, mainly on the amniotic fluid. There is a significant increase in intrauterine pressure, due to uniform pressure from the bottom and walls of the uterus, amniotic fluid, according to the laws of hydraulics, rush towards the lower segment of the uterus. Here, in the center of the lower part of the fetus, there is an internal os of the cervical canal, where there is no resistance. Amniotic fluid rushes to the internal pharynx under the influence of increased intrauterine pressure. Under the pressure of amniotic fluid, the lower pole of the fetal egg exfoliates from the walls of the uterus and is introduced into the internal pharynx of the cervical canal. This part of the membranes of the lower pole of the egg, which penetrates along with the amniotic fluid into the cervical canal, is called fetal bladder. During contractions, the fetal bladder stretches and wedged deeper and deeper into the cervical canal, expanding it. The fetal bladder contributes to the expansion of the cervical canal from the inside (eccentrically), smoothing (disappearing) of the cervix and opening the external os of the uterus.

Thus, the process of opening the pharynx is carried out by stretching the circular muscles of the cervix (distraction), which occurs in connection with the contraction of the muscles of the body of the uterus, the introduction of a tense fetal bladder, which expands the pharynx, acting like a hydraulic wedge. The main thing that leads to the opening of the cervix is its contractile activity; contractions cause both cervical distraction and an increase in intrauterine pressure, as a result of which the tension of the fetal bladder increases and it is introduced into the pharynx. The fetal bladder in the opening of the pharynx has an additional role. Of primary importance is the distraction associated with the retraction rearrangement of muscle fibers.

Due to the retraction of the muscles, the length of the uterine cavity decreases slightly, as if it slides off the fetal egg, rushing upwards. However, this sliding is limited by the ligamentous apparatus of the uterus. Round, sacro-uterine, and partly wide ligaments keep the contracting uterus from being excessively displaced. Tense round ligaments can be felt in a woman in labor through the abdominal wall. In connection with the indicated action of the ligamentous apparatus, uterine contractions contribute to the promotion of the fetal egg downwards.

When the uterus is retracted, not only its neck is stretched, but also the lower segment. The lower segment (isthmus) of the uterus is relatively thin-walled, there are fewer muscle elements in it than in the body of the uterus. Stretching of the lower segment begins during pregnancy and increases during childbirth due to retraction of the muscles of the body or the upper segment of the uterus (hollow muscle). With the development of strong contractions, the border between the contracting hollow muscle (upper segment) and the stretching lower segment of the uterus begins to be indicated. This boundary is called the boundary, or contraction, ring. The boundary ring is usually formed after the discharge of amniotic fluid; it has the appearance of a transverse furrow, which can be felt through the abdominal wall. In normal delivery, the contraction ring does not rise high above the pubis (no higher than 4 transverse fingers).

Thus, the mechanism of the opening period is determined by the interaction of two forces that have the opposite direction: attraction from the bottom up (retraction of muscle fibers) and pressure from the top down (the fetal bladder, hydraulic wedge). As a result, the cervix is smoothed out, its canal, together with the external uterine os, turns into a stretched tube, the lumen of which corresponds to the size of the born head and body of the fetus.

Smoothing and opening of the cervical canal in primiparous and multiparous occur differently.

In primiparas, the internal os opens first; then the cervical canal gradually expands, which takes the form of a funnel, tapering downwards. As the canal expands, the cervix shortens and, finally, completely smoothes (straightens out); only the outer os remains closed. In the future, stretching and thinning of the edges of the external pharynx occurs, it begins to open, its edges are pulled to the sides. With each contraction, the opening of the pharynx increases and, finally, becomes? complete.

In multiparous, the external os is ajar at the end of pregnancy due to its expansion and tears during previous births. At the end of pregnancy and at the beginning of childbirth, the pharynx freely passes the tip of the finger. During the opening period, the external pharynx opens almost simultaneously with the opening internal os and flattening of the cervix.

