Home birth through the eyes of an obstetrician-gynecologist. What kind of eyes do male doctors look at women

You can still hear stories about how “dangerous” it is to give birth, what terrible torments it is, what a threat a woman who decides to become a mother exposes herself to. Oddly enough, but these stories most often come from women who have one or two children. It is difficult to understand what is more in their stories: the desire to appear in the eyes of nulliparous women a kind of "heroine" who doesn't care about anything, memories of the actual complications that accompanied their birth, or latent jealousy for those who also want to have children? Be that as it may, such “passions” do not contribute to an increase in the population, just as “warnings” like: “If you give birth to a child, consider that your youth is over. Why do you need to rush with a child? your pleasure!" And many women, having heard a lot of terrible stories and good "warnings", actually begin to live "for their own pleasure."

We adhere to the point of view that a young family "without a child is a flawed family that robs itself of the greatest pleasure - the happiness of raising a child. In addition, a childless family is, as a rule, a fragile family, spouses in such a family are not bound by common responsibility , a common concern for the child, and therefore easily part at the first encounter with difficulties.

In Czechoslovakia, there is another trend that does not contribute to the creation of harmonious families: an increasing number of marriages concluded not for love, but because the young showed negligence and the partner became pregnant. In such "forced" marriages, of course, the child is perceived as an unfortunate misunderstanding that has made life difficult for the young, and one cannot count on the fact that the child will receive from his parents everything that he can and should receive for normal development.

Both the fear of having a child and the view of the child as a burden ultimately turn against the child, against the young family, and against society as a whole. The child, of course, should be welcome in the family. BUT welcome child can become only in a family where partners love each other, where both a man and a woman have determined their place in life, where, in addition to these two conditions, at least an elementary material base has been created. That is why we, while opposing marriages concluded for mercantile reasons, at the same time warn young people against too hasty marriages, concluded in a state of first blindness to each other.

The time most favorable for the birth of the first child is for a woman between twenty and twenty-eight years (deviations of one year in either direction are permissible); the second and subsequent children can be born without any health risk even after twenty-eight years. Here, however, exceptions are possible. Due to a number of reasons (for example, long-term infertility, for which a woman was treated), the first pregnancy can occur at the age of 35-40, and gynecologists know cases when pregnancy in middle-aged and older women proceeded and was completely resolved. normal delivery. At this age, of course, certain complications also occur, which are successfully dealt with. modern medicine, but we at least we see no good reason why a woman who has crossed the twenty-eight-year mark would consider herself incapable of giving birth to a child. We only want to warn against the birth of a child women who have not reached twenty or at least nineteen years. The point here is not only that pregnancy in early age may occur with complications; the fact is that a woman who is too young is not yet prepared physically, spiritually, or materially to become a mother.

We do not share the point of view of those psychologists who consider childbirth as a state of shock for a woman. In no doubt, pregnancy, like childbirth, leads to a restructuring of not only the woman's body, but also her psyche. Much here depends on individual characteristics the psyche of every woman. In impulsive, poorly adapting to environment women, pregnancy can actually occur with certain complications, while a woman is balanced, with normal state mental complications are extremely rare. It also depends a lot on the woman’s environment, on whether her husband is attentive or inattentive, whether she has friends, how her parents treat pregnancy, etc. In this sense, a woman, of course, must be prepared primarily psychologically, then and psychologists will have no reason to consider childbirth as a shock, and women themselves, properly prepared for childbirth, will not experience any shock conditions.

Fertilization

Pregnancy begins with the fertilization of a mature female reproductive ovum, or simply an egg, with a male reproductive cell, or sperm.

The very word fertilization, or syngamy (from the Greek syngamos - connected by marriage), means the fusion of male and female germ cells, resulting in the formation of the so-called zygote (from the Greek zygotos - connected together), capable of developing into a new independent organism. Fertilization is widespread in nature and is inherent in both plants and animals, as well as humans. It should be noted that fertilization underlies only sexual reproduction and ensures the transmission of hereditary traits from parents to offspring (we will talk about the transfer of hereditary traits from parents to children a little later).

Our task, of course, does not include consideration of the entire diversity of fertilization inherent in both the plant and animal worlds (those who wish to become more familiar with this issue, we refer to the special literature). We will consider only the process of fertilization in humans, and even then we will touch on this issue briefly, of necessity, so that our readers can imagine the essence of the process of fertilization and which organs are involved in it.

AT abdominal cavity women, on either side of the uterus, B are the ovaries. Once a month, in the middle of the menstrual cycle, only one egg matures in the ovaries, which separates from the ovary and enters the uterine, or fallopian, tube. Occurs, as gynecologists say, ovulation.

Here, a mature egg is located for no more than a day, slowly moving towards the uterine cavity. Fertilization occurs right here, in the fallopian tube, where male sex cells - spermatozoa - penetrate through the vagina and uterine cavity.

The nucleus of the egg, which can only connect with one sperm, is surrounded by a crown. If a mature egg retains vital activity for no more than a day, then spermatozoa have the ability to fertilize up to two to two and a half days.

From the moment of connection of the spermatozoon with the nucleus of the egg, a complex process begins, which has not yet been fully studied. The fertilized egg divides in two, each of the halves of the egg divides into new halves, the egg growing in this way begins to resemble a miniature raspberry in shape, which, continuing to grow, turns into a human embryo.

Start of pregnancy

A woman, of course, cannot know exactly when fertilization occurred and whether it happened. The beginning of pregnancy is indicated by the absence next menstruation. If the delay or absence of menstruation is not caused by any other reasons, then a woman, subtracting 14 days from the day of the expected start of menstruation, can determine the onset of pregnancy with an accuracy of two to three days.

However, a delay in the onset or absence of menstruation does not necessarily serve as a "signal" of pregnancy. The menstrual cycle in a woman can also be associated with other reasons: a general deterioration in health (anemia, diabetes mellitus), mental disorders(depressed state, a feeling of anxiety), the extinction of the function of the reproductive system (menopause).

If menstruation does not occur within two weeks after the expected date, a woman should contact a gynecologist who will determine exactly whether pregnancy has occurred or not. (You should also see your gynecologist if you experience pain in your lower abdomen.)

