Quick delivery. Periods of childbirth

Surely you have already asked your girlfriends who gave birth about how long does it take to give birth. Some told you a saga in the spirit of "and the day lasts longer than a century" (and were not far from the truth, if there were prolonged labor), others brushed it off - they gave birth, they say, and did not notice. Which is also partly true if it was a case of rapid, and even repeated.

How long does childbirth actually take?

Duration of labor depends on many things, and it is impossible to accurately name the time it will take for the birth of a baby. The age of the mother, the position of the fetus, the state of health of both play a role here.
Also, the duration of labor is influenced by emotions, physiological features women, even the use of painkillers. And this is not the whole list.

Physicians, however, determine the average time normal delivery thus.
If you are giving birth for the first time, then the process will take 6-10 hours according to some sources, 15-20 according to others. This discrepancy, it seems, is due to the fact that in the first case, the active phase of childbirth is considered, and in the second, all stages.

Therefore, I propose to consider all periods of childbirth, their characteristics and duration.

Duration of labor: first stage

This period is divided into 3 phases.
The first phase, called the latent, occupies most all the time, and can last up to 9 hours. At this time, contractions begin, while they are rather weak, the cervix becomes softer and more elastic and begins to open up a little. This happens rather slowly and for the entire first phase there is an opening of 3-4 centimeters.

The second phase is active- continues from 3 to 6 hours. At this time, the contractions become stronger, more painful, occur more often, the cervix continues to open. By the end of the phase, the neck should open up to 7-8 centimeters.

Third or transitional phase, actually means the transition to the process of birth, that is, attempts. At this time, the contractions become even stronger and more frequent, the cervix opens by 10 centimeters. Phase lasts several minutes to an hour and ends with a feeling that you need to push.
This is the signal that the second period has begun.

Duration of labor: second stage

By this time, during normal childbirth, the cervix has already opened by 10 centimeters, that is, it is quite capable of missing the baby's head. During attempts, the doctor will ask you to make every effort to push the head out. Then the doctors will help him get out into the world.
In a normal birth, this the period lasts about 45 minutes, giving birth for the first time and half as many in those who give birth again.

This is a very responsible period. Here, if the matter drags on for a long time, doctors will have to help the baby, using tools or other methods. You need to understand that this is necessary, since the baby, remaining for a long time in the birth canal in an uncomfortable position, may suffer.

Duration of labor: third stage

Actually, the baby has already been born and you are completely happy. You want your eyes and rest, but it's still too early. After the birth of the baby, the placenta, which still remains in the uterine cavity, should come out.

In some cases, everything happens quickly, and the placenta comes out just a couple of minutes after birth. If this does not happen, the doctors will wait, but no more than half an hour, since after this time, an independent exit of the placenta is already unlikely.
Then the midwife simply helps him to separate with the help of special, almost painless manipulations.

That's actually all. But you also need to consider that after childbirth, minor operations may be needed in case of cracks and tissue ruptures. You will also have to spend some time in the delivery room with a cooling pad to bleed.

In conclusion, I would like to focus on the fact that you yourself in some way can influence duration of labor.

So, for example, from your emotional state directly depends on how long does it take to give birth. If you experience fear and distrust of doctors, the process may be delayed. Experiencing psychological stress, you thereby provoke stress, which should not be done.

In this case, doctors may resort to the introduction of drugs that stimulate labor. On the one hand, there is nothing wrong with this, it is a normal practice. On the other hand, in this case, the contractions will not only become frequent, but will also be more painful than in the normal state.

Also a significant role in how long does it take to give birth plays your behavior, especially in the first period. If you lie still on your back, then you are not using gravity for the process. It is much better to stand or walk (of course, not too fast), then the baby will “move to the exit” faster. At worst, you can lie on your side or sit down.
But it should be borne in mind that at some point you will be forbidden to sit and then you should listen to the doctors.

Labor can be delayed if you decide that you cannot stand the pain and require anesthesia before the labor enters the active phase. According to the observations of physicians, such untimely intervention very often leads to a weakening of labor activity.
So, it is better to gain strength and endure.
Good helpers at this time will be correct breathing and massage of special points.

