How to promote cervical dilatation. Ways to accelerate the opening of the cervix before childbirth. Puncture of the fetal bladder

The neck of the reproductive organ plays the role of a ring that closes the entrance, holding the child inside. For 9 months, the baby grows, the volume of amniotic fluid increases. The pressure on the pelvic bones becomes more and more. The body does not always withstand the load. Often there are symptoms and signs of dilatation of the cervix during preterm pregnancy. The phenomenon is dangerous, quite common. If timely treatment is not taken, a miscarriage will occur.

In the course of bearing a child, failures occur in the body. Muscle tissue is partially replaced by connective tissue. New collagen fibers begin to form. Unlike the previous ones, they are more flexible and elastic. A small amount is absorbed, forming the main substance. You can understand that the neck is opening by appearance. It looks loose, shortened, with a visible channel.

The body begins to prepare for labor at 32 to 34 weeks. This is manifested by softness on the outside. The channel is still quite dense. Complete softening of the cervix occurs at 36-38 weeks. The baby moves into the pelvis at this stage of pregnancy. The pressure on the reproductive organ increases, forcing it to open.

The process begins with the internal pharynx. The baby moves along the birth canal, which has the form of a cone with a wide side at the exit. The fabrics are gradually stretched. In women who give birth again, the procedure is faster. The channel opens from both sides at the same time, the opening of the cervix during pregnancy is practically not felt.

Immediately before the onset of the birth process, it is depleted, it looks too short. 2 or more fingers will fit inside. However, the action does not stop. The limit is 10 - 12 cm. This width of the hole is required for the successful exit of the baby's head. The degree of cervical maturity is determined according to the Bishop scale.

There are 3 types:

1. immature;
2. maturing;
3. mature.

The first is characterized by density, length more than 2 cm, closeness of the external pharynx. The second corresponds to external softness, internal hardness. There is a shortening to 1 - 1.5 cm. Half of the path becomes passable. The third type is marked by softness, the ability to insert 2 fingers.

A couple of hours before the start of the birth process, cramping pains appear when the cervix opens. They do not differ in long-term nature, are not very intense, and do not cause structural changes. The duration is normally about 6 hours.

Signs of ICI

It is difficult to consider isthmic-cervical insufficiency in the second trimester of bearing a baby. The doctor receives data when examining the vagina with an ultrasound, examining it using a mirror. You need to find the problem quickly so that a miscarriage does not happen.

Can you feel the dilatation of the cervix? Yes and no. Some women in labor come to the maternity hospital with an opening of 2 cm, without feeling anything. Others experience pain with contractions.

Signs of dilatation of the cervix in the second trimester:

• bleeding;
• pain in the lower abdomen;
• shortening, softening;
• pressure on the vagina;
• on examination, the amniotic sac is visible;
• length discrepancy with the parameters of the norm;
• pharynx is open.

If at least one of these symptoms is detected, immediate therapy is required. Two or more are considered a signal for the placement of a woman in labor in the clinic. Diarrhea, nausea when opening the cervix are also observed. Speaks of insufficiency protrusion of the fetal bladder.

Accommodation options:

1. on top of the internal pharynx;
2. on the line of the hole, but invisible to the eye;
3. in the canal, visible during inspection;
4. moved into the vagina.

What does it feel like when the cervix opens?

• pain of a pulling nature, radiating to the hips;
• a feeling of discomfort due to a lowered baby;
• spasms in the vagina.

A gynecologist is able to diagnose CCI by having:

1. information about previous miscarriages that occurred in the last trimester of gestation;
2. data on premature termination of pregnancy by labor activity at an early stage;
3. information that conception occurred after IVF;
4. results of prolapse of the fetal bladder;
5. mirror inspection indicators.

Quite often, many signs are absent. Therefore, it is difficult to understand that the opening of the cervix is ​​​​difficult. Ultrasound is considered the most effective method. The method will promptly indicate the insufficiency, and will also determine why it appeared.