Physical changes during pregnancy

The human embryo begins to live and develop at the expense of the mother's body, which in turn adapts to the changes that have taken place in it. The fetus receives oxygen and food along with the mother's blood and returns decay products to the mother's blood. So that the fetus does not experience any inconvenience during its development, it is surrounded by a liquid called amniotic fluid. These waters are expelled from the mother's body during childbirth.

First physical change women during pregnancy is a growing belly. The size of the abdomen does not indicate, however, the height and weight of the fetus, and even more so that a woman may have twins or even triplets. Of course, the belly of a woman carrying twins is larger than the belly of a woman expecting one child, but the size of the belly as a whole depends on the individual structural features of the body, and in different women in the same stage of pregnancy, carrying a fetus of the same height and weight, the size of the growing belly may be different.

The breast of a pregnant woman also increases in size due to the intensive growth of the mammary glands, the nipples swell and darken, from which a few drops of a thick translucent liquid may stand out already in the first weeks of pregnancy. A few months later, even before the onset of childbirth, this liquid will acquire a yellowish tint. It's not really yet breast milk, but the secret of the mammary gland, known as colostrum. Compared to milk, colostrum contains more proteins, fats and mineral salts and is an indispensable nutritional food for newborns.

A pregnant woman undergoes another physical change that gives her a lot of grief: it turns into dark color skin on the abdomen in the navel and on the face. There are so-called dark spots. They should not be frightened, they will disappear without a trace five to six weeks after birth.

More major changes may touch blood vessels a pregnant woman: she may have nodules of veins on her legs that are hard to the touch, and hemorrhoidal bumps may appear in the area anus. These changes are usually seen in last stage pregnancy, and women at this time are advised to rest more often or lying down, placing pillows under their feet to reduce blood flow in them, or sitting with their feet on a bench.

Some young women who are about to become mothers may be intimidated by our story. However, we must reassure such expectant mothers: nothing unusual is happening to you, it’s just that your body adapts to new conditions for it, and after childbirth everything will return to normal and you will become even nicer and more beautiful than you were before pregnancy. It has long been noted that motherhood is beneficial to the appearance of the vast majority of women, and in this sense, of course, you will not be an exception.

Women's consultations

Having determined with the help of a gynecologist the time of pregnancy, future mom must register with the antenatal clinic closest to her home and undergo regular examination. Many of your possible fears will help you get rid of experienced doctors; they will also monitor the normal course of your pregnancy. At the appearance of the first warning signs you will be hospitalized or assigned ambulatory treatment, but in any case, you will be helped to carry the fetus until the time when you can have a normal healthy baby.

Your good health during pregnancy should not serve as a basis for you to stop visiting the antenatal clinic. You should visit this medical institution throughout the entire period of pregnancy on the days and hours that the doctor observing you will appoint.

Child's estimated birthday

Every pregnant woman begins to calculate the days when she will have a baby. Only a specialist doctor can determine the exact date of birth of a child. However, given your natural desire to know the expected birthday of the child, we will help you to do it yourself with a greater or lesser degree of accuracy.

Pregnancy lasts an average of 280 days, or ten lunar months. Usually European women living according to the Gregorian, or solar, calendar, are confused by this term - "lunar month" (it is also called "obstetric month"). But the female body does not live according to the solar calendar, as, however, strictly speaking, and not according to the lunar calendar. A woman's menstrual cycle takes an average of 28-30 days, that is, about one month, while the number of days in each of the months of the Gregorian calendar is not constant and ranges from 28-29 to 30-31 days. Moon month is slightly more than 29 days and, thus, is more applicable to the rhythm in which the female body lives, and therefore we are talking for greater accuracy not about nine months of the solar calendar, but ten months of the lunar calendar in relation to medium duration pregnancy.

How to determine the date of birth of your child, "reconciling" the lunar calendar with the solar (or, as it is also called, tropical) calendar? Remember when you had your last period before pregnancy. Subtract three months from the first day of the last menstruation and add seven days to the resulting number - this will be the expected date of birth of your child. Let's pretend that last period The woman started on October 17th. October is the tenth month of the Gregorian calendar. We make a calculation: X-III \u003d VII. The seventh month in the Gregorian calendar is July. Now, by July 17, we add seven days and get 24. Therefore, the expected birthday of a child for a woman whose last menstruation began on October 17 of the past year will fall on July 24 of the next year. (In general, we strongly recommend that women who are about to become mothers keep an individual schedule of the menstrual cycle; after all, menstruation in different women happens not only once every 28-30 days, but can also occur according to the so-called shortened cycle and fall on days 21-24 or even exceed 30 days.)

If you haven't kept records and can't remember when your last period was, you can figure out your baby's expected birthday in a different way. When you feel the first movement of the fetus, add 20 weeks to this day (women who have given birth before can feel the movement of the fetus on average two weeks earlier than women who have become pregnant for the first time, so they must add 22 weeks to the first push of the fetus). However, this method of determining the probable birthday of a child, as you can see, is less accurate.

The course of pregnancy

Different women experience pregnancy differently. Everything depends on the general physical condition pregnant woman, on her character, mental balance, family situation and a host of other reasons, which at first glance may seem insignificant, but which, nevertheless, can have a very noticeable effect on a pregnant woman. It also matters how a woman herself relates to her pregnancy. It is clear that a woman living in a happy marriage and wanting to have a baby will treat her pregnancy differently than a woman who constantly quarrels with her husband or becomes pregnant out of wedlock.

In any case, we urge all pregnant women to inner peace, try to evoke positive emotions in themselves (it is not at all difficult to do if you listen to your favorite music recordings or reread your favorite books), not to succumb to mood swings that pregnant women really do not are stable.

Try to think more about your future child, about what name you will give him, how you will take care of him, what fairy tales you will tell - in a word, do not let anxiety or fear develop in yourself.

By the fourth month of pregnancy, some mental instability and internal anxiety give way, as a rule, to a calm balance, but on recent months there may again be a feeling of fear and anxiety before the upcoming birth, the expectation of pain that accompanies childbirth, and other undesirable sensations. Share your concerns with your doctor - modern medicine knows many ways and means, including psychological ones, that will help you regain peace of mind.

So much to create Have a good mood in a woman who is in the last months of pregnancy, the husband and other relatives of the expectant mother, as well as her friends, can do it. A woman should approach the birthday of her child calmly, confident in the happy outcome of her pregnancy, with the feeling that from now on she cannot imagine her future existence without a child whom she will love with all the strength of her soul and heart.