Alexandra Panyutina
Women's magazine JustLady

Being in the last trimester of pregnancy, women often think about upcoming birth. Will it hurt to give birth? Will everything go well? And most importantly, how long does childbirth last? In order for the process of giving birth to a baby to go as well as possible, you need to prepare in advance and determine the answers to these questions.

So, how long does the first birth last? It is believed that in primiparous women, the process of childbirth is longer, and with the second child, labor activity will be faster. The third and subsequent births will follow the scenario of the second, and possibly will last even less. But it is impossible to say for sure about this, since the pregnancy of all women was different, each has its own characteristics and genetic predisposition.

Periods of childbirth, their duration

Childbirth is a natural process, you should not be afraid of it, because during pregnancy there is a smooth physiological preparation for it. There are stages of childbirth, different in their duration:

- the main period, the longest in childbirth. It lasts for primiparous about 7-12 hours, and 7-8 hours for those who decide to give birth a second time. Opening up during fights uterine cervix and it is very painful. The cervix should open well, and this process occurs faster in the second birth (often on recent weeks pregnancy, the cervix is already ajar, that is, everything is ready for childbirth). In primiparous, the neck is undeveloped, tight and, therefore, it takes longer to open: first, its internal pharynx, and then the external one.

Initially, the latent phase of this period begins (up to 6 hours), when contractions become regular after 5 minutes, each contraction lasts 45 seconds, while the uterus opens by 3 cm.
Active phase (3-5 hours) - now each contraction lasts 60 seconds, the interval between them is 2-4 minutes, while the neck is open by 7 cm.
Transitional (30 minutes - 1.5 hours) - the duration of the contraction is 70 - 90 seconds with an interval of 0.5-1 minute. The cervix should open completely - 10 cm.

The amniotic sac helps the opening: it presses on the neck, and when it opens by 5 cm, it bursts, and the water comes out.

Important!

The discharge of water should not occur before the first contractions begin.
If the waters have broken, then you must immediately gather in the hospital.
The waterless period should not be longer than 6 hours.

When the neck is long period is not fully disclosed, then for the safety of the fetus, it is worth resorting to the stimulation of labor.

Attempts - the expulsion of the fetus when the neck is fully opened. This period is less long and painful than the main contractions during opening. In the second birth, it can end in 15 minutes, and in primiparas - up to 1 hour. Here there are attempts - reflex contractions pelvic muscles that help the baby appear faster. The contractions will become shorter, the interval between them will increase, during which time it will be possible to rest. It is important not to panic, breathe properly, push when the doctor or midwife asks, so as not to harm yourself and the health of the child.
The birth of the placenta (afterbirth) - lasts 10 - 30 minutes - continues in this period, but not the same as during childbirth in terms of its intensity: the placenta should appear (be born). The midwife must check it to assess the integrity, thickness, condition. Not a single piece of the placenta should remain in the uterus. If it remains, then it is removed manually.

Second and subsequent births faster?

Previously, when answering the question “How long does the first birth last”, they meant that a woman in labor should not give birth for more than 24 hours, that is, not to catch the second dawn in labor. Now, the time before 18 hours is considered normal for the first birth. Having made calculations, we can say that the average duration of labor is 12 hours, but not more than 18 hours. This is the time from the first contraction until the placenta appears.

How long does the second birth last? They will end faster than the first, on average, by 4 hours (the duration of labor is 7-8 hours). The woman is already psychologically set up correctly, she knows how to behave in order to meet the baby faster. The cervix, once passed through tribal activity will open more easily. Therefore, women whose first birth was carried out by caesarean section are not recommended. natural way give birth to a second child: for them, the period of contractions and attempts will take place for the first time.

The third birth proceeds even faster than the next ones, the child can already be with you in 6-7 hours, and the contractions will not be so long - they will end in 4-5 hours. In the second stage of labor, attempts, the child will not appear gradually, but immediately, he will come out easily in a few minutes, and the afterbirth will appear in 10 minutes.

Important! In the second and subsequent births, it is necessary to pay special attention to the labor activity that has begun. If contractions appear, then you can not wait for the water to break, but immediately follow to the hospital.

Rapid and protracted childbirth: what is the danger

If the birth as a whole takes 6 hours for primiparas, then these are fast births, if less than 6 hours, they are called rapid. But when labor activity is delayed for a time, more than 18 hours - this is a protracted birth. Then doctors will stimulate (accelerate) childbirth or perform surgery - a caesarean section. You should not be afraid and resist this: maybe it will keep you or your unborn child healthy.

