Where and how to have a baby?
During antenatal visits to the doctor, discuss all variants of childbirth and decide how and where you will give birth to the child. Determine what you want yourself and write down a detailed "plan" for delivery. Of course, this is not exactly a plan, but, most likely, an accurate representation of what will happen. Each genus flows in different ways and it is impossible to predict all the moments, so remember that it can happen quite differently from what you planned. Do not forget about possible complications and allow yourself to make adjustments at any time. Be prepared for the fact that the birth will not go the way it was planned before.
The "birth plan" is not a contract for the doctor, which should be followed in case of unforeseen situations, as the doctor himself makes a decision for the safety of the mother and the child. You can say your word, but the deciding voice will be for the doctor.
When making a "plan" for childbirth, think about where you would like to have a baby, who will take the baby and who will be next to you - a friend, family member or a female nursing mother. If before you did not attend school for expectant mothers, it's time to enroll for 6-7 months of pregnancy. After that, decide whether you need pain medications, fetal monitoring or special medical procedures. Do not forget also about where the child will be after the birth.
Periods of childbirth
The first period begins with the first regular bout and lasts until the uterine throat is fully opened. The second period begins with the full disclosure of the cervix and ends with the birth of a child. During the third period, the placenta is born.
At the beginning of the contractions, the muscles of the uterus begin to contract and relax, as a result of which the cervix opens and the child can move along the birth canal. The first contractions are usually irregular, last less than a minute and appear with a frequency of 5-20 minutes.
They can last a long time, up to 2-3 days, so women are advised to walk, watch TV, take a warm shower, which greatly facilitates discomfort. At the beginning of the second period of contraction, the uterus becomes more intense and regular, with fights lasting more than a minute and appear every 2-3 minutes. Right now it's time to go to the hospital. The intensity of pain in bouts varies from moderate to strong, so it is important that a woman with a close friend who could support in a difficult moment. In addition, during labor, specialists usually recommend changing positions frequently and doing breathing exercises. Many women are asked to give them an anesthetic at that time.
When the cervical canal has completely opened, the body is reconstructed into "pushing" movements. During the second stage of childbirth a child is born. This happens in different ways - from a few minutes to several hours. It is believed that the second period of labor lasts less if the woman already has children. During the third period of labor, the uterus continues to contract until the placenta is released.
How to prepare for labor and childbirth?
- Physical exercises throughout pregnancy prepare the body for debilitating labor. Try to do exercises to strengthen the muscles of the pelvic floor, which contributes to the rapid flow of the second stage of labor.
- On the sixth-seventh month of pregnancy, sign up with a partner for special courses for pregnant women. Experts will learn how to best deal with stress before and during childbirth, and also tell what to expect in this period. You will learn to relax, and your partner will know how to help in this difficult moment.
- Shortly before the birth, discuss with the doctor important points of the birth itself, because you yourself must decide where and how you will give birth to the child.
- Determine the place of birth. Most women cooperate with doctors and give birth to children in medical institutions. This is where you will always get qualified help in case of unforeseen circumstances.
- Think about whom you would like to see next to during labor and delivery. It can be friends, family members, spouse or someone else.
- What relaxing techniques will you use during the battles: practice breathing exercises, immerse yourself in water, change position or wish to see a loved one.
- Your preferences regarding medicines. Think about whether you need pain medication, and know in advance about alternative drugs.
- Child care after childbirth: a child can be in the room with you. Consult with a specialist about breastfeeding and how to apply the baby to your chest.
Make a kind of birth plan and write down all your preferences. This is how you will have a clear picture of what is happening. But remember that it is impossible to foresee everything, especially if it concerns fights and the birth itself. Sometimes an emergency doctor must make an important decision within a few minutes.
Should epidural anesthesia be used during labor?
Some pain medications are prescribed only by the doctor in an emergency, when surgical intervention is required. But still, a woman should know about such means.
- Local anesthesia is the injection of an analgesic, which causes numbness in the area of the skin. It is done before epidural anesthesia or with episiotomy (dissection of the perineum to facilitate labor).
- Spinal anesthesia is the injection of an anesthetic into the cerebrospinal fluid, with a complete numbness of the exit plane from the pelvis (used in cesarean section or vacuum extraction of the fetus, or the application of forceps to extract the fetus). A parturient can not push.
