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About how a normal birth should take place. Periods of labor Main periods of childbirth

Childbirth is the process of expulsion or removal from the uterus of a child and placenta (placenta, membranes, umbilical cord) after the fetus reaches viability. Normal physiological childbirth occurs through the natural birth canal. If the child is removed by caesarean section or using obstetric forceps, or using other delivery operations, then such birth is operative.

Typically, timely birth occurs within 38-42 weeks of the obstetric period, counting 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. Childbirth occurs at 28-37 weeks. pregnancy and earlier are considered premature, and more than 42 weeks. - belated. The average duration of physiological labor ranges from 7 to 12 hours for primiparous women, and from 6 to 10 hours for multiparous women. Labor that lasts 6 hours or less is called rapid, 3 hours or less - rapid, more than 12 hours - protracted. Such births are pathological.

Characteristics of normal vaginal delivery

Singleton pregnancy.
Head presentation of the fetus.
Full proportionality between the fetal head and the mother's pelvis.
Full-term pregnancy (38-40 weeks).
Coordinated labor activity that does not require corrective therapy.
Normal biomechanism of childbirth.
Timely release of amniotic fluid when the cervix is dilated by 6-8 cm in the active phase of the first stage of labor.
Absence of serious ruptures of the birth canal and surgical interventions during childbirth.
Blood loss during childbirth should not exceed 250-400 ml.
The duration of labor for primiparous women is from 7 to 12 hours, and for multiparous women from 6 to 10 hours.
The birth of a living and healthy child without any hypoxic-traumatic or infectious damage and developmental abnormalities.
The Apgar score at the 1st and 5th minutes of the 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 pharynx up to 10-12 cm; advancement of the child through the birth canal and its birth; separation of the placenta and discharge of the placenta. There are three periods during childbirth: the first is the dilation of the cervix; the second is the expulsion of the fetus; the third is subsequent.

The first stage of labor - dilatation of the cervix

The first stage of labor lasts from the first contractions until the cervix is fully dilated and is the longest. For primiparous women, it ranges from 8 to 10 hours, and for multiparous women, 6-7 hours. In the first period there are three phases. 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 pharynx by at least 4 cm. The duration of the latent phase is on average 5-6 hours. In primiparous women, the latent phase is always longer than in multiparous women. During this period, contractions are usually not painful. As a rule, no drug correction is required during the latent phase of labor. But in women of late or young age, if there are any complicating factors, it is advisable to promote the processes of dilation of the cervix and relaxation of the lower segment. For this purpose, it is possible to prescribe antispasmodic drugs.

After the cervix dilates 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 pharynx 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 most often become painful. Pain sensations predominate in the lower abdomen. When a woman is active (standing, walking), the contractile activity of the uterus increases. In this regard, drug pain relief is used in combination with antispasmodic drugs. The amniotic sac should open on its own at the height of one of the contractions when the cervix opens 6-8 cm. At the same time, about 150-200 ml of light and transparent amniotic fluid is poured out. If spontaneous rupture of amniotic fluid has not occurred, then when the uterine pharynx is dilated by 6-8 cm, the doctor must open the amniotic sac. Simultaneously with the dilation of the cervix, the fetal head moves along the birth canal. At the end of the active phase, the uterine os opens completely or almost completely, 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 uterine os is dilated by 8 cm and continues until the cervix is fully dilated to 10-12 cm. During this period, it may seem that labor has weakened. This phase in primiparous women lasts from 20 minutes to 1-2 hours, and in multiparous women it 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 efficiency of labor, the condition of the woman in labor (well-being, pulse rate, breathing, blood pressure, temperature, discharge from the genital tract). The fetal heartbeat is regularly listened to, but most often constant cardiac monitoring is performed. During normal labor, the baby does not suffer during uterine contractions, and its heart rate does not change significantly. During labor, it is necessary to assess the position and advancement of the head in relation to pelvic landmarks. A vaginal examination during labor is performed to determine the insertion and advancement of the fetal head, to assess the degree of opening of the cervix, and to clarify the obstetric situation.

Mandatory vaginal examinations performed in the following situations: when a woman enters the maternity hospital; when amniotic fluid ruptures; with the onset of labor; in case of deviations from the normal course of labor; before anesthesia; when bloody discharge appears from the birth canal. One should not be afraid of frequent vaginal examinations; it is much more important to ensure complete orientation in assessing the correct course of labor.

Second stage of labor - expulsion of the fetus

The period of expulsion of the fetus begins from the moment the cervix is fully dilated and ends with the birth of the child. During childbirth, it is necessary to monitor bladder and bowel function. Fullness of the bladder and rectum interferes with the normal course of labor. To prevent the bladder from overflowing, the woman in labor is asked to urinate every 2-3 hours. In the absence of independent urination, catheterization is used. Timely emptying of the lower intestine is important (enema before childbirth and during a prolonged period). Difficulty or absence of urination is a sign of pathology.