With rapid childbirth:

the birth canal is injured - rupture of the cervix, perineum;
fetal hypoxia - due to the pressure of the uterus on the vessels of the umbilical cord and placenta;
birth trauma in a child - with a quick passage, the bones of the skull and neck vertebrae are displaced, which can lead to further complications;
due to severe blood loss from wounds and birth, hemoglobin may decrease in a woman in labor.

Prolonged childbirth:

lead to oxygen starvation fetus (hypoxia);
if the head has been in the birth canal for a long time, birth injuries (compression of the head) may occur;
when the waters have departed, and the cervix still does not open to the desired value within 12 hours, then there is a risk of infection getting to the fetus.

premature birth (the body is not yet prepared);
term ;
narrow pelvis of the woman in labor;
improper attachment of the fetus;
large fruit;
insufficient hormonal background;
uterine anomalies;
severe distension of the uterus due to multiple pregnancy, excess amniotic fluid.

Doctors are very careful to ensure that the birth does not turn into a protracted one due to the possibility of numerous irreversible complications. In some cases, it is possible to stimulate labor with the help of medications that speed up labor, puncture the amniotic fluid bladder, and for more serious pathologies, they resort to emergency unscheduled surgery.

Remember: no matter how well you know the theory, everything can turn out to be completely different on the spot. You need to be very responsible about your condition during childbirth, listen to the recommendations of doctors, because the life and health of your unborn baby depends on this.

Childbirth is the process of expulsion or extraction from the uterus of the child and the afterbirth (placenta, amniotic membranes, umbilical cord) after the fetus has reached viability. Normal physiological childbirth proceeds through the natural birth canal. If the baby is removed by caesarean section or by obstetric forceps, or using other delivery operations, then such childbirth is operational.

Usually, timely delivery occurs within 38-42 weeks of the obstetric period, if counted from the first day of the last menstruation. At the same time, the average weight of a full-term newborn is 3300 ± 200 g, and its length is 50-55 cm. Births that occur at 28-37 weeks. pregnancies before are considered premature, and more than 42 weeks. - belated. Average duration physiological childbirth ranges from 7 to 12 hours in nulliparous, and in multiparous from 6 to 10 hours. Childbirth that lasts 6 hours or less is called fast, 3 hours or less - rapid, more than 12 hours - protracted. Such births are pathological.

Characteristics of normal vaginal delivery

Single pregnancy.
head presentation fetus.
Full proportionality of the fetal head and mother's pelvis.
Full-term pregnancy (38-40 weeks).
Coordinated labor activity that does not require corrective therapy.
Normal biomechanism of childbirth.
Timely discharge of amniotic fluid when the cervix is dilated by 6-8 cm in the active phase of the first stage of labor.
No major breaks birth canal and surgical interventions in childbirth.
Blood loss during childbirth should not exceed 250-400 ml.
The duration of labor in primiparous is from 7 to 12 hours, and in multiparous from 6 to 10 hours.
The birth of a living healthy child without any hypoxic-traumatic or infectious injuries and developmental anomalies.
The Apgar score at the 1st and 5th minutes of a child's life should correspond to 7 points or more.

Stages of physiological childbirth through the natural birth canal: development and maintenance of regular contractile activity of the uterus (contractions); changes in the structure of the cervix; gradual opening of the uterine os up to 10-12 cm; promotion of the child through the birth canal and his birth; separation of the placenta and excretion of the placenta. In childbirth, three periods are distinguished: the first is the opening of the cervix; the second is the expulsion of the fetus; the third is sequential.

First stage of labor - dilation of the cervix

The first stage of labor lasts from the first contractions to the full opening of the cervix and is the longest. In primiparous it is from 8 to 10 hours, and in multiparous 6-7 hours. There are three phases in the first period. First or latent phase the first stage of labor begins with the establishment of a regular rhythm of contractions with a frequency of 1-2 per 10 minutes, and ends with smoothing or pronounced shortening of the cervix and opening of the uterine os by at least 4 cm. The duration of the latent phase is on average 5-6 hours. In primiparas, the latent phase is always longer than in multiparas. During this period, the contractions, as a rule, are still slightly painful. As a rule, any medical correction in the latent phase of childbirth is not required. But in women of late or young age, if there are any complicating factors, it is advisable to promote the processes of opening the cervix and relaxing the lower segment. For this purpose, it is possible to prescribe antispasmodic drugs.

