How is the birth process going? The process has begun! How does childbirth begin?
Not only for men, but also for many women who are far (yet) from issues related to childbearing, the maternity hospital seems to be a kind of “black box”: a pregnant woman with a huge belly at a certain moment known only to her, hides behind the doors of this institution, and through for a few days, she comes out of it much thinner, accompanied by a nurse with a beautiful bundle in her hands. What and how happened inside - "shrouded in darkness." Ignorance is the main cause of fear and insecurity, knowledge is a reliable weapon against them. The sooner a pregnant (and maybe not only pregnant) woman finds out in as much detail as possible what exactly lies ahead for her, the more invulnerable she will become to irrational fears and forebodings, the more time she will have for rational, i.e. reasonable and conscious, preparation for the great sacrament of childbirth. How does the birth process go? During childbirth, three periods are distinguished: cervical dilatation; the birth of a fetus; expulsion of the afterbirth. Let us describe in more detail what happens at each of these stages.
Larisa Kommisarova
Head maternity department of the Center for Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences
First period (opening of the cervix)
ABOUT early labor shows one of three signs.
First, labor can begin with contractions - rhythmic uterine contractions causing cervical dilatation 1 . The opening of the cervix is also facilitated by the pressure of the fetal bladder, which, under the influence of uterine contractions, descends. The degree of disclosure is determined by the diameter of the fingers, which, during vaginal examination, can be inserted into the external uterine os. A dilation of 10 cm is considered complete.
Secondly, it happens that the signal for the onset of childbirth is rupture of amniotic fluid . As a rule, the waters break at the end of the first stage of labor, but in 20-30% of cases, the outflow of amniotic fluid occurs prematurely or early, i.e. before or with the onset of labor. When amniotic fluid leaks, moisture is felt on the inner surface of the thighs, as with involuntary urination, but the water can leave immediately in large quantities. When the anterior waters (i.e., the waters under the fetal head) depart, the baby’s head descends into the lower part of the uterus, largely blocking the path for the waters above the head (posterior waters), so the posterior waters do not leave at once, but in small portions for throughout the entire period of childbirth. When the amniotic fluid breaks, you should immediately contact the obstetric institution, regardless of the gestational age and the presence of contractions. The fact is that the outpouring of water indicates a violation of the integrity of the fetal bladder. At the same time, an “entrance gate” is formed from the vagina into the uterine cavity and to the fetus, so the pregnant woman must constantly be under the supervision of a doctor or midwife, who will take the necessary measures in a timely manner.
And finally, thirdly, sometimes childbirth begins with mucus plug discharge (a mucous plug is called a mucous-bloody discharge, which appears in a relatively small amount in a woman at the beginning of childbirth). During pregnancy, the mucous plug closes the entrance to the cervix, and with the onset of labor, as the cervix opens, it is discharged.
So, at least one of the signs of the onset of labor is evident, and the woman in labor went to the hospital 2 . She certainly needs to have a passport, an exchange card obtained at the antenatal clinic, and it is very desirable to have an insurance policy with her. The procedure for receiving and registering a woman in labor in Russian maternity hospitals is more or less standard. An obstetric examination is carried out, the blood group, the Rh factor is determined. In many maternity hospitals, it is not allowed to be in your own underwear and clothes - upon admission, everyone is given official "vest". Then, as a rule, they again carry out a standard set of hygiene procedures - an enema, shaving the pubis, a shower, and the woman enters the prenatal ward.
The first stage of labor is the longest of the three. It lasts an average of 4 to 10 hours, but can drag on for 20-22 hours, and at the birth of the first child, it takes more time to open the cervix than with the second and subsequent births.
The first stage of childbirth requires a woman to calm relaxation, self-confidence. Any effort, attempt to help the initial contractions will only bring harm. The secret to quickly dilating the cervix is complete relaxation.
It is useful to be aware of the symptoms, the appearance of which in the first stage of labor requires immediate contact with a doctor or midwife. It's6
- a sharp deterioration in well-being, weakness, cold sweat, headache;
- the appearance of "flies", dark circles before the eyes, blurred vision;
- the appearance of bright bloody discharge from the genital tract;
- severe dizziness, tinnitus.
There is a transitional period between the full opening of the cervix and the onset of pushing. At this time, there is a feeling of pressure on the rectum, contractions intensify, there may be back pain, a desire to push. At this critical stage, it is very important to relax and not interfere with the natural progression of the presenting part of the fetus.
