Pregnancy

Periods of labor and their course

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Childbirth is a physiological process that takes place naturally and ends with the birth of a child. It is normal that every woman is worried on the eve of such an important event. But fears and experiences should not prevent her from relieving herself from the burden. To go through all periods of childbirth is not an easy test, but at the end of this journey a woman is waiting for a miracle.

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

Harbingers of childbirth, what are they?

Harbingers of childbirth are called changes in the body of a woman, which begins at about 37 weeks of pregnancy. In the later periods, the following changes occur:

  1. Sharp weight loss. A weight loss of 1-2 kg at the end of the third trimester of pregnancy is completely normal. Excess fluid during this period is gradually excreted from the body, which signals the beginning of its preparation for childbirth.
  2. Frequent urination and diarrhea. Frequent urging to the toilet suggests that labor can begin at any time. The child is gaining weight and by the end of the pregnancy, the enlarged uterus is pressing on the intestines and bladder of the woman.
  3. Discharge of mucus plug. A pregnant woman who is closely monitoring her health can notice changes in daily secretions from the genital tract. The increase in their number and the presence of a small lump or streak of mucus are the result of the preparation of the cervix for childbirth. But if the discharge is abundant, with an unpleasant smell and an admixture of blood, an urgent need to contact your local gynecologist, or call an ambulance.
  4. Aching pain in the lower abdomen or back. Such discomfort is usually associated with training fights. They do not have a clear periodicity, do not increase, and eventually cease. So muscle tissue is preparing for the upcoming work in childbirth. Training fights usually subside when the body position changes.
  5. Omission of the abdomen. This is a sign that the baby is preparing for childbirth. If he is in the correct position, then his head is already inserted in the pelvis. During this period, pregnant women note ease, despite the large belly. This happens because the uterus with the baby goes down and makes more space for the lungs, stomach and other internal organs of the future mother. If a woman is bothered by heartburn, she usually goes away after the abdominal ptosis.
  6. Changes in the cervix (smoothing, softening). The woman does not feel them, to judge the readiness of the cervix for childbirth can obstetrician-gynecologist during the examination.
  7. Decreased fetal motor activity. At the end of the pregnancy, the woman notices that the baby has become less moving. This is normal, because it is growing rapidly and there is less room for movement. But one should not overlook the very active behavior of the child during this period. Often, it signals that the baby does not have enough oxygen. Read more about fetal hypoxia →

To dispel doubts, you must undergo an examination (ultrasound, CTG, Doppler) and consult a doctor.


Periods of labor: their duration and characteristics

Childbirth consists of certain stages of labor. There are only three of them, and every woman has to put some effort into helping a new man to be born.

Normally, the first birth lasts 8-12 hours, the second and subsequent pass faster. But there may be cases of protracted (more than 18 hours) or rapid delivery, when from the start of contractions to the appearance of a child it takes about an hour.

The first stage of labor

This is one of the longest periods of labor in obstetrics. It begins with the aching stinging in the lower abdomen or back. There are three active phases:

  1. Latent phase Contractions of the uterus become regular, the gap between them decreases, they repeat with a frequency of 15-20 minutes. Usually after 5-6 hours of such contractions, the cervix opens to 4 cm.
  2. Active phase The intensity and pain of contractions is increasing. The woman has 5-6 minutes to try to rest between contractions. At this stage, rupture of the amniotic fluid may occur. If necessary, this process helps the doctor. Due to the frequent painful contractions that follow each other with increasing frequency, after a few hours the opening of the uterine mouth is already 8 cm.
  3. Transitional phase Pain decreases slightly. In a woman in labor may be a desire to push. But until the uterus has fully opened, this can not be done, otherwise there is a risk of injuring the child and harming their own health. Phases of the first period end when an obstetrician-gynecologist ascertains full disclosure of 10 cm.

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

The slightest suspicion or doubt is a reason to go to the maternity hospital and make sure that everything is in order with the child. A timely examination by a specialist will help prevent possible complications and ascertain whether the labor has begun.

