Providing first aid during childbirth. Emergency help for a woman in labor: how to take birth outside the hospital

CAUSES OF DELIVERY n n n At the end of pregnancy - 2 weeks before delivery, the pregnant woman's body undergoes: - hormonal changes (progesterone level, amount of estrogen) - changes in the cerebral cortex (birth dominant) - endocrine disorders in the placenta - increased concentration of neurohormones: oxytocin, acetylcholine, serotonin and catecholamines, which excite uterine beta-adrenergic receptors and inhibit alpha-adrenergic receptors

The concept of the body's readiness for childbirth. Harbingers of childbirth: n n n The overlying part descends, presses against the entrance to the small pelvis, and the bottom of the uterus also descends. It becomes easier for a woman to breathe. The "maturity" of the cervix is ​​determined by bimanual examination. The cervix softens, shortens, is located in the center of the small pelvis, the cervical canal passes 1 transverse finger. The amount of amniotic fluid decreases, there is no weekly weight gain.

n n n There are irregular, weak aching pains in the lower abdomen (false contractions). Thick viscous mucus (Christeller's cork) leaves. The uterus becomes more sensitive to oxytocin. Mammary test: with irritation of the nipples after 3 minutes. uterine contractions appear (for 10 minutes - 3 contractions). Cytological test - changes in the ratio of vaginal epithelial cells (type III - intermediate cells predominate and type IV superficial cells predominate)

BIRTH is a physiological process during which the expulsion from the uterus takes place through the birth canal of the fetus, placenta with membranes and amniotic fluid. Physiological childbirth is a childbirth with spontaneous onset and progression of labor in a low-risk pregnant group at a gestational age of 37-42 weeks in the occipital presentation, a satisfactory condition of the mother and newborn after childbirth

CLASSIFICATION OF BIRTH n n n Term - partus maturus normalis - 37-42 weeks. Premature - partus praematurus - from 28 to 37 weeks. Belated - partus serotinus - after 42 weeks. Induced - artificial labor induction according to indications from the mother or fetus. Programmed - provide for the process of the birth of the fetus in the daytime, convenient for the doctor and the woman.

PERIODS OF BIRTH n n There are three periods in the birth act: - І period - disclosure - from the beginning of regular contractions to full disclosure of the cervix (for primiparous - 10-11 hours, multiparous - 6-8 hours) Phases: latent, active, slowing down - ІІ period - expulsion - from full disclosure of the cervix to the birth of the fetus (for primiparous 1-2 hours, for multiparous - from 20 minutes to 1 hour,). n - III period - afterbirth - from the birth of the fetus to the birth of the placenta (5 -30 min).

The onset of labor is considered to be the onset of regular contractions of 10-15 seconds. after 10 - 12 minutes. which lead to smoothing and opening of the cervix.

* During the FIRST PERIOD of the first birth, the cervix is ​​completely smoothed out first (due to the opening of the internal pharynx of the cervix), then the cervical canal expands, and only after that - disclosure (due to the external pharynx).

DISCLOSURE OF THE CERVICAL n With repeated births, the smoothing and opening of the internal and external os occurs simultaneously.

n n Full disclosure of the cervix is ​​considered to be 10-12 cm, while the edges of the cervix are not determined during vaginal examination, only the presenting part of the fetus is palpated. The place of docking of the head to the walls of the lower segment of the uterus is called the contact zone. It separates the amniotic fluid into anterior and posterior. Below it, a birth tumor forms on the head.

SECOND PERIOD n n When lowering the presenting part of the fetus (head) to the pelvic floor, there are attempts. The duration of contractions in the second period is 40 - 80 seconds. , after 1 - 2 min. The head and torso of the fetus advance through the birth canal and the birth of the child occurs. The totality of all successive movements that the fetus performs when passing through the mother's birth canal is called the biomechanism of childbirth. Depending on the position, presentation of the fetus, type and position, the biomechanism of childbirth will be different.

BIOMECHANISM OF LABOR n n n 1 moment - flexion of the head 2 moment - internal rotation of the head and shoulders (arrow-shaped suture in direct size) 3 moment - extension of the head (around the point of fixation) 4 moment - external rotation of the head and internal rotation of the shoulders 5 moment - flexion of the body in the cervicothoracic department and birth of shoulders

THIRD PERIOD n n n During this period, separation and discharge of the placenta from the uterus occurs. The follow-up period lasts an average of 15-30 minutes. Blood loss should not exceed 0.5% of a woman's body weight, which averages 250-300 ml. Immediately after the birth of the fetus, the uterus contracts significantly and decreases in size, so the uterus is in a state of tonic contraction for several minutes, after which "afterbirth" contractions begin.

n Under the influence of these contractions, the placenta with membranes is separated from the walls of the uterus and is born out of the uterine cavity.