Second period (birth of the fetus)
The second stage of labor is marked by the beginning attempt . Attempts are simultaneous reflex contractions of the muscles of the uterus, diaphragm and abdominals. They begin when the cervix is fully dilated. With the onset of attempts, the woman goes to the delivery room. As a rule, the woman in labor is placed on the delivery bed. During contractions, she bends - so that her knees are at the armpits.
It must be said that the duration of childbirth largely depends on the efforts of a woman during attempts. A woman needs a lot of effort. It is during this period of childbirth that the child experiences the strongest pressure, with prolonged attempts, uteroplacental circulation may be disturbed. Therefore, the most important thing during this period is to relax between attempts, breathe correctly and push properly.
When the pressure of the presenting part of the fetus (usually the head) on the bottom of the pelvis occurs and increases, the attempts intensify, the intervals between them are reduced to 2-3 minutes. From the genital gap, the head begins to appear. When the head ceases to hide during attempts, but, as it were, is fixed in the genital gap, they talk about head eruption . Usually, the occipital region is cut through first, then the parietal, then the front part is shown. Happened head birth . The born head is more often turned face down. At the next moment, the head turns to the right or left thigh of the mother and, at the same time, the shoulders turn in the birth canal. Then the front shoulder is born, and after it the back shoulder. After the birth of the head and shoulders, the body and legs of the baby are born easily. The child takes his first breath.
The second stage of labor lasts for the primiparous, as a rule, 30-40 minutes, for the multiparous - 10-15.
After the birth of the child and the removal of mucus from the oral cavity, his condition is assessed according to the Apgar scale. (This method of assessing the condition of a newborn bears the name of its author, the American anesthesiologist Virginia Apgar, and is based on 5 indicators: heartbeat, breathing, muscle tone, reflexes, and skin color. The Apgar scale has 10 points; 7 or more points are considered a sign of good or excellent condition health.) Then the midwife puts the mother’s baby on her chest, and until signs of separation of the placenta appear, the mother communicates with the child. This is a very important point: in this way, the mother and child receive a signal that their hard work has been successfully completed.
Third period (expulsion of the placenta)
10-15 minutes after the birth of a child, a woman has light contractions, during which the placenta separates from the uterine wall, and then the placenta, membranes and umbilical cord (all this together is called the placenta) are expelled from the uterine cavity with a slight attempt. At the same time, up to 300 ml of blood is released from the genital tract - this is a physiological (harmless) blood loss during childbirth. The doctor carefully examines the afterbirth, because if parts of it remain in the uterine cavity, this is fraught with the development of infectious inflammation of the uterus (endometritis) or bleeding in the postpartum period. After the birth of the placenta, the external genitalia, perineum and inner thighs are washed with a disinfectant solution. The birth canal is examined to exclude soft tissue injuries (cervical rupture, vaginal rupture).
After separation of the placenta, the child is examined by a pediatrician. The baby is wiped with sterile gauze or washed with soap, a 30% solution of sodium sulfacyl is instilled into the eyes to prevent blennorrhea 3 , then clamps are applied to the umbilical cord at a distance of 2 and 10 cm from the umbilical ring and, having wiped it with 5% alcohol solution of iodine or 96% ethyl alcohol, cut between the clamps.
After this, the child is applied to the mother's breast. It is very important that the newborn receives colostrum from the mother's breast already in the first hour after birth. The fact is that colostrum - immature milk - contains vitamins, enzymes, antibodies that will help the baby avoid many infections and quickly adapt to new conditions.
For two hours, the woman remains in the maternity ward under observation, because. during this period there is a possibility of early postpartum hemorrhage.
From the editor:
Read more about ways to relax during contractions, breathing techniques, the Apgar scale in the following issues of the magazine.
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1 Contractions must be distinguished from the so-called harbingers of childbirth, in the past called "ambassadors of childbirth." The intervals between contractions-harbingers are fickle, they can either increase or decrease - in contrast to the intervals between regular contractions, the frequency and intensity of which tends to increase. |
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 performed at different periods of childbirth.
Childbirth is the process of expulsion of the fetus from the uterine cavity, its immediate birth and the release of the placenta and 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 from the uterine cavity into the birth canal, formed by the bones and soft tissues of the 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 outflow of amniotic fluid. Of great importance is the time of outflow of water in relation to the degree of cervical dilation, as this can affect the course of the birth process.
