Physiology of birth

Childbirth as a physiological process of expulsion of the fetus from the uterus is divided into 3 periods:

Period of disclosure

First period - the period of disclosure (expansion, dilatation) starts with a progressive labor and ends with the disclosure of the cervix. The duration of his or her identity for each pregnant woman: in nulliparous women, it is usually 9-12 hours, multiparous - 5-7 hours, with rapid delivery, this period may be reduced to 2-3 hours.

In the process of uncovering the necessary conditions for the expulsion of the fetus, the cervix is ​​smoothed (or thinner) revealed outer mouth cervical canal, broken shell.

A week before the birth the cervix is ​​high and towards the back; it gradually moved down and forward. In nulliparous significant degree of smoothing typically occurs to a significant opening of the cervix. In multiparous cervix is ​​usually smoother and revealed at the same time. Smoothing is determined by examination of the vagina and is estimated as a percentage. "Zero percent smoothing" - the cervix has not yet begun to thin; "50% smoothing" - cervix is ​​thinned to about half; "100% smoothing" - the cervix is ​​completely thinned. The degree of disclosure is estimated at survey and measured in centimeters. When the cervix is ​​revealed only by the thickness of a finger - is 1 cm, on average - about 5 cm and with full disclosure - 10-12 cm, fetal head (the largest part of the fruit) may pass through a hole.

Major expelling forces - contractions occur regardless of the will of the mother and occur spontaneously under the control of hormonal and other physiological factors.

Contractions continued intermittently for all deliveries, shortening the muscle fibers of the uterine body and stretching the cervix. Each contraction wave passes; it reaches a peak, then gradually weakened, allowing the uterus to relax for a while. At the beginning of birth pains may be felt as a dull pain or menstrual pain. These initial bout is usually (but not always) a short and gently extending from 30 to 40 seconds at intervals of 15-20 minutes. Some clans, however, begin with frequent and strong enough contractions. With the development of the birth process, you feel contractions more in the abdomen or in the abdomen and lower back, and the pain can not take place and between contractions. By the end of the first period, the fight is usually very intense and lasts for 90-120 seconds at an interval of just 2-3 minutes.

The quality of labor (intensity, duration) is estimated by means of special devices - monitors, which in addition to indicators of labor, are recorded and heart rate of the fetus.
If the monitor is not, the fight simply counted by defining their duration and the intervals between them with a stopwatch, and their power - the voltage of the uterus during labor, putting a hand to her stomach pregnant.
By the time of full disclosure of the uterus is usually opened amniotic bubble and depart the water front.

The first stage of labor is divided into three phases : Latent, active and transition. Each phase has its own physiological and emotional characteristics.

Latent phase   - The longest, fight less and less intense than in the subsequent phase. The neck is smoothed and disclosed for 2 - 4 cm and 5 cm possible. During this time, it is better not to be one, to try to calm down and than a distraction. Talk to a friend, listen to music and so on. D.
There will come a time when you will not be able to distract from fights - their frequency increases. Try to breathe slowly, it is time to the hospital.

The active phase   - Contractions become painful, but bearable, last for minutes or more at intervals of 3-5 minutes. No way back, only forward, to complete the process. You are concentrating more on their struggles, progress may seem very slow, and the forces in the battle need more.
Your confidence and optimism can restore the news that you move to a new state.

You are already in the delivery room, try to get comfortable .  You can try to pressure on the lower back and a cold or hot compresses on the lower abdomen, groin and lower back .  But it can solve the doctor or midwife .  Go to the bathroom every hour, because a full bladder is inconvenient and slow contractions .  Frequently change the position, unless you are very tired and need a rest or if the contractions do not follow one after another so often that you do not have time to move; Try to walk and sit, not lie in bed .  Some women make the mistake of staying immobile in bed for all births .  Lying can enhance the pain of contractions, and slow the progression of birth .  With the help of gravity, standing or hike at least for a while .  You can punctuate activity with rest .  It is important to obtain a liquid, so drink anything after each bout, or suck on hard candy .  Your progress is assessed by smoothing and dilatation of the cervix, as well as the movement of the child .

The main thing now - to relax during contractions, try not particularly tense, breathe slowly.
Keep calming and breathing exercises. Now is a good time to get maximum support from your partner, that can praise your efforts, rub his back and legs, count every 15 seconds of the fight, remind you that you need to move, to supply water to the toilet and escort. Relaxed now - the main thing. Especially try not to strain during labor.

