2nd stage of labor expulsion 1 moment. Tribal activity, main periods. General condition assessment

Childbirth is the process of expulsion or extraction from the uterus of the child and the afterbirth (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 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, 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, catheterization is used. 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 the location is known (according to ultrasound data), 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 ruptures of the perineum 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.

The whole process of childbirth is divided for three periods - the first, the second (lowering the baby into the pelvic cavity) and the third (direct birth). - the longest, its essence lies in the dynamic opening of the cervix and the formation of a single channel with the cavity. After that, the baby can safely descend into the pelvic cavity for a subsequent birth.

It all starts with harbingers- different intensity of pain, discharge of the mucous plug and even "training contractions". They can last from several hours to several days and even weeks. In the course of such preparation, the cervix becomes soft, supple, it opens by 2-3 cm, it shortens.

The first sign of the beginning of the first stage of labor is regular contractions with a frequency of one or two in 15-20 minutes, lasting at least 15-20 seconds. Moreover, their intensity and frequency should increase. If the opposite happens, these are harbingers of childbirth.

Together with cramping contractions of the uterus, a woman may feel pressure, pulling pains in the lower abdomen or lower back, a feeling of fullness. The baby is not very active.

Also, childbirth can begin with the outpouring of water without contractions. The latter should normally begin within 4-6 hours. The rupture of amniotic fluid is considered premature in this case.

In women who give birth for the first time, the duration of the first period is no more than 10-12 hours, with repeated births - no more than 6-8 hours. When using various stimulant drugs, the time of the first period is reduced. For a longer duration, . Phases of the first stage of labor:

• Hidden. It goes unnoticed, while the expectant mother may feel slight pulling pains in the lower abdomen or lower back. Such contractions are short - up to 15 seconds and are repeated every 15-30 minutes.
• Active. The contractions are already disturbing every 5-10 minutes and last for 30-40 seconds. It is during this period that women should normally pour out amniotic fluid. The active phase ends when the cervical dilatation is about 8-9 cm.
• Braking

Throughout the first stage of labor, the doctor monitors the condition of the fetus using CTG monitoring - recording the baby's heart rate with a special sensor that is fixed on the pregnant woman's stomach. Normal heart rate should be in the range of 120-160 beats per minute, spike-like rise during a fight. Any deviation may be an indication for emergency delivery by caesarean section.

Multiplicity of vaginal examination in normal course:

• To establish the fact of the onset of labor - with complaints of pain, leakage of a clear liquid, mucous plug, etc.
• With the outflow of water - at any time of childbirth, if a woman notes the appearance of copious watery discharge, an additional examination is necessary. In some cases, the detection of pathology may be an indication for emergency delivery.
• To set the beginning of the second stage of labor - if a woman notes that during contractions she wants to push, as if constipated.
• For the timely establishment of the pathological course of childbirth - with the appearance of bloody discharge from the genital tract, if the childbirth is delayed, if it is visually noticeable that the contractions become less intense, and also every 6 hours during their normal course.

Features in primiparous and repeated births:

Possible complications of the first period:

• Bleeding. It may be the result of a formidable complication - placental abruption. It is necessary to conduct an ultrasound, and if time or conditions do not allow this, a caesarean section is immediately performed. Sometimes this is a consequence of damage to the cervix during vaginal examination. There is no need to worry in this case.
• Weak contractions. It is diagnosed if the opening of the cervix does not occur over a period of time or it is insufficient. Timely identified weakness of contractions can be corrected using various techniques. Prevention - adequate anesthesia of childbirth.
• outpouring of waters. Normally, the water leaves in the first stage of labor at the opening of the cervix for more than 6 cm. If this happens earlier, but there are contractions, it is an early outflow of amniotic fluid. If the amniotic fluid leaves before the start of uterine contractions - premature outflow. All variants of deviations are quite common.

If the birth proceeds with deviations, or an additional one is performed, uterine contractions can be strong and even unbearable. In these and other cases, various options for anesthesia during childbirth are used.

The simplest and most affordable pain relief option for every woman- psychoprophylaxis. Its meaning lies in teaching the still pregnant breathing techniques, educating her about the stages of childbirth. massage, calm music, aromatherapy, childbirth in water.

The second most common option is the introduction of antispasmodics and painkillers. It can be Papaverine, Platifillin, No-shpa, Analgin and others. Narcotic drugs, such as Promedol, can also be used as painkillers.

One of the popular methods today anesthesia childbirth in the first stage of labor. Its essence is to conduct a "prick in the back."

Read more in our article on the first stage of labor.