Normally, amniotic fluid is poured out in the active phase of labor, since due to intense uterine contractions, the pressure on the fetal bladder increases, and it opens. 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 opening has reached 5 cm. The fact is that at the beginning of labor, before the cervix opens by 5 cm, there is an increased risk of developing weakness of labor, that is, weakening 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 intrauterine infection increases. 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 water leaks quite a bit or, conversely, pours out in large quantities, you should keep a 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.
In the normal course of the first stage of labor, a vaginal examination is performed every 4 hours to assess the dynamics of cervical dilatation. If complications occur, more frequent testing may be required.
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 the head, making certain rotational movements with its smallest size, gradually descends to the pelvic floor with each contraction 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, descending to the pelvic floor, the fetus exerts significant pressure on nearby organs, including the rectum, as a result of which the woman has an involuntary strong desire to 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 exactly.
In the second stage of labor, obstetric tactics are 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 can be accompanied by unpleasant pain 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 ensure the first bodily contact. The doctor assesses the condition of the newborn according to special criteria - the Apgar scale. At the same time, such indicators as heartbeat, respiration, skin color, reflexes and muscle tone of the newborn at 1 and 5 minutes after birth are evaluated on a ten-point scale.
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 pulled 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 infection. 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 the woman in childbirth does not worry about an overfilled bladder for the next few hours. Then, in order to prevent postpartum hemorrhage, a special bag of ice is placed on the lower abdomen of the woman, which remains 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 in order to provide the necessary assistance in a timely manner in the event of postpartum hemorrhage in full.
With a satisfactory condition of the puerperal and the newborn, 2 hours after birth, they are transferred to the postpartum ward.
Almost all expectant mothers are afraid to miss the onset of labor. Fearing not to be in time, they come to the maternity hospital on a false alarm and are disappointed that the meeting with the baby is being postponed. Childbirth is a unique and individual process. But there are still typical signs of the onset of labor activity.
280 days is a conditional period, after which childbirth begins. It is calculated from the 1st day of the last menstruation. In fact, the appearance of a baby at any time between 259 and 294 days of pregnancy is considered absolutely normal.
Childbirth does not begin suddenly: already from the beginning of the 9th month, the female body is reconstructed at an accelerated pace from “preserving pregnancy” to “giving birth”.
When the baby is ready to be born, the placenta begins to change its hormonal production, which causes a chain reaction of various physiological processes that lead to the launch of the birth act and cause contraction of the uterine muscle.
How are the fights
Contractions are rhythmic contractions of the uterus, they are felt as pressure in the abdominal cavity, which can be felt throughout the abdomen. Due to contractions, the cervix opens and the baby moves through the birth canal.
At first, the contractions are weak and not painful, the intervals between them are about half an hour, and sometimes more, the contraction of the uterus itself lasts 5-10 seconds. Gradually, the intensity and duration of contractions increases, and the intervals between them decrease. Between contractions, the abdomen is relaxed.
Pain during contractions is not like the pain we feel due to accidental injury or any disease. Cramping pain is a natural response of the body to the processes occurring during childbirth, it is due to the opening of the cervix, compression of nerve endings, tension of the uterine ligaments. Sometimes the first shocks are felt in the lumbar region, then they spread to the stomach, becoming girdle. This is perceived by a woman as muscle tension, which reaches its peak, and then gradually weakens. Drawing sensations can also occur in the lower abdomen, and not in the lumbar region, in which case the pain resembles menstrual pain.
Each contraction begins at the top of the uterus and "diverges" down the muscles. Its intensity increases gradually, the peak lasts 2–3 s, then it weakens and ends. As the labor progresses, the contractions become more frequent and painful, their duration increases, and the pauses between them decrease.
While the contractions are insensitive, it is difficult to distinguish them from the harbingers of childbirth. However, there are still differences. Harbinger, or false, are such contractions that appear shortly before childbirth and are not actually labor activity, since they do not lead to the opening of the cervix.
Unlike true contractions, false ones are irregular: their duration and pauses between them fluctuate, the duration and strength of sensations do not increase in time, but stop within half an hour - two hours. In addition, false contractions are easily removed by changing the position of the body (just lie down or turn on the other side), deep breathing, back massage, a warm bath, or taking antispasmodics (NO-ShPA, PAPAVERIN).