The second period of labor

As is known, periods of childbirth and their duration are individual for each woman and take place in different ways for all. At the second stage, a difficult, but very important work awaits the parturient. Its result will depend on the joint efforts of the woman and the medical staff of the hospital.

So, a 10 cm neck opening and attempts are a sign of the body’s complete readiness for the birth of a child.

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

During the second stage of labor, in order to avoid multiple breaks, it may be necessary to make a perineal incision (episiotomy). This is required if the child has a large head or a large weight. After childbirth, a woman under local or general anesthesia is stitched to incision sites.

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

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

The third stage of labor

Stages of labor activity are approaching their logical conclusion, it remains only to give birth to the placenta. The uterus begins to contract again, but the intensity of the painful sensations is significantly reduced and, after several attempts, the woman gets rid of the afterbirth.

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

When the afterbirth is incomplete, doctors must perform a manual examination of the uterus. The procedure takes place under anesthesia and over the next several hours the condition of the woman is observed.

The third period for a happy mom runs almost unnoticed. A baby is taken from her to weigh and assess his general condition. She no longer feels pain, all attention is focused on the newborn, which is first applied to the chest.

Methods to facilitate the birth process

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

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

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

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

Visiting such classes, pregnant women learn to behave properly during childbirth, get acquainted with various breathing techniques and massage techniques. Instructors not only tell, but also clearly demonstrate all the techniques and ways to facilitate the generic process.

The author: Natalia Kochetkova,
specifically for Mama66.ru

1 (first) period of birth - the period of disclosure:

This period of childbirth begins after a short or prolonged preliminary period, the final smoothing of the cervix occurs and the opening of the external pharynx of the cervical canal to a degree sufficient for the expulsion of the fetus from the uterus, t.


E. 10 cm or, as noted in the old days - 5 cross fingers.

Cervical dilatation occurs differently in primiparous and multiparous women.
In primiparous women, the inner pharynx first opens, and then the outer one, and in the case of multiparous women, the inner and outer jaw open at the same time. In other words, the woman first gives birth to a shortening and smoothing of the neck, and only then the opening of the external pharynx. In a heterogeneous woman, both shortening, smoothing, and opening of the neck occur simultaneously.

As already mentioned, the smoothing of the cervix and the opening of the external pharynx occurs due to retractions and distractions. The average rate of disclosure of the neck from 1 to 2 cm per hour. The cervical dilatation is promoted by moving the amniotic fluid towards the lower pole of the fetal bladder.

When the head is lowered and pressed against the entrance to the small pelvis, it is on all sides in contact with the area of ​​the lower segment. The location of the head of the fetus walls of the lower uterus segment is called the belt of contact, which divides the amniotic fluid into the front and rear. Under the pressure of the amniotic fluid, the lower pole of the fetal egg (fetal bladder) exfoliates from the walls of the uterus and penetrates the inner pharynx of the cervical canal.

During contractions, the fetal bladder is poured with water and strained, contributing to the opening of the cervix. The rupture of the membranes occurs at the maximum stretch of the lower pole during the contraction. The optimal is the spontaneous opening of the fetal bladder when cervical dilatation is 7-8 cm in a primiparous woman, and in a repetitive woman 5-6 cm disclosure is enough. Promotion of the head through the birth canal contributes to greater stress. If the water does not flow away, they are artificially dissected, which is called amniotomy. With the insolvency of the fetal membranes of water depart earlier.

The discharge of waters prior to the onset of labor activity is considered premature, the earliest - in the first stage of labor, but before optimal disclosure. With spontaneous or artificial dissection of the fetal bladder, the front amniotic fluid flows away, and the back water is poured out along with the child.

As the cervix opens (especially after the discharge of the front waters), the head does not hold anything, and it goes down (moves along the birth canal). During the first period of physiological labor, the head performs the first two points of the biomechanism of labor: bending and internal rotation, while the head is lowered into the pelvic cavity or the pelvic floor.

