Photo Legion-Media.Ru
Admission department
This is a place for parting with loved ones. Husband, mom, friends - all of them are not supposed to go further. The only way to enter the hospital with a pregnant woman is to conclude a contract for a partner delivery. Otherwise, the expectant mother goes alone to the room where the midwife is on duty. She accepts the woman in labor, checks for documents, asks about her well-being, and then calls the gynecologist on duty. The doctor examines the woman in labor, including an ultrasound scan (ultrasound), and decides which department to send the woman to.
In the event that the contractions turned out to be false, the pregnant woman (at choice) may be offered hospitalization or return home. With an uncomplicated pregnancy and a satisfactory state of health, a woman may well return home and wait for the start of labor at home, next to her family.
If the contractions turned out to be not training, but real, and in addition to this, the doctor recorded the discharge of amniotic fluid, then the pregnant woman is immediately sent to the maternity ward. Previously, the midwife measures the height and weight of the expectant mother, the abdominal circumference and the height of the uterus, studies the results of important analyzes that must be entered into the exchange card.
Next, the midwife conducts a general examination of the pregnant woman: the skin must be clean, the nails must be trimmed short. Chains, bracelets, watches, rings, including a wedding ring, are best left at home - you will still be asked to remove all jewelry. Next procedure: enema and shaving of the pubic area. You can shave in advance at home, but experimenting with an enema is not recommended. Entrust this work to experienced professionals.
After all the above procedures, the woman in labor takes a shower, puts on clean clothes - in most maternity hospitals it is forbidden to bring clothes with her, the medical staff gives out their kit - and goes to the physiological department.
Photo Legion-Media.Ru
If during the examination complications of the course of pregnancy are found, the woman is admitted to the pathology department of the maternity hospital (pictured). Pregnant women are also kept here. In this department, expectant mothers are treated for, fetaplacental insufficiency, exacerbation of pyelonephritis, etc. Women in labor who are scheduled for a planned cesarean section for medical reasons are also in the pathology department.
To stimulate labor and prepare the cervix for the labor process, doctors often use prostagladin-based gels. These substances significantly increase the contractile activity of the uterus.
Observational department
Photo Legion-Media.Ru
An expectant mother suffering from infectious diseases is sent to this department. Pregnant women with high fever, acute respiratory viral infections, acute respiratory infections, influenza, carriers of the hepatitis C and B virus, HIV, patients with sexually transmitted diseases also come here.
By the way, the absence of an exchange card can also lead to disastrous consequences: if the doctors do not receive any guarantees that the woman in labor is not sick with venereal and infectious diseases, they will have to send her to the observational department. Therefore, from the moment the exchange card is issued by the observing gynecologist, the expectant mother should always carry this document with her. The same thing awaits a woman whose exchange card lacks important analyzes.
The observational department has its own prenatal and birth blocks, postpartum boxes.
Lookout
Photo Legion-Media.Ru
Here, a second, more thorough examination of the woman in labor takes place, the degree of preparation of the birth canal for childbirth is assessed. If necessary, doctors perform simple obstetric manipulations without surgical intervention. The examination room includes prenatal wards and, in fact, the delivery room.
Prenatal room
Photo Legion-Media.Ru
This room is designed for the simultaneous reception of several women in labor. As a rule, doctors are ready to accept from 2 to 6 women here. Partner births take place in a separate prenatal unit, so no one will interfere with a family wishing to be together at such an important and crucial moment as the birth of a common baby.
In this room, the expectant mother can spend several hours, therefore, in most modern maternity hospitals, the presence of such benefits of civilization as a kettle, TV, fitball, a bed that turns into a maternity chair, etc. is provided.
Ancestral hall
The doctor is not always present at childbirth, since he may be busy with several expectant mothers at once. But even at a distance, he controls the process of childbirth. If complications arise during childbirth, he will immediately be notified of this and will come to the rescue. A normal birth is usually guided by a midwife. She will tell you to push. If the woman in labor is unbearable to tolerate pain during labor, the midwife will offer pain relief. Between contractions, she does cardiotocography, thanks to which she controls the baby's heartbeat, monitors the intensity of the labor process.
After the birth of a newborn, it is laid out on the mother's stomach, the umbilical cord is cut and applied to the breast. Next, the baby falls into the hands of a neonatologist, who examines the child and assesses his state of health.