Read in this article

The course of the first stage of labor

For the convenience of assessing the dynamics of childbirth, the whole process is divided into three periods - the first, (lowering the baby into the pelvic cavity) and (direct birth). The first stage of labor is the longest. In each case, an individual course of childbirth, different duration, degree of pain is possible. It depends on the state of health of the woman, her psychological readiness for contractions and the appearance of the baby.

The essence of the first stage of labor is the dynamic opening of the cervix and the formation of a single channel with the cavity. After that, the baby can safely descend into the pelvic cavity for a subsequent birth.

signs

It all starts with harbingers. It can be of varying intensity of pain, discharge of the mucous plug, and even "training contractions." Harbingers of childbirth can last from several hours to several days and even weeks. During this preparation, the cervix becomes soft, pliable, it opens by 2-3 cm, it shortens.

Expert opinion

The first sign of the beginning of the first stage of labor is regular contractions with a frequency of one or two in 15-20 minutes, lasting at least 15-20 seconds. Moreover, their intensity and frequency should increase. If the opposite happens - the interval between them increases, and the duration decreases, these are harbingers of childbirth.

Together with cramping contractions of the uterus, a woman may feel pressure in the lower abdomen, a feeling of fullness. At the same time, the baby is not very active - he is also “focused” on the birth process. The contractions themselves are described by many as “the stomach becomes like a stone and then relaxes”, while some people experience pulling pains in the lower abdomen or lower back.

Also, childbirth can begin with the outpouring of water without contractions. The latter should normally begin within 4-6 hours. The outflow of amniotic fluid is considered premature in this case, there is a slight increase in complications during childbirth and after them.

Phases and their duration

In women who give birth for the first time, the duration of the first period is no more than 10-12 hours, with repeated births - no more than 6-8 hours. When using various stimulant drugs, the time of the first period is reduced. With a longer duration, weakness of childbirth is established.

Contractions should be productive - lead to the opening of the cervix. However, this happens at different rates, on the basis of which the following periods (phases) of the first stage of labor are distinguished:

• Hidden phase. Even from the name, it becomes clear that this is a latent course of childbirth; in healthy and ready-to-birth women, this period goes unnoticed, regardless of the parity of childbirth - first or repeated. At the same time, the expectant mother may feel slight pulling pains in the lower abdomen or lower back, which do not prevent her from leading her usual lifestyle. Such contractions are short - up to 15 seconds and are repeated every 15-30 minutes.

• active phase. Usually it is during this period that women turn to the maternity hospital about the onset of contractions. They are already disturbing every 5-10 minutes and last for 30-40 seconds. It is during this period that amniotic fluid should normally flow out in women, since until this moment the fetal bladder performs the function of a “wedge”, pressing on the cervix contributes to its systematic opening.
• The active phase ends when the cervical dilatation is about 8-9 cm.
• Deceleration phase. Characterized by a slower pace. At this time, there is a disclosure from 8-9 cm to 10-12 cm (full). Only after this is it possible to lower the fetus and its subsequent birth. The duration of the deceleration phase is about 40-120 minutes; in multiparous women, it proceeds faster.

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

Throughout the first stage of labor, the doctor monitors the condition of the fetus using CTG monitoring - recording the baby's heart rate with a special sensor that is fixed on the pregnant woman's stomach. Normally, the heart rate should be in the range of 120-160 beats per minute, peaking up during a contraction. Any deviation may be an indication for emergency delivery by caesarean section.

Multiplicity of vaginal examination

It is carried out at the discretion of the doctor. In the normal course of the first stage of labor, a vaginal examination is necessary only in the following cases:

Vaginal examination can be performed on a special obstetric chair or in bed. At the same time, the woman’s task is to relax as much as possible so as not to provoke pain during examination and not to interfere with the doctor’s clarification of the obstetric situation.

Features in primiparous and recurrent births

The first births are in most cases harder and longer. The differences are presented in the table, but it still depends on the individual characteristics of the woman, so the indicators are variable and the first period in primiparas can proceed smoothly and quickly.

Possible Complications

The first stage of childbirth is an important stage, timely detection of complications helps to avoid irreparable consequences for the mother and baby. Most often you have to deal with the following.

Bleeding

It may be the result of a formidable complication - placental abruption. At the same time, against the background of normal labor activity in the first stage of labor, spotting is recorded up to heavy bleeding. If placental abruption is suspected, an ultrasound should be performed, and if time or conditions do not allow this, a caesarean section is immediately performed.