The duration, intensity and frequency of true contractions, on the contrary, increase with time. The pauses between them are shortened. Changing the position of the body, breathing and water procedures alleviate the condition, but do not stop the contractions. If a woman has determined that she is still having true contractions, then it is time for her to get ready for the hospital. This is usually worth doing when the contractions last 30-40 seconds and come every 15 minutes.
Preparing for childbirth
It is advisable to take a shower, put on clean underwear, cut your nails and remove varnish from them.
For many women, shaving the perineum upon admission to the hospital is a very unpleasant moment. However, this procedure is necessary, as it allows you to control the degree of stretching of the perineum during childbirth, to prevent its rupture, and in case of injury, it is better to match the tissues during suturing. Feelings of embarrassment can be avoided if you perform this simple procedure at home on your own or with the help of your husband. It is only better to take a completely new razor and treat the skin well with an antiseptic solution or antibacterial soap.
How to ease the pain
During contractions, the expectant mother is allowed to choose a body position that is convenient for her: you can lie on your side, walk, stand on all fours or kneel, sway while sitting on a large gymnastic ball (fitball). Walking speeds up the process of childbirth by 30?%. This is especially important at the initial stage of childbirth.
Water has a good analgesic effect, in particular, a warm shower. At the height of the fight, you need to slowly, deeply and rhythmically inhale air through the nose and exhale it through the mouth. If the contractions become very strong, frequent shallow breathing, in which the inhalation is also made through the nose, and the exhalation through the mouth, will help.
After a contraction, there is always a period of time when the pain recedes, you can relax and rest. It is important to monitor the duration of contractions and the intervals between them.
It is necessary to remember about the regular emptying of the bladder - this stimulates contractions.
What Not to Do
With the onset of labor, it is highly not recommended:
Eating. This requirement is explained by the fact that during childbirth there may be a need for general anesthesia, during which there is a risk of throwing the contents of the stomach into the mouth, and from there into the lungs, which can lead to the development of severe pneumonia (pneumonia). In addition, during contractions, due to the reflex connection that exists between the cervix and the stomach, in some cases, the woman in labor opens up vomiting. The more content is in the stomach, the higher the likelihood of such phenomena.
Sit. Especially this prohibition applies to multiparous women, with rapid labor activity. At the beginning of the first period, the sitting position will do no harm. However, by the end of it, the baby's head has already entered the birth canal, and, sitting down on a hard surface (chair, bed), the expectant mother creates additional pressure on the baby's head. The exception is the sitting position on the fitball or on the toilet, where such pressure is excluded.
Lie on your back- to avoid the manifestation of inferior vena cava syndrome. In the supine position, a heavy pregnant uterus compresses the large vessels that pass behind it, disrupting blood flow to the heart. In response to this, arterial pressure drops sharply reflexively, causing fainting and impaired blood supply to the placenta and fetus. In some maternity hospitals, it is customary to record the fetal cardiotocogram while lying on your back. If such a position causes discomfort in a woman (weakness, dizziness, nausea, loss of orientation), then she should definitely tell the staff about this: CTG can also be recorded in the supine position.
Taking pain medication on your own: they will not relieve normal labor pain, but they can mask important symptoms.
We collect the bag
The delivery bag (which is best packed before delivery) should contain a T-shirt or cotton nightgown, socks, washable slippers, a bathrobe, a diaper, a small terry towel, drinking water, personal hygiene items: toothbrush and paste, soap, comb, toilet paper. The maternity ward is usually not allowed to take anything else.
In some maternity hospitals, you can take a mobile phone and a player, a camera and even a video camera with you, but it is better to find out about this in advance. Food during childbirth can not be taken, so you do not need to take food.
Before leaving for the maternity hospital, it is necessary to check the availability of documents: passport, exchange card, insurance policy, labor contract (if any). If there is an individual agreement for childbirth, the onset of contractions is the time to call the doctor who will conduct the birth.
Considering that childbirth often begins suddenly, it is better to carry medical documents with you at all times.
When to go to the hospital?
- You should go to the maternity hospital when the contractions become regular and will come every 10-15 minutes.
- If a clear interval between contractions has not yet been established, but they are accompanied by severe pain, it is also necessary to seek medical help.
Without delay
It is necessary to immediately go to the hospital in the following cases:
- There were bleeding.
- A woman is worried about headache, blurred vision, pain in the epigastric region and in the uterus.
- The movements of the child became very violent or, conversely, ceased to be felt well.