The woman in labor has the last stage of labor - the discharge of the placenta, after which she is again examined by a doctor. If tears occurred during childbirth or the doctors had to make incisions, now they are sewn up and the stitches are processed.
After all the procedures, the young mother is transferred to the postpartum ward, where she can enjoy communicating with her baby. By this time he had already been examined, washed and swaddled.
8.10. Planning meeting. Late for my usual 5 minutes, I sneak back to my place. Catching the reproachful glance of the head physician, I smile sweetly at her. But, looking at the doctors on duty, the smile leaves my face, happy in anticipation of the upcoming vacation. Tousled hair a la "I fell from the hayloft", a nervous tic at the responsible duty officer, different slippers on the feet of the second, meaningfully say that duty was awful. Having made my way to my room, I quietly ask a colleague sitting next to me, "What's in the delivery room?" To which I get a short but succinct answer "W..pa !!!". The mood spoils, but not entirely. It's still the penultimate day! The last watch! We will give birth to everyone! We will operate! And then: “Ole! Ole, ole, ole !!! " No, no, Siberian obstetricians do not earn money for a ticket to the World Cup game, it's just a very joyful cry.
8.30. I go up to the delivery room as on the scaffold (because I know everything after the planning meeting). 7 women in childbirth. SEVEN! For a modest second-level maternity hospital, this is quite a lot, given that I am alone in the delivery room. The second doctor will not be out of the busy postpartum ward until lunchtime. And the third is on vacation. Summer is generally a hot season both literally and figuratively! Everyone wants to go on vacation in the summer! Well, at least for a little bit, at least for two weeks, three is already happiness, and four is practically a jackpot.
I am distracted however. I begin to rush between the delivery rooms. Fortunately, experienced midwives are on duty today. Bison! Sharks of their craft! Every maternity doctor knows that an experienced midwife is like a second hand. You just opened your mouth to say the appointment, and she has already done. Although all the midwives of the maternity ward are masters of their craft. Deputies to the State Duma would be elected as we are midwives in a maternity ward.
9.00. Gives birth to a third-born (obstetricians, as, probably, all have their own slang: primiparous - "firstborn", multiparous - "repetition", partner childbirth - "partners", a woman with a scar on the uterus after KS - "scar". grenadier, height 180, weight 110 kg. The child is large at 4500-5000. She gave birth to the same, but all the same exciting, anything can happen. It’s about pushing. She swears in the fight. So much so that her ears curl up into a tube: "Anya! ! "In response:" Doctor, do not swear! It's easier for me! Milkmaid, I did not finish academies! "Damn you, mother! Just give birth. Gives birth easily, from the third push into the hands of the midwife comes a strong peasant, the same yelling and red-cheeked Like a mother! Weighed - 4800, height 58 cm, neonatologist generously puts 9-9b on APGAR. Afterbirth gave birth. Introduced pabal. All is well! No hypotonia. Exhaled. The beginning seems to be quite good. I went to write a story.
10.00. A 16-year-old first-born is on the way (you won't be surprised anymore). Gives birth at night. It can be seen that it hurts. Crying softly, whining like a little puppy, fist in mouth in a fight, apparently so as not to scream. Eh, honey !! Sorry for you! To anesthetize with an epidural, but in the diagnosis "Dermatitis", the whole back is in a small pustular rash, Anrem refused. What can you do, you can't do that. Katyusha, you shout! Maybe it will be easier! We often shout! Looks with eyes full of tears "The mother said that if I scream, the doctors will swear." Here, after all, what a mother, in childhood I suppose she scared with babies, now she is obstetricians! Shout honey, shout, I won't swear. Attempts. The child moves slowly. The pelvis is narrow. You can't rush. After another pushing, exhausted “That's it! I won't push! I can not!" “Hello! And who will be? " Let him come out! Or will you get it out somehow! " “Uh, honey, that won't work. Come on one more time! On one, two, three: come on, Katyusha, come on, Everyone. Also a boy. No asphyxiation. Things are good.
10.30 - 14.00. Childbirth, childbirth, childbirth again, how different they are: childbirth with weakness of labor (praise oxytocin), with discoordination (epidural anesthesia is all ours), with hypotonic bleeding (coped with uterotonics), deep rupture of the vagina (thanks, brothers anesthesiologists, for anesthesia) ... Phew, even a little worn out. One warms the soul, soon on vacation! They already took out the suitcase, bought a new swimsuit: Ole, ole! Stop. Early.