Types of placental separation n n I type - central (according to Schulze), when the placenta separates from the center of its attachment and a retroplacental hematoma is formed. In this case, the afterbirth is born with the fruit surface outward. Type II - marginal (according to Duncan), in which the afterbirth begins to separate from the edge of the placenta, a retroplacental hematoma is not formed, and the afterbirth is born on the maternal surface outward.

Management of the 1st stage of labor I - the state of the fetus - heart rate, the state of the fetal bladder and amniotic fluid, the configuration of the head. II - the course of labor - the rate of opening of the cervix, lowering of the fetal head, contraction of the uterus (counting contractions). ІІІ – woman's condition – pulse, arterial pressure, temperature. All these data are entered into the partogram

MEDICAL METHODS OF PAIN RELIEF OF CHILDHOOD, requirements for them n n Analgesic effect No negative impact on the mother and fetus No negative impact on labor activity Simplicity and accessibility for all obstetric institutions

MEDICAL METHODS OF ANESTHETIC DELIVERY, drugs n Non-inhalation (systemic) anesthetics n Inhalation anesthetics n Regional anesthesia

NON-MEDUCATIONAL METHODS OF PAIN RELIEF OF LABOR n Active behavior of a woman in labor during the 1st stage of labor n Music and aromatherapy with essential oils n Shower, bath, self-massage of pain points

MANAGEMENT OF THE II PERIOD OF LABOR Assessment of the condition of the woman in labor: measurement of blood pressure and pulse every 10 minutes n Control of the fetal heart every 10 minutes n Control of the progress of the head and the state of the lower segment n

MANAGEMENT OF THE II PERIOD OF LABOR n Provision of obstetric assistance at the birth of the fetal head (preservation of the integrity of the perineum and prevention of intracranial and spinal injury) 5 methods of protecting the perineum

2. Regulation of attempts. 3. Removal of the fetal head outside the attempt. 4. Reducing tension in the perineum and borrowing tissue.

MANAGEMENT OF THE II PERIOD OF LABOR Provides the informed right of a woman to choose a position convenient for both her and the medical staff n Episio- or perineotomy is performed by a doctor according to indications and with provision of preliminary anesthesia

MANAGEMENT OF THE III DELIVERY PERIOD In order to prevent bleeding in the first minute after the birth of the fetus, 10 IU of oxytocin is administered intramuscularly n Controlled traction for the umbilical cord is performed only if there are signs of separation of the placenta from the uterus n

Signs of separation of the placenta: n n Schroeder - a change in the shape and height of the fundus of the uterus. Alfeld - lengthening the outer segment of the umbilical cord (the clamp is lowered 10 - 12 cm from the genital slit).

n Sign of Kyustner-Chukalov - when pressed with the edge of the palm over the symphysis, the umbilical cord is not retracted if the placenta has separated from the wall of the uterus. (You can not pull the umbilical cord, massage the uterus, etc.!).

Childbirth is the physiological process of expulsion of the fetus, membranes and placenta through the mother's birth canal.

A physician, paramedic, or EMS midwife (E&E) may experience any period of labor: dilation, expulsion, afterbirth, and early postpartum.

The health worker should be able to diagnose the periods of childbirth, assess their physiological or pathological course, find out the condition of the fetus, choose a rational tactics for the management of childbirth and the early postpartum period, prevent bleeding in the afterbirth and early postpartum period, and be able to provide obstetric assistance with head presentation.

Childbirth outside the hospital most often occurs with preterm pregnancy or with full-term pregnancy in multiparous women. In such cases, they proceed, as a rule, rapidly.

There are premature, urgent and delayed births.

Births that occur between 22 and 37 weeks of gestation, resulting in premature babies, are considered preterm. Premature babies are characterized by immaturity, their body weight ranges from 500 to 2500 g, length is from 19-20 to 46 cm.

Births that occur at a gestational age of 40 ± 2 weeks and end with the birth of a live full-term fetus with a body weight of approximately 3200-3500 g and a length of 46 cm or more are considered urgent.

Childbirth that occurred at a gestational age of more than 42 weeks and ended with the birth of a fetus with signs of postmaturity (dense skull bones, narrow sutures and fontanelles, severe desquamation of the epithelium, dry skin) are considered postmature. Delivery by a post-term fetus is characterized by a high percentage of birth traumatism.

There are physiological and pathological births. A complicated course of childbirth develops in pregnant women with extragenital pathology, aggravated obstetric and gynecological history or pathological course of pregnancy.