- General anesthesia is an intravenous or inhalant anesthetic, in which the woman in childbirth is unconscious. It has more negative consequences, but is considered more effective than epidural or spinal anesthesia. General anesthesia is used in extreme cases if immediate fetal extraction is necessary, when, for example, epidural anesthesia has not been applied in time.
The position of a woman during childbirth
The parturient can occupy a different position, for example, sit, crouch, bend, lie in a special armchair for childbirth or a bed.
Medical procedures that are performed during childbirth
- Fetal heartbeat monitoring is a routine procedure, but if necessary, a number of others are performed.
- Stimulation of labor provides for the opening of a fetal bladder, the use of drugs to soften the cervix and stimulate uterine contractions. Childbirth does not always stimulate, but when a woman pans for more than two weeks or in case of an urgent fetal extraction.
- The use of antibiotics.
- Electronic monitoring of the fetal heartbeat (continuous or episodic).
- Episiotomy (dissection of the perineum for the purpose of facilitating childbirth). Often it is done when there is a need for an emergency fetal head extraction in case of distress syndrome. (In order to prevent gusts, make a crotch massage or control how the maternity wears off).
- The application of forceps or vacuum extraction of the fetus is carried out when the woman can not give birth, for example, at the termination of labor or fetal distress syndrome, when an emergency extraction of the fetus is indicated.
- The need for a cesarean section during labor is due to the state of maternal and child health.
- If you have already had a cesarean section, you have the choice of deciding to try vaginal births or planning a repeat cesarean section.
Care of the newborn
Before the birth of a child, you need to think carefully and plan ahead.
- Finding a child with you during the first hour of his life. Do you want the baby to be with you after birth? Some maternity homes have special blocks for mothers and children when the newborn is with her mother. Such a policy also provides that sometimes a mother may need time to rest.
- Prevent breastfeeding problems. Think about whom you can ask for help if necessary. Meet a lactation specialist. Sometimes maternity hospitals offer such services. Talk with the medical staff about the fact that your child is given formula for artificial feeding only in case of emergency.
- Postpone certain medical procedures: injecting vitamin K, piercing the heel of the baby for blood analysis and using ophthalmic drops - make it a transition to a new stage of life less painful.
- Tell your relatives when you would like to see them after giving birth.
- Do you want to store the baby's cord blood (stem cells) after giving birth for possible treatment in the future? (For this you need to plan everything at an early pregnancy).
- Sign up and go to the school for young mothers, go on an excursion to the maternity hospital and see where the women spend different periods of childbirth. This will help you feel more confident when the time comes to give birth.
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How to reduce stress during labor and labor?
There are many ways to reduce stress during labor and delivery.
Long-term support from the moment of the first contractions to the postpartum period has a positive impact on the parturient woman. Women, with whom are close people or carers for the care of women in childbirth, rarely resort to painkillers and describe this process less negatively. Although it is not proven that support contributes to reducing pain, nevertheless, the mother is more prone to self-control and confidence when a close person is nearby.
- Walking during labor, in spite of prolonged or periodic monitoring of the fetus. Most women prefer freedom of movement, but with risk factors, continuous monitoring is recommended.
- Natural (non-medicamentous) pain control and "natural" procreation: constant support, breathing exercises, distraction, massage, etc.
- The first period of labor in the water helps relieve tension, and sometimes promotes the normal course of slow, heavy births. Childbirth in the water is not yet fully understood from the point of view of the safety of mother and child.
- Eating food and fluids during labor. In some maternity hospitals women are allowed to drink water, in others - only to suck ice crumbs. The reception of solid foods is often not recommended, because during the birth the stomach digests it very slowly. An empty stomach is desirable in case of need for general anesthesia.
- Listen to music.
- Acupuncture and hypnosis are considered less dangerous and quite effective means of removing painful sensations. Analgesic medications
- Opioid drugs are used to relieve tension and, in part, pain. They are used before delivery because they affect the breathing of the newborn. Opioid means compared with general anesthesia are less likely to cause the termination of labor, which requires the extraction of the fetus by auxiliary means.