Falling down, the head goes through the following steps: above the entrance to the pelvis, pressed to the entrance to the pelvis, a small segment at the entrance to the pelvis, a large segment at the entrance to the pelvis, in the pelvic cavity, on the pelvic floor. Promotion of the head is promoted by regular contractions, the characteristics of which are given. Pushing the fetus most contributes to the contractile activity of the body of the uterus.

In normal labor, the first period of labor flows harmoniously in terms of the main indicators: cervical dilatation, contractions, lowering of the head and discharge of water. The first period begins with regular contractions (lasting at least 25 seconds, with an interval of no more than 10 minutes) and opening the neck (in this case, the whole waters and the head pressed against the entrance to the small pelvis are optimal). The first period ends when the cervix is ​​fully opened (10 cm), contractions - every 3-4 minutes for 50 s, and the attempts begin, the waters have moved, and the head should sink to the pelvic floor by this time. In the first stage of labor, three phases are distinguished: latent, active, and transient.

The latent phase is 50-55% of the duration of the first period, begins with the onset of regular contractions and the beginning of the opening of the cervix, at the end of her contractions should be 30–35 seconds after 5 minutes, the cervix opening 3-4 cm. pelvis. The duration of this phase depends on the readiness of the birth canal and is 4-6 hours.

The active phase lasts no more than 30–40% of the total time of the disclosure period, its initial characteristics are the same as at the end of the latent period. By the end of the active phase, the opening is 8 cm, contractions in 3-5 minutes at 45 s, the head is in a small or even large segment at the entrance to the pelvis. By the end of this period, amniotic fluid or amniotomy should be withdrawn.

Transient phase lasts no more than 15% of the time, with multiplicative faster. It ends with a complete opening of the neck, contractions to its end should be every 3 min for 50-60 s, the head sinks into the pelvic cavity or even sinks to the pelvic floor.

2 (second) period of birth - the period of exile:

It begins after the full opening of the throat and ends with the birth of a child. Waters by this period must move. The contractions become more powerful and occur every 3 minutes for almost a minute. All kinds of contractions reach a maximum: both contractile activity, and retractions, and distractions.

Head in the pelvic cavity or pelvic floor. Intra-uterine pressure increases, and then intra-abdominal pressure. The walls of the uterus become thicker and more tightly wraps around the fetus. The unfolded lower segment and the smoothed cervix with an open throat form together with the vagina the birth canal, which corresponds to the size of the head and body of the fetus.

By the beginning of the expulsion period, the head intimately comes into contact with the lower segment - the inner belt of contact and with it closely adjoins the walls of the small pelvis - the outer belt of contact. The attempts are joined to the contractions - reflexively arising contractions of the striated muscles of the abdominals. A woman in labor can manage - to strengthen or weaken.

During the attempt, the woman's breath is delayed, the diaphragm is lowered, the abdominal muscles become very tense, the intrauterine pressure increases. Плод под влиянием изгоняющих сил приобретает очертание баклажана: позвоночник плода разгибается, скрещенные ручки плотнее прижимаются к туловищу, плечики поднимаются к головке, и верхний конец плода приобретает цилиндрическую форму, ножки согнуты в тазобедренных и коленных суставах.

Translational movements of the fetus are made along the wire axis of the pelvis (the axis of the pelvis, or the axis of the birth canal, passes through the intersection points of the direct and transverse dimensions of the four classical planes of the pelvis). The pelvic axis is bent in accordance with the concave shape of the front surface of the sacrum, at the exit of the pelvis, it is directed anteriorly to the symphysis. The bone channel is characterized by the unequal size of its walls and sizes in separate planes. The walls of the pelvic uneven. Symphysis much shorter than the sacrum.