Therapeutic and tactical measures for the workers of the SLU

1. Decide on the possibility of transporting a woman in labor to the maternity hospital.
2. Assess the data of the general and obstetric anamnesis: the number of pregnancies and childbirth in history, their course, the presence of complications.
3. Determine the course of a real pregnancy: the threat of abortion, overall weight gain, blood pressure dynamics, changes in blood tests (according to the exchange card).
4. Analyze the data of the general objective study.
5. Assess the period of labor: the onset of contractions, their regularity, duration, intensity, pain. Conduct 4 external examinations and determine the height of the uterine fundus, the position and position of the fetus, the nature of the presenting part and its relationship to the plane of the entrance to the small pelvis (movable above the entrance to the pelvis, fixed by a small segment, a large segment at the entrance to the pelvis, in the cavity of the small pelvis, pelvic floor). Perform auscultation of the fetus.
6. Assess the nature of the discharge: the presence of bloody discharge, leakage of amniotic fluid, the presence of meconium in them.
7. If necessary, perform a vaginal examination.
8. Diagnosis of childbirth
   • first or second;
   • urgent, premature or late;
   • the period of childbirth - disclosure, exile, afterbirth;
   • the nature of the outflow of amniotic fluid - premature, early, timely;
   • complications of pregnancy and childbirth;
   • features of obstetric and gynecological history;
   • concomitant extragenital pathology.
9. In the presence of conditions and possibilities of transportation - hospitalization in an obstetric hospital.

In the absence of the possibility of transporting a woman in labor to the maternity hospital, labor should be started. A woman is given a cleansing enema, pubic hair is shaved, the external genitalia are washed with boiled water and soap, bed linen is changed, under which an oilcloth is placed, a home-made polster is prepared - a small pillow wrapped in several layers of sheets (preferably sterile). The polster during childbirth is placed under the pelvis of the woman in labor: due to the elevated position, free access to the perineum opens.

From the moment of full or almost complete opening of the cervix, the progressive movement of the fetus through the birth canal (the biomechanism of childbirth) begins. The biomechanism of childbirth is a set of translational and rotational movements that the fetus produces while passing through the birth canal.

The first moment - with developing labor activity, the head is inserted with one of the oblique sizes of the entrance to the small pelvis: in the first position - in the right oblique, in the second - in the left oblique size. The sagittal suture is located in one of the oblique dimensions, the leading point is the small fontanel. The head is in a state of moderate flexion.

The second point is the internal rotation of the head (rotation). In a state of moderate flexion in one of the oblique dimensions, the head passes through a wide part of the small pelvic cavity, starting an internal turn, which ends in the narrow part of the small pelvis. As a result, the fetal head changes from oblique to straight.

The rotation of the head is completed when it reaches the exit cavity from the small pelvis. The head of the fetus is installed with a sagittal suture in a direct size: the third moment of the biomechanism of labor begins.

The third moment is the extension of the head. Between the pubic articulation and the suboccipital fossa of the fetal head, a fixation point is formed, around which the head is extended. As a result of extension, the crown, forehead, face and chin are successively born. The head is born with a small oblique size equal to 9.5 cm, and a circumference of 32 cm corresponding to it.

The fourth moment is the internal rotation of the shoulders and the external rotation of the head. After the birth of the head, there is an internal rotation of the shoulders and an external rotation of the head. The shoulders of the fetus produce an internal rotation, as a result of which they are set in the direct size of the exit of the small pelvis in such a way that one shoulder (anterior) is located under the bosom, and the other (rear) is facing the coccyx.

The born head of the fetus turns with the back of the head to the left thigh of the mother (in the first position) or to the right thigh (in the second position).

A fixation point is formed between the anterior shoulder (at the point of attachment of the deltoid muscle to the humerus) and the lower edge of the womb. There is a bending of the fetal body in the thoracic region and the birth of the posterior shoulder and handle, after which the rest of the body is easily born.

The forward movement of the fetal head at the end of the second stage of labor becomes noticeable to the eye: a protrusion of the perineum is found, increasing with each attempt, as a result of which the perineum becomes more extensive and somewhat cyanotic. The anus also begins to protrude and gape, the genital slit opens and at the height of one of the attempts, the lowest segment of the head is shown from it, in the center of which there is a leading point. With the end of the attempt, the head hides behind the genital slit, and with a new attempt it reappears: the head begins to penetrate, indicating that the internal rotation of the head ends and its extension begins.

Shortly after the end of the attempt, the head does not go back behind the genital slit: it is visible both during the attempt and outside the latter. This condition is called head eruption. The eruption of the head coincides with the third moment of the biomechanism of childbirth - extension. By the end of the extension of the head, a significant part of it already comes out from under the pubic arch. The occipital fossa is located under the pubic articulation, and the parietal tubercles are tightly covered by highly stretched tissues that form the genital gap.