- Epidural anesthesia is a prolonged injection of a medical preparation into the epidural region near the spinal cord, which leads to complete or partial numbness of the lower body. Light epidural anesthesia allows you to feel your body and the woman in labor can push, which reduces the risk of side effects of complete anesthesia, namely, the cessation of labor and the need for extraction of the fetus by auxiliary means (vacuum extraction or forceps).
- Pudendal and paracervical anesthesia is used to anesthetize contractions and is considered the safest form of anesthesia in the field of the birth canal. It does not harm the child. Paracervical anesthesia is usually replaced with an epidural, which is considered more effective.
Childbirth: when to call a doctor?
You or people near you need to call an ambulance immediately if you:
- loss of consciousness;
- severe vaginal bleeding;
- acute pain in the abdominal cavity or pelvic organs;
- flow of the amniotic fluid (with a burst of the bladder) and you are sure that the umbilical cord falls out. This happens rarely enough, but if so, immediately kneel down, lower your head and trunk below the buttocks to reduce pressure on the umbilical cord and do not change the position before the help comes.
Go to the maternity ward when:
- any vaginal bleeding;
- symptoms of late toxicosis of pregnant women:
- acute headache, which does not go away after taking acetaminophen (Tylenol);
- visual impairment (ambiguity or blurred vision);
- sharp swelling of the face, hands or feet;
- pain in the abdominal cavity;
- temperature above 38 degrees Celsius;
- regular contractions of the uterus for an hour - 4 or more fights for 20 minutes or 8 per hour, even if you are now resting and drinking water;
- sudden release of fluid (amniotic fluid is often confused with involuntary discharge of urine);
- prolonged back pain or pressure in the pelvic area;
- lack of fetal movement or fewer shocks.
At 20-37 weeks of pregnancy, immediately go to the hospital if:
- suspect that the child has stopped moving or moving much less than before;
- observe any vaginal bleeding;
- feel the soreness of the uterus, weakness and fever (no reason) (possible signs of infection);
- vaginal discharge of fluid (large amount - more than 240 ml).
The following symptoms may indicate premature birth:
- regular uterine contractions for an hour - 4 or more fights for 20 minutes or 8 per hour, even if you are now resting and drinking water;
- pain in the back or pelvic organs of an unexplained nature;
- contraction of the intestine (with or without diarrhea).
After 37 weeks of pregnancy, immediately go to the maternity ward if you:
- suspect that the child has stopped moving or moving less than usual;
- observe any vaginal bleeding;
- experience regular bouts (4 or more for 20 minutes or 8 for an hour);
- observe sudden vaginal discharge.
At any time of pregnancy, contact your doctor if you experience profuse or moderate vaginal discharge, accompanied by twitching, burning, or a certain odor.
After childbirth, call an ambulance when:
- sudden acute pain in the abdominal cavity;
- loss of consciousness.
Immediately seek medical help if:
- observe abundant vaginal discharge with blood clots, while changing the gasket every two hours;
- vaginal discharge becomes abundant and still bright red 4 days after childbirth or blood clots larger in size for the golf ball;
- the head is spinning and it seems that you lose consciousness;
- vomiting is observed, and you can not drink liquid;
- the temperature rises;
- there is pain in the abdominal cavity of a new nature;
- vaginal discharge accompanied by a muscle tissue (not only blood clots);
- experience acute headache, visual impairment, swelling of the face, hands and feet.
Closely monitor your health and contact your doctor if:
- You do not get better within 2-3 days;
- vaginal discharge has an unpleasant odor;
- there are symptoms of postpartum depression (feelings of despair for several days, restless or dangerous thoughts or hallucinations);
- the mammary glands become painful and the temperature rises - the symptoms of engorgement of the mammary glands and mastitis.
The process of giving birth involves contractions and childbirth. No one can say for sure when the fights begin. Sometimes a pregnant woman may have symptoms that the body is ready for the birth of the child, but, nevertheless, the child can be born a few weeks later. Also, often in the absence of labor, labor can begin. It is very difficult to predict the first birth.
Signs of labor
Harbinger of the approach of delivery
- the child moves to the lower part of the pelvis;
- thinning and opening of the cervix;
- uterine contractions become more frequent and intense, perhaps more painful; involuntary stool and constant lower back pain;
- rupture of the fetal bladder: in most cases this occurs already during the delivery, so you need to immediately go to the hospital at the slightest suspicion.
