Stages in childbirth; The obstetrician-gynecologist tells what happens to you and the baby from the first contraction to the birth of the placenta.
According to statistics, 75-80% of women give birth through the vaginal birth canal. Most often, this is a single fetus delivery in a cephalic presentation that begins spontaneously – the so-called normal delivery. They will be discussed below.
Before childbirth: the appearance of harbingers
For 1-2 weeks before delivery (but may not be at all).
At full term, most pregnant women develop predictive symptoms.
- There are pulling pains in the lower abdomen and lower back. They are irregular and do not disrupt lifestyle. They appear spontaneously and gradually disappear.
- The bottom of the uterus descends as the fetal head is pressed against the entrance to the small pelvis.
- The mucous plug comes off. The cervix softens, shortens, the cervical canal opens up and the prerequisites are created for the discharge of mucus.
The appearance of harbingers does not mean that you are about to start labor. These are just signs of their approach, which can be subjective.
When does labor begin and what does these terms depend on?
Childbirth is a natural physiological process. From 37 weeks, pregnancy is considered full-term, and childbirth is timely, however, the timing of the spontaneous development of labor is individual, and they differ for all pregnant women. Why does someone give birth at 38 weeks, and someone at 40 or 41? It all depends on the formation of the generic dominant. By the end of pregnancy, a number of hormonal changes occur in the body, inhibition is noted in the cerebral cortex, and the excitability of the subcortical structures increases. Thanks to all this, by the time of childbirth, a temporary physiological system with higher centers of regulation is formed.
First stage in childbirth: from the first contractions to the full opening of the cervix
On average, 10-16 hours for primiparous, 7-9 – for multiparous. However, there are no clear time criteria in modern obstetrics. Childbirth is an individual process, and many factors affect the time range.
In the first period, two phases are distinguished – latent and active.
- Latent phase. Comes with the onset of contractions – regular involuntary uterine contractions. At firstthey are repeated every 10 minutes. Gradually, the contractions become more frequent, lengthen, the intervals between them are shortened, and the sensations intensify.
Under the action of contractions, the cervix shortens, softens, the cervical canal becomes passable first for one, then for two fingers. The cervix continues to flatten and open. The latent phase lasts up to 5 cm of the opening of the uterine pharynx.
- Active phase. It lasts from the opening of the uterine pharynx 5 centimeters to full opening (10 centimeters) . Contractions become longer, more frequent, and more painful. There should be at least three of them in 10 minutes. As a rule, amniotic fluid is ruptured at this stage.
Fact! Sometimes the water flows out prematurely, before the onset of labor (contractions). This is a possible scenario.
Second stage in childbirth: from full opening of the cervix to the birth of the fetus
In primiparous – up to 3 hours, in multiparous – up to 2 hours
In the second stage of labor, there is a passive lowering of the fetal head to the pelvic floor. The contractions are joined by attempts – synchronous contraction of the muscles of the anterior abdominal wall, perineum and diaphragm with contractions. Correct breathing is very important at this stage. In a number of maternity hospitals you are given a special tube and offered to exhale for a long time through it. This helps the head to descend to the pelvic floor passively, slowly, without forcing.
Fact! After the start of the attempts, a midwife is constantly next to you, telling you how to breathe. In continuous mode, fetal cardiotocography is written.
The fetus, passing through the birth canal, makes a series of movements, without which childbirth through the birth canal would be impossible. This is called the biomechanism of labor. It depends on the variant of presentation of the fetal head in each case. Most often, a child is born according to the following mechanism:
- The cervical spine bends, the chin is pressed against the chest, the back of the head drops.
- The head makes an internal turn and most often turns with the back of the head forward, continuing to descend.
- The suboccipital fossa of the head rests on the lower edge of the pubic articulation and, under the action of attempts, is “pushed away” from it. The head is extended. Gradually, the crown, forehead, face, chin and finally the whole head are born.
- There is an internal rotation of the shoulders and an external rotation of the fetal head. The shoulders are installed at the exit of the small pelvis so that one is located under the bosom and is fixed to the lower edge of the pubic articulation. Further, there is a gradual birth of the back shoulder and handle, and then the rest of the body.
This biomechanism allows the fetus to be born with its minimal head and shoulder circumference.
Third stage in childbirth: from the birth of the fetus to the birth of the placenta
The baby was born. It is laid out on your mom’s belly, and you begin the first minutes of motherhood. You hear the first cry, feel the baby on your skin, feel its warmth. The newborn is wiped off with a diaper, covered with another, clean and dry, and remains on your stomach. The umbilical cord is cut strictly at the end of the pulsation.
In the meantime, your body is entering the third stage of labor. It ends with the birth of the placenta, that is, the placenta, membranes and umbilical cord. As a rule, signs of placental separation appear 10-15 minutes after the baby is born. The obstetrician-gynecologist asks you to push, and she is born painlessly. The doctor examines the placenta for integrity so that no fragments remain in the uterus.
Fact! In the first minutes after the birth of the placenta, the uterus rapidly contracts and shrinks to size, as in 15-16 weeks of pregnancy. This prevents the development of bleeding.
Early postpartum period
Two hours after giving birth, you are with your baby in the delivery unit under supervision. To adequately control the tone of the uterus and the amount of discharge, you regularly receive an external massage of the uterus.
The doctor examines the birth canal for injuries, ruptures. Sutures are applied if necessary. If you have had epidural analgesia during labor, pain relief is added to examine the birth canal. If there was no epidural analgesia during labor, tissue integrity is restored under local anesthesia.
Then you are transferred to the postpartum ward in the ward for joint stay with the baby. Your new life begins together.