The most painful, albeit short-term, moment of childbirth comes: with an attempt, the forehead and face pass through the genital gap, from which the perineum slides off. This ends the birth of the head. The latter makes its outer turn, the head is followed by the shoulders and torso. The newborn takes its first breath, lets out a cry, moves its limbs and begins to turn pink quickly.

In this period of labor, the condition of the woman in labor, the nature of labor, and the heartbeat of the fetus are monitored. The heartbeat must be listened to after each attempt; attention should be paid to the rhythm and sonority of fetal heart sounds. It is necessary to monitor the progress of the presenting part - during the physiological course of childbirth, the head should not stand in the same plane of the small pelvis for more than 2 hours, as well as the nature of the discharge from the genital tract (during the period of disclosure and expulsion of bloody discharge from the genital tract should not be).

As soon as the head begins to cut in, that is, at the moment when, when an attempt appears, it appears in the genital gap, and with the end of the attempt it goes into the vagina, one must be ready to receive childbirth. The woman in labor is placed across the bed, her head is on a bedside chair, and a homemade polster is placed under the pelvis. Another pillow is placed under the head and shoulders of the woman in labor: in a half-sitting position it is easier to push.

The external genitalia are washed again with warm water and soap, treated with a 5% iodine solution. The anus is closed with sterile cotton wool or a diaper.

The delivery person washes their hands thoroughly with soap and treats them with a disinfectant solution; it is advisable to use a sterile disposable obstetric kit.

The reception of childbirth consists in the provision of obstetric benefits.

With cephalic presentation, obstetric assistance in childbirth is a set of sequential manipulations aimed both at promoting the physiological mechanism of childbirth and at preventing injuries to the mother and fetus.

As soon as the head crashes into the genital gap and will maintain this position outside the contraction, the eruption of the head begins. From this moment on, the doctor or midwife, standing to the right of the woman in labor, sideways to her head, with the palm of her right hand with a widely abducted thumb, clasps the perineum, covered with a sterile napkin, through which she tries to delay the premature extension of the head during a contraction, contributing to this exit of the occiput from under the symphysis . The left hand remains "ready" in case the forward movement of the head was too strong and one right hand could not hold it. As soon as the suboccipital fossa fits under the pubic arch (the delivery person feels the back of the head in the palm of his hand), and the parietal tubercles are palpated from the sides, they begin to remove the head. The woman in labor is asked not to push; with the palm of the left hand, they clasp the protruding part of the head, and with the palm of the right hand with the thumb abducted, they clasp the perineum and slowly, as if removing it from the head (from the face), at the same time gently lift the head up with the other hand - at the same time, the forehead is first shown above the crotch, then the nose , mouth and finally the chin. By all means, you need to remove the head until the perineum "comes off" from the chin, that is, until the chin comes out. All this must be done outside the fight, since during a fight it is very difficult to slowly withdraw the head, and with a quick withdrawal, the perineum is torn. At this point, the flowing mucus should be sucked out of the fetal mouth, as the child can take the first breath, as a result of which the mucus can enter the respiratory tract and cause asphyxia.

After the birth of the head, a finger is passed along the neck of the fetus to the shoulder: they check if the umbilical cord is wrapped around the neck. If there is an entanglement of the umbilical cord, the loop of the latter is carefully removed through the head.

The born head usually turns with the back of the head towards the mother's thigh; sometimes the external rotation of the head is delayed. If there are no indications for the immediate end of labor (intrauterine asphyxia of the fetus, bleeding), one should not rush: one must wait for the independent external rotation of the head - in such cases, the woman is asked to push, while the head turns with the back of the head towards the mother's thigh and the front shoulder fits under womb.

If the front shoulder does not fit under the bosom, they help: the turned head is grasped between both palms - on the one hand by the chin, and on the other - by the back of the head, or they put their palms on the temporo-cervical surfaces and gently, easily rotate the head with the back of the head towards the position, at the same time gently pulling it down, bringing the front shoulder under the pubic joint.

Then they clasp the head with the left hand so that its palm rests on the lower cheek and lifts the head, and with the right hand, just as it was done when removing the head, carefully shift the perineum from the back shoulder.

When both shoulders are out, they carefully grab the baby by the torso in the armpits and, lifting it up, remove it completely from the birth canal.

The principle of "perineum protection" in anterior occipital presentation is to prevent premature extension of the head; only after the back of the head comes out and the suboccipital fossa rests against the lunar arch, the head is slowly released over the perineum - this is an important condition for maintaining the integrity of the perineum and giving birth to the smallest head - small oblique. If the head erupts in the genital gap with a small oblique size (with occipital presentation), it can easily break.

Birth trauma of the newborn (intracranial hemorrhages, fractures) can often be associated with the technique and methodology of childbirth.