14.40. Let's go to the operation. An ambulance brought a pregnant woman with two scars from previous COPs, with contractions from 2.00 at night! Eat, why were you sitting at home, dear ?! Waited for the uterus to break ?! Guilty "Husband from work at night!" Oh women, women. Recklessness? Stupidity? Ignorance? During the operation, the scar is sharply thinned, spreading under the scalpel. The fetal bladder shines through. Kapets! Just a little more and ... Thank God! We got the child. The uterus was sutured. They bandaged the pipes (well, at least she showed prudence here). She exhaled again.
16.00. The watch began. Go for lunch or what? But no. Foster. They brought a woman with an accident. Covered in blood. The term is 27 weeks. Began. Watch, you're the last. Damn, I'm running.
The face and surname are familiar. "Did you lie with us?" “Yes, a month ago they brought me in with bleeding. I have placenta previa! You took me to the edge! " "That was not enough yet." Face, clothes in blood. Somewhat inhibited. There is already an examination by a neurosurgeon (multidisciplinary hospital). Diagnosis: SHM. After consulting an obstetrician, hospitalization in o / neurosurgery. "Are there any complaints?" "My head hurts!" “And the belly? Is there bloody discharge from the genital tract? " "Not! The stomach does not hurt. The airbags went off. " "Now fine! And where is so much blood? " “She broke her lip.” “Okay, let's see. The uterus is in normal tone, painless on palpation. Cito ultrasound. Okay, the ultrasound doctor is late at work. There is no placental abruption. The fetal heartbeat is normal, movement is active. I calmly examine it vaginally. The neck is formed, the pharynx is closed. Discharge of leucorrhoea. I am writing in conclusion: At the time of examination, there is no data for acute obstetric pathology. I'm sending to neurotrauma. The soul is still restless. Still, placenta previa (retrospectively the next day, re-examination of the obstetrician and ultrasound, everything is normal). Uff.
17.00 Again reception. 4 childbirth with harbingers. The term is full-term. Examining. Contractions are rare, after 20 minutes. During vaginal examination, the cervix is \u200b\u200balmost smoothed, the edges are soft pliable, the opening is 3 cm. In response, "Doctor, can I come back later ?!" "You mean later?" “Well, in three hours, I need to spud the potatoes. Only 5 acres left "" Uh, how much is there? " "Ten". It's 30 degrees outside, 4 births, mature cervix. “What a potato! You are crazy?" "Doctor! I will have time, I live nearby. After giving birth, I will have no time! My husband is on a business trip, there are no assistants. " I ran away. I'm worried again! She will give birth there among her potatoes! Why did you let go? Arrived exactly three hours later. The opening is complete! From the reception on the gurney to the delivery room! They gave birth in 5 minutes. "Did you manage to spill the potatoes?" Laughs "I did everything, I still had time to wash!" Truly, there are women in Russian villages.
18.00. Bypass in the postpartum department. Okay, I'm on duty with the boss. She fights off the pathology department plus resuscitation patients. Did I even eat today?
20.00. A call to the city maternity hospital: "I would have a doctor on duty!" The tone is icy. Hello! The doctor on duty is such and such, with whom do I have the honor? " "I am Susanna's mother" (Susanna, a 28-year-old firstborn, was admitted in the afternoon with precursors and an immature cervix. In the delivery room under supervision. Regular contractions began only an hour ago). "I am listening to you attentively" "Is anyone going to study my daughter?" To myself: "Have sailed" "And in your opinion, no one is doing it?" "Of course not! She's been suffering for 24 hours! " Well, we often hear this song. I make my voice extremely friendly. “You see, so they say and so, I acted without an active generic ...” In response, “You don’t fool me. I gave birth 28 years ago, and I remember very well what contractions are! Why isn't she giving birth? Did you fix everything there for her? " Fathers, what is there to "fix something"? We haven't given her a single injection yet (to ourselves). Out loud: “Yes, everything is going fine. Do not worry! We do not offend your girl! We will do everything right. ”“ Keep in mind, I have my own person in the regional health service, if anything, I’m all of you there. ” Yes, we already understood that everyone would be shot or on a rack. Where is my Valerian?
21.00. Partner childbirth. Again. Husband immediately from the doorway. "We are for unnatural childbirth!" (He just said so) “We don't need to open the fetal bladder. I will cross the umbilical cord myself. We will take the placenta with us. ”“ Oh, Lord, please. ”Well, at least without shamanic tambourines and sprinkling of holy water in the corners (there were some).