You better keep breathing slowly until it helps to relax. If breathing is difficult, if you can not breathe slowly or can not concentrate on your breathing and relax, even after repeated attempts, switch to a superficial (rapid) breathing. This can give you extra power.

Transition phase   - The most difficult for most women giving birth. Contractions more often and longer, the pressure on the pelvis more, and physical and emotional feelings stronger. The cervix opens on the last 1 or 2 centimeters, the baby's head and leaves the uterus is pressed down into the birth canal, and delivery become the bearing-down period. The relatively short transition phase usually lasts from five to twenty fights. These contractions, the longest for the time of birth, followed by the shortest interval. Most likely, you will be tired, anxious, irritable, wholly absorbed in her attempts to cope with contractions. The intensity of the transition is almost overwhelming, and you need considerable help to go through this phase.

This phase, in fact, the transition from the first to the second period .  Not only finally revealed the cervix, but the baby started to move down .  The head slips cervix and out the vagina .  Your body shows some signs of the second period, though, from a medical point of view, labor is still in the first period .  Probably, you will have to cope with new, very intense feelings .  For example, your diaphragm can be irritated by involuntary spasms, harbingers of the child's birth .  As a result, you can start a hiccup or burp .  You may notice that holding your breath and straining during each bout .  This is called "urge to vain attempts" .  Often nausea and vomiting .  The pressure of the baby's head through the wall of the vagina to the rectum may be felt as enhanced intestinal motility or cause pain in the lower back and hips .  Trembling legs, gave over the body and profuse discharge of bloody mucus from the vagina demonstrate increased pressure down .  Contractions may be irregular, with a double peak last 90-120 seconds with a 30 second break Despite the strength and pain of contractions in a transitional phase - you can fall asleep between them if the body is trying to save the extra energy to fight .

In the transition phase, you fully concentrate on delivery; Nothing else matters. You may worry that something is wrong. You can feel the fear of struggle and dependence on others. You may think that the transition will last forever, and you do not soak. But, as aptly said one woman, "when you think that no longer sustain, endure nothing more."

Bearing-down period

Second period - bearing-down period, or the period of exile, begins with a full disclosure of the uterus and
It ends with the birth of the child. To his top fights reach a considerable length and strength, as well as the cervix no longer prevents the birth of the fetus, the uterus gradually squeezes it out of its cavity.

While contractions at the end of the first stage of labor is much stronger and longer than the onset of labor, and their strength is insufficient to overcome the resistance of the tissues of the birth canal nascent fetal head. When the head is lowered into the pelvic cavity, included another expulsive force - attempts - reflex mechanism, causing the muscles to shrink the anterior abdominal wall and diaphragm and the muscles of the perineum, abdomen, thighs, a number of other muscles, synchronous with the uterine contractions. When vain attempts sharply increased pressure in the abdomen and uterus, so the fetus and moves through the birth canal.

With the features of the size and shape of the pelvic fetal head connected movements that makes the fetus during birth.

Under the influence of labor and any attempts fruit falls, and the head of his (in normal previa) enters the pelvic cavity; here there is a turn of the head .  Passage of the fetal head through the birth canal, to some extent facilitated by the ability of the head to a slight change in the configuration (the compound of the bones in the head of the fetus moving) .  Soon, attempts to increase, the spaces between them are becoming shorter .  With the advancement of the fetus through the birth canal occurs crotch bulging of mothers, after which some disclosed pudendal cleft .  When the next vain attempts to open the genital slit showing the fetal head, but during pauses head pulls back, and pudendal cleft closes again .  When, finally, the fetal head ceases to fade between attempts, saying that the eruption occurred heads .  First cut through the occipital region, and then parietal bumps, forehead and then - the face .  For mothers are the most difficult moments, she experiences severe pain .  The doctor and the midwife maternity prompt when to hold your breath, increase or decrease the attempts .

After the birth of the internal rotation of the head makes the shoulder girdle fruit. Shoulder it down the birth canal and are born. After them easily born torso and legs, because the size of their significantly smaller born already heads and shoulders of the fetus. Along with the birth of the legs are moving away "rear" amniotic fluid, they are unclear, may contain an admixture of blood, if there are lacerations of the birth canal.

There are cases where the size of the fetus (especially its head) is greater than the size of the pelvic organs, through which it must pass. It occurs when the birth of a large baby and even a child of normal size, if mothers narrow pelvis. In such cases, delivery is possible by caesarean section. Typically, the possibility of such an option is stipulated in advance of delivery, and the woman in labor psychologically prepared for it.