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

Sometimes spotting from the vagina is a consequence of damage to the cervix during a vaginal examination. This is possible if a woman previously had erosion, ectopia, some kind of manipulation on the cervix, and also if on the eve of childbirth she suffered a common colpitis. In this case, you should not worry, the condition does not pose a threat to the mother and baby.

Weak contractions

It is diagnosed if the opening of the cervix does not occur over a period of time or it is insufficient. Most often, weakness of contractions occurs:

• with a large fetus;
• in pregnant women with pathological weight gain;
• with pathologies of the body of the uterus (, with a septum and others);
• with premature outflow of amniotic fluid;
• with multiple pregnancy;
• with psycho-emotional overstrain of a pregnant woman.

Timely identified weakness of contractions can be corrected using various techniques. For this can be used:

• uterotonics - drugs that increase uterine contractions, such as oxytocin;
• drug sleep - with its help you can "reboot" the contractile activity of the uterus.

Prevention of weakness of generic forces - adequate anesthesia of childbirth.

outpouring of waters

Normally, it is assumed that the waters leave in the first stage of labor at the opening of the cervix more than 6 cm. If this happens earlier, but there are contractions, it is an early outflow of amniotic fluid. If the amniotic fluid leaves before the start of uterine contractions - premature outflow. All variants of deviations are quite common. This increases the risks:

• intrauterine infection of the fetus - for prevention, antibiotics are prescribed for an anhydrous period of more than 12 hours after the completion of childbirth;
• anomalies of labor activity - it is necessary to carefully monitor the puerperal, timely detection and correction of deviations.

Watch this video about what complications can be during childbirth:

When is anesthesia needed and what happens

Normally, they proceed smoothly, without causing the woman excessive discomfort. In this case, anesthesia is not necessary. If the birth proceeds with deviations, or additional stimulation is performed, uterine contractions can be strong and even unbearable. In these and other cases, various options for anesthesia during childbirth are used. The indications are the following states:

• tension and psycho-emotional lability of a woman;
• overly painful contractions according to her sensations, which depends on the individual pain threshold of sensitivity;
• if the expectant mother suffers from high blood pressure, the pain will provoke a serious rise in blood pressure;
• if puerperas had at the end of pregnancy;
• with anomalies of labor activity to correct violations.

The simplest and most accessible option for every woman is psychoprophylaxis. Its meaning lies in teaching the still pregnant breathing techniques, educating her about the stages of childbirth. This helps to follow all the recommendations of the doctor and midwife without fear.

The following options are also possible:

• massage - you need to knead yourself or ask your husband (in partner childbirth) for the lower back, this helps to anesthetize and relieve anxiety;
• calm music - as an option for influencing the psyche of a woman, the sounds of nature are suitable - water, rain, forests and others;
• the same effect can be achieved by aromatherapy, but this is not practiced in maternity hospitals;
• childbirth in water - an accessible interpretation of the method is carried out by the action of a warm jet of water on the lower abdomen of a woman's lower back in the shower in the prenatal ward.

The second most common option is the introduction of antispasmodics and painkillers. It can be Papaverine, Platifillin, No-shpa, Analgin and others. They are especially recommended for a dense cervix.

Narcotic drugs, such as Promedol, can also be used as painkillers. However, it is allowed to be administered at least three hours before delivery, as the drug crosses the placenta and can affect the fetal respiratory center, causing respiratory problems immediately after birth.

If a woman is tired, for example, did not sleep all night due to harbingers, sedatives, such as Diazepam, can be used additionally with antispasmodics and painkillers. This allows a woman to “plunge” into a drug-induced sleep, after which labor activity, as a rule, improves.

One of the most popular methods of labor pain relief in the first stage of labor today is epidural anesthesia. Its essence is to conduct a "shot in the back" - the anesthesiologist installs a catheter and injects anesthetic medicine into the epidural space of the spinal cord at the level of the lower lumbar vertebrae, which leads to a decrease in the sensitivity of the lower body.

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

The main difference between epidural anesthesia in childbirth is that the drugs do not enter the woman's systemic circulation. And this means that they do not get to the fetus. Therefore, epidural anesthesia in many cases is the method of choice.

Complications of epidural anesthesia include:

• pressure drop, so it must be constantly monitored, especially in women prone to hypotension;
• allergic reactions to drugs;
• slight heaviness, numbness in the legs, complete immobility indicates the incorrect implementation of the technique and the introduction of the drug deeper;
• insufficient pain relief - a woman notes a decrease in pain, but not their complete disappearance, which depends on the individual characteristics of the organism.

Signs of the first stage of childbirth normally begin barely noticeable for a woman - with pulling pains in the lower abdomen or lower back. Active contractions are one of the important conditions for the successful course of the first stage of childbirth. During this period, careful monitoring of the puerperal is necessary for the timely detection of complications and their correction.