Position of the woman in labor

The position of the woman in labor during labor deserves special attention. In obstetric practice the most popular are back birth, 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 the first stage of labor sit, walk for a short time, or stand. You can get up and walk both with intact and emptied water, but provided that the fetal head is tightly fixed at the pelvic inlet. In some cases, it is practiced for a woman in labor to stay in a warm pool during the first stage of labor. If the location is known (according to ultrasound data), then the optimal one is 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 does not decrease, the basal tone of the uterus remains normal. In addition, studies have shown that in this position the blood supply to the uterus, uterine and uteroplacental blood flow improves. The fetus is always positioned facing the placenta.

It is not recommended to feed a woman in labor during labor for a number of reasons: the food reflex is suppressed during labor. During childbirth, a situation may arise in which anesthesia is required. The latter poses a risk of aspiration of stomach contents and acute respiratory distress.

From the moment the uterine os opens completely, the second stage of labor begins, which consists of the actual expulsion of the fetus, and ends with the birth of the child. The second period is the most critical, since the fetal head must pass through the closed bony ring of the pelvis, narrow enough for the fetus. When the presenting part of the fetus descends to the pelvic floor, contractions are joined by contractions of the abdominal muscles. Attempts begin, with the help of which the child moves through the vulvar ring and the process of his birth occurs.

From the moment the head is cut in, everything should be ready for delivery. As soon as the head has erupted and does not go deeper after pushing, they proceed directly to the delivery. Help is necessary because, as the head erupts, it puts strong pressure on the pelvic floor and ruptures of the perineum are possible. During obstetric care, the perineum is protected from damage; carefully remove the fetus from the birth canal, protecting it from adverse effects. When the fetal head is brought out, it is necessary to restrain its excessively rapid advancement. In some cases they perform perineal dissection to facilitate the birth of a child, which avoids failure of the pelvic floor muscles and prolapse of the vaginal walls 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 for primiparous women is 30-60 minutes, and for multiparous women it is 15-20 minutes.

In recent years, in some European countries, the so-called vertical birth. Proponents of this method believe that in the position of the woman in labor, standing or kneeling, the perineum is easier to stretch and the second stage of labor is accelerated. However, in this position it is difficult to monitor the condition 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 vertical childbirth, they can be classified as alternative options.

Immediately after the birth of the child, if umbilical cord is not compressed, and it is located below the level of the mother, then a reverse “infusion” of 60-80 ml of blood occurs from the placenta to the fetus. In this regard, the umbilical cord should not be crossed during a normal birth and the newborn is in satisfactory condition, but only after the pulsation of the vessels has stopped. In this case, until the umbilical cord is crossed, the child cannot be raised above the plane of the delivery table, otherwise a backflow of blood from the newborn to the placenta occurs. After the birth of the child, the third stage of labor begins - the afterbirth stage.

The third stage of labor is the afterbirth

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

Newborns are given screening assessment for phenylketonuria, hypothyroidism, cystic fibrosis, galactosemia. After the birth, information about the characteristics of the birth, the condition of the newborn, and the recommendations of the maternity hospital are transmitted to the antenatal clinic doctor. If necessary, the mother and her newborn are advised by specialized specialists. Documentation about the newborn is sent to the pediatrician, who subsequently monitors the child.

It should be noted that in some cases, preliminary hospitalization in a maternity hospital is necessary to prepare for delivery. In the hospital, in-depth clinical, laboratory and instrumental examinations are carried out to select the timing and method of delivery. An individual birth management plan is drawn up for each pregnant woman (mother in labor). The patient is introduced to the proposed delivery plan. Obtain her consent to the proposed manipulations and operations during childbirth (stimulation, amniotomy, cesarean section).

Caesarean section is performed not at the woman's request, 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 birth is fraught with the possibility of various complications for the mother, fetus and newborn. The birth is led by a doctor, and the midwife, under the supervision of a doctor, provides manual assistance at the birth of the fetus and carries out the necessary treatment of the newborn. The birth canal is examined and repaired by a doctor if it is damaged.

Childbirth is a physiological process that occurs naturally and ends with the birth of a child. It is normal that every woman worries on the eve of such an important event. But fears and worries should not prevent her from safely relieving herself of the burden. Going through all stages of childbirth is not an easy test, but at the end of this journey a miracle awaits a woman.

The initial stage (precursors) is practically painless, so pregnant women often doubt the sensations they experience. Let's try to figure out what signs indicate the onset of labor, how to distinguish between its periods and facilitate the process of bringing a child into the world.

