Symptoms and signs of dilatation of the cervix before childbirth. Changes in the cervix during childbirth The cervix is ​​dilated by 2 fingers

Childbirth, perhaps, is a truly wonderful, amazing phenomenon of nature, the mystery of which is familiar to us women firsthand. And doctors. It is the people in white coats who do everything possible so that modern women give birth to healthy children, remain healthy themselves and enjoy the delights of motherhood in the future.

For the entire long period of bearing her beloved baby, a woman learns a lot of new things, reads, studies and hears new terms from doctors. Perhaps women with experience who once gave birth feel like a fish in water, and seem to be able to communicate with doctors on an equal footing. What about primiparous girls? Everything is new for them, including these medical "chips", one of which we will deal with today. So, let's talk about dilating the cervix.

A bit of theory

To make it clear what will be discussed in general, it is worth briefly talking about the process of childbirth and the preparation of internal organs for them.

From about 36 weeks, the baby begins its journey, smoothly moving towards the birth canal. The stomach drops, it becomes easier for the mother to breathe, it stops tormenting, but the bladder becomes less “hardy” due to mechanical pressure on it from the uterus.

But not only the baby is preparing for the birth. The uterus, including its cervix, undergoes some changes. During a gynecological examination, you can hear similar words: "opening the cervix by 2 fingers." If you translate into Russian, you get something like this: "Honey, it seems you will give birth soon."

Indeed, shortly before childbirth, the cervix becomes more elastic, undergoes changes. The fetal bladder pressing on her makes her supple, soft, under pressure she still gives up and begins to open up. But, you can collect an alarming bag and be at a low start in the hospital if, say, you heard this at 38 weeks of gestation and later. But it happens otherwise. Opening of the cervical canal long before the due date is a threatening condition and should be eliminated as soon as possible.

So, the process of childbirth itself is usually divided into 3 periods (we will call them as simply as possible):

• ✓ contractions;

• ✓ attempts;

• ✓ the birth of the placenta.

The period of contractions is considered the longest and most painful, it is during this period that the uterine os opens for the subsequent expulsion of the fetus.

Vaginal examination

In the antenatal clinic, upon admission to the antenatal unit or directly in the maternity ward, the doctor, during the examination on the chair, can comment on the condition of the genital organs, in particular, the condition of the cervix. But these comments are not always clear. The doctor, for example, says that the opening of 2 fingers ... when is the birth? Is it good or bad? How much more to walk with a big heavy belly, after all!

In general, disclosure is measured in centimeters, this is accepted everywhere. So, full disclosure is 10 centimeters. But for convenience (since no one will climb there with a tape measure or ruler), doctors use the “obstetric finger” as a unit of measurement. It's just more convenient.

During a vaginal examination, the doctor evaluates the nature of changes in the cervix according to some parameters, in particular, studies its size, length, degree of maturity, dilatation, etc.

A loose, flat, supple neck is considered mature, easily passing several fingers into the cervical canal when examined by a specialist. A mature neck is completely ready for the birth of a baby.

During the first stage of labor, during contractions, the doctor can assess the degree of cervical canal dilatation, conditionally measuring the value in the fingers. So one "obstetric finger" is conditionally equal to 1.5-2 cm, respectively, the full disclosure of the uterus is equal to 5-6 "obstetric finger".

When to give birth?

But disclosure does not always mark the beginning of labor. Not always. As already mentioned, the doctor makes a complete assessment based on many criteria. There are cases that the opening of the cervix by 2 fingers in multiparous women was observed from the middle of the gestation period until delivery, and someone "opened" 4-6 hours before the expulsion of the fetus. That is, there are cases when the cervical canal opens a few centimeters, but the neck does not change, it remains dense and elongated. That is why the doctor evaluates the following criteria:

• ✓ consistency of the neck (loose, dense, soft);

• ✓ length;

• ✓ location;

• ✓ disclosure.

Based on these signs, one can judge the readiness of a woman for childbirth. It often happens that the still immature cervix opens by 3-4 cm, but there are still a few weeks before delivery. But, in most cases, the stretching of the uterine pharynx by 4-5 itself, and this is just about 2 fingers, indicates the onset of labor and the presence of tangible contractions about once every 7 minutes.

In turn, they speak of full disclosure with 8-10 centimeters or a width of the uterine os of 4-5 fingers, a lowered fetal head and regular contractions with a short interval.

Opening phases

Let's take a closer look at the process itself. The opening of the cervical canal is usually associated with the onset of contractions. With their onset or shortly before this moment, a woman may notice the discharge of cervical mucus (plug), which closes the entrance to the uterus and performs barrier functions. The passage of the cork is individual. Someone notices a gradual discharge of portions of mucus a week or two before giving birth, for someone the cork comes out with the onset of contractions.

The stretching itself and the preparation of the cervical canal are divided into 2 phases that are included in the first phase of childbirth:

Latent phase

It is characterized by systematic contractions of the uterine myometrium, occurring approximately every 5-7 minutes. At first, contractions may be painless or cause some discomfort to the woman, but there is usually no pronounced pain syndrome. The period is quite long and lasts about 5-8 hours in nulliparous women. At this point, it is important to recognize true contractions (unlike false ones, they are constant, with a regular, ever-shrinking interval) and not put off a trip to the maternity hospital if you are not already there. Each contraction of the uterus shortens the cervix, flattening and opening it. Opening dynamics: about half a centimeter per hour;

active phase

It is shorter than latent and is marked by intensive opening up to 8-10 cm. The contractions are already strong, painful and frequent, about once every 1-2 minutes. The cervix opens faster and more, the head of the fetus sinks to the pelvic floor. Opening the cervix by 1 finger per hour is typical for the active phase. In the active phase, the fetal bladder itself no longer withstands pressure, bursting and provoking an outpouring of water. The woman begins to feel the desire to push, which is a harbinger of the onset of the second stage of labor. However, it is worth considering the position of the presenting part of the fetus (head, buttocks with breech presentation). It is impossible to push if she has not yet sunk to the pelvic floor, and the uterine os is not fully opened.

In the second phase, premature rupture of the membranes (PROM) may occur: the pharynx is less than 7 cm open, but the bubble has already burst. The evacuation of waters is considered timely when opening 8-10 cm.

When outflow, the doctor is obliged to assess the nature of the amniotic fluid. The waters are clean, with a neutral smell are considered the norm, but an alarming sign is the outpouring of muddy, greenish waters with an unpleasant odor. This symptom is a symptom of intrauterine fetal hypoxia (lack of oxygen) and requires urgent action. The original feces from the rectum of the fetus enters the fluid of the amniotic sac, and can enter the respiratory tract of the child.

Pathological conditions

As mentioned, everything does not always happen on time, and the cervix can begin to open long before the baby is ready to be born. In this case, it is necessary to make every effort to ensure that the pregnancy is maintained and reaches the due date. In the event of a similar situation, a woman is diagnosed with "isthmic-cervical insufficiency" or abbreviated ICS.

This pathology is explained by the fact that the cervix cannot cope with its functions, which are currently protective and holding the fetus in the uterine cavity. Under the pressure of a growing baby, due to injury or imbalance of hormones, it stretches, provoking disclosure.

In this case, the priority is to preserve the pregnancy with medication and adherence to the regimen. Sometimes surgery is required by suturing or installing a special restraining ring.

It's time to give birth, but the body is in no hurry

The situation is reversed, when 40 weeks are already on the way or the 41st has gone, and there are no forerunners, including the uterine pharynx is in no hurry to open. Doctors soften and stretch the "oak" neck medically or mechanically by prescribing hormonal suppositories and gel or stretching the neck with kelp, air balloon, etc.

A woman herself can help start the process and move the fetus to the pelvic floor by stimulating the production of prostaglandin hormones. Many experts advise in the last stages of pregnancy to stimulate disclosure on their own.

How to give birth faster and speed up the preparation of the uterine os:

Physical exercise

Strong and adequate, of course. This is swimming, walking in the fresh air, gymnastics for pregnant women, any physical activity stimulates the descent of the fetus and the maturity of the uterine pharynx;

Sex

Orgasm provokes the production of the hormone oxytocin, which triggers the contraction of the uterus, and, accordingly, the opening of the cervix. It is worth mentioning the composition of sperm (contains prostaglandins), and the mechanical effect, and the stimulation of a woman's nipples during intercourse. But here you need to be careful: in order to avoid infection, this method should be excluded if the cork has already come out (partially out) or;

Enema and diet

A direct dependence of the fullness of the intestine and contraction of the uterus was revealed. The emptying of the bowel stimulates the opening. Including a special diet containing fresh vegetables helps to avoid constipation and timely evacuation of the contents of the rectum.