- In these cases, it is necessary to get to the hospital as quickly as possible, ideally by ambulance with medical escort.
Outflow of waters
Childbirth may not begin with full-fledged contractions. In some cases, a pregnant woman first has an outpouring of amniotic fluid. This is the environment in which the fetus lives and develops inside the mother's womb. Amniotic fluid is in a closed space (in the membranes of the fetus). The placenta and fetal membranes provide a barrier that is usually completely impervious to bacterial (purulent) infection.
Throughout pregnancy, the baby develops in a sterile environment. The key to this sterility, and hence the well-being of intrauterine development, is the integrity of the amniotic membranes.
Normally, amniotic fluid is poured out in the first stage of labor (until the cervix is fully dilated, but not before the cervix is 4 cm dilated). At the height of one of the contractions, the bubble becomes tense and bursts. The outflow of water before the onset of labor (before contractions) is considered prenatal, or premature, and if the water is poured out during regular contractions, but with insufficient opening of the cervix, they speak of an early outflow of water. Before the onset of contractions, water often breaks in multiparous women.
High or low? The discharge of water is not accompanied by any unpleasant sensations. In case of premature outflow of water, the fetal bladder can burst high above the cervix (then the water flows out slowly), or it can “burst” directly above the opening of the cervix (then the water will immediately leave in large quantities, “gush like a bucket”).
With a high rupture of the fetal bladder, it can be difficult to determine the nature of the discharge: whether it is water, or the mucous plug leaves, or simply the amount of discharge from the vagina is increased. After all, both those and other discharges are liquid, and at first glance they seem similar.
Cork or water? The mucous plug departs 1-5 days before delivery, has a beige, brown, pinkish color, mucous or lumpy consistency, sometimes with streaks of blood. She can depart in portions, more often in the morning, for several days in a row. The discharge is not aggravated by coughing and squatting.
The amniotic fluid is transparent, watery, may be yellowish and greenish, after discharge it flows constantly, and their amount increases with coughing and squatting. Labor activity after the outpouring of water develops over the next few hours.
Immediately after the discharge of the amniotic fluid, bacteria from the vagina and cervix enter the uterine cavity, the child is no longer protected from possible infections, so childbirth should occur no later than 12 hours after the rupture of the fetal bladder. In the event of an outflow of water, it is necessary to note the time when this happened and go to the hospital without delay, even if there are no contractions yet.
It is important to pay attention to the color of the departed waters. Normally, they are transparent or light pink, odorless. With a normal color of the waters, you can get to the maternity hospital on your own.
In the car, the woman in labor must take a horizontal position lying on her side. This posture slows down labor activity; is the prevention of compression of the umbilical cord when its loops fall out (one of the serious complications with premature outflow of water); provides the fetus with sufficient oxygen.
Green, brown or black amniotic fluid indicates that there has been a release of meconium (original feces) from the baby's intestines. This happens with oxygen starvation in a child.
If the waters are colored with bright blood, then placental abruption is likely. In this case, hospitalization by special transport in the presence of qualified doctors is necessary. This situation requires the immediate call of an ambulance brigade to the place where the waters broke.
Before the arrival of specialized medical transport, it is necessary to take a lying position on your side.
In no case
Unlike the option when childbirth begins with contractions, when the waters break, it is strictly forbidden:
Stay indoors. This is associated with both the risk of infection and the threat of hypoxia in the child: after the discharge of water, the fetal head is inserted into the uterine cavity and, in some cases, can press the umbilical cord.
Take hygiene measures. Invasive hygiene procedures (shaving, enema, deep washing) at home can contribute to the entry of microbes into the uterine cavity (after all, it is no longer protected by the fetal bladder).
eat food, since with departed waters, there is often a need for operative delivery using anesthesia.
In addition, the ban on food and baths is associated with the need to get to a specialized maternity ward with a minimum investment of time.
Childbirth has begun! Every minute of this event brings you closer to the long-awaited meeting with the baby. Be patient, do not be afraid, keep a positive, fighting mood, and this meeting will not be long in coming.
Instruction
By the end of the ninth month of intrauterine development in the fetus, all systems are ready to function outside the mother's body. At this time, the blood flow through the placenta becomes difficult, the weight of the fetus is large enough and the baby's head descends into the small pelvis.
