Runny nose

Smoothing of the cervix before childbirth symptoms. Secret language

The cervix changes dramatically before childbirth (and almost imperceptibly for the expectant mother herself) - and this is what allows the child to be born unhindered. What exactly changes does the uterus undergo before childbirth, and in what cases is medical intervention necessary?

What should the cervix look like before natural childbirth?

What matters is its location in the pelvis, length and softness. The fact that a woman’s birth canal is prepared is indicated by the softening of the cervix before childbirth to such an extent that it begins to allow 1-2 fingers of the doctor inside. Due to such changes, the woman observes the release of the mucous plug. It turns out that the earlier the cervix begins to dilate before childbirth, the sooner the woman notices this clear sign of approaching contractions.

In addition, it is shortened. It is known (this is recorded using transvaginal ultrasound) that the length of the cervix before childbirth is no more than 1 cm. And gradually it completely smoothes out.

As for the location, it becomes exactly in the center of the small pelvis, while the cervix during pregnancy, even 3-4 weeks before the onset of labor, is deviated posteriorly.

These 3 parameters are assessed on a two-point scale. With 5 points scored, the cervix is considered mature.

How to stimulate uterine dilatation using medical methods

If an examination of the cervix before childbirth shows that it is not yet mature, whereas, judging by the doctors’ calculations, you should be about to give birth, it is quite possible that you will be asked to speed up the process a little and carry out stimulation. Otherwise, there is a high probability that the child will suffer from oxygen starvation, since by 40-42 weeks the placenta can no longer properly perform its functions; it “grows old.” Stimulation by medical means is possible in a hospital setting. 4 methods are used, sometimes in combination with each other.

1. Intramuscular injections of Sinestrol. This drug speeds up the preparation of the cervix for childbirth, but does not directly provoke contractions.

2. Introduction of kelp sticks - seaweed - into the cervix. This procedure is performed by a doctor, while the patient is on a gynecological chair. The sticks, 5-6 cm each, are placed almost the entire length into the cervical canal. After approximately 3-4 hours, they begin to swell under the influence of moisture, thereby mechanically opening the cervical canal. Within a day, a dilatation of 1 cm is usually observed - a softened and short cervix before childbirth is the key to a quick and easy delivery.

3. Introduction into the cervical canal of a gel containing prostaglandins. For example, Prepidil-gel. It usually acts very quickly, the neck opens in a few hours.

4. Intravenous administration of the drug Enzaprost containing prostaglandins. With its introduction, the cervix becomes soft before childbirth, thereby shortening the period of contractions and expulsion of the fetus.

Self-induction of labor

More often, these techniques are used by women without indications and can be dangerous.

1. Cleansing enema. It is noticed that after it the mucous plug quickly comes away and the cervix opens. This can only be done for those who have already reached their expected due date, that is, the baby is definitely full term.

2. Taking a warm bath. This is not possible if the mucus plug and amniotic fluid have already drained. In addition, it is not recommended for women with high blood pressure.

3. Sex. Sperm contains prostaglandins - the same substances that are part of the drugs used to stimulate labor in a hospital setting. Those who have already lost their mucus plug should not have sex, as there is a high probability of introducing an infection into the uterus. Well, having sex with a condom is useless in terms of stimulating the dilatation of the cervix.

4. Physical activity. Walking up and down stairs, squatting mopping, cleaning the house, etc. But don't overdo it. Especially if you have hypertension or gestosis, or placenta previa.

Now you know what the cervix should be like before giving birth. Just don’t try to independently diagnose how ready she is for childbirth. Leave this task to the doctors.

10.12.2019 18:24:00 Tangerine diet: lose weight for the New Year! In autumn and winter we eat tangerines almost every day. And this is very good, because tangerines are not only tasty and healthy, but also help you lose weight. You will learn further how to lose weight with their help!
09.12.2019 19:05:00 5 ways to tune your brain to lose weight Have all the diets you've tried failed? If there is always some kind of obstacle standing between you and your desired weight, you should regularly use some psychological tricks to get rid of those extra pounds.
09.12.2019 18:15:00 These vegetables burn more calories than they contain Lose weight with food? If you think that in order to lose weight you need to starve or give up delicious foods, you are mistaken. There are so many wonderful vegetables that can burn fat!

The first stage of labor is the opening and effacement of the cervix.

Ancestral expelling forces.

Ancestral expelling forces include:

1. Contractions are periodically repeated contractions of the uterine muscles.

2. Pushing - rhythmic contractions of the abdominal press that join contractions.

Contractions. Wave-like contractions of the smooth muscles of the uterus are the main labor expulsion force. Thanks to contractions, the cervix opens - dilating contractions.

Contractions contribute to the expulsion of the fetus - expelling contractions.

Contractions that promote the separation of the placenta from the uterine wall and the expulsion of the placenta are subsequent contractions.

Rhythmic contractions of the uterus are also observed some time after childbirth - postpartum contractions.

Contractions occur involuntarily, the woman in labor cannot control them

at will. Οʜᴎ occur periodically after a certain period of time. The intervals between contractions are called pauses.

Contractions of the uterus are usually painful, but the degree of pain varies widely among different women (depending on the threshold of pain sensitivity).

Contractions of the uterus gradually increase, reach their highest degree, then muscle relaxation occurs, turning into a pause. When examining with your hand, you can easily see how the uterus thickens, becomes hard, and then gradually relaxes.

At the beginning of labor, each contraction lasts 10 -15 seconds, then - 50 -60 seconds and by the end of labor - 60 - 80 seconds.

Pauses between contractions at the beginning of labor last 10–15 minutes, then shorten; by the end of the expulsion period they last 2-3 minutes.

Labor is considered good when contractions repeat after 3-4 minutes for 50-60 seconds. Such contractions can do the job: open the cervix and move the fetus along the birth canal.

Attempts . This is the second component of labor expulsion forces - contraction of the abdominal muscles and diaphragm. Attempts occur reflexively due to irritation by the presenting part of the fetus of the nervous elements embedded in the cervix, parametrial tissue and pelvic floor muscles. Pushing occurs involuntarily, but the woman in labor can regulate it to a certain extent (strengthen the pushing or slow it down). Attempts play a role only during the expulsion period and in the afterbirth period. During pushing, intra-abdominal pressure increases. At the same time, contraction increases intrauterine pressure, which causes the contents of the uterus to rush in the direction of least resistance, ᴛ.ᴇ. small pelvis.

As soon as contractions become rhythmic, they repeat at least 5 times in 1 hour, that is, they repeat every 10 to 12 minutes, and then more often. Their rhythm increases, the duration of the contraction increases from 20 seconds to 35 - 45 - 60 seconds, and the pause decreases to 3 - 4 minutes, they say that the first stage of labor has begun.

In the first stage of labor, there is a gradual smoothing of the cervix, opening of the external and internal pharynx of the cervical canal to a degree sufficient to expel the fetus from the uterine cavity

1. The opening and smoothing of the cervix is carried out under the influence of labor contractions.

2. The dilatation of the cervix is facilitated by the movement of amniotic fluid towards the cervical canal.

With each contraction, the muscles of the uterus exert pressure on the contents of the fertilized egg, mainly on the amniotic fluid. Due to uniform pressure from the fundus of the uterus, amniotic fluid, according to the laws of hydraulics, rushes towards the lower segment of the uterus. Here, in the center of the lower part of the fetal sac, the internal os of the cervical canal is located, where there is no resistance. Amniotic fluid rushes to the internal os and, under their pressure, the lower pole of the fertilized egg is introduced into the internal os of the cervical canal. This part of the membranes of the lower pole of the fertilized egg is usually called amniotic sac.

During contractions, the bladder stretches (fills up) and penetrates more and more into the cervical canal, expanding it.

The opening of the cervix is also facilitated by the presenting part of the fetus moving through the birth canal.

The cervix consists of cavernous spaces filled with blood. The presenting part displaces blood from these spaces, the neck becomes thinner and gradually disappears, and the pharynx opens.

The opening increases by 2 - 4 - 6 cm, etc. until full opening - 10 -12 cm.

The process of dilation of the cervix is different for primiparous and multiparous women.

In primiparas Before the start of the first stage of labor, the external and internal os are closed. With the beginning of the first stage of labor, the internal os opens, then the cervical canal gradually expands, which takes the shape of a funnel, tapering downward. As the canal expands, the cervix shortens and finally flattens out completely. Only the outer pharynx remains closed. Next, the edges of the external pharynx become thinner, and it begins to open with each contraction.

more and more until it opens completely (up to 1-12 cm).

Dynamics of opening - 1 cm per hour.

In multiparous women already at the end of pregnancy, the external pharynx is dilated by 1.5 - 2 cm. During the period of dilation, the external and internal pharynx open simultaneously and the cervix is smoothed. Dynamics of opening - 2 cm per 1 hour, ᴛ.ᴇ. 2 times faster.

Contact belt.

During each contraction, amniotic fluid rushes to the lower pole of the fertilized egg; the amniotic sac is stretched (filled) and inserted into the pharynx. When the head descends, it comes into contact on all sides with the lower segment of the uterus and presses this area of the uterine wall against the entrance to the pelvis.

The place where the head is covered by the walls of the lower uterine segment is usually called contact belt. It divides the amniotic fluid not anteriorly and posteriorly. The anterior waters are located below the contact zone, the posterior waters are located above. The water is distributed as follows: front water - 200 - 250 ml, rear water - up to 1.5 liters. During contractions, the anterior segment of the amniotic sac tenses, the “wedge” plunges into the expanding cervix. This type of amniotic sac is usually called functioning .