Conclusion

Overcoming a long way from conception to childbirth, a woman is faced with many new phenomena, opens herself from the other side. In order to maintain a pregnancy and give birth to a healthy child, the expectant mother must be aware of the possible phenomena and conditions that she will face.

So, the opening of the cervix heralds the onset of labor, which may not always begin on time. A woman should warn this when it is not yet time to give birth, in a timely manner and immediately contacting a doctor. During contractions, the degree of opening of the uterine pharynx, which the obstetrician-gynecologist who leads the birth necessarily comments on, allows the woman in labor to assess the situation and estimate the approximate time before the start of attempts. If a woman "walks", then after the examination, she can also understand from the comments of a specialist how ready her body is for the emergence of a new life.

It is important to fully comply with the recommendations of physicians during childbearing and in preparation for childbirth. Already in the delivery room, it is extremely important not to panic, not to get lost, to fully and unquestioningly listen to the doctor leading the birth, the midwife, to remember all the theory that you studied earlier. In particular, it does not hurt to learn and practice breathing and relaxation techniques. Since the opening of the cervix and the contractions themselves are a long and painful process, the ability to “breathe” the contraction will save energy for energy-consuming attempts and the birth of the placenta.

With an increase in the gestational age, processes begin to occur in the uterus that involve the partial replacement of muscle tissue with connective tissue. As a result, new collagen fibers are formed, which have greater extensibility and flexibility than before pregnancy. Clinically, this process manifests itself in loosening and shortening of the cervix, as a result of which the cervical canal begins to gape in the later stages. It is in this way that the gradual preparation of the uterus for the upcoming birth takes place.

What features does the uterus have in late pregnancy?

Already starting from 32-34 weeks, the cervix begins to prepare for childbirth. This is manifested in its softening along the periphery, however, the area of ​​dense tissue lining the canal is still preserved.

In nulliparous women, the neck at this time can pass only the tip of the finger, but in those women who give birth again - 1 finger freely passes the internal pharynx. So by the 37-38th week, the neck is almost completely softened. At the same time, a woman can hear from a gynecologist that there is a dilatation of the cervix by 2 fingers. At the same time, the fetus itself gradually begins to descend into the small pelvis, putting pressure on the neck with its weight, which contributes to its further opening.

How does the cervix dilate?

It starts directly from its internal pharynx. At the same time, in primiparas, it takes the form of a truncated cone, the base of which is turned upwards. On examination, the gynecologist says that the neck is short, and the opening is 2 fingers. As the fetus moves into the small pelvis, the external os of the uterus also stretches.

In women who give birth again, the opening of the cervix occurs, as a rule, faster and easier. This happens because the external pharynx in such women is already ajar by 1 finger by the end of pregnancy. That is why, often, the disclosure of the external and internal pharynx occurs almost simultaneously.

Just before the woman's labor is imminent (3-5 days), the opening is 2 fingers, and the cervix is ​​smoothed out, exhausted.

In those cases when the doctor, when examining a pregnant woman in a gynecological chair, says that the neck is long, despite the opening of 2 transverse fingers, it is not necessary to count on childbirth in the next 3 days.

When does the cervix need stimulation?

A week before the expected date of birth, a woman, once again visiting a gynecologist, may find out that her cervix is ​​“immature” and needs to be artificially prepared for the birth process. This can also be observed after the 40th week of pregnancy, i.e. while walking. Often the neck is slightly open (opening 2 fingers), but not soft, i.e. fingers pass through the channel tightly.

The process itself can be carried out in 2 ways: drug and non-drug. As the name implies, in the implementation of the first, various drugs are used.

The second involves the use of various aids. So, quite often, kelp sticks are used in this case. They are introduced directly into the cervical canal, for its entire length. In this case, the woman experiences pain. After 4-5 hours from the moment of installation, they begin to swell and increase in size, thereby mechanically opening the channel. Also, in order to increase the opening of the cervix, special tubes can be used, similar in appearance to a catheter, at the end of which there is a ball. By forcing air, it swells, thereby expanding the cervical canal, stimulating the onset of the birth process.

Before childbirth, a woman's body undergoes a number of processes that are aimed at the successful resolution of the burden and the birth of a viable fetus. The birth process itself is divided into three stages, each of which is characterized by certain characteristics.

Throughout pregnancy, and especially in the first stage of childbirth, the cervix plays an important role. This part of the uterus is the "lock" that locks the fetus for nine months and then releases it. The correct functioning of the cervix, its adequate condition during pregnancy is the key to the full bearing of the fetus.

If the cervix is ​​not able to close tightly, this can lead to miscarriages at any stage of pregnancy and premature birth. Then it is worth talking about isthmic-cervical insufficiency. This process is controlled by a leading gynecologist who monitors the state of the female genital area throughout the pregnancy. When viewed on a gynecological chair, it is not difficult to diagnose a slight opening or softening of the cervix. This pathology is a threat to a normal pregnancy. And if in the first months, while the fetus is small, a miscarriage will not occur, since the pressure on the cervix is ​​still small, then already during the period of active growth of the child, the cervix may not withstand such pressure. In such cases, miscarriages occur most often from 20 to 30 weeks.

It is very important for a woman to visit a gynecologist in a timely manner, because symptoms of cervical dilatation for the woman herself may not appear, due to the fact that the disclosure did not occur under the influence of the hormonal system. Often, a pregnant woman does not feel any symptoms of disclosure at all and learns about this trouble only upon examination. And in some cases, a woman may experience tingling pain in the vaginal area, which must be consulted. The sooner the pathology is diagnosed, the sooner doctors will take the necessary measures to preserve the pregnancy. In this case, the process of maintaining pregnancy will be controlled in other ways (suturing the cervix, applying a pessary, wearing a bandage).

The cervix, as one of the most important organs in the entire process of pregnancy, undergoes changes throughout the entire period of gestation. For a woman and for a child, the processes that take place in the cervix at the very end of pregnancy are important - they signal that childbirth will begin soon. Every expectant mother needs to know the symptoms of cervical dilatation in order to seek help from a medical institution in time - perhaps to maintain pregnancy, and possibly for childbirth (depending on the stage at which these signs appear).

Changes that affect the opening of the cervix take place at 38-40 weeks. At this time, the placenta begins to age, which secretes hormones that serve for the normal course of pregnancy. At this time, the uterus and its cervix have such a tone that does not allow the child to grow, but, nevertheless, still does not allow to be born. After the placenta stops producing hormones aimed at maintaining the uterus, antagonist hormones appear in the woman's body, the task of which is to help the cervix to open up and the uterus itself to contract. Thus, the level of estrogen increases and the level of progesterone decreases, oxytocin, prostaglandins, acetylcholine, and serotonin accumulate. All these hormones will affect the course of labor and directly on the opening of the cervix.

Recently, while in the mother's abdomen, the child, under the influence of a slightly infantile uterus, descends into the pelvic cavity. As a result of pressure on the cervix, the body receives signals about the upcoming birth. The uterus is slightly strengthened in tone to facilitate childbirth. Thus, we are talking about the harbingers of childbirth - false contractions due to short-term prenatal hypertonicity. During this period, despite the pressure on the cervix, it does not open, although the uterus can contract.

The main feature of the cervix during the birth period is its smoothing (shortening) and softening. At the moments of smoothing the cervix, it expands its space for entry, this does not happen immediately, but gradually, over several hours. In fact, the entire first stage of labor consists of preparing the uterus and its cervix for subsequent active actions.

10 cm is the norm for the baby to be born

All the time for nine months the cervix is ​​called immature. At this time, it is closed, does not let a finger inside, the length is about two centimeters. In the first few hours of the birth process, the uterus opens up quite a bit - just one centimeter, which is determined by the free passage of one finger.

Briefly about the opening of the cervix before childbirth in the video.