If the obstetric manual aid during the eruption of the head is carried out roughly (or the delivery person presses his fingers on the head), this can lead to the indicated complications. In order to avoid such complications, it is recommended to eliminate the excessive counterpressure of the stretching perineum on the fetal head, for which the perineal dissection operation is used - perineo- or episiotomy.

Obstetric manual aid when teething the head should always be as gentle as possible. It aims first of all to help the birth of a healthy child, without causing him any injury, and at the same time to preserve the integrity of the pelvic floor as much as possible. This is the only way to understand the term "crotch protection".

Immediately after the birth of the head, it is necessary to suck out mucus and amniotic fluid from the upper parts of the pharynx and nostrils using a pre-boiled rubber bulb. To avoid aspiration of the contents of the stomach in a newborn, the pharynx is first cleaned, and then the nose.

The born baby is placed between the mother's legs on sterile diapers, covered with another one on top to prevent hypothermia. The child is examined and evaluated according to the Apgar method immediately at birth and after 5 minutes (Table). The Apgar method of assessing the state of the fetus allows for a quick preliminary assessment of five signs of the physical condition of the newborn: heart rate - using auscultation; breathing - when observing the movements of the chest; baby skin color - pale, cyanotic or pink; muscle tone - by the movement of the limbs and reflex activity when slapping on the plantar side of the foot.

A score of 7 to 10 (10 indicates the best possible condition for the infant) does not require resuscitation.

A score of 4 to 6 indicates that these children are cyanotic, have arrhythmic breathing, weakened muscle tone, increased reflex excitability, heart rate over 100 bpm and can be saved.

A score from 0 to 3 indicates the presence of severe asphyxia. Such children at birth should be classified as requiring immediate resuscitation.

0 points corresponds to the concept of "stillborn".

Assessment 1 min after birth (or sooner) should identify infants in need of immediate care, assessment 5 min correlated with rates of neonatal morbidity and mortality.

After the appearance of the first cry and respiratory movements, stepping back 8-10 cm from the umbilical ring, the umbilical cord is treated with alcohol and cut between two sterile clamps and tied with thick surgical silk, a thin sterile gauze ribbon. The stump of the umbilical cord is lubricated with a 5% solution of iodine, and then a sterile bandage is applied to it. You can not use a thin thread to tie the umbilical cord - it can cut through the umbilical cord along with its vessels. Immediately, bracelets are put on both hands of the child, on which his gender, surname and name of the mother, date of birth and birth history number are indicated.

Further processing of the newborn (skin, umbilical cord, prevention of ophthalmoblenorrhea) is carried out only in an obstetric hospital, under conditions of maximum sterility to prevent possible infectious and purulent-septic complications. In addition, inept secondary processing of the umbilical cord can cause intractable bleeding after cutting the umbilical cord from the umbilical ring.

The woman in labor is removed urine with the help of a catheter and proceed to the management of the third - afterbirth - period of childbirth.

Follow-up management

The afterbirth period is the time from the birth of the child to the birth of the placenta. During this period, placental abruption occurs along with its membranes from the uterine wall and the birth of the placenta with membranes - the placenta.

With the physiological course of childbirth in their first two periods (disclosure and expulsion), placental abruption does not occur. The follow-up period normally lasts from 5 to 20 minutes and is accompanied by bleeding from the uterus. A few minutes after the birth of the child, contractions occur and, as a rule, bloody discharge from the genital tract, indicating separation of the placenta from the walls of the uterus. The bottom of the uterus is above the navel, and the uterus itself, due to gravity, deviates to the right or left; at the same time, there is an elongation of the visible part of the umbilical cord, which is noticeable by the movement of the clamp applied to the umbilical cord near the external genitalia. After the birth of the placenta, the uterus enters a state of sharp contraction. Its bottom is located in the middle between the womb and the navel and is palpated as a dense, rounded formation. The amount of blood lost in the afterbirth period usually should not exceed 100-200 ml.

After the birth of the placenta, the woman who gave birth enters the postpartum period. Now she is called a mother.

The management of the postpartum period is conservative. At this time, you can not leave the woman in labor for a minute. It is necessary to monitor whether everything is all right, that is, whether there is any bleeding - both external and internal; it is necessary to control the nature of the pulse, the general condition of the woman in labor, the signs of separation of the placenta; urine should be expelled, since an overfilled bladder interferes with the normal course of the afterbirth period. In order to avoid complications, it is not allowed to perform an external massage of the uterus, pull on the umbilical cord, which can lead to violations of the physiological process of placental separation and the occurrence of severe bleeding.