Sometimes women enter the maternity hospital with an opening of 1 - 2 cm. They are not even aware of the ongoing process. Everything is carried out imperceptibly, the opening of the cervix begins without contractions. Sipping, tingling is rarely observed.

The reasons

Premature opening of the cervix in early pregnancy often ends in miscarriages. Softening provokes expansion, opening. It is difficult for the fetus to hold on.

ICI is of 2 types:

1. organic;
2. functional.

What a particular woman will have will be determined by the reasons that formed her. Organic is also called traumatic because it is caused by trauma. The neck loses its elasticity, becomes scarred.

• abortions;
• miscarriages;
• neck injury;
• treatment of polyps, erosion;
• scraping.

Scar tissue cannot stretch. It is made up of connective fibers. They differ in increased rigidity. The ability to contract is lost. As a result, the baby is not kept inside. IC appears.

Function call:

1. restructuring of hormones;
2. polyhydramnios;
3. pathology of the genital organ;
4. tissue imbalance.

A large amount of androgen produced or a small amount of progesterone leads to hormone failure. A consequence is revealed at the 11th week of bearing a child. The neck weakens, opens.

A large accumulation of water is also considered a serious cause. This phenomenon is observed in multiple pregnancies. The load on the reproductive organ increases, insufficiency is formed.

These reasons contribute to softening of varying degrees. The uterus prepares for childbirth ahead of time, becomes supple. The baby grows, the ability to keep inside decreases. Functional insufficiency affects women who have problems with the work of the ovaries. Congenital CI is also sometimes present.

This disease varies from woman to woman. Instead of one reason, it can be caused by two or more. In any case, it is difficult for the child to hold on, he is heading for the exit. As you go down, the pressure increases. A low position leads to infection. As a result, a miscarriage or premature labor is obtained.

Treatment

The doctor establishes the exact causes of the insufficiency, then recommends a course of therapy. With functional hormonal drugs are often prescribed. They restore hormone levels in 1-2 weeks. After the situation improves, the treatment does not stop.

How to check the cervix before childbirth:

• manual inspection;
• ultrasound diagnostics.

It is necessary to observe bed rest, when all signs of the opening of the cervix before childbirth are observed in a woman in the early stages of bearing a child. The gynecologist recommends complete calm. Any load should be limited.

Conservative treatments involve the use of the Meyer ring. The product is made of plastic. Purpose: to restrain the pressure of the child on the neck. Manipulation is suitable for women in labor with a small opening at a gestation period of 28 weeks or more. Thanks to him, the weight of the baby is evenly distributed. This method is used as an auxiliary.

At an earlier period, in the absence of infectious diseases, surgical intervention is prescribed. The goal is to suture the cervix so that dilatation does not occur until after delivery. During surgery, no discomfort is felt. Anesthesia is administered in advance. The suture material is removed before the onset of labor, when the fetal bladder is opened.

Both types of treatment of the disease involve the appointment of antibacterial drugs. They are needed to exclude birth, to prevent the infectious process. To enhance effectiveness, antispasmodics are prescribed. Reduce hypertonicity by tocolytic means. Hormonal drugs are prescribed if the opening is observed due to a malfunction of the endocrine system.

Stimulation of dilation during childbirth

With a mature cervix, labor begins at 38 weeks and ends with the birth of a baby. Sometimes doctors stimulate the process. Indications are premature, late labor activity. The beginning is spontaneous, weakly flowing, with an unexpected stop.

How to open the uterus before childbirth:

1. with the help of the introduction of medicines;
2. use amniotomy;
3. manually.

The obstetrician ascertains the weakness of the process, stimulates, if the reproductive organ stops contracting, contractions are not enough to fully open. The doctor uses medicines when 12 hours have passed after the waters have broken, and the process of giving birth to a child does not begin. Such stimulation is carried out carefully under the supervision of medical staff. The absence of an allergic reaction to drugs is checked prematurely.

Signs of the need to stimulate the opening of the uterus during childbirth:

• hypertension;
• preeclampsia;
• early discharge of water;
• stretch;
• weak contractions, complete absence;
• the reproductive organ is not disclosed;
• heart failure;
• detachment of the placenta;
• late toxicosis.