The opening of the pharynx occurs gradually. First, he misses the tip of one finger, then two fingers (3-4 cm) or more. As the pharynx opens, its edges become thinner and thinner; by the end of the opening period, they have the form of a narrow, thin border, located on the border between the uterine cavity and the vagina. Disclosure is considered complete when the pharynx has expanded by 11-12 cm. With this degree of opening, the pharynx lets the head and body of a mature fetus pass.

During each contraction, amniotic fluid rushes to the lower pole of the fetal egg; the fetal bladder stretches (poured) and is introduced into the pharynx. After the end of the contraction, the water partially moves upward, the tension of the fetal bladder weakens. The free movement of amniotic fluid towards the lower pole of the fetal egg and back occurs as long as the presenting part is mobile above the entrance to the pelvis. When the head descends, it comes into contact with the lower segment of the uterus from all sides and presses this area of the uterine wall against the entrance to the pelvis.

The place where the head is covered by the walls of the lower segment is called the contact zone. The belt of contact divides the amniotic fluid into anterior and posterior. The amniotic fluid located in the fetal bladder below the contact zone is called the anterior fluid. Most of the amniotic fluid, located above the belt of contact, is called the back water.

The formation of the contact belt coincides with the beginning of the entry of the head into the pelvis. At this moment, the presentation of the head (occipital, anterior head, etc.), the nature of the insertion (synclitic, asynclitic) are determined. Most often, the head is installed with a sagittal suture (small oblique size) in the transverse size of the pelvis (occipital presentation), synclitically. During this period, preparations begin for progressive movements in the period of exile.

The fetal bladder, filled with anterior waters, is filled more and more under the influence of contractions; by the end of the opening period, the tension of the fetal bladder does not weaken in the pauses between contractions; he is ready to break. Most often, the fetal bladder ruptures with complete or almost full disclosure pharynx, during a fight (timely outpouring of water). After the rupture of the fetal bladder, the anterior waters leave. The posterior waters usually pour out immediately after the birth of the child. The rupture of the membranes occurs mainly due to their overstretching by amniotic fluid, rushing to the lower pole of the fetal bladder under the influence of increased intrauterine pressure. The rupture of the membranes is also facilitated by the morphological changes that occur in them by the end of pregnancy (thinning, decreased elasticity).

Less commonly, the fetal bladder ruptures with incomplete opening of the pharynx, sometimes even before the onset of childbirth. If the fetal bladder ruptures with incomplete opening of the pharynx, they speak of an early outflow of water; the discharge of amniotic fluid before the onset of labor is called premature. Early and premature rupture of amniotic fluid adversely affects the course of childbirth. As a result of untimely rupture of the membranes, the action of the fetal bladder (hydraulic wedge), which plays an important role in smoothing the cervix and opening the pharynx, is excluded. These processes are carried out under the influence of the contractile activity of the uterus, but for a longer time; at the same time, there are often complications of childbirth that are unfavorable for the mother and fetus.

With an excessive density of membranes, the fetal bladder ruptures after full opening of the pharynx (late rupture of the fetal bladder); sometimes it persists until the period of expulsion and protrusion from the genital slit of the presenting part.

The part of the head located below the contact zone, after the discharge of the front waters, is under atmospheric pressure; the higher part of the head, the body of the fetus experience intrauterine pressure, which is higher than atmospheric pressure. As a result, the outflow conditions change. venous blood from the presenting part and on it a generic tumor is formed.

Maintaining a disclosure period

When managing the first period, based on the above features of its course, it is necessary to take into account the following points:

The condition of the woman in labor is important (complaints, skin color, mucous membranes, blood pressure dynamics, pulse rate and filling, body temperature, etc.). It is necessary to pay attention to the function of the bladder and bowel movements.

It is important to correctly assess the nature of labor, the duration and strength of contractions. By the end of the first stage of labor, contractions should recur after 2-3 minutes, last for 45-60 seconds, and acquire significant strength.