The soft tissues of the birth canal, in addition to the unfolded lower segment and vagina, include the parietal muscles of the pelvis and the pelvic floor. The pelvic muscles lining the bony canal smooth out the unevenness of its inner surface, which creates favorable conditions for the advancement of the head. The muscles and fascia of the pelvic floor and the Boulevard ring until the last moments of childbirth offer resistance to the advancing head, thereby facilitating its rotation around the horizontal axis. Resisting, the muscles of the pelvic floor at the same time stretch, mutually displace and form an elongated outlet tube, the diameter of which corresponds to the size of the nascent head and body of the fetus. This tube, which is a continuation of the bone canal, is not rectilinear, it goes obliquely, curving in the form of an arc.

The lower edge of the birth canal is formed by the vulvar ring. The wired line of the birth canal has the shape of a curve ("fishing hook"). In the bone canal it goes downwards almost straight, and at the bottom of the pelvis - bends and goes anteriorly. In the first stage of labor, the head is flexed and its internal rotation occurs, and in the second stage of labor, the remaining moments of the biomechanism of the childbirth.

3 (third) period - follow-up period:

3 period of childbirth ends with the birth of a child. Its duration is 30–60 min in primiparous and 20–30 min. During this period, the woman feels frequent, long, strong and painful contractions, feels strong pressure on the rectum and the muscles of the perineum, which causes her to push. She does very hard physical work and is under stress. In this regard, there may be an increase in pulse rate, an increase in blood pressure, due to tension and delay in breathing, there is a flushing of the face, an abnormal rhythm of breathing, tremors and muscle cramps. After the birth of the fetus, the third stage of labor begins - the afterbirth.

In the third stage of labor occurs:

1. The separation of the placenta and membranes from the walls of the uterus.
2. The expulsion of exfoliated afterbirth from the genital tract.

A few minutes after the birth of the fetus, contractions resume, contributing to the detachment of the placenta and the expulsion of the separated afterbirth (placenta, membrane, umbilical cord). After the birth of the fetus, the uterus decreases and becomes rounded, its bottom is located at the level of the navel. With subsequent contractions, the entire musculature of the uterus is reduced, including the area of ​​attachment of the placenta - the placental site. The placenta does not shrink, and therefore it is shifted from a smaller placental site.

The placenta forms folds, bulging into the uterine cavity, and, finally, exfoliate from its wall. The placenta exfoliates in the spongy (spongy) layer, in the area of ​​the placental site on the wall of the uterus the basal layer of the mucous membrane and gastric of the spongy layer will remain.

In violation of the connection between the placenta and the uterine wall, the uteroplacental vessels of the placental site rupture. The separation of the placenta from the uterine wall occurs from the center or from the edges. With the beginning of placental detachment from the center, blood accumulates between the placenta and the uterus wall, and a retro-placental hematoma is formed. The growing hematoma contributes to the further detachment of the placenta and its protrusion into the uterine cavity.

When trying to escape, the placenta leaves the genital tract with the fetal surface to the outside, the membranes are turned inside out (the water membrane is outside), the maternal surface is facing the inside of the afterbirth. This variant of placental abruption, described by Schulze, is more common. If the separation of the placenta begins from the periphery, then the blood from the damaged vessels does not form a retroplacental hematoma, but flows down between the wall of the uterus and the membranes. After complete separation, the placenta slides down and pulls the shell.

The placenta is born with the lower edge forward, the maternal surface outward. Shells retain the location in which they were located in the uterus (the water shell inside). This option is described by Duncan. The birth of the afterbirth, separated from the walls of the uterus, apart from contractions, is promoted by the attempts that occur when the afterbirth moves into the vagina and irritates the muscles of the pelvic floor. In the process of excretion of the placenta, the severity of the placenta and retroplacental hematoma are of secondary importance.

With the horizontal position of the woman in labor, it is easier to separate the placenta, located on the front wall of the uterus. In normal labor, separation of the placenta from the uterine wall occurs only in the third stage of labor. In the first two periods, the separation does not occur, since the place of attachment of the placenta is reduced less than other departments of the uterus, intrauterine pressure prevents the separation of the placenta.