The child's place (the placenta with membranes and the umbilical cord) that has come out of the vagina is carefully examined: it is laid flat with the mother's surface up. Attention is drawn to whether all the lobules of the placenta have come out, whether there are additional lobules of the placenta, whether the membranes have completely stood out. Delay in the uterus of parts of the placenta or its lobules does not allow the uterus to contract well and can cause hypotonic bleeding.

If there is not enough placental lobule or part of it and there is bleeding from the uterine cavity, you should immediately perform a manual examination of the walls of the uterine cavity and remove the delayed lobule by hand. Missing membranes, if there is no bleeding, can not be removed: usually they come out on their own in the first 3-4 days of the postpartum period.

The born placenta must be delivered to an obstetric hospital for a thorough assessment of its integrity by an obstetrician.

After childbirth, the toilet of the external genital organs is made, their disinfection. Examine the external genitalia, the entrance to the vagina and the perineum. Existing abrasions and cracks are treated with iodine; ruptures should be sewn up in a hospital setting.

If there is bleeding from soft tissues, suturing is necessary before transportation to an obstetric hospital or applying a pressure bandage (bleeding from a perineal rupture, clitoral area), vaginal tamponade with sterile gauze pads is possible. All efforts during these manipulations should be directed to the urgent delivery of the puerperal to the obstetric hospital.

After childbirth, the puerperal should be changed into clean linen, laid on a clean bed, covered with a blanket. It is necessary to monitor the pulse, blood pressure, the condition of the uterus and the nature of the discharge (bleeding is possible); you should give the woman hot tea or coffee to drink. The born afterbirth, the puerperal woman and the newborn must be delivered to the obstetric hospital.

A. Z. Khashukoeva, doctor of medical sciences, professor
Z. Z. Khashukoeva, Candidate of Medical Sciences
M. I. Ibragimova, Candidate of Medical Sciences
M. V. Burdenko, Candidate of Medical Sciences
RSMU, Moscow

Despite the well-established clinical examination of pregnant women and the desire of expectant mothers to go to the hospital in advance, even before the scheduled date, sometimes sudden births still occur. Such childbirth usually occurs a little earlier than the period established by doctors and proceeds rapidly - from the moment of the first contractions to the expulsion of the fetus from the birth canal, sometimes only 40-60 minutes pass.

Who is at risk?

It is believed that most often sudden labor begins:

• in women who lead a too active life in the last months of pregnancy (long trips, travel, sports, physical activity, etc.);
• in multiparous;
• expectant mothers who are expecting twins or triplets;
• those who experience stress during the period of bearing a child.

Therefore, the best solution for a woman in the last trimester of pregnancy would be to avoid travel, especially long-distance and involving air travel, to avoid excessive physical activity (only light, easy exercises, no heavy lifting, no general cleaning), maintaining a stable emotional background. Sometimes a premature birth can simply cause a strong fright or a serious emotional experience, so a woman should try to take care of her nervous system - and her loved ones should take care of the same.

Why is sudden childbirth dangerous?

Any childbirth is a serious stress and a huge burden on the body of both the woman in labor and the child. Qualified medical care in this case is extremely important: professional obstetric care will help to avoid many complications. The main danger of sudden childbirth is that during them the risk of infant death increases significantly, and there is no access to intensive care that could help with sudden complications. In addition, childbirth in unsuitable conditions is always the risk of infection of the mother or child, the risk of injury to the birth canal of a woman, the risk of high blood loss.

In any case, it is better to give birth in a specialized institution, under the supervision of doctors and obstetricians. But if it so happened that a woman began a sudden birth, you should not panic, but call an ambulance, if possible, calm the woman in labor and try to give her first aid before the arrival of the medical team.

Signs of incipient labor

In order not to panic in vain, you need to be able to distinguish between the harbingers of the upcoming birth and the signs indicating the immediate onset of labor. Harbingers of childbirth are considered to be a slight decrease in the weight of the pregnant woman, lowering the abdomen downward, frequent urination and / or defecation, pulling mild pain in the lumbar region. As a rule, precursors appear 2-3 weeks before delivery. Also, a harbinger of an early birth is the discharge of a mucous plug - the release of a certain amount of mucus, possibly stained with bloody patches. The cervical mucus plug can go away a couple of weeks before the birth, and a couple of days before them, and sometimes it leaves just before the start of the birth.

Signs that labor has begun are:

• The appearance of pain in the lower back and hips, pain in the pelvic bones. The pains are pulling, persistent.
• Pain in the abdomen, similar to pain during menstruation, only more pronounced.
• Sensation of rhythmic regular contractions in the pelvic area (the uterine muscles contract, and this can almost always be felt).
• Departure of amniotic fluid. It can begin even before the first contractions, or it can come in the process of contractions. Sometimes the waters “leak”: they don’t leave in a continuous stream, but are released gradually. In the latter case, the woman has every chance to have time to get to the hospital.
• The appearance of pronounced contractions with ever-decreasing intervals between them. Contractions are sometimes very energetic, but it may also be that a woman does not experience much pain during contractions and therefore does not immediately understand that childbirth has already begun.
• An irresistible desire to push, which is constantly increasing.