Precursors of childbirth are changes in the body that begin at approximately 37 weeks of pregnancy. In the later stages, the following changes occur:

Sharp weight loss. A decrease in body weight of 1–2 kg at the end of the third trimester of pregnancy is absolutely normal. During this period, excess fluid is gradually eliminated from the body, which signals the beginning of its preparation for childbirth.
Frequent urination and diarrhea. An increased urge to go to the toilet indicates that labor can begin at any time. The baby is rapidly gaining weight and by the end of pregnancy the enlarged uterus puts pressure on the woman’s intestines and bladder.
Removal of the mucus plug. A pregnant woman who closely monitors her health may notice changes in daily vaginal discharge. An increase in their number and the presence of a small lump or streaks of mucus are a consequence of the preparation of the cervix for childbirth. may come off in parts or entirely. But if the discharge is abundant, with an unpleasant odor and mixed with blood, you need to urgently contact your local gynecologist or call an ambulance.
Aching pain in the lower abdomen or back. Such discomfort is usually associated with. They do not have a clear periodicity, do not become more frequent and eventually stop. This is how the muscle tissue prepares for the upcoming work during childbirth. Training contractions usually subside when changing body position.
Abdominal prolapse. This is a sign that the baby is preparing for birth. If he is in the correct position, then his head is already inserted into the small pelvis. During this period, pregnant women note lightness, despite a large belly. This happens because the uterus, along with the baby, moves down and frees up more space for the lungs, stomach and other internal organs of the expectant mother. If a woman was bothered, it usually goes away.
Changes in the cervix (smoothing, softening). The woman does not feel them; the obstetrician-gynecologist can judge the readiness of the cervix for childbirth during the examination.
Decreased fetal motor activity. At the end of pregnancy, a woman notices that the baby begins to move less. This is normal, because he is growing quickly and there is less and less room for movement. But the child’s overly active behavior during this period cannot be ignored. Often it signals that the baby does not have enough oxygen.

To dispel doubts, you need to undergo an examination (ultrasound, CTG, Doppler sonography) and consult a doctor.

Periods of labor: their duration and characteristics

Childbirth consists of three stages of labor. At each stage, you have to make some effort to help a new person come into the world.

Normally, the first birth lasts 8–12 hours, the second and subsequent ones pass faster. But there may be cases of prolonged (more than 18 hours) or rapid labor, when about an hour passes from the start of contractions to the birth of the child.

First stage of labor

This is one of the longest periods of labor in obstetrics. It begins with aching stretching in the lower abdomen or back. There are three active phases:

Latent phase. Uterine contractions become regular, the interval between them decreases, and they are repeated at intervals of 15–20 minutes. Typically, after 5–6 hours of such contractions, the cervix dilates by 4 cm.
Active phase. The intensity and pain of contractions increases. There are 5-6 minutes to try to rest between contractions. At this stage, amniotic fluid may leak. If necessary, a doctor helps this process. Thanks to frequent painful contractions that follow each other with increasing frequency, after a few hours the opening of the uterine pharynx is already 8 cm.
Transition phase. At this stage of labor, pain decreases slightly. The woman in labor may feel the urge to push. But until the uterus is fully dilated, this cannot be done, otherwise there is a risk of injuring the child and harming your own health. The phases of the first stage of labor end when the obstetrician-gynecologist ascertains a full dilation of 10 cm.

It also happens that labor begins not with contractions, but with the rupture of amniotic fluid or bleeding. That is why a woman should especially carefully monitor her health during pregnancy.

The slightest suspicion or doubt is a reason to go to the maternity hospital and make sure that everything is fine with the child. A timely examination by a specialist allows you to prevent possible complications and accurately determine whether labor has begun.

Second stage of labor

As you know, the periods of labor and their duration are individual for each woman and proceed differently for everyone. At the second stage, difficult but very important work awaits the woman in labor. Its result will depend on the joint efforts of the mother and the medical staff of the maternity hospital.

So, opening the neck of the shirt by 10 cm and pushing is a sign that the body is completely ready for the birth of a child.

During this period of labor, the woman in labor should listen to the obstetrician, who will tell her how to push and breathe correctly. Usually, the doctor recommends that at the beginning of the contraction, take a deep breath, hold your breath, and push the baby out. Then, breathe out and start all over again. During one fight, it is advisable to do three such approaches.

During the second stage of labor, in order to avoid multiple ruptures, it may be necessary to perform an (episiotomy). This is required if the child has a large head or heavy weight. After labor is completed, sutures are placed at the incision sites under local or general anesthesia.

The baby's head is not born immediately; at first it appears and disappears several times in the perineum, then, finally, it is fixed in the pelvis of the woman in labor. If a woman follows the advice of the obstetrician, then the baby will be fully born at the next push.

After his birth, the umbilical cord is clamped with special sterile instruments, then it is cut and the baby is placed on the mother’s chest. After hard and intense work, the body produces endorphin (“the hormone of happiness”), thanks to which pain and fatigue are forgotten.