After opening the cervix by 4 cm, the second or active phase the first stage of labor, which is characterized by intense labor and rapid opening of the uterine os from 4 to 8 cm. The average duration of this phase is almost the same in primiparous and multiparous women and averages 3-4 hours. The frequency of contractions in the active phase of the first stage of labor is 3-5 per 10 minutes. Contractions often become painful. Pain predominate in the lower abdomen. With the active behavior of a woman (position "standing", walking), the contractile activity of the uterus increases. In this regard, apply drug anesthesia in combination with antispasmodic drugs. The fetal bladder should open on its own at the height of one of the contractions when the cervix opens by 6-8 cm. At the same time, about 150-200 ml of light and transparent amniotic fluid is poured out. If there was no spontaneous outflow of amniotic fluid, then when the uterine os is opened by 6-8 cm, the doctor should open the fetal bladder. Simultaneously with the opening of the cervix, the fetal head advances through the birth canal. At the end of the active phase, there is a complete or almost complete opening of the uterine os, and the fetal head descends to the level pelvic floor.

The third phase of the first stage of labor is called deceleration phase. It begins after the opening of the uterine os by 8 cm and continues until the cervix is fully dilated up to 10-12 cm. During this period, it may seem that labor activity has weakened. This phase in primiparous lasts from 20 minutes to 1-2 hours, and in multiparous may be completely absent.

During the entire first stage of labor, the condition of the mother and her fetus is constantly monitored. They monitor the intensity and effectiveness of labor activity, the condition of the woman in labor (health, pulse rate, respiration, arterial pressure, temperature, discharge from the genital tract). Regularly listen to the fetal heartbeat, but most often carry out constant cardiomonitoring. At normal flow childbirth, the child does not suffer during uterine contractions, and the frequency of his heartbeats does not change significantly. In childbirth, it is necessary to assess the position and advancement of the head in relation to the landmarks of the pelvis. A vaginal examination during childbirth is performed to determine the insertion and advancement of the fetal head, to assess the degree of opening of the cervix, to clarify the obstetric situation.

Mandatory vaginal examinations perform in the following situations: when a woman enters maternity hospital; with the outflow of amniotic fluid; with the onset of labor activity; with deviations from the normal course of childbirth; before anesthesia; when spotting from the birth canal. Do not be afraid of frequent vaginal examinations, it is much more important to provide a complete orientation in assessing the correctness of the course of childbirth.

Second stage of labor - expulsion of the fetus

The period of expulsion of the fetus begins from the moment of full disclosure of the cervix and ends with the birth of a child. During childbirth, it is necessary to monitor the function Bladder and intestines. Bladder and rectal overflow interferes with the normal course of childbirth. In order to prevent overflow of the bladder, the woman in labor is offered to urinate every 2-3 hours. In the absence of independent urination, they resort to catheterization. Timely emptying is important lower section intestines (enema before childbirth and during their protracted course). Difficulty or lack of urination is a sign of pathology.

The position of the woman in childbirth

special attention deserves the position of a woman in childbirth. In obstetric practice, the most popular are childbirth on the back, which is convenient from the point of view of assessing the nature of the course of labor. However, the position of the woman in labor on her back is not the best for the contractile activity of the uterus, for the fetus and for the woman herself. In this regard, most obstetricians recommend that women in labor in the first stage of labor sit, walk for a short time, and stand. You can get up and walk both with whole and outflowing waters, but on condition that the fetal head is tightly fixed in the pelvic inlet. In some cases, it is practiced that a woman in labor is in the first stage of labor in a warm pool. If the location is known (according to ultrasound data), then the optimal is the position of the woman in labor on that side where the back of the fetus is located. In this position, the frequency and intensity of contractions do not decrease, the basal tone of the uterus retains normal values. In addition, studies have shown that this position improves the blood supply to the uterus, uterine and uteroplacental blood flow. The fetus is always located facing the placenta.