Useful video

Watch in this video about what happens in the first stage of labor, what types of anesthesia are used during childbirth:

Come to the end of 9 months of pregnancy. The expectant mother lives in anticipation of the birth. Generic activity takes place in three periods. The first period of labor is the beginning of labor, which is the longest and most painful in time.

Signs of the onset of labor

In the period between 259 and 294 days - the child is ready for birth. At any moment of this period of time, hormones are produced by the mother's body to start the birth process.

By 35–36 weeks, the fetus is grouped into a pose, namely, the torso is bent, the chin is pressed to the sternum, the legs are bent, pressed to the stomach, and the arms are crossed, lying on the chest. In this position, he is until delivery. In the first stage of labor, the fetus moves along the birth canal while maintaining this body position.

A couple of days before the onset of labor, certain signs appear - this is a pulling pain in the lower back and lower abdomen, a frequent desire to urinate, insomnia, prolapse of the uterus and a decrease in body weight. The closer the day of birth, the softer the uterus becomes. As a result, a yellowish plug with blood splashes is pushed out of its channel. But the process sometimes begins without precursors. The first stage of labor in primiparas begins with the occurrence of periodic, constant contractions with a gradual increase. This also applies to repeaters.

Two signs of the onset of labor:

1. frequent contractions;
2. bubble burst.

Contractions are measured contractions of the muscles of the uterus. They can occur a few weeks before childbirth. True labor pains resume after 20 minutes, and the time between them gradually decreases. In the maternity hospital, the lady needs to gather when the period between contractions reaches 10 minutes, and they become permanent.

Bubble burst. Sometimes amniotic fluid leaks before contractions or there is a sudden rupture of the amniotic membrane. This process is not accompanied by pain. Labor activity begins to develop after 5-6 hours. A woman needs to remember the time when the outflow of water occurred and immediately come to the hospital even in the absence of contractions.

In some women in labor, the period when contractions do not become more frequent is delayed for several days. During this time, she is exhausted and loses a lot of strength. Her psyche is starting to fail. So that the expectant mother does not exhaust herself mentally and physically, you need to visit a gynecologist. The specialist will examine it and make the right decision about further actions. Often it is enough for a lady to sleep a few hours under the influence of drugs in order to fully recover and prepare for childbirth.

Phases

The birth process begins with the onset of the first contraction. It can reach several days, although this is undesirable and lasts until the uterus is fully prepared for childbirth.

How long is the first period? This period is the longest in time and painful in sensations. The duration of the first stage of labor in primiparous reaches 11 hours, in multiparous it proceeds faster and is about 7 hours.

The course of 1 period of labor is divided into 3 phases:

1. latent;
2. active;
3. slowdown.

latent phase. Contractions in a pregnant woman are observed after 20-30 minutes. Their duration is 20 seconds. The latent phase of the first stage of labor is characterized by moderate contractions. The woman in labor tolerates pain mostly calmly, although this depends on the individual characteristics of the lady. At the end of the phase, the cervix opens up to 4 cm.

active phase. The duration of the period reaches 3 hours. During this period, the time between contractions sharply decreases, it reaches two contractions in 10 minutes, the duration increases and reaches a minute. The neck opens up to 8 cm.

deceleration phase. Contractions begin to gradually weaken. The opening of the neck ends and reaches 10–12 cm. Attempts begin to appear. At this stage, the management of labor in young primiparas is important, since the woman in labor cannot be allowed to start pushing. This is prohibited, as it will lead to swelling of the cervix of the uterus and, as a result, childbirth will be delayed. The duration of the phase is from 15 minutes to 2 hours.

The essence of the principles of the introduction of the first stage of labor is to support and control labor. It is also required to take into account that this is a painful period of childbirth, so it is allowed to use painkillers.

Anesthesia

The tactics of managing the first period in some cases involves the use of anesthesia, since not all women in labor are able to withstand the pain symptom. But this does not mean only the use of medications.

There are ways to relieve pain without medication. Their plus is that there is no effect of drugs on the fetus, they do not cause an allergic reaction. The drug method of pain relief is intravenous or intramuscular injections, which include narcotic or non-narcotic substances.

Narcotic anesthesia is used only for serious complications. The management of childbirth in adult primiparas sometimes requires just such an injection. But do not be afraid of this, because the dose of the drug is strictly calculated and cannot harm either the woman in labor or the child.

The use of any pain medication can cause drug-induced depression in the fetus. This is due to the effect of drugs on his weak nervous system.