Third stage of labor

The stages of labor are coming to their logical conclusion, all that remains is to give birth to the placenta. The uterus begins to contract again, but the intensity of the pain is significantly reduced and, after several attempts, the woman gets rid of the placenta.

Then, the gynecologist carefully examines the birth canal for cracks and tears. If the placenta comes out entirely, and the woman in labor has no injuries, then after all the necessary manipulations she is left to rest.

When the placenta does not come out completely, doctors have to perform a manual examination of the uterus. The procedure takes place under anesthesia and the woman’s condition is monitored over the next few hours.

The third stage of labor goes almost unnoticed for a happy mother. The baby is taken from her to be weighed and his general condition assessed. She no longer feels pain, all her attention is concentrated on the newborn, who is being put to the breast for the first time.

Methods to facilitate the birth process

The stages of childbirth differ from each other in the nature and frequency of pain.

But there are several ways and techniques that can make the process easier. These include:

Walking and changing body position during contractions. Many doctors recommend that a woman, during intense dilation of the cervix, move as much as possible and choose the most comfortable positions. The speed of opening of the uterine pharynx depends on how much the woman in labor can relax. During a contraction, the uterus is tense and the expectant mother herself involuntarily contracts in pain. It is difficult for muscle tissue to contract quickly under such conditions. It is worth studying the process of childbirth step by step in order to know what is happening to her body. The faster she can relax her abdominal muscles, the sooner the baby will be born.
Massage painful areas. Since a woman in labor cannot always make the necessary efforts on her own, this matter cannot be done without outside help (husband, mother, sister or friend). By massaging the sacral area and influencing painful points during contractions, the partner thereby switches the woman’s attention and helps her relax.
Breathing exercises. As is known, during the period of strong contractions, a woman in labor periodically experiences respiratory rhythm disturbances. This leads to insufficient oxygen supply to the child and threatens his health. Therefore, you need to choose a suitable technique that will help the expectant mother cope with the problem.
Positive attitude and self-confidence. Oddly enough, this approach to childbirth is quite effective. When a woman is afraid of pain and allows herself to panic, she loses control over the process. And vice versa, as soon as she manages to pull herself together, the contractions are easier to bear.
Epidural anesthesia. This method of pain relief is used during childbirth when the cervix is dilated by 4-5 cm. A special catheter is inserted into the epidural space, which is located in the lower back. Through it, a drug that blocks pain sensations enters the mother's body. After some time, its effect weakens or stops completely so that she can feel contractions and fully participate in the birth process.

We are approaching the end of 9 months of pregnancy. The expectant mother lives waiting for labor to begin. Labor takes place in three periods. The first stage of labor is the beginning of labor, which is the longest and most painful.

Signs of the onset of labor

Between days 259 and 294, the baby is ready to be born. At any point during this period of time, the mother’s body produces hormones to start the birth process.

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

A couple of days before the onset of labor, certain signs appear - a nagging pain in the lower back and lower abdomen, a frequent desire to urinate, insomnia, prolapse of the uterus and a decrease in body weight. The closer the day of birth, the softer the uterus becomes. As a result, a yellowish plug with blood specks is pushed out of its canal. But the process sometimes begins without warning. The first stage of labor in first-time mothers begins with the occurrence of periodic, constant contractions with a gradual increase in frequency. This also applies to multiparous women.

Two signs of the onset of labor:

frequent contractions;
bubble rupture.

Contractions are measured contractions of the muscles of the uterus. They can occur several weeks before birth. True labor contractions resume after 20 minutes, and the time between them gradually decreases. The lady needs to get ready for the maternity hospital when the period between contractions reaches 10 minutes and they become constant.

Bubble burst. Sometimes amniotic fluid leaks before contractions or a sudden rupture of the membrane occurs. This process is not accompanied by pain symptoms. Labor begins to develop after 5–6 hours. The woman needs to remember the time when the water broke out and immediately come to the maternity hospital even in the absence of contractions.

For some women in labor, the period when contractions do not become more frequent lasts for several days. During this time, she becomes exhausted and loses a lot of strength. Her psyche begins to fail. To prevent the expectant mother from exhausting herself mentally and physically, she needs to visit a gynecologist. The specialist will examine it and make the right decision on further actions. Often, it is enough for a woman to sleep for several hours under the influence of medications in order to fully recover and prepare for childbirth.

Phases

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

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

The course of the 1st stage of labor is divided into 3 phases:

latent;
active;
slowdown

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

Active phase. The period lasts up to 3 hours. During this period, the time between contractions sharply decreases, it reaches two contractions in 10 minutes, the duration increases and reaches a minute. The cervix dilates to 8 cm.

