Complex delivery: delivery induced, cesarean section, labor in a double

• What is induced labor?

Under this term, the method of artificial delivery is known. The fact is that sometimes it is necessary that labor starts, but they do not start on their own. This is necessary: if the pregnancy lasts longer than 41 weeks; in the case of a rhesus-conflict in the mother and fetus; if the bladder has burst before time; with too much weight of the fetus, which can become even greater; at some chronic diseases at the future mum (a diabetes, an idiopathic hypertensia).

If this method is used according to strict indications, then it does not represent any danger. For its implementation, it is necessary to observe the following conditions: the present part should be the head of the fetus, and the neck should be prepared for childbirth (softened and yawned ajar).

Induced births are carried out in the hospital, under the supervision of an experienced obstetrician-gynecologist. Such births are conducted with the help of oxytocin preparations (oxytocin - a hormone that causes natural contractions). Before you decide on such a method of delivery, you need to weigh all the chances of success, because if the contractions are ineffective and the birth will not "go," they will have to end them by cesarean section.

Contraindications to the conduct of induced labor are: breech presentation of the fetus; transverse or oblique position of the fetus; cesarean section in the past.

If everything proceeds normally, then the birth begins and ends in the same way as normal.

• Why do cesarean section?

This operation is carried out in those cases when a woman can not give birth herself or it is necessary to immediately remove the child.

The main indications for cesarean section are: acute hypoxia (oxygen starvation) of the fetus; placenta previa (the placenta closes the exit from the uterus, and even if only its margin is to exit, the probability of a life-threatening woman bleeding is great); the beginning of an abruption of the placenta (when bleeding has already begun); threat of rupture of the uterus during childbirth; severe gestosis (pre-eclampsia or eclampsia); high degree of myopia (there is a threat of retinal detachment and blindness); a clear discrepancy between the size of the fetal head and the size of the mother's birth canal. In addition to these indications, there are some others that may appear in each case. Determine before the onset of labor, whether there will be a need for cesarean section, can not always. But if you are offered this operation - agree. This means that the doctor doubts that during natural childbirth and with you and the baby everything will be fine.

Cesarean section can be performed either under general anesthesia or against epidural anesthesia. Sometimes these methods combine. Each of these methods has its pros and cons.

General anesthesia is that a woman is injected into a vein with drugs that deactivate consciousness and motor activity (even breathing is turned off), as well as pain medications. Thus, a woman during a surgery is in a coma. Naturally, after the end of the action of injected drugs, consciousness and motor activity will be restored. But the fact is that some of these drugs can get to the fetus. This is not too dangerous for him, but, nevertheless, in the first minutes after extraction, he can sleep under their action. And that the child does not suffocate, at this time he is given artificial respiration. Another negative aspect of cesarean delivery is that the baby is not born through the natural birth canal, but through the incision in the uterus. The fact is that at birth the child, passing through the birth canal, is compressed on all sides by its walls. At the same time, the chest is squeezed and lungs are squeezed out of the remains of amniotic fluid (the child in utero makes respiratory movements). In addition, the compression of the lungs promotes the activation of the first inspiration. At caesarean section such mechanism is absent. In addition, there is an "immaterial" component - the child feels the state and mood of the mother, and the fact that during the operation she is unconscious, does not add to him "optimism".

Epidural anesthesia is carried out by insertion into the epidural space of local anesthetic preparations such as lidocaine. These drugs block the transmission of painful impulses from the area of operation, without turning off consciousness. With epidural anesthesia during surgery, the woman is conscious, but does not feel pain. It remains only a sense of sipping (when the fruit is extracted). Thus, with epidural anesthesia, the psychological contact of the mother and the child is not disturbed and the woman is shown the extracted baby, just as it is done during childbirth.

Negative points of epidural anesthesia are that drugs injected into the epidural space reduce blood pressure and aggravate the possible squeezing of the large vein (the inferior vena cava) by the uterus, which carries blood to the heart. This can cause a sharp drop in blood pressure - collapse, which is accompanied by nausea, vomiting, loss of consciousness and fetal hypoxia. However, an experienced anesthesiologist (and inexperienced, as a rule, do not know how to do epidural anesthesia) can always anticipate and prevent these negative aspects.

• What is the complexity of childbirth in a double?

First, these births occur usually before the fortieth week. Consequently, children are born with some degree of prematurity. In addition, both (or more) fetuses receive somewhat less nutrients, and even if deliveries occur on time, most often children are born immature, and this can create difficulties in the process of their adaptation. We will consider this in more detail when we talk about premature infants.

Secondly, twins, as a rule, are in the uterus in a different presentation: one in the head and the other in the gluteal. Naturally, this can create certain difficulties at the birth of one of them who goes "into the light" with the buns. In addition, they can "catch" pens or legs for each other, or the umbilical cord of one can be wrapped around the other, which makes the birth altogether impossible (not to mention the fused "Siamese twins").

Therefore, the doctor should determine in which position the two fetuses are located, and decide whether to carry out the delivery in the usual way or better to do a cesarean section. If the children lie transversely, if the child born first is in the breech presentation, it is better to finish the labor with the operation. If, however, the first fruit lies head anteriorly, there are usually no obstacles for the second fetus, since the first one already "paved" the "road" for his follower. If, after the birth of the first child, the doctor determines that the second person is lying obliquely, then, by inserting a hand into the uterus, rotates it so that the baby is born with buttocks or legs forward. This, of course, is not very good, but it is better than urgently to operate a woman to extract the second fruit, although this also happens.

[1], [2], [3], [4]