In maternity hospitals, epidural anesthesia is often used. This method, in which an analgesic is injected into the spinal canal. As a result, pain impulses do not pass through the nerves of the spine and the brain simply does not receive them. So the woman does not feel pain. The dose of the drug is calculated taking into account that at the beginning of the second stage of labor it does not work. During the back procedure, the patient's brain is not affected.

Deviations

Not always labor activity goes according to the rules, often deviations from the norm are observed in women in labor. This is influenced by: age, the presence of pathologies in a woman, multiple pregnancy, low water or polyhydramnios, previous abortions, fetal size, endocrine diseases.

Deviations from the norm in labor activity:

• weak;
• excessive;
• discoordinated.

Weak labor activity. The duration of labor in primiparas reaches 12 hours. But sometimes the process is delayed, and this time can reach several days. The woman in labor has rare and short contractions. As a result, the cervix and the movement of the fetus to the exit is delayed. This birthing scenario proceeds in two ways.

The first way is a weak generic activity that manifests itself initially. The second way is when the process is running normally, but at some point it slows down. Any of the two paths will lead to a long, traumatic birth. Which will provoke bleeding and hypoxia in the baby. Gynecologists with this course of pregnancy use stimulation of labor, if the treatment does not give positive results, then only surgery remains: a caesarean section.

Excessive labor activity. These labors are characterized by frequent, violent, and painful contractions. If a woman in labor has contractions of this nature, then the process of resolving the burden proceeds rapidly. The danger is that a woman will get ruptures of the cervix, vagina and even the uterus. The fetus at this time experiences oxygen starvation. Specialists use drugs that weaken childbirth or use medical sleep.

Discoordinated labor activity. This course is characterized by a mosaic of contractions, that is, they do not increase in strength, but different ones come: weak and painless or strong and frequent. The lower part of the uterus is in good shape, which prevents the baby from moving through the birth canal. The cause of such pathological births are: deviations in the development of the uterus, surgery or cauterization of cervical erosion, as well as the banal fatigue of the woman in labor. Gynecologists with this course of the first period use drug sleep and anesthesia. If this does not improve, then a caesarean section is performed.

Proper management of the 1st stage of labor is an important point. The further development of the whole process depends on how it goes. The main thing is that the expectant mother should not be afraid and be prepared for childbirth psychologically and physically.

Childbirth is a rather complex and unpredictable physiological process. Nevertheless, the body of a healthy woman is endowed with all the necessary resources for a successful childbearing. In order to be less anxious and know what to expect, the mother-to-be should know basic information about the periods of labor and their duration. This will allow a woman to mentally prepare for the upcoming difficult events, which will end in a real miracle - the appearance of a long-awaited baby.

How should normal labor begin?

Natural childbirth in a pregnant woman should begin spontaneously, spontaneously, for a period of 38 to 42 weeks. The waters may break immediately or later. Throughout the process, with a successful, normal birth, the body of the expectant mother does not need any intervention, everything happens as it was intended by nature. Medical help is needed if something goes wrong.

It's important to know! The minimum gestational age at which a baby can be born completely healthy and adapted to life outside the womb is 28 weeks, while the weight of the fetus should be at least 1 kg. Childbirth is considered natural from 38 to 42 weeks.

Such a baby is considered premature and will be in intensive care under close supervision for the first time, but he has every chance of survival.

A couple of days before the onset of labor, the expectant mother may feel strong pressure in the lower abdomen. Usually, a lot of mucus begins to stand out from the vagina (the mucous plug that closes the uterine canal leaves), the pelvic joints may begin to ache. The activity of the fetus is markedly reduced, which is the norm.

The main periods of childbirth

The birth process begins with contractions and the moment the cervix opens, and ends after the placenta is expelled. It is impossible to determine exactly how long this whole difficult act of the birth of a new life will last. Everything is individual: in primiparous it can last longer - up to 1 day; in multiparous, everything happens faster - within 5-8 hours. It is extremely rare that everything happens in a fairly short period of time - 2-3 hours.

The course of childbirth is divided into 3 periods:

1. The first one is preliminary (disclosure period). It begins with the departure of amniotic fluid (they leave later), and the first, still weak contractions, ends with the full opening of the cervix.
2. The second is the expulsion of the fetus. It is fixed at the moment of full disclosure of the birth canal and ends when the fetus is born.
3. The third is sequential. It is fixed after the fetus has already been expelled, and ends with the release of the placenta (afterbirth).

If the pregnant woman is at home, then with the beginning of the first stage, she must be immediately taken to the hospital.