Nutrition of a pregnant woman

Great value for normal flow pregnancy has a woman's nutrition. It is noticed that pregnant women begin to feel the need for one dish, and from the sight of another dish that they used to love, they develop nausea. When compiling the menu of a pregnant woman, we advise you to adhere to the following simple rules:

a) food should be varied;

b) give preference to foods that are not too high in calories in order to avoid excess weight;

c) the menu should be dominated by fresh fruits and vegetables, especially those that contain vitamin C;

d) spicy spices should not be included in dishes;

d) try to avoid legumes leading to bloating of the stomach;

f) eat boiled dishes more often, which are easier to digest;

g) be sure to include in your daily diet milk and dairy products (at least 1/2 liter).

It should be avoided by a pregnant woman

Many modern women used to drinking strong natural coffee in the morning (some women do this several times during the day). Avoid this habit during pregnancy, as the caffeine in natural coffee increases blood pressure. For the same reason, avoid strong tea, which dilates the vessels of the brain and heart. During pregnancy, rosehip decoction will benefit you the most.

In no case do not smoke! The nicotine contained in tobacco can act as a powerful poison on the fetus.

It is unnecessary to talk about this specifically, but in all seriousness it should be recalled that the strongest and extremely dangerous poison for the normal development of the fetus is alcohol, which should be completely excluded from the diet of a pregnant woman, even in microscopic doses.

Some pregnant women complain about bad dream, to increased excitability and other ailments and therefore independently prescribe sleeping pills and tranquilizers. Self-treatment generally unacceptable, and especially during pregnancy. Take only those medicines and in such doses as your doctor has prescribed for you.

Chair

Literally two words about the chair of a pregnant woman. Empty your bowels at the same time every day. To avoid constipation, move more, eat fresh fruits with skins and vegetables. It is good to drink a glass of water on an empty stomach room temperature. If you have difficulty with stool, see your doctor.

Clothing and footwear

The clothes of a pregnant woman should be spacious, so as not to hamper movements, and correspond to the season. Avoid wearing clothes that are tight and uncomfortable, too warm or, conversely, unseasonably light. The shoulders of the bra should not cut into the body, and the cups should be chosen so that they do not compress the chest. You can find many models in fashion magazines, from which it is easy to choose the style that suits you best. However, stores always have a sufficient assortment of inexpensive dresses for pregnant women, which are suitable for both home and street.

The shoes of a pregnant woman should also be free and comfortable. We do not recommend wearing flat shoes during pregnancy, which can develop flat feet, but the heel should not be too high. Before going to bed, it is useful to stretch and massage the soles of your feet to relieve them of the tension that has accumulated during the day. You can do this with the help of your husband, or you can do it yourself, raising and lowering a handkerchief or pencil from the floor with your toes. A few minutes of such exercises will remove any fatigue from your legs.

Dental care

The fetus developing in the womb of a woman needs a large amount of phosphorus and calcium, which goes to the "building" of bones. It receives these components necessary for the embryo, naturally, from the mother's body. It is not surprising that a pregnant woman who does not watch her mouth may miss one or even several teeth by the end of her pregnancy.

That is why it is important to visit the dentist's office in the first weeks of pregnancy. Throughout pregnancy, do not forget to take good care of your teeth, eat more fresh fruits and vegetables, drink milk, include lemons and oranges in your diet, they are very useful. fish fat and other foods containing phosphorus and potassium.

At the first sign of tooth decay, contact your dentist.

Outdoors and body hygiene

Pregnant women should spend at least two hours a day on fresh air. useful in summer sunbathing, which contribute to the production of vitamin D in the body. However, you should be aware of the danger of sunburn, so do not spend more than 5 minutes in the hot sun. In the following days, you can increase the time spent in the sun and gradually bring it up to 20 minutes, a longer stay is harmful to everyone, including pregnant women. Make sure that your head is covered with a scarf, and for women prone to freckles, wide-brimmed summer hats are suitable.

Pregnant women sweat easily. We recommend a cool shower in the morning and a warm shower in the evening, remembering to place a rubber mat on the bottom of the tub first to prevent slipping. hot shower, like hot tub pregnant women are contraindicated. Women who do not have their own bath should wash over the basin with soap and a washcloth.

We are often asked if a pregnant woman can swim in open water in summer. If the water in the reservoir is clear and warm, you can swim, but only in the presence of a husband or people who can swim well. In closed reservoirs, devoid of natural channels, we do not recommend swimming either for pregnant women or for women who have recently given birth to a child, in order to avoid pathogenic microbes entering the internal genital organs.

The breasts of a pregnant woman require special attention. In addition to morning and evening washing, you should lubricate the nipples twice a week with baby cream, which can be purchased at any pharmacy or perfume department of stores. Flat or sunken nipples should be massaged more often to firm them up.

Pregnant woman cosmetics

A woman always remains a woman, even when she is expecting a child. There are no contraindications against the use of cosmetics during pregnancy.

However, we would like to draw your attention to the following circumstance. The skin during pregnancy releases increased amount fat, so we recommend washing your hair at least once every five days. When washing your hands, use a special brush or an ordinary toothbrush with soap and water so that your nails are always kept clean.

The rest depends on your tastes and habits.

Physical exercises

We have already talked about the colossal energy that a woman expends during childbirth. To prepare the body for these enormous loads, a pregnant woman should pay the most serious attention to physical exercises, aimed primarily at strengthening the muscles of the abdomen, legs and hip joint. A well-prepared woman's body will more easily endure the upcoming birth, and in some cases will significantly reduce the sensation of pain. Most effective complex exercise, suitable specifically for your body, you will be helped to compile in the antenatal clinic, in which experienced doctors carefully monitor the course of your pregnancy. For some women's consultations special Sport halls where pregnant women do physical exercises under the supervision of doctors or physical education instructors trained for this purpose.

Exercise is contraindicated only for women who are threatened premature birth. In such cases, the supervising physician acts in accordance with the rules that exclude or minimize the risk of preterm birth.

When a woman has twins

The closer the day of the expected birth gets, the more often the woman looks anxiously at her stomach and asks the doctor who observes her, or her husband: "Is it possible that I will have twins?"

Of course it can. And now we will tell you in what cases twins are born.