3 period of labor is the shortest. The tired woman in labor lies calmly, her breathing is even, tachycardia disappears, blood pressure comes to the initial level. Body temperature is usually normal. The skin has a normal color. Sequential contractions usually do not cause discomfort. Moderately painful contractions are only in multiparous.

The bottom of the uterus after the birth of the fetus is located at the level of the navel. During post-labor contractions, the uterus becomes denser, narrower, flatter, the bottom of it rises above the navel and more often deviates to the right side. Sometimes the bottom of the uterus rises to the costal arch. These changes indicate that the placenta, together with the retroplacental hematoma, has descended into the lower uterine segment, while the uterus body has a dense texture, and the lower segment has a softish consistency.

The woman has a desire to push, and the afterbirth is born. In the period following normal birth, physiological blood loss is 100-300 ml, an average of 250 ml or 0.5% of the body weight of the woman in women weighing up to 80 kg (and 0.3% with a body weight over 80 kg). If the placenta is separated in the center (the variant described by Schulze), then blood is secreted along with the placenta. If the separation of the placenta from the edge (option, described by Duncan), then part of the blood is allocated before the birth of the placenta, and often - with him. After the birth of the placenta, the uterus is sharply reduced.

What are childbirth periods?

Waiting for a baby is always associated with a certain amount of excitement. In particular, due to the upcoming birth pregnant women are experiencing for the first time. Excessive anxiety, as a rule, arises due to insufficient awareness of the physiological side of the issue. In order to avoid the emergence of a feeling of fear before the upcoming event, expectant mothers need to know that generic activity is a natural act aimed at driving the fetus out of the womb after it reaches a certain degree of maturity.

As a result of this event, changes occur in the woman’s body, allowing the child to be born unhindered. Thus, the expulsion of the fetus occurs due to the opening of the throat of the cervical canal and intensive uterine contractions. In this case, the minimum allowable period for the natural release of the child from the membranes is 28-29 week of pregnancy.

Average duration of labor

The duration of the process for each woman depends on a huge number of both exogenous and endogenous factors. Along with this, the average duration of natural childbirth in nulliparous is 10-12 hours, while in multiparous ones - 6-8 hours. In some cases, the process can take a protracted nature and last from 1.5 to 2 days. Prompt is the birth of the child into the world within 3 hours after the start of the woman's first uterine contractions.

Periods of labor and their duration

The uncomplicated process of the appearance of a child is characterized by the successive change of one stage by another. There is no doubt that each individual woman gives birth in completely different ways. At the same time, regardless of the duration and intensity of the process, the woman's body invariably undergoes a whole series of hormonal and physical changes. The latter begin to manifest themselves already in the preliminary (preparatory) stage and reach their peak in the subsequent phases of labor:

  • disclosures
  • exile
  • postpartum (puerperalnogo) observation.

Preliminary

This stage can last from several hours to days. During the preparatory period, a woman in labor feels only slight spasms, resembling discomfort at the onset of menstruation. The preliminary stage is characterized by softening and shortening of the cervix, abundant whitish vaginal discharge. In some women, this period may be accompanied by so-called training painless contractions of the uterus, which in obstetrics qualify as Brexton-Hicks contractions and are referred to as precursors to the imminent appearance of the baby.

This stage is considered the most painful and long. For the first and secondary women, the first period is uneven. So, in the first case, there is a gradual opening of the uterine cavity, which lasts about 10 hours. In the second, simultaneous smoothing and expansion of the cervical canal is observed. The duration of the first period in multiparous is 6-7 hours. At the same time, smoothing of the cervical canal and opening of the external pharynx occur under the influence of labor contractions, during which the following muscles are observed in the muscles of the uterus:

  • contraction - reduction of fibers
  • retractions - muscle displacement,
  • distraction - pulling the circulatory muscles of the cervical canal to the sides and upwards.

Against the background of these processes, the lower segment of the uterus becomes smooth, short, soft. This condition indicates an early birth. At the beginning of the opening period, uterine contractions become regular, although still relatively rare, short-lived and weak, and the woman in labor experiences painful sensations of varying intensity.