Sometimes there is little front water. They cannot contribute to the opening of the cervix, but, on the contrary, by stretching on the head, they prevent the advancement of the head. This type of amniotic sac is usually called flat – not functioning. By preventing the advancement of the head, it helps to lengthen the period of dilation, and, consequently, the duration of labor. Such a fetal bladder is opened.

When the anterior waters outside the contraction do not leave due to the contact zone, they say that this amniotic sac is “ready to rupture”.

Rupture of membranes.

Rupture of the membranes usually occurs at the end of the first stage of labor, that is, at full dilation, when the function of the membranes is completed.

This timely rupture of amniotic fluid.

For some women in labor, the water does not pour out in a timely manner:

Before the onset of labor - premature.
Until full disclosure - early. Early rupture of the membranes (as well as premature rupture) leads to complete rupture of water from the uterus -

“dry birth”, which is accompanied by a number of complications, sometimes severe:

1. rupture of amniotic fluid before the formation of the contact zone can lead to the loss of umbilical cord loops and small parts of the fetus

(arms or legs), which complicates the course of labor and poses a threat to the life of the fetus;

2. the cervix dilates more slowly;

3. the first stage of labor is lengthened. if the anhydrous period exceeds 12 hours, they speak of a long anhydrous period, which poses a threat of the development of an intrauterine infection.

If the membranes are very dense, the amniotic sac may not open and then the baby is born “in a shirt” - in the membranes. This - belated rupture of the membranes. A child at birth may choke on water. For this reason, such a fetal bladder is opened in advance, ᴛ.ᴇ. produce amniotomy

Biomechanism of childbirth.

The bony pelvis is characterized by unequal size of its walls and dimensions in individual planes. The walls of the small pelvis are uneven: the symphysis is much shorter than the sacrum, the inner surface of the latter is concave. The shape of the small pelvis at different levels is not the same: the inlet has a transversely elongated shape, the pelvic cavity is round, the outlet is an oval, elongated in the anteroposterior direction.

As the head moves through the birth canal, it undergoes a series of movements. It performs translational movements, rotations around the longitudinal axis and rotation around the transverse axis - flexion and extension.

The first stage of labor is the opening and effacement of the cervix. - concept and types. Classification and features of the category "The first stage of labor - opening and smoothing of the cervix." 2017, 2018.

What should the cervix look like before natural childbirth?

As for the location, it becomes exactly in the center of the small pelvis, while the cervix during pregnancy, even 3-4 weeks before the onset of labor, is deviated posteriorly.

These 3 parameters are assessed on a two-point scale. With 5 points scored, the cervix is considered mature.

How to stimulate uterine dilatation using medical methods

1. Intramuscular injections of Sinestrol. This drug speeds up the preparation of the cervix for childbirth, but does not directly provoke contractions.

3. Introduction into the cervical canal of a gel containing prostaglandins. For example, Prepidil-gel. It usually acts very quickly, the neck opens in a few hours.

Self-induction of labor

More often, these techniques are used by women without indications and can be dangerous.

2. Taking a warm bath. This is not possible if the mucus plug and amniotic fluid have already drained. In addition, it is not recommended for women with high blood pressure.

4. Physical activity. Walking up and down stairs, squatting mopping, cleaning the house, etc. But don't overdo it. Especially if you have hypertension or gestosis, or placenta previa.

Now you know what the cervix should be like before giving birth. Just don’t try to independently diagnose how ready she is for childbirth. Leave this task to the doctors.

www.missfit.ru

What are the stages of cervical dilatation?

The anatomical changes that occur to the cervix in connection with preparation for an early delivery begin somewhere from 32-34 weeks of pregnancy. They are expressed in the fact that this anatomical structure softens significantly along the periphery, but near the cervical canal it is still possible to palpate fairly dense tissue. In those women who are about to give birth for the first time, during a vaginal examination, you may find that the tip of the finger can penetrate the external os. In those giving birth, the patency of the canal allows one finger to penetrate up to the internal pharynx. At approximately 36-38 weeks, almost complete softening of the cervix is observed. Further dilatation is also stimulated by the fact that the fetus presses on the cervix with its own weight (during this gestational period the fetus descends into the pelvis).

The process of opening the cervix begins with the internal pharynx. In primigravidas, the canal becomes similar to a truncated cone, the base of which will face upward. Due to the gradual movement of the fetus forward, its further expansion is observed. In multiparous women, the process of opening the cervix is much easier and faster, due to the fact that already at the end of the gestational period the external os is open by 1 finger. This category of women in labor is characterized by simultaneous opening of the external and internal pharynx.

The ideal cervix before childbirth - what is it like?

A common feature of the cervix of both first and multiparous women is that it sharply shortens (smoothes), becomes thinner, and the canal allows 2 or more fingers to pass through. Over time, the cervix becomes fully dilated to 10-12 cm. This makes it possible for the fetal head and torso to pass through the birth canal.

The period of contractions - what happens to the cervix?

This period is the longest - it lasts until the cervix opens to a size that allows the fetus to pass through. The most pressing question for expectant mothers is how much should the cervix open (how many fingers to let through) in order for the birth process to begin?

Dilatation of 2 fingers - when to give birth?

In principle, it can be indicated that before the start of the delivery process, the cervix will be dilated by at least 2 fingers, and at the same time it will be smoothed. But it is very difficult to say anything regarding whether a woman will begin labor when the cervix reaches two fingers dilatation - first, it will be necessary to find out how intensely dilatation occurs during the contractile activity of the myometrium.

Characteristics of different periods of contractions. Anatomical features of the uterus before childbirth

The period of contractions is divided into a slow period, otherwise called the latent period, and a fast period (otherwise known as the active phase of contractions). The duration of contractions lasts about 10-12 hours in primiparous women, and 6-8 hours in those giving birth.

The latent phase begins from the moment contractions acquire a certain rhythm - as a rule, they occur at intervals of 1-2 in 10 minutes, the duration of this phase is about 6 hours and there is no pronounced pain syndrome during it. The duration of this phase in primiparous women is always an order of magnitude longer.

The use of medications at this stage is not indicated, but the need to prescribe tocolytics for women in labor whose age is less than 20 or more than 35 years cannot be ruled out. At this time, a dilation of about 3 cm is already observed, but the exact time of the onset of labor cannot yet be indicated, since the alternating contraction of the uterine myometrium with its subsequent relaxation is just beginning. The result of these processes is a shortening of the length of the cervix. Taking into account the fact that the baby’s head is adjacent to the entrance to the small pelvis, the amniotic sac begins to put pressure on the internal os, resulting in its opening.

Is it possible to tell when labor will occur by the size of the cervical dilatation?

The doctor can tell you after what time period the process of delivery begins when the cervix reaches 4 cm dilatation. It is complete effacement and such dilatation that clearly indicate that the active phase of contractions is starting. Regardless of what kind of birth is expected, the duration of this phase does not exceed four hours. Further disclosure is carried out in record time. The speed of this process is about 2 cm per hour for first-time mothers, and 2.5 cm for repeat births. Once the cervical dilation reaches 5 cm, delivery can be expected within 2 hours, since for normal passage of the fetal head and its body, the dilation must be about 10, and sometimes 12 cm.

What sensations does a woman experience when the cervix dilates?

The pain syndrome during contractions becomes most pronounced after five centimeters of opening. In order to alleviate the condition of the pregnant woman, the following measures are taken:

Non-medicinal: massage; warm bath, relaxing music.
Drug pain relief - the drug can only be chosen by the attending physician.

In the event that, when the cervix is fully opened, the waters do not drain spontaneously, an opening of the amniotic sac is indicated. At the same time, full dilation is possible only with a sufficient level of contractile activity of the myometrium - weak labor activity is an indication for its stimulation. When performing this intervention, extreme caution must be taken, since if the lumen of the cervix is not opened, stimulation cannot be carried out at all - this can lead to serious consequences, including the occurrence of obstetric hemorrhage.

What changes does the uterus undergo before childbirth?

With increasing gestational age, partial replacement of the muscle tissue of the cervix with connective tissue occurs. “Young” collagen fibers appear, characterized by more pronounced flexibility and extensibility than their counterparts outside pregnancy. A certain percentage of them is absorbed, resulting in the formation of the main substance, leading to an increase in the hydrophilicity of the tissue. For the clinical course, this is of great importance, since this process ensures loosening and shortening of the cervix, as well as gaping of the cervical canal. It is thanks to this feature that the so-called smoothing of the cervix occurs.

What problems may be associated with the process of cervical dilatation?

From approximately 37-38 weeks of the gestational period, the physiological dominant of pregnancy gives way to the dominant of childbirth, and the uterus becomes not a womb, but an organ that is entrusted with the main function of expelling the fetus. In this situation, the possibility of a certain psychological barrier cannot be excluded, which, without appropriate preparation, can lead to hormonal imbalance. Because of this, the cervix does not undergo any changes, and the process of preparation for the upcoming birth is disrupted.

In order for the cervix to dilate completely, regular labor will be required. If labor contractions become weak, the process of cervical dilatation automatically stops. Often, the picture under consideration must be noted with polyhydramnios (overstretching of the uterus is observed, resulting in a deterioration in its ability to contract) or oligohydramnios (there is a flaccid or flat amniotic sac that cannot affect the cervix with the proper intensity).

Similar problems can most often be found in women over 35 years of age. In this case, the so-called tissue rigidity (low elasticity) contributes to the development of pathology. This feature is one of the most unfavorable reasons that often necessitate a cesarean section in women in labor in this age category.

How is the preparation of the cervix for childbirth stimulated?

It often turns out that just before the expected date of birth it turns out that the pregnant woman’s cervix is “not ready” and it needs artificial preparation for the upcoming process. This issue becomes much more relevant after the 40th week of pregnancy. This is explained by the fact that it is during this period that the functionality of the placenta is extremely depleted, which can cause fetal hypoxia.