In the chapter "Fertilization", which is part of the chapter "Motherhood through the eyes of a gynecologist", which you are now reading, you must have noticed one "inconsistency" that we did not specifically dwell on. There, we recall, it was about the fact that in the abdominal cavity of a woman there are two ovaries, and once a month, in the middle of the menstrual cycle, only one egg matures. Meanwhile, there is no "inconsistency" here, just nature once again showed its wisdom, taking care not only of the woman's health, but also of replenishing the human race.

Let's explain what is meant here. AT normal conditions and the egg matures once every four weeks in only one ovary - right or left. Next menstrual cycle the ovary, which has already produced one egg, seems to be resting, and the second ovary produces a new egg. So they function alternately throughout the entire period of a woman's maturity. However, there are cases when nature would definitely "feel" that the human race is threatened by a reduction, or boys began to be born more than girls, or, on the contrary, the number of girls began to outstrip the number of boys born, and then she "intervenes" in the woman's body, and the ovaries no longer alternately, but both at once produce one egg each, or one ovary produces two eggs, while the second ovary "rests", or one ovary produces one egg, and the second two at once, which happens much less often; ovaries can produce even four and five, and in exceptional cases more mature eggs, and they will all be fertilized (of course, you remember that each egg is fertilized by only one sperm, although each portion of sperm contains a huge number of vital sperm). Then a woman can give life to two at once, and in exceptional cases to more children.

Twins born from different eggs are no more similar to each other than siblings born at different times are similar to each other, and at the same time they are of the same or different sexes. Such twins are sometimes called fraternal twins.

But that's not all. The ovary can produce an egg, which after fertilization will give not one, but two embryos. This happens in nature much less frequently than the birth of fraternal twins, but it still happens, and then twins are born, like two drops of water. similar friend on the other and, moreover, endowed with the same properties of character. At the same time, it is curious to note that twins in this case are always born same-sex - either only boys, or only girls. Such twins are also called identical twins.

Of course, you are interested in how often twins are born? Infrequently. On average, one twin accounts for 80-85 twins. fetal birth, triplets - already for 6-8 thousand births, but a greater number of twin children are born, as we have already said, in extremely rare cases.

It should be noted that the probability of giving birth to twins is higher in those women whose mothers or even more distant ancestors were themselves twins (the same applies to men who either themselves or their ancestors were twins).

Boy or girl?

And, of course, every pregnant woman wants to know: who will be born to her - a boy or a girl? We will try to answer this question, having figured out in which cases boys are born, and in which girls.

Each human body is made up of many billions of cells, and each of these billions of cells contains 46 chromosomes, connected two by two into 23 pairs of chromosomes, approximately the same in shape and size. In women, all 23 pairs of chromosomes are the same, and since these chromosomes, with a very strong increase, resemble latin letter"X", they are called the X chromosome. In men, only 22 pairs of chromosomes are the same (i.e., only 44 X chromosomes), but the last, 23rd pair of chromosomes consists of one X chromosome and a second Y chromosome, so named because with a strong When enlarged, it resembles the Latin letter "Y".

Mature male and female germ cells consist of the same chromosomes as any other living cell of the human body, but it no longer contains paired, but single chromosomes, that is, a total of 23 chromosomes (in this sense, it would be more correct to call sex cells not actually cells, but half-cells, as if "sawed" in half along all 23 pairs of chromosomes, however we will not confuse the established terminology). And if the female sex cell, "taking" from each pair of chromosomes only one X chromosome, "takes", of course, also the X chromosome from the last, 23rd cell, then in the male germ cell one of the two X or Y chromosomes contained in the latter, the 23rd pair, it turns out to be "superfluous", and the spermatozoon "chooses" either the X chromosome or the Y chromosome as the last, 23rd chromosome.

When the female and male germ cells merge, a new living full-fledged cell is formed, containing in total the same 46 chromosomes as any other of the billions of cells in our body, connected by two into 23 pairs of chromosomes. Now, we believe, it will not be difficult for you to guess that if the spermatozoon contained the last, 23rd X chromosome, then the embryo of a girl arises, and if the Y chromosome, then the embryo of a boy arises.

From the figure we have presented, where the last, 23rd pair of chromosomes is depicted against each human figure, it is clearly seen how in one case a boy arises from the combination of X and Y chromosomes, and how a girl.

It remains to be added that all 23 single chromosomes contained in both female and male germ cells carry "information" about their owners, including even such information as the characteristics of their characters. It is not surprising, therefore, that a newly formed living fertilized cell, already containing 23 new pairs of chromosomes, inherits all the features of its parents: their appearance, character traits, and so on. A child can inherit both the strengths and weaknesses of the parents (the "strong" side does not necessarily become the father), and then he will look more like a father or a mother; if both parents are strong or weak, then the child is not like either the father or the mother, but represents something in between. Unfortunately, the child inherits not only the appearance of his parents and their character, but also some hereditary diseases that one or both of the parents suffer from and which they, in turn, inherited from their ancestors. That is why it is important for young people to go through medical examination. We advise you to do this not in order to "humiliate" one of the partners: you will simply know in advance whether healthy children will be born to you or whether they will inherit some diseases that some people may not even know about. If one of the partners turns out to be a carrier hereditary disease, modern achievements medicine will help him recover (which is important for the health of the partner himself - the carrier of the hereditary disease), and then the children will be born healthy.

However, we, having explained in which case a boy is born, and in which a girl, did not answer your main question: who exactly will be born to you?

We must confess to you with all sincerity: we do not know.

The question of whether we will have a boy or a girl will worry people from time immemorial. In one of the Berlin museums, a papyrus from the time of Ramses II (end of the 14th - middle of the 13th century BC) is kept, in which it is assured that in order to find out the sex of an unborn child, one should pour grains of barley and wheat with the urine of a pregnant woman ; barley will sprout before - a boy will be born, wheat will be ahead of barley - to be a girl. The ancient Egyptians were naive people, don't you think? To prove this, in the forties of our century, an experiment was carried out in accordance with the "recipe" of papyrus. And what? In 80 percent of cases, the recommendation of the ancient Egyptians was confirmed!

In the past, in the 19th century, scientists came up with not one, but a round score of 250 ways to determine the sex of an unborn child. Unfortunately, none of them proved to be true in practice. In this century, careful studies of amniotic fluid and fluoroscopy have been applied, but, alas, they have not yielded any results.