At a period after 36 weeks of pregnancy, the body is actively preparing for childbirth. The expectant mother often has "training" contractions, in which the uterus spasms. By the end of the third trimester of pregnancy, some changes occur in a woman's body - the level of oxytocin rises, aching pain in the lumbar region increases.
Under the influence of special hormones, the cervix of the uterus softens, shortens and gradually opens. The opening of the cervix of the cervix is slower, since its tissue is very dense. This process begins 1-2 weeks before childbirth, it can be judged by the discharge of the cervical plug, which is presented in the form of an accumulation of thick mucus. In women, the cervix can be loosely compressed throughout pregnancy, its opening is permissible by 1-2 cm before the birth process, with this phenomenon, the pregnant woman does not observe the discharge of the cervical plug.
The birth process begins with contractions - these are regular contractions of the uterus, which are caused by a spasm of the muscle fibers of this organ. Cramping movements of the uterus cause the fetus to move down. The opening of the cervix and contractions indicate the activation of labor. The duration of the process of childbirth in those women who become mothers for the first time is 10-12 hours, and the time of childbirth, as a rule, is half as much.
The outflow of amniotic fluid in parturient women occurs at a different period and depends on the individual characteristics of the walls of the amniotic sac. If a woman in labor has infections of the birth canal, then the wall of the bladder becomes thinner, and the anterior waters are poured out at the first. The amniotic sac can become thin due to the metabolic characteristics of a pregnant woman and for other reasons. If the walls of the amniotic sac are dense and do not rupture with the onset of labor, then the doctor makes a neat incision through the opened cervix and the anterior amniotic fluid is poured out.
When the cervix is fully dilated, the posterior amniotic fluid and the walls of the uterus press on the fetus and it moves along the birth canal. The obstetrician evaluates the strength of the attempts, their frequency and gives instructions to the woman in labor at what point and how to push properly. When a woman should not scream, she should take more air into her lungs and try hard to strain her abdominal muscles.
The birth of a child from the moment of attempts takes about 40 minutes, but more often 10-15 minutes. At this time, the fetus moves forward headfirst through the birth canal, the obstetrician controls and helps the process of the appearance of the child. In cases where the skin of the external genital organs of the woman in labor does not stretch to the size of the fetal head, an incision is made in the perineum to avoid tearing it. With a weak labor activity, a pregnant woman is injected intravenously with oxytocin or other similar hormonal drugs.
You and your future baby, having overcome a long way, are finally ready to loudly announce the birth of a new person. How does childbirth take place, and what physiological periods is this complex process divided into? The mechanism of normal childbirth includes three main stages: disclosure, expulsion and exit of the placenta. The duration of the delivery process for all women is different, there can be no single standard here.
How is the birth of a child in women (with video)
Childbirth is a complex process that occurs reflexively and is regulated by the nervous system. It is aimed at expelling the fetus, and then the placenta with fetal membranes and amniotic fluid from the uterine cavity through the birth canal after the fetus has reached viability. Births that occurred at 28-37 weeks are called premature, at 38-41 weeks - urgent, and at 41-42 weeks - late.
How is childbirth in women who carried a child without pathologies?
The mechanism of childbirth is provided by contractions and attempts.
Contractions are periodically repeated rhythmic contractions of the muscles of the uterus that occur involuntarily, regardless of the desire of the woman.
Attempts - simultaneously occurring contractions of the muscles of the diaphragm, abdominals and pelvic floor.
During childbirth, 3 periods are distinguished:
1) the period of opening of the cervix before childbirth;
2) the period of expulsion of the fetus;
3) succession period.
The period of opening of the uterus before childbirth begins with the first regular contractions, and ends with the complete opening of the external os of the cervix.
The period of exile in childbirth begins from the moment the cervix is fully dilated and ends with the birth of the child.
The afterbirth period begins with the birth of the child and ends with the expulsion of the placenta.
The video "Mechanism of childbirth" presents all the stages of the delivery process:
Biomechanism of normal childbirth- this is the totality of all movements performed by the fetus when passing through the birth canal.
There are 7 moments of the biomechanism of childbirth.
1. The fetal head is inserted into the pelvic inlet.
2. Flexion of the fetal head. Under the influence of intrauterine pressure, the upper part of the fetal spine is bent in such a way that the chin approaches the chest, and the back of the head rests down at the entrance to the small pelvis.
3. Passage of the head into the pelvic cavity.
4. Internal rotation of the fetal head.
5. Extension of the head, it corresponds to the moment of cutting and eruption of the head of the pelvic floor (it first appears from the genital gap).