Based on the assessment of the nature of contractions, the rate of cervical canal opening, the first period includes the following phases:

  1. Latent - at this stage a woman experiences unpleasant pulling sensations in the lower abdomen. In this case, the interval between contractions is relatively the same and amounts to 15-20 minutes. The duration of uterine contractions reaches 10-25 seconds. The latent phase of labor lasts 5-6 hours and ends with a cervical opening up to 4-5 cm. At this stage, anesthesia can be set.
  2. Active - provides for the enhancement of labor activity. The active phase lasts from 1.5 to 3 hours. Disclosure of the cervical canal progresses to 4-8 cm. Against the background of regular contractions of the uterus (every 5-6 minutes), the woman experiences severe pain, which often serves as an indication for pain relief of labor. The majority of women during the active phase disrupts the integrity of the fetal bladder.
  3. Transitional - characterized by some slowdown in the process. In addition, there is an increase in generic pain. The transitional phase lasts 1-2 hours and ends with the full disclosure of uterine pharynx to 11-12 cm.

Normally, all stages of labor activity systematically replace each other. Meanwhile, in a situation where there is a slowdown in the process, it is possible to assign stimulants (drip with pitocin). In addition, if there is a premature rupture of the amniotic fluid, the doctor must control the fetal heartbeat and ensure that the dry period does not exceed 12 hours.

Do primiparous

It is known that the first stage in women who are preparing for the first time to become mothers, proceeds somewhat differently than in women who are experienced in this sense. So, in primiparas, an internal pharynx first opens. Gradually expanding, the cervical canal becomes funnel-shaped. As this process progresses, the cervix is ​​completely smoothed. In the future, there is a stretching and thinning of the edges of the external pharynx, which for multiparous people may be slightly ajar at the end of pregnancy.

At the beginning of this stage, contractions begin in 2-4 minutes and last for 50-60 seconds. In this case, the cervix is ​​fully opened in order to allow the head of the baby to stand in the birth canal. In the second period, attempts at, or spastic contractions of the uterus, join the regular contractions. Conducting childbirth by period helps specialists to track this transitional moment clearly and to prepare a woman for the active expulsion of the fetus from the uterus.

In addition, during attempts, separate attention is paid to proper breathing techniques. During the eruption of the fetal head, it is necessary to take shallow frequent breaths. In this case, all efforts to push the baby should be sent to the crotch area. As a result of these actions (after 3-4 attempts), the child's top head first appears, and then its entire tiny body. After pre-clamping, the baby’s umbilical cord is placed on the mother’s chest. On average, the second stage lasts about 1.5 hours.

After the appearance of the baby, the bottom of the uterus is at the level of the navel, while the organ itself is temporarily at rest. In this regard, in order to stimulate the afterbirth and placental separation, it is recommended to attach the infant to the chest. After the release of the “children's place” (afterbirth), the gynecologist examines the birth canal of the woman for tears, bleeding and, if necessary, stitches. At this third stage of labor does not end. The woman remains under medical supervision for two hours, after which she is transferred to the ward with the child..

Postpartum period

The first 6-8 weeks after the appearance of the baby - this is the time of emotional and physical restructuring. With all this, the woman is experiencing a cascade of hormonal changes. In the first two hours after birth, the uterus is greatly reduced, and postpartum bleeding from its gaping vessels practically stops. In this case, the further process of involution of the genital organs of each of the fair sex proceeds according to a purely individual scenario.

Along with this, complaints of discomfort in the perineum, pelvic area are noted in practically all women, as I must say, in the soreness of the breasts. The latter occurs a day or two after childbirth and indicates the intensification of the process of formation of milk. In addition, during the first days there may be a clear tendency to constipation, which is caused by a decrease in the tone of the abdominal muscles. During the puerpera period, close attention should be paid to hygiene rules:

  • monitor the cleanliness of the gaskets, change them every 4 hours and remove them from front to back,
  • rinse the crotch with warm water every time you need it,
  • wipe genitals should be moving from front to back,
  • do not touch the perineum until the tears heal.