Feeding a woman in childbirth is not recommended for a number of reasons: the food reflex during childbirth is suppressed. During childbirth, a situation may arise in which anesthesia is required. The latter poses a risk of aspiration of stomach contents and acute violation breathing.

From the moment the uterine os is fully opened, the second stage of childbirth begins, which consists in the actual expulsion of the fetus, and ends with the birth of a child. The second period is the most critical, since the fetal head must pass through a closed bone ring of the pelvis, which is narrow enough for the fetus. When the presenting part of the fetus sinks to the pelvic floor, muscle contractions join the contractions abdominals. Attempts begin, with the help of which the child moves through the vulvar ring and the process of his birth takes place.

From the moment the head is inserted, everything should be ready for delivery. As soon as the head has cut through and does not go deep after an attempt, they proceed directly to the reception of childbirth. Help is needed because, when erupting, the head exerts strong pressure on the pelvic floor and ruptures of the perineum are possible. With obstetric benefits protect the perineum from damage; carefully remove the fetus from the birth canal, protecting it from adverse effects. When removing the fetal head, it is necessary to restrain its excessively rapid advancement. In some cases, perform perineal incision to facilitate the birth of a child, which avoids the insolvency of the pelvic floor muscles and the prolapse of the walls of the vagina due to their excessive stretching during childbirth. Usually the birth of a child occurs in 8-10 attempts. The average duration of the second stage of labor in primiparas is 30-60 minutes, and in multiparous 15-20 minutes.

AT last years in some European countries promote the so-called vertical delivery. Proponents of this method believe that in the position of a woman in labor, standing or kneeling, the perineum is more easily stretched, and the second stage of labor is accelerated. However, in this position it is difficult to observe the state of the perineum, prevent its ruptures, and remove the head. In addition, the strength of the arms and legs is not fully used. With regard to the use of special chairs for reception vertical delivery, they can be classified as alternatives.

Immediately after the birth of a child umbilical cord is not clamped, and it is located below the level of the mother, then there is a reverse "infusion" of 60-80 ml of blood from the placenta to the fetus. In this regard, the umbilical cord during normal delivery and satisfactory condition the newborn should not be crossed, but only after the cessation of vascular pulsation. At the same time, until the umbilical cord is crossed, the child cannot be raised above the plane of the delivery table, otherwise there is a reverse outflow of blood from the newborn to the placenta. After the birth of a child, the third stage of childbirth begins - afterbirth.

Third stage of labor - afterbirth

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

Newborns spend screening assessment for phenylketonuria, hypothyroidism, cystic fibrosis, galactosemia. After childbirth, information about the characteristics of childbirth, the condition of the newborn, recommendations maternity hospital transferred to the doctor antenatal clinic. If necessary, the mother and her newborn are consulted by narrow specialists. Documentation about the newborn goes to the pediatrician, who then monitors the child.

It should be noted that in some cases, preliminary hospitalization in the maternity hospital is necessary to prepare for delivery. The hospital conducts in-depth clinical, laboratory and instrumental examinations to select the timing and method of delivery. For each pregnant woman (parturient woman), an individual plan for the conduct of childbirth is drawn up. The patient is introduced to the proposed plan for the management of childbirth. Get her consent to the alleged manipulations and operations in childbirth (stimulation, amniotomy, caesarean section).

C-section perform not at the request of a woman, since this is an unsafe operation, but only for medical reasons (absolute or relative). Childbirth in our country is not carried out at home, but only in an obstetric hospital under direct medical supervision and control, since any childbirth is fraught with the possibility of various complications for the mother, fetus and newborn. Childbirth is conducted by a doctor, and the midwife, under the supervision of a doctor, provides manual assistance at the birth of the fetus, carries out the necessary processing of the newborn. The birth canal is examined and restored by a doctor if it is damaged.

In modern clinics, the process of childbirth differs from that programmed by nature. Doctors are able to speed up or slow down, and in some cases turn off contractions, if any. medical indications. But at each stage, the duration of individual periods is noted. This allows you to monitor the condition of the mother and baby and choose the tactics of delivery. starting point accurate calculation is how long childbirth lasts in primiparas. Not only the total duration is taken into account, but also the course of each stage.

Main periods

The duration of the birth of a child is affected by the contractile activity of the uterus, which is regulated by several factors:

hormonal background;
the work of the autonomic and central nervous system;
condition muscular system uterus.