6. Internal rotation of the body and external rotation of the head. The born head turns with the back of the head to the right or left (depending on the position) thigh of the mother.
7. Birth of the trunk and the whole body of the fetus. First, the anterior shoulder appears under the pubic symphysis. The trunk bends in the thoracic region and the rear shoulder and handle are born, after which the front shoulder and the whole body are born.
Watch the video "Biomechanism of Birth" to better understand how the fetus passes through the birth canal:
Opening the cervix before childbirth
Before the start of the first period, during normal delivery, the woman in labor is transferred from the emergency department to the prenatal room, where passport data is specified, an additional examination, and a detailed obstetric examination are carried out. Be sure to determine the blood group, Rh factor, produce a study of urine and blood. The mother is put to bed.
A woman in labor is allowed to get up only when the waters have not broken, not very strong and not very frequent contractions, and subject to the fixation of the fetal head at the entrance to the pelvis. In the absence of these factors, the woman lies in bed on her back or on her side, in the most comfortable position for her. This helps to bend the fetal head and lower it into the pelvis. It is recommended to lie on the back in a position close to semi-sitting, which contributes to the favorable insertion of the head into the pelvis and better use of the birth forces.
How is the birth of a child at this stage? In the period of disclosure, the condition of the woman in labor is carefully monitored. Find out her well-being (fatigue, dizziness, degree of pain, headache, visual disturbances, nausea), examine the condition of the skin, listen to the fetal heartbeat. Regularly check the pulse, blood pressure, body temperature. They observe the nature of labor activity, monitor the strength, duration, frequency and pain of contractions, count their number. Repeatedly used external obstetric examination. The heartbeat of the fetus during the opening period with a whole fetal bladder is determined every 15-20 minutes, and after the discharge of water - every 5-10 minutes, while paying attention to its frequency, rhythm and sonority. These are very important indicators for assessing the condition of the fetus. Immediately after the contraction, the fetal heart rate slows down to 100-110 beats due to changes in the uteroplacental circulation with a strong contraction of the uterus. 10-15 seconds after the end of the contraction, it
levels out. They also monitor the condition of the fetus, especially in the presence of obstetric pathology.
During a vaginal examination, women in labor find out the condition of the muscles of the pelvic floor, vagina, cervix, the degree of its smoothing and disclosure. Find out if the fetal bladder is intact.
In the process of childbirth, the fetal bladder bursts and amniotic fluid is poured out - this is a very crucial moment in the normal course of delivery, requiring special attention. Normally, the amniotic fluid should be light or slightly cloudy. If meconium is present in it, this indicates the beginning of fetal asphyxia. If at the time of outflow the head is not fixed, then along with the waters, loops of the umbilical cord or fetal handles can enter the vagina, which in turn causes difficulty or an obstacle to its expulsion from the uterine cavity.
In the period of disclosure in childbirth, the function of the bladder and intestines is also monitored. A full bladder or bowel interferes with the normal course of labor, so a woman in labor needs to urinate every 2-3 hours. It is also important to have a bowel movement. If the opening period lasts more than 12 hours, make a cleansing enema.
The external genitalia of a woman in labor during the period of disclosure before childbirth is treated with a disinfectant solution at least once every 5-6 hours, and also after each visit to the toilet.
Due to contractions, the cervical opening necessary for the expulsion of the fetus occurs during childbirth: uterine contractions begin in the area of \u200b\u200bits bottom, capture all the muscles of her body to the lower segment. It is believed that in the uterus there is a dominant focus of excitation, located most often in its right corner, from here the wave of contractions spreads to all the muscles and goes in a downward direction. There are fewer smooth muscle fibers in the lower segment of the uterus, so during childbirth it becomes thinner and stretched. Each fight develops in a certain sequence. The contractions of the uterus gradually increase, reach the highest degree, and then the muscles relax, turning into a pause. At the beginning of labor, each contraction lasts 10-15 seconds, by the end of an average of 1.5 minutes (60-80 seconds). Pauses between them at the beginning of labor last 10-15 minutes, and then become less long. By the end of the period of expulsion of the fetus during childbirth, contractions occur after 2-3 minutes and even more often.
