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Nursing care for the mother. Nursing childbirth care

Kamyshinsky branch of GAPOU "Volgograd Medical College"

METHODOLOGICAL DEVELOPMENT OF A LECTURE

(lecture-dialogue)

Subject:

Name of MDK 01.01: A healthy person and his environment

Well: 2

Speciality: nursing

Form of study: full-time

Number of hours: 2

Developer: Smirnova E.V. - teacher

Methodical development

reviewed and approved

at the UMO meeting No. 4

(Minutes No. __ dated " ____" __________ 2018)

Chairman of the UMO _________ / Tolstokoraya T.N. /

" _____" ________________2018

Kamyshin, 2018

Motivation for studying the topic:

The lack of knowledge of a medical worker can not only lead to insufficient assistance, but also provoke the development of complications, both on the part of the woman and the fetus.

The task of a medical worker, knowing the signs of the onset of childbirth, the features and procedure of the birth process, is to provide qualified, timely and sufficient assistance.

Lesson objectives

Training: the student must know:

Definition of the concept "Forerunners of childbirth", "Regular labor activity", "Lactation", "Humanization of childbirth", "Partnership in childbirth";

Characteristics of generic expelling forces; periods of childbirth, postpartum period;

Influence of the state of the woman in labor on the course and outcome of childbirth;

Principles of monitoring and caring for a woman in labor and childbirth;

The role of the nurse in promoting natural feeding and a healthy lifestyle.

Developing:

Contribute to the formation of the development of skills in mastering terms and knowledge;

To promote the development of memory, the ability to highlight the main thing in the material being studied;

Contribute to the development of clinical thinking.

Educational:

Contribute to the formation of interest in the future profession;

Cultivate a positive attitude towards learning, form a cognitive interest.

Formed general and professional competencies:

	Name of learning outcome	mark
	Understand the essence and social significance of the future profession, show a steady interest in it.
	Organize their own activities, choose standard methods and methods for performing professional tasks, evaluate their effectiveness and quality.
	Make decisions in standard and non-standard situations, bear responsibility for them.
	To search for and use the information necessary for the effective implementation of professional tasks, professional and personal development.
	Use information and communication technologies in professional activities.
	Work in a team and team, communicate effectively with colleagues, management, consumers.
	Take responsibility for the work of subordinate team members and the result of completing tasks.
	Independently determine the tasks of professional and personal development, engage in self-education, plan advanced training.
	Navigate in the conditions of frequent change of technologies in professional activity.
	Carefully treat the historical heritage and cultural traditions of the people, respect social, cultural and religious differences.
	Be ready to take on moral obligations in relation to nature, society and man.
	Organize the workplace in compliance with the requirements of labor protection, industrial sanitation, infectious and fire safety.
	Lead a healthy lifestyle, engage in physical culture and sports to improve health, achieve life and professional goals.
	Carry out activities to preserve and improve the health of the population, the patient and his environment
	Conduct sanitary and hygienic education of the population
	Participate in the prevention of communicable and non-communicable diseases

Integration links:

Intradisciplinary:

Human needs in different age periods. The role of nursing staff in the preservation and promotion of health;

The period of infancy;

The role of the family in human life. Family planning;

Physiology of pregnancy. Observation and care of a pregnant woman.

Interdisciplinary:

Anatomy and physiology of man.

Hygiene and human ecology.

Fundamentals of the Latin language with medical terminology.

MDT 04.02 Solving patient problems through nursing care

Equipment:

Methodological development of lectures.

Projector, screen, laptop.

The main stages of the lesson:

Bibliography:

1. Kryukova, D.A. A healthy person and his environment: textbook. allowance. - Rostov n / D: Phoenix, 2012. - 384 p. - (Medicine for you).

2. Aizman, R.I. Fundamentals of medical knowledge and a healthy lifestyle: textbook. allowance / R.I. Aizman, V.B. Rubanovich, M.A. Sbetyalov. - Novosibirsk: Sib. university publishing house, 2009.- 214p.- (University series)

3. Medic, V.A. Public health and healthcare: textbook / V.A. Medic, V.K. Yuriev. - M. : GEOTAR-Media, 2013. - 288 p.

Lesson progress:

Stage name	Stage description	The pedagogical goal of the stage	Stage time
Organizational	The teacher greets the students, pays attention to their appearance, notes those who are absent. Informs the topic, plan, objectives of the lesson, motivates the study of the topic.	Creation of a working atmosphere, the formation of cognitive interest in educational activities on this topic, discipline and motivation of students.
Explanation material	Communication to students of new knowledge (Appendix 1):	Formation cognitive interest in this topic.
Fixing new material	front poll. (Appendix 2).	Level detection assimilation of the studied material, detection weak points. Formation of OK and PC.
Homework	1. Lecture notes. 3. Make a "Fishbone" scheme (Problem: Lack of knowledge of a pregnant woman in preparation for childbirth) - Appendix 3.	Ensuring fair and conscious execution homework. This task can use in the formation Student Portfolio

Annex 1

SUBJECT: Physiology of childbirth and the postpartum period. Observation and care of a woman in labor and childbirth

PLAN:

1. Harbingers of childbirth. Ancestral exorcising forces.

2. Periods of childbirth, their duration and course.

3. Observation and care of the woman in labor. Influence of the state of a woman in labor on the course and outcome of childbirth. Humanization of childbirth. Partnership in childbirth.

4. Postpartum period: early and late. The course of the postpartum period.

5. Observation and care of the puerperal. Hygiene and dietetics.

6. Lactation. Promotion of natural feeding and a healthy lifestyle.

Harbingers of childbirth. Ancestral exorcising forces.

If a pregnant woman is attentive to the signals of her body, and the examination by a specialist is of high quality, we will not miss a number of signs that characterize the preparation of the body of a pregnant woman for childbirth. The period of manifestation of this group of signs is called pre-vesnikov.

What subjective changes in the body of a pregnant woman can mean the imminent onset of childbirth?

1. 2-3 weeks before childbirth, the bottom of the uterus descends and the restriction of the diaphragm stops

(the woman notes the relief of breathing).

2. There are signs of "maturity" of the cervix: the cervix shortens, softens, the cervical canal opens, as a result, a pregnant woman may notice a discharge of the mucous plug (discharge of a viscous mucous secret from the vagina).

3. Pulling non-rhythmic pains in the lower abdomen, in the region of the sacrum (appearance of pre-term contractions)

4. Slight weight loss (increased urination)

5. Objectively - the presenting part of the fetus is pressed against the entrance to the small pelvis.

What (what tribal forces) ensures effective labor activity in childbirth?

Contractions are regular contractions of the muscles of the uterus. At the beginning of labor, they alternate after 10-20 minutes for 10-15 seconds, by the end of labor up to 1 minute.

Attempts - contraction of the abdominal muscles and diaphragm.

Are contractions and attempts controlled or not, and why?

Contractions occur involuntarily and are not regulated by the woman in labor. A woman in labor can control her efforts.

What hormone is responsible for contractions during childbirth?

The main hormone responsible for contractions during childbirth is the hormone oxytocin, produced by the hypothalamus and accumulated in the pituitary gland.

Contractions of the uterus begin in the area of the bottom and tubal angles → quickly capture the entire muscles of the body of the uterus to the lower segment. There are fewer smooth muscle fibers in the lower segment of the uterus, so during childbirth, the lower segment stretches and becomes thinner.

Periods of childbirth, their duration and course.

childbirth- This is the physical process in which the fetus is expelled from the uterine cavity through the birth canal.

How many birth periods do you know?

Disclosure period

Period of exile

succession period

Let's describe each of these periods.

DISCLOSURE PERIOD

Duration: in primiparas - from 12 to 16 hours; in multiparous - from 8 to 10 hours

It begins with the occurrence of regular labor activity - labor pains and ends with the complete opening of the uterine os to a degree sufficient to expel the fetus from the uterine cavity.