In the clinic, delivery by periods can be carried out by different doctors. Immediately before the birth itself, the patient is monitored by nurses, the obstetrician-gynecologist only periodically examines the woman in labor. At this stage, before giving birth, the patient is given a cleansing enema to completely empty the intestines.

With the transition to the second stage, the woman is transported from the prenatal ward to the sterile delivery room, and now obstetricians will be with her until the process is completed.

Let us consider in more detail each stage of childbirth.

First stage of labor - disclosure

The initial, preliminary period of childbirth is fixed from the moment the uterus opens. Usually a woman with dilation feels the first contractions. They are not so painful yet and last only a few seconds. Unpleasant sensations begin from the lower back and only then spread to the pelvic area. The intervals between contractions can be 20-25 minutes. In rare cases, the opening of the cervix begins without contractions, the woman only feels sipping in the back and lower abdomen.

The organism during the 1st period contributes to the softening of the tissues of the uterine pharynx, its smoothing. The stomach at this moment can become very hard, tense.

In multiparous and giving birth for the first time, the stages of disclosure occur in different ways. At the first birth, first there is a shortening of the uterine muscles and smoothing of the neck, and only then the opening of the external pharynx. With repeated childbirth, these actions of the body often occur simultaneously.

On average, the uterus expands the pharynx at a rate of 1-2 cm per hour. Disclosure is considered sufficient when the birth canal has dissolved by 8-12 cm (depending on the mass and physique of the woman in labor). The obstetrician periodically examines the vagina and monitors the course of this process.

The fetus in this stage gradually approaches the head to the pelvic floor. Under such pressure, the fetal bladder (if it has not burst earlier) bursts and the amniotic fluid comes out. Bubble rupture does not always occur spontaneously. If the cervix has already opened up to 6-8 cm, and the water has not yet broken, the doctor pierces the bladder wall so that the baby can move on freely. For the patient, this action (puncture) is almost imperceptible, you should not be afraid of it.

The first stage of childbirth for the expectant mother is painful. In addition to contractions, a woman may feel nausea, dizziness, profuse sweating, chills or fever, frequent urge to empty. The intensity of pain and associated symptoms are individual and depend on the neuropsychological characteristics of each woman. For some, everything goes quite easily and quickly, for others the torment seems barely tolerable.

In medicine, the preliminary period is divided into 3 phases:

• Phase I is latent. Its beginning occurs from the first contraction and continues until the uterus opens up to 4-5 cm. Intervals of contractions in this period are usually 10-15 minutes, the rate of cervical dilatation is up to 1 cm per hour. In time, the phase can last from 2-3 to 6-7 hours.
• Phase II - active. Contractions noticeably become more frequent (occur every 3-5 minutes) and become longer, more painful. The speed of the opening of the pharynx increases (1.5-2.5 cm per hour). The phase ends when the uterus dilates to 8 cm.
• III phase - slow. After the active and most difficult phase, there is a slight slowdown in the process, painful contractions gradually turn into strong pressure, which the woman begins to feel in the pelvic floor. At this stage, the uterus is fully opened and the body is ready for childbirth.

Important! Throughout the preliminary period, the woman in labor should not push and strain. The main task for the expectant mother at this time is to breathe deeply in order to saturate her body and the blood of the baby with oxygen. The subsequent periods of childbirth largely depend on how these three phases proceed.

Ideally, everything should happen in this order, but there are cases when the sequence of stages is violated or pathological situations arise. In such situations, doctors decide on the spot what to do to successfully resolve the birth. Sometimes you have to urgently do a caesarean to save the life of the child.

When everything ends well in the first stage, the main part follows.

Second stage of labor - expulsion of the fetus

The hardest and most painful stage is over. Now the contractions almost stop and turn into pushing. Feelings are unpleasant, but not so painful. This act cannot be controlled. The attempts are reflexive, the muscles of the diaphragm, abdominals, and pelvic floor are actively contracting.

The head of the fetus intensively begins to move along the birth canal. The body of a little man gradually straightens, the arms straighten along the body, the shoulders rise to the head. Nature itself guides the process.

In the second stage of labor, the patient is transferred to the delivery room, on a special couch, and the time comes when you have to push. The doctor tells the woman what to do, how to breathe and at what point to strain. The baby's head is shown in the crotch. With each push, the baby gradually moves outward. At this stage, some patients experience a rupture of the soft tissues of the perineum. There is no particular danger to this, later the doctors will sew up the perineum and in a couple of months there will be no trace left on it. The woman giving birth herself, against the background of strong attempts, no longer feels the breaks.

The duration of labor depends on the following factors:

• Physique of a woman.
• The physical and psychological state of the woman in labor.
• The position and activity of the fetus, its size.

