4 cm opening of the cervix no contractions. Cervical dilation period - active phase

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

We will try to give a consistent description of what physiological processes occur during childbirth, what a woman feels at this time, and what medical manipulations can be performed at different periods of childbirth.

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

Opening of the cervix

During this period, there is a gradual expansion of the cervical canal, that is, the opening of the cervix. As a result, a hole of sufficient diameter is formed through which the fetus can penetrate from the uterine cavity into the birth canal, formed by the bones and soft tissues of the small pelvis.

The opening of the cervix occurs due to the fact that the uterus begins to contract, and due to these contractions, the lower part of the uterus, i.e. its lower segment is stretched and thinned. Disclosure is conditionally measured in centimeters and is determined during a special obstetric vaginal examination. As the degree of cervical dilatation increases, muscle contractions intensify, become longer and more frequent. These contractions are contractions - painful sensations in the lower abdomen or in the lumbar region that the woman in labor feels.

The first stage of labor begins with the appearance of regular contractions, which gradually become more intense, frequent and prolonged. As a rule, the cervix begins to open with the appearance of contractions lasting 15-20 seconds with an interval of 15-20 minutes.

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

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

active phase the first stage of labor begins after 5 cm of disclosure and continues until full disclosure, that is, up to 10 cm. At this stage, contractions become frequent, and pain -
more intense and pronounced.

In addition to uterine contractions, an important part of the first stage of labor is the outflow of amniotic fluid. Of great importance is the time of outflow of water in relation to the degree of cervical dilation, as this can affect the course of the birth process.

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

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

How to behave

If you experience regular painful or pulling sensations in the lower abdomen, begin to note the time of the beginning and end of these sensations, as well as their duration. If they do not stop within 1–2 hours, last approximately 15 seconds every 20 minutes and gradually increase, this indicates that the cervix has begun to gradually open, that is, the first stage of labor has begun and you can go to the maternity hospital. At the same time, it is not necessary to rush - you can observe your condition for 2-3 hours and go to the hospital with more or less intense labor activity, that is, with contractions every 7-10 minutes.

If your amniotic fluid has broken, then it is better not to delay the trip to the maternity hospital, regardless of whether contractions have appeared or not, since premature or early discharge of amniotic fluid can affect the choice of labor management tactics.

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

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

During the contraction, try different positions that make the pain easier to bear, such as resting your hands on the bed and leaning forward slightly with your feet shoulder-width apart. If a husband is present at the birth, then you can lean on him or squat down, and ask your husband to support you.

A fitball, a special large inflatable ball, will help ease the sensations during contractions.

If possible, contractions can be carried under the shower, directing a warm stream of water on the stomach, or immersed in a warm bath.

What does a doctor do?

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

An external obstetric examination is performed when the expectant mother enters the maternity hospital. During this procedure, the approximate weight of the fetus is estimated, the external dimensions of the pelvis of the expectant mother are measured, the location of the fetus, the height of the presenting part, that is, at what level in the birth canal is the presenting part of the fetus - the head or buttocks.

During a vaginal examination, the condition of the cervix, the degree of its disclosure, the integrity of the fetal bladder are assessed. The presenting part is determined: the head, legs or buttocks of the fetus - and the nature of its insertion, that is, which part - the back of the head, forehead or face - the head was inserted into the small pelvis. The nature of the amniotic fluid, their color and quantity are also evaluated.

In the normal course of the first stage of labor, a vaginal examination is performed every 4 hours to assess the dynamics of cervical dilatation. If complications occur, more frequent testing may be required.

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

For a more accurate assessment of the nature of the fetal heartbeat and an indirect study of its condition during childbirth, each woman in labor undergoes a cardiotocographic study - CTG. Two sensors are installed on the surface of the uterus, one of them captures the fetal heart rate, and the other - the frequency and intensity of uterine contractions.

As a result, two parallel curves are obtained, having studied which the obstetrician-gynecologist can objectively assess the well-being of the unborn baby, notice signs of possible complications in time and take measures to prevent them. In normal labor, CTG is performed once and lasts for 20–30 minutes. If necessary, this study is performed more often; sometimes, when childbirth is at high risk, a permanent cardiotocogram is recorded. This happens, for example, in the presence of a postoperative scar on the uterus or in preeclampsia - a complication of pregnancy, which is manifested by increased pressure, edema and the appearance of protein in the urine.

Fetal expulsion period

After the cervix is ​​fully dilated, the second stage of labor begins, that is, the expulsion of the fetus from the uterine cavity, its passage through the birth canal and, ultimately, its birth. This period lasts for primiparas from 40 minutes to 2 hours, and for multiparous ones it can end in 15-30 minutes.

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

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

How to behave?

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

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

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

If you are already on the delivery chair and your baby is about to be born, you will be asked to push as hard as possible while pushing. At this point, you should concentrate as much as possible on what the midwife says, as she sees what stage the fetus is at and knows what needs to be done to facilitate its birth.

With the beginning of the attempt, you should take a deep breath and start pushing, trying to push the baby out. As a rule, during one push you may be asked to push 2-3 times. Try not to scream or let out air in any case, as this will only weaken the attempt, and it will be ineffective. Between attempts, you should lie quietly, try to even out your breathing and rest before the next attempt. When the fetal head erupts, i.e. will be installed in the genital gap, the midwife may ask you not to push again, since the force of the uterine contraction is already enough to further advance the head and remove it as carefully as possible.

What does a doctor do?

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

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

An external obstetric examination is also performed regularly to determine where the presenting part is located. If necessary, a vaginal examination is performed.

When the head erupts, it is possible to perform an episiotomy - a surgical dissection of the perineum, which is used to shorten and facilitate the birth of the head. When giving birth in the breech presentation, an episiotomy is mandatory. The decision to use episiotomy is made in cases where there is a threat of perineal rupture. After all, an incision made with a surgical instrument is easier to sew up, and it heals faster than a lacerated wound with crushed edges with a spontaneous rupture of the perineum. In addition, an episiotomy is performed when the condition of the fetus worsens in order to speed up its birth and, if necessary, immediately carry out resuscitation.

After the birth, the baby is placed on the mother's stomach to ensure the first bodily contact. The doctor assesses the condition of the newborn according to special criteria - the Apgar scale. At the same time, such indicators as heartbeat, respiration, skin color, reflexes and muscle tone of the newborn at 1 and 5 minutes after birth are evaluated on a ten-point scale.

succession period

During the third stage of labor, the placenta, the remnant of the umbilical cord and the fetal membranes are separated and released. This should happen within 30-40 minutes after the baby is born. In order for the placenta to separate, after childbirth, weak uterine contractions appear, due to which the placenta gradually separates from the uterine wall. Having separated, the placenta is born; from that moment on, it is considered that the birth has ended and the postpartum period has begun.