Preliminary (preparatory)

Signs of upcoming birth appear a few weeks before the baby is born. After about 36 weeks of pregnancy, the following changes are noted in the pregnant woman’s body:

  • Body weight is reduced. In the last 14 days, the weight of a pregnant woman can decrease to 1.5 kg.
  • The belly drops. The child occupies a position that should be at birth. The abdomen descends with the descending uterus.
  • The frequency of urination increases. This is due to the prolapse of the uterus and the increased pressure on the bladder.
  • The frequency of movements of the child decreases. After taking a prenatal position, the baby is hard to move.
  • Appear training bouts. Contractions of the uterus are short, they stop after changing the position of the body.
  • Separated mucus plug.
  • Periodically there are discomfort in the lumbar region and lower abdomen, which quickly pass.

In addition, the pregnant woman becomes easier to breathe, passes heartburn. In some cases, there may be diarrhea. The preliminary period of labor can last from 6 to 24 hours. There are short painless cramps of the uterus, the discomfort passes immediately after the spasm. At the preliminary stage, the cervix softens and begins to open.

A few hours after the start of the preliminary phase, spasms may become more frequent. However, sometimes the preparatory stage takes a pathological character. The pathological preliminary period of labor has the following characteristics:

  • the appearance of sharp painful uterine contractions,
  • duration more than a day,
  • no signs of cervical ripening (does not soften, does not shorten)
  • fully closed cervical canal,
  • no signs of increased uterine cramps.

If at this time there is a rupture of the amniotic fluid, normal labor can begin. The tactics of obstetricians in the pathological course of the preliminary period of labor depends on the state of the mother and fetus. Medicines can be used to normalize the preliminary period of labor.

The first (gripping)

После прелиминарного наступает первый период родовых этапов, который характеризуется регулярными болезненными схватками. Существует 3 фазы этой стадии:

При активной фазе нарастает интенсивность схваток, увеличивается их продолжительность и сокращается временной промежуток между ними. Сокращения матки принимают более болезненный характер. Они происходят через каждые 5-6 минут и длятся от 20 до 40 секунд.

Under normal management of labor at this stage, the rupture of the membranes occurs. However, many waters begin to flow in the first phase. The active period is two hours. The cervix expands at a speed of 2 cm per hour. At the end of the second phase, an opening of about 8 cm.

During the transition phase, pain during contractions is slightly reduced. Uterine spasms occur less frequently, but it continues to open. The rate of disclosure reaches 1 cm per hour. By the end of the transitional phase, the shed should open at least 10 cm.

In the last phase of the first period of childbirth, you may feel that you need to push (like a strong desire to empty your bowels). However, the attempts are undesirable because they can cause perineal rupture and swelling of the cervical canal of the uterus.

Second (expulsion of the fetus)

The second stage of labor occurs after the opening of the cervix at 10-12 cm. At this time, the woman begins to feel intense attempts. Fights occur every 3-4 minutes and last up to 1 minute each. The head of the baby is fully lowered into the pelvis and begins to move along the birth canal.

At this time it is necessary to use a special breathing technique to speed up and facilitate the expulsion of the fetus. Obstetricians recommend that when a contraction appears, take a deep breath, hold the air in your lungs and push the baby out. After this exhale, repeat the inhale and push out. For one fight, you need to repeat these steps three times.

During attempts, all efforts to push the child away should be directed to the point where the greatest pressure and pain is felt. The cutting head occurs gradually. At first she shows a little, and after the end of the attempt can move back. The baby's head is usually born for 3-4 attempts.

When exile, you should listen to the recommendations of the obstetrician, who controls the process. Incorrect behavior can lead to perineal tears, damage to blood vessels in the face and neck, and fetal hypoxia.