Or maybe it's good that there are no reliable ways to determine the sex of an unborn child? Maybe Nature needs it so much that for every 100 girls 106 boys are born? Maybe, in fact, a person should not interfere in this secret of Nature, which she carefully guards from us in the belief that she will be able to save the human race better than we ourselves will be able to do it for her?

childbirth

Do not rush things, everything, as they say, has its time. So we have come to the consideration of the most complex physiological act of expulsion of the fetus and afterbirth from the uterine cavity, well known to everyone under the name of childbirth.

Indeed, childbirth is a most complex physiological act, which in turn consists of three periods: the opening of the cervix, the expulsion of the fetus and the birth of the placenta. It is in this sequence that we will consider the process of childbirth.

Opening of the cervix. This period begins with rhythmic contractions of the muscles of the uterus, sometimes called labor pains. With the advent of the first contractions, a pregnant woman, in fact, is no longer pregnant, but a woman in labor (after the end of childbirth, a woman in labor becomes a puerperal, but when she is discharged from the maternity hospital and she, happy, returns to her family, she is already a young mother. However, we are somewhat ahead of events). The first contractions are short - 20-30 seconds, no more - they seem to prepare the body of the woman in labor for the onset of childbirth. The time intervals between the first contractions are also significant - the body of the woman in labor must not only prepare for the upcoming birth, but also rest and gain new strength. Thus prepared, the body begins to experience new contractions - lasting up to 45 seconds, and the intervals between them are reduced from thirty to twenty, then to fifteen, ten, five, and, finally, are only two or three minutes. With the increase in contractions, the cervix opens more and more, preparing to release the fetus from the uterus.

Amniotic fluid rushes into the slightly opened cervix and pours out. At this time, the head of the fetus is pressed against chest, due to which the pressure on the brain decreases, and the fetus itself falls closer to the vagina: The first stage of labor lasts from 3-6 hours and can reach 11 or more hours. End of the first stage of labor full disclosure cervix.

It is important that throughout the first stage of labor, the woman in labor should try not to strain, breathe deeply and only through the nose (when breathing through the mouth, the lips, tongue and mucous membrane of the larynx dry out, which makes the woman in labor feel thirsty). You should not be afraid of anything, nature has foreseen everything in advance and gave you great strength, try to relax - a relaxed body will more easily cope with its duties when the second stage of childbirth begins.

Expulsion of the fetus. The second period, in fact, has already come after the full disclosure of the cervix. The regular contractions of the uterus in the first stage of labor in the second period are joined by the so-called attempts, or contractions of the muscles of the uterus with simultaneous muscle contractions abdominals and diaphragms. The fetus moves into the vagina and gradually comes out.

The second stage of labor is painless for the woman in labor and lasts no more than an hour, and for some women it takes only 15-20 minutes. Experienced doctors and obstetricians will constantly be near you, they will accept your child, slap him lightly on the ass, the child will startle from an unexpected slap, his lungs, which were in a "folded" state, will "open", air will rush into them, causing pain to the child , he, instinctively defending himself, will “compress” his lungs again, the child will scream in pain, and at that very time, as you might have guessed, his breathing will begin to function - inhalation, exhalation, a new inhalation and a new exhalation, which will henceforth accompany him throughout his life. The baby will be laid on a blanket, the umbilical cord will be bandaged, the excess will be cut off (don't worry about the baby - there are no nerves in the umbilical cord, so your baby will not feel any new pain) and a mark will be made on your child so as not to confuse him with another baby.

The birth of the afterbirth. Does this mean that in the second period, with the birth of a child, the process of childbirth ends? No, it does not mean that the woman in labor must also expel the afterbirth from herself.

What is the afterbirth and why should it be expelled from the uterus? The placenta consists of the placenta (i.e., the organ that communicated between the mother's body and the fetus during the period prenatal development), membranes and umbilical cord. They have fulfilled their function, intended for them by nature, and now they have become superfluous in the body of the woman in labor.

20-30 minutes after the birth of the child, the woman in labor will begin contractions again - contractions of the muscles of the uterus, abdominal muscles and diaphragm - and the afterbirth will be expelled outward without any pain.

The woman in labor is given the opportunity to rest for two hours, she, as a rule, falls asleep, and wakes up not as a woman in labor, but as a puerperal. That, in fact, is all that we wanted to tell you about childbirth.

Feet forward baby birth

In the vast majority of cases, the fetus in the mother's womb develops head down. However, there are times when the fetus develops head up.

In this case, during childbirth, the legs of the child appear earlier, and not the head. There is nothing unnatural in such a birth of a child. True, with this position of the fetus, the first stage of labor is somewhat lengthened, when the cervix opens, but otherwise, as in the case of the birth of a child head down, experienced doctors and obstetricians will help you. There is absolutely no reason to fear for the normal outcome of childbirth, when the fetus in the womb is head up.

Newborn weight and height

What mother doesn't want a healthy baby? normal child! But if everything is more or less clear with the concept of healthy, then in the definition of the concept of normal there is a big disagreement of opinions.

It is quite normal when twins (not to mention triplets and more children born) are inferior in height and weight to singleton children, this is not surprising, and healthy twins quickly catch up in both height and weight of their peers.

Normal singleton newborns reach 50 centimeters in height and weigh 3300 grams. Deviations in one direction or another are acceptable.

postpartum period

It remains for us to say a few words about the postpartum period, when a woman returns from the maternity hospital to her family.

Biggest disappointment in the first postpartum period women are delivered by an enlarged and limp belly. The abdominal muscles should be strengthened not only with special belts, but also with a set of physical exercises, which you will be introduced to in the maternity hospital. Help you recover former form abdomen and in the antenatal clinic, where you applied during pregnancy.

Colostrum secreted from mammary glands even during pregnancy and so necessary for your child in the first days of life, will gradually be processed into regular breast milk, which contains all necessary substances for the normal development of the child.

Six weeks after giving birth, a young mother should definitely visit a gynecologist. The doctor will carefully examine you to make sure that the postpartum period went well for you, and if necessary, will provide you with timely and effective medical care.

Even in adult women, an examination by a gynecologist often causes fear. And for the most part, not because the doctor himself is so terrible, but because he conducts an examination with a gynecological mirror. How is the examination with a gynecological mirror?

AT certain period life girls begin to visit a gynecologist. Often this happens long before the first sexual intercourse. And all because elementary hypothermia can lead to unpleasant sensations in the abdomen.