How to behave and what does the doctor do?

This period is the shortest and painless, and practically no effort is required from the puerperal. The midwife watches to see if the placenta has separated. To do this, she may ask you to push slightly. If at the same time the rest of the umbilical cord is drawn back into the vagina, then the placenta has not yet separated from the placental site. And if the umbilical cord remains in the same position, the placenta has separated. The midwife will again ask you to push and with light, gentle pulls on the umbilical cord, gently bring the placenta out.

After this, a thorough examination of the placenta and fetal membranes is performed. If there is any suspicion or indication that part of the placenta or membranes remains in the uterine cavity, a manual examination of the uterine cavity should be performed to remove the remaining parts of the placenta. This is necessary to prevent the development of postpartum hemorrhage and infection. Under intravenous anesthesia, the doctor inserts his hand into the uterine cavity, carefully examines its walls from the inside, and, if retained placental lobules or fetal membranes are found, removes them outward. If within 30-40 minutes there was no spontaneous separation of the placenta, this manipulation is performed manually under intravenous anesthesia.

After childbirth

After the birth of the placenta, a thorough examination of the soft tissues of the birth canal and perineum is performed. If ruptures of the cervix or vagina are detected, they are sutured, as well as surgical restoration of the perineum, if an episiotomy has been performed or its ruptures have occurred.

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

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

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

With a satisfactory condition of the puerperal and the newborn, 2 hours after birth, they are transferred to the postpartum ward.

Normal and timely labor never begins suddenly and violently. On the eve of childbirth, a woman experiences their precursors, and the uterus and her cervix prepare for the birth process. In particular, the cervix begins to "ripen" and expand, that is, it enters the stage of opening the uterine os. Childbirth is a complex and lengthy process and largely depends on the interaction of the uterus, cervix and the state of the hormonal background, which determines their successful completion.

The cervix is...

The lower part of the uterus is called its cervix, which looks like a narrow cylinder and connects the uterine cavity with the vagina. Directly in the neck, the vaginal part is distinguished - the visible part that protrudes into the vagina below its arches. And also there is supravaginal - the upper part, located above the arches. In the cervix passes the cervical (cervical) canal, the upper end of it is called the internal pharynx, respectively, the lower end is the outer one. During pregnancy, there is a mucous plug in the cervical canal, the function of which is to prevent the penetration of infection from the vagina into the uterine cavity.

The uterus is the female reproductive organ, the main purpose of which is the bearing of the fetus (fetal container). The uterus consists of 3 layers: the inner one is represented by the endometrium, the middle one is the muscular tissue and the outer one is the serous membrane. The main mass of the uterus is the muscular layer, which hypertrophies and grows during gestation. The myometrium of the uterus has a contractile function, due to which contractions occur, the cervix (uterine os) opens and the fetus is expelled from the uterine cavity during the birth act.

Periods of childbirth

The birth process lasts quite a long time, and normally in primiparous women in labor it is 10-12 hours, while in multiparous women it lasts about 6-8 hours. Childbirth itself includes three periods:

• I period - the period of contractions (opening of the uterine os);
• II period is called the period of attempts (the period of expulsion of the fetus);
• III period - this is the period of separation and discharge of the child's place (afterbirth), therefore it is called the afterbirth period.

The longest stage of the birth act is the period of opening of the uterine os. It is caused by uterine contractions, during which the fetal bladder is formed, the fetal head moves along the pelvic ring and cervical opening is provided.

Contraction period

First, contractions arise and are established - no more than 2 in 10 minutes. Moreover, the duration of uterine contraction reaches 30 - 40 seconds, and relaxation of the uterus 80 - 120 seconds. Prolonged relaxation of the uterine muscles after each contraction ensures the transition of the cervical tissues into the structure of the lower uterine segment, as a result of which the length of the visible part of the cervix decreases (it shortens), and the lower uterine segment itself is stretched and lengthened.

As a result of the ongoing processes, the presenting part of the fetus (usually the head) is fixed at the entrance to the small pelvis, separating the amniotic fluid, as a result, anterior and posterior waters are formed. A fetal bladder is formed (contains anterior waters), which acts as a hydraulic wedge, wedged into the internal os, opening it.

In first-borns, the latent phase of disclosure is always longer than in women giving birth for the second time, which causes a longer total duration of labor. Completion of the latent phase is marked by complete or almost complete smoothing of the neck.

The active phase begins with 4 cm of cervical dilatation and lasts up to 8 cm. At the same time, contractions become more frequent and their number reaches 3–5 in 10 minutes, the periods of contraction and relaxation of the uterus equalize and amount to 60–90 seconds. The active phase lasts for primiparous and multiparous 3-4 hours. It is in the active phase that labor activity becomes intense, and the cervix opens quickly. The fetal head moves along the birth canal, the cervix has completely passed into the lower uterine segment (merged with it), by the end of the active phase, the opening of the uterine os is complete or almost complete (within 8–10 cm).

At the end of the active phase, the fetal bladder opens and the water is poured out. If the cervical opening has reached 8 - 10 cm and the water has departed - this is called a timely outflow of water, the discharge of water at the opening of up to 7 cm is called early, with 10 or more cm of opening of the pharynx, an amniotomy is indicated (the procedure for opening the fetal bladder), which is called a belated outflow of water.

Terminology

The opening of the cervix does not have any symptoms, only a doctor can determine it by conducting a vaginal examination.

To understand how the process of softening, shortening and smoothing the neck is progressing, one should decide on obstetric terms. In the recent past, obstetricians determined the opening of the uterine os in the fingers. Roughly speaking, how many fingers the uterine pharynx passes through, such is the opening. On average, the width of the "obstetric finger" is 2 cm, but, as you know, everyone's fingers are different, so measuring the opening in cm is considered more accurate. So:

• if the cervix is ​​​​opened by 1 finger, then they say about the opening of 2 - 3 cm;
• if the opening of the uterine os has reached 3–4 cm, this is equivalent to opening the cervix by 2 fingers, which, as a rule, is diagnosed already at the beginning of regular labor (at least 3 contractions in 10 minutes);
• an almost complete opening is indicated by the opening of the neck by 8 cm or by 4 fingers;
• full disclosure is fixed when the cervix is ​​completely smoothed (the edges are thin) and passable for 5 fingers or 10 cm (the head falls to the pelvic floor, turning with an arrow-shaped seam in a straight size, there is an irresistible desire to push - it's time to go to the delivery room for the birth of a baby - the beginning of the second period childbirth).

How does the cervix mature?