The obstetrician, based on the indicators of the state of health of the woman in labor, makes a decision on stimulation. If symptoms of premature cervical dilatation appear during pregnancy in the third trimester, the doctor will recommend that the woman in labor go to the clinic for a couple of weeks. The medical staff will monitor the condition of the woman and the baby. If necessary, use the operational method.

The method of amniotomy is widely known. The bottom line is to pierce the bubble. The main indication for manipulation is a sudden stop of disclosure, which has already occurred by 2 cm. Piercing will speed up labor. Amniotic fluid will depart, pressure on the pelvic bones will decrease. The method is considered safe, absolutely painless.

Another way of stimulation is the opening of the cervix manually. Often used special tools - expanders. A prominent representative is an inflatable balloon filled with liquid. It acts on the neck, seeking an opening. During the application of the method, there is a danger of rupture of the bubble. Therefore, it is carried out in case of emergency.

Straightening of the cervix before childbirth occurs on the eve of the process. If during the examination the gynecologist finds that this did not happen, the procedure is carried out manually. Sometimes accompanied by severe pain. Manipulation is necessary to facilitate the exit of the child.

Signs of disclosure begin imperceptibly in many cases. Then a pulling pain sensation appears, the mucous, blood plug leaves. The main indicator of the approach of labor is uterine contractions. If these symptoms have made themselves felt in the middle of pregnancy, inform the gynecologist. There was a threat of premature birth of the baby.

Not every pregnant woman knows that her body needs to be prepared for childbirth. Many people think that this process should take place without their participation, but recently there have been more cases of medical exposure due to the fact that the cervix is ​​not ready for the birth process.

Why is the cervix not ready and when should it be prepared for childbirth?

The cervix is ​​the anatomical structure of the female reproductive system, through which the fetus necessarily passes during natural childbirth. For the normal course of this process in the last weeks of pregnancy, many changes occur in the body of the expectant mother. This structure undergoes a series of metamorphoses, allowing it not to be injured during the expulsion of the fetus. When she is completely ready for the birth process, this indicates her maturity. This is determined only by the doctor during a gynecological examination.

Scoring table:

The doctor summarizes the points obtained during the examination and determines the readiness of the cervix for childbirth. Evaluation results:

• up to 2 points - the neck is immature;
• 3-4 points - insufficient maturity;
• 5-8 points - indicate a mature neck.

The cervix before childbirth should be soft, short, with the opening of the internal os and occupy a median position. Such indicators are of great clinical importance for determining the further management of a pregnant woman. In a planned manner, the doctor begins to examine the cervix, starting at 38 weeks at each visit.

If for the first time it turned out that there is no normal degree of maturity, then you should not worry. Changes may occur later, due to the individual characteristics of the organism. Softening of the cervix before childbirth can happen quite quickly. In the absence of the necessary dynamics, the gynecologist gives general recommendations and prescriptions that speed up this process.

This is important for the prevention of birth trauma for both the mother and the fetus. With an immature cervix, the risk of rupture during expulsion of the fetus is very high. All measures are aimed at its reduction.

An immature cervix at 40 weeks can be associated with a number of reasons:

Important for the disclosure of the cervix and its maturation is the regulation of changes in the nervous system. In the later stages, the dominant of childbirth is formed in the pregnant woman, in which the woman is mentally prepared for the childbirth process. With panic attacks and extreme fear, the nervous system can indirectly inhibit the necessary changes.

Not all pregnant women and not always need to prepare themselves for childbirth artificially. Why the cervix does not open is difficult to say. Any interference from outside must have certain indications:

A contraindication is the impossibility of natural childbirth in a pregnant woman (planned or emergency caesarean section). Only a doctor can determine whether it is necessary to accelerate the process artificially and how to soften the cervix in the safest way.

Drug exposure and how to prepare at home for the birth process?

Drug methods of preparing the cervix for childbirth can be carried out as a preliminary stage before childbirth or immediately at their onset.