The state of the fetus is being monitored by listening to the heartbeat after 15-20 minutes, and in case of outflowing waters, after 10 minutes. Fluctuations in the frequency of fetal heart tones from 120 to 160 in the first stage of labor is considered normal. The most objective method for assessing the condition of the fetus is cardiography.

Monitoring the condition of the soft birth canal helps to identify the condition of the lower segment of the uterus. In the physiological course of childbirth, palpation of the lower segment of the uterus should not be painful. As the pharynx opens, the contraction ring rises above the womb and, with full opening of the uterine pharynx, it should be no higher than 4-5 transverse fingers above the upper edge of the womb. Its direction is horizontal.

The degree of opening of the uterine os is determined by the level of standing of the contraction ring above the upper edge of the womb (Schatz-Unterbergon method), by the height of the fundus of the uterus relative to the xiphoid process of the woman in labor (Rogovin method). The most accurate disclosure of the uterine pharynx is determined by the vaginal examination. Vaginal examination in childbirth is performed with the onset of labor and after the outflow of amniotic fluid. Additional Research carried out only according to indications.

The progress of the presenting part is being monitored with the help of external methods of obstetric research.

The time of discharge and the nature of the amniotic fluid are being monitored. When water is poured out, a vaginal examination is performed until the uterine os is fully opened. Pay attention to the color of amniotic fluid. Waters indicate the presence of fetal hypoxia. With full disclosure of the uterine pharynx and the whole fetal bladder, an amniotomy should be performed. The results of monitoring a woman in labor are recorded in the history of childbirth every 2-3 hours.

In childbirth, you should set the mode for the woman in labor. Before the outflow of amniotic fluid, a woman in labor, as a rule, can occupy an arbitrary position, move freely. With a moving fetal head, bed rest is prescribed, the woman in labor should lie on the side of the occiput of the fetus, which facilitates the insertion of the head. After inserting the head, the position of the woman in labor can be arbitrary. At the end of period I, the most physiological position is the position of the woman in labor on her back with a raised body, since it contributes to the advancement of the fetus through the birth canal, because the longitudinal axis of the fetus and the axis of the birth canal in this case coincide. The diet of the mother in labor should include easily digestible high-calorie food: sweet tea or coffee, pureed soups, kissels, compotes, milk porridges.

In childbirth, it is necessary to monitor the emptying of the bladder and intestines. The bladder has a common innervation with the lower segment of the uterus, in connection with this overflow Bladder leads to dysfunction of the lower segment of the uterus and weakening of labor activity. Therefore, it is necessary to recommend a woman in labor to urinate every 2-3 hours. If urination is delayed up to 3-4 hours, resort to bladder catheterization. Great importance has timely bowel movements. The first time a cleansing enema is given when a woman in labor enters the maternity hospital. If the opening period lasts more than 12 hours, the enema is repeated.

For the prevention of ascending infection, careful observance of sanitary and hygienic measures is of utmost importance. The external genitalia of the woman in labor is treated with a disinfectant solution at least 1 time in 6 hours, after each act of urination and defecation and before vaginal examination.

The period of disclosure is the longest of all periods of childbirth and is accompanied by pain varying degrees intensity, therefore, the maximum anesthesia of childbirth is necessarily carried out. Antispasmodic drugs are widely used to anesthetize childbirth:

Atropine 0.1% solution, 1 ml intramuscularly or intravenously.

Aprofen 1% solution 1 ml / m. Greatest effect observed when aprofen is combined with analgesics.

No-shpa 2% solution 2 ml subcutaneously or intramuscularly.

Baralgin, spazgan, maxigan 5 mg IV slowly.

In addition to these drugs for pain relief in the 1st stage of labor, epidural anesthesia can be used, giving a pronounced analgesic, antispasmodic and hypotensive effect. It is performed by an anesthesiologist and is performed when the uterine os is opened by 4-3 cm. Of the drugs that have an effect mainly on the cerebral cortex, the following are used:

Nitrous oxide in a mixture with oxygen (respectively 2:1 or 3:1). In the absence of a sufficient effect, trilene is added to the gas mixture.