The harbingers of childbirth that have appeared indicate the imminent onset of the birth act (from about 2 weeks to 2 hours):

• the bottom of the uterus descends (for 2-3 weeks before the onset of contractions), which is explained by the pressing of the presenting part of the fetus to the small pelvis, a woman feels this sign by easing breathing;
• the pressed head of the fetus presses on the pelvic organs (bladder, intestines), which leads to frequent urination and constipation;
• increased excitability of the uterus (the uterus “hardens” when the fetus moves, the woman moves abruptly, or when the abdomen is stroked / pinched);
• appearance is possible - they are irregular and rare, pulling and short;
• the cervix begins to "ripen" - softens, skips the tip of the finger, shortens and "centers".

The opening of the cervix before childbirth proceeds very slowly and gradually over a month, and intensifies on the last day - two on the eve of childbirth. In nulliparous women, the dilatation of the cervical canal is about 2 cm, while in multiparous women, the dilatation exceeds 2 cm.

To determine the maturity of the cervix, a scale developed by Bishop is used, which includes an assessment of the following criteria:

• the consistency (density) of the neck: if it is dense, this is regarded as 0 points, if it is softened along the periphery, but the internal pharynx is dense - 1 point, soft both from the inside and outside - 2 points;
• the length of the neck (the process of its shortening) - if it exceeds 2 cm - 0 points, the length reaches 1 - 2 cm - a score of 1 point, the neck is shortened and does not reach 1 cm in length - 2 points;
• patency of the cervical canal: a closed external pharynx or skips the tip of a finger - a score of 0 points, the cervical canal is passable to a closed internal pharynx - this is estimated at 1 point, and if the canal passes one or 2 fingers through the internal pharynx - it is estimated at 2 points;
• how the neck is located in relation to the wire axis of the pelvis: directed backwards - 0 points, shifted anteriorly - 1 point, located in the middle or "centered" - 2 points.

When summing the points, the maturity of the cervix is ​​​​estimated. An immature neck is considered with a score of 0 - 2 points, 3 - 4 points is regarded as an insufficiently mature or ripening neck, and with 5 - 8 points they speak of a mature neck.

Vaginal examination

To determine the degree of readiness of the cervix and not only, the doctor conducts a mandatory vaginal examination (upon admission to the maternity hospital and at 38-39 weeks at the appointment at the antenatal clinic).

If a woman is already in the maternity ward, a vaginal examination to determine the process of opening the uterine os every 4 to 6 hours or according to emergency indications:

• discharge of amniotic fluid;
• carrying out a possible amniotomy (weak birth forces, or a flat fetal bladder);
• with the development of anomalies of generic forces (clinically narrow pelvis, excessive labor activity, discoordination);
• before regional anesthesia (EDA, SMA) to determine the cause of painful contractions;
• the occurrence of discharge with blood from the genital tract;
• in the case of established regular labor activity (preliminary period that turned into contractions).

When conducting a vaginal examination, the obstetrician assesses the condition of the cervix: its degree of disclosure, smoothing, thickness and extensibility of the cervical edges, as well as the presence of scars on the soft tissues of the genital tract. In addition, the capacity of the pelvis is assessed, the presenting part of the fetus and its insertion are palpated (localization of the swept suture on the head and fontanelles), the advancement of the presenting part, the presence of bone deformities and exostoses. Be sure to evaluate the fetal bladder (integrity, functionality).

According to the subjective signs of disclosure and the data of the vaginal examination, a partogram of childbirth is compiled and maintained. Contractions are considered subjective signs of childbirth, in particular, the opening of the uterine os. Criteria for evaluating contractions include their duration and frequency, severity and uterine activity (the latter is determined instrumentally). Partogram of childbirth allows you to visually record the dynamics of the opening of the uterine os. A graph is drawn up, horizontally indicating the duration of labor in hours, and vertically opening the cervix in cm. Based on the partogram, one can distinguish between the latent and active phases of labor. The steep rise of the curve indicates the effectiveness of the birth act.

If the cervix dilates prematurely

The opening of the cervix during pregnancy, that is, long after childbirth, is called isthmic-cervical insufficiency. This pathology is characterized by the fact that both the cervix and the isthmus do not fulfill their main function in the process of gestation - obturator. In this case, the neck softens, shortens and smoothes, which does not allow the fetus to be kept in the fetus and leads to spontaneous abortion. Termination of pregnancy, as a rule, occurs in 2 - 3 trimesters. The failure of the cervix is ​​evidenced by the fact of its shortening to 25 mm or less at 20-30 weeks of gestation.

Isthmic-cervical insufficiency is organic and functional. The organic form of the pathology develops as a result of various cervical injuries - artificial abortions (see), cervical ruptures during childbirth, surgical methods for treating cervical diseases. The functional form of the disease is due either to a hormonal imbalance or an increased load on the neck and isthmus during pregnancy (multiple pregnancies, excess water or a large fetus).

How to keep a pregnancy when dilating the cervix

But even with a cervical opening of 1 - 2 fingers in a period of 28 weeks or more, it is likely to keep the pregnancy, or at least prolong it until the birth of a completely viable fetus. In such cases are appointed:

• bed rest;
• emotional peace;
• sedatives;
• antispasmodics (magne-B6, no-shpa,);
• tocolytics (ginipral, partusisten).

Be sure to carry out treatment aimed at the production of surfactant in the lungs of the fetus (glucocorticoids are prescribed), which accelerates their maturation.

In addition, treatment and prevention of further premature opening of the cervix is ​​​​surgical - stitches are applied to the neck, which are removed at 37 weeks.

The cervix is ​​immature - what then?

The opposite situation is possible, when the cervix is ​​“not ready” for childbirth. That is, the hour X has come (the expected date of birth), and even several days or weeks have passed, but there are no structural changes in the cervix, it remains long, dense, rejected backwards or forwards, and the internal pharynx is impassable or passes the tip of the finger. How do doctors act in this case?

All methods of influencing the neck, leading to its maturation, are divided into drug and non-drug. Medical methods include the introduction into the vagina or into the cervix of special gels and suppositories with prostaglandins. Prostaglandins are hormones that accelerate the process of maturation of the cervix, increase the excitability of the uterus, and in childbirth, their intravenous administration is practiced in case of weakness of the birth forces. Local administration of prostaglandins has no systemic effect (no side effects) and contributes to the shortening and smoothing of the neck.

Of the non-drug methods of stimulating the opening of the cervix, the following are used:

Sticks - kelp

Sticks are made from dried kelp algae, which are highly hygroscopic (absorb water well). Such a number of sticks are introduced into the cervical canal so that they fill it tightly. As the sticks absorb liquid, they swell and stretch the cervix, causing it to dilate.

Foley catheter

The catheter for opening the cervix is ​​represented by a flexible tube with a balloon fixed at one end. A catheter with a balloon at the end is inserted into the cervical canal by a doctor, the balloon is filled with air and left in the neck for 24 hours. Mechanical action on the neck stimulates its opening, as well as the production of prostaglandins. The method is very painful and increases the risk of infection of the birth canal.