In the second stage of labor, as in the first, labors may weaken - the weakness of attempts. Thus fruit like "stuck" in the pelvic cavity, which usually causes it to hypoxia. If it occurs immediately change the heart rate of the fetus. I must say that the nature of cardiac judge the status of the fetus during labor. His heart and listen during pregnancy and childbirth by a special portable device (if not performed continuously monitor control) or obstetric stethoscope at least 2 times per hour in the first stage of labor and after each attempts - in the second.

In the absence of any complications born baby gave a loud cry - this time to straighten out the baby's lungs; baby cries, moves legs and arms. The skin had a bluish - pink, in the mucus (grayish grease that protects skin from prolonged fetal exposure to amniotic fluid), face edema.

After you have performed initial processing newborn (removal of mucus with sterile gauze skin, aspiration of mucus from the mouth and nose, instillation into the eyes to prevent infection with a 2% solution of silver nitrate and so forth.), Performed ligation of the umbilical cord; do this procedure 2-3 minutes after birth of the baby. Next, the child weighed on special scales, measure its growth, put on his vest, swaddled (all - under sterile conditions) and, after watching him for a while, go to the neonatal ward.

Once established the breath of the newborn, the doctor conducts a regular inspection. To assess the state of the newborn is used a method developed by Virginia Apgar. In some Russian clinics Apgar score accepted in others - assessment of the state parameters is carried out without the use of evaluation by points.
Apgar assessment is carried out twice - at 1 and 10 minutes, 5 parameters 0-2 score.

The child is evaluated for all parameters at each inspection. The first one (minute) score of 7-10 points shows that the baby is normal (newborns rarely get 10 marks, the majority of kids arms and legs are bluish some time, which reduces the value); score 4-6 points indicates mild to moderate depression; 0-3 points - severe depression. Evaluation of 6 points or less means that the child needs additional medical care and follow-up. Second (10 minute) evaluation is generally higher than the first, and shows improvement over time or as a result of medical treatment. Although the Apgar score helps to identify children who need urgent medical care, improved indicators of the overall health of the child is not. The doctor or midwife will carry out a thorough examination of the newborn within a few hours after birth, to give an accurate assessment of the state of his health.

Apgar score

 Physiology of birth


Third period - post-partum, or sequence. The volume of the uterus after childbirth greatly reduced. It takes some time, so that it once again has found the tone - and the birth of the separation of the placenta and is due to its reduction. They usually begin within 5-10 minutes after the end of the second period in nulliparous and later - at multiparous, as the muscle of the uterus they have less tone due to the stretching in the previous birth. Usually the last born 15-20 minutes.

If the placenta is under the influence of uterine contractions is not separated from its wall, and is not born for 20-30 minutes, it has to be separated and removed under anesthesia or squeeze. At squeezing of women having short-term discomfort.

After the end of the woman giving birth is still 2:00 left in the delivery room .  The doctor is required to inspect the placenta and birth canal .  The process of separation of child seats (placenta, placenta) is always accompanied by a small blood loss (normally, if the physiological loss of blood - 250-350 ml) .  Blood necessarily going into the tray to assess blood loss and the need to take urgent measures .  The cause of bleeding may be abnormal attachment of the placenta to the uterine wall, decreased contractility of the uterus, birth canal injury .  In such cases, take the necessary measures: remove manually born of the placenta; or massage the uterus through the abdominal wall, designate the ice on the lower abdomen (for 15-20 minutes), administered drugs that reduce the uterus; sewn or damage the birth canal .  The doctor watches the stabilization of the mother (puerperal) on the testimony of blood pressure, pulse, lohiyam (discharge of blood and fetal membranes) and the tone of the uterus .

The bottom of the uterus, you can check out on their own, and if the tone is restored enough fundus soft massage. This issue should be discussed with your doctor.

Massage the uterus : Lying on his back, check the bottom of the uterus pressing on the abdomen above the pubic bone. If the bottom of the uterus thick, it should not be massaged, but if you do not feel your uterus, do massage.
With one hand, grab and tight circular movements massage the lower abdomen until you feel that the uterus has decreased and become solid. This can be painful. If you could not make the uterus cut, the doctor will prescribe the necessary procedures.

In the first minutes after birth, you can feel the tremors in his legs, the pain of uterine contractions (especially frequent in multiparous), swelling and discomfort in the crotch by stretching or seams. Warm blanket helps to relieve tremors and ice on the perineum reduces the discomfort and swelling. Make slow breathing exercises, it will help relieve postpartum pain. There may be hunger and thirst - not surprising, because you have worked intensely and probably missed lunch or dinner.