In this case, the issue can be resolved in two ways - with or without the use of medications:

Medication method is quite effective and helps to achieve the desired result in the shortest possible time, however, it can only be implemented in a hospital setting, since its implementation requires medical training.
Introduction of kelp sticks into the cervical canal. They are placed along the entire length of the cervical canal, and after 4-5 hours, under the influence of moisture, they swell, which contributes to mechanical opening. In addition, another useful property of kelp in this situation is its ability to secrete endogenous prostaglandins, which also contribute to the process of cervical ripening. This method ensures the fastest and gentle preparation of the cervix for the process of delivery, which will happen in the near future;
Introduction of synthetic prostaglandin into the lumen of the cervix in the form of suppositories or gel. Provides the necessary clinical effect within 1-2 hours;
In stationary conditions it is carried out amniotomy(violation of the integrity of the amniotic sac). After the water is released, the fetal head descends, which leads to increased pressure on the cervix, due to which dilation occurs faster.

How to help dilate the cervix at home?

Non-drug method in principle, it can be used at home, but before that you need to carefully analyze all its pros and cons:
Cleansing enema. The use of this method leads to irritation of the posterior wall of the uterus, which provokes contraction of the myometrium. In addition, a relationship has been established between the discharge of the mucous membrane and the proposed procedure - a cleansing enema promotes its rapid discharge, which provokes dilatation of the cervix. However, it is indicated only for those women whose labor is due today or has already passed, but the child does not want to be born;
Sex. This is the most natural stimulant for the onset of labor. Firstly, intimacy promotes contraction of the muscles of the uterus, increasing the intensity of blood circulation in it. Secondly, male seminal fluid contains prostaglandins, which are activators of the contractile activity of the myometrium. This method of stimulation is contraindicated if the mucus plug has already come off, since the likelihood of infection increases significantly;
Moderate physical activity. Long walks in the fresh air, cleaning the house, walking up the stairs. Not allowed for preeclampsia and placenta previa.

After reviewing the information provided, you have learned the reasons for the disruption in the process of preparing the cervix for labor, so you can take preventive measures to prevent such an undesirable phenomenon. In any case, you must remember that first of all you need to take into account the recommendations of your attending physician, since only he knows best the individual characteristics of your body and can decide on the advisability of following one or another management tactics.

prorozhdenie.ru

The structure of the cervix and the entire organ and their role in pregnancy and childbirth

The uterus is the female reproductive hollow organ in which the fetus develops from conception to birth. The shape resembles an inverted pear, and consists of a bottom (widened upper part), a body and a neck.

It is connected by the cervix to the vagina, and on the sides to the fallopian tubes. In the body it is located in the pelvis, behind the bladder and in front of the rectum. It has three layers: perimeter, myometrium, endometrium.

Its position depends on the state of the digestive and urinary systems, and may shift slightly during the day.

The cervix looks like a light pink ring of muscles and consists of an isthmus, cervical canal and vaginal part. On both sides, the cervix is limited by pharynxes - external (vaginal) and internal (uterine).

During pregnancy, the cervix produces a special secretion to protect the fetus and uterus from infection, and maintains the uterus in the desired position at the required level.

Functions of the cervix during pregnancy and childbirth:

production of mucous secretion to protect against viral, fungal, bacterial infections;
keeping the fetus in the proper place;
informational - the gynecologist confirms the fact of pregnancy during a vaginal examination, based on the appearance of the cervix - the color changes from pink to bluish-purple and increases in size. Shortly before childbirth, the cervix becomes soft, the organ prepares for labor. During the process of childbirth, the gynecologist assesses the degree of dilation, and this indicator is used to guide the process.

Causes of cervical dilatation

Labor that begins at 37 weeks or later is considered normal. During this period, the cervix independently opens to one finger, which indicates the physiological maturity of the uterus.

She begins to contract, and her body becomes smaller. The pressure of the fetus on the birth canal increases and it opens.

Before birth, amniotic fluid is divided into the upper and lower poles of the amniotic sac.

The lower part enters the cervical canal and also helps to open the cervix.

Towards the end of pregnancy, the amount of the pregnancy hormone progesterone decreases and this marks the beginning of labor.

Dilation may be premature and occur long before the due date. The main reason is hormonal deficiency.

Dilation of the uterus after 28 weeks leads to the birth of a viable baby.

If the opening occurs earlier, its causes may be infections, placental abruption, inflammatory diseases of the genitourinary system, or lack of progesterone.

How to prepare the cervix for dilatation

It happens that labor has begun, but the cervix is not ready - it is hard and does not open. In this case, there is nothing else left to do but speed up the dilation of the cervix before childbirth.

If you do not stimulate, tissue ruptures will occur during childbirth, the process will be delayed and you will have to resort to a caesarean section.

The cervix is prepared for dilatation in case of post-term pregnancy, and the need to induce labor ahead of time - in case of gestosis and fetal hypoxia, and other indications.

Disclosure is helped by:

gynecological examination;
taking antispasmodics;
Sinestrol injections intramuscularly - soften the uterus and do not cause contractions;
Enzaprost intravenously - contains prostaglandins and speeds up the labor process;
prostaglandins - under their action, the cervix softens. Produced naturally by massaging the cervical canal, or gels containing prostaglandins are introduced intravaginally;
Laminaria seaweed is introduced into the vagina in the form of sticks 3-4 mm thick. A humid environment causes them to swell 10 times, the cervix stretches, softens, and training contractions begin. Algae comes out along with mucous secretions. There are also vaginal suppositories with kelp;
sex - mechanical stimulation and prostaglandins, which are part of sperm, help. Orgasm, with a sufficient degree of readiness, can become the beginning of labor;
physical activity - cleaning before childbirth better prepares the cervix. Walking, going up and down stairs, squatting (for example, when washing floors) are useful;
herbal medicine - raspberry and strawberry leaves, rose hips help the neck to ripen.

Medication methods are used only in a hospital; the use of drugs accelerates labor.

Usually, closer to childbirth, if the course of pregnancy is favorable, the gynecologist explains to the pregnant woman how to prepare for childbirth and open the cervix at home.

Symptoms of disclosure

Inexperienced women are concerned about the dilation of the cervix at which labor begins.

Normal childbirth begins with the cervix dilating by 1 cm. After the mucous plug comes off, it dilates by 2 or more fingers - up to 10-12 cm, sufficient to pass the baby’s head.

The opening is accompanied by contractions varying in strength and frequency. The neck becomes short, about 1 centimeter.

In women giving birth for the first time, dilation begins from the internal os, and the cervix resembles a cone with a base at the uterus.

In multiparous women, both pharynxes open simultaneously, and this happens faster.

The main sign of dilatation is contractions. At first they occur at intervals of 20-30 minutes, then they become more frequent and occur with a break of 5 minutes or continuously.

After opening by 2 fingers, its speed is 1 centimeter per hour.

Periods and phases of cervical dilatation

Dilatation is the first and longest stage of labor.

This period is divided into three phases:

Latent - the initial phase of disclosure, lasts six or more hours. Symptoms at this stage are absent or mild. The opening of the neck reaches four centimeters - two fingers.
Active - within four hours the cervix dilates to 6-8 centimeters, at the end of the phase an outpouring of amniotic fluid occurs in a volume of approximately 200 ml. The woman in labor experiences pain, distension in the lower abdomen, and aching in the lower back. When walking and other physical activity, the process accelerates. At this time, the baby is involved in labor - his head reaches the pelvic floor.
Transition – This phase is also called the deceleration phase. In multiparous women, it may be absent or go away very quickly. Women giving birth for the first time go through this phase in varying amounts of time - usually from an hour to two. At this time, the greatest dilation of the cervix of 10-12 centimeters occurs.

The opening period is divided into two stages:

disclosure - lasts from the beginning of the process, when the pharynx is opened by 4 centimeters and until full disclosure. The amount of full dilatation is individual for each case and is about 6 centimeters for a premature pregnancy, 10-12 cm for a normal pregnancy;
maximum dilation - from full dilation to the birth of the child, and then the placenta.

Sensations of a woman in labor during dilatation of the cervix

All births are individual, and the same woman experiences different sensations during repeated births.

The fetus presses on the lower abdomen, the pain is characterized as bursting. Pulls the lower back and lower abdomen. At the beginning of labor, it is similar to the sensations of painful menstruation; after the contractions increase, the pain intensifies.

Often, shortly before childbirth, contractions subside and the pain goes away. After a short rest, contractions resume, usually more intense.

The opening of the cervix at the last stage, before pushing, is the most painful in the entire birth process.

Degree of cervical dilatation

A dilation of more than 8 centimeters cannot be determined during a vaginal examination - the edges cannot be felt. Therefore, the question of how many fingers should be open is not entirely correct.

They focus not only on the degree of opening, but also on the structure of the tissues and the placement of the cervix.

During pregnancy, the external os is tilted back, and during childbirth it is turned straight.

The degree of cervical dilatation corresponds to the following indicators:

1 finger - 2 cm;
2 fingers - 4 cm;
3 fingers - 6 cm;
4 fingers - 8 cm.

The degree of dilatation is also assessed based on the condition of the cervix:

not flattened or opened;
completely smoothed out;
dilated 6 cm;
fully opened.

How is the degree of opening of the cervix determined?

The degree of dilation is determined by vaginal examination of the cervix before birth.

The middle and index fingers are inserted into the vagina. Then the inspector moves them in different directions until the edges touch.

The resulting distance in centimeters is the desired value. The meaning is subjective.