If the period has already come, and the cervix is ​​immature before childbirth, then doctors use the following methods:

Of the medicines prescribed:

• prostaglandin preparations;
• antispasmodics.

Prostaglandins are used in the form of gels - Prepidil, Prostin E2. They not only contribute to better “ripening”, but also activate labor activity. Therefore, the cervical softening gel is administered vaginally only in a hospital setting.

Indications for their appointment is maturity, assessed by the doctor at 0-4 points. However, despite their effectiveness, doctors do not often prescribe them due to the high cost and a large number of contraindications. Of the antispasmodics, the appointment of Buscopan suppositories is acceptable, but in recent years their use has been small. This is due to the low degree of efficiency.

Laminaria sticks are inserted into the cervical canal. They are small seaweeds. Being in a humid environment, kelp absorb water molecules and increase. Thus, the internal pharynx opens mechanically, contributing to a faster shortening and softening of the neck. The effect is observed within a day. With any attempt to artificially accelerate the "maturation", the woman in labor will have more intense contractions than during the natural process.

If a situation arises when the waters have broken, labor activity has begun and the cervix does not open, doctors quickly take emergency measures to ripen it. These include:

• the appointment of Prostenon (prostaglandin) intravenously;
• installation of a Foley catheter in the cervical canal above the fetal head;
• manual opening of the cervix (with the ineffectiveness of all the above methods).

The danger of such situations is:

• weakness of labor activity;
• pathological uterine contractions;
• high risk of bleeding;
• fetal suffering from hypoxia.

Before preparing the uterus for childbirth at home, a preliminary consultation with a doctor is indicated!

He will tell and explain what is permissible in each case, and what is contraindicated. Preparation of the cervix for childbirth includes:

The choice of method for improving the maturation of the cervix is ​​quite large. It is worth knowing some of their features.

Regular sexual life without the use of a condom implies the absolute health of the partner, so as not to infect the pregnant woman. During sex, in addition to the mechanical effect on the vagina, there is also a hormonal one. Semen contains natural prostaglandins that stimulate smooth muscle contraction, which accelerates the process of cervical maturation.

Contraindications:

• discharge of the mucous plug and water;
• the risk of preterm labor.

The diet is due to the presence in certain foods of substances that promote the production of prostaglandins. These include oily fish, flaxseed oil, blackcurrant. Refusal of preservatives, margarine-containing products that interfere with the production of the necessary substances.

Evening primrose oil is often prescribed from 34 weeks, gradually increasing the dose to 3 capsules.

Before using them, you should consult your doctor. It must be remembered that a number of medicinal herbs do not affect the maturation of the uterus, but activate the birth process.

Physiotherapeutic methods of influence are carried out under the careful supervision of specially trained personnel.

Of the antispasmodics, if the cervix is ​​not ready for childbirth, suppositories with papaverine are prescribed. They are safe for the baby, but help soften the cervix better.

The immaturity of the cervix complicates the natural course of childbirth. This situation is accompanied by a number of unpleasant complications. Only a doctor knows how to prepare the cervix for childbirth! Self-administration of certain methods can lead to serious consequences.

The maturity of the cervix determines an adequate and less traumatic course of childbirth. However, no one is safe from injuries at the birth of a baby, but a mature cervix reduces the risk of their occurrence.

The uterus is the main organ necessary for carrying a pregnancy. It consists of the bottom, body and neck. The latter looks like a kind of tube connecting the uterus to the vagina. The successful course of pregnancy and natural childbirth directly depends on her condition. The cervix changes significantly before childbirth, although for the woman herself these changes are practically not noticeable, since this process is not accompanied by any special symptoms. What happens in the prenatal period and why is the neck given special attention?

How is cervical maturity assessed?

Starting at 38 weeks' gestation, at a gynecological examination at the antenatal clinic or at the maternity hospital, the doctor performs a vaginal examination to assess the condition of the cervix. It is also mandatory to examine the cervix before childbirth, as well as during labor. This is necessary to understand how fast the process of its maturation takes place.