First aid for a woman in labor

If one of the relatives is next to the woman at the time of the onset of sudden childbirth, he will have to take over the provision of first aid (of course, the first thing to do is to call an ambulance, and then proceed to feasible obstetric care). Basic rules for providing such assistance:

• Put an oilcloth or a waterproof diaper on a bed or sofa, put the woman in labor in a position convenient for her, calm and encourage if possible.
• Wash your hands well with soap.
• Prepare a sterile bandage, sterilize a strong thick thread in alcohol to tie the umbilical cord, sterilize a knife or scissors, prepare a rubber pear, which may be required to remove mucus and amniotic fluid from the baby's mouth and nose.
• Lay a clean towel next to the bed of the woman in labor, a diaper or sheet ironed with a hot iron.
• If time permits, change into clean clothes, wipe your hands with alcohol and smear your nails with iodine.
• If possible, you need to shave the woman's perineum, cover the anus with a sterile napkin (a piece of sterile bandage), and lubricate the external genitalia with iodine.
• When the baby's head becomes visible, you need to take a sterile napkin, press it against the perineum of the woman in labor and carefully pull it down, freeing the baby's face.
• When the head is completely out of the birth canal, the hand from the perineum must be removed and made sure that the shoulders come out without interference, support and accept the baby's body.
• The first step is to examine the baby's neck - if it is wrapped around the umbilical cord, the umbilical cord must be quickly and very carefully removed through the head.
• With a sterile napkin, you need to wet the nose and mouth of the child, if necessary, remove mucus from them with a pear.
• Place the child on a prepared clean diaper, wait until the pulsation of the umbilical cord stops and tie it with a sterile bandage (or a prepared and sterilized thread) in two places: at a distance of about 5 and 10 cm from the newborn's tummy. Then you need to cut the umbilical cord between the two dressings.
• The cut of the umbilical cord is treated with iodine, a sterile bandage is applied on top.

Now you should wait for the placenta to leave with the remains of the umbilical cord and put it in a bag - the placenta will definitely need to be shown to the doctor. The perineum of the puerperal should be covered with a clean diaper or sheet. A woman with a newborn should be taken to a hospital as soon as possible.

We give birth alone

It also happens that at the time of sudden childbirth, there is no one next to the woman who could help. In this case, you will have to give birth on your own. The main thing is not to panic, calm down and, if possible, tune in to the best. Childbirth is a natural process, and a woman can easily cope with it if she is not too nervous. The algorithm of actions for independent childbirth will be something like this:

• Between contractions, you need to urinate, if possible, wash yourself and shave off the hair in the perineum. If you don't have time for that, don't worry.
• It is better to take a semi-lying position in order to be able to control the time of the appearance of the head and have time to immediately reach the child.
• First of all, the baby's head appears, with each contraction it moves forward, but in the intervals between contractions it moves back a little. Therefore, you need to push, helping the child to overcome the birth canal.
• After the appearance of the head, you should, if possible, hold the perineum with your hands to avoid tearing it. When shoulders appear, you need to hold the child and help him finally exit the birth canal (extremely carefully and carefully!).
• The newborn is lowered upside down for a few seconds so that mucus flows out of his mouth and nose, then the baby is placed on his stomach and covered with a diaper.
• After the pulsation of the umbilical cord stops, it must be cut as described above. If there were no scissors at hand, you don’t need to get up - it’s better to let the child stay with the umbilical cord uncut for the time being.

And, of course, at the first opportunity, you need to get to the hospital with the baby. It is advisable not to forget to call an ambulance at the beginning of labor.

What Not to Do

Childbirth at home is an emergency situation, and it is categorically not recommended to deliberately put a woman in labor in such conditions. If there is an opportunity to get to the maternity hospital, you must definitely go and not tune in to home birth.

In no case should you forcibly pull the umbilical cord out of the birth canal or try to “separate the placenta” manually - manual removal of the placenta is a risky operation that can only be performed by an experienced midwife if there are clear indications for such a procedure.

Also, you can not strongly pull the child out of the birth canal. It is important to help the baby "get out into the light" and support it so that it does not fall, you do not need to pull. When providing first aid, it is necessary to ensure that in the process of contractions and attempts, the woman keeps her legs apart and does not bring them together (sometimes pain forces her to do this). Bringing her legs together, a woman risks injuring the child.