Harbinger of labor (latent phase of labor)
The first fights are often the longest period of labor, which sometimes lasts up to 2-3 days. Cuts of the uterus:
- light or moderate (a woman is able to speak during labor) and lasts from 30 to 45 seconds;
- irregular (with a frequency of 5-20 minutes), and sometimes they can stop altogether;
- provoke the opening of the cervix to 3 cm (women who give birth for the first time, can experience a long latent phase without opening the cervix).
This phase of labor is long and painful, so women are advised to walk, watch TV, listen to music or take a warm shower.
Progressive phase of contractions
When you go to the hospital for a latent phase of labor, which provokes the opening of the cervix:
- You will be changed into a special hospital shirt;
- You will be measured by pressure, pulse and temperature;
- Look at the history of your previous pregnancy;
- You will be questioned in detail about the frequency and intensity of labor, and also look at how much the cervix has opened;
- Monitor fetal cardiac activity during fights (heart rhythm indicates the condition of the child);
- Depending on your condition, you can put a dropper with medications.
In maternity homes there are wards for all periods of labor. If there are no complications, a woman can stay in one ward throughout the entire time. In emergency cases, a woman is transferred to specially equipped wards, where she will be given emergency care.
After you were taken to the maternity ward and made an initial examination, you:
- they will say more to walk, since the movement facilitates easier cramping;
- will often monitor the fetal heart rate;
- will allow to receive visitors, but with the progression of fights, you may want to see only your partner.
Active phase of contractions, the first stage
When the cervix opens at 3-4 cm, the first stage of the active phase of labor begins, which ends when the cervix is fully opened and the child is ready to move along the birth canal. At the last stage of the bout the most intense.
Compared with the first contractions, uterine contractions in the active phase are characterized by greater intensity and frequency (every 2-3 minutes), while lasting for 50-70 seconds. If the fetal bladder has not yet burst (this happens at this stage), with increasing intensity of labor:
- women feel tired and uneasy, they find it difficult to stand, they do not want to drink or eat; sometimes they are allowed to drink water, but eating is forbidden, because if necessary, surgical intervention will require general anesthesia;
- You can use respiratory relaxation exercises, acupuncture, hypnosis, or other techniques to relieve pain and anxiety;
- women change their position, which helps to increase blood circulation;
- The mothers can ask for anesthesia, for example, an epidural;
- sometimes they put a dropper.
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The transition phase
The end of the first stage of active contractions is called the transition phase. The child moves down, with the fights becoming more intense and frequent, and sometimes with a very small break. In the transition phase it is already clear that a child will be born soon. At this stage, you need to listen to your body, sometimes women are annoyed by outside help, but, nevertheless, you should not push it away. Increased irritation, nausea, anxiety and fear.
Primitive women spend up to 3 hours in the transition phase, whereas those women who have already given birth in the past do not have more than an hour. Sometimes the transition phase is short, although more intense.
Active grip phase, second stage
The second stage of active contractions is associated with the birth of a child, when it moves along the birth canal due to contraction of the uterine muscles. At this stage:
- Fights have a different character. With regularity, they can slow down to 2 -5 minutes and last 60-90 seconds; when the termination of labor is to change position. If this does not help, the doctor may prescribe stimulation of labor.
- You can feel a strong need to push every time you cut;
- the baby's head creates a strong pressure on the rectum;
- You can change the position several times until you determine the appropriate one;
- when the head of the child passes through the birth canal, the woman feels a burning pain, since the head is the largest part of the body and it is very difficult to give birth. If the child moves too fast, the doctor will advise not to push, so that the crotch itself can stretch out. Otherwise, episiotomy is done (as a rule, it is carried out only in extreme cases);
- a team of specialists will be on the alert for any surprises. In emergency cases, the medical team immediately begins to act.
It is then the decision is made only by the doctor. This phase of attempts can last from several minutes to several hours, with the second birth occurring more quickly.