And in order to diagnose this or that, the gynecologist must conduct a complete examination, which will include:

Examination of the external genitalia. To do this, the doctor simply approaches the woman, who has already settled down on the gynecological chair at this point, and examines how well the external genital organs are developed, whether there are any signs of infection or damage. It is believed that this is the most harmless stage, since the doctor practically does not touch the woman.
Examination with a gynecological mirror, during which the doctor examines the condition of the mucous membrane, but already inside. And although this process is unpleasant, it is very important.
Feeling the uterus. This must be done if the doctor suspects the presence, or the uterus does not match the size
Palpation of the appendages, during which the doctor examines the presence of growths that can cause pain, especially in young girls whose hormonal level still not completely back to normal
Taking analyses. Usually, a microflora analysis is taken to determine the presence or absence of some kind of infection or fungi.

In fact, an examination by a gynecologist is not as scary as many people think. Yes, purely from an aesthetic point of view, it can cause a lot of inconvenience and stress, more moral. But it is necessary to pass it, because women Health- very important, especially her reproductive system, as the possibility of having a child depends on it.

Gynecological speculum

Due to the fact that the most, so to speak, terrible moment in the process of examination by a gynecologist is the manipulation of the mirror, it is necessary to dwell in more detail on the instrument itself.

So, today there are several types of mirrors, primarily differing from each other in size, since each woman has her own complexion. And it is necessary to strictly observe all proportions so as not to cause harm.

By size it is customary to allocate:

XS size. It is used in children and adolescents, since the organs are not fully formed, or rather, not formed, and their size is much smaller than in an adult
Size S. This mirror has a diameter of 23mm. It is used mainly in girls who have not yet given birth.
Size M. This mirror has a diameter of 25 mm. It is mainly used in women who have already given birth, who are distinguished by a thin complexion.
Size L. This mirror has a diameter of 30mm

Depending on the build of a woman, on whether she gave birth or not, leads sexual life etc., the choice of mirror will depend.To date, there are reusable gynecological mirrors and disposable.

More information about the gynecological examination can be found in the video.

As for reusable mirrors, they are used in antenatal clinics and hospitals. They are made of metal and must be sterilized after each inspection. But since most women do not inspire much confidence in this process, they prefer to use disposable mirrors.

A disposable mirror can be purchased at any pharmacy kiosk, but the main thing is to indicate the size correctly.

The main advantages of such a mirror are that it cannot be used more than once, that is, accordingly, the risk of transmission of sexual infections is reduced, more rounded shapes, which makes the process itself much more pleasant.

Before you buy a gynecological speculum at a pharmacy on your own, you need to consult a doctor so that he can tell you exactly what size is needed.

For many women, the question arises whether an examination with a gynecological mirror is so necessary, and whether it can be avoided.

In fact, an examination is necessary, since during it the doctor can establish such deviations as:

Tears in the mucous membrane, which will not only cause discomfort, but will also cause infection, or rather, will be its conductor further through the body
Edema, which also causes malaise. And when it is detected, it is necessary to establish the cause as soon as possible.
Changing the color of the mucosa, as well as its structure
The presence of scars that may appear after past illness or surgery

And that is not all. Examination with a mirror is necessary to consider a disease such as erosion, which is very dangerous and is considered precancerous. Therefore, it is important not only to undergo such an examination, but also to pass all the relevant tests.

How is the inspection

Many women become calmer when they find out how the examination is carried out with the help of a gynecological mirror, moreover, in detail and with a list of points.

So, it consists of the following steps:

After examining the external organs. The doctor will gently part the labia and insert a mirror. And he will do it slowly. But there is a category of doctors who prefer to do it quickly, since such an acceleration seems to them less painful.
A woman should remove all clothes up to her waist, including underwear, and sit in a gynecological chair
You need to relax so that the discomfort is invisible. If a woman is tense, then the muscles are also tense, which makes the examination difficult, and the girl will feel pain.
The introduction of a mirror, during which the woman will feel pressure, and she may also develop pain syndrome, mostly against the backdrop of excitement
After the introduction of the mirror, the doctor will begin a full examination, during which he will just consider the main points
After the inspection is over, the mirror will be removed, and also carefully, because these are the two most difficult moments.

Doctors say that you should try to avoid any movements with your body during the examination, as this can lead to muscle tension, and therefore pain and a spoiled mood.

Preparing for an inspection

And although many believe that it is not necessary to somehow prepare for this kind of examination, all doctors love cleanliness and order.

Therefore, if a woman is scheduled for an examination, then she needs to prepare:

Try to avoid sexual contact about a day or two before viewing
A few hours before the procedure, you need to prepare, namely to swim
Try not to go to the toilet a few hours before the examination

The view is not so scary. Just someone scares other women in his soreness. Examination with a speculum scares many. And not only from the medical side, but also from the aesthetic side.

But if you properly prepare and listen to the doctor, then it will go unnoticed.

If the woman prepared correctly, and the doctor completely carried out his actions as needed, then the result can be obtained in about 3 or 5 working days, but on condition that they are handed over at the clinic. If they are rented elsewhere, the result will be ready in a few hours.

A desired pregnancy is happiness for every woman, but sometimes this happiness does not come immediately, and the emotional mood of a woman directly affects it: conception, the course of pregnancy and childbirth, the condition of the fetus and the development of the child.

It is difficult to understand what is more in their stories: the desire to appear in the eyes of nulliparous women as a kind of "heroine" who does not care about anything, memories of the actual complications that accompanied their birth, or latent jealousy for those who also want to have children? Be that as it may, this kind of "passion" does not contribute to an increase in the population, and many women, having heard enough terrible stories and good "warnings", actually begin to experience fear.

This fear can be caused by many reasons, one of which is the age of the woman at the time of conception.

Due to a number of reasons (for example, long-term infertility, for which a woman was treated), the first pregnancy can occur at the age of 35-40, and gynecologists know cases when pregnancy in middle-aged and older women proceeded and was resolved by quite normal childbirth.

At this age, of course, there are certain complications that modern medicine successfully copes with, but at least gynecologists do not see good reasons why a woman who has crossed the twenty-eight-year mark would consider herself unable to give birth to a child.

I just want to warn against the birth of a child women who have not reached twenty or at least nineteen years. The point here is not only that pregnancy at an early age can proceed with complications; the fact is that a too young woman is not yet prepared physically, spiritually, or materially to become a mother.