In primiparas, the cervix is smoothed (opening of the internal uterine os), and then the external os is opened; in multiparous, these processes occur simultaneously.

The process of opening the pharynx is carried out due to: distraction - stretching the circular muscles of the cervix and the introduction (wedging) of the tense fetal bladder into the cervical canal.

The diameter of the uterine os at full opening reaches 10-12 cm. A contact belt is formed - the place where the head is covered by the walls of the lower segment, which divides the amniotic fluid into anterior and posterior.

When strong contractions develop, the border between the contracting upper segment and the stretching lower segment begins to appear - a contraction or boundary ring

PERIOD OF EXILE

Duration: in primiparas - from 1 to 2 hours; in multiparous - from 20 minutes to 1 hour

It begins with the moment of full disclosure of the uterine pharynx and ends with the birth of the fetus.

Soon after the timely discharge of amniotic fluid, the contractions intensify, their strength and duration increase, the pauses between contractions shorten.

Reflexive attempts occur, under the influence of which the fetus is expelled:

The totality of movements of the fetus when passing through the small pelvis is called biomechanism of childbirth:

With the threat of perineal rupture, an episiotomy or perineotomy is performed.

Simultaneously with the birth of the fetus, the back waters are poured out.

Head piercing - during an attempt

Head eruption - no pushing

SUBSEQUENT PERIOD

Up to 15 minutes active-waiting tactics.

It begins with the birth of the fetus and ends with the birth of the placenta.

The afterbirth includes the placenta, amniotic membranes and umbilical cord.

The expulsion of the placenta is carried out under the influence of afterbirth attempts.

The nature of contractions, depending on the period of childbirth, is different.

What is the function of contractions depending on the period of childbirth?

Opening contractions - opening of the cervix

Banishing contractions - expulsion of the fetus

Subsequent contractions - contribute to the separation of the placenta from the uterine wall and its expulsion.

Observation and care of the mother. Influence of the state of a woman in labor on the course and outcome of childbirth. Humanization of childbirth. Partnership in childbirth.

Observation and care of a woman in labor is carried out on the basis of a clinical protocol for the management of childbirth.

In the first stage of childbirth, complaints, anamnesis of the disease and life are collected;

Physical examination (BP, pulse, determination of uterine contractions; determination of the position and presentation of the fetus, listening to the fetal heartbeat);

Evaluation of contractions;

The doctor performs a vaginal examination;

Produce thermometry - at least every 4 hours;

Determine the blood type and Rh affiliation of the woman in labor

In the second stage of labor is carried out:

Listening to the fetal heartbeat after each contraction-attempts;

Continuous clinical monitoring of the general condition of the woman in labor (consciousness, color of the skin and mucous membranes, pulse, blood pressure), the state of the lower uterine segment, the nature of labor, discharge from the genital tract.

From the moment of insertion of the head - readiness to provide benefits, carried out at the birth of the fetus.

Assessment of the state of the newborn on the Apgar scale at the 1st and 5th minute together with the neonatologist.

In the third stage of labor, it is important to carry out:

Monitoring the general condition of the woman in labor (consciousness, color of the skin and mucous membranes, pulse, blood pressure);

The state of the uterus, the nature of contractile activity, discharge from the genital tract;

Removal of urine by a catheter, identification of signs of separation of the placenta within 30 minutes;

Assessment of total blood loss, allocation of the placenta, examination of the placenta, examination of the birth canal;

Evaluation of blood loss during childbirth.

During the entire period of childbirth, a woman loses a certain amount of blood. blood loss May be:

Physiological- 0.5% of body weight, but not more than 400 ml.

border- 400 ml

Pathological- more than 400 ml

Postpartum period: early and late. The course of the postpartum period.

*early- the first 2 hours after childbirth

*late- up to 8 weeks

It starts from the moment the placenta is born and lasts 6-8 weeks.

What changes, in your opinion, should occur in the body of the puerperal?

During this period, there is a reverse development (involution) of the female genital organs and changes in other organs and systems that have arisen in connection with pregnancy and childbirth.

An exception is the mammary glands, their function is achieved maximum development in the postpartum period.

The healing process of the inner surface of the uterus is accompanied by the formation of a wound secret - lochia

In the first 3 days - bloody

3-4 days - serosanguineous

day 10 - light

3 weeks - scanty with cervical mucus

5 weeks - stop

The process of cervical formation occurs within 2-3 weeks of the postpartum period - first, the internal os is formed and closed, this happens by day 10, and by the end of 3 weeks after birth, the external os is closed.

By the end of the postpartum period, pigmentation disappears on the face, along the white line of the abdomen, on the nipples and areola.

Acromegaly - nose, ears, feet will pass in 1-2 weeks after childbirth.

The mammary glands after childbirth increase, colostrum is secreted, and on the third day milk is secreted.

How long does childbirth take?

Doctors of ancient Greece said that the sun should not rise twice over the head of a woman in labor.

The duration of labor in the primiparous is 10-12 hours, in the multiparous - 6-8 hours.

Childbirth can be:

Rapid - within 2 hours

Fast - 4-6 hours

Protracted - more than 12 hours

What status has been assigned to the maternity hospital and children's clinics in our city?

Over the past decade, the international program of "friendly attitude to the child" has been actively implemented. In relation to the mother, too, there is such a program. It is called “Ten Steps of the Mother-Friendly Childbirth Initiative for Hospitals, Birth Centers, etc.

1. Offers all women in labor:

Access to a woman's choice of birth attendants, including fathers, partners, children, family members and friends;

Unlimited access to a professional, experienced woman or childbirth caregiver providing ongoing emotional and physical support throughout the birth process;

Access to professional obstetric care.

2. Publishes accurate descriptive and statistical information about its maternity care services, including intervention and outcome.

3. Provides assistance in childbirth, depending on the cultural, religious and ethnic values of the mother.

4. Gives the woman in labor complete freedom to walk, move at her discretion and take the position of her choice during contractions and attempts (except in cases of medical complications).

5. Precisely defines strategy and order:

Collaboration and consultation during the perinatal period with other maternity support services, including communication with a specialized obstetric facility in case of need to move a woman in labor from one place to another.

Connecting mother to child in all possible ways, including prenatal, postnatal care after discharge, and support for breastfeeding.

6. Does not routinely apply procedures that are not scientifically sound, including (but not limited to)

7. Practices limiting interventions such as:

The use of artificial labor induction and stimulation of the birth process - in 10% of cases or less;

Use of episiotomy - in 20% of cases or less, preferably 5% or less;

Carrying out a caesarean section - in 10% of cases or less in ordinary maternity hospitals and in 15% or less in specialized ones (in women at high risk);

The birth of a child vaginally after caesarean section - in 60% or more, preferably 75%.

8. Trains staff in non-drug methods of pain relief and does not advocate the use of analgesic or anesthetic drugs unless required in the event of a complication.

9. Encourages all mothers and their families, including families with sick or premature babies or babies with birth problems, to contact, close companionship, breastfeed and care for their newborns, to the extent their condition allows.

10. Strives for the achievement of the WHO (World Health Organization) - UNICEF (United Nations Children's Fund) initiative to create conditions for successful breastfeeding: "Ten steps of a friendly attitude towards the child."

Observation and care of the mother. Hygiene and dietetics.

Lactation. Promotion of natural feeding and a healthy lifestyle.

After childbirth, the birth canal of a woman is an extensive wound surface. Sources of infection can be endogenous and exogenous. Endogenous infection is pustular diseases, carious teeth, tonsillitis, inflammation of the genitourinary organs of the woman herself. Exogenous infection penetrates through the hands, tools, dressings (microflora of the throat and nose of staff). The fight against postpartum infections is carried out with preventive measures. The basis of prevention is the strict observance of asepsis and antisepsis in medical institutions and the rules of personal hygiene.

During pregnancy, it is of great importance to follow the rules of pregnancy hygiene, eliminate foci of infection, keep the body clean, sexual abstinence in the last 2 months of pregnancy, and isolate the pregnant woman from an infectious patient.