The mature uterus is soft and loose to the touch. To determine maturity, they use the concept of cervical effacement, which means its thinning, and softening of the cervix before childbirth.

During pregnancy, the cervix is dense; closer to childbirth, it becomes thinner. Measured as a percentage. 90% effacement indicates readiness for childbirth.

To determine the degree of disclosure, external methods are also used. During labor, the uterus forms a contraction ring.

Using the Schatz-Unterberger method, the distance from the pubis to the groove of the ring is measured in centimeters.

This distance is equal to the size of the opening of the internal mouth.

Consequences and possible complications during disclosure

A long and dense cervix before childbirth is a pathological condition and often becomes the cause of labor complications. In this case, complications are possible:

perineal rupture;
cervical rupture;
uterine rupture;
long painful labor;
fetal hypoxia.

The duration of labor directly depends on the degree of readiness of the cervix. Since the preparation of the uterus is asymptomatic, sometimes pathology is detected when the body is already involved in childbirth.

In this case, urgent stimulation with medications or mechanical stimulation is carried out - during contractions, the pharynx is expanded manually.

Premature dilatation can cause the birth of a premature baby or fetal death.

Too early shortening of the cervix often indicates isthmic-cervical insufficiency. This pathology is one of the main causes of spontaneous miscarriages.

kakrodit.ru

How is cervical maturity assessed?

Starting from 38 weeks of pregnancy, during an examination with a gynecologist at a antenatal clinic or in a maternity hospital, the doctor conducts a vaginal examination to assess the condition of the cervix. It is also mandatory to examine the cervix before childbirth, as well as during labor. This is necessary to understand how quickly the process of maturation occurs.

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

What happens to the cervix before childbirth

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

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

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

In the latter, the process of opening the internal and external pharynx occurs simultaneously, since by the end of pregnancy their external pharynx usually already allows one finger through. As it opens, the neck thus becomes shorter. A couple of days before the onset of labor itself, the process of its maturation accelerates significantly. Gradually it completely smoothes out and easily lets through 2 fingers or more.

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

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

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

If the cervix is not ready for childbirth

A soft, shortened cervix, which is located in the center and slightly open, indicates the approach of labor. However, it also happens that the due date has already approached, but the maturity of the cervix has not yet occurred.

An immature cervix can lead to complications during labor, so if it is not ripe by the expected date of birth, the doctor may decide to induce stimulation.

Pregnancy after 40 weeks is post-term and dangerous for the baby. At this point, the placenta ceases to fully perform its functions. Therefore, if the cervix does not ripen by this time, then its stimulation is mandatory.

In addition to postterm pregnancy, indications for stimulation are:

The mother has a disease in which further pregnancy threatens her health.
Development of hypoxia in the fetus.
Large fetus or multiple pregnancy.
The cessation or weakening of contractions during labor.
Premature placental abruption.

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

Medical methods include the following:

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

If the cervix opens prematurely

The opposite situation also happens, when the cervix begins to open and prepare for childbirth ahead of schedule. This is usually associated with a pathology of the cervical canal called isthmic-cervical insufficiency. It lies in the inability of the cervix to properly contain the fetus. It shortens and opens early, which often leads to spontaneous abortion.

The presence of this pathology is indicated by the length of the cervical canal at 20–30 weeks of less than 25 mm.

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

In addition, treatment is carried out to promote the rapid maturation of the fetal lungs in case labor begins prematurely. Before childbirth, the cervix changes so much that it allows the baby to be born unhindered.

The gradual dilatation of the cervix before childbirth is almost unnoticed by the woman herself.

Therefore, visits to the gynecologist in the third trimester should be regular and accompanied by a vaginal examination, which allows you to assess the degree of readiness of the body for childbirth. This is especially true for those women who already feel other warning signs. If the due date has already approached, but cervical maturity has not yet arrived, then there is no need to be afraid of stimulation. Sometimes delay can cost the lives of both mother and child.

daberemenna.ru

Your baby's birthday is approaching - it's time to give yourself a little exam and make sure that none of the questions that concern you are left unanswered.

When to go to the maternity hospital?
Every expectant mother asks this question. Don't worry, your first baby won't be born in five minutes, and you'll have time to prepare for the event. By certain signs you will understand that the moment of birth is approaching. The first of them is regular, gradually intensifying contractions that become more and more noticeable. Remember, you may have had similar sensations during pregnancy: placing your hand on your stomach, you could feel your uterus tightening. So, these contractions did not have a specific rhythm and frequency, and they did not cause unpleasant sensations. And with the onset of labor, contractions become regular and more intense. At first, the interval between them will be 20–30 minutes, and then gradually decrease. If contractions appear every 5 minutes for 2 hours (every 10 minutes for 1.5 hours, if you are not a “newbie”), it’s time to go to the maternity hospital.

The second sure sign of the onset of labor is the rupture of amniotic fluid. They can leave at any time - at home or already in the maternity hospital ward. In addition, amniotic fluid (as they are also called), which has neither color nor odor, can pour out in a “stream” and almost immediately or will flow out in small “portions” - and then the process will take some time. Those expectant mothers whose amount of amniotic fluid, according to ultrasound, exceeds the norm, need to lie down while it is pouring out: then the excess fluid will not prevent the baby’s head from inserting correctly into the woman’s pelvis, which will prevent the baby’s umbilical cord from falling out. This complication is dangerous because, once outside, the umbilical cord can become pinched, and then the child will suffer from a lack of oxygen.

So, with the onset of contractions and (or) the release of water, you need to go to the maternity hospital, and preferably by ambulance - a trip on specialized transport will save you from traffic jams and other adventures.
Is it possible to confuse the release of a mucus plug with the outpouring of water?

The mucus plug “clogs” the cervix for the entire duration of pregnancy and protects the baby from infections. It looks like a viscous clot of mucus, transparent or streaked with blood. To be fair, it must be said that sometimes it is liquid, and in this case its release can be mistaken for the outpouring of water. Only a doctor can resolve these doubts - he will examine you and determine whether the bladder is intact.

At what point does the mucus plug come off?
It's different for everyone. Its release means that the cervix has begun to change, in other words, to ripen. Separation of the mucus plug before the onset of contractions is not a reason to urgently go to the maternity hospital.

Is it possible to take a bath and eat before going to the hospital?
If your water breaks, take a shower to protect your baby from germs entering the uterus - this can happen if you decide to soak in the bath. But if the bladder is intact, a warm bath will help you relax and ease painful contractions. Don't overeat before going to the maternity hospital! The process of opening the cervix often causes a gag reflex, and nausea may occur later when you are given pain medication. In addition, emergency operations are performed only on an empty stomach! During labor, you can take a sip of water or wet your lips.

Who will meet me at the maternity hospital?
You arrive at the maternity hospital with an exchange card and passport in hand. You will be met by a midwife who will ask you to describe the rhythm of contractions, ask if your water has broken and if the baby is moving. To resolve controversial issues, she will call the doctor on duty. Then the midwife conducts the first examination: measures the pressure, takes a blood test to check the group and Rh factor. Next comes the time for the first examination: the midwife will palpate your abdomen, determining the height of the uterus, the position of the baby, measure the size of the pelvis, and listen to the baby’s heartbeat. If labor has already started, she will give you an enema. A vaginal examination is carried out by a doctor - this is how the phase of labor and the absence of deviations in its course are determined.

What are all these people doing?
Midwife
She will meet you upon arrival at the maternity hospital, examine you and be with you until the very end of the process. If problems arise during labor, the midwife will call the doctor.

Obstetrician-gynecologist
He observes the process of childbirth, examines the expectant mother from time to time, determines the need and time of administering anesthesia, performs large and small operations (caesarean section, episiotomy, applies forceps, stops bleeding), assists in complicated births when the baby walks, for example, with the butt or his shoulders are stuck.

Anesthetist
With the help of a nurse, he gives the expectant mother anesthesia and checks how the patient tolerates it. If a woman is sent for an emergency caesarean section, he will select an appropriate anesthesia for her and will be with her throughout the entire operation.

Pediatrician
You will only meet with him after the baby is born, unless his advice is needed during childbirth.

Pediatric nurse
She will take care of your baby and help you get used to your new responsibilities as a mother. Typically, a pediatric nurse is not present at birth, although in some institutions she participates in the first examination of the baby after birth.

Is shaving necessary?
Yes, definitely. There should be no hair on the pubis and perineum - their presence complicates examinations and is incompatible with surgery if it is suddenly required.
I have a slight fever, is this a problem?

Perhaps we are talking about an infection or the body’s reaction to the onset of labor. If necessary, you will be given antibiotics and antipyretics, and all necessary tests will be performed.
What is a heart monitor for?

This is a device connected to sensors that are attached to the expectant mother’s belly and transmit information about the strength and intensity of her contractions and the baby’s heartbeat in response to them. Typically, the expectant mother is connected to the monitor after she enters the maternity ward, and disconnected after the baby is born.

What methods of pain relief will be offered to me until epidural anesthesia can be administered?
The midwife will be with you throughout the entire journey to support and help you breathe correctly. Deep and regular breathing allows a woman not to concentrate on the pain, and it seems less intense. In addition, thanks to proper breathing, both the baby and the muscles of the uterus are well supplied with oxygen. If necessary, the doctor will prescribe you painkillers, which are administered intravenously. In any case, don’t worry, you will definitely receive help at the right time, especially since modern methods of pain relief not only relieve a woman of unpleasant sensations, but also improve labor, speed up the opening of the cervix, and give mother and child the opportunity to gain strength for the important moment.