It should be noted that a situation is often observed when young people show negligence and the partner becomes pregnant earlier than planned. In such cases, the child is perceived as an unfortunate misunderstanding that complicates the life of the young. The couple has not yet determined their place in life, has not created a material base, and suddenly discovered that "paradise in a hut" is a beautiful fairy tale.

In such cases, the situation turns both against the child himself and against the young mother. Psychological discomfort can cause physical harm to a woman's health, and a decrease in lactation, for example, and an early cessation of breastfeeding will already harm her baby.

Some psychologists consider childbirth as a state of shock for a woman. No doubt, pregnancy, like childbirth, leads to a restructuring of not only the woman's body, but also her psyche. Much here depends on the individual characteristics of the psyche of each woman. In an impulsive, poorly adapting woman, pregnancy and postpartum period can actually occur with certain complications, while in a woman who is balanced, with a normal state of mind, complications are extremely rare.

A lot also depends on the environment of a woman, on whether her husband is attentive or inattentive, whether she has friends, how her parents relate to pregnancy, etc. The professional help and support of doctors also plays an invaluable role here: a properly prepared woman will not experience any shock conditions.

In this regard, private clinics are developing various programs for pregnant women and women planning pregnancy. The implementation of these programs is designed to provide an informed choice in favor of maintaining pregnancy, obstetric and psychological support woman during pregnancy, childbirth and the postpartum period.

Nelly Shadrina, obstetrician-gynecologist, sling consultant, lactation consultant: Do not tell anyone that you have read this material. It is generally desirable to destroy it before reading it, tk. there is quite a lot of sedition in it. And certainly you should not share it with other obstetrician-gynecologists (suddenly, my friends will meet among them).

So, I’ll tell you a terrible secret: most of my acquaintances are obstetrician-gynecologists, and in general, most of my acquaintances of doctors are not against home birth. Actually, they don't care where you give birth: at home, in the field, in the forest under the Christmas tree, in the Great Concert Hall or somewhere else. If only you were healthy and the children were healthy. According to my observations, the most ardent opponents of home births are medical students, doctors of specialties very distant from obstetrics and people who have nothing to do with medicine.

Many of the statements that are made as arguments against home births seem to me ... well, a little illogical. I won’t take the liberty to analyze them all, I’ll give only the most common ones (well, my opinion about them). I emphasize that my opinion is only mine, it does not claim to be an absolute truth.

1. Childbirth must be monitored all the time with the help of equipment, otherwise it may happen so-o-o-e ...

In the popular mind, the role of the doctor during pregnancy and childbirth is often exaggerated, it undoubtedly exists, and I will write about it someday, but not where most of us think. Moreover, the phrases “because of the doctor I had a miscarriage at 5 weeks” and “the doctor saved my 5-week pregnancy” are equally absurd, because. the obstetrician could only not interfere with the natural process (chromosomal anomalies that no one in the world can treat are thrown out at 5 weeks). The same with childbirth. They can be controlled, but nothing good usually comes out of it. According to Nardin JM, the only consequence of continuous monitoring of the fetus during labor is an increase in the number caesarean sections. Accordingly, there is no difference where a woman will be listened to every 15 minutes with a wooden tube: at home or in the maternity hospital.

2. A perfectly healthy woman in childbirth can happen so-o-o-e...

As one of my old, old teachers used to say: “If a woman bore and gave birth to a child normally, she doesn’t need to go to the doctors – she is healthy.” If a woman gave birth badly, then something hurts her: either her body or her soul, she just doesn’t know about it. Therefore, before childbirth, the body and soul must be healed. Unfortunately, few people take into account the state of mind - that's where "sudden" (although, if analyzed, quite natural) difficulties come out. By the way, all participants in the process, including the midwife, should be healed.

In fact the majority possible problems can be prevented in a timely manner if the woman or her midwife is sufficiently informed.

placenta previa

There is no sudden presentation. The placenta cannot suddenly jump from the bottom of the uterus into the pharynx. Its position is easily recognized by ultrasound. If a woman is against ultrasound, there is Clinical signs presentation (bleeding, high standing of the head, noise of the placenta in the lower part of the uterus, etc.) These signs can be determined before childbirth, even with only an experienced midwife with a wooden tube in her arsenal. The same goes for suddenly formed twins, breech or transverse presentation - well, they cannot arise suddenly.

Incorrect insertion of the head, clinically narrow pelvis

Recognized during childbirth. None special devices you don’t need to do this - only the hands of a midwife or a doctor. And it doesn’t matter if these hands will find a problem at home or in the hospital. In the absence of artificial stimulation, childbirth with a clinically narrow pelvis stops and does not go any further, there is time to get to the hospital. But in the hospital they are dangerous, because. artificial oxytocin continues to shove a big head into a small pelvis and she has severe injuries. The only problem here may be the illiteracy of the midwife or her excessive arrogance. If the midwife did not suspect something was wrong at the 5th hour of the attempt, then the claims are against a specific midwife, and not at home birth in general.

Premature placental abruption

People, but most of the detachments are brought to us “from the street”. I mean, a pregnant woman walked around, suddenly, with the first contractions, she shed blood. What difference does it make, at the same time she was going to give birth at home or in the maternity hospital - all the same, any sane mother will rush to the maternity hospital. Detachment has certain risk factors and clinical signs.

Asphyxia

This is a situation in which it is better to be in the hospital. However, 80% of asphyxia can be cured with an oxygen mask (and they are found in the arsenal of midwives). In addition, there are signs that make it possible to suspect the risk of asphyxia (meconium staining of the water, changes heart rate baby, etc.)

postpartum hemorrhage

There are risk factors: abortion, large fetus, difficult childbirth etc. Many midwives have oxytocin and other contractions in their suitcases. The cause of medical horror stories are most often illiterate midwives who failed to assess blood loss in time and stop the bleeding. In all seriousness, I read on some forum that blood loss per liter is the norm during childbirth (I saw such blood loss only once, and then during the operation, after which the whole brigade wring out the shirt - everyone was so worried). Note that again we are talking about individual illiterate midwives, and not about home births in general.