Deceleration phase. The contractions begin to gradually weaken. The dilatation of the cervix ends and reaches 10–12 cm. Attempts begin to appear. At this phase, the management of labor in young primiparas is important, since the woman in labor cannot be allowed to begin to push. This is prohibited, as it will lead to swelling of the uterine pharynx and, as a result, labor will be delayed. The duration of the phase ranges from 15 minutes and reaches 2 hours.

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

Anesthesia

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

There are methods to relieve pain without drugs. Their advantage is that the drugs do not affect the fetus and do not cause an allergic reaction. The drug method of pain relief is intravenous or intramuscular injections, which include narcotic or non-narcotic substances.

Narcotic pain relief is used only for serious complications. Managing childbirth in adult primiparas sometimes requires just such an injection. But you should not be afraid of this, because the dose of the drug is strictly calculated and cannot harm either the mother or the child.

The use of any painkillers can cause drug-induced depression in the fetus. This is explained by the effect of the drugs on his weak nervous system.
In maternity hospitals, epidural anesthesia is often used. This is a method in which an analgesic is injected into the spinal canal. As a result, pain impulses do not pass through the nerves of the spine and the brain simply does not receive them. This means that the woman does not feel pain. The dose of the drug is calculated taking into account that at the beginning of the second stage of labor it does not act. During the procedure, the patient's spinal cord is not affected.
Deviations
Labor does not always follow the rules; women in labor often experience deviations from the norm. This is influenced by: age, the presence of pathologies in the woman, multiple births, low or high water levels, previous abortions, fetal size, endocrine diseases.

Deviations from the norm in labor:

weak;
excessive;
discoordinated.

Weak labor. The duration of labor for first-time mothers reaches 12 hours. But sometimes the process is delayed, and this time can reach several days. The woman in labor experiences rare and short contractions. As a result, the cervix and the movement of the fetus towards the exit are delayed. This birthing scenario occurs in two ways.

The first way is that weak labor manifests itself initially. The second way is when the process goes normally, but at some point it slows down. Either of the two paths will lead to a long, traumatic birth. Which will provoke bleeding and hypoxia in the baby. In this type of pregnancy, gynecologists use induction of labor; if the treatment does not produce positive results, then the only option left is surgical intervention: caesarean section.

Excessive labor. This birth is characterized by frequent, strong and painful contractions. If a woman in labor experiences contractions of this nature, then the process of relieving herself of the burden proceeds rapidly. The danger is that a woman may suffer ruptures of the cervix, vagina and even the uterus. At this time, the fetus experiences oxygen starvation. Specialists use drugs that weaken labor or use medicated sleep.

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

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

The entire birth process is divided for three periods - the first, second (lowering the baby into the pelvic cavity) and third (immediate birth). – the longest, its essence lies in the dynamic opening of the cervix and the formation of a single canal with a cavity. After this, the baby can calmly descend into the pelvic cavity for subsequent birth.

It all starts with harbingers– varying intensity of pain, release of the mucous plug and even “training contractions.” They can last from several hours to several days and even weeks. During this preparation, the cervix becomes soft, pliable, opens by 2-3 cm, and shortens.

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

Along with cramping contractions of the uterus, a woman may feel pressure, nagging pain in the lower abdomen or lower back, and a feeling of fullness. The baby is not very active.

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

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

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

Throughout the first stage of labor, the doctor monitors the condition of the fetus using CTG monitoring - recording the baby’s heart rate with a special sensor, which is fixed on the pregnant woman’s stomach. Normally, heart rate should be between 120-160 beats per minute, rise in a peak manner during a contraction. Any deviations may be an indication for emergency delivery by cesarean section.

Frequency of vaginal examination during normal course:

To establish the fact of the onset of labor - in case of complaints of pain, leakage of light fluid, mucus plug, etc.
When water breaks - at any time during labor, if a woman notices the appearance of copious watery discharge, additional examination is necessary. In some cases, the detection of pathology may become an indication for emergency delivery.
To establish the beginning of the second stage of labor - if a woman notes that during contractions she wants to push, as if she were constipated.
For timely identification of the pathological course of labor - when bloody discharge appears from the genital tract, if labor is prolonged, if it is visually noticeable that contractions are becoming less intense, as well as every 6 hours during their normal course.

Features for first-time mothers and repeat births:

Indicator	Primipara	Multiparous
Start of the first period
	Up to 12 hours	Up to 8 hours
Painful contractions
Other Features

Possible complications of the first period:

Bleeding. It may be a consequence of a serious complication - placental abruption. It is necessary to perform an ultrasound, and if time or conditions do not allow this, a caesarean section is performed immediately. Sometimes this is a consequence of damage to the cervix during a vaginal examination. In this case, there is no need to worry.
Weakness of contractions. It is diagnosed if the opening of the cervix does not occur over a period of time or it is insufficient. Timely identified weakness of contractions can be corrected using various techniques. Prevention – adequate pain relief during labor.
Outpouring of waters. Normally, the waters break in the first stage of labor when the cervix is more than 6 cm dilated. If this happens earlier, but there are contractions, there is early rupture of amniotic fluid. If the amniotic fluid leaves before the uterine contractions begin, it is a premature rupture. All types of deviations occur quite often.