The neck is slightly softened and shortened. This condition of the cervix is ​​called insufficiently mature. After a few hours, the cervix opens up so much that it can no longer hold the mucous plug - it quickly comes out, which signals the imminent start of the second stage. In the process of its opening, the cervix changes its location - in relation to the body of the uterus, it becomes larger in the center, and during pregnancy it can be shifted all the time. You can talk about the maturity of the cervix when it passes more than one finger inside, its length is less than one centimeter, and the cervix itself is soft. Usually, this condition of the cervix is ​​determined by thirty-nine weeks, and with repeated births a little earlier. Physiologically, a woman is ready for childbirth, but in practice, most often pregnant women walk around with an open neck for a couple of weeks and give birth completely without pathologies at forty to forty-one weeks. Symptoms of cervical dilatation for a woman are practically not noticeable. Only sometimes can sip at the bottom of the stomach, which indicates the pressure of the fetus on the softened neck.

A very reliable sign of dilatation of the cervix - expulsion of the mucous plug. But the leakage of amniotic fluid - a signal that hospitalization is needed - either labor is approaching, or they will be stimulated so as not to leave the child without amniotic fluid. Gynecologists determine the signs of cervical dilatation more clearly.

The opening of the cervix begins shortly before childbirth, as the cervix of the hollow organ matures. When it is ready, it will completely soften and smooth out, and during a vaginal examination, an opening of 1 finger will be determined, that is, the doctor will be able to freely hold his index finger behind the internal pharynx.

Labor does not always begin in such conditions, you can go on for several more days, despite the fact that your uterus is already in a state of readiness.

Opening the cervix during pregnancy

A premature indicator of the body's readiness occurs with its pathology, the so-called isthmic-cervical insufficiency. It occurs as a result of damage to the cervix during abortion, rupture during childbirth. This can begin to happen as early as 16 weeks of gestation and, if left untreated, ends in a late miscarriage or premature birth.

If a woman is healthy, the hollow organ can remain closed until the deadline, but for many, even 2-3 weeks before this joyful event, the neck undergoes serious changes, leading to a gradual process of readiness of the body.

Smoothing and opening of the cervix is ​​called its maturation. Its symptoms are obvious: training bouts are disturbing and the mucous plug leaves. Of course, there is no exact way for expectant mothers; a vaginal examination is needed, which is performed by a doctor.

According to this indicator, the doctor can judge how soon you will start giving birth. As a rule, changes in the cervix in nulliparous women begin earlier; in multiparous women, this process can go much faster and therefore can begin immediately before childbirth.

If the gestation period has come to an end, and the cervix is ​​​​still not ready for childbirth, in order to speed up, you may be prescribed supportive measures. There are drug and non-drug ways to accelerate the maturation of a hollow organ.

So, physical activity, squatting and walking contributes to this matter, and sex in the last weeks of pregnancy also helps, and the point here is not only in the physical effect on the neck itself, but in the fact that male sperm contains a large amount of prostaglandins, substances that accelerate maturation. Of course, some special exercises for opening the cervix have not been invented, but still, many women note that their birth began after physical exertion. It is worth warning that active walking on stairs, long walks that lead you to exhaustion, and shifting furniture at home is not the right way and even dangerous. You should not test yourself for strength before the most crucial moment in your life, instead of accelerating the onset of labor, you can get complications, for example, premature outflow of water or placental abruption.

If all the deadlines have passed, or the condition of the child requires speeding up the birth, and the body is not yet ready, drug stimulation is possible.

How is cervical dilation checked?

The doctor looks at the pregnant woman on the gynecological chair. He puts 2 fingers of his right hand into the woman's vagina, and assesses the condition of the hollow organ by simple palpation. During pregnancy, the cervix is ​​normally wrapped backwards, it is very difficult to reach it during examination. By the time the mother resolves, the cervix turns in front, along the axis of the pelvis, becomes easily accessible and soft. Her canal gradually expands and when she fully matures, she easily passes the doctor's index finger into the uterus, to the child. Of course, the amniotic sac separates him from the baby, but such a degree of maturity of the uterus indicates that the birth is about to begin.

If it is necessary to accelerate maturation, different methods are used. For example, you can act on it locally, a gel containing prostaglandins causes a rather rapid softening.

Some methods force the body to produce these substances on its own. For example, you can use non-drug effects, special sticks made from dried algae (kelp). They are introduced into the canal, and here they swell under the influence of moisture, significantly increasing in volume, under their pressure, it opens both mechanically and due to increased production of prostaglandins in its tissues. Candles, pills and other drugs, in any case, are prescribed by a doctor, do not try to speed up the birth on your own.

Childbirth, cervical dilatation

The opening of the cervix before childbirth barely reaches 1 finger, the uterine os resembles a dense elastic ring, but with the onset of childbirth, amazing changes occur. The first period of childbirth is a matter of hours, during which time it becomes thinner, diverging in a wide ring, until it practically disappears, merging with the walls of the birth canal, and now it does not interfere with the birth of the baby at all.

How does the cervix dilate?

The wall of a hollow organ consists of two powerful layers of muscles, longitudinal and circular. The circular layer resembles rings and is concentrated mainly in the lower segment of the uterus, including the cervix. Throughout pregnancy, the circular layer in the cervical area is tense and holds it like a lock, while the longitudinal one is relaxed so that the baby is comfortable and gets everything he needs.

The onset of labor changes the function of the muscles to the opposite. Now, strong contractions of the longitudinal muscles at each contraction stretch the lower segment of the woman's hollow organ, pull the neck in different directions, and the circular layer relaxes without resisting this thrust. As a result, the cervix opens up more and more and becomes thinner. The opening of the cervix by 2 fingers, which is usually present in the first hours of labor, progresses to the final result, when the cervix freely passes all 5 fingers (10 cm).

Throughout all childbirth, doctors monitor the progress of childbirth according to these indicators. Many women describe the vaginal examination during childbirth as extremely unpleasant and painful. When the doctor checks the dilatation of the cervix, the sensations are really not pleasant, because the uterus reacts to this with another contraction.

Sometimes there is a violation of the coordination of contractions of the hollow organ for one reason or another, and, despite the fact that there are strong contractions, the neck does not react. Stimulation, in such cases, is carried out with the help of labor anesthesia, the use of antispasmodics. Manual opening of the cervix, when at its last stages the midwife stretches and tucks the cervix with her hand over the head of a child rapidly moving along the birth canal, is rarely used, mainly in cases where the woman in labor cannot overcome attempts, although it is too early to push, and this measure helps prevent breaks.

The function of a hollow organ during pregnancy allows a woman to endure and give birth to her baby. A uterus damaged by abortions may later turn out to be inconsistent, and begin to open long before childbirth, or it will not respond properly due to scarring. Take care of yourself, do not allow abortions that can damage her, so that nothing interferes with your motherhood in the future.

Hi all!

I will break this review into points, because. There are many points that I would like to highlight. FOR THE NERVOUS PLEASE DO NOT READ - I will describe all the intimate details!

PREFACE.

I am 26 years old, the first pregnancy, proceeded without complications, even toxicosis was not. But, as they say, not a single pregnancy passes without a trace for a woman. My surprises were hemorrhoids and uterine fibroids (rare for my age). There were still minor inconveniences, but now we are talking about the final stage of pregnancy - childbirth.

DISCHARGE OF THE MUCOUS PLUG.

It all started at 36 weeks and 6 days. In the morning, I found a meager mucous discharge of a pinkish tint (sorry for the details, but I myself was looking for such a detailed description not so long ago). Naturally, I got scared, and the first thing I did was to get on the Internet. (Now I scold myself for this. You should not be shy and immediately call your attending gynecologist!) In general, I read that in the later stages this happens after intercourse due to an abundant rush of blood to the causative site. At the courses for young parents, we were told that after 35 weeks it is better to abstain, but who remembers that ... After a couple of hours, everything went away and I calmed down.

The next morning, the mucus plug was completely gone. It cannot be confused with anything: a VISCOUS mucous substance with small red streaks with a volume of a tablespoon. That's when I called the gynecologist, described the situation. She replied that she needed to monitor her further condition, more carefully monitor the cleanliness of the intimate area and not walk a lot. She also reassured me that after the cork is released, childbirth can begin in two weeks, the cork is not yet the beginning of labor.

LEAKING OF AMBIENT WATER.

At 37 weeks and 2 days after lunch, I began to notice that the discharge (usual for this period) became a little more liquid (to notice this, it is better to use paper napkins instead of panty liners), but the volume did not increase much. After 20 minutes, the situation repeated itself, a new portion of the liquid stood out. I called the doctor again with a suspicion of amniotic fluid leakage. She said to wait a couple more hours to see if there were any other symptoms and call to report back.