There are four main parameters, evaluating which the obstetrician-gynecologist can conclude that the cervix is ​​ready for childbirth. Its maturity is determined by a special Bishop scale, according to which each of the parameters is evaluated on a three-point system (from 0 to 2 points). If this scale is rated 5, then we can talk about readiness for natural childbirth.

What happens to the cervix before childbirth

The cervix begins to prepare for the birth of a child from 32 to 34 weeks of pregnancy. First, its edges soften, leaving a dense patch of tissue along the cervical canal. Closer to childbirth, the uterus often comes into tone, due to which its lower segment softens and becomes thinner. The upper myometrium, on the contrary, becomes denser.

Due to this, the fetus begins to gradually descend and press its weight on the neck, provoking its further opening.

The opening of the cervix before childbirth does not occur equally in women who give birth for the first time, and in multiparous women. In the first, it begins with the opening of the internal pharynx.

In the latter, the process of opening the internal and external pharynx occurs simultaneously, since by the end of pregnancy, their external pharynx usually already passes 1 finger. Opening, the neck thus becomes shorter. A couple of days before the onset of the birth itself, the process of its maturation is significantly accelerated. Gradually, it is completely smoothed out and calmly skips 2 fingers or more.

Based on the Bishop scale above, on the eve of childbirth, the cervix must meet certain parameters.

A soft neck is ideal for childbirth. Her softness is evidenced by the fact that she freely passes 2 or more fingers of the doctor. During this period, a woman may notice the discharge of the mucous plug. This is one of the harbingers of the next birth, indicating the imminent start of labor. As for the length of the neck, during pregnancy, a length of 3 cm is considered normal for it. In this case, both ends of the cervical canal must be closed. Closer to childbirth, it is shortened. The length of the cervix before childbirth should not exceed 1 cm, gradually smoothing out completely.

As for its location, it has been tilted back throughout the pregnancy. This additionally helps to keep the fetus inside. Gradually, due to the softening of the lower segment of the uterus, it begins to turn forward. When the time comes for childbirth, it should be located exactly in the center of the small pelvis.

If the cervix is ​​not ready for childbirth

A soft, shortened cervix, which is located in the center and slightly opened, indicates the approach of childbirth. However, it also happens that the term of childbirth has already come, but the maturity of the cervix has not yet come.

An immature cervix can lead to complications during labor, so if it does not mature by the expected date of birth, the doctor may decide to stimulate.

Pregnancy after 40 weeks is overdue and dangerous for the baby. By this time, the placenta ceases to fully perform its functions. Therefore, if by this time the cervix does not mature, then its stimulation is mandatory.

In addition to prolongation of pregnancy, indications for stimulation are:

• The presence of a disease in the mother, in which further pregnancy threatens her health.
• The development of hypoxia in the fetus.
• Large fetus or multiple pregnancy.
• Termination or weakening of contractions during labor.
• Premature detachment of the placenta.

In all other cases, the question of the need for stimulation is decided individually. There are various methods to prepare the cervix for childbirth.

Medical methods include the following:

There are other non-medical methods to prepare the body for natural childbirth. Unlike the first ones, they can be used at home, but subject to a full-term pregnancy, a satisfactory state of health of the woman and the baby, and only after consulting a doctor. Otherwise, such stimulation can be dangerous. Non-medical methods of stimulation include:

If the cervix opens prematurely

There is also a reverse situation, when the cervix begins to open and prepare for childbirth ahead of time. This is usually associated with a pathology of the cervical canal, called isthmic-cervical insufficiency. It lies in the failure of the cervix to properly hold the fetus in itself. It shortens and opens at an early stage, which often leads to spontaneous abortion.

The presence of this pathology is evidenced by the length of the cervical canal in the period of 20-30 weeks less than 25 mm.

Isthmic-cervical insufficiency can develop due to trauma to the cervix, hormonal disorders, or excessive stress on the cervix during pregnancy.
In this situation, measures should be taken to maximize the prolongation of pregnancy:

In addition, a treatment is carried out that promotes the rapid maturation of the lungs of the fetus in case the birth begins prematurely. The cervix before childbirth changes so much that it allows the baby to be born unhindered.