Is it possible to move during childbirth?
Until your water breaks, the heart monitor is not connected, the IV is not in place, you can walk around the ward or along the corridor - with the consent of the midwife, of course. If you get busy, time will go faster. In addition, the upright position of the mother will allow the baby to put more pressure on the cervix, which will help it open. In some maternity hospitals, expectant mothers will even be asked to move rather than lie down.

What do these terms mean?
Smoothing and dilation of the cervix
Under the influence of contractions, the cervix gradually shortens until it disappears completely. Experts call this process smoothing the cervix. Then, also under the influence of contractions, it begins to open. For those women who become mothers for the first time, the processes of smoothing and opening occur one after the other, but for “experienced” parents - simultaneously.

Crotch
This is the name given to the group of muscles covering the urethra, vagina and anus. They play an important role during labor by stretching and allowing the baby to get out.

Oxytocin
This is a hormone produced by the posterior lobe of the pituitary gland, it stimulates contractions and is involved in milk production. Synthetic oxytocin is often used during labor to increase the frequency and intensity of contractions.

Prostaglandins
These biologically active substances, which are produced in the body of mother and baby, are involved in the initiation and regulation of the birth process. Their synthetic analogues are administered to expectant mothers in order to correct its development.

Fetal suffering
Experts judge the baby’s well-being by his heart rate, which is measured by a heart monitor. If it slows down at a rate of 120–160 beats per minute, the doctor makes a decision on the further course of events: either labor continues as usual, or the doctor uses obstetric forceps, or the expectant mother undergoes a cesarean section.

Expulsion of the placenta
After the baby is born, contractions resume to deliver the placenta. This event concludes the last stage of childbirth, which is called “expulsion of the placenta.”

What about the baby?
At first, he hardly feels the contractions, despite the fact that they push him down from the top of the uterus. At this time, her neck stretches, but, on the contrary, from the bottom up. The baby floats in the amniotic fluid and... for example, sleeps, which confirms the calm rhythm of his heartbeat. He still doesn't understand what will happen next. Since amniotic fluid acts as a shock absorber, it is very important that the amniotic sac functions as long as possible and that the little one gains strength before the difficult test.

What is false labor?
This is the name for sluggish and irregular contractions that do not change the condition of the cervix in any way, that is, they do not open it. When the expectant mother arrives at the maternity hospital, the doctor determines the maturity of the cervix, and if it turns out that she is not yet ready for the start of labor, the woman may be asked to return home or stay in the maternity hospital under the supervision of specialists. It happens that preparatory, or false, contractions cause a lot of unpleasant sensations: they are painful, interfere with sleep and eating, make the baby quiet down or, on the contrary, move violently. In this case, the expectant mother will need the help of specialists, and if this is not provided, the birth process may take a much more difficult path.
What about the baby?
The contractions intensify and move the baby towards the exit of the small pelvis through the opening of the cervix. The bubble passes into its opening and ruptures - now the muscles of the uterus tightly clasp the baby’s head, and it comes into contact with the bones of the mother’s small pelvis.

The cervix has dilated by 2 cm. What does this mean?

This means that the latent phase of labor has ended: now the cervix will begin to intensively shorten, smooth out and open further until it reaches 10 cm in diameter. This process can have a different pace: up to 4 cm, things go slower, and then much faster.

What is epidural anesthesia?

An anesthetic drug is injected into the epidural space, that is, between the vertebrae and the dura mater. After 15 minutes, the entire lower part of the body loses sensitivity - the expectant mother continues to feel only the tension of the uterus. Cases of refusal of a request to administer epidural anesthesia are very rare. It is not given to women who have bleeding disorders, those who have a fever, a skin infection, spinal deformities and diseases of the nervous system. And one more thing: if the cervix opens quickly, there is no need for epidural anesthesia: you will give birth faster than the medicine will take effect.

Is the birth of a small baby faster?

The duration of labor cannot be predicted: it all depends on the rate of dilatation of the cervix, the position of the baby and the speed of its movement through the mother’s small pelvis. It is only known that the second and third births proceed faster than the first.

They put me on an IV. What's in it?

Once you are in the delivery room, you will have an intravenous catheter inserted so that you can be connected to an IV with medication if necessary. The catheter will be removed at the end of the birth process before transfer to a regular ward.

How is a baby's head born?
Nature has made sure that the tissues of the woman’s birth canal are very elastic, and the bones of the baby’s skull are loose; their mobility facilitates the movement of the head forward, helping it adapt to the size of all planes of the mother’s bony pelvis. Since it will be easier to get into it with a bent head, the baby bends his neck and turns so as to get forward with its smallest circumference.

It must be said that expectant mothers are not always given an IV; this requires strict indications, and depending on how the process develops, oxytocin, prostaglandins can be added to its contents to intensify contractions, or nutritional drugs that will help the baby cope with the shortage oxygen if available.

How often will I be examined?
This is not done as often as is commonly thought: the first time - upon admission to the maternity hospital, then - after the water breaks, then - before the prescription of anesthesia and, finally, after it is administered. During an internal (vaginal) examination, the doctor determines the condition of the cervix according to several criteria: its position (posterior or central), length (already smoothed or not yet), consistency (hard or soft), degree of dilation (5 or 6 cm). A separate question is whether the baby’s head was inserted into the woman’s pelvis? In addition, every two hours the midwife measures the expectant mother's blood pressure, pulse rate and temperature. And finally, both the doctor and the midwife can monitor the development of the birth process based on the results of external examinations.

This hitch can occur if the process develops sluggishly or, conversely, rapidly or the muscles of the cervix are spasmed. Having determined the cause, the doctor will act according to the situation: if labor is weak, you can open the amniotic sac and inject oxytocin or prostaglandins into the woman through an IV, and spasm of the cervical muscles usually relieves pain.

How long do contractions last?

During the first birth – 10–12 hours, and during the second and third – 6–8. At first, when the cervix just begins to open, they occur every 5 minutes and last 30 seconds. Then contractions appear more often, because it is with their help that the cervix opens. By the time this happens, they occur every 2.5 minutes and last 1 minute.

Why is a urinary catheter needed?

During childbirth, the expectant mother is not always able to cope with such a delicate task herself, and a full bladder can prevent the baby from moving into the pelvis.

I feel nauseous, is this normal?

Yes, this sensation can occur while the cervix is dilating. Another reason is the side effects of pain medications.

How long will it take me to give birth?

The first birth takes an average of 10–12 hours, the second and third – about 6–8. Expectant mothers usually think that they last longer, because for a woman everything begins with the appearance of the first contractions or with the rupture of the bladder at home - events that, strictly speaking, are not the beginning of the process. This is where the stories of 24 hour labor come from! You shouldn’t believe those who “did it in 2 hours,” as those mothers say who did not feel the hidden phase of labor, but “caught” only its end.

How will I know when I need to push?

This desire appears in the expectant mother at the moment when the cervix dilates completely (10 cm), and the child descends into the pelvis and comes into contact with the muscles of the perineum. Under the pressure of his head, the latter begin to gradually stretch. In addition, the midwife, who will closely monitor developments, will definitely inform you that the time to push has come. This stage of labor, called expulsion of the baby, lasts from 5 to 30 minutes.

What are obstetric forceps used for?

They help bring the baby's head out. The doctor leading the birth uses them if the expectant mother cannot push or cannot do this for some other reason, and the child needs to be removed quickly, in his own interests. The tongs consist of two metal spoons that meet in the center. In the interval between contractions, the doctor places them on the baby’s head and pulls the arms, following the “route” of her movement.

How should I breathe?

At the beginning of a contraction, inhale deeply through your nose, then hold your breath and push. Repeat this cycle three times in 1 contraction. At the end of it, exhale smoothly and relax until the next “wave” appears.

Is it true that an unpleasant surprise can happen during pushing? To prevent this from happening at the most crucial moment, upon admission to the maternity hospital, expectant mothers must undergo a cleansing enema. The baby must be born in absolute purity!

Will I have an episiotomy?

Not at all necessary! Research shows that this manipulation does not always help to avoid perineal ruptures and urinary incontinence in patients in the future. Today, most doctors carry it out on a case-by-case basis if indications arise: a large baby is born, forceps had to be applied, the child walks bottom-first, he does not have enough oxygen, or labor began long before the scheduled date.

Do all children scream?

The baby reacts to a change in environment by screaming, although there are children who, in response, begin to cry quietly or are completely silent.

What happens after the baby is born?

About a few minutes after the baby's birth, contractions begin again to expel the placenta and membranes surrounding the baby. Don’t worry, in most cases these contractions are mild and barely noticeable, and against the background of epidural anesthesia they are completely unnoticeable. This final stage of childbirth is scientifically called “expulsion of the placenta.”

Why does the midwife examine the placenta?

She checks whether its surface is intact to make sure that all the lobules of the placenta are in place and none of them remain in the uterus. Otherwise, in search of the “loss,” the doctor will have to examine its cavity manually.

Do I need to stay in the delivery room after everything is done?

You will be left under observation for another two hours: during this time, the midwife will visit you to check whether the uterus is contracting well after childbirth, determine the amount of blood loss, and measure your blood pressure, temperature, and pulse.

SVETLANA MIKHSIN, obstetrician-gynecologist

www.baby.ru

a large amount of amniotic fluid has passed

If possible, spend as much time as possible in an upright position, on all fours or squatting. This will speed up the dilation of the cervix. In general, it is better to go through this stage quickly, otherwise by the time of childbirth you will be completely exhausted from the lack of rest and sleep.

The second stage is the dilatation of the cervix

When the cervix is dilated by 8-10 centimeters, we can assume that labor is in full swing. Contractions become more frequent and more painful, gradually the intervals between them become shorter and disappear completely. During this period, you can groan, moan, howl, but you cannot scream (this causes fetal hypoxia) and bite your lips (the lips are connected to the cervix, it is better to keep them slightly open, then the cervix will open more easily).