Trilene has analgesic effect at a concentration of 0.5-0.7%. With intrauterine fetal hypoxia, trilene is not used.

GHB is administered in the form of a 20% solution of 10-20 ml.v. Anesthesia occurs in 5-8 minutes. And continue for 1-3 hours. Contraindicated in women with hypertension syndrome. With the introduction of GHB, a 0.1% solution of atropine is premied - 1 ml.

Promedol 1-2% solution - 1-2 ml or fentanyl 0.01% - 1 ml, but no later than 2 hours before the birth of the child, because. depresses his respiratory center.

Period of exile

The course of the period of exile

In the second stage of labor, the fetus is expelled from the uterus through the birth canal. After the outflow of water, the contractions stop for a short time (several minutes); at this time, the retraction of the muscles and the adaptation of the walls of the uterus to the reduced (after the discharge of water) volume continue. The walls of the uterus become thicker and more closely in contact with the fetus. The unfolded lower segment and the smoothed neck with an open pharynx together with the vagina form the birth canal, which corresponds to the size of the head and body of the fetus. By the beginning of the period of exile, the head intimately touches the lower segment (internal fit) and, together with it, closely and comprehensively adheres to the walls of the small pelvis (external fit). After a short pause, contractions resume and intensify, retraction reaches its highest limit, intrauterine pressure increases. The intensification of expelling contractions is due to the fact that the dense head irritates the nerve endings more than the fetal bladder. During the period of exile, contractions become more frequent, and the pauses between them are shorter.

Join the fight soon attempts- reflex arising contractions of the striated abdominal muscles. Attaching attempts to expelling contractions means the beginning of the process of expelling the fetus.

During attempts, the woman's breathing is delayed, the diaphragm lowers, the abdominal muscles tense up strongly, and intra-abdominal pressure increases. Increasing intra-abdominal pressure is transmitted to the uterus and fetus. Under the influence of these forces, the "formation" ("formation") of the fetus occurs. The fetal spine unbends, the crossed arms are pressed more tightly against the body, the shoulders rise to the head and the entire upper end of the fetus acquires a cylindrical shape, which contributes to the expulsion of the fetus from the uterine cavity.

Under the influence of increasing intrauterine and joining intra-abdominal pressure, translational movements of the fetus through the birth canal and its birth are performed. Translational movements occur along the axis of the birth canal; at the same time, the presenting part performs not only translational, but also a number of rotational movements that contribute to its passage through the birth canal. With the increasing strength of expelling contractions and attempts, the presenting part (normally - the head) overcomes the resistance from the muscles pelvic floor and vulvar ring.

The appearance of the head from the genital slit only during attempts is called cutting out heads. It indicates the end of the internal rotation of the head, which is installed in the exit cavity from the small pelvis; a fixation point is formed. With the further course of the birth act, the head turns out to be so deeply cut into the genital gap that it remains there outside the attempt. This position of the head indicates the formation of a fixation point (suboccipital fossa in the anterior view of the occipital insertion). From this moment, under the influence of continuing attempts, teething, heads. With each new push, the fetal head comes out more and more from the genital slit. First, the occipital region of the fetus is cut through (born). Then parietal tubercles are installed in the genital slit. The tension of the perineum at this time reaches a maximum. The most painful, albeit short-term, moment of childbirth comes. After the birth of the parietal tubercles, the forehead and face of the fetus pass through the genital slit. This completes the birth of the fetal head. The fetal head has erupted (born), this corresponds to the end of its extension.

After birth, the head makes an external turn according to the biomechanism of childbirth. In the first position, the face turns to the right thigh of the mother, in the second position - to the left. After the external rotation of the head, the anterior shoulder lingers at the pubis, the posterior shoulder is born, then the entire shoulder girdle and the entire body of the fetus, together with the posterior waters pouring out of the uterus. The posterior waters may contain particles of cheese-like lubricant, sometimes an admixture of blood from small tears in the soft tissues of the birth canal.