I ate tightly (I know that it’s impossible, but until the last moment I didn’t want to believe that the process had already been started. By the way, I didn’t have an enema before giving birth and nothing superfluous popped up). Two hours later (once!) slightly pulled the lower back for half a minute. Portions of fluid continued to be released approximately every 20 minutes at 0.5 - 1 tablespoon. There were no other symptoms.

Three hours later I reported to the gynecologist. She said to collect packages and call an ambulance. I was so worried that I had to call the doctors to my husband. An ambulance arrived, they measured the pressure - 150/100! Apparently the excitement has taken its toll. They offered to inject magnesia, I agreed (I thought that I would have to lie in storage for a couple more weeks). They took him to the hospital.

PAINLESS PARTICLES OR INCEPTABLE DISCOVERY OF THE NECK.

In the sanitary inspection room, they filled out the necessary paperwork, took blood for analysis, measured the pelvis, weight upon admission, and took me to the department. They also had to fill out a bunch of paperwork, since the nurse did it. I was assigned to the prenatal ward, where I changed clothes and went to the examination room. Upon examination, the obstetrician confirmed the leakage of amniotic fluid and stunned me with the news: "YOU HAVE A 5 CM OPENING!!!". But I don't feel contractions. How can that be? It turned out that it can! If I had delayed, I would have had to give birth at home!

By the way, during pregnancy I read a lot of horror stories about pain during the examination before childbirth and when the bladder was punctured. Nothing like this! At least in my case, everything went smoothly and painlessly.

So, they pierced my bladder, or rather, they pierced it for about 10 minutes (the child tried to quickly get out and constantly closed the puncture site). Looking ahead, I’ll debunk a common myth, they say, a piercing hook can scratch a child’s head. Nothing like this! After so many punctures, my child did not have a scratch! Doctors know what they are doing and in no case do they want to harm your baby!

PAINFUL STRENGTHS AFTER THE PUNCH OF THE AMNIANIC BLADDER.

Five minutes after the water broke, I finally felt the first contractions (in fact, they had been going on for several hours, but I did not feel any pain or tension in my stomach). There were clear contractions, they gradually, but quickly intensified. The sensations are not like acute pain, but like pain during a spasm. At this moment, proper breathing helps a lot: a short deep breath in through the nose before the fight itself and the longest possible exhalation during.

PUTTING AND WHAT HELPED TO REDUCE THE PAIN.

An hour later, I had full disclosure. I felt the baby trying to move through the birth canal (pressure on the pelvic bones during contractions). From that moment on, I began to actively move, try different positions to help the baby. The main thing during this period is to FOLLOW YOUR BREATH and LISTEN TO THE DOCTOR. The following helped me: I hung on my husband’s neck (we had a partner birth) so that my legs relaxed as much as possible, and on exhalation I made a sound resembling a lowing. For some reason, I didn't feel pain that way. In addition, during the fight, on the advice of the obstetrician, I strained the press to increase the contractions of the uterus. But nothing worked. Perhaps due to magnesia (see above).

NARROW PELVIS AND TRIPLE TIGHT CORD.

CTG showed that the child begins to choke (ultrasound revealed a double entanglement at 33 weeks). Therefore, the decision was made to stimulate with oxytocin. He was injected to me twice during childbirth. I did not feel a noticeable increase and acceleration of contractions (although they write about the opposite everywhere). There was always time to rest between contractions.

Because of the narrow pelvis, I could not start giving birth until the baby's head was rebuilt to the desired diameter. I think everyone knows that the bones of the skull in a newborn are mobile? The situation was also delayed by the fact that the umbilical cord, wrapped around the neck, did not allow the baby to move towards the “exit”. Only 2.5 hours after the full opening, I was allowed to push. It was impossible to wait any longer.

THE APPEARANCE OF THE HEAD AND THE REMOVAL OF THE HINGES.

I lay down on a special bed and began to remember everything I read and watched about childbirth. And that only bothered me! Bottom line: I missed the precious minutes of the birth of my child. All you have to do is listen to the doctors! At this moment, you need to push the child out through “I can’t”. It will seem that the stretched skin is about to crack, but in fact, most likely there will be no tears. If there is concern, the doctor will suggest making an incision.

After 6 attempts, a miracle happened - a head appeared! The loops of the umbilical cord were immediately removed from the neck. There were three of them! After that, they gave me a little rest, allowed me to stroke the baby on the head (which I did not do) and showed this intermediate process to my husband! I do not understand why?! I tried to express dissatisfaction, but it was already necessary to continue to push.

THE APPEARANCE OF A CHILD.

This stage was the most difficult for me. The head had already appeared, the baby turned around, stretched out her legs, and it was not so easy to push her out. It is much easier to put pressure on the “ball” than on the “rope”, if you understand what it is about?)) Then the midwife came to the rescue and put her hand on my stomach, made an emphasis on the legs. After all, the child also makes a lot of efforts to be born: it is drilled with the head, it is repelled by the legs ...

After the appearance of the head, there was no pain at all. The departure of the afterbirth seemed to be a pleasant process!

Due to hypoxia, after entwining the child, the neonatologist immediately took him. They didn't even wait for the blood to pulsate through the umbilical cord. At that moment, I was very afraid that the child would not survive. The baby did not scream, and the doctors did not say anything ...

CONDITION OF THE CHILD AFTER THE BIRTH.

According to the ultrasound and the height of the uterine fundus, a large fetus was predicted. These were the results at 33 weeks:

But the baby was born at 37 weeks and 3 days with a weight of 2.390 kg and a height of 49 cm, 7-7b on the Apgar scale. The head was severely deformed (elongated occiput). But by three months, the appearance returned to normal. So if you have a similar problem, don't worry!

The baby did not cry immediately after birth. Because of this, the oval window in her heart did not completely close. This is a fairly common pathology in children. In principle, while you should not be afraid, it may still be delayed by itself. All the internal organs were in order, and the brain had already developed by the month.

Protracted jaundice also turned out to be a complication. Such a reaction was to oxytocin in a child. Therefore, we sunbathed under the lamp for another two weeks.

EXAMINATION AFTER DELIVERY, RUPTURES AND CUTS, SEWING.

In my experience, this is the most embarrassing part of childbirth. I had only one tear, but not on the perineum, but on the labia minora. Obstetricians stretched the “causal place” with their hands to help the baby be born faster and slightly overdid it. I had to get a couple of stitches. This is where the pain is already felt. But I heroically endured it!)))

Since the gap was in a non-standard place, it did not bother me. It didn't even hurt to go to the toilet. I could sit right after giving birth.

Tip: Do not ignore Kegel exercises before or after childbirth! They will greatly help you avoid unnecessary damage and contribute to a speedy recovery!

HAEMORRHOIDS.

Hemorrhoids that appeared during pregnancy, after childbirth, alas, did not go away, although there was a chance. So after the end of breastfeeding I will go for a consultation with a surgeon.

BIRTH AFTER TREATMENT OF EROSION WITH SOLKOVAGIN.

Before planning a child, I successfully got rid of cervical erosion with the help of Solkovagin. This is a kind of acid peeling that renews the cells of the affected area. During childbirth, a small area with erosion appeared again, but after sea buckthorn suppositories (horror, not medicine!) It almost completely dragged on.

BIRTH WITH UTERINE MYOMA.

Also, in the process of bearing a child, I developed a myomatous node in the uterus measuring 53x30 mm (at 33 weeks). In this regard, I was injected with Ceftriaxone (an antibiotic, but I did not know about it!) And Oxytocin while I was in the hospital. During childbirth, a change in the hormonal background occurs and, theoretically, the fibroids should have decreased to a minimum, but two months have passed, and its dimensions are still 39x35 mm - too big. Let's see what will happen in six months ... most likely it will be necessary to put the uterine spiral.

STRETCHES AND WEIGHT AFTER BIRTH.

During pregnancy, I recovered by 11.5 kg (from 53.7 kg to 65.2 kg), tried to control weight and monitor calorie content. Immediately after giving birth, I lost 5.5 kg, the remaining 6 kg were gone in 3 months without much effort and training. A month later, another kologram left. It remains only to pump up the muscles.

I didn’t have a single stretch mark, either before or after the birth of a child (although in adolescence I got a few on my hips, that is, there is still a tendency to this problem).

What helped me? First of all, genes! Stretch marks are caused by dysfunction of the adrenal glands, which secrete too much cortisol. It's built into the body. If you have a problem with this, then no cream will save you! But I still additionally helped the skin stay in good shape: a daily light massage using olive oil (the most common unrefined food), a contrast shower after bathing, exercises and light exercises for pregnant women.