Shoulder dystocia

It must be said that this nightmare home midwives in countries where AR is legal. This is indeed a situation that requires extraordinary abilities from an obstetrician. I know about 2 cases of such a pathology (I talked with mothers): one gave birth in the maternity hospital, the other at home - and at home the midwife worked more competently, and the maternity hospital baby got a neck injury. This is not to say that all home midwives are super pros, but to the fact that few people in the maternity hospital also know how to competently manage shoulder dystocia.

3. An ambulance in our country is going ...

Yes, unfortunately there is such a thing. However, here every woman herself is able to assess the possibilities of an ambulance in her region.

4. Frozen women only care about themselves, not about the child

Most of the frostbites I know went to this just for the sake of the child. Childbirth leaves an indelible imprint on a person's life. And the course of childbirth really depends on the environment of the woman in labor. If she is tense, oxytocin stops being produced, childbirth stops. Stimulations, operations, medicines lead not to mythical, but to very real health problems. For some women, giving birth at home is the only chance to give birth (for example, not all maternity hospitals undertake to deliver with a scar, while according to WHO recommendations, vaginal birth is less dangerous than a second caesarean).

I can talk a lot about ridiculous philistine ideas about childbirth, perhaps it’s time to write a book.

Oh yes, I completely forgot:

5. It is impossible to give birth naturally in maternity hospitals. Or is it too expensive

Well, depending on what you mean by natural. However, in many maternity hospitals it is no longer uncommon for partner, vertical births, births on the side, births after caesarean, there are many where they do not give an enema and do not shave their pubis, do not wipe lubricant and do not drip eyes, do not put vitamin K, do not scream, do not swear, they don’t episiotomize and don’t amniotomize everyone in a row, they don’t take away the baby and don’t smear the chest with brilliant green. I'm not telling fairy tales, I worked in one of these maternity hospitals.

So, my opinion is this: it is not necessary to divide into home births and maternity hospital births. It is necessary to divide into justified risk and unjustified risk.

I am against home birth because of the fear of the hospital (fear generally does not belong in childbirth).
I am against agitation for home births - everyone should come to this on their own.
I am against denigrating anyone: doctors, midwives, women in labor.
I am against home birth by all means.
I am against reinsurance like "let's have a caesarean right away." My experience suggests that natural childbirth more prosperous.
I am against shifting responsibility to anyone, be it a doctor or a midwife.
And so I am not against home birth.

P.S.: I know 2 women affected by the home midwife. And in one case, I ran after a gurney with a straw and listened to the baby’s heart every minute to see if he was alive. And after 3 months I found out that the same midwife with another woman in a similar situation made the same mistake, the child suffered. At the same time, I also know several women. who gave birth perfectly at home, I know cases of complications that arose when the midwife did an excellent job at home or sent the woman in labor to the hospital on time.

I know cases when in the maternity hospital they first drove the birth into a whirlpool of problems, and then heroically saved the mother and baby.

And I know cases when childbirth in the maternity hospital went naturally, everyone is healthy and happy.

Well, well, a woman herself chooses a midwife or a doctor, a house or a maternity hospital - no one will do it for her. In obstetrics, as in life, there is nothing unambiguous.

Protecting themselves from unwanted conception with a condom, 15 out of a hundred women become pregnant within a year. That is why the number of "fans" this method contraception is constantly decreasing. Unfortunately, condoms often break.

2. Coitus interruption: at its peak

According to a study conducted by Bayer in the fall of 2014, 6% of women still consider coitus interruptus the most effective method contraception! And they are wrong.

The pre-semen fluid, which is released at the beginning of sex for lubrication, can contain from 10 to 20 million spermatozoa. Not a single man is able to “keep” the first portion, which means that the most agile sperm can get to the egg and fertilize it. In addition, this method of contraception violates the natural mechanism of sexual intercourse and has a bad effect on both partners. Regular intrusion into natural satisfaction over time leads to frigidity in women, impotence in men or sharp decline Both have libido.

3. Douching with acidic solutions

For contraception, douching with acidic solutions is used ( lemon acid, herbs), as they are detrimental to spermatozoa. But the action of such solutions can adversely affect the condition of the mucous membranes of the internal female organs, call allergic reaction, wash off the natural lubricant, provoking a change in the microflora and the uncontrolled reproduction of harmful microorganisms.

4. We measure the degree of sexual life

Calendar, cervical and symptothermal methods of contraception are based on monitoring the temperature in the rectum, the condition of the cervix, the nature of vaginal discharge and other indicators. They, taken together and each separately, indicate the period most favorable for conception. So, in fact, they are rather methods of pregnancy planning, and not protection against it.

5. Contraceptive sponge: dubious effect

A contraceptive sponge is a small pad of polyurethane impregnated with substances that destroy spermatozoa (spermicides). In fact, it is a combination of mechanical and chemical methods. The sponge prevents the penetration of spermatozoa into the cervical canal and at the same time releases a composition that deprives spermatozoa of activity. Immediately before sexual intercourse, a woman should carefully insert a sponge previously moistened with water into the vagina and “wear” it for at least six hours after sex. The effectiveness of this method is rather low: 20-30 pregnancies occur annually in every 100 women using it.

6. Hormonal contraceptives

Enough on the market now hormonal contraceptives. They are divided into containing two types of hormones (progestins and estrogens), purely progestin and. The first and last are represented by several groups depending on the amount of estrogen - micro-, low- and high-dose.

Oral contraceptives reliably protect against pregnancy. The main thing is to choose the most suitable one with the help of a doctor and not violate his recommendations. Tablets should be taken daily, preferably at the same time. And passes for any reason - “husband left”, “forgot to buy”, etc. - have no right to exist. Hormonal contraceptives are compatible with most drugs, but not all. Some medicines can reduce the effectiveness contraceptives. In order not to harm yourself, you should tell the specialist in time what exactly you are going to treat a cold, flu or some other disease.

To choose the best for yourself, reliable and safe contraceptive You need to visit a gynecologist for a consultation. The doctor will determine the relative or absolute contraindications, chronic diseases, allergies and bad habits, will conduct a gynecological examination and, if necessary, prescribe additional tests. In particular, ultrasound, as well as consultations of narrow specialists, for example, an endocrinologist, if a woman has diabetes, and if varicose disease or hypertension will refer to a cardiologist and vascular surgeon. The independent choice of hormonal contraceptives is dangerous because it can harm the body - the very side effects, which it would be more correct to call a consequence of inadequate choice of the drug.