Cleansing enema

Unfortunately, in some maternity hospitals they refused to conduct a cleansing enema for a woman who came to give birth, but in vain. The free intestine, as well as its peristalsis during defecation, increases the excitability of the uterus, increases its tone, and, consequently, accelerates the process of opening the cervix.

Question answer

How can you speed up the opening of the cervix at home?

• prolonged walks in the fresh air increase the excitability of the uterus and the production of prostaglandins, and the presenting part of the baby is fixed at the entrance to the small pelvis, further stimulating the opening of the cervix;
• watch the bladder and intestines, avoid constipation and prolonged abstinence from urination;
• eat more salads from fresh vegetables seasoned with vegetable oil;
• take a decoction of raspberry leaves;
• stimulate the nipples (when they are irritated, oxytocin is released, which causes uterine contractions).
• Are there any specific neck opening exercises?

At home, walking up the stairs, swimming and diving, bending and turning the torso accelerates the maturation of the neck. It is also recommended to take a warm bath, massage the ear and little finger, breathing exercises and exercises to strengthen the perineal muscles, yoga. In maternity hospitals there are special gymnastic balls, the seat and jumps on which, during the period of contractions, accelerate the opening of the uterine os.

Does sex really help prepare the cervix for childbirth?

Yes, having sex in the last days and weeks of pregnancy (subject to the integrity of the fetal bladder and the presence of a mucous plug in the cervical canal) contributes to the maturation of the cervix. First, during orgasm, oxytocin is released, which stimulates uterine activity. And, secondly, the semen contains prostaglandins, which have a beneficial effect on the process of maturation of the cervix.

At what opening do attempts begin?

Pushing is a voluntary contraction of the abdominal muscles. The desire to push arises in a woman in labor already at 8 cm. But until the cervix opens completely (10 cm), and the head sinks to the bottom of the small pelvis (that is, it can be felt by a doctor by pressing on the labia) - you can’t push.

I share my experience:
PDR - May 1-2, pregnancy and childbirth first. On Monday, April 20, I surrendered to the maternity hospital department of pathology to wait for childbirth, because on the 19th the uterus contractions went on all day (irregular, from very painful to completely painless) and the doctor said during the examination "the neck is beautiful, the bubble is pouring, now you can start giving birth any day" and recommended to stay in the hospital under supervision. I stayed (in fact, I’m still sitting here), but for some reason I changed my mind about being born. Last week at night there were several times sensitive contractions, but from Saturday they also passed. Now the stomach only periodically painlessly stony (this happened before). On April 24, they looked at me again on the armchair, the doctor said "the opening is 4 cm, the head is in the pelvis. Let's go give birth right now, huh?" I refused, because I really want the baby to get ready to go out on his own - without haste, in a natural way. the doctor accepted my arguments, promised that on April 25-26 I would probably give birth myself (without her, because she has days off). I was delighted, but nevermind. She did not give birth to the child. Yesterday, April 28, the doctor looked at the cervix again. She said dilation is "up to 5 cm". Again campaigned to go to give birth. I refused again. Then she put the question point-blank: like, decide when we will give birth - on the 29th or 30th. I tried to drag out the old "song about the main thing" - that we have nowhere to rush, we would have to do it naturally .. To which the doctor replied that there are more May holidays, I must understand that she also wants to go to the dacha, she won't be here because of me May 1-2 in the city to sit. Those. if I am going to give birth on the May holidays, I will have to give birth with the duty team ("there will be no one else here, everyone has the weekend"). In general, I have a birth under a contract (with my husband, with the choice of a doctor and a stay after the birth in a superior room). My doctor is a deputy. the head physician of the maternity hospital (she is just involved in the contract childbirth program, and in general, as I understand it, "what she wants, she turns back"). Before concluding the contract, she explained to me and my husband that if it was impossible for the chosen doctor to be present at the birth, another doctor would take delivery (also a doctor who conducts "payers" - but not the doctor on duty). Why now they suddenly tell me that there will be only a team on duty - hez .. In my opinion, the doctor is trying to put pressure on me for reasons of personal gain. With such an approach and attitude towards me of my “chosen” doctor, I don’t see how worse it is to give birth with the person on duty (especially since I didn’t particularly choose the “chosen” doctor, she herself volunteered, citing the fact that those doctors whom I I wanted to, either they will be on vacation, or they don’t suit me in terms of character). Out of confusion, I agreed to give birth on the 30th. However, after reflecting in a calm atmosphere, I came to the conclusion that I still do not like the situation. I really want a natural birth, but it turns out that if the contractions themselves do not start by tomorrow, they will stimulate me. On the other hand, how can it be that there is already such a disclosure, but there are no contractions? Maybe it's really time to stimulate? According to the ultrasound, everything seems to be in order, he is full-term, the degree of development of the lungs last Thursday was 2nd. Saturday CTG - in order, the child is moving as usual. As for the fact that his head is in the pelvis - so, in my opinion, she has been there since the middle of pregnancy, she did an ultrasound at the 24th week somewhere, so the doctor was exhausted with the sensor to look under my pubic bone, but we were looking for a position for a very long time, in which the head would be visible. My belly either did not drop, or it dropped by 2 centimeters, no more. So it goes. What to do? Go look for a doctor and refuse tomorrow's birth, or what other options are there?

UPD: Thanks to the collective mind. It seems that my head and the brains attached to it fell into place, and I still decided to mow from stimulation - at least until the moment _medical_ indications appear, other than the doctor's desire not to miss the May barbecue. I went to the doctor, calmly expressed my doubts to her, complained that I was very worried because I had agreed to stimulation yesterday, and that I think it would be better if we still wait for active actions on the part of the child. The doctor did not quarrel with me, she only said that this is my business, I do not want to be stimulated - she is not going to force me. She repeated that in any case she was going to the dacha for May holidays, and I would still have to give birth in her absence with the duty team. I asked to clarify exactly how it will look in the form of a contract. It turns out that this will be the case, as originally promised - just a doctor allocated to payers is part of the duty team. In short, straight from the heart it was relieved :) I, by and large, don’t care which doctor to give birth with, the main thing is to ensure the naturalness of the process, as far as possible. And there was no sabotage on the part of the deputy chief physician, whom, to be honest, I had already begun to fear. And in the end, everything turned out not so scary.

The first stage of labor is the longest. In primiparas, it is from 8 to 10 hours, in multiparous - 6-7 hours. At the same time, the latent phase of labor (from the onset of contractions to the opening of the cervix by 4 cm) accounts for 5-6 hours (an average of 5.4 hours in primiparous and 4.5 hours in multiparous). This phase is painless or painless.