You can not try to sew up the tears yourself if they were formed during childbirth. This should only be done by a doctor.

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When contacting a medical unit of a unit, medical clinic, hospital that does not have a maternity ward, a woman with labor that has begun, amniotic fluid rupture, bloody discharge from the genital tract or a puerperal, it is necessary to ensure urgent hospitalization in a maternity facility. Obstetric benefits are provided on the spot to women in labor during the period of exile and in the afterbirth period. Symptoms of the period of exile: the appearance of attempts (attachment to regular contractions of contractions of the abdominal muscles), protrusion of the perineum, gaping of the anus, incision of the fetal head (with cephalic presentation).

First and pre-medical care

Urgent hospitalization.

Medical emergency

Medical Center

When contacting a part of a woman with labor that has begun on the spot, decide on the possibility of delivering a woman in labor to a hospital or calling a specialist doctor to a woman in labor; in case of impossibility of hospitalization - reception of childbirth.

Omedb, hospital

The position of the woman in labor is lying on her back with her legs bent at the hip and knee joints. The fetal head is removed by unbending it after fixing the suboccipital fossa under the pubic arch. They raise their heads. After the birth of the posterior handle of the fetus, its chest is covered with both hands, placing the thumbs on its front surface. With a slight upward pull, the birth of the lower part of the fetal body occurs without difficulty.

According to the indications, a perineal dissection (perineotomy) is performed. In order to prevent bleeding in the postpartum and early postpartum period, at the time of the eruption of the fetal head, a woman in labor is injected intramuscularly with 1 ml of oxytocin (pituitrina). Immediately after the birth of the newborn, the contents are aspirated from the respiratory tract, then the umbilical cord is crossed between two clamps at a distance of at least 30 cm from the umbilical ring. The newborn, together with the clamp on the umbilical cord, is swaddled without removing the cheese-like lubricant from the skin, and wrapped in a blanket. After the birth of the child, the woman is urinated with a catheter.

In the postpartum period - control over the condition of the woman, the amount of blood loss and the appearance of signs of separation of the placenta. If there are signs of separation of the placenta, the woman in labor is offered to push.

1st period (disclosure). It is characterized by the appearance of regular contractions. Duration from 6 to 10 hours. Set the frequency and intensity of contractions. Conduct an external obstetric examination:

• the position of the fetus, the presenting part;
• listen to the fetal heartbeat;
• condition of the fetal bladder (anhydrous period in hours).
• the degree of cervical dilation (according to the height of the contraction ring above the pubic joint);

Familiarize yourself, if available, with the map of the antenatal clinic. With an oblique position of the fetus, breech presentation, discharge of amniotic fluid - transportation on a stretcher on the left side.

2nd period (exiles). At the beginning of the second period, childbirth is carried out at home. Duration from 10 - 15 minutes to 1 hour. They are characterized by the attachment of attempts and full disclosure of the cervix (the contraction ring is 4-5 pp above the womb). Call the emergency room for help. Treat the external genitalia with 5% alcohol tincture of iodine.

After the “embedding” of the head, begin to provide obstetric benefits:

• protection of the perineum from ruptures with spread fingers;
• restrain the rapid advancement of the head during an attempt;
• removal of the head outside the straining activity;
• if after the birth of the head there is an entanglement of the umbilical cord around the neck, carefully remove it;
• after the birth of the head, offer the woman in labor to push;
• separation from the umbilical cord is performed immediately after birth.

3rd period (birth of the placenta). Duration 10 - 30 minutes. Observe the condition of the woman:

• a container under the pelvic area for assessing blood loss (normal 200 - 250 ml), control of pulse and blood pressure;
• emptying the bladder with a catheter;
• press on the uterus with the edge of the palm above the pubis, if the umbilical cord is not retracted, the afterbirth has separated;
• if the placenta was not born in 30 minutes - do not wait, transport the woman on a stretcher.

Primary toilet of the newborn

• The child is taken on sterile linen, placed between the legs of the mother so that there is no tension on the umbilical cord.

• Prevention of gonoblenorrhea is carried out: the eyes are wiped with various sterile swabs, 2-3 drops of a 30% solution of sulfacetamide (sulfacyl sodium) are instilled into the inverted conjunctiva of the upper eyelid, for girls 2-3 drops of the same solution are applied to the vulva area.

• The umbilical cord is captured with two clamps, the first of them is applied at a distance of 8-10 cm from the umbilical ring, the second - at a distance of 15-20 cm; ligatures can be used instead of clamps; between the clamps (ligatures), the umbilical cord is crossed with scissors, having previously treated the intersection with 95% ethyl alcohol.

• The newborn is wrapped in a sterile material, wrapped warmly and delivered to the maternity hospital.