During pregnancy honey. the employee visits the pregnant woman at home, teaches her to take care of herself, provides the necessary assistance. Early registration of a pregnant woman is important. After discharge from the maternity hospital, the antenatal clinic continues to monitor the puerperal. Honey. the employee visits her at home, monitors the fulfillment of the doctor's instructions, helps in organizing everyday life, caring for the child, and feeding him properly.

The diet of the puerperal in the first week after childbirth is to consume easily digestible food at least 4 times a day. During breastfeeding, nutrition should be complete, as in pregnancy, with a high content of vitamins, without salt and liquid restrictions, but with the prohibition of alcoholic beverages, spicy and spicy dishes,

Even during pregnancy, a woman's body begins to prepare for the process of feeding a child. Milk production begins in the second trimester of pregnancy.

Lactation is the formation of milk in the breast of a nursing mother, its accumulation and excretion. Every woman has a different lactation period.

What are the challenges faced by medical staff when working with a puerperal?

The task of the medical worker is:

Teaching a pregnant woman hygienic care of the mammary glands, preparing the mammary glands for breastfeeding;

Teaching proper attachment and principles of breastfeeding;

Informing about the diet during breastfeeding and promotion of healthy lifestyles;

Informing about ways to increase lactation (if necessary).

Homework:

1. Study the lecture notes.

2. Kryukova D.A. "A healthy person and his environment" pp. 256-283

3. Draw up a “Fishbone” chart (Problem: Lack of knowledge of a pregnant woman in preparation for childbirth) - Appendix 3.

Appendix 2

front poll.

1. What are called harbingers of childbirth?

2. Childbirth - is it?

3. What is the difference between contractions and pushing?

4. How many periods of childbirth are distinguished?

5. When does the postpartum period start?

6. Define the term "lactation".

7. What principles of humanization of childbirth are used in modern maternity hospitals?

Annex 3

Fishbone scheme

Explanation: the scheme includes the main four blocks, presented in the form of a head, tail, upper and lower bones. The connecting link is the ridge of the fish.

The head is the problem, question, or topic to be analyzed.

Upper bones (located to the right at an angle of 45 degrees from above) - they fix the basic concepts of the topic, the reasons that led to the problem.

The lower bones are facts confirming the existence of the formulated reasons, or the essence of the concepts indicated in the diagram.

The tail is the answer to the question, conclusions, generalizations.

Assignment: analyzing all the material passed on the MDK 01.01. "Healthy person and his environment", it is necessary to fill in the "Fishbone" scheme.

Problem: lack of knowledge of a pregnant woman in preparation for childbirth.

The postpartum (puerperal) period is the final stage of the gestational process, characterized by the reverse development of organs and systems that have undergone changes due to pregnancy and childbirth, the formation, flourishing of the lactation function of the mammary glands and the restoration of the activity of the hypothalamic-pituitary-ovarian system. The postpartum period lasts 6-8 weeks.

The first 2 hours after delivery are singled out and designated as the early postpartum period. In this period, monitoring of the general condition of the puerperal, the height of the uterine fundus and the amount of bloody discharge from the vagina continues. Women at risk of developing bleeding continue intravenous administration of uterotonics.

30-60 minutes after delivery, an examination is necessary with the help of mirrors of the soft birth canal, which can also be performed under intravenous anesthesia. Perineorrhaphy can be performed under local infiltration anesthesia.

An individual sterile set of instruments for examining the cervix and walls of the vagina includes: vaginal mirrors, two pairs of terminal clamps, tweezers, a needle holder, needles, suture and sterile dressings.

Inspection of the soft birth canal is carried out in the following order:

Treatment of the external genitalia and hands of the obstetrician with an antiseptic solution, examination of the condition of the perineum and vulvar ring;

Insertion of mirrors into the vagina and removal of blood clots from the vagina;

Exposing the cervix with the help of mirrors and sequentially examining it using terminal clamps (if there are ruptures of the cervix, catgut sutures are applied to the wound),

Inspection of the walls of the vagina, suturing in the presence of damage to the walls of the vagina, removal of mirrors;

Inspection of the perineum and restoration of its integrity after perineotomy or rupture;

Assessment of the total volume of blood loss;

Excretion of urine.

The puerperal is transferred to the postpartum ward 2 hours after delivery. In the translation epicrisis, her general condition, blood pressure indicators, pulse rate, body temperature, the height of the uterine fundus and the amount of discharge from the genital tract are recorded, and medical appointments are indicated. Daily examination of the puerperal is carried out in the following sequence.

1. Evaluate the complaints of the puerperal and her general condition. At least 2 times a day, measure body temperature, blood pressure, pulse rate, which is compared with body temperature. In case of somatic pathology, auscultation and percussion of the heart and lungs are performed.

2. Determine the formation of lactation and the state of the mammary glands - the shape, features of the nipples (inverted, flat, the presence of cracks), the degree of engorgement, the outflow of milk.

3. The abdomen is palpated (superficial and deep), the height of the uterine fundus is determined and compared with the day of the postpartum period. By the end of the 1st day after birth, the bottom of the uterus is located at the level of the navel. During each following day, it falls 1.5-2 cm below the navel. On the 5th day, the bottom of the uterus is located in the middle of the distance between the womb and the navel, by the 12th day it is hidden behind the womb. By the end of the 6-8th week after birth, the uterus is not enlarged in size. Evaluate the consistency and soreness of the uterus.

4. Assess the number and nature of lochia and their correspondence to the day of the postpartum period. In the first 3 days, the lochia is bloody, on the 4-7th day - sanious. On the 10th day, the discharge is light, liquid, without admixture of blood, then scanty; 5-6 weeks after birth, the discharge from the uterus completely stops.

5. Conduct an examination of the external genitalia, perineum, sutures (edema, infiltration, divergence of sutures, suppuration of the wound), their treatment.

6. Specify physiological functions.

With the physiological course of the postpartum period, a diet with a restriction of citrus fruits, chocolate, strawberries, honey is recommended (the energy value of the daily diet is 3200 kcal). The amount of liquid should be at least 2 liters per day. From the 2nd day are shown: therapeutic exercises, daily shower.

Breastfeeding is carried out at the request of the newborn, without observing time intervals. It is necessary to fulfill the hygienic requirements for the care of the mammary glands.

Daily (in the examination room) the external genital organs of the puerperal are treated. If there are stitches on the perineum, they are treated with tincture of iodine, iodonate or 1% alcohol solution of brilliant green. If necessary, UVI is prescribed for the perineal region.

The sutures from the perineum are removed on the 5th day after childbirth (the day before they put a cleansing enema).

The puerperal is discharged on the 5-6th day after childbirth (after receiving the results of a clinical analysis of blood and urine and ultrasound examination of the uterus).

In the postpartum period, the most common complications are nipple fissures, hypogalactia, and subinvolution of the uterus. In case of nipple cracks, to accelerate healing and prevent infection, ultraviolet radiation, ointment applications (methyluracil, solcoseryl, actovegin and benopten ointments, sea buckthorn oil, rosehip oil) are used, breastfeeding is carried out through a special overlay. For hypogalactia, it is recommended:

Frequent breastfeeding;

Sufficient fluid intake (2-3 l), currant or rosehip syrup, potato juice, walnuts;

Intramuscular injections of lactin (100 IU 2 times a day for 5-6 days);

Metoclopramide (cerucal, raglan) or motilium (1-2 tablets 3 times a day);

Apilak (0.01 g 3 times a day for 10-15 days);

Nicotinic acid (1-2 tablets 15 minutes before breastfeeding);

UVI, ultrasound on the area of the mammary glands or their vibration massage.

With subinvolution of the uterus, the use of uterotonics is indicated for 1 treatment of 3-4 days:

Oxytocin (2 times a day intramuscularly or intravenously, 1 ml in 400 ml of isotonic sodium chloride solution);

Ergometrine (0.0002 g 3 times a day);

Ergotal (0.001 g 2-3 times a day);

Quinine (0.1 g 3 times a day);

Tinctures of water pepper (20 drops 3 times a day).