I was also saved by the fact that the breasts are small in size. When poured with milk, it does not stretch so much under its own weight. In addition, throughout my pregnancy and after childbirth, I wore (without taking off!) Sports seamless tops. I highly recommend! Let's see what happens after the end of breastfeeding.

STOMACH AFTER BIRTH.

The stomach became so soft that the fingers fell straight when pressed. Horror! This state will continue until the uterus is completely reduced - about 1.5 months. The skin, in my case, did not sag (as I read), it was just not in good shape and hurt a little. I continued to use sea buckthorn oil (I took it to the hospital) and do a pinching massage. The dark vertical streak has not gone away after 3 months.

GO TO THE TOILET AFTER BIRTH.

I've heard tales about this. Like, urinary incontinence, the inability to empty the intestines due to muscle weakness. Everything was fine! You can take one microclyster with you, so as not to worry. I personally didn't need it.

SEX AFTER PARTNER BIRTH.

In a word - TERRIBLE! It hurts a little at first, but then the feeling goes away. Lubricants help you! And it’s better not to rush to resume intimate life as soon as possible, let the body recover properly. Ideally - after going to the gynecologist.

When I asked my husband if there was a difference before and after childbirth, he replied that there were no fundamental differences. And for the first time, he was so afraid of hurting me that he didn’t even pay attention to the difference)).

In my opinion, it became even more pleasant. But there was also one downside. Due to the expansion of the diameter ... sometimes air gets inside and when enough air accumulates, it comes out with a characteristic sound ...)) That's why you need to do Kegel exercises regularly.

As I wrote above, the husband observed all the “charm” of the process of giving birth to a daughter, although initially we agreed that he would go out into the corridor at this stage. According to her husband, he did not associate the ongoing process with something intimate, so this did not affect his sexual life in any way (plus abstinence played into the hands). What will happen in your case is not known, so do not take risks if the husband himself does not take the initiative.

HAIR FALL.

It began three months after the birth of the child. And it's been a month and a half now. Very intense, although during pregnancy the hair also fell out a little.

FIRST INSPECTION AT THE GYNECOLOGIST.

I went to the gynecologist 2 months after giving birth. The examination was carried out with an individual plastic set with a mirror. Usually I was uncomfortable with this procedure. And now everything was fine. Due to a slight inflammation, sea buckthorn suppositories and Polygynax (antibiotic) were prescribed, breastfeeding did not stop on the recommendation of a doctor.

_______________________

In general, you can write like this endlessly ...))) Every time I re-read, I remember something new. Maybe I'll add more.

6 months later.

Haemorrhoids.

The state has not changed. There are small nodes, but they do not bother. Ointment Relief (which is not hormonal) did not give anything, so I abandoned it. I'll go to a specialist after I finish feeding.

Erosion of the cervix after childbirth.

Still, it didn't fully stretch. I had to cauterize with electric currents (reviews will be a little later, when I pass the control examination). I can tell you one thing for sure - it hurts, but it lasts a matter of seconds. For some reason, the current gynecologist recommended in this situation this particular method of eliminating cervical erosion.

Myoma of the uterus.

The myomatous node is now 37x32 mm in size (it has decreased quite a bit from 39x35 mm). And this is taking into account lactational amenorrhea (menstruation has not yet begun). Plus, a new myomatous node is formed with a size of 8 mm in diameter ... Will there be more ... (((Uzist said that when the menstrual cycle resumes, the size of the nodes will increase. If 50 mm is reached, you will have to operate.

Stretch marks and weight .

Not a single stretch has appeared.

After 4 months of breastfeeding, I abandoned the diet, after which the weight crept up again and I was again at my pre-pregnancy weight of 54 kg. I feel that I will soon return to the diet again, I really liked the look)).

Abdominal condition.

The pigment line on the abdomen is still visible six months later, but has become much brighter. The skin is no different from other parts of the body. The old pre-pregnancy press is in place!))

Sex.

Everything returned to its place, no more squelching is felt, no extra air gets in. Feelings have become more pleasant than about pregnancy!)))))

Hairfall.

Stopped only after 6 months, and then not completely. Now the hair falls out in the old habitual mode. The density has not changed. But the condition of the hair has improved markedly. But I associate this with better and more complete nutrition than with pregnancy.

Observation at the gynecologist.

The examinations on the chair became a little painful. Now again you have to run around half the city to find a C-size speculum for less discomfort.

I'll do a mammogram after I'm done feeding, just in case. Health above all!)

_________________________________________

OK it's all over Now. Thanks for reading! I hope someone finds my article useful. Easy childbirth and happy motherhood!

The first stage of childbirth is called dilatation of the cervix. The cervix is ​​a muscular long cylinder at the base of the uterus. During childbirth, she will be the channel through which the child will enter the world from the womb.

To better understand what processes

are happening in the body of a pregnant woman, you need to imagine the uterus in the form of a balloon, inside of which there is a doll. In order to remove it and not damage the ball, you need to stretch its neck very strongly so that the head passes. But this must be done slowly and very carefully, otherwise the rubber will simply break. And when the diameter of the hole becomes equal to the circumference of the head, carefully begin to pull out the doll.

During pregnancy the cervix is ​​very dense, has a length of up to 4 centimeters and is completely closed. Her task is to prevent the premature birth of the baby. A few weeks before, under the influence of special hormones, it begins to soften and the head of the fetus shortens from pressure on it. By the beginning of labor due to prenatal contractions in many women, especially those who have given birth before, it is no longer than 1.5 cm and can already be opened even up to 4 cm in diameter. This opening, which is called passive, mommy usually does not feel in any way. There may be small short pulling pains in the lower abdomen, reminiscent of menstruation.

Further opening of the birth canal called active, as it requires strong and regular contractions of the muscles of the uterus. That's what it is contractions. In order for a child to be born, the diameter of the cervix must be at least 12 cm. With the help of contractions, its opening occurs on average 1 cm per hour for nulliparous women and 2-3 cm per hour for the rest. That is, labor contractions are felt from 6 to 12 hours.

First stage of labor is the longest and most painful. It is better for a woman to be ready for this in advance in order to properly distribute forces. Ignorance breeds suspicion that something is wrong, and fear increases pain. What to expect? At first, the contractions are short, painless, with an interval between them of up to 10 minutes. But gradually they become longer, more tangible, and the time for rest decreases. The last hour the uterus is reduced every 2-3 minutes for 1-2 minutes. The woman feels a bursting burning pain in the lower abdomen, radiating to the hips and sacrum.

What do we have to do?

First, you should already be at the maternity hospital (nearby or where you have agreed to conduct labor, for example, Maternity Hospital 9) when the interval between contractions is less than 10 minutes.

Secondly, if the doctor does not mind, you can choose such a position of the body in order to feel less painful uterine contractions (stand, walk, sit on a fitball, stand on all fours or lie down).

Thirdly, it is useful to joke and laugh in the company of neighbors in the prenatal ward. When the muscles of the face relax, the muscles of the vagina also relax, the pain becomes less pronounced.

Fourthly, you can take a relaxing warm shower and even take a nap (healing sleep-rest at the opening of the neck up to 8 cm is very welcome).

Fifthly, do a back massage in the sacrum and wings of the ilium. At partnership childbirth let an assistant do it - husband, sister, assistant.

Sixthly, during the fight, loudly scold the husband present for all the faults (and at the same time for the future) (just don’t overdo it), and when she lets go, listen with a smile to his excuses and declarations of love.

No need to despair - there is very little left.

You need to think that each new contraction brings you closer to relief from pain, heartburn, shortness of breath, swelling in the legs, duck walking and insomnia. The long-awaited happy moment of meeting with the baby is about to come. You can’t give free rein to fears - at this time there is always a midwife who will never miss the beginning of the second stage of labor, saying with a smile: "Well, it's time."

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Childbirth is one of the most important periods in a woman's life. The organs of the female reproductive system are actively preparing for the process of childbirth. Particularly the cervix. For a favorable course of childbirth, in order for the fetus to calmly pass through the birth canal, a sufficient distance in the throat of the cervical part is necessary.