Multiparous. Active phase of labor, 6 cm. They will not give birth for a long time. Uh, I wonder if I still have time to buy a pareo to match the swimsuit? Early, Tanya, early.
By the way, I'll go and look at Suzanne. Again with the phone. Looks like my mother is in correspondence. I would like to take all the phones at the entrance to the emergency room. So they say and so, a secure object, with a phone nizyayaya. I looked, thank God, the process is going on - 5 cm, but the bubble is flat. I need an amniotomy so as not to tighten. She explained for a long time why. She said she would sign an amniotomy consent after calling my mother. E-mine! 28 years old and we are all calling mom. Hold on, Tanya, hold on. We shared half of the night with the chief. So at least a little sleep will be possible.
23.00. Partners gave birth. Thank God, everything is as they wanted, everything is natural! True, the daddy grabbed the umbilical cord, he controlled the termination of the pulsation. The neonatologist could not stand it, shouted - let go. “Don't forget to give us the placenta! Otherwise, we know you, let them wear all sorts of masks! " Yeah, I'll go straight to the office, lie on the sofa and place your placenta on my face with a SLAP. (Ugh!) I took out the prepared package from the Magnet ahead of time. I wanted to be sneering, they say, somehow disrespectful to the tree of life. Shut up, Tanya, shut up.
Suzanne has requested an epidural. And if mom is against it? “I will sign the consent! I'm an adult. " Well, okay, you can see that I'm tired, it hurts.
23.45. Call to city. Shout "Ale, this is Suzanne's mom" "What happened?" “Why did you poke her back? What if her legs fail? "
Yes, ekarny babay! Already losing my patience. “Your daughter is 28 years old! She asked herself, signed an informed consent! Besides, there were testimonies ”. The scream turns into a screech: “I know your testimony! And do not try to Caesarean. You just want to cut everyone. Keep in mind, I have my own man in ... ”Yes, yes, I remember, quartered, burned at the stake. Ole, ole, ole !!! Vacation, come.
00.00. I didn't have time to make an entry in history, a call from pathology. Began! Slept during the day, woke up at night. I go to the second floor. Silence, darkness, only in the lookout light. What do you have, Galina Stepanovna? Galina Stepanovna is a midwife, big and beautiful like the "Titanic" "Look, she speaks a little bit."
The second birth, full-term, is already in the chair, smiling. "Yes, Galina Stepanovna raised you in vain!" (hmm, who else would go to bed) It hurts a little. " But Galina Stepanovna is still from the old guard of midwives, she will not call a doctor for every bunch. I look, Batiushki, 9 cm, the head is low, well fetal whole. I say, get up on the sly, and quickly pack your things for the maternity ward. " “Doctor, it’s too early, let’s take an hour or two, I need to finish the report” “What REPORT?” “Doctor, I'm the chief accountant at the firm! The quarterly report is on. I have a little left! " "Step march to the maternity ward, I already had one that almost gave birth in potatoes." Okay, okay, let's run! Doctor, can I have a laptop in the postnatal ward? "
01.00. The chief accountant has given birth long ago. My feet are buzzing. There is sand in the eyes. Midwives: "Let's go drink some coffee!" “Let's go. Girls, do you have bacon? " They laugh, they know that I love bacon “There is - they say - and bacon, and mustard, and black bread”. Mmm. Fuck the diet!
2.00. Suzanne gave birth. Surprisingly, she was pushing well, already without hysterics. Thank you Lord! Eyes stick together.
4.30. Phone call. Damn, it doesn't seem to be my half. The boss is on the line. " Term term, outpouring of water, pelvic, large fetus, first birth. The operating room is ready. " I'm coming! Damn, why didn't I become a physical therapist?
7.00 I still managed to sleep. 2 hours. Ole! Ole, ole! We could only hold out for a day now! (from)
8.10. Planning meeting. Judging by the smiles of those present, our appearance with the boss is no better than the previous shift. Well, okay, but no excesses.
15.00. The day was almost calm. A couple of births and an operation. I'm going out onto the porch! I breathe deeply. One thought in my head: SLEEP! What the hell to sleep? Tomorrow the plane is at 11.00. The sea is waiting! The suitcase is not packed! Ole! Ole, ole, ole!