If labor occurs with deviations, or additional labor is performed, uterine contractions can be strong and even unbearable. In these and other cases, various options for pain relief during childbirth are used.

The simplest and most accessible pain relief option for every woman– psychoprophylaxis. Its meaning is to teach breathing techniques to a pregnant woman and educate her about the stages of childbirth. massage, calm music, aromatherapy, water birth.

The second most common option is the introduction of antispasmodics and painkillers. These may be Papaverine, Platyfillin, No-shpa, Analgin and others. Narcotic drugs, for example, Promedol, can also be used as painkillers.

One of the popular methods today pain relief childbirth in the first stage of labor – . Its essence is to carry out an “injection in the back”.

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

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During the first stage of labor

For the convenience of assessing the dynamics of childbirth, the entire process is divided into three periods - the first (lowering the baby into the pelvic cavity) and (immediate birth). The first stage of labor is the longest. In each case, an individual course of labor is possible, with different durations and degrees of pain. This depends on the woman’s health, her psychological readiness for labor and the birth of the baby.

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

Signs

It all starts with harbingers. This can be pain of varying intensity, the release of a mucus plug, and even “training contractions.” Precursors of labor can last from several hours to several days and even weeks. During this preparation, the cervix becomes soft and pliable, it opens by 2-3 cm, and it shortens.

Expert opinion

Along with cramping contractions of the uterus, a woman may feel pressure in the lower abdomen, a feeling of fullness. At the same time, the baby is not very active - he is also “focused” on the birth process. Many describe the contractions themselves as “the stomach becomes like a stone and then relaxes,” while some experience nagging pain in the lower abdomen or lower back.

Also, labor may begin with the rupture of water without contractions. The latter should normally begin within 4-6 hours. In this case, the rupture of amniotic fluid is considered premature, and complications during and after childbirth are slightly increased.

Phases and their duration

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

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

Latent phase. Even from the name it becomes clear that this is a latent course of labor; in healthy women who are ready for the birth process, this period passes unnoticed, regardless of the parity of births - first or repeated. In this case, the expectant mother may feel minor nagging pain in the lower abdomen or lower back, which does not prevent her from leading her usual lifestyle. Such contractions are short-lived - up to 15 seconds and are repeated every 15-30 minutes.

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

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

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

Frequency of vaginal examination

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

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

Features in first-time mothers and repeat births

The first birth is in most cases more difficult and longer. The differences are presented in the table, but it still depends on the individual characteristics of the woman, so the indicators are variable and the first period in primiparous women can proceed smoothly and quickly.

Indicator	Primipara	Multiparous
Start of the first period	More often with characteristic harbingers	There may be no warning signs of labor, but contractions begin immediately
Duration of the first stage of labor	Up to 12 hours	Up to 8 hours
Painful contractions	Less painful but longer lasting	More painful, but also more productive
Other Features		The end of the first period can “connect” with the beginning of the second

Possible complications

The first stage of labor is an important stage; timely detection of complications allows you to avoid irreparable consequences for the mother and baby. Most often you encounter the ones below.

Bleeding

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

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

Sometimes bloody vaginal discharge is a consequence of damage to the cervix during a vaginal examination. This is possible if a woman previously had erosion, ectopia, some kind of manipulation on the cervix, and also if on the eve of giving birth she suffered from ordinary colpitis. In this case, there is no need to worry; the condition does not pose a threat to the mother and baby.

Weakness of contractions

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

with a large fruit;
in pregnant women with pathological weight gain;
with pathologies of the uterine body (with septum and others);
with premature rupture of amniotic fluid;
during multiple pregnancy;
with psycho-emotional stress in a pregnant woman.

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

uterotonics - drugs that increase uterine contractions, for example, oxytocin;
medicated sleep - with its help you can “reset” the contractile activity of the uterus.

Prevention of weakness of labor forces - adequate pain relief during labor.

Outpouring of waters

Normally, it is allowed that the waters break in the first stage of labor when the cervix is more than 6 cm dilated. If this happens earlier, but there are contractions, there is early rupture of amniotic fluid. If the amniotic fluid leaves before the uterine contractions begin, it is a premature rupture. All types of deviations occur quite often. This increases the risks:

intrauterine infection of the fetus - antibiotics are prescribed for prophylaxis during an anhydrous period of more than 12 hours after the completion of labor;
anomalies of labor - careful monitoring of the postpartum woman, timely detection and correction of abnormalities is necessary.

Watch this video about what complications can occur during childbirth:

When is pain relief needed and what is it like?