Transition into the birth canal

This stage looks like one big and painful contraction. You will experience the main pain sensations at this stage. It is best to spend it squatting or standing on all fours, or, in extreme cases, lying on your side.

Attempts

At the very beginning of this period, you cannot push, although you really want to. If it is completely impossible not to push, try breathing “dog” - often, often. At the moment of eruption of the head, you should absolutely not push. Once the head is out (usually face down), the baby's body turns - most often facing left - and the baby "flies" like a bullet out of the mother's body.

First hours

It is very important to feed your baby within 15 minutes after birth. It is possible that doctors will assure you that there is no milk in your breast yet and persuade you to give him a bottle. Don’t listen to the doctors: he doesn’t need milk, he doesn’t have the appropriate enzymes yet! The baby needs colostrum, but it is only in your chest, and its composition changes every 15 minutes. In the first half hour there is a very high concentration of immune bodies; in addition, early breastfeeding stimulates lactation and gives the baby the opportunity to start eating properly. And if you give him a bottle, he may not take the breast later. Just as a chicken considers the object it saw first to be its mother, so the baby considers its first feeding experience to be correct.

After feeding your baby, take care of yourself. You need:
— empty the bladder (this is the prevention of postpartum hemorrhage);
- drink a solution of mumiyo - this is the prevention of postpartum inflammation for you and your baby): a match head of the drug per 100 g of water. You need to drink this drink for a week - once a day.
— drink a solution of 2/3 teaspoons of alcoholic propolis in any amount of water. Drink this for a week twice a day: on an empty stomach and at night.

Watch the chair! The perineal area, especially after an episiotomy, is very painful, the veins of the anus are swollen, but the intestines need to be emptied every day. If necessary, do enemas, you can drink paraffin (vaseline) oil - a spoon before meals, otherwise you will be guaranteed hemorrhoids.

You need to feed the baby as often as possible - then the uterus will return to its place earlier. If this is not the first birth, uterine contractions can be quite painful.

After 48-72 hours the milk comes. Try to hold out and not give your baby a bottle. He won't die of hunger! The Nikitins’ book describes a case when in Brazil, during an earthquake, access to the ward of newborns was blocked, and they could not get to it for 6 (!) days. When they were finally able to enter, 20 newborns were alive, healthy and screaming angrily. Milk will definitely appear, you just need to continue feeding and drinking more.

http://www.about-health-care.com/

www.iwoman.ru

1. The opening and smoothing of the cervix is carried out under the influence of labor contractions. In the muscles of the cervix occurs:

Contraction – contraction of muscle fibers.
Retraction - displacement of muscle fibers. The muscle fibers move, move into the adjacent layer and shorten. As a result, the wall of the uterus thickens, and the lower uterine segment becomes thinner and stretched, which leads to shortening, smoothing of the cervix and opening of the uterine pharynx.
Distraction - contracting muscle fibers of the uterus pull the circular muscles of the cervix to the sides and upwards, which also contributes to the opening of the uterine pharynx.

2. The dilatation of the cervix is facilitated by the movement of amniotic fluid towards the cervical canal.

During contractions, the bladder stretches (fills up) and penetrates more and more into the cervical canal, expanding it.

The opening of the cervix is also facilitated by the presenting part of the fetus moving through the birth canal.

The cervix consists of cavernous spaces filled with blood. The presenting part displaces blood from these spaces, the neck becomes thinner and gradually disappears, and the pharynx opens.

The opening increases by 2 - 4 - 6 cm, etc. until full opening - 10 -12 cm.

The process of dilation of the cervix is different for primiparous and multiparous women.

more and more until it opens completely (up to 1-12 cm).

The dynamics of opening is 1 cm per hour.

In multiparous women already at the end of pregnancy, the external pharynx is dilated by 1.5 - 2 cm. During the period of dilation, the external and internal pharynx open simultaneously and the cervix is smoothed. The dynamics of opening is 2 cm per 1 hour, i.e. 2 times faster.

Contact belt.

During each contraction, amniotic fluid rushes to the lower pole of the fertilized egg; the amniotic sac is stretched (filled) and inserted into the pharynx. After the end of the contraction, the water partially moves upward, the tension of the fetal bladder weakens. Free movement of amniotic fluid occurs as long as the presenting part is mobile above the entrance to the pelvis. When the head descends, it comes into contact with the lower segment of the uterus on all sides and presses this area of the uterine wall against the entrance to the pelvis.

The place where the head is covered by the walls of the lower uterine segment is called contact belt. It divides the amniotic fluid not anteriorly and posteriorly. The anterior waters are located below the contact zone, the posterior waters are located above. The water is distributed as follows: front water - 200 - 250 ml, rear water - up to 1.5 liters. During contractions, the anterior segment of the amniotic sac tenses, and the “wedge” plunges into the expanding cervix. This type of amniotic sac is called functioning .

Sometimes there is little front water. They cannot facilitate the opening of the cervix, but, on the contrary, by stretching on the head, they prevent the advancement of the head. This type of amniotic sac is called flat – not functioning. By preventing the advancement of the head, it helps to lengthen the period of dilatation, and, consequently, the duration of labor. Such a fetal bladder is opened.

When the anterior waters outside the contraction do not leave due to the contact zone, they say that this amniotic sac is “ready to rupture.”

Rupture of membranes.

Rupture of the membranes usually occurs at the end of the first stage of labor, that is, at full dilation, when the function of the membranes is completed.

This timely rupture of amniotic fluid.

For some women in labor, the water does not pour out in a timely manner:

Before the onset of labor - premature.
Until full disclosure - early. Early rupture of the membranes (as well as premature rupture) leads to complete rupture of water from the uterus -

“dry birth”, which is accompanied by a number of complications, sometimes severe:

1. rupture of amniotic fluid before the formation of the contact zone can lead to the loss of umbilical cord loops and small parts of the fetus

(arms or legs), which complicates the course of labor and poses a threat to the life of the fetus;

2. the cervix dilates more slowly;

3. the first stage of labor is lengthened. if the anhydrous period exceeds 12 hours, they speak of a long anhydrous period, which poses a threat of the development of an intrauterine infection.

If the membranes are very dense, the amniotic sac may not open and then the baby is born “in a shirt” - in the membranes. This - belated rupture of the membranes. A child at birth may choke on water. Therefore, such a fetal bladder is opened in advance, i.e. produce amniotomy

Biomechanism of childbirth.

The soft tissues of the birth canal include the expanded lower uterine segment, vagina, parietal muscles and pelvic floor.

The diameter of the birth tube corresponds to the diameter of the emerging head and body of the fetus. This tube, which is a continuation of the bone canal, is not straight; it goes obliquely, bending in the form of an arc. The lower edge of the birth canal, the formations of the vulvar ring, also lengthens and sharply bends anteriorly (upward). Therefore, the pelvic wire line has the shape of a curve: in the bone canal it goes down almost straight (through the centers of straight dimensions), in the pelvic floor it bends and goes anteriorly (up).

Due to these features of the birth canal, the head cannot pass through the birth canal in a straight line without making turns. Simultaneously with translational movements along the axis of the birth canal, the fetus, especially the head, makes a series of movements. It performs translational movements, rotations around the longitudinal axis and rotation around the transverse axis - flexion and extension.

studopedia.ru

Cervical dilatation methods

There are conservative methods that use pharmaceutical agents aimed at stimulation. Radical methods can be used in emergency cases: amniotomy, perineal incision. There are also non-medicinal products: kelp sticks, special catheters, gels and oils, suppositories. Physical exercise, sex, meditation, breathing techniques, and local candles work well.

Catheter and foley balloon to dilate the cervix

A special catheter, which is presented in the form of a tube with a balloon. Injected into the cervix for 24 hours. The balloon is gradually filled with air, which expands the walls of the uterus. Has many disadvantages.

Can be described as a catheter containing a balloon. It is filled with air. It is inserted for a day, and gradual opening occurs due to the expansion of the cervical wall. The likelihood of developing an infection increases significantly.

Cervical dilation gel

A special gel containing prostaglandins is injected into the cervical canal. Hormonal stimulation occurs, the effect can be achieved after 2-3 hours.

Exercise

Squats are effective exercises. Twisting and jumping are contraindicated. At the same time, during practice you need to strive for maximum relaxation and control your breathing. You need to perform static exercises that train willpower and endurance. It is better to perform the exercises in a calm environment, with relaxing music. There are many video lessons for pregnant women, where all the exercises are shown clearly, selected in the optimal sequence, and smoothly transition from one to another. Such video lessons effectively combine static and dynamic complexes, breathing exercises and meditative practices.

The best option is yoga, pranayama (breathing exercises and internal contemplation), qigong, meditation, swimming, and water aerobics. You can sign up for special preparatory courses for pregnant women, where physical and psychological preparation of expectant mothers is carried out; training is carried out under the supervision of experienced specialists who can choose an individual pace and exercise regimen. Special gymnastic balls and fitballs are used. You can train at home even using a regular staircase, making frequent ascents and descents.

Physical exercises will be more effective if you start preparing early. And even better - long before pregnancy. Trained muscles are the key to quick and successful opening of the uterus, since it is also essentially a muscle. But if preparations were not started when planning the pregnancy, it’s okay. It is better to start late than not to exercise at all. They are beneficial even if you start regular practice in the last weeks.

Fitball for dilation of the cervix

In modern clinics, it has long been recommended to take not the traditional position on a horizontal plane, but a vertical one. A sitting position is also recommended. But the surface should not be hard. The ideal fitball is a large inflatable ball, which is used in sports and gymnastics. If you sit on it and perform special exercises, you can relax tense areas and tighten those areas that will be in good shape. It is better to spread your legs apart. Nervous and hormonal activity is activated, and the uterus is more stimulated. At the preparatory courses you can receive special training in exercises and positions on a fitball.