Definition

The cervix is ​​part of the main organ of a woman. It connects the uterus to the vagina. It consists of three layers: mucous, muscular and outer - connective tissue. Normally, the cervical part of the uterus before childbirth is about 3 cm long and also about 3 cm wide. A pharynx and two walls are distinguished in the neck: anterior and posterior. During pregnancy, the main body undergoes changes under the influence of hormones - progesterone and estrogen. The cervix lengthens before childbirth, becomes less elastic. The blood circulation in her vessels increases, she becomes blue-purple in color.

Before childbirth

The cervix before childbirth, starting from the 38th week, begins to actively prepare, opening its pharynx. This condition is associated with a decrease in the action of the main hormone of pregnancy - progesterone, an increase in estrogen and oxytocin. Her condition is one of the indicators of readiness for the birth of a child. The main changes that are taking place:

• The placement of the uterus in the pelvis changes (falls lower).
• Elasticity changes, its cervical part becomes softer.
• The length is reduced, even up to 1 cm. The neck is smoothed, that is, the space for entering the neck expands.

The opening of the cervix before childbirth occurs gradually and smoothly.

Inspection

The opening of the cervix is ​​the only reliable criterion for the body's readiness for childbirth. It is determined by the obstetrician-gynecologist on the gynecological chair, starting 1-2 weeks before the expected date of birth. The woman is located on the chair, the doctor conducts a visual examination, then examines the cervix before childbirth, that is, the condition is determined by palpation (feeling) with the hand. The doctor inserts two fingers into the vagina, trying to reach the uterine os and determine the main properties:

• Neck length.
• Its width.
• Elasticity.
• consistency.
• The degree of opening of the pharynx (how many passes fingers).

Then the doctor, taking into account the above criteria, makes a conclusion about the readiness of the organism of labor activity, that is, determines the properties of the cervical part, the main of which is the opening of the cervix before childbirth.

Symptoms of change

A woman does not always feel when the opening of the uterus begins during childbirth. As a rule, this process is painless and physiological. The main symptoms she may experience are:

1. Feelings of heaviness in the lower abdomen, radiating to the groin and labia, passing on their own.
2. Symptoms of heaviness in the lumbar region, sensations of aching pain.
3. Departure of the mucous-blood plug, which occurred independently.
4. Regular contractions begin, initially with an interval of 25 minutes, then as they open up to 1 contraction in 5 minutes and one contraction in 1 minute. It is important to keep track of how many contractions occur and at what interval.

Stages of disclosure

In the opening of the uterus, I distinguish several stages, characterized by a different state of the cervix. Each stage is accompanied by its own sensations. The main stages are as follows:

• The first stage is characterized by slow opening of the uterus, starting with opening to one or two fingers during the week before childbirth, reaching opening before childbirth in 4-6 hours, but not more than 10 cm. The process is accompanied by regular contractions, but rare.
• At the second stage, there is an opening of about 1 centimeter per hour, the cervical part expands to 10 cm or more, contractions are already going on every minute.
• The third stage is characterized by the complete completion of the opening process and the full readiness for the birth of the fetus.

1 finger opening

The minimum width to which the uterus opens is 1 finger of the doctor conducting the examination. One finger is approximately 1.5–2 cm. This process occurs at the 38th or 39th week of pregnancy, that is, it means the beginning of the period of preparation for childbirth. A woman may feel heaviness in the vaginal area, slight discomfort, pulling pains in the lower abdomen and lower back, which is why she turns to the doctor. But 1 finger does not mean hospitalization in a hospital, you can stay at home in this state.

2 finger opening

When opened by 2 fingers or more, hospitalization in the maternity ward is shown, which means that the period of childbirth has begun. As a rule, cervical dilatation occurs around the 40th week, accompanied by regular contractions and pain in the lower abdomen. The woman is placed in the maternity ward and regularly examined, following the process of expanding the pharynx to the size required for childbirth.

The main thing to remember is that if the opening is 2 centimeters earlier than 38 weeks, this indicates a premature birth, which is why it requires urgent action.

Length

The length of the cervix also changes, which is why it is important to determine it. Determine it using ultrasound. Normally, it is from three to four centimeters. In preparation for childbirth, the cervix shortens significantly. This is necessary in order to minimize the path for the child as much as possible. In the period from 16 to 20 weeks, the length reaches 4.5 centimeters, from 25 to 28 weeks, the length is about 3.5 cm, and at 32 and thirty-sixth weeks it is shortened to 3 centimeters. This is her normal state, which means her complete readiness for labor.

Cervical immaturity

The cervix is ​​called immature the entire period of pregnancy. Why immature? What signs define? At this time, it is dense, elastic, does not miss the pharynx even 1 finger. And its length is about two centimeters. If, starting from the 38th week of pregnancy, dilatation does not occur, the cervix is ​​considered immature, this is already a variant of the abnormal course of pregnancy, which is why it is important to diagnose this condition in time.

It is necessary to use additional methods that stimulate the disclosure process. The mature cervix before childbirth is softened, short and opened to the required number of centimeters.

Reasons for immaturity

The immaturity of the uterus means a condition in which it does not become soft, it does not shorten, and it does not open in due time. This prevents the onset of normal labor activity. Determined at about 39 weeks. The pharynx should open in a period of 40 weeks sequentially by 1 finger, then by 2 fingers and to the point that it passes the palm. Why is the expansion not happening:

• Underdevelopment of the pelvic organs, congenital anomalies.
• Nervous disorders, feelings of anxiety.
• Lack of production of estrogen hormones and oxytocin.
• Strong contractions, muscle spasm.
• Insufficient amount of amniotic fluid.
• The woman is over 35 years of age.

Treatment

If the cervix does not open in the period from 35 to 40 weeks, then this condition is tried to be left without treatment. Perhaps, due to the characteristics of the organism, the process will occur a little later. If in the period of 40 weeks there are no signs that the uterus is opening, then the problem arises of how to speed up the opening of the cervix. Measures are taken both non-drug (exercises that stimulate expansion) and medication (drugs, catheter, sticks). Also treated are women with type 2 diabetes mellitus, women in labor who have undergone severe gestosis. Insufficient opening threatens the development of early fetal hypoxia, and possibly asphyxia.

Non-drug treatment

Non-drug treatment includes physical exercises that stimulate the opening of the cervix. They are the first step in treatment. You can do the usual exercises, which are enough in everyday life. Exercise examples:

• Clean up, but very carefully, without heavy loads.
• Take walks down the street every day.
• Swimming is possible.
• Regular sex also stimulates the process of opening the uterus. Since during sex there is an improvement in blood circulation in the uterus, and it has also been proven that semen contains substances that accelerate the course of childbirth.

If the fetus is full-term, then you can try using a cleansing enema. The water in the enema, when it enters the intestine, stimulates the posterior wall of the uterus, causing the cervix to dilate.

Medical treatment

The main method of treatment is medication. You cannot self-prescribe medications. It is prescribed only by the attending obstetrician-gynecologist, who is confident in the diagnosis of immaturity of the cervix and believes that it is already necessary for a woman to give birth. The main drugs and methods used:

1. Preparations of prostaglandin, a hormone that stimulates the relaxation of smooth muscles. It promotes the opening of the uterus. As a rule, gels with prostaglandins are used: Progestogel 1%. Enter into the vagina, several times a day, constantly monitor the dynamics of the condition. It is possible to use prostaglandins intravenously. Also, a prostaglandin tablet can act as a stimulant.


2. The hormone of labor activity - oxytocin (solution or tablet), administered intramuscularly also stimulates labor activity, acts faster than prostaglandins.
3. Use kelp sticks. The sticks are inserted into the vagina, into the uterine canal. These sticks contribute to its expansion in a purely mechanical way (when the sticks come into contact with the liquid, they swell in the channel). Sticks have proven effective, but are rarely used.
4. The Foley catheter also acts mechanically, which is inserted into the cervical canal and expands it. In addition, when a catheter is inserted, a significant amount of prostaglandins is produced. This method is faster than the others.

Thus, for the normal course of pregnancy, timely and correct disclosure of the uterus during childbirth is necessary. It is important to monitor her condition from the last weeks of pregnancy. Only a doctor can diagnose when it has not opened and prescribe the appropriate treatment.

The opening of the cervix is ​​a necessary condition for normal childbirth. A truly unique organ in a woman is the uterus - the main instrument in the continuation of the species. Without it, this process would not be possible with any of the latest technologies. The uterus is at first a fruit-bearing place, and then it performs the function of fetal expulsion and the birth of a child after reaching the necessary development.