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Third stage, postpartum
After the baby is born, your body will continue to clean. In the third stage, the placenta is born, while the uterus is still contracting. As a result of these contractions, the placenta separates from the walls of the uterus and is pushed out, while bleeding may occur. A doctor or midwife should carefully examine the uterus for the presence of placental remains that cause bleeding. In extreme cases, the midwife can press on the abdomen, helping the uterus push out the placenta. Medications or putting the baby to the breast also contribute to better uterine contraction and less bleeding. The third stage lasts 5 minutes, sometimes longer. But in most cases the placenta comes out within 30 minutes. If her birth is incomplete, the doctor removes her remains manually. Contractions cease only after the full birth of the placenta.
A child is considered full, if born on 37-42 weeks of pregnancy (weeks are considered from the last menstrual cycle). If a woman does not give birth for 42 weeks or more, it is considered a pregnancy retention.
Sometimes perenashivanie is not considered as such, as weeks are often considered incorrect. If ovulation occurred later in your cycle, then the pregnancy comes later. The ultrasound can determine the date of birth according to the size of the fetus, but these calculations are, nevertheless, presumptive.
In most cases, the reason for delaying the pregnancy is not clear.
What should I worry about when I am pregnant?
As a rule, the born child is born healthy, but a small number of cases of overdrafting are associated with the fading and death of the baby. This risk increases with each week and reaches 10% of 1000 cases after 43 weeks. Therefore, the doctor monitors the child's condition for 40-41 weeks.
Many doctors reduce the risk of mortality, stimulating labor until 42 weeks. In most cases, just an observation is made, as no one knows which solution will be best for a persistence for 2 weeks:
- when the patient is in danger, if the monitoring shows a threat to the health of the child, the delivery should be stimulated;
- if the cervix is thinned and opened, many doctors stimulate labor by puncturing the fetal bladder. Watching up to 42 weeks is also considered advisable. There is no data indicating that one option is better for the mother and the child than the others.
- If the cervix does not become thin and does not open, the correct decision is to observe. Stimulation of labor does not give more advantages. According to statistics, the stimulation of labor after 41 weeks of pregnancy lowers the risk of neonatal mortality and stillbirth.
In order to preserve the health of the mother and child, most specialists agree that it is better to stimulate childbirth until 42 weeks. It is believed that the risk of re-suspension is longer than 42 weeks longer compared to benefits.
What happens after giving birth?
At this moment you can look at your baby for the first time and hold it in your arms. This is a very exciting moment, as a woman after a grueling test with awe contemplates her child.
If you planned to breastfeed, you can start right after giving birth. Do not worry if it does not work out right away. Breastfeeding is a long and mutual process that the mother and child learn. Skills will come with time, but you can consult with a specialist about the proper technique of feeding.
In the first hours after giving birth, women usually have painful feelings, so they need to help take a shower. Sharp and painful contractions of the uterus are observed for several days, as the uterus returns to its usual size.
During the first weeks after childbirth (the postpartum period), the woman's body begins to recover and adapt to a new state - the state of "non-pregnancy". Women often get tired and frustrated, so family members need to create optimal conditions for the rest of the young mother.
- Try to sleep when the child is sleeping.
- Ask family members or friends to prepare food or do housework.
- Drink plenty of fluids if you are breastfeeding.
During the postpartum period, women are very emotional, but with prolonged depression, gloomy thoughts (harming oneself or a child), one should consult a specialist, since postpartum depression needs to be treated.
On the 2nd-6th week after the birth the doctor should make an examination. Right now, we need to discuss all the exciting issues, including contraceptives. If you do not plan to have another child, you should take contraceptives even while breastfeeding. The doctor will prescribe medications that are right for you.
When a child is already born
Women after childbirth often embrace contradictory feelings - emotion, surprise and fatigue. When, at last, the child is in his arms, and you can talk with him and carefully consider him, you feel calm and a great relief in your soul. During the first hour after childbirth, you can bring a baby for the first application to the breast and feeding, unless, of course, you plan to breast-feed your baby.
Breastfeeding is beneficial for both the mother and the baby. But do not be upset if the first time you and the child will be difficult. The skills of breastfeeding come with time, and minor failures can easily be remedied at home, simply by consulting with a specialist. Virtually every maternity home has at least one lactation specialist who will answer all the exciting questions. During the first days of feeding, your nipples can become rough, become painful and crack, but these symptoms usually pass with time.