Squats to open the cervix

Squats stimulate the neck, both by activating nervous activity and mechanically. You need to perform regular squats, or squats according to a special pattern. The time gradually increases. First, you need to perform each stage for 10 seconds. Then increase the time to 1 minute for each stage. At the first stage, we slowly squat. The duration of the squat should be 10 seconds, that is, we should completely lower ourselves in 10 seconds. Then we sit in this position for another 10 seconds, and begin to relax as much as possible. Then we rise partially. You need to stop in such a position that your thighs are parallel to the floor. We remain in this position for 10 seconds, then slowly, over the next 10 seconds, lower ourselves down. We rest, relax in a squat for another 10 seconds. We begin a slow rise for 10 seconds. Then rest for 10 seconds and begin squatting again. After we managed to complete 10 such squats in one approach, we move on to the next stage - the duration of each stage increases to 20 seconds, then to 30, 40, 50 seconds and one minute. After squatting 10 times at a slow pace, you definitely need to squat at a fast pace. The speed should reach 50 squats per minute. If this doesn’t work, it’s better not to squat completely; you can only lower yourself partially. Gradually you need to increase the depth of the squats.

Meditation to open the cervix

The “Shavasana” pose used in yoga is effective. You need to lie on your back, legs and arms slightly apart. Eyes closed. You can turn on relaxing music and an aroma lamp. The sounds of nature are good, especially the sound of a sea wave, the sounds of rain, and a waterfall. Birdsong, animal sounds, and instrumental music may be suitable. You need to try to relax as much as possible, not think about anything. Muscles should be relaxed consciously, directing attention to them. First, let's focus on the legs. We feel how the leg muscles relax, become soft and heavy. Relaxation covers the tips of the fingers, is understood along the shin, along the thigh. The kneecap drops. The pelvic area, perineum, and uterus relax. Both legs are relaxed, the pelvic area is relaxed, gradually relaxation covers the stomach, back, the lower back, and the muscles along the spine relax. The chest and arms relax. Relaxation of the hands rises from the fingertips, glides along the wrist, elbows, forearm, relaxes the elbow, shoulder, collarbone.

Once again, walk your attention throughout your body, feel the relaxation in every area. Particular attention should be paid to the face: feel how your forehead, nose, eyes, ears, cheeks relax. The chin is relaxed, the lower jaw is relaxed and may be slightly open. Eyes closed. You are motionless and relaxed, your whole body is heavy. There are no thoughts in my head. There is only silence. If thoughts come, you need to let them go, not delay them. This meditation should last at least 30 minutes. There is no maximum limit. Ideally, it should be up to three hours. After this, you need to lie down and do not rush to get up. You can drink tea or herbal decoction. Raspberry leaf tea is ideal.

There are also video lessons and audio materials for meditation, which explain in detail all the nuances and provide meditation accompaniment. The slow, calm voice of a specialist smoothly guides your attention, directing it to the right areas, reminding you to relax and not think. The voice does not accompany all meditation: it is effectively combined with moments of silence, a special background and musical accompaniment are selected. The rhythm intensifies and subsides, which creates the desired tonality.

Drugs for dilation of the cervix

Various drugs are used. Oxytocin, intramuscular administration of sinestrol, and suppositories with prostaglandin have proven themselves well. Enzaprost is also administered intravenously. The use of synthetic prostaglandin is allowed. The dosage and frequency of administration can only be determined by a doctor, since it is strictly individual and determined by the results of the partogram.

Pills

Miropristone is used. It stimulates the contractile activity of the myometrium. Take 1 tablet every day, under the strict supervision of a doctor.

Oxytocin-MEZ is often used to stimulate uterine dilation and induce labor. This is a solution for intramuscular and intravenous administration.

The opening can be facilitated by no-spa, which is an antispasmodic drug, relaxes the muscles and makes them more elastic. Prescribed 1-2 tablets 2-3 times a day or in the form of injections.

Papaverine can be used both in the form of injections and in the form of tablets. The dosage depends on the speed of dilation and the condition of the uterus, and is determined exclusively after palpation and gynecological examination. Helps reduce blood pressure and relax smooth muscles.

Caulophyllum 30 is a homeopathic remedy that is used to induce labor. It makes giving birth much easier and reduces the pain threshold. A remedy of Indian origin that has long been used in Indian medicine. Significantly reduces the risk of cesarean section, the need for oxytocin disappears. Eliminates trembling, fatigue and thirst, gives strength.

Castor oil, when taken orally, promotes rapid expansion. In the early stages it has abortifacient properties.

Many women, after being discharged from the hospital, say that they were given too many injections. And no one knows what drugs are used for this. In order to avoid unnecessary fears, it is better to understand this.

First of all, drugs are administered for pain relief. These are narcotic drugs that are administered in various ways. Most often - intramuscularly, intravenously. Epidural anesthesia (an injection in the back) is also used. It is the safest type of pain relief, since it does not affect either contractile activity or the fetus, the drug does not enter the blood. Other types are usually used only if there are 2-3 hours left before the baby is born, this eliminates the risk of developing hypoxia.

For labor weakness, stimulation medications are used. An amniotomy is often mistaken for an injection - a puncture of the amniotic sac. Depending on the situation, symptomatic remedies are used - to reduce swelling, pressure, heartbeat, and to stimulate the fetus.

If the contractions are long and painful, but unproductive, the woman weakens. She is given a sleep-rest drug, which allows her to quickly regain strength. This type of sleep lasts 2 hours. After it, labor activity intensifies.

Injections are often used to prevent or stop bleeding. In case of surgery, many injections are also used. Injections are also given to remove the placenta and postpartum rest.

A dropper is used to stimulate opening. It is based on saline solution or glucose, which ensures the maintenance and nutrition of the body. If necessary, drugs of various effects are added to the droppers.

Suppositories for dilation of the cervix before childbirth

Used for intravaginal administration with a high content of synthetic prostaglandin. Their effectiveness is high: the result is achieved within 2-3 hours.

Laminaria sticks for dilating the cervix before childbirth

They are sticks made from sea kelp. Dried algae, small in size, is inserted into the neck. Gradually it becomes saturated with moisture and expands, the cervix also expands. As many sticks are inserted as required to completely fill.

Manual dilatation of the cervix

It involves artificial dilatation by inserting and expanding a finger during a gynecological examination.

Pessary and ball dilation of the cervix

It is used to prevent early dilation and maintain pregnancy. The pessary is presented in the form of a plastic device that provides support for the organs. It is formed from several rings connecting to each other. Provides reliable support and can even be performed on an outpatient basis. Duration – several minutes. For insertion, the ring is lubricated with gel and inserted into the vagina. After the procedure, sex is contraindicated. Every 2-3 weeks you need to monitor the state of the vaginal microflora and conduct ultrasonography.

To mechanically open and stimulate the uterus, a special plastic ball is inserted into the cervix and left for a day.

Raspberry leaf for cervical dilatation

Raspberry leaves are very effective in dilating the cervix. Can be used in tea or as a decoction.

Dilatation of the cervix according to Rogovin

The full name is the Rogovin-Zanchenko method. This is an external measurement method that allows you to assess the degree of opening of the external pharynx. At the height of the contraction, measure the distance from the xiphoid process to the fundus of the uterus, in centimeters. The resulting indicators are subtracted from 10 cm to obtain height indicators. The method is approximate.

In the first stage of labor, there is a gradual smoothing of the cervix, opening of the external os of the cervical canal to a degree sufficient to expel the fetus from the uterine cavity, and position the head at the pelvic inlet. Smoothing of the cervix and opening of the external pharynx are carried out under the influence of labor pains. During contractions, the following occurs in the muscles of the uterine body: a) contraction of muscle fibers - contraction, b) displacement of contracting muscle fibers, a change in their relative position - retraction. The essence of retraction is as follows. With each contraction of the uterus, temporary movement and interweaving of muscle fibers is noted; as a result, the muscle fibers, which lie one after the other in length before contractions, are shortened, moved into the layer of adjacent fibers, and lie next to each other. In the intervals between contractions, the displacement of muscle fibers remains. With subsequent contractions of the uterus, the retraction of muscle fibers increases, which leads to increasing thickening of the walls of the uterine body. In addition, retraction causes stretching of the lower segment of the uterus, smoothing of the cervix and opening of the external os of the cervical canal. This happens because the contracting muscle fibers of the uterine body pull the circular (circular) muscles of the cervix to the sides and upwards - cervical distraction; at the same time, increasing shortening and expansion of the cervical canal is noted with each contraction.

The dilatation of the cervix is facilitated by the movement of amniotic fluid towards the cervical canal. With each contraction, the muscles of the uterus exert pressure on the contents of the fertilized egg, mainly on the amniotic fluid. There is a significant increase in intrauterine pressure. Due to uniform pressure from the fundus and walls of the uterus, amniotic fluid, according to the laws of hydraulics, rushes towards the lower segment of the uterus. Here, in the center of the lower part of the fetal sac, the internal os of the cervical canal is located, where there is no resistance. Amniotic fluid rushes to the internal os under the influence of increased intrauterine pressure (Fig. 74).