It is possible to assign a diodynamic to the lower abdomen.

Goals of postpartum care:

The fastest possible return of the puerperal to normal life, the formation of exclusive breastfeeding skills;

prevention of postpartum complications;

Preserving the health of the newborn and preventing its diseases.

A well-organized obstetric institution contributes to successful breastfeeding that lasts for a long time. In maternity hospitals with the joint stay of the mother and the newborn, puerperas are helped to start breastfeeding in the first minutes after the birth of the child (subject to the physiological course of childbirth). Immediately after crossing the umbilical cord, the newborn is wiped with a sterile warm diaper and laid on the mother's naked stomach, covered with a blanket. In this position, the puerperal woman independently holds the baby for 30 minutes. The midwife then assists with the first attachment to the breast. It should not be violent, the desire to suck may not appear in the child immediately.

Contact "skin to skin", "eyes to eyes" contributes to a favorable feeling of psychological comfort in the puerperal, the emergence of emotional closeness with the child. The most important point of this technique is to facilitate the adaptation of the newborn to extrauterine life by populating his skin and gastrointestinal tract with mother's microorganisms.

After processing the umbilical cord, a healthy child is placed in the ward with the mother.

The first 2-2.5 hours after normal delivery, the puerperal is in the delivery room. The physician-cousher carefully monitors the general condition of the woman, her pulse, blood pressure, constantly monitors the state of the uterus: determines its consistency, WDM, monitors the degree of blood loss. In the early postpartum period, the soft tissues of the birth canal are examined. Examine the external genitalia, perineum, vagina and its vaults. Inspection of the cervix and upper vagina is performed using mirrors. All discovered gaps are sutured. When assessing blood loss during childbirth, the amount of blood released in the afterbirth and early postpartum periods is taken into account. The average blood loss is 250 ml.

The maximum physiological blood loss is no more than 0.5% of the body weight of the puerperal, i.e. with a body weight of 60 kg - 300 ml, 80 kg - 400 ml.

After 2-4 hours, the puerperal is transported on a stretcher to the postpartum department.

The processes occurring in the body of the puerperal after uncomplicated childbirth are physiological, therefore the puerperal should be considered healthy.

It is necessary to take into account a number of features of the course of the postpartum period associated with lactation, the presence of a wound surface at the site of the placental site, and the state of physiological immunodeficiency. Therefore, along with medical supervision for the puerperal, it is necessary to create a special regimen with strict observance of the rules of asepsis. In the postpartum department, it is necessary to strictly observe the principle of cyclic filling of the chambers. Mothers who gave birth within one day are placed in one ward. Compliance with the cycle facilitates the presence of small chambers (2–3 beds), as well as the correctness of their profiling, i.e. the allocation of wards for women in childbirth who, for health reasons, are forced to stay in the maternity hospital for a longer period. Rooms in the postpartum ward should be spacious. Each bed is provided with at least 7.5 sq.m. area. In the wards, wet cleaning, ventilation, ultraviolet irradiation (up to 6 rubles / day) are carried out twice a day. After discharge of the puerperas, the ward is thoroughly cleaned (washing and disinfecting the walls, floor and furniture). Beds and oilcloths are also washed and disinfected. After cleaning, the walls are irradiated with mercury-quartz lamps. Soft inventory (mattresses, pillows, blankets) is processed in a disinfection chamber.

The joint stay of mother and child significantly reduces the risk of postpartum complications in puerperas and newborns. This is due to the fact that the mother takes care of the child on her own, limiting the contact of the newborn with the staff of the obstetric department, and the possibility of infection with hospital strains of opportunistic microorganisms is reduced. On the first day, the nurse of the department helps to care for the newborn. She teaches the mother the sequence of processing the skin and mucous membranes of the child (eyes, nasal passages, washing), teaches the use of sterile material and disinfectants, feeding and swaddling skills. Inspection of the stump of the umbilical cord and umbilical wound is carried out by a pediatrician.

At present, active management of the postpartum period has been adopted, which consists in getting up early (after 4-6 hours), which improves blood circulation, accelerates the processes of involution in the reproductive system, normalizes the function of the bladder and intestines, and also prevents thromboembolic complications. Every day, the puerperas are monitored by a obstetrician and a midwife. Body temperature is measured 2 times a day. Particular attention is paid to the nature of the pulse, blood pressure is measured. The condition of the mammary glands, their shape, the condition of the nipples, the presence of abrasions and cracks (after feeding the child), the presence or absence of engorgement are assessed. Daily examine the external genitalia and perineum. Pay attention to the presence of edema, hyperemia, infiltration.

With urinary retention, you should try to call it reflexively (open a tap with water, pour warm water on the urethra, put a warm heating pad on the pubic area). With a negative result, injections of oxytocin 1 ml 2 times a day intramuscularly, 10 ml of a 10% solution of magnesium sulfate intramuscularly once, bladder catheterization are used. If re-catheterization is necessary, a Foley catheter should be used for a day.

In the absence of an independent stool on the third day after childbirth, a laxative or cleansing enema is prescribed.

To obtain an accurate idea of the true rate of uterine involution on days 2–3, it is recommended to perform an ultrasound of the uterus using special nomograms of ultrasonic parameters. In addition, this method allows you to evaluate the number and structure of lochia in the uterus. The retention of a significant amount of lochia in the uterus can serve as a reason for its surgical emptying (vacuum aspiration, light curettage, hysteroscopy).

Care of the external genital organs, especially in the presence of a rupture or incision in the perineum, includes washing with a weak disinfectant solution and treating the skin sutures with an alcohol solution of brilliant green or potassium permanganate. Silk sutures on the skin of the perineum have hardly been applied in recent years, since their care is more complicated and requires their removal no earlier than 4 days of the postpartum period. In addition, there is a possibility of formation of ligature fistulas. An alternative to silk sutures are modern absorbable synthetic threads (Vicryl, Dexon, Polysorb). Their use does not preclude the earliest discharge.

With the appearance of hyperemia, tissue infiltration, signs of suppuration, the sutures should be removed.

To prevent genital prolapse, urinary incontinence, all puerperas are recommended to practice Kegel exercises from the first day after childbirth. This complex is designed to restore the tone of the pelvic floor muscles and consists in their arbitrary contraction. The main difficulty of these exercises is to find the necessary muscles and feel them. You can do this in the following way - try to stop the stream of urine. The muscles that are used for this are the perineal muscles.

The complex of exercises consists of three parts: • slow contractions: tighten the muscles, as to stop urination, slowly count to three, relax; contractions: tighten and relax these same muscles as quickly as possible; pushing out: to push, as in defecation or childbirth.

You need to start training with ten slow compressions, ten contractions and ten push-ups five times a day. After a week, add five exercises to each, continuing to perform them five times a day. In the future, add five exercises every week until there are thirty of them.

Only after restoring the tone of the muscles of the perineum, the puerperal woman is allowed exercises to restore the tone of the abdominal muscles.

After childbirth, a healthy puerperal can return to her usual diet. However, until normal bowel function is restored (usually the first 2-3 days), it is recommended to include more fiber-rich foods in the diet. The presence in the daily menu of lactic acid products containing live bifidus and lactocultures is very important. Lactating women can be recommended to include in the diet of special dry dietary mixtures used as a milk drink. Oxygen cocktails are very useful.

However, lactation and breastfeeding dictate certain dietary restrictions. It should be remembered that the composition of breast milk deteriorates if a nursing mother overloads food with carbohydrates, eats a lot of sugar, confectionery, cereals. At the same time, the amount of protein in milk decreases. It is necessary to limit the use of so-called obligate allergens: chocolate, coffee, cocoa, nuts, honey, mushrooms, citrus fruits, strawberries, some seafood, as they can cause unwanted reactions in a child. You should also avoid canned food, spicy and sharp-smelling foods (peppers, onions, garlic), which can give milk a specific flavor.