When the body is fully prepared for the birth of a child, a natural mechanism starts. usually last 7-14 hours. For the second, the duration can be reduced to 5-12 hours. Each subsequent one may decrease in duration.

There are other options that are not the norm:

more than 18 hours - protracted;
less than 6 hours - fast;
less than 4 hours - swift, or assault.

Some new mothers believe that shortening the length of stay in maternity ward is beneficial. According to various studies, pathological variants of childbirth are associated with an increase in complications for mother and child.

The obstetrician-gynecologist detects the time of the onset of contractions and during the examination controls each stage. They are brought into special table in medical card woman, which is called a partogram. It helps to visually see at what stage the acceleration of the opening of the cervix occurs, with what frequency the contractions occur, their intensification or weakening.

Harbingers of childbirth are not taken into account when calculating the duration. They can last several days and do not lead to the opening of the cervix. The starting point is the appearance of the first. They should be regular, with a short break of 10-15 minutes. The strength of contractions gradually increases. At this stage, the neck begins to smooth out.

Disclosure

From the moment of smoothing the cervix and from the beginning of contractions, the first time period is noted. Experienced Doctors know that it differs in manifestation in primiparas and in repeated pregnancies. In the first case, the neck is first smoothed and then it gradually opens slightly. At repeated births everything happens faster due to the fact that the fabrics are easily stretchable. The neck simultaneously smoothes and opens.

The initial stage is called the latent phase. The uterus contracts rhythmically and regularly, and the cervix gradually shortens. This stage ends when the external os opens 3-4 cm. The opening rate is approximately 0.35 cm/h. This period is maximum in duration and reaches 5-6 hours. In multiparous, it is shortened as much as possible.

The peculiarities of uterine contraction in the latent phase are that the contraction spreads to all departments evenly, and after it ends, the muscles completely relax, and a weak tone is maintained in them. With the contraction of the bottom and body of the uterus, it relaxes lower segment. This helps to expand the neck. Contractions in the latent phase are not painful and do not require anesthesia.

The second stage of disclosure is the active phase. The uterine os reaches 4 cm, its expansion accelerates sharply. In primiparas, this occurs at a speed of 1.5-2 cm / h, and with repeated 2-2.5 cm / h. It takes an average of 3-4 hours to move to the next phase. In some cases, disclosure can accelerate dramatically.

In the active phase, the rupture of the fetal bladder normally occurs. Women in labor who did not happen in a timely manner are given an amniotomy. Opening the membranes does not cause pain. it necessary procedure, after which contractions are accelerated by 30%. The amniotic bladder with anterior waters acted as a hydraulic wedge that helped to gently open the cervix. But at a disclosure of more than 7-8 cm, it ceases to fulfill its role and only slows down the process.

The last stage is the deceleration phase. The cervix is already ajar by 8 cm and it takes from 40 minutes to 2 hours until the birth canal is completely formed. In multiparous, this period is shortened. For a child, this small gap is necessary so that the head can slowly pass the narrowest part of the birth canal and correctly configure. Doctors avoid stimulation in the third phase to prevent injury to the baby or the expectant mother.

Exile

After the cervix is fully dilated, the second stage begins - the expulsion of the fetus. In women giving birth for the first time, this moment lasts 30-60 minutes. How long the second birth lasts at this stage depends on the ability of the mother to push and preparedness, but in most cases it takes 15-20 minutes.

A woman has attempts - an involuntary desire to push. Contractions are complemented by contraction of the abdominal muscles and diaphragm. For the birth of a child, 5-10 attempts are enough. Before the onset of the laboring period, the woman in labor is transferred to the delivery room on the obstetric chair. She takes a position with an emphasis on her feet and grabs special handles on the sides with her hands. The tactics during this period are as follows:

when a contraction appears, it is necessary to capture as much air as possible;
an attempt is accompanied by a delay in breathing and a maximum of pressure on the perineum;
after an attempt, you need to slowly exhale, for a fight they push 3 times;
After each contraction, the doctor listens to the fetal heartbeat.

A large number of attempts are an alarming symptom. At this time, there is a decrease in uteroplacental blood flow, the child receives less oxygen. The risk of birth trauma and subsequent cerebral palsy increases.