The gradual opening of the cervix before childbirth is almost imperceptible to the woman herself.

Therefore, a visit to the gynecologist in the third trimester should be regular and accompanied by a vaginal examination, which allows you to assess the degree of readiness of the body for childbirth. This is especially true for those women who already feel other harbingers. If the term of childbirth has already come up, but the maturity of the cervix has not yet come, then there is no need to be afraid of stimulation. Sometimes delay can cost the life of both the mother and the child.

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

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

Characteristics of normal vaginal delivery

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

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

First stage of labor - dilation of the cervix

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

After opening the cervix by 4 cm, the second or active phase the first stage of labor, which is characterized by intense labor and rapid opening of the uterine os from 4 to 8 cm. The average duration of this phase is almost the same in primiparous and multiparous women and averages 3-4 hours. The frequency of contractions in the active phase of the first stage of labor is 3-5 per 10 minutes. Contractions often become painful. Pain is predominant in the lower abdomen. With the active behavior of a woman (position "standing", walking), the contractile activity of the uterus increases. In this regard, drug anesthesia is used in combination with antispasmodic drugs. The fetal bladder should open on its own at the height of one of the contractions when the cervix opens by 6-8 cm. At the same time, about 150-200 ml of light and 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 it is known (according to ultrasound) the location of the placenta, then the optimal is the position of the woman in labor on that side where the back of the fetus is located. In this position, the frequency and intensity of contractions do not decrease, the basal tone of the uterus remains normal. In addition, studies have shown that this position improves the blood supply to the uterus, uterine and uteroplacental blood flow. The fetus is always located facing the placenta.

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

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

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

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

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

Third stage of labor - afterbirth

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

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

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

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

By the time childbirth occurs, the cervix, imperceptibly to the woman herself, has completely changed. And this makes it possible for the baby to be born in a completely natural way. But not always the cervix can change itself to the extent that is necessary for independent childbirth. In this case, medical intervention is simply necessary.

How to check the dilatation of the cervix during childbirth

Also, these changes are confirmed by such a process as the discharge of the mucous plug. The cork can move away long before the appointed time, and this indicates that contractions will soon begin. Also, before childbirth, the neck should be shortened and its length should be within one centimeter. And when it comes to her position, the most optimal position is in the middle of the small pelvis.

Although during pregnancy, the cervix is ​​slightly tilted back. Based on the indicators of these parameters, doctors put an estimate, the maximum can be equal to five. According to the same assessment, it is possible to determine the readiness of the cervix for labor. If the score is five, then they say that the cervix is ​​​​ripe.

But quite often it happens that labor activity should begin soon, but the cervix is ​​still completely unprepared. Then stimulation will be used to open it. If you do not resort to this method, then the child will soon begin to experience a lack of oxygen due to the fact that the placenta ages very quickly before childbirth, and the functions that it should perform become beyond its power.

How to help dilate the cervix during childbirth

• Sinestrol injections into the muscles. Thanks to this drug, you can make the cervix mature, but it has nothing to do with contractions.


• Laminaria sticks. The doctor places these 5 cm sticks into the cervical canal. As moisture acts on them, they swell and mechanically open the cervix.


• Gel with prostaglandins. This is one of the most effective methods. Under its influence, the cervix will open in 2-3 hours.


• Enzaprost intravenously. This drug also contains prostaglandins. Therefore, when using it, you can also reduce the duration of contractions.

If there are no contractions, but the water and the cork have already departed, then in this case stimulation with a warm bath is strictly prohibited. So, as there is a risk of catching some kind of infection. You can also use a variety of physical activities. The best thing for the body will be walking. But you can also clean up. But in such cases, you need to monitor your well-being, because the consequences will not always be the most pleasant.

Stages of cervical dilatation

But sometimes there are cases when the cervix can open ahead of time. Therefore, in the last trimester, a woman should be ready for absolutely everything.