Rice. 74. Under the influence of increasing intrauterine pressure, amniotic fluid rushes towards the internal os; the fetal bladder is wedged into the pharynx. Under the pressure of amniotic fluid, the lower pole of the fertilized egg peels off from the walls of the uterus and penetrates into the internal pharynx of the cervical canal. This part of the membranes of the lower pole of the egg, which penetrates along with the amniotic fluid into the cervical canal, is called the amniotic sac. During contractions, the amniotic sac stretches and wedges deeper and deeper into the cervical canal, expanding it. The amniotic sac promotes expansion of the cervical canal from the inside (eccentrically), smoothing (disappearance) of the cervix and opening of the external pharynx of the uterus. Thus, the process of opening the pharynx is carried out by stretching the circular muscles of the cervix (distraction), which occurs in connection with the contraction of the muscles of the body of the uterus, insertion a tense amniotic sac that expands the pharynx, acting like a hydraulic wedge. The main thing that leads to dilatation of the cervix is its contractile activity; contractions cause both distraction of the cervix and an increase in intrauterine pressure, which results in tension of the fetal bladder and its penetration into the pharynx. The amniotic sac plays an additional role in opening the pharynx. Of primary importance is the distraction associated with the retraction rearrangement of muscle fibers. Due to muscle retraction, the length of the uterine cavity decreases slightly; it seems to slide off the fertilized egg, rushing upward. However, this sliding is limited by the ligamentous apparatus of the uterus. The round, uterosacral and partially broad ligaments keep the contracting uterus from moving too far. Tense round ligaments can be felt in a woman in labor through the abdominal wall. In connection with the indicated action of the ligamentous apparatus, the force of contractions of the uterus is used to move the fertilized egg downward. When the uterus is retracted, not only its cervix, but also the lower segment is stretched. The lower segment (isthmus) of the uterus is relatively thin-walled, there are fewer muscle elements in it than in the body of the uterus. Stretching of the lower segment begins during pregnancy and intensifies during childbirth due to retraction of the muscles of the body or the upper segment of the uterus (the hollow muscle). With the development of strong contractions, the boundary between the contracting hollow muscle (upper segment) and the stretching lower segment of the uterus begins to appear. This boundary is called the contraction, or border, ring. The contraction ring is usually formed after the discharge of amniotic fluid; it looks like a transverse groove that can be felt through the abdominal wall. During normal childbirth, the contraction ring does not rise high above the womb (no higher than 4 transverse fingers). Thus, the mechanism of the dilatation period is determined by the interaction of two forces that have the opposite direction: attraction from bottom to top (retraction of muscle fibers) and pressure from top to bottom (fetal bladder, hydraulic wedge). As a result, the cervix is smoothed, its canal, together with the external uterine os, turns into a stretched tube, the lumen of which corresponds to the size of the nascent head and body of the fetus. Smoothing and opening of the cervical canal in primiparous and multiparous women occurs differently. In primiparous women, the internal os opens first; then the cervical canal gradually expands, which takes the shape of a funnel, tapering downward (Fig. 75, 76). As the canal expands, the cervix shortens and finally completely flattens (straightens); Only the outer pharynx remains closed. Subsequently, stretching and thinning of the edges of the external pharynx occurs, it begins to open (Fig. 77, 78), its edges are pulled to the sides. With each contraction, the opening of the pharynx increases and finally becomes complete. In multiparous women, the external os is already slightly open at the end of pregnancy (Fig. 79) due to its expansion and tears during previous births. At the end of pregnancy and at the beginning of labor, the pharynx freely allows the tip of the finger to pass through.

Rice. 79. Cervix of the uterus of re-roles. Beginning of the opening period. 1 - internal pharynx; 2- external pharynx; the cervical canal is opened by one finger. During the opening period, the external pharynx opens almost simultaneously with the opening of the internal pharynx and smoothing of the cervix (Fig. 80, 81). The opening of the pharynx occurs gradually. First, he passes the tip of one finger, then two or more fingers are placed in the open throat. As the pharynx opens, its edges become thinner and thinner; by the end of the opening period, they take the form of a narrow, thin border located on the border between the uterine cavity and the vagina. Dilation is considered complete when the pharynx has expanded by 11-12 cm. With this degree of dilation, the pharynx allows the head and body of the mature fetus to pass through. During each contraction, amniotic fluid rushes to the lower pole of the fertilized egg; the amniotic sac is stretched (filled) and inserted into the pharynx. After the end of the contraction, the water partially moves upward, the tension of the fetal bladder weakens. Free movement of amniotic fluid towards the lower pole of the ovum and back occurs as long as the presenting part is mobile above the entrance to the pelvis. When the head descends, it comes into contact with the lower segment of the uterus on all sides and presses this area of the uterine wall against the entrance to the pelvis. The place where the head is covered by the walls of the lower segment is called the contact belt. The contact zone divides the amniotic fluid into anterior and posterior (Fig. 82). The amniotic fluid located in the amniotic sac below the contact zone is called anterior water.

Most of the amniotic fluid located above the contact zone is called posterior water. The formation of the contact belt coincides with the beginning of the entry of the head into the pelvis. At this moment, the presentation of the head (occipital, anterior cephalic, etc.) and the nature of insertion (synclitic, asynclitic) are determined. Most often, the head is installed with a sagittal suture (small oblique size) in the transverse dimension of the pelvis (occipital presentation), synclitically. During this period, preparations begin for forward movements during the period of exile. The amniotic sac, filled with anterior fluid, becomes increasingly full under the influence of established contractions; by the end of the period of dilatation, the tension of the amniotic sac does not weaken in the pauses between contractions; he's ready to break.

Rice. 82. Full opening of the external pharynx, head at the pelvic inlet. - contact belt; 2-front waters; 3 - posterior waters. Normally, the amniotic sac ruptures when the pharynx is fully or almost fully dilated, during contractions (timely release of waters). After the rupture of the membranes, the anterior waters leave. The posterior waters usually burst immediately after the birth of the child. Rupture of the membranes occurs mainly due to their overstretching by amniotic fluid rushing to the lower pole of the fetal bladder under the influence of increased intrauterine pressure. The rupture of the membranes is also facilitated by the morphological changes that occur in them towards the end of pregnancy (thinning, decreased elasticity). Less commonly, the fetal bladder ruptures when the pharynx is not fully dilated, sometimes even before the onset of labor. If the amniotic sac ruptures when the pharynx is not fully dilated, they speak of early rupture of water; The discharge of amniotic fluid before the onset of labor is called premature. Early and premature rupture of amniotic fluid adversely affects the course of labor. As a result of untimely rupture of the membranes, the effect of the fetal bladder (hydraulic wedge), which plays an important role in smoothing the cervix and opening the pharynx, is eliminated. These processes occur under the influence of the contractile activity of the uterus, but over a longer period; in this case, complications of childbirth often arise that are unfavorable for the mother and fetus. If the membranes are too dense, the fetal bladder ruptures later than the onset of full dilatation of the pharynx (delayed rupture of the membranes); sometimes it persists until the period of expulsion and protrusion of the presenting part from the genital slit. The part of the head located below the contact zone, after the departure of the anterior waters, is under atmospheric pressure; the superior part of the head and the fetal body experience intrauterine pressure, which is higher than atmospheric pressure. In this regard, the conditions for the outflow of venous blood from the presenting part change and a birth tumor forms on it.

The cervix must change significantly before childbirth, softening, then shortening and smoothing, and finally, it begins to open. This process is called cervical ripening; it occurs differently during the first and repeated births.

Throughout pregnancy, the cervix was a strong lock, closing the exit from the uterus and preserving the pregnancy.. A hard, long neck did not allow microorganisms to penetrate the baby’s uterus, and was an obstacle to his premature birth.

However, such a cervix is not at all necessary during childbirth, and under the influence of growing levels of estrogen and prostaglandin hormones, it begins to change. Softening and shortening of the cervix occur in parallel, and usually this process is accompanied by increased mucous discharge.

Softening of the cervix before childbirth begins long before real labor begins, from 35-36 weeks. This occurs due to contractions of the muscles of the uterus, precursor contractions. Even if you don’t feel them, all women have them. At the same time, the length of the cervix before childbirth decreases; by the time real contractions begin, the cervix will shorten by about 2 times.

During the birth itself, its smoothing will begin, which will end with full disclosure. For a baby to be born, the cervix will have to dilate to 10 cm, roughly speaking, the width of 5 fingers. Most women go into labor already 1-2 fingers dilated.

The dilatation of the cervix before childbirth occurs gradually and practically painlessly, and is accompanied by the passage of the mucous plug.

The opening of the cervix before childbirth occurs differently in primiparous and multiparous women. The cervix consists of two circular fibers that form the internal and external os of the uterus. During the first birth, the internal os opens first, and only then does the outer os begin to open. With repeated births, the internal and external os of the uterus open simultaneously. The size of the cervix before childbirth decreases due to its opening and gradual smoothing.

Since the condition of the cervix determines the pregnant woman’s readiness for labor, in the last weeks of pregnancy you will again have to remember the existence of a gynecological chair. At each visit to the gynecologist, the doctor will evaluate her condition during a vaginal examination. Examination of the cervix before birth allows you to assess how soft it is, the degree of opening and how much the cervix is shortened and smoothed.

By the beginning of labor, the cervix not only shortens and smoothes, its direction in the woman’s pelvis changes. During pregnancy, it is tilted posteriorly, as if located behind the baby’s head, and is therefore difficult to reach. By birth, the cervix moves anteriorly, along the axis of the pelvis, and now becomes easily accessible during examination.

A soft, slightly open and short cervix before labor indicates its imminent onset. A hard and immature cervix before childbirth can cause labor to not begin on time, or there will be abnormalities in labor with long, painful contractions, since the cervix will have to soften and open very quickly during the birth itself. This does not always work out, and then the birth may end in a caesarean section because the cervix has not dilated.

If your pregnancy is approaching full-term and there are no signs of cervical ripening, your doctor can speed up this process with the help of kelp or gel.