The newborn begins to breathe, scream loudly, actively move his limbs. His skin turns pink quickly.

The woman in labor experiences severe fatigue, rests after intensive muscle work. The pulse rate gradually decreases. After the birth of a child, a woman in labor may experience severe chills associated with a large loss of energy during strong attempts. The period of exile in primiparous lasts from 1 hour to 2 hours, in multiparous - from 15 minutes to 1 hour.

Maintaining a period of exile

In the second stage of labor, it is necessary to monitor for:

mother's condition;

the nature of labor activity;

the state of the fetus: determined by listening to his heartbeat after each attempt in the middle of a pause, fluctuations in the frequency of the heart sounds of the fetus in the second stage of labor from 110 to 130 beats. in minutes, if it levels off between attempts, it should be considered normal;

the state of the lower segment of the uterus: assessed by the level of standing of the contraction ring above the upper edge of the womb;

advancement of the presenting part of the fetus (head).

Delivery carried out on a special Rakhmanov bed, well adapted for this. This bed is higher than usual (it is convenient to provide assistance in the II and III periods of childbirth), consists of 3 parts. The head end of the bed can be raised or lowered. The foot end can be retracted: The bed has special footrests and "reins" for the hands. The mattress for such a bed consists of three parts (polsters) covered with oilcloth (which facilitates their disinfection). In order for the external genitalia and perineum to be clearly visible, the polster located under the feet of the woman in labor is removed. The woman in labor lies on Rakhmanov's bed on her back, her legs are bent at the knee and hip joints and rest against the supports. The head end of the bed is raised. This achieves a semi-sitting position, in which the axis of the uterus and the axis of the small pelvis coincide, which favors an easier advancement of the fetal head through the birth canal and facilitates attempts. To strengthen the attempts and be able to their to regulate, a woman in labor is recommended to hold her hands on the edge of the bed or on special “reins”.

To receive each child in the delivery room, you must have:

individual set of sterile linen (blanket and 3 cotton diapers), heated to 40°C;

an individual sterile kit for the initial treatment of a newborn: 2 Kocher clamps, a Rogovin bracket, forceps for applying it, a triangular gauze, a pipette, cotton balls, a tape 60 cm long and 1 cm wide for anthropometry of a newborn, 2 oilcloth bracelets, a catheter or a balloon for suction of mucus.

From the moment the head is inserted, everything should be ready for delivery. The external genitalia of the woman in labor are disinfected. The midwife taking delivery washes her hands, as before an abdominal operation, puts on a sterile gown and sterile gloves. Sterile shoe covers are put on the legs of the woman in labor; the thighs, legs and anus are covered with a sterile sheet, the end of which is placed under the sacrum.

During the insertion of the head, they are limited to monitoring the condition of the woman in labor, the nature of the attempts and the heartbeat of the fetus. To receive childbirth start during the eruption of the head. The woman in labor is given a manual aid called "perineum protection" or "perineal support". This manual aims to promote the birth of the head smallest size for this insertion, to prevent violation of the intracranial circulation of the fetus and trauma to the soft birth canal (perineum) of the mother. When providing manual assistance with head presentation, all manipulations are performed in a certain sequence. The delivery person, as a rule, stands to the right of the woman in labor.

First moment - preventing premature extension of the head. The more the fetal head is bent in the anterior view of the occipital presentation, the smaller the circumference it cuts through the genital gap. Consequently, the perineum is less stretched and the head itself is less squeezed by the tissues of the birth canal. By delaying the extension of the head, the doctor (midwife) taking delivery contributes to its eruption in a bent state with a circle corresponding to a small oblique size (32 cm). With an unbent head, it could cut through a circle corresponding to a straight size (34 cm).