All 9 months the fetus is safely in it in the most comfortable optimal conditions, receiving nutrition, oxygen, developing until the possibility of birth. Its appearance occurs through labor activity, the expulsion of the fetus from the uterine cavity and its exit through the birth canal to the outside should occur. Behind him, the placenta, which consists of the placenta, the walls of the fetal bladder and the umbilical cord, is also removed.

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Brief description of childbirth

If childbirth occurs in the usual natural way, they are physiological and normal. If the child was removed surgically through a caesarean section, using a vacuum, forceps and other auxiliary instruments, they are called operational.

Normal delivery occurs at the limit of 40 weeks, plus or minus 2 weeks of obstetric gestation. If the birth occurred before 28-37 weeks, they are called premature, with a period of more than 42 weeks - late, and the fetus is overdue.

In primiparas, the process of childbirth lasts from 7 to 12 hours, in multiparous ones - from 6 to 10 hours. If the birth was completed within 6 hours, they are considered fast, less than 3 hours - rapid, and more than 12 hours - protracted. Any childbirth with deviations from physiological terms is considered pathological.

Organ status

The uterus is a muscular hollow organ that has its own body, bottom and continuation in the form of a neck. The walls of the uterus are composed of muscle and fibrous tissue, which increases their strength. The cervix looks like its continuation, it looks like an adapter tube connecting the organ and the vagina. Its upper opening, which opens into the uterine cavity, is called the internal pharynx, the lower end, which opens into the vagina, is called the external one.



The cervical canal runs through the middle of the cervix. The consistency of this area during pregnancy remains dense, the channel is closed due to the presence of a mucous plug in the external pharynx. Its presence reliably protects the fetus and uterus from the penetration of various pathological agents from the vagina. This role of the guard is maintained until the very birth. After 37-38 weeks, the dominant of pregnancy is replaced by the dominant of childbirth, and the uterus from the fetus becomes an expelling organ (according to obstetricians).

Translated into ordinary language, this means the following: the stage of gestation is completed, in fact, the pregnancy stops, the child has completed its development and is now viable. It remains to help him to be born, and his mother to cope with it safely. This condition is determined 2-4 weeks before delivery. To do this, the body itself begins to prepare the uterus for labor: its lower segment begins to gradually soften, it becomes thinner, and the upper body thickens.

The uterus, as it were, slowly begins to “slide, move down” from the fetal egg upwards. At the same time, she does not forget to help the fetus gradually begin its descent down into the pelvic area, and from there into the cervical canal of the uterus itself. Muscle tissues in the lower pole of the organ are replaced by fresh, young and new collagen fibers, which are intensively produced by cells. This is an urgent need, since these fibers are elastic, flexible, much more hardy and energetic than the old wall layer. Often, women during this period may experience discharge of mucus from the cervix.

Starting from the 37th week of pregnancy, when the body is preparing for childbirth, the state of the cervix changes. At the same time, there are no special distinguishing features for a woman, the process remains invisible and is determined only by a doctor in a antenatal clinic when examining the vagina. The doctor, knowing about the gestational age, can tell you that the cervix has begun to open or has opened by 1 cm. There is no need to panic after such words: this does not mean at all that the birth will occur on the way home. They can begin in a few days, and in 1-2 weeks.



Harbingers of labor activity

The well-being of the expectant mother is absolutely serene. Some unusual sensations for her may be noted, but the general background of health remains unchanged. These states include:

1. 1. Irregular short-term painless or slightly painful contractions.
2. 2. The appearance of again irregular pulling pains in the lower abdomen, in the lower back and sacrum. At the same time, there may be a feeling of fatigue, heaviness, you want to find a comfortable position for a certain period of time and relax.
3. 3. Drawing pains in the lower abdomen are similar to the feeling and condition before menstruation.
4. 4. Discharge of mucus from the vagina, sometimes with a small amount of blood streaks. They are plentiful, sticky, milky-white in color - this is an indicator of the gradual “opening” of the mucous plug in the cervix. Sometimes it can have a greenish tint.



Frequent soft stools may appear. Some women associate it with indigestion, but it is also a harbinger of childbirth. It is caused by an increase in the production of prostaglandins, which help to cleanse the intestines, creating additional volume for the passage of the fetus. All of these indicated symptoms and manifestations do not require any treatment and are absolutely normal. The abdomen drops during this time, the navel protrudes. The body of each woman is always individual, the precursors may vary, but in any case they are physiological. But if they begin to occur before 37 weeks, you need to see a doctor.

If the process of childbirth has already begun, the cervix will become soft in a fairly short period of time, shrink, thin, and smooth out to form a single birth canal with the uterus. After the completion of childbirth, she returns to her former appearance and the entrance to the postpartum uterus is closed. This happens quickly, within just a few days.

Premature start of the process

Sometimes, under the influence of various causes, changes in the uterus and cervix can begin to occur ahead of time, this is just the case of premature birth. If at this time the development of the fetus is already completed, it will simply be born prematurely. If this is not the case, then the pregnancy will end in miscarriage. In any case, this is an unfavorable diagnostic sign. This condition may occur for reasons including:

1. 1. Isthmic-cervical insufficiency (ICN) - the inability of the cervix and isthmus to withstand the pressure of the uterus and fetus before delivery. This condition is considered pathological, occurs at a period of 16 to 36 weeks and leads to miscarriages. Its cause can be organic changes as a result of inflammation, operations on the uterus. With functional disorders, this occurs in cases of violation of the ratio of the muscular and fibrous layers of the organ wall, as well as in case of failures of its normal susceptibility to hormonal regulation during ovarian dysfunction.
2. 2. Unfavorable burdened obstetric history (frequent abortions, miscarriages at different times in previous pregnancies).
3. 3. Existing erosion of the cervix.
4. 4. Transferred injuries of the uterus in previous births with a large fetus, with its ruptures, operations.
5. 5. Low progesterone and other hormonal disorders.

Sometimes, with premature disclosure in order to carry the fetus, the cervix is ​​temporarily sutured. By week 38, the stitches are removed so that there are no obstacles during childbirth for the fetus to exit. In these cases, the scar usually has time to dissolve before childbirth. Normal and physiological in terms of softening and opening of the cervix should occur only before childbirth.



From the start of preparation

Starting from the 32-34th week of pregnancy in the cervix, the muscle tissue begins to yield in thickness to the connective tissue due to its growth. New and fresh young collagen fibers are formed, which are much more elastic, flexible and can withstand a lot of stretching. Some of them are able to dissolve, increasing hydrophilicity. In this case, the tissue of the cervix becomes loose, shortens and the pharynx becomes gaping.

Softening begins from the periphery to the center of the organ, the density of the tissue is preserved in the cervical canal until the last. At the first birth, the external pharynx can spring to the tip of one finger; at repeated births, it misses it completely. By 36-38 weeks, the cervix is ​​already softened completely. The fetus gradually begins to descend into the small pelvis, additionally presses on the neck, forcing it to continue its opening.



In general, the process of disclosure begins with the internal pharynx, where the head of the fetus presses. As a result of this process, the cervix becomes like a cone, its base is turned inside the uterus and is located on top. All this together is called the maturation of the cervix. The gradual advancement of the fetus continues, the internal pharynx has already stretched - now it's the turn for the outer one.

With repeated births, the opening of the internal and external os occurs almost simultaneously. This process is generally faster and easier for them. When the lower part of the uterus becomes thinner and the cervix shortens, maturation occurs, that is, the cervical canal decreases (first to 2 cm).

The neck has lost its rigidity, it misses one finger - this is called its prenatal softening. It is this condition that the gynecologist fixes in the antenatal clinic. The child continues its downward movement, is already in the center of the canal in the middle of the small pelvis, the head presses on its neighbor - the bladder - and the expectant mother has an increase in urination.

Now you can expect the fight to start. In other words, the upper dome of the uterus is already ready for attempts, contractions, and the lower one is able to release the fetus out. Immediately before the start of the process, in primiparous and multiparous, the cervix is ​​sharply shortened and smoothed, it is thinned, the canal passes 2 fingers or more. As a result, the continuing opening of the cervix reaches 10-12 cm, through such an opening the fetal head can already pass, and hence its torso.



A day or 12 hours before the onset of childbirth, the time comes for the discharge of the mucous plug. It may contain streaks of blood as a result of capillary rupture, which is the norm at this time. But the baby after that, of course, does not fall out. It is protected by the remaining membranes of the fetal bladder. The discharge of the cork signals to the obstetrician that the birth is about to begin. It happens that more than a day passes, sometimes (rarely) more than a week, when the contractions begin. That's when they become regular, strong, we can talk about the beginning of the "real work" of the uterus.