On average, the exile time lasts from 20 minutes to 2 hours. While the baby's head is moving through the birth canal, it is very important to monitor the baby's pulse. If his face lingers in the pelvic area longer than necessary, hypoxia (lack of oxygen) may begin. This happens if suddenly, for some unknown reason, the attempts fade away. Doctors take action to expel the fetal head as quickly as possible.

When the head of the little man is completely out, the obstetrician removes mucus from his face to clear the airways and completely removes the body from the womb. The baby is connected to the placenta, which is still inside, by the umbilical cord. It is cut and bandaged on the child's body. The umbilical cord has no nerve endings, so neither the mother nor the newborn feel any pain.

If the course of childbirth went well, the baby began to breathe and screamed, it is placed on the mother's chest for a few minutes. Such an action began to be practiced not so long ago. According to psychologists, this allows a woman to recover faster, and the baby to calm down, feeling the familiar beating of her mother's heart in a new, frightening environment. Later, the child is taken away and taken to a special department so that the baby can also rest after such severe stress. The mother is still on the couch.

On this, the 2nd stage of labor is considered completed.

The third stage of childbirth - postpartum (postpartum)

After some time (15-30 minutes), the woman who gave birth again feels soreness and attempts. This is completely normal and necessary. The placenta (children's place) remained inside, and it should come out spontaneously.

As soon as the woman again felt contractions in the abdomen and pressure, the third stage of labor began. Everything is happening much faster and not so painful. If the placenta does not come out within half an hour after the completion of the second stage, doctors do a "squeezing" or manual cleaning under anesthesia.

At the end of the third period, the obstetrician sews up the perineum (if there were tears), disinfects the birth canal. The woman may assume a more comfortable position, but must still remain in her position, lying on her back. Within an hour, sometimes two after childbirth, doctors observe the patient with a frequency of 15-20 minutes. If no complications and pathologies are observed, she is transported to the postpartum ward. Now a woman in labor is considered a puerperal.

It's important to know! For the first couple of days, a new mother may have a fever (within 38º C). This is a normal reaction, the temperature will gradually return to normal.
At the end of the third period, a woman is recommended to lie on her back for several more hours.

The duration of childbirth significantly exhausts the body and an accomplished mother usually experiences severe weakness after everything. Along with fatigue, there may be a feeling of thirst or hunger, chills, drowsiness, fever. There is bloody discharge from the vagina. These are all perfectly normal reactions. Linen is put on the puerperal, a gauze swab is laid in the perineum, which will need to be changed periodically. It is impossible to use ordinary sanitary pads after childbirth, they do not allow air to pass through, promoting the growth of bacteria, and can lead to suppuration of the tissues.

Gradually, the state of a happy mother returns to normal.

On a note! If the birth was successful, and there were no gaps, the woman can stand up on her own after 3-4 hours.

These are the main three stages of childbirth that any woman who gives birth naturally goes through. Our body is perfect and has sufficient resources to safely withstand such a serious and difficult act of the birth of a new life. Today, there are various preparatory courses for pregnant women that teach proper behavior and breathing during childbirth. The more confident and calm a woman is, the easier and faster the whole process will go. A positive mental attitude also has a huge positive impact on childbirth.

Naturally, every woman is very much worried on the eve of such an important event in her life as childbirth. The initial stage, which is called the prenatal period, is practically painless, however, it indicates the beginning of the birth process.

First stage of labor

From about the 37th week of pregnancy, characteristic changes occur in the body of the woman in labor, which are harbingers of the onset of the birth process.

At much later stages, changes such as:

• A sharp decrease in weight;
• Frequent urination and diarrhea;
• Departure of a complete mucous plug;
• Pain in the lower abdomen or back;
• The prolapse of the abdomen;
• Change in the structure of the cervix;
• Slow down fetal activity.

In the prenatal period, there is a sharp decrease in weight. At the end of the third trimester, a woman loses about 1-2 kilograms of weight. Increased urge to go to the toilet may indicate that labor can begin at any time. In addition, another characteristic feature is the discharge of the entire mucous plug. From this moment, labor begins, which continues until the birth of the child and the discharge of the placenta.

Obstetrics distinguishes several periods of labor activity during its normal course. The first period is the most painful and time-consuming stage of childbirth. It starts from the moment of the first contraction, can continue for even several days and ends with a sufficient opening of the uterine os.

Childbirth begins precisely with the fact that the cervix softens enough, becomes thinner, the uterus itself contracts and the woman feels it in the form of contractions.