Conducting childbirth in the period of dilatation of the cervix

Contractions are established initially with a frequency of 1-2 in 10 minutes, the tone of the uterus is 10 mm Hg. Art. The duration of contraction of the uterus (systole of contractions) is 30-40 s, relaxation (diastole of contractions) is 2-3 times longer (80-120 s). Intrauterine pressure during contractions rises to 25-30 mm Hg. Art.

This phase is characterized by prolonged relaxation of the uterus after each contraction, especially the isthmus (lower segment and cervix), since each contraction causes the cervical tissue to move into the structure of the lower segment, resulting in a decrease in the length of the cervix (the cervix is ​​shortened), and the lower segment of the uterus is stretched , lengthens.

The presenting part is tightly fixed in the entrance of the small pelvis. The fetal bladder gradually, like a hydraulic wedge, is introduced into the area of ​​\u200b\u200bthe internal os, contributing to the opening of the cervix.

Cervical dilation period - latent phase

The latent phase in primiparas is always longer than in multiparas, which basically increases the total duration of labor. By the end of the latent phase, the neck is completely or almost completely smoothed out. The rate of cervical dilatation in the latent phase of labor is 0.35 cm/h.

Any medical correction in the latent phase of childbirth is not required. But in women of late or young age, in the presence of a burdened obstetric and gynecological history, any complicating factors, it is advisable to promote the processes of cervical dilatation and relaxation of the lower segment. For this purpose, rectal suppositories with antispasmodic drugs (papaverine, no-shpa, baralgin) are prescribed, 1 every hour No. 3.

Cervical dilation period - active phase

In the active phase (opening of the cervix from 4 to 8 cm), there is a gradual increase in the tone of the uterus (up to 11-12 mm Hg). The frequency of contractions increases to 3-5 in 10 minutes, the duration of systole and diastole equalizes to 60-90 s. Intrauterine pressure during contractions rises to 40-50 mm Hg. Art. The duration of the active phase is almost the same in primiparous and multiparous women and is 3-4 hours. The active phase is characterized by intense labor and rapid opening of the uterine os. The opening rate is 1.5-2 cm / h in the primiparous and 2.5-3.0 cm / h in the multiparous. At the same time, the fetal head moves along the birth canal. At the end of the active phase, there is a complete or almost complete opening of the uterine os. The cervix completely merges with the lower segment of the uterus, the edges of the uterine os are at the level of the spinal plane.

The fetal head moves along the birth canal synchronously with the opening of the uterine os. So, at 6 cm of opening of the uterine os, the head is located in a small segment at the entrance of the small pelvis or is +1 cm away from the spinal plane. At 8 cm of opening, the fetal head descends as a segment into the entrance of the small pelvis (+2 cm). When fully opened, it is located in the pelvic cavity, most often already on the pelvic floor. With coordinated labor activity in the active phase of labor, reciprocity (conjugation) of the activity of the upper and lower segments of the uterus takes place. Contraction of the fundus and body of the uterus is accompanied by active relaxation of the lower segment of the uterus. The curve of the external hysterography, reflecting the state of the lower segment, has a curve opposite to the upper segment (mirror reflection).

The intensity of labor activity in this phase increases, the tone and frequency of contractions also increase, the rate of cervical dilatation is maximum, contractions most often become painful. In the active phase of labor, it is especially important to maintain the normal basal tone of the uterus, since with hypertonicity of the myometrium (13 mm Hg or more), the frequency of contractions increases above normal values ​​(over 5 per 10 minutes), and the amplitude (strength) of the contraction decreases. This leads to ruptures of the cervix, disruption of the uterine, uteroplacental and fetal-placental blood flow, fetal hypoxia. There may also be a decrease in basal tone (less than 10 mm Hg), leading to a decrease in the frequency of contractions and a decrease in intrauterine pressure. Childbirth with both options is delayed.

The outflow of amniotic fluid with uterine hypertonicity helps to reduce intramyometrial pressure and can normalize uterine contractions. In order to determine the nature of the violations of contractions that have arisen, one should first of all evaluate the tone of the myometrium (decreased, increased, normal), as well as the rhythm, frequency, duration and strength of the contraction. Labor activity is the work of the uterus (of course, and the whole body of the woman in labor), aimed at opening the birth canal, promoting and expelling the fetus, separating and isolating the placenta.

This work is carried out mainly due to the mechanical contractile function of the uterus and is provided with the necessary energy of biochemical, metabolic, oxidative processes, intensification of the activity of the cardiovascular, respiratory, neuroendocrine and autonomic nervous systems. With an average amplitude of contraction of the upper segment of the uterus, which is 50 mm Hg. Art., normal basal tone of the uterus in 10-12 mm Hg. Art., the number of contractions in childbirth ranges from 240 to 300 (24-30 contractions per hour). This work often causes fatigue, fatigue in a woman in labor, especially since the contractions are almost always painful, they begin at night, which the woman spends in anxiety and excitement.

In the active phase of labor, it is necessary to use drug anesthesia (oxygen-oxide analgesia or a single administration of promedol 20 mg) in combination with antispasmodic drugs. The latter are especially useful for the prevention of cervical rupture, smoother opening of the cervix and stretching of the vaginal walls. Antispasmodics (no-shpa 4 ml or baralgin 5 ml) are administered either intravenously by drip or intravenously simultaneously (2 ml with glucose solution).

Amniotic fluid - outpouring

The fetal bladder bursts at the height of one of the contractions when opening 6-8 cm. 150-200 ml of light (transparent) amniotic fluid is poured out.

If there was no spontaneous outflow of amniotic fluid, then when the uterine os is opened by 6-8 cm, an artificial amniotomy is performed. However, in this case, it is advisable to pre-administer antispasmodic drugs so that a too rapid decrease in the volume of the uterus does not provoke hypertonic contraction dysfunction.

Amniotomy is accompanied by a short-term decline in uteroplacental blood flow and a change in the heart rate of the fetus (often bradycardia). Therefore, in addition to antispasmodics, before amniotomy, 40.0 ml of a 40% glucose solution and 5 ml of a 5% ascorbic acid solution, 150 mg of cocarboxylase are prescribed to maintain the energy level and oxygenation of the fetus.

Cervical dilation period - third phase

The third phase of the first stage of labor (not expressed in all women in labor) is called the deceleration phase. It is determined from the moment of opening the cervix by 8 cm and continues until the full (10-12 cm) opening of the uterine os. Its duration is from 20 to 60 minutes.

In this short phase of slowing labor, the tone of the uterus changes (increases by another 2-3 mm), the strength (amplitude) of contractions weakens somewhat, the frequency remains the same (from 4.4 to 5 contractions in 10 minutes).