Normally, they proceed smoothly, without causing the woman excessive discomfort. In this case, there is no need for pain relief. If labor proceeds with deviations, or additional stimulation is performed, uterine contractions can be strong and even unbearable. In these and other cases, various options for pain relief during childbirth are used. The following conditions are indicated:

tension and psycho-emotional lability of a woman;
contractions that feel excessively painful, which depends on the individual pain sensitivity threshold;
if the expectant mother suffers from high blood pressure, the pain will provoke a serious rise in blood pressure;
if postpartum women had it at the end of pregnancy;
in case of anomalies of labor to correct violations.

The simplest and most accessible pain relief option for every woman is psychoprophylaxis. Its meaning is to teach breathing techniques to a pregnant woman and educate her about the stages of childbirth. This helps to follow all the recommendations of the doctor and midwife without fear.

The following options are also possible:

massage - you need to warm up your lower back yourself or ask your husband (in case of partner childbirth), this helps relieve pain and relieve anxiety;
calm music - as an option to influence a woman’s psyche, the sounds of nature are suitable - water, rain, forests and others;
the same effect can be achieved with aromatherapy, but this is not practiced in maternity hospitals;
birth in water - an accessible interpretation of the method is carried out by applying a warm stream of water to the woman’s lower abdomen and lower back in the shower in the prenatal ward.

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

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

If a woman is tired, for example, did not sleep all night due to precursors, sedatives, for example, Diazepam, can be used in addition to antispasmodics and painkillers. This allows the woman to “plunge” into medicated sleep, after which labor, as a rule, improves.

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

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

The main difference between epidural anesthesia during childbirth is that the drugs do not enter the woman’s systemic bloodstream. This means that they do not reach the fetus. Therefore, epidural anesthesia is the method of choice in many cases.

The complications of epidural anesthesia include the following:

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

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

Useful video

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

Classification

Pain relief for childbirth

Lecture 4. Course and management of labor.

Childbirth- the physiological process of expulsion of the fetus and placenta from the uterus through the natural birth canal.

Labor activity is a process accompanied by contractions that occur with increasing frequency and intensity and lead to dilatation of the cervix, the birth of the fetus and placenta.

Timely birth ( syn. urgent, i.e. due on time ) - occurred during pregnancy 37-42 weeks.

Premature birth- occurring between 21 and 37 weeks of pregnancy.

Delayed birth- occurring after 42 weeks of pregnancy.

Spontaneous birth(syn. spontaneous) - ended without medication or surgical intervention in their course.

Normal birth(as defined by WHO) is labor that begins spontaneously in low-risk women at the onset of labor and remains so throughout labor; the baby is born spontaneously in a cephalic presentation at 37 to 42 completed weeks of gestation and mother and baby are in good condition after delivery.

Thus, normal birth is spontaneous birth during a pregnancy of 37-42 weeks, in a cephalic presentation with a low risk of the onset and course of the entire birth process.

Pathological childbirth- in which any deviations from the normal course of the process occurred.

Childbirth is quick- the duration of which is for primiparous women from 6 to 4 hours, for multiparous women from 4 to 2 hours.

Rapid labor- the duration of which is less than 4 hours for primiparous women, and 2 hours for multiparous women.

Labor is prolonged- the duration of which exceeds 18 hours.

Distinguish preparatory period(harbingers of childbirth) and true birth. Precursors include increased urination, the appearance of bloody-mucous discharge from the vagina, painful irregular contractions of the uterus ( Braxton Hicks).

Preparatory period labor occurs at 38 weeks of pregnancy. At this time, the pregnant woman’s body experiences a number of changes :

Formation of a generic dominant in the central nervous system. Clinically accompanied by drowsiness, calm behavior, and a decrease in body weight by 800-1000 g 7-10 days before birth.

Increased estrogen levels and decreased progesterone.

The predominance of the influence of the sympathetic-adrenal system.

Structural changes in the cervix. The mature cervix is located along the pelvic axis. The neck is shortened to 1-1.5 cm, completely softened, the internal pharynx is soft, smoothly passes into the lower segment. The cervical canal allows the finger to pass freely (opened by 2-3 cm). The length of the vaginal part of the cervix corresponds to the length of the cervical canal.

Firm pressing of the presenting part of the fetus to the entrance to the pelvis.

Detachment of the lower part of the amniotic sac from the walls of the uterus.

The appearance of mucous-sacral discharge from the vagina (discharge of the mucous plug of the cervix).

First period(disclosure) - begins with the appearance of regular contractions. During the first stage of labor, contractions become quite frequent, intense, prolonged and cause smoothing and dilation of the cervix. The first period ends with complete dilatation of the cervix, the transition of contractions to pushing and the discharge of amniotic fluid.

Second period(expulsion) - begins after the cervix is fully opened and ends with the birth of the fetus.