At the very beginning, they are less painful and prolonged, lasting mostly for 15-30 seconds with an interval of 15-20 minutes. However, over time, the intervals themselves are gradually reduced, and the time of contractions becomes longer and longer. The course and pain of contractions largely depend on the individual characteristics of the woman.

According to the intensity and frequency of repetition of contractions, the first stage of labor is divided into three separate phases, namely:

• latent phase;
• Active period;
• Decline phase.

The latent phase occurs during the period when there is a regular rhythm of contractions, and they continue every 10 minutes with an equal degree of intensity. This phase lasts from 5 hours to 6.5. During this period, the pregnant woman should go to the hospital. When the uterus is ajar by 4 cm, the active phase of labor begins, which is characterized by an increase in the course of labor. Contractions at this time become more frequent, intense and prolonged. How long the active phase lasts depends on the degree of opening of the pharynx. Basically, in time it is 1.5-3 hours.

The deceleration phase is characterized by the fact that labor activity gradually weakens and the opening of the pharynx by 10-12 cm occurs. During this period, it is forbidden to push, as this can provoke swelling of the uterus and prolong the process of childbirth. This phase lasts from 15 minutes to 1.5 hours.

Important! The management of women throughout the entire process of childbirth must be carried out by an experienced obstetrician-gynecologist.

However, labor can proceed in a slightly different way. Initially, there may be an opening of the fetal bladder, and only after that contractions occur. In addition, during this period, a woman may notice spotting spotting, indicating the passage of a mucous plug. If severe bleeding has opened, the discharge has an unpleasant odor or a greenish color, then you must immediately call an ambulance, as this may be a sign of serious violations.

Second stage of labor

The second period of the course of labor activity is characterized by the birth of a child.

At this time, the woman controls the intensity of attempts:

• Holding your breath;
• Omission (as far as possible) of the diaphragm;
• Strong muscle tension.

The degree of opening of the pharynx is controlled by the obstetrician-gynecologist leading the birth. He tells the woman in labor when to push and how to do it correctly. At this stage, contractions also continue, which help push the baby out. The duration of contractions in this period is about a minute, and the interval is 3 minutes. A woman in labor can independently manage contractions, periodically strengthening and weakening them.

3rd stage of labor

The third stage of labor is not as intense and exciting as the two previous ones, since at this time the child has already been born and only the separation and exit of the placenta remains. After the baby comes out, the contractions resume.

During this period, there is an exfoliation of tissues that nourished the baby throughout pregnancy, namely, such as:

• Placenta;
• Umbilical cord;
• Fruit shells.

In nulliparous women, contractions in the 3rd period do not cause any particular discomfort. Slight pain is observed with repeated and subsequent births.

Consecutive periods of labor and their duration

For many women, the periods of labor and their duration can be very different. However, these indicators change slightly.

There may be such types of childbirth as:

• protracted;
• accelerated;
• Swift.

The first births are basically the longest than all subsequent ones and they last for 9-11 hours. The longest duration is 18 hours. For second-borns, the duration of labor is from 4 to 8 hours. The maximum possible duration of labor activity is 14 hours. Labors that exceed the maximum duration are considered protracted, fast if they passed earlier, and labors that ended earlier than 4 hours in primiparas are considered rapid.

There is a special table according to which it is possible to determine the normal time for the course of each period of labor activity.

The first period is the longest and it includes the process of contractions, so the woman experiences strong pain. The second period is the birth of a child. The third period is the passage of the placenta.

Important periods of childbirth and their characteristics

Generic activity consists of certain periods, the characteristics of which depend on a certain stage of this process. In total, there are three periods of childbirth, on each of which a woman needs to make an effort and be patient. The stages of the course of labor activity differ in the nature and frequency of the onset of pain.

There are several techniques that will help facilitate the process of resolving labor, such as:

• Walking and changing position during contractions;
• Massage of painful areas;
• Breathing exercises;
• Positive mood and self-confidence;
• epidural anesthesia.

During the rapid opening of the pharynx of the uterus, doctors recommend that the woman be in motion. How much she can relax depends largely on the rate of opening of the pharynx of the uterus. Massage helps a lot, which helps to relax as much as possible and reduce pain. During an active labor process, a woman's respiratory rhythm is often disturbed, which leads to insufficient oxygen supply to the fetus and threatens its health. That is why it is necessary to carry out special breathing exercises that will help normalize the breathing of the fetus and mother.

All periods of childbirth (video)

A pregnant woman can get all the information she needs regarding the birth process from her obstetrician-gynecologist. In addition, in order to learn how to behave correctly during childbirth, it is necessary to attend special courses.