Labor management
The final stage of any pregnancy is childbirth. The correct management of childbirth largely determines the health status of the mother and child in the future. During childbirth, medical personnel take timely and adequate measures to avoid many complications. That is why, in our country, childbirth, as a rule, is carried out in specialized institutions equipped with all the necessary equipment.
The tactics of labor management traditionally have a wait-and-see-active nature, that is, during delivery there is not only careful observation, but also prevention and correction of emerging abnormalities, and if necessary, emergency delivery is used.
The main periods of labor
There are three periods in the management of physiological childbirth, and in each of them, the medical staff adheres to a certain tactics of labor management:
- First stage of labor. In terms of duration, this period of labor is the longest - from 8 to 16 hours, and sometimes more. The beginning of the first stage of labor is considered the appearance of contractions with the same interval, which gradually become more frequent. There is a slow opening of the cervix, as well as the formation of the birth canal. The minimum speed at which the cervix dilates is 1 cm per hour. The discharge of amniotic fluid occurs during the first stage of labor. With a protracted course, oxytocin is administered to stimulate labor and an amniotomy (bladder piercing) is performed;
- Second stage of labor. The duration of this period is 1 - 2 hours. Contractions are replaced by attempts, the expulsion of the fetus occurs. In the first hour, the head, gradually descending, reaches the pelvic floor. An hour later, she is born, then the shoulders and immediately the torso of the newborn appear. To prevent rupture of the perineum with difficult passage of the head, an episiotomy is performed - an incision of the perineum;
- Third stage of labor. The duration of the third period is no more than 10 - 30 minutes, during which the placenta and membranes pass away. If this process is delayed, manual separation of the placenta is used. The risk of bleeding is possible precisely in the last period.
When conducting physiological childbirth, the following features should also be taken into account: the age of the woman, the volume of the uterus and the position of the fetus, the first or second birth. All these features are very important and help to choose the optimal tactics of labor management in each period.
Management of labor in the first period
The woman is in the prenatal ward, after which she undergoes general hygiene procedures (cleansing enema, shower, shaving).
Systematically during the period of disclosure, an external obstetric examination is performed, the state of the uterus in contractions, as well as outside them, is noted. Every two hours, records are made in the history of labor management, and every 15 minutes, the doctor listens to the fetal heartbeat. Monitoring the gradual movement of the baby's head through the birth canal is carried out using the following methods:
- External methods of palpation;
- Vaginal examination;
- Listening to the fetal heartbeat;
- Ultrasound procedure.
If the contractions of the woman in labor are too painful, then anesthesia is recommended to maintain the mutual contraction of the lower and upper segments of the uterus and to prevent ruptures in the cervix.
Managing childbirth in the first period does not imply strict adherence to bed rest. A woman can walk, sit, swing in a rocking chair, etc. All this is quite acceptable if there are no obstetric or extragenital pathologies.
Management of the second stage of labor
When the cervix is fully dilated, the second stage of labor begins. Contractions of the uterus become more frequent and lengthened, the fetal head makes a turn, moving along the birth canal. The woman in labor feels strong pressure in the rectal area, as well as pain in the legs and pelvis. Brief periods of relaxation are followed by strong pushing.
The woman in labor is regularly measured pressure and other indicators, and as needed, anesthesia is given. All data is recorded in the partogram. The planned tactics of labor management may change precisely in the second period. It depends on the state of the woman in labor, the activity of labor and the duration of the period itself.
Here, the experience of the medical staff and the individual management of childbirth come first. As soon as the head appears, the obstetrician prepares to receive the fetus and begins to help its birth, while trying to prevent ruptures in the woman in labor at the same time, for example, by performing an episiotomy.
As soon as the head is born, the doctor determines whether there is an entanglement or not, and when it is detected, he tries to move the umbilical cord down. With the help of certain methods of labor management, the obstetrician helps one shoulder appear, and then another. Then the body and legs of the newborn appear. Mucus is aspirated from the child's mouth and nose, and the eyes are rinsed with sterile water. The baby is temporarily placed between the legs of the mother so that part of the placental blood flows out to him through the umbilical cord. After about 3 minutes, the umbilical cord is cut and the baby takes its first breath and screams. At the same time, the condition of the newborn is assessed using the Apgar scale. The baby is examined to identify possible pathologies, and then placed on the mother's abdomen for the first breastfeeding.
Management of physiological labor in the third period
In order not to disrupt the natural course of contractions, it is forbidden to palpate the uterus in the third period, otherwise the correct separation of the placenta will not occur. When the placenta is naturally detached on its own, the risk of bleeding is minimal.
The tactics of conducting childbirth in this period is reduced to waiting. The doctor monitors the color of the mother's skin, pulse and blood pressure. It is also necessary to monitor the bladder: an overflowing bladder reduces uterine contraction, which means that the normal flow of placenta is disrupted.
At this stage of labor management, the woman in labor is offered to push, but if the birth of the placenta does not occur, the obstetrician resorts to an external method of removing the placenta. Attempts to isolate the placenta before the placenta separates is strictly prohibited.
The next important task is to examine the walls of the vagina and cervix. If gaps are found, catgut sutures are applied. The integrity of the perineum after injury or episiotomy is also restored by suturing.
After the placenta leaves, the woman in labor becomes the puerpera, the postpartum period begins. For two hours, the postpartum woman continues to be in the maternity ward under the supervision of doctors and obstetricians, who monitor her general condition. Two hours later, the woman is transferred to the postpartum department.
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