The physiological essence of this phase is that the contractile activity of the uterus is rebuilt to the function of fetal expulsion. The entire uterus acts in the same direction. Uterine contractions occur synchronously from the bottom to the uterine os. The task is one - to expel the fetus from the birth canal. At the same time, all departments and layers of the uterus contract and relax.

The deceleration phase is considered transitional from the first stage of labor to the second. The delayed phase of labor is based on two factors of biological expediency: one is the need for a slower (careful) advancement of the fetal head through the spinal plane - the narrowest part of the closed bone ring of the pelvis, and the second - in the accumulation of the energy potential of the uterus for the most intensive work on a relatively a short period of time.

The delayed phase of the first stage of labor is isolated so that the doctor does not rush to diagnose the secondary weakness of labor and does not apply unindicated labor stimulation.

During the entire first stage of labor, the condition of the mother and her fetus is constantly monitored. They monitor the intensity and effectiveness of labor activity (the number of contractions in 10 minutes, the duration of contraction and relaxation of the uterus, its tone), the condition of the woman in labor (health, pulse rate, respiration, blood pressure, temperature, discharge from the genital tract).

The period of cervical dilatation - the condition of the bladder and intestines

In childbirth, it is necessary to monitor the function of the bladder and intestines. Overflow of the bladder and rectum prevents the normal course of the period of disclosure and expulsion, the release of the placenta. Overflow of the bladder may occur due to its atony, in which the woman does not feel the urge to urinate, as well as due to the pressing of the urethra against the pubic symphysis by the fetal head. In order to prevent overflow of the bladder, the woman in labor is offered to urinate every 2-3 hours. In the absence of independent urination, they resort to catheterization. Timely emptying of the lower intestine is important (enemas before childbirth and during their protracted course). In the history of childbirth, the presence or absence of spontaneous urination every 2 hours is noted. Difficulty or lack of urination is a sign of pathology.

Vaginal examination during childbirth

A vaginal examination during childbirth is performed to maintain a partogram (WHO, 1993), orientation in the insertion and advancement of the head, assessment of the location of sutures and fontanelles, i.e., to clarify the obstetric situation.

Mandatory vaginal examinations are indicated in the following situations:

• when a woman enters the maternity hospital;
• with the discharge of amniotic fluid;
• with the onset of labor (assessment of the condition and disclosure of the cervix);
• with anomalies of labor activity (weakening or excessively strong, painful contractions, as well as early onset attempts);
• before anesthesia (find out the cause of painful contractions);
• with the appearance of bloody discharge from the birth canal.

The results of the vaginal examination reflect the effectiveness of labor activity (the degree of opening of the uterine os, the advancement of the fetal head), the biomechanism of childbirth.

You should not be afraid of frequent vaginal examinations, it is much more important to ensure their complete safety in terms of asepsis, antisepsis and atraumaticity (carry out with cleanly washed hands, in sterile gloves using disinfectant solutions, sterile liquid vaseline oil). Research must be carried out gently, carefully and painlessly.

During vaginal examination during childbirth, attention should be paid not only to the degree of cervical dilatation, the position of the sutures and fontanelles of the fetus, the pelvic bones and its capacity, but also to the condition of the edges of the cervix.

During normal labor, the edges of the cervix are thin, soft, easily extensible. In a fight, the edges of the neck do not tighten, which indicates a good relaxation of the tissues; the fetal bladder is well expressed. In a pause between contractions, the tension of the fetal bladder weakens, and through the fetal membranes it is possible to determine the identification points on the head: the sagittal suture, the posterior (small) fontanel, the wire point.

The position of the woman in childbirth

Particular attention deserves the position of the woman in childbirth. Historical evidence shows that the supine position has been predominantly common in France since the 17th century, when Marie de Medici, the daughter-in-law of Countess Duchesse Monpezier, Marie de Medici, gave birth in this position in the presence of the royal court midwife, Louise Burgois, and the barber-obstetrician, Julien Clémont. Childbirth in the presence of a man led to the spread in the higher spheres of the position of the woman in labor on her back. This custom was widely promoted by such famous obstetricians as Pare and Morisot. Childbirth on the back has become a tradition for a number of centuries. Obstetric practice readily accepted this method as beneficial and convenient, first of all, for the obstetrician (it is more convenient to conduct a vaginal examination, listen to the fetal heartbeat, carry out cardiomonitor control, etc.).

However, a comprehensive assessment of the various positions of the woman in labor, carried out independently in 3 centers (Germany, Spain and the USA), showed that the position of the woman in labor on her back is not the most beneficial for the contractile activity of the uterus (contractions weaken), for the fetus (uteroplacental blood flow decreases ) and for the woman herself (danger of compression of the inferior vena cava). In this regard, most obstetricians recommend that women in labor in the first stage of labor sit, walk (for short periods of time), stand or lie on their side. In the future, apparently, it will be possible for a woman in labor to stay in a warm pool in the first stage of labor.

You can get up and walk with whole or outflowing waters, but with a tightly fixed fetal head in the pelvic inlet.

If the localization of the placenta is known (according to ultrasound data), then the position of the woman in labor on the side where the back of the fetus is located is optimal. In this position, the frequency and intensity of contractions do not decrease, the basal tone of the uterus remains normal. In addition, studies have shown that this position improves the blood supply to the uterus, uterine and uteroplacental blood flow. The fetus is always located facing the placenta.

A woman in labor in the first stage of labor

In the first stage of labor, in the active phase of cervical dilatation, a woman in labor can perform psychoprophylactic analgesia techniques. Feeding a woman in labor during childbirth is not recommended for a number of reasons: the food reflex during childbirth is suppressed. During childbirth, a situation may arise in which anesthesia is required. The latter creates a risk of regurgitation (aspiration of the contents of the stomach) and the development of Mendelssohn's syndrome.

During childbirth, the position and advancement of the head in relation to the plane of the entrance of the small pelvis and in relation to the spinal plane (the narrowest plane of the small pelvis) are constantly assessed. They listen to the fetal heartbeat (the results are recorded in the history of childbirth), but most often they carry out constant cardiomonitoring. Coordinated contractions of the uterus during childbirth provide a normal biomechanism of labor.

Identification points at different positions of the fetal head

Recall the identification points at different positions of the fetal head in relation to the main planes of the pelvis.

1. Head above the entrance of the small pelvis. The entire head is located above the entrance of the small pelvis, movable or pressed against the entrance of the small pelvis. During vaginal examination: the pelvis is free, the head is high, does not interfere with the palpation of the border (nameless) lines of the pelvis, the cape (if it is achievable), the inner surface of the sacrum and the pubic symphysis. Sagittal suture in transverse size at the same distance from the pubic symphysis and promontory, anterior and posterior fontanelles at the same level (with occiput presentation). In relation to the spinal plane, the head is in position -3 or -2 cm.