A maternity hospital is a medical institution where a pregnant woman can receive qualified medical care from the moment of conception to childbirth, including the process of childbirth itself and the early postpartum period. For a newborn baby, the maternity hospital is the first medical institution where they will be helped not only to be born, but also to adapt to life in the environment.
The rules in the maternity hospital are very different from the rules of other medical institutions, because an infection is especially terrible for a sterile baby's body. Therefore, every maternity hospital has a strict regime that must not be violated.
Delivery room
The delivery room is the main place in the maternity hospital where the baby is born. From the moment of the establishment of regular labor activity, the woman in labor is transferred to the delivery room, where she stays with the medical staff, and, if desired, with a partner (husband, mother, sister).
Modern delivery rooms are made in warm colors and equipped with all the necessary equipment. The most important attribute of every delivery room is the Rachmaninov chair-bed, on which a child is often born. The well-equipped delivery room also has a bed, a gymnastic wall, a fitball, a dedicated chair for vertical labor, a heated changing table and a newborn resuscitation kit in the delivery room.
How do women give birth in a maternity hospital?
Currently, the active behavior of women in the first stage of labor is practiced. A woman in labor can freely move around the delivery room, perform exercises on a gymnastic wall and an inflatable ball, which helps to reduce pain, quickly open the cervix and lower the fetal head. The woman herself can choose where and how she wants to give birth. Currently, childbirth is practiced while sitting on a special chair, childbirth in the knee-elbow position.
Caring for a child in a maternity hospital begins from the moment he is born. The condition of the newborn is assessed on the Apgar scale at 1 and 5 minutes after birth, the maximum score is 10 points. It consists of 5 criteria, each of which is rated from 0 to 2 points: heart rate, skin color, respiration, muscle tone and reflex excitability.
The primary toilet of the newborn in the delivery room begins to be carried out as soon as the head has erupted. A neonatologist removes mucus from the baby's oral cavity using suction, then the baby is placed on the mother's stomach and applied to the breast, if the child does not need additional medical care. Early attachment of a newborn baby to the breast is very important, as it promotes the establishment of close contact between mother and baby, the skin and intestines are colonized by protective microflora, and also stimulates the production of oxytocin in the woman in labor, which helps the uterus to contract.
Then the child is taken to the changing table, where they wipe the generic lubricant from his skin, carry out the prevention of conjunctivitis, weigh, measure, dress and tie a bracelet on the handle, which indicates the number of the birth history, surname, name, patronymic of the mother, day and time of birth.
Many pregnant women are interested in how to dress a child in a maternity hospital? There is one peculiarity: the newborn's thermoregulation center is not yet mature and, under the influence of the room temperature, the child may become hypothermic, so the baby needs to be dressed a little warmer than the mother is wearing, especially in the early days.
Vaccinations for children in the maternity hospital are done by a children's nurse after examination by a neonatologist, the absence of contraindications and the signing of special documents by the mother.
Maternity hospital care
After giving birth, the doctor on duty in the maternity hospital examines the woman in labor, checks the condition of the seams, the size of the uterus, and the condition of the mammary glands. Examination in the maternity hospital is carried out in special examination rooms under sterile conditions 
after a woman has performed hygiene procedures.
Recently, there is a lot of information about childbirth outside the hospital (at home, in the pool), and there are couples who decide on such risky actions. It must be remembered that the process of childbirth cannot be predicted, and there is always a risk of a situation when the life of a woman and a child depends on qualified medical care provided on time, so you should not endanger yourself and your child.
The "holy of holies" of any maternity hospital and the place where our babies are usually born is the delivery room. Those who are just about to give birth, undoubtedly, want to know - what is it, how does it work and what happens in the delivery room?
The delivery room can be general or individual, but, one way or another, the main piece of furniture in it is the delivery table, or, to be precise, Rakhmanov's bed. In appearance, this is an ordinary gynecological chair, only larger in size. If necessary, the table can be easily transformed into a bed, and you can stretch (not stretch!) Your legs. Another distinctive feature of this simple device is special handles, popularly also called "reins".
When is it time to move to the delivery room
But let's go back to the prenatal ward for a while and see what happens there. After the cervix opens 10 cm, the woman in labor is transferred to the delivery room, or birth room. Subjectively, full disclosure can be determined by the attempts that have begun. Attempts are felt as an irresistible desire to empty the intestines, many women say so: "I want to go to the toilet in a big way." Sometimes there is no such obvious desire, but you suddenly notice that during the fight, your breath is held by itself, and you tense your abdominal muscles. This happens reflexively, since the baby's head has dropped very low and presses on the nerve endings.