The use of alcohol and tobacco is strictly prohibited. Alcohol and nicotine easily pass into breast milk, which can cause serious disorders in the child's central nervous system, up to mental retardation.

For the prevention of infectious complications, strict adherence to sanitary and epidemiological requirements and personal hygiene rules is important.

Compliance with the rules of personal hygiene should protect the mother and the newborn from infection. Shower daily and change underwear. Keeping the external genitalia clean is of great importance.

Lochia not only pollute them, but also cause maceration of the skin, and this contributes to the upward penetration of the infection. To prevent this, it is recommended to wash the external genital organs with soap and water at least 4-5 times a day.

Caring for a healthy puerperal is inseparable from caring for her healthy newborn, it is carried out in accordance with modern perinatal technologies. They are based on the joint stay of the puerperal and the newborn, which ensures exclusive breastfeeding.

Modern perinatal technologies include a set of measures based on traditional methods of nursing healthy children recognized by all peoples.

The basis of modern perinatal technologies is exclusively breastfeeding.

To ensure exclusive breastfeeding, you need:

Immediate attachment of the child to the mother's breast after birth;
joint stay of mother and child in the maternity hospital;
exclusion of all types of drinking and feeding, except for breast milk;
· the inadmissibility of the use of nipples, horns and "pacifiers" that weaken the oral motility of the newborn;
breastfeeding on demand, without night intervals;
The earliest possible discharge from the maternity hospital.

First of all, cohabitation is necessary to reduce the contact of the newborn with other children. Even in a four-bed ward, this contact is limited to three children, and not 20–25
newborns."

The most important thing is the implementation of the possibility of feeding on demand, which also prevents children from supplementing water, glucose, etc.

An equally important result of living together is the formation of a biocenosis in the child with the mother and the acquisition by the puerperal of the skills of caring for the newborn under the guidance of medical personnel.

Watering and supplementary feeding of healthy children is generally not required either in wildlife or in human society. Moreover, drinking and feeding produced with the help of nipples and horns leads to a weakening of oral motility - the main factor in full sucking.

With the weakening of sucking, there is no complete emptying of the myoepithelial zone of the nipple, alveoli, and there is no full-fledged stimulus for the production of prolactin. All this leads to the development of hypogalactia. This fully applies to the use of "dummies".

A large role in the formation of breastfeeding skills and successful subsequent lactation belongs to medical personnel (midwife, neonatal nurse).

Basically, its tasks are as follows:

in most cases it is just observation, communication, psychological and emotional support;
It is possible to participate together with the doctor in preparation for further breastfeeding (explaining the advantages of such feeding, informing about the feeding technique and the processes occurring after childbirth, the mechanisms of lactation, discussing the issues that have arisen);
Assistance with the first attachment of a newborn to the breast immediately after childbirth;
· early in breastfeeding when the mother is having difficulty - providing practical assistance (mother's position, nipple latching), encouraging on-demand feeding, helping the mother to realize that she has enough colostrum (milk) for successful feeding.

Medical staff should not give newborns other food and drink, as well as sedatives.

Absolute contraindications to breastfeeding:

use of drugs and alcohol;
· T-cell leukemia;
breast cancer (BC);
herpetic rash on the nipples;
active form of pulmonary tuberculosis;
reception of chemotherapeutic agents for oncological diseases;
· HIV infection;
galactosemia in a child.

The presence of breast implants is not a contraindication to breastfeeding.

Modern perinatal technologies involve early discharge of the mother with the newborn from the hospital.

To speed up the discharge from the maternity hospital allows a very effective technique of surgical cutting off the umbilical cord 12 hours after birth, providing a significant reduction in the infection of the umbilical cord.

In Russia, discharge is usually possible on the third day after vaccination (anti-tuberculosis vaccine).

In various countries, these periods vary from 21 hours (USA) to 4–5 days (Germany, Italy). The purpose of early discharge is to prevent infections in puerperas and newborns.

The same goal is served by home births, resurgent, in particular, in Northern Europe (Netherlands). Due to the high cost of medical care for childbirth at home, in the near future they will not dominate in most countries of the world.

These technologies allow minimizing postpartum complications in mothers and newborns.

Before the discharge of the puerperal from the hospital, it is necessary to assess the condition of her mammary glands, the degree of uterine involution and its pain, to assess the nature of lochia and the condition of the sutures. It is necessary to palpate the soft tissues of the thighs and lower legs to exclude deep vein thrombophlebitis. In case of a complicated course of pregnancy and childbirth, a clinical blood test and a general urine test should be performed. With deviations from the physiological course of puerperia, a vaginal examination may be necessary. The doctor must make sure that the puerperal has normal stools and urination, and also inform that lochia will be released for at least three, and sometimes five weeks. On the eve of discharge, it is necessary to have a conversation about the features of the regimen at home.

A woman must follow the same rules of personal and general hygiene as in a maternity hospital. It should be recommended that she reduce the amount of usual physical activity, provide daytime rest for at least two hours and mandatory walks in the fresh air. Regular and balanced nutrition is an important condition for the successful course of puerperia. The timing of the return to a normal lifestyle, normal physical activity and return to work are determined individually. The duration of temporary disability is 6 weeks. Usually, on the first day after discharge, active patronage of the puerperal woman and the newborn is carried out at home.

At the first visit to the antenatal clinic within 4-6 weeks after delivery, the patient should be weighed, blood pressure should be measured. Most women in childbirth lose up to 60% of their body weight gained during pregnancy. If childbirth is complicated by bleeding and concomitant anemia, a clinical blood test should be performed in dynamics. In the presence of spotting, it is necessary to carry out additional studies (ultrasound) and prescribe appropriate treatment. When examining the mammary glands, pay attention to the condition of the nipples (cracks), signs of milk stagnation (lactostasis). At the same time, it is desirable to support the setting for successful breastfeeding in every possible way. In lactating women, as a result of hypoestrogenism, there is often dryness of the vaginal mucosa. In these cases, it is necessary to prescribe a topical estrogen cream to reduce discomfort during intercourse.

When examining the external genital organs, attention should be paid to the condition of the scar on the perineum (in case of ruptures or episiotomy) and the presence of signs of failure of the pelvic floor muscles. When examining the cervix in the mirrors, a PAP test should be performed. With a two-handed vaginal examination in the postpartum period, it is often possible to determine a slight deviation of the uterus back, which resolves over time without treatment. With uterine prolapse, stress urinary incontinence, cysto and rectocele, surgical methods of treatment are used only if the woman no longer plans childbirth. Vaginoplasty is recommended to be performed no earlier than 3 months after childbirth.

When visiting a doctor, it is also necessary to choose a method of contraception, to diagnose possible complications of childbirth, such as back pain and postpartum depression. A trusting relationship between a patient and a doctor contributes to the preservation of a woman's reproductive health for many years.

Examination of a newborn

Examination of a newborn child usually begins with an assessment of his condition. There are 3 degrees of condition: satisfactory, moderate and severe. In addition, there is also an extremely severe or pre-agonal (terminal) condition. The severity of the condition of a newborn child can change not only during the day, but even hours.

Apgar score
In obstetrics and pediatrics, the Apgar scale is used to assess the severity of the condition of a newly born child. The Apgar score is a method for assessing the state by examining the frequency of breathing, heartbeat, muscle tone and activity of movements, skin color. Each investigated clinical sign is tested and evaluated according to a three-point system. A well-pronounced sign is rated with a score of 2, an insufficiently expressed one - 1, the absence or distortion of a sign - 0. Usually, scoring is carried out at the first and fifth minutes of a child's life and the values are summed up. The Apgar score is two-digit, for example - 5/6 points or 7/8 points. The first number corresponds to this sum of points in the first minute, the second number corresponds to the sum of points in the fifth minute. A child's condition with a score of 7–10 is considered good, optimal, and a child's condition with a score of 4–6 points indicates a slight deviation in the state of health, 3–4 points is regarded as a state of moderate severity, 0–2 points indicates serious deviations in the state of health. newborn.