First hours of recovery
Immediately after childbirth, chills can occur, but this is the usual reaction of the body after childbirth. Just get warmed more warmly. Immediately after birth, a doctor or midwife:
- Massage the uterus for 15 minutes to better reduce it and stop bleeding, later you will do it yourself. If the uterus does not contract, the bleeding will continue, in which case medications are prescribed and the doctor will again examine the uterus for the presence of placental remains (the most common cause of bleeding) and gusts of the cervix or vagina. In severe cases, surgical intervention and droppers are required to prevent loss of blood and shock.
- It will check the bladder, as the overflowed bladder presses on the uterus and prevents it from contracting. Sometimes a woman herself can not urinate because of pain and swelling, then put a catheter. But do not worry, all functions will soon be restored.
- Measures several times the pressure.
- Will put the stitches on the place of ruptures of the cervix and vagina.
- Remove the epidural catheter (if you were doing epidural anesthesia). But if you are planning to do a ligation of the fallopian tubes, the catheter will be left to anesthetize this procedure.
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Recovery period after childbirth
In the postpartum period, the body of a woman undergoes many changes, some of which last for a long time, but each woman experiences them in her own way.
- The uterus begins to return to its normal size from the moment of birth of the placenta, while the reduction in total reduction occurs over a period of 2 months. After 24 hours, the uterus has a size of 20 weeks of pregnancy, a week later - half its size at the time of contractions. After 6 weeks, the uterus has a size as before pregnancy.
- Postnatal fights can be observed for two days, and their soreness increases with each subsequent pregnancy. They usually pass on the third day.
- Women also experience muscle soreness (hands, neck and jaw), which is a consequence of the hard work of a woman during labor (they go away in a few days), as well as cyanotic spots on the face and redness of the eyes as a result of strong attempts.
- A few days after birth, a woman may experience difficulties in the destruction of the bladder and intestines. You need to drink a lot of fluids and take laxatives if necessary.
- Postpartum hemorrhage (lochia) can be observed from 2 to 4 weeks, with it appear and pass for 2 months.
- Recovery after episiotomy occurs for 2 weeks. Pain, swelling and numbness of the area around the vagina are common phenomena after vaginal delivery.
- On the third or fourth day, breast engorgement can occur as a result of the influx of milk, while the breast glands are swollen and painful. Take a warm shower and put a warm compress.
- Restoration of pelvic bones, for example, with pubic symphysis or fracture of the coccyx takes several months. Treatment involves applying ice, taking non-steroidal anti-inflammatory drugs and sometimes physical therapy.
If you are concerned about symptoms in the postpartum period, consult a doctor.
How to overcome the problems of the postpartum period?
After returning home from the hospital it can be quite difficult to cope with new responsibilities due to lack of energy and time. Try to calm down. Pause and think about what needs to be done. Experts recommend taking the help of people around you, eating well and drinking plenty of fluids, resting at the slightest opportunity, restricting visits to relatives, allocating a little time to yourself and making friends with the same moms as you are for communication and joint walks.
If you are in a depressed mood for a long time after the birth and suspect that postpartum depression has begun, seek help from a specialist.
Even in the absence of postpartum problems, you need to visit a doctor for a planned checkup at 2 and 6 weeks after childbirth. It's time to think about contraceptive methods and discuss this with your doctor.
Sexuality, fertility and contraception
You should not have sexual intercourse and use tampons before stopping bleeding. If the bleeding has stopped, but you, nevertheless, experience painful sensations during intimacy, pause with it for a while. The body needs at least 4-6 weeks to recover from childbirth. Usually women after giving birth show little interest in sex. During the recovery and increased needs of the baby you and your partner need to be very tolerant of each other. Discuss everything with the partner, including changes in intimate relationships.
The menstrual cycle and fertility are renewed on their own. Remember that ovulation occurs a month before the first cycle, that is, 2-3 weeks after delivery. Therefore, if you do not plan to have another child, use contraceptives, even if you are breast-feeding.
- If you do not breastfeed, the cycle will recover within a month or two after delivery.
- With full breastfeeding, there is no cycle for several months. As a rule, women breastfeed for 8 months, but this is not a reliable contraceptive.
- Most methods of contraception are quite safe and effective for nursing mothers. Talk with your doctor about which method is right for you.