2. The head at the entrance of the small pelvis with a small segment. The head is motionless. Most of it is above the entrance to the pelvis, a small segment of the head is below the plane of the entrance to the pelvis. During vaginal examination: the sacral cavity is free, you can approach the promontory with a bent finger. The inner surface of the pubic symphysis is accessible for examination, the posterior fontanelle is lower than the anterior one (flexion). The sagittal suture is transverse or slightly oblique. In relation to the spinal plane, the head is -1 cm apart.

3. Head at the entrance of the small pelvis with a large segment. With an external examination, it is determined that the head with its largest circumference (large segment) has descended into the cavity of the small pelvis.

The smaller segment of the head is palpated from above. During vaginal examination, the head covers the upper third of the pubic symphysis and sacrum, the cape is not achievable, the ischial spines are easily palpable. The head is bent, the posterior fontanel is lower than the anterior, the sagittal suture is in one of the oblique dimensions. In relation to the spinal plane - "O".

4. Head in a wide part of the pelvic cavity. With an external examination, only a small part of the head is probed. During vaginal examination - the head of the largest circumference passed the plane of the wide part of the pelvic cavity; 2/3 of the inner surface of the pubic symphysis and the upper half of the sacral cavity are occupied by the head. The vertebrae SIV and Sv and the ischial spines are freely palpable. The sagittal suture is located in one of the oblique dimensions. In relation to the spinal plane, the head is +1 cm apart.

5. Head in the narrow part of the pelvic cavity. During vaginal examination, it is determined that the two upper thirds of the sacral cavity and the entire inner surface of the pubic symphysis are occupied by the head. Only vertebrae SIV and SV are palpated. The sagittal suture is in an oblique size, closer to a straight one. The head with the lower pole is in the +2 cm position.

6. Head in the outlet of the pelvis. On external examination, the head is not palpable. The sacral cavity is completely filled with the head, the sciatic spines are not defined, the sagittal suture is located in the direct size of the exit of the small pelvis (in relation to the "0" plane +3 cm).

childbirth- this is the process of expulsion or extraction from the uterus of the child and the placenta (placenta, amniotic membranes, umbilical cord) after the fetus has reached viability. Normal physiological childbirth proceeds through the natural birth canal. If the child is removed by caesarean section or with the help of obstetric forceps, or using other delivery operations, then such births are operational.

Usually, timely delivery occurs within 38-42 weeks of the obstetric period, if counted from the first day of the last menstruation. At the same time, the average weight of a full-term newborn is 3300 ± 200 g, and its length is 50-55 cm. Births that occur at 28-37 weeks. pregnancies before are considered premature, and more than 42 weeks. - belated. The average duration of physiological childbirth ranges from 7 to 12 hours in primiparous, and in multiparous from 6 to 10 hours. Childbirth that lasts 6 hours or less is called fast, 3 hours or less - rapid, more than 12 hours - protracted. Such births are pathological.

Characteristics of normal vaginal delivery

• Single pregnancy.
• Head presentation of the fetus.
• Full proportionality of the fetal head and mother's pelvis.
• Full-term pregnancy (38-40 weeks).
• Coordinated labor activity that does not require corrective therapy.
• Normal biomechanism of childbirth.
• Timely discharge of amniotic fluid when the cervix is ​​dilated by 6-8 cm in the active phase of the first stage of labor.
• The absence of serious ruptures of the birth canal and surgical interventions in childbirth.
• Blood loss during childbirth should not exceed 250-400 ml.
• The duration of labor in primiparous is from 7 to 12 hours, and in multiparous from 6 to 10 hours.
• The birth of a live and healthy child without any hypoxic-traumatic or infectious injuries and developmental anomalies.
• The Apgar score at the 1st and 5th minutes of a child's life should correspond to 7 points or more.

Stages of physiological childbirth through the natural birth canal: development and maintenance of regular contractile activity of the uterus (contractions); changes in the structure of the cervix; gradual opening of the uterine os up to 10-12 cm; promotion of the child through the birth canal and his birth; separation of the placenta and excretion of the placenta. In childbirth, three periods are distinguished: the first is the opening of the cervix; the second is the expulsion of the fetus; the third is sequential.

First stage of labor - dilation of the cervix

The first stage of labor lasts from the first contractions to the full opening of the cervix and is the longest. In primiparous it is from 8 to 10 hours, and in multiparous 6-7 hours. There are three phases in the first period. First or latent phase the first stage of labor begins with the establishment of a regular rhythm of contractions with a frequency of 1-2 per 10 minutes, and ends with smoothing or pronounced shortening of the cervix and opening of the uterine os by at least 4 cm. The duration of the latent phase is on average 5-6 hours. In primiparas, the latent phase is always longer than in multiparas. During this period, the contractions, as a rule, are still slightly painful. As a rule, any medical correction in the latent phase of childbirth is not required. But in women of late or young age, if there are any complicating factors, it is advisable to promote the processes of opening the cervix and relaxing the lower segment. For this purpose, it is possible to prescribe antispasmodic drugs.

After opening the cervix by 4 cm, the second or active phase the first stage of labor, which is characterized by intense labor and rapid opening of the uterine os from 4 to 8 cm. The average duration of this phase is almost the same in primiparous and multiparous women and averages 3-4 hours. The frequency of contractions in the active phase of the first stage of labor is 3-5 per 10 minutes. Contractions often become painful. Pain is predominant in the lower abdomen. With the active behavior of a woman (position "standing", walking), the contractile activity of the uterus increases. In this regard, drug anesthesia is used in combination with antispasmodic drugs. The fetal bladder should open on its own at the height of one of the contractions when the cervix opens by 6-8 cm. At the same time, about 150-200 ml of light and clear amniotic fluid is poured out. If there was no spontaneous outflow of amniotic fluid, then when the uterine os is opened by 6-8 cm, the doctor should open the fetal bladder. Simultaneously with the opening of the cervix, the fetal head advances through the birth canal. At the end of the active phase, there is a complete or almost complete opening of the uterine os, and the fetal head descends to the level of the pelvic floor.

The third phase of the first stage of labor is called deceleration phase. It begins after the opening of the uterine os by 8 cm and continues until the cervix is ​​fully dilated up to 10-12 cm. During this period, it may seem that labor activity has weakened. This phase in primiparous lasts from 20 minutes to 1-2 hours, and in multiparous may be completely absent.