When calculating the duration of labor, the first and second periods are summed up. The duration of the first birth is up to 10 hours. With repeated - up to 8.

serial

From the moment the baby is born, the contractions do not stop completely. The uterus needs time to decrease slightly in volume, after 5-7 minutes subsequent contractions occur. They differ in strength from the previous ones several times and are not so painful. For 2-3 contractions and a small attempt, the afterbirth is separated and born. Regardless of the parity of childbirth, this period lasts 30 minutes.

The doctor carefully monitors the signs of separation of the placenta. A slight pull on the umbilical cord is allowed, but it does not aim to pull the child's place out. Forcible separation of the placenta can lead to massive bleeding. Therefore, to control the midwife or gynecologist presses on the bottom of the uterus, may ask the woman in labor to push. If the end of the umbilical cord moves forward and does not retract inward, this indicates a complete separation. The absence of signs is an indication for a manual examination of the uterine cavity.

Only after the birth of the placenta, the uterus is completely reduced, becomes dense and capable of involution.

What affects duration

In a woman, the total duration of labor is more dependent on the first period - the opening of the cervix. Readiness affects speed endocrine system and enough substances involved in muscle contractions:

sufficient amount of prostaglandins;
calcium ions;
release of oxytocin;
large amounts of estrogen.

Preparation of the body lasts throughout pregnancy, but the maximum of estrogens and prostaglandins is noted a few days before childbirth. The first contractions may appear in the perliminary period, but they do not lead to the opening of the uterine os. They are characterized by changes in the structure of the neck:

central location;
softening;
opening;
shortening.

In primiparas, this takes longer than in subsequent deliveries. On average, they last a few hours less than the first ones. Sometimes they coincide in duration with the second.

The lengthening of the period of childbirth occurs with polyhydramnios. The fetal head does not form close contact with the pelvic bones, and a hydraulic wedge is not formed. Low water can also lead to a lengthening of the first period.

In addition to parity, the state of the neck matters. Cicatricial changes do not allow it to open normally, so the first period is delayed. Acceleration of childbirth is fraught with the appearance.

Why is it dangerous to wait

In modern maternity hospitals, it is customary not to wait as long as possible after the onset of contractions in order to avoid complications. To complete the birth, they try to allocate 12 hours. The maximum duration of labor allowed by clinical protocols is 18 hours. During this time, the doctor has the opportunity to assess the condition of the fetus and mother and decide on stimulation or transfer to the operating room. The following factors influence the decision:

the dynamics of contractions (grow in strength and duration or not);
neck opening speed;
data ;
concomitant diseases of the mother;
whether or not the fetal bladder is preserved;
color of amniotic fluid;
the size of the pelvis of the woman in labor.

Prolonged contractions tire the woman and the child. Good strong contractions deplete the energy resource of the myometrium and calcium reserves. Therefore, they gradually weaken and pass into the secondary generic weakness. Oxytocin stimulation at this point is useless. Then the doctor decides to complete the birth with an operation. Less often, a special anesthetic sleep is used, which gives the woman in labor the opportunity to rest.

Opened amniotic fluid leads to contact of the fetus with the contents of the vagina. In the presence of vaginitis, genital infections, symptoms of herpes, the risk of infection of the child increases. An anhydrous interval of more than 12 hours is not recommended by WHO and requires the use of antibiotics to prevent infection of the fetus.

Ways to speed up the process

During vaginal examination the gynecologist evaluates the condition of the cervix. Polyhydramnios is usually diagnosed shortly before delivery during a routine ultrasound. If excess amniotic fluid interferes with acceleration, a decision is made to perform an amniotomy. In most cases, after the bladder is punctured, normal contractions begin within 1-2 hours.

In the transition to the active phase of disclosure, they begin with oxytocin. In more early period the hormone is used less frequently so that acceleration does not lead to cervical ruptures. If the body responds well to stimulation, with the transition to the deceleration phase, oxytocin is stopped or temporarily slowed down.

Facilitates the opening of the neck and reduces the pain of the introduction of antispasmodics. In childbirth, a solution of Drotaverine is used. It helps well in parturient women when the head of the fetus presses hard on the neck, and it looks dense and swollen.

There are no special ways to speed up the second period. Pressure on the abdomen is not used in modern maternity hospitals. This method may cause injury to the child or mother.