Visual inspection
During examination, a healthy newborn is characterized by a calm facial expression, a kind of lively facial expression. The beginning of the inspection can often be accompanied by a loud emotional cry. The duration and strength of the cry characterize the indicator of the maturity of the child.

Movements in newborns are mostly unconscious, excessive, uncoordinated, athetosis-like.

Usually the newborn lies on his back: the head is brought to the chest, the arms are bent at the elbows and pressed to the side surface of the chest, the hands are clenched into fists, the child's legs are bent at the knee and hip joints. In the position of the child on the side, the head is sometimes thrown back. This is the so-called embryonic posture (flexion posture due to the physiological increase in the tone of the flexor muscles).

When examining a child, various congenital defects can also be noted: strabismus, facial paralysis, drooping of the upper eyelid, nystagmus.

A newborn baby has a normal smell. A peculiar smell emanating from a newborn may be one of the earliest symptoms of hereditary metabolic diseases.

When examining the skin of a mature full-term newborn, tender, elastic, pink, velvety to the touch and slightly dry skin attracts attention. When you try to collect it in a fold, it instantly straightens out. Immediately after birth, it is covered with primordial lubrication (caseous, cheese-like lubrication). It is a whitish color and a greasy viscous mass. In some newborns, whitish-yellowish dots (milia) are found on the wings and back of the nose, less often in the region of the nasolabial triangle, telangiectasias - reddish cyanotic vascular spots, petechial hemorrhages. Mongolian spots can be found, which are located in the sacrum, buttocks, less often on the thighs and are cyanotic pigment spots; brown birthmarks can be localized in any area of the body of a newborn. Milliaria crystalina are pinpoint dew-shaped vesicles that are found in newborns in the nose. They are retention cysts of the sweat glands.

The skin of a newborn is covered with a network of capillaries that are easily visible through the skin.

The color of the skin in a healthy newborn baby can be different. So in the first minutes after birth, cyanosis around the mouth is possible, cyanosis of the arms and legs, hands and feet. But after a few hours from the moment of birth, the skin of the child acquires a bright red hue. Subsequently, the skin may also acquire an icteric tint as a result of the appearance of physiological jaundice of the newborn. The skin of a healthy newborn is warm to the touch, although in the first hours after birth it may be cool (especially the limbs) due to a physiological decrease in body temperature.

Assessing the condition of the skin, it is also necessary to evaluate the color of the sclera of the eyes and visible mucous membranes. Examination of the eyes of a newborn is difficult, since the eyes of the child are mostly closed. When examining the eyes, it can be seen that the eyes of a healthy newborn are clear, the cornea is transparent, the pupils are round, about 3 mm in diameter, the reaction to light is alive. When the eyeballs move, converging strabismus may occasionally occur. With a change in the position of the head or sometimes at rest, short-term sweeping horizontal nystagmus is possible. The eyes are shiny, tears usually do not appear when the child cries.

Along with the assessment of the skin, be sure to pay attention to the hair, nails and vellus hair (lanugo) of the baby, which are usually located on the shoulder girdle.

Subcutaneous tissue is quite well developed, especially on the face, limbs, chest and back. The turgor of the soft tissues of a healthy child gives a feeling of firmness and elasticity. The head of the newborn is covered with hair 2 cm long, the eyelashes and eyebrows are almost invisible, the nails are dense, reaching the fingertips. The bones of the skull of a newborn are elastic, not fused with each other.

In places of fusion, the bones remain soft. These are non-ossified areas of connective tissue - fontanelles. The large fontanel has the shape of a rhombus, it is determined where the connection of the parietal and frontal bones occurs, its dimensions are 1.5–2 cm, 5–3 cm. The small fontanel is located in the place where the parietal and occipital bones are located, it has a triangular shape and most often closed. The head circumference of a newborn is 1–2 cm greater than the circumference of the chest, and the body length is longer than the lower limbs, as well as the arms are longer than the legs, the height of the head is 1/4 of the body length. The chest is wide and short (barrel-shaped), the ribs are located horizontally. The muscular system is poorly developed, but already formed; the diameter of the muscle fiber is on average about 7 microns. Motor skills due to the immaturity of the nervous system are absent. The spine has no physiological curves and consists of cartilaginous tissue. The joints are highly mobile.

Bone tissue in a newborn has a fibrous bundle structure (in adults it is lamellar). When examining a child, special attention should be paid to the integrity of the clavicles (they can often be damaged at the time of the removal of the shoulders) and to the breeding of the legs in the hip joints. With neurological pathology and congenital diseases of the musculoskeletal system, symptoms of a "clawed foot", a hanging hand, a "seal's foot", a hanging foot, and a calcaneal foot may be noted.

When examining the oral cavity, the oral mucosa is tender, easily vulnerable, and richly vascularized. The color of the mucous membranes is bright pink, they are usually dry due to slight salivation.

The mucous membrane of the lips has a transverse striation and forms pads, covered in some children with a whitish coating. When examining the oral cavity, a rather large tongue is visible, on the mucous membrane of the lips there are small elevations in the form of pads; they are separated by deep grooves and are located perpendicular to the length of the lips, their color is usually whitish. The fold on the gums along the jaw processes in the oral mucosa ensures the tightness of the oral cavity when sucking the mother's breast. In the thickness of the cheeks there are dense accumulations of adipose tissue - Bish's lumps, which give elasticity to the cheeks.

On the mucous membrane of the hard palate, yellowish dots can be seen along the medial line. A low hard palate is characteristic.

When examining the cardiovascular system, one should evaluate the heart rate, heart size, the nature of heart sounds, and the presence of heart murmurs. The heart of a healthy child has a rounded shape. The size of the right and left ventricles in a newborn is almost the same. In the neonatal period, the borders of the heart shift to the right, its upper border descends from the level of the first intercostal space - the II rib to the second intercostal space. The left border goes beyond the mid-clavicular, and the right border goes beyond the edge of the sternum. The pulse rate in a newborn is 120-140 beats per 1 minute. Blood pressure on the first day of life averages 66/36 mm Hg. Art. In healthy children, a weak pulsation of the carotid artery can be observed. The respiratory system is characterized by a description of the shape of the chest, percussion and auscultation data. In newborns, the nasal passages are narrow, with a delicate mucous membrane, which is covered with a large number of blood vessels. The cartilages of the nose are soft. Due to the horizontal position of the ribs and the weak development of the respiratory muscles, the newborn's breathing is superficial, largely due to the diaphragm.

The respiratory volume of the lungs of newborns is only 11.5 ml, the minute respiratory volume is 635 ml. In the neonatal period, breathing is arrhythmic, its frequency is 40-60 breaths per 1 min.

When examining the abdomen and abdominal organs, attention is drawn to the participation of the abdominal wall in the act of breathing. Normally, the anterior abdominal wall does not extend beyond the plane, which is a continuation of the chest. An external examination determines the roundness of the abdomen, an increase or retraction, whether there is asymmetry. The abdomen on palpation in a newborn with a calm behavior is soft, the liver protrudes from under the edge of the costal arch no more than 2 cm along the midclavicular line. The spleen can be palpated at the edge of the costal arch, and the kidneys can be palpated only in children with a mild subcutaneous fat layer. The number of urination up to 5-6 times a day is considered the norm.

In healthy full-term boys, the testicles descend into the scrotum, the glans penis is hidden under the foreskin and is usually not completely removed from under it. The size of the penis and scrotum is strictly individual. In healthy full-term girls, the labia minora are covered by the large lips. A slight swelling of the mucous labia of the labia, as well as the presence of mucous or bloody discharge is considered the norm.