During the entire first stage of labor, the condition of the mother and her fetus is constantly monitored. They monitor the intensity and effectiveness of labor, the condition of the woman in labor (health, pulse rate, respiration, blood pressure, temperature, discharge from the genital tract). Regularly listen to the fetal heartbeat, but most often carry out constant cardiomonitoring. In the normal course of childbirth, the child does not suffer during uterine contractions, and his heart rate does not change significantly. In childbirth, it is necessary to assess the position and advancement of the head in relation to the landmarks of the pelvis. A vaginal examination during childbirth is performed to determine the insertion and advancement of the fetal head, to assess the degree of opening of the cervix, to clarify the obstetric situation.

Mandatory vaginal examinations perform in the following situations: when a woman enters the maternity hospital; with the outflow of amniotic fluid; with the onset of labor activity; with deviations from the normal course of childbirth; before anesthesia; with the appearance of bloody discharge from the birth canal. One should not be afraid of frequent vaginal examinations, it is much more important to provide a complete orientation in assessing the correctness of the course of childbirth.

Second stage of labor - expulsion of the fetus

The period of expulsion of the fetus begins from the moment of full disclosure of the cervix and ends with the birth of a child. In childbirth, it is necessary to monitor the function of the bladder and intestines. Bladder and rectal overflow interferes with the normal course of childbirth. In order to prevent overflow of the bladder, the woman in labor is offered to urinate every 2-3 hours. In the absence of independent urination, they resort to catheterization. Timely emptying of the lower intestine is important (enemas before childbirth and during their protracted course). Difficulty or lack of urination is a sign of pathology.

The position of the woman in childbirth

Particular attention deserves the position of the woman in childbirth. In obstetric practice, the most popular are childbirth on the back, which is convenient from the point of view of assessing the nature of the course of labor. However, the position of the woman in labor on her back is not the best for the contractile activity of the uterus, for the fetus and for the woman herself. In this regard, most obstetricians recommend that women in labor in the first stage of labor sit, walk for a short time, and stand. You can get up and walk both with whole and outflowing waters, but on condition that the fetal head is tightly fixed in the pelvic inlet. In some cases, it is practiced that a woman in labor is in the first stage of labor in a warm pool. If it is known (according to ultrasound) the location of the placenta, then the optimal is the position of the woman in labor on that side where the back of the fetus is located. In this position, the frequency and intensity of contractions do not decrease, the basal tone of the uterus remains normal. In addition, studies have shown that this position improves the blood supply to the uterus, uterine and uteroplacental blood flow. The fetus is always located facing the placenta.

Feeding a woman in childbirth is not recommended for a number of reasons: the food reflex during childbirth is suppressed. During childbirth, a situation may arise in which anesthesia is required. The latter creates the danger of aspiration of the contents of the stomach and acute respiratory failure.

From the moment the uterine os is fully opened, the second stage of childbirth begins, which consists in the actual expulsion of the fetus, and ends with the birth of a child. The second period is the most critical, since the fetal head must pass through a closed bone ring of the pelvis, which is narrow enough for the fetus. When the presenting part of the fetus descends to the pelvic floor, contractions of the abdominal muscles join the contractions. Attempts begin, with the help of which the child moves through the vulvar ring and the process of his birth takes place.

From the moment the head is inserted, everything should be ready for delivery. As soon as the head has cut through and does not go deep after an attempt, they proceed directly to the reception of childbirth. Help is needed because, when erupting, the head exerts strong pressure on the pelvic floor and perineal ruptures are possible. With obstetric benefits protect the perineum from damage; carefully remove the fetus from the birth canal, protecting it from adverse effects. When removing the fetal head, it is necessary to restrain its excessively rapid advancement. In some cases, perform perineal incision to facilitate the birth of a child, which avoids the insolvency of the pelvic floor muscles and the prolapse of the walls of the vagina due to their excessive stretching during childbirth. Usually the birth of a child occurs in 8-10 attempts. The average duration of the second stage of labor in primiparas is 30-60 minutes, and in multiparous 15-20 minutes.

In recent years, so-called vertical delivery. Proponents of this method believe that in the position of a woman in labor, standing or kneeling, the perineum is more easily stretched, and the second stage of labor is accelerated. However, in this position it is difficult to observe the state of the perineum, prevent its ruptures, and remove the head. In addition, the strength of the arms and legs is not fully used. As for the use of special chairs for receiving vertical births, they can be attributed to alternative options.

Immediately after the birth of a child umbilical cord is not clamped, and it is located below the level of the mother, then there is a reverse "infusion" of 60-80 ml of blood from the placenta to the fetus. In this regard, the umbilical cord during normal delivery and a satisfactory condition of the newborn should not be crossed, but only after the cessation of vascular pulsation. At the same time, until the umbilical cord is crossed, the child cannot be raised above the plane of the delivery table, otherwise there is a reverse outflow of blood from the newborn to the placenta. After the birth of a child, the third stage of childbirth begins - afterbirth.

Third stage of labor - afterbirth

The third period (afterbirth) is determined from the moment the child is born until the separation of the placenta and the release of the placenta. In the afterbirth period, within 2-3 contractions, the placenta and membranes are separated from the walls of the uterus and the placenta is expelled from the genital tract. In all women in childbirth in the afterbirth period, intravenous administration is administered to prevent bleeding. drugs that promote uterine contraction. After childbirth, a thorough examination of the child and mother is carried out in order to identify possible birth injuries. In the normal course of the succession period, blood loss is no more than 0.5% of body weight (average 250-350 ml). This blood loss is physiological, since it does not adversely affect the woman's body. After the expulsion of the placenta, the uterus enters a state of prolonged contraction. When the uterus contracts, its blood vessels are compressed, and the bleeding stops.

Newborns spend screening assessment for phenylketonuria, hypothyroidism, cystic fibrosis, galactosemia. After childbirth, information about the characteristics of childbirth, the condition of the newborn, the recommendations of the maternity hospital are transferred to the doctor of the antenatal clinic. If necessary, the mother and her newborn are consulted by narrow specialists. Documentation about the newborn goes to the pediatrician, who then monitors the child.

It should be noted that in some cases, preliminary hospitalization in the maternity hospital is necessary to prepare for delivery. The hospital conducts in-depth clinical, laboratory and instrumental examinations to select the timing and method of delivery. For each pregnant woman (parturient woman), an individual plan for the conduct of childbirth is drawn up. The patient is introduced to the proposed plan for the management of childbirth. Get her consent to the alleged manipulations and operations in childbirth (stimulation, amniotomy, caesarean section).

Caesarean section is performed not at the request of a woman, since this is an unsafe operation, but only for medical reasons (absolute or relative). Childbirth in our country is not carried out at home, but only in an obstetric hospital under direct medical supervision and control, since any childbirth is fraught with the possibility of various complications for the mother, fetus and newborn. Childbirth is conducted by a doctor, and the midwife, under the supervision of a doctor, provides manual assistance at the birth of the fetus, carries out the necessary processing of the newborn. The birth canal is examined and restored by a doctor if it is damaged.