The afterbirth period also cannot be artificially accelerated, and pressure on the uterus or twitching of the umbilical cord is dangerous with massive bleeding. When this period is extended, manual separation placenta under anesthesia.

The bad side of speeding up the birth process

A rapid course is characteristic of repeated delivery. The shorter the interval between pregnancies, the greater the chance that the baby will be born in a few hours. Rapid delivery have a negative side:

lead to rupture of the cervix;
the baby's head does not configure the birth canal in shape, there may be injuries;
frequent injuries cervical spine.

Therefore, at the stage of disclosure, the woman in labor is forbidden to push and strain so that the baby's head is not pressed into the closed neck.

It is difficult to predict how long the third and subsequent births last. When registering for pregnancy, the features of the course of previous births and their number must be indicated. So the gynecologist can make predictions.

Childbirth is divided into three periods: the period of disclosure, the period of exile and succession period. The total duration of childbirth depends on many circumstances: age, readiness of the woman's body for childbirth, features bone pelvis and soft tissues of the birth canal, the size of the fetus, the nature of the presenting part and the features of its insertion, the intensity of the expelling forces, etc.

The average duration of normal labor in primiparas is 9-12 hours, in multiparous - 7-8 hours.

Childbirth in primiparas lasts 3 hours, in multiparous - 2 hours.

Quick delivery respectively 4-6 hours and 2-4 hours.

Duration of childbirth by periods:

I period: -8-11 hours in primiparous; 6-7 hours in multiparous;

II period: - primiparous - 45-60 minutes; multiparous - 20-30 minutes;

III period: -5-15 minutes, maximum 30 minutes.

First period labor begins with the very first contraction and continues until the cervix opens 10 cm (this is called full dilation). contractions are infrequent (1 contraction in 7-10 minutes), weak and not painful. The latent phase of labor lasts an average of 4-6 hours. The intensity of contractions increases as labor progresses. Gradually contractions become more frequent, stronger and more painful. active phase childbirth lasts about 4 - 6 hours. In multiparous women, the process of opening the cervix proceeds somewhat faster than in primiparas. The border between the first and second stages of labor is the full disclosure of the cervix.

Full dilatation of the cervix indicates that the second stage of labor- period of exile. It is significantly shorter than the first period: in primiparous it lasts 1-2 hours, in multiparous - from 15 minutes to 1 hour. By the beginning of the exile period, the amniotic fluid had already poured out (the fetal bladder either burst itself, or the doctor performed an amniotomy to coordinate labor). The head presses on nerve plexuses, and the woman begins at first very frequent and strong contractions, and then attempts are added to them - contraction of the abdominal muscles and pelvic floor. The closer the baby is to the exit, the stronger pressure on the muscles, the more active the attempts. At the beginning of the second period - the stage of exile, the head of the child can be seen during the fight. Every contraction and every push helps her move down her vagina. Initially, the baby's head disappears when the contraction ends, pushed back by the tension of the pelvic floor muscles. But there is already progress: each time the head moves back a shorter distance. This short period called head cutting. After several contractions, the resistance of the mouse is overcome and the head does not move back, but moves forward with each contraction. Soon, even in the pauses between attempts, the head does not disappear - the eruption of the head begins. Initially, the back of the head and parietal tubercles appear. At this point, the doctor or midwife should be especially careful to monitor the further process. If necessary, the doctor may place a hand on the baby's head to slow and direct the baby's movement a little. Indeed, at this culminating moment, both the woman in labor and the fetus can be injured: the baby, due to strong squeezing of the muscles, is in danger of breaking the head. intracranial pressure, and his mother - perineal rupture. After the fetal head has erupted, the baby should turn around to face the right or left thigh. At this time, the midwife asks the woman in labor not to push, so as not to rush the baby. If the child does not have time to complete his turn, the doctor or midwife should help him with this. with the next one or two attempts, the shoulders, trunk and pelvic end of the fetus come out. The remains of amniotic fluid are poured out. The mouth and nose of the infant is cleared of mucus. Sometimes the infant may be held upside down to expel the mucus from the lungs. The newborn takes its first breath and starts to scream. cut the umbilical cord after it stops pulsing. The incision of the umbilical cord is completely painless for both the mother and the newborn, since there are no nerves in it.