To assess the neurological status, the examination of a newborn child should be carried out on a flat, semi-rigid surface in a warm, well-lit room. During the examination, his motor activity is revealed, the quantity, quality and symmetry of the child's movements are assessed. An external examination of the child can reveal signs of increased neuro-reflex excitability. One of these signs is a small-scale tremor of the hands and lower jaw during screaming and anxiety.

The next sign is the spontaneous Moro reflex, when, when tapping a finger on the sternum, the child spreads his arms to the sides, and then returns them to their original position, crossing his arms over his chest. Spontaneous jerks and spontaneous and induced clonus of the feet are also possible.

A newborn child can react to sharp light and auditory stimuli with anxiety and screaming, which is also accompanied by blinking of the eyelids, a change in the rhythm of breathing and pulse. In the first days of life, the child usually does not fix his gaze yet, his eye movements are not coordinated, nystagmus, physiological strabismus are often noted, and lacrimal fluid is not produced.

Muscle tone in newborns is often weakened. A sharp decrease or lack of muscle tone can be a sign of prematurity or immaturity.

Pain sensitivity is somewhat reduced, but the temperature and tactile sensitivity of the newborn is already well developed. A child is born with a mass of unconditioned reflexes, which can be divided into three categories: persistent lifelong automatisms, transient (passing) reflexes, reflecting different levels of development of the motor analyzer, and reflexes or automatisms that only appear at the birth of a child, but they can not always be identified. Unconditioned reflexes must be assessed in the supine position, on the stomach and in a state of vertical suspension.

proboscis reflex. When a finger strikes the lips, a contraction of the circular muscle of the mouth occurs, causing the lips to stretch with the proboscis.

Search reflex or Kussmaul search reflex. If you stroke the skin in the corner of the newborn's mouth (but you should not touch the lips), then the lip drops, the tongue deviates and the head turns towards the stimulus.

Pressing on the middle of the lower lip causes the mouth to open, the lower jaw to drop, and the head to bend.

With pain irritation, the head turns in the opposite direction. The reflex is well expressed before feeding and helps the baby to find the mother's nipple.

Babkin's palmar-mouth reflex. When you press your thumbs on the child's palm in the tenor area, he responds by bending his head, shoulder and forearm. The child opens his mouth, closes his eyes, while trying to pull himself up to his fists.

defensive reflex. This reflex protects the baby and prevents him from suffocating when laying the baby on his stomach, as he turns his head to one side.

grasp reflex. If you place your index fingers in the position of the child on the back on the palm of the newborn, without touching the dorsal side, and press on them, the child bends his fingers and captures the fingers of the examined. Sometimes a newborn wraps his fingers so tightly that he can be lifted up (Robinson's reflex). By pressing at the base of the II and III fingers on the baby's feet, you can cause a tonic reflex - plantar flexion of the fingers (Wercombe's symptom).

Support reflex. It is necessary to take the child under the armpits from the back, supporting the head from the back with the index fingers and put the child's soles on the surface of the changing table, while he, as it were, stands on half-bent legs on a full foot.

Automatic walking reflex. This reflex lies in the fact that if, at the moment of performing the support reflex, the child is tilted forward, then he will sort out his legs, performing step-by-step movements. At the same time, the legs are bent at the knee and hip joints, sometimes when walking they cross at the level of the lower third of the lower leg and feet.

Babinski's reflex.

This reflex may not be elicited in all newborns. It can be defined as follows: with a dashed irritation of the surface of the foot, the toes of the foot diverge like a fan, while the thumb is bent.

Kernig's reflex. In a child lying on his back, one leg is bent at the hip and knee joints, and then they try to straighten the leg at the knee joint. With a positive reflex, this cannot be done.

Reflex Talent. In a child lying on his side, you need to draw your thumb and forefinger along the paravertebral lines in the direction from the neck to the buttocks. Irritation of the skin causes arching of the trunk in an arc that is open posteriorly. Sometimes at the same time the leg is unbent and retracted.

Perez reflex. In the position of the child on the abdomen, a finger is passed along the spinous processes of the spine in the direction from the coccyx to the neck, which causes the trunk to bend, the upper and lower extremities to bend, the head and pelvis to rise, sometimes urination, defecation and crying. This reflex causes pain, so it should be examined last.

Similar information.

Every pregnant woman is preparing for the birth of a child, and the closer the due date, the stronger the expectation. But often about what happens in the first hours and days after the birth of a child, the expectant mother does not know anything. But the postpartum period is a special time for a woman who is now learning in practice to be a mother, to breastfeed, to take care of a baby, to comprehend motherhood.

Let's talk in more detail about what happens to the body in the postpartum period, about what it is, what phenomena you can expect and what you should prepare for.

"The postpartum period is a period of approximately 6-8 weeks, starting immediately after the birth of the placenta. During this period, there is a reverse development (involution) of all changes that have arisen in connection with pregnancy and childbirth, until the initial state of the woman's body is restored.

in obstetrics the postpartum period is conditionally divided into early and late.

The early postpartum period lasts only 4 hours after the end of childbirth. At this time, the woman who has given birth must be carefully monitored, since it is in the first hours after childbirth that the manifestation of the most serious postpartum complications is most likely. Most often it takes place under the supervision of the medical staff of the maternity hospital.
The late postpartum period begins 4 hours after delivery and ends with full recovery genital organs, nervous, cardiovascular and other systems of the female body, as well as changes in the endocrine system and mammary glands that provide the function of lactation. At the same time, psychological changes occur: a woman needs to comprehend what happened, get used to new feelings and sensations.

Physiological changes that occur in the body after childbirth

We list the physiological changes that necessarily occur in a woman's body after childbirth and are associated with the completion of pregnancy and the onset of lactation.

The uterus shrinks and returns to its original size, its mucous membrane is restored. The transverse size of the uterus immediately after childbirth is 12-13 cm, weight is 1000 g. At the end of 6-8 weeks after birth, the size of the uterus corresponds to its size at the beginning of pregnancy, and the weight is 50-60 g.
Heal soft tissue injuries: cracks and breaks. Cracks heal without a trace, and scars form at the sites of ruptures.
Reduces swelling of the external genitalia, which was formed in the last weeks of pregnancy and during childbirth.
Ligaments lose their elasticity who during pregnancy and childbirth carried heavy loads. The mobility of the joints and other bone joints, which also carried loads during pregnancy and childbirth, is lost.
The internal organs take their former position that were displaced due to the large size of the uterus (stomach, lungs, intestines, bladder, etc.)
Gradually all organs return to work in the previous mode who carried a double load during pregnancy (kidneys, liver, heart, lungs, etc.)
happening changes in the endocrine system. The endocrine glands, which were enlarged during pregnancy, gradually decrease to their normal state. However, the organs of the endocrine system that provide lactation continue to work actively.
Enlargement of the mammary glands. Now they must ensure the feeding of the newborn and learn how to produce milk in accordance with the age needs of the growing body of the child.

Now let's discuss the course of the postpartum period and the features of postpartum care, based on knowledge of the changes taking place in a woman's body.

The course of the postpartum period and features of postpartum care

For successful contraction of the uterus, it is very important to attach the newborn to the breast within the first hour after birth and frequent(once every 2 hours during the daytime) and prolonged feeding further.
Breast sucking stimulates the production of the hormone oxytocin and is therefore very effective in uterine contractions. During feeding, the uterus is actively contracting, due to which a woman may experience cramping pains in the lower abdomen. In the first days after childbirth, uterine contraction should be put on an ice pack for 30 minutes and more often lie on your stomach.
It is also worth using preventive herbal medicine, aimed at reducing the uterus, starting from the 4th day after birth. Can be used for this shepherd's purse grass, nettle, yarrow and birch leaves.Herbs can be alternated (for example, shepherd's purse for 3 days, then during the week alternate nettle and yarrow every other day, then birch leaves; or change all herbs in turn every other day) or mix in equal proportions.

1 tablespoon of herbs is poured with a glass of boiling water and infused for 30 minutes, then filtered. Ready broth drink ¼ cup 4 times a day.