And here - ATTENTION !!! - you should definitely call a doctor and do your best to restrain attempts. This must be done for one simple reason: sometimes attempts begin before the cervix is \u200b\u200bfully opened. Therefore, in order to keep the cervix intact and safe, we breathe "like a dog" during the fight, that is, often, superficially, you can stick out your tongue. If that doesn't work, add the "on all fours" pose. In this case, the head should be lower than the place where we usually sit. This is achieved very simply - we kneel and lower our head to the level of our palms. The baby rolls back to the bottom of the uterus, and the pressure on the cervix decreases.
"Surely you have painted yourself a picturesque picture: a woman with a big belly is on all fours with her fifth point up and breathes often, sticking her tongue out ... Jokes aside! And there is no place for embarrassment here either. The most crucial moment is coming - the real work will begin soon.
After the doctor examines you and confirms that "everything is ready" - that is, the cervix is \u200b\u200bfully opened, you can begin to push. But you need to do it wisely.
- Firstly, do not rush to climb onto the delivery table - carry out 2-3 contractions while standing. This will allow the baby's head to find a comfortable position for easier exit.
- Secondly, if you did everything right at the fights, by the time the attempts began you should have a “second wind”: fights become rare, after 7-10, or even 15-20 minutes; the mood improves - "there is a little left!", it is not clear from where new forces appear. This happens because the baby's head is pushed through the open cervix into the birth canal, and the uterus needs time to contract.
As soon as the uterus copes with this task, contractions will resume. And attempts will join them. Your time has come!
Labor is the most important job
Unlike contractions, a woman can influence both the strength and the length of the push. Typically, the tugging period lasts from 25 minutes to 2 hours, on average 35-40 minutes. So, when you find yourself on the delivery table, do not forget about pens - the midwife will show you where they are. You need to grasp them with your hands.
As soon as the fight begins, we sequentially perform the following actions:
- You need to breathe in "deeply" as much air as possible, and hold your breath.
- Raising your head and pressing your chin to your chest is necessary in order for the push to be effective, that is, the muscles of the abdomen are strained, and not the neck and face.
- Imagine that the air that we have inhaled is directed downward and pushes the baby out. And in the meantime, SMOOTHLY, WITHOUT JURKS, we strain the abdominal muscles and increase the strength of this tension. Your whole body seems to envelop your tummy, and all the muscles work to help the baby get out into the light. And the hands (you hold onto the handles with them) and legs (they are fixed in the holders) work to create a reaction force. Complicated? Let's try it easier: imagine that you are sailing on a boat, and the handles that you hold onto are oars.
- When you feel that you no longer have the strength to hold your breath, exhale VERY smoothly and relax the abdominal muscles. And everything is new.
During the fight, you need to do all these actions 2-3 times. Moreover, the last attempt should be the strongest. The kid with every attempt will move closer and closer to the exit, but at first, he will "roll back". Therefore, all our actions are smooth, but strong. After all, the baby is literally trapped in a cramped birth canal!
"It is very difficult to describe how to push in words. Better to see once than hear a hundred times. In our case, it is better to try once than read a hundred times. Therefore, do not be lazy, attend a lesson at school on preparation for childbirth. Such trainings exist in almost all schools.Believe me, you will not regret it, and the acquired skills will benefit both you and your baby.
And now the long-awaited moment comes: the head of the child appears. ALL ATTENTION TO THE MIDWIFE !!! She's your commander for the rest of your labor. And she will command you the following: "Don't push!" This is a signal to restrain the push. Sometimes it is enough to just relax, but sometimes the urge to push is so strong that you have to remember about breathing "like a dog." The baby's head should be born outside of the push to keep the perineum from tearing.
At this time, the kid makes a "turn with a deflection" inside you, and first the head appears, then one shoulder, another ... The last efforts, and literally everything else slips out.
"Here he is, such a long-awaited, wet, wrinkled, and such a beautiful, most beloved baby in the world!
The baby is placed on mother's warm belly. The midwife (and sometimes, if the father is involved in childbirth, this honorable mission is entrusted to him), after the pulsation stops, cuts the umbilical cord.
Congratulations! You did it!