From the beginning of the appearance of regular contractions, which are expelling generic forces, the fetus begins to experience intrauterine pressure. Part of the amniotic fluid rushes under the influence of pressure into the lower part of the uterus to the isthmus, which is becoming more and more filled. The fetal bladder is introduced into the cervical canal, which contributes to the smoothing and progressive opening of the cervical os. During contractions in the muscles of the body of the uterus, contractions of muscle fibers occur - contraction and displacement of contracting muscle fibers, a change in their relative position - retraction. These shifts persist in the intervals between contractions.
Opening of the cervix and cervical canal during childbirth
Retraction promotes thickening of muscle fibers and stretching of the lower segment of the uterus. Simultaneously with the opening of the cervix during childbirth, this is the opening of the cervical canal, first the internal pharynx, and then the external one. In multiparous, these two processes occur simultaneously. The fetal bladder (part of the membranes of the lower pole of the fetal egg, together with amniotic fluid) contributes to the expansion of the birth canal.
With full disclosure during childbirth of the uterine pharynx, the uterine cavity and vagina make up the birth canal. When the uterus is retracted, not only the cervix is stretched, but also the lower segment. With an increase in contractions, a contraction ring is formed. The head, covered by the uterus, divides the amniotic fluid into anterior and posterior (internal contact zone). The volume of the anterior waters is about 300 ml, and the rear - 1,000 ml. Due to the increase in intrauterine pressure under the influence of growing contractions, the effect on the fetal bladder, which wedged into the cervical canal, increases.
With full or almost complete opening of the uterine os, at the height of one of the contractions, the fetal bladder bursts under pressure, which leads to the outflow of the anterior amniotic fluid. The posterior ones are shed along with the birth of the fetus. If this occurs with incomplete opening of the cervix (up to three fingers enter the canal), then such an outpouring is called early, and in the absence of labor, it is premature.
Sometimes, when the cervix is fully dilated during childbirth, the amniotic fluid does not leave (delayed discharge). This is due to excessively dense membranes of the fetal bladder. In this case, they resort to amniotomy - a puncture of the amniotic sac. The duration of the first stage of labor in primiparas is 9-10 hours, in multiparous - 5-6 hours.
Childbirth: the period of expulsion of the fetus
As soon as the cervix has opened, and the first attempts have appeared, the second stage of labor begins. The duration of this period in primiparous is from 1 to 2 hours, and in multiparous - from 20 minutes to 1 hour.
At the beginning of the second stage of labor, the woman in labor is transferred to the delivery room. She is placed on a special bed in the supine position, the head end of the bed is raised, her legs are spread as much as possible, bent at the knees and hip joints. For the purpose of disinfection, the external genital organs are treated with a solution of iodine or potassium permanganate.
In the period of exile, the body of the woman in labor experiences great stress. The nervous and cardiovascular systems, muscles, respiratory organs and other organs and systems function with an increased load. Therefore, monitoring the condition of the woman in labor in this period of childbirth should be enhanced. They evaluate her general condition, the color of the skin and visible mucous membranes, inquire about her well-being (does the head hurt, are there visual disturbances, dizziness), count the pulse rate, measure blood pressure. They carefully monitor the nature of labor (strength, duration, frequency of attempts) and the condition of the uterus. Pay attention to the condition of the lower segment of the uterus (whether it is thinning and sore).
A perineal incision, or episiotomy, is a surgical intervention used in cases where it is necessary to complete labor as soon as possible (premature birth, fetal hypoxia, anomalies in its development) or tissue rupture threatens.
Attempts are amenable to regulation - weakening or strengthening. During this period, it is important to breathe correctly and direct your efforts. After a deep breath and holding the breath, it is necessary to rest with your feet and, straining your hips, push with the diaphragm and stomach. No need to direct your efforts to the face. During this period, it is important to focus all your strength on the work of the necessary muscles. After an attempt, it is important to relax as much as possible in order to gain strength for the next attempt, and so on until the birth of the child.
The infant's mouth and nose are cleared of mucus and may sometimes be held upside down to remove mucus from the lungs. The newborn takes its first breath and makes its first cry: "I'm born!" The umbilical cord is cut after the end of the pulsation of the umbilical vessels. All this time, the child lies on the mother's stomach or chest, his first attachment to the breast is carried out. After crossing the umbilical cord, the baby is transferred to a neonatologist and a nurse in the children's department. Each newborn in the first minutes of life is evaluated on the Apgar scale.
On the video "How the birth goes" you can see how the fetus is expelled:
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