Too much impact on the uterus and other organs of the abdominal cavity, which have not yet taken their original position, may lead to a change in the position of these organs or cause an inflammatory process. That's why it is not recommended to wear tightening bandages and engage in active physical exercises aimed at tightening the abdominal press.
In connection with the contraction of the uterus in the first week after childbirth, abundant postpartum discharge is released from it - lochia. When standing up or changing the position of the body, the discharge may increase. This discharge will gradually lighten up from bloody to pale pink and will finally stop 6 weeks after delivery. , as well as to accelerate the healing process of ruptures or soft tissue injuries, it is necessary to carefully carry out the toilet of the external genitalia. In the first week after childbirth, three times a day, washing with warm water should be completed by washing the external genitalia. decoction of oak bark.

4 tablespoons of oak bark in an enamel bowl pour 500 ml of boiling water. Boil for 15 minutes, adding boiling water. Remove from heat and insist another 15 minutes, strain.

From the second week until the discharge is clarified, you can use a decoction of chamomile twice a day for these purposes.

Pour 2 tablespoons of chamomile with 1 liter of boiling water, leave for 20 minutes, strain.

Very important for tissue splicing dry the seams after washing and treat them with additional healing agents. It is recommended to use the entire postpartum period underwear only from natural fabrics and, if possible, the same gaskets.

Starting breastfeeding

It is important from the very first days to establish full breastfeeding. The processes of normal lactation contribute to the normalization of the hormonal background in the female body, due to which the postpartum recovery period will be more successful.

On the 2-7th day, depending on the nature of the course of childbirth, flow of milk. From now on, it is convenient to use for breast support nursing tops or shirts. In some cases, the flow of milk may be accompanied by high fever, the appearance of pain and seals in the mammary glands. In this case, it is necessary to reduce fluid intake. You should resort to pumping only when painful sensations arise in the full breast, 1-2 times a day, and pump the breast only until a feeling of relief appears. lasts milk fever 1-3 days.

From the moment the milk appears, it is important to breastfeed the baby often enough., it improves the contractile activity of the uterus and contributes to the formation of lactation.
If the child is with the mother, we must try apply it to the chest at least once every 2 hours. When kept separately, it is necessary to establish regular pumping every 3 hours, except for the night interval from 24.00 to 6.00 in the morning. At this time, a woman needs rest.

Before the baby develops sucking rhythms, there may be restless sucking, where there are practically no pauses, or, conversely, sluggish sucking when the baby sleeps and skips feedings. That's why, starting from the third week after birth, mom needs to monitor the number of attachments so that weight loss and dehydration do not develop, and allow the baby to be at the breast for as long as he needs to compensate for the birth stress.

It is important from the very first days to make sure that the child sucks not only nipple, but also captured as much of the areola as possible, in order to avoid the occurrence of abrasions or cracks in the nipple.

Need to feed the baby in a comfortable position not to get tired. At first, especially if the woman has tears, this will be the “lying on the arm” position. Then the mother can master the “sitting”, “standing”, “under the arm” poses and begins to alternate them. By the seventh week, the mammary glands are adapting to the process of lactation and feeding.

Prevention of postpartum depression

The term " postpartum depression”is familiar in our time to everyone, even those who have never given birth. There are many reasons for this, and listing them would require a separate article. Therefore, it is imperative to carry out the prevention of postpartum depression, starting from the 6th day after birth, for at least two weeks.

For this, they take infusion of motherwort, valerian or peony, 1 teaspoon 3 times a day.
Of great importance is also support and understanding of relatives and friends, in the first place husband.
Worth the first month limit the number of guests, even with the best of intentions, as this requires additional efforts from a woman.
Important do not overload giving birth to a woman with household chores, allow her to restore her strength, adapt to her new role as a mother.
Healthy get enough sleep including going to bed 1-2 times a day. For a good sleep, a mother needs to learn how to sleep with her baby. When a woman has the opportunity to relax, and not jump up at every squeak of a newborn, and the children themselves sleep much more calmly next to their mother.
It is very important to find a person who will help a young mother to get used to new duties for her, will prompt and teach her how to deal with a baby, will calmly listen to conversations about events and experiences related to the child.

"Traditionally, the first nine days after childbirth, a woman was considered sick, and she was entitled to especially thorough postpartum care. Until 42 days, it was believed that the woman and child still needed special care.

Therefore, she was not allowed to the household, allowing her to establish relationships in the mother-child pair and get used to changes in life. And those around her took care of the woman herself, made sure that she did not need anything and could fully recover after childbirth.

That's why within 6 weeks after giving birth, you do not need to go for walks. Mother and baby at this time need recovery after childbirth, breastfeeding and peace, and not walking. Especially if the baby was born during the cold season. Due to a decrease in immune forces, even a slight cooling can lead to the development of an inflammatory process.
For the same reasons, a woman is not recommended to walk barefoot and in light clothes, but taking a bath is better than a shower.
Pleasant drinks in the form of drinks will also help take care of the health of the woman who has given birth. Good for recuperation drink based on chaga.

Chaga mushroom drink

Pour 2 tablespoons of chopped chaga into 900 ml of warm boiled water. Separately, boil a whole lemon in 100 ml of water for 10 minutes. Then crush the insides of the lemon and mix with chaga, add 2 tablespoons of honey. Insist 6-8 hours.

For better restoration and maintenance of immunity, a woman can take rose hips, in the form of syrup (2 teaspoons 3 times a day) or in the form of compote, infusion, with thyme herb.

2 tablespoons of rose hips and 1 tablespoon of thyme pour 300-400 ml of boiling water. Insist thermos for 30 minutes, drink throughout the day.

The postpartum period is no less important for a woman than pregnancy and childbirth. At this time, not only the functioning of the body is restored, but the transition of the woman to a new state occurs. She learns to care for a newborn, breastfeeding, lays the foundation for the further health of the child, is aware of her maternal role and comprehends maternal science.
The success of the postpartum period, and in the future, the physical and mental health of the mother and child depends on compliance with the rules for postpartum care and the application of traditional recommendations for caring for a woman in labor.

11.04.09
Shmakova, Elena
prenatal instructor
and lactation consultant
Center "Mother's House" Novosibirsk,
mother of four children

The postpartum period begins from the moment the placenta appears and ends after 7 weeks. The main symptoms of this crucial period can be safely called an excellent contraction of the uterus, thickening of its walls. Every day after childbirth, the uterus begins to gradually decrease. It was revealed that during the first 10 days after childbirth, the bottom of the uterus descends every day by about one transverse finger.

If the postpartum period proceeds normally, then the state of health remains normal. The pulse is rhythmic, the breathing is deep, the temperature is within the normal range. The separation of urine is usually normal, but in some cases it is difficult. Women in childbirth are often worried about stool retention, which appeared against the background of intestinal atony.

But on the fourth day after childbirth, the breast of the puerperal begins to separate milk. The mammary glands become the most vulnerable and sensitive. But such a case is possible that the chest swells strongly, and then unbearable arching pain follows. Remember that pumping at this time can be considered extremely harmful.

Basic rules for caring for a puerperal.

The most important thing is to control the general well-being of the lady. Regularly measure the pulse, monitor the condition of the mammary glands, measure the height of the uterine fundus, examine the genitals from the outside. All indications are included in the history of childbirth.

If the contractions were painful, then antipyrine or amidopyrine can be prescribed. If urination is difficult, then a number of measures are necessary. If the stool is delayed, it is recommended to make an enema or resort to a laxative in the form of vaseline or castor oil.

The mother must wash her hands before each feeding and observe intimate hygiene at least twice a day. Also, change your shirt every day. But the chest must be rinsed with a 0.5% solution of ammonia, nipples - with a 1% solution of boric acid. You can also use warm soapy water for this purpose.

The diet for puerperas should include more vegetables, fruits, berries, cottage cheese, kefir, milk. It is best to avoid overly fatty and spicy foods.