Third stage of labor, birth of placenta
But that's not all - the shortest and easiest period of childbirth is ahead, the third. Some time after the birth of your son or daughter (usually 20-30 minutes), the uterus will contract so much that the afterbirth can separate from it - after all, it is no longer needed. You will be asked to push - and the uterus will be completely free. A doctor will then examine you.
In the meantime, the baby is examined by a pediatrician, he undergoes initial treatment, and then, if all goes well, the baby is applied to the breast. Enjoy these minutes of getting to know your baby. Praise the kid, he also worked! Precious drops of colostrum will serve the baby as a reward for hard work, and will provide reliable protection - this is the first immunity.
"It is very desirable that after childbirth the mother and the baby are not separated. After all, the baby is for the first time in a new, such a huge and unfamiliar world! Only a mother can provide her own little man with a sense of security, peace and safety. And only a mother can make this first meeting joyful!
Going to the hospital, a mother-to-be who is expecting her first baby usually feels anxious. A lot of incomprehensible procedures that await a woman in a maternity hospital, like everything else unknown, causes some concern. To dispel it, let's try to figure out what and why the medical staff will do at each stage of childbirth.
Childbirth in the hospital. Where will you be directed?
So, you have started regular contractions or amniotic fluid began to depart, in other words, labor has begun. What to do? If at this time you will be in the hospital in the department of pregnancy pathology, then you need to immediately inform the nurse on duty, and she, in turn, will call a doctor. The on-duty obstetrician-gynecologist will examine and decide whether you really have begun labor, and if so, he will transfer to the maternity ward, but before that, they will do a cleansing enema (an enema is not done in case of bleeding from the genital tract, when full or close to it opening of the cervix, etc.).
In the event that labor begins outside the hospital, you need to seek help from the hospital.
When hospitalized in a maternity hospital, a woman passes through an admission and access block, which includes: a reception (lobby), a filter, examination rooms (separately for healthy and sick patients) and rooms for sanitization.
A pregnant woman or a woman in labor, entering the waiting room, takes off her outerwear and goes into the filter, where the doctor on duty decides which department she should be sent to. To do this, he collects a detailed anamnesis (asks about health, about the course of this pregnancy) in order to clarify the diagnosis, trying to find out the presence of infectious and other diseases, gets acquainted with the data, conducts an external examination (reveals the presence of pustules on the skin and various types of rashes, examines the pharynx) , the midwife measures the temperature.
Patients with an exchange card and no signs of infection are admitted to the physiological department. Pregnant women and women in childbirth who pose a threat of infection to healthy women (without an exchange card, who have certain infectious diseases - acute respiratory infections, pustular skin diseases, etc.) are sent to the observational department specially designed for these purposes. Thanks to this, the possibility of infection in healthy women is excluded.
A woman can be admitted to the pathology department in the case when the onset of labor is not confirmed using objective research methods. In doubtful cases, a woman is hospitalized in a maternity ward. If, during the observation, labor does not develop, then the pregnant woman after a few hours can also be transferred to the pathology department.
In the examination room
After it has been established to which department the pregnant or parturient woman is sent, she is transferred to the appropriate examination room. Here, the doctor, together with the midwife, conducts a general and special examination: weighs the patient, measures the size of the pelvis, the circumference of the abdomen, the height of the fundus of the uterus above the bosom, the position and presentation of the fetus (head or pelvic), listens to his heartbeat, examines the woman for edema, measures the arterial pressure. In addition, the doctor on duty performs a vaginal examination to clarify the obstetric situation, after which he determines whether there is labor, and if so, what kind of character it has. All survey data are recorded in the birth history, which is started here. As a result of the examination, the doctor makes a diagnosis, writes out the necessary tests and appointments.
After the examination, sanitization is carried out: shaving of the external genital organs, an enema, a shower. The scope of examinations and sanitization in the examination room depends on the general condition of the woman, the presence of labor and the period of labor. At the end of the sanitization, the woman is given a sterile shirt and dressing gown. If childbirth has already begun (in this case, the woman is called a parturient woman), the patient is transferred to the prenatal ward of the birth block, where she spends the entire first stage of labor until the onset of attempts, or to a separate birth box (if equipped with such a hospital). A pregnant woman who is still awaiting childbirth is sent to the department of pregnancy pathology.
What is CTG for childbirth?
Cardiotocography is of great help in assessing the condition of the fetus and the nature of labor. A cardiac monitor is a device that records the fetal heartbeat, and also makes it possible to track the frequency and