Third period(afterbirth) - begins from the moment of birth of the child and ends with the separation of the placenta and the release (birth) of the placenta.

Occurs before and during childbirth cervical effacement- shortening of the cervical canal from approximately 2 cm to 1 cm. Ultimately, the canal is a round hole with edges thinned almost to the thickness of paper due to the fact that the smooth muscle cells surrounding the internal os are stretched upward, towards the lower segment of the uterus.

Cervical dilatation happens gradually. First, the pharynx allows the tip of a finger to pass through, then two or more fingers. As the pharynx opens, its edges become thinner. In order for an average-sized newborn's head to pass through the cervix, the cervical canal must widen to approximately 10 cm in diameter. This is full dilatation of the cervix.

There are some features of the opening of the uterine pharynx in first- and multiparous women. U primiparous First the internal pharynx opens, then the external one. U multiparous The outer pharynx opens simultaneously with the internal pharynx.

Fetal position - the position of the fetal axis relative to the longitudinal axis of the uterus.

Fetal presentation classified according to the part of the fetal body located closest to the upper aperture of the small pelvis (cephalic, pelvic).

Occipital(parietal) presentation occurs in 95% of all births.

It is necessary to distinguish between positions and types of fetal positions.

Position defined as the ratio of the fetal back to the left (first position) or right (second position) sides of the uterus.

Position type defined as the ratio of the fetal back to the anterior (anterior view) or posterior (posterior view) side of the uterus.

The process of adjusting the position of the fetal head to pass through the various planes of the pelvis is necessary for the birth of a child. These changes in the position of the presenting part constitute the mechanism of labor and include seven sequential movements during anterior view of occipital presentation:

1. Inserting the head- the position of the fetal head at the moment of crossing the plane of the entrance to the pelvis. Normal insertion of the head is called synclitic when the vertical axis of the head is perpendicular to the plane of the entrance to the pelvis, and the sagittal suture (between the two parietal bones) is located approximately at the same distance from the promontory and the pubis. For any deviation, the insertion is considered asynclitic. With anterior asynclitism (Nägele asynclitism), the sagittal suture is located closer to the promontory. In the posterior case (Litzmann asynclitism) - to the symphysis.

2. Promotion ( wire point - small fontanelle ).

3. Flexion of the head.

4. Internal rotation of the head.

5. Head extension ( fixation point - area of the suboccipital fossa ).

6. External rotation of the head and internal rotation of the body.

7. Expulsion of the fetus.

Principles of labor management boil down to the following:

· Assess the risk level of a pregnant woman on the eve of childbirth

· Select a hospital for delivery

· Choose an adequate method of delivery

Monitoring the condition of the mother and fetus during labor

· Maintaining a partogram

Pain relief for childbirth

· Careful provision of assistance during childbirth

Prevention of bleeding during childbirth

· Assess the condition of the child at birth and, if necessary, provide timely assistance

· Early attachment of the baby to the mother's breast

TO risk factors include the mother’s age, height, number of births in history, complicated obstetric history (stillbirth, history of cesarean section, etc.), complications of this pregnancy (threat of miscarriage, abnormal position of the fetus, abnormal localization of the placenta, severe anemia, etc.). In most countries, risk is divided into low and high, using special scales.

Risk must be determined repeatedly and assessed during pregnancy and childbirth. Complications may appear at any time, which gives grounds to classify a woman as being at a higher risk. In the prenatal period (from 37 to 42 weeks), a labor management plan should be developed and the pregnant woman should be familiarized with it. In the absence of risk factors, childbirth is considered low risk.

The important point is choosing a place for delivery. Many researchers and WHO experts believe that delivery rooms should be closer to home, with parents and family members present during labor (with the consent of the pregnant woman). This contributes to the normal course of labor. In many countries, births are carried out at home. In the Netherlands, more than 30% of pregnant women give birth at home. This country has a formal home birth system with good results. In England, home births are currently carried out in 1-2% of cases. In our country, as a rule, childbirth is carried out in a hospital, where all the necessary conditions are available to provide qualified care to the woman and child. The birth is conducted by a doctor. Only in small maternity institutions, the management of normal childbirth is entrusted to a midwife, who calls a doctor if complications arise.

Preparing for childbirth upon admission to the hospital, includes routine procedures, such as measuring body temperature, pulse, blood pressure, shaving pubic hair, and administering an enema. Upon admission to the hospital, it is mandatory to conduct an external obstetric examination, including a vaginal examination, assessment of the maturity of the cervix, and the integrity of the amniotic sac. Upon admission for childbirth, it is necessary to determine the blood type, Rh factor, hematocrit, hemoglobin level, HIV, RW, be examined for hepatitis B and C, hemostasiogram, etc.

It's important to choose adequate method of delivery. Most hospitals adhere to expectant-active management of labor rather than just observation. Each stage of labor requires special intensive monitoring.