Possible problems

Problems can always arise, especially during the first birth. Women in such cases are afraid, they panic. This creates psychological barriers to the onset of the generic dominant. And the body, like a caring nanny, inhibits the production of hormones necessary for childbirth, “persuading” the woman and postponing the onset of the process. For the fetus, this, of course, is not good, since its output is disturbed. For labor, this is also bad, because it does not occur.

Another type of complication is the weakening of labor activity for various reasons. Such a picture can be observed with polyhydramnios: the uterus is overstretched in this case, and its contractility is reduced. The opposite condition with oligohydramnios and, as a result, lethargy of the fetal bladder causes other complications: a small bag filled with liquid does not have sufficient pressure on the cervix, and it also does not open well.



Another obstacle to the normal course of childbirth can be the age of a woman: if she is over 35, then there is no need to talk about particularly strong tissue elasticity, and therefore the opening of the cervix again becomes problematic.

The essence of the phenomenon

The very direct process of opening the cervix during childbirth consists of 3 stages:

• elementary;
• average;
• active childbirth.

The first stage is also called latent, slow, initial (all names are correct). It can last from 4 to 6 hours, sometimes up to several days. Contractions during this period are still irregular, weak, without pain. At the end of the first stage, the opening of the cervix is ​​4 cm. Contractions become more frequent - every 5-7 minutes. If they are not very painful and soft, the best thing a woman in labor can do for herself is to try to sleep, as much more strength will be required in the future. If at this stage the doctor detects signs of impending complications, he can speed up the process of dilating the cervix.

Then comes the second period - medium, active, fast. It is characterized primarily by the frequency and strength of contractions: they become longer, and the pauses between them are shortened. The degree of expansion of the cervix during this period can reach from 4 to 8 cm. Every hour the uterus opens by 1 cm. Now the contractions are almost continuous and occur every minute. Then the transitional phase begins, in which labor activity weakens somewhat. It can last up to 1-2 hours.



At the second stage, another important event occurs - the outpouring of amniotic fluid. Their volume is from 150 to 200 ml. Normally they are transparent and light. Some new moms sometimes think they accidentally peed right into the bed. But, unlike urine, water does not have a characteristic ammonia smell. If the opening of the cervix is ​​already 8 cm, and the water has not yet departed, obstetricians often pierce the fetal bladder: this speeds up the opening. The procedure is called an amniotomy and is completely painless. there are no nerve endings in the bladder.

In the second period, a woman in labor needs a lot of strength, and she must observe certain precautions. So, during the period of contractions, the expectant mother wants to relax and sit down, but this cannot be done. As doctors say, this is tantamount to sitting on the head of a child. You can not lie down, as the opening of the neck slows down. The best way out is to simply walk around the ward, the process in this case is accelerated, as is the progress of the fetus.

Young mothers trained in the antenatal clinic can at this moment apply their knowledge of breathing methods:

• deep breaths and slow exhalations, as if blowing out a candle;
• slow inhalations through the nose and exhalations of air through the mouth;
• alternating short breaths.

At the opening of the cervix up to 7-8 cm, along with contractions, attempts begin. They are already controlled by the woman herself, but it is too early to push, obstetricians warn about this. This can cause neck ruptures. And finally, the third, final, final stage comes: the cervix is ​​fully opened by 10 cm, its edges are elastic, the fetus cannot be damaged while moving along the birth canal. That's when it's time for pushing. The expulsion of the fetus begins.

With attempts, the pain during contractions decreases, the woman feels better. She herself accelerates the expulsion of the fetus and the eruption of the head. The transition can be different for different mothers, so the presence of a doctor nearby is important. The process ends with the birth of a child and his cry.



rupture danger

If the uterus is mature enough, then according to the classical scenario, ruptures are not provided. How does a gap appear? This is, in essence, the fruit's overcoming of obstacles in its path while advancing. He needs it to get out. Another cause of ruptures is the undeveloped muscles of the perineum and the lack of flexibility and elasticity in them. That's why it's so important to train your muscles before giving birth.

The cause of the gap can also be the appearance of a large fetus, rapid delivery, when the ratio of processes and time is violated. Additional factors may be incorrect positions of the fetus, the use of auxiliary tools by obstetricians. Tears cause bleeding from the birth canal, but they are safely sutured right during childbirth with absorbable threads. The woman does not feel these seams. Their healing is painless.



The question of artificial stimulation

It has already been said about how important it is not to be nervous before childbirth. But there are often situations when it becomes necessary to conduct stimulation in order to speed up the onset of childbirth. This is already determined by the doctor himself. Such moments arise for the following reasons:

• diagnosing a future mother with diabetes, obesity;
• inflammation of the genitals, toxicosis, arterial hypertension;
• early discharge of water, as the risk of infection of the fetus increases;
• with polyhydramnios, when the size of the uterus is too stretched, it contracts weakly, and the opening force is also low;
• with oligohydramnios, when the bubble does not press on the neck with the necessary force;
• if the woman in labor is over 35 years old, and the opening process is delayed due to a decrease in tissue elasticity;
• non-disclosure of the uterus;
• lack of contractions;
• cardiac pathologies in the body of a pregnant woman;
• Rhesus conflict between mother and fetus;
• early detachment of the placenta.

In addition, stimulation is carried out when the fetus is overdue. During this period, the pregnancy is completed, the baby is no longer supplied with everything necessary, since the placenta has completed its task. Then the child develops hypoxia. The doctor makes the decision on stimulation based on ultrasound, blood tests, urine. Stimulation of labor is carried out in two ways: in a hospital - medication and at home - non-drug.



The first method should be carried out only in a hospital setting. For this, there are special gels, tablets, injections that are used to speed up the opening of the cervix. The most common and easiest way is to use kelp sticks for this: they are inserted into the cervical canal and, due to their friability, are quickly saturated with moisture. After 4-5 hours, the sticks begin to swell strongly, mechanically gently expanding the channel. Another plus of such funds is that kelp secretes natural prostaglandins - the main hormones of childbirth, which are needed for the maturation of the cervix.

Prostaglandins can be injected into the cervical canal and in its natural form with the help of suppositories and gel. It does not cause side effects, and there is no harm to the child. The effect of the drug begins to appear after half an hour, before that the woman in labor can move around the ward.

Oxytocin stimulation is another type of drug effect on cervical dilatation. The drug has a side effect: it can speed up the opening too much and increase the expansion of the neck, so it is combined with antispasmodics. At home, non-drug stimulation methods can be used as self-help, but caution should come first here. Methods should be chosen indifferent to the health of the fetus and harmless to the mother.



From 37 weeks, it is recommended to introduce more oil-filled salads into the diet. Good results are obtained by swimming, drinking a decoction of raspberry leaves, massage of the auricle and little finger. During this period, active sex is recommended and shown, since semen contains prostaglandins. In addition, orgasm causes a rush of blood to the uterus and causes it to contract.



Sometimes before childbirth, when the date of their onset is specified, a cleansing enema can be done: the liquid irritates the back wall of the uterus, stimulating contraction. You can do house cleaning, long walks, climbing stairs and other physical activities. Of course, this does not mean that it is useful for a pregnant woman to lay sleepers.

The walls of the uterus are well developed exercises on the fitball, while:

• relax the tense muscles of the pelvis and back;
• the heart rate and blood pressure are aligned;
• the spine is unloaded;
• reduced pressure on the kidneys.

For exercise, just 5 minutes a day is enough. Would need:

• sit like on a chair;
• try to lean in different directions at the same time;
• lying on your back, squeezing the ball with your feet;
• roll the ball under the lower back, lying on it with your back;
• jump on it like on a spring.

Kegel exercises for training the muscles of the perineum and small pelvis do not lose their popularity. They begin 3 weeks before the expected birth. The principle of these exercises is to alternate slow compression, rapid contraction and pushing out the muscles of the vagina and perineum of an imaginary object. This is especially recommended when urinating, when the result of your efforts is obvious. The alternation of contractions and the complete subsequent relaxation of the muscles trains them very well and allows the woman to control their work herself. There are several Kegel techniques, and they are often published online.

Finally, it is worth noting that your careful preparation of labor activity will justify itself in the future. Even according to official data, the risk of complications is reduced by at least 60%.