After teething, the baby turns slightly, shoulders and other parts of the body appear. As soon as the baby is completely out, the doctors pinch the umbilical cord, which will soon be cut. The child is placed on the breast of the mother. The duration of the second period of labor is from 15 minutes to 1.5 hours.

Third (Sequential)

Many believe that after the birth of the baby labor activity ends. However, to complete labor, it is necessary for the placenta (afterbirth) to leave the uterus.

The well-known definition of this period of labor is the last. Last is born as a result of uterine contractions. They appear 10-20 minutes after the birth of the child. To stimulate contractions, the baby is applied to the mother’s breast.

The third period of childbirth is carried out for several attempts. Many women do not notice the birth of the placenta, as uterine contractions become less intense and are not accompanied by severe pain. If the placenta does not go out after 30 minutes, doctors resort to a special operation to manually remove the placenta.

At the final stage of the post-mortem period, the midwife examines the vagina of the parturient woman to rule out the possibility that part of the afterbirth remains in the uterus. If there are gaps, the woman is sewn up the damage.

After the next step, the mother is left for 2-3 hours in the delivery room. At this time, doctors are monitoring her condition.

The following measures are taken to eliminate bleeding:

  • sew up damage to the birth canal,
  • put ice on the woman's maternity
  • administer drugs that stimulate uterine contractions,
  • make intravenous injections of hemostatic agents.

Ways to facilitate the birth process

Childbirth is a physiological process that is accompanied by severe pain. There are various ways to alleviate the condition of the woman in labor and the birth process:

  • Motor activity during contractions. During contractions, the muscles contract, so if a woman lies down at this time, relaxation takes longer, as the muscle fibers experience additional pressure. You can walk and change poses for cramps until the end of the second phase of a cramping period.
  • Back and waist massage. For this woman needs help. A husband or other close relative may massage a parturient woman in areas of the body where she experiences the most intense pain. Massage helps to distract from pain and relax.
  • Breathing exercises. Proper breathing, most women learn in the third trimester of pregnancy. The use of breathing exercises helps to relax and also accelerates the access of oxygen to the fetus.
  • Positive attitude. Many experts point out that women who are committed to a positive outcome, bear childbirth much easier. Some future mothers are trying to listen to music for a good mood.

Special attention is given to epidural anesthesia. In modern society, it has widespread popularity as one of the methods of pain relief. However, there are both adherents and opponents of this method of facilitating labor. Among the positive aspects of epidural anesthesia are the following:

  • after anesthesia, the woman continues to feel contractions of the uterus, but ceases to feel intense pain,
  • the duration of the opening of the uterus is reduced,
  • the drug helps to lower blood pressure, which is important for women suffering from hypertension.

However, this type of anesthesia also has negative aspects and contraindications. Anesthesia can not be done with diseases of the hematopoietic system, the spine, inflammatory manifestations in the area of ​​the puncture, hypotension. The negative points of epidural anesthesia:

  • the possibility of allergic reactions,
  • decrease in the activity of the uterus during the expulsion of the fetus, which increases the duration of the second period and often leads to ruptures of the perineum,
  • decrease in the reflex activity of the newborn in the first hours after birth.

The postpartum period

The postpartum period begins at the moment of birth of the afterbirth and lasts about 5-8 weeks. At this time, the uterus returns to the prenatal state and the mother’s condition returns to normal. In the early hours of the postpartum period, uterine bleeding may occur, so the woman should lie down.

A few hours after the birth of the baby, mother is allowed to stand up. It is recommended to immediately empty the bladder, despite the fact that the urge to urinate a woman may not experience over the next day.

During the first postpartum weeks, the woman will periodically experience pain in the abdomen and lower back, resembling contractions. This is due to the fact that the uterus is gradually reduced, returning to its original position. The main postpartum phenomena include:

  • bleeding from the vagina for 5 weeks (the most intense - in the first 7 days),
  • swelling of the breast and the appearance of milk 2-3 days after delivery (the optimal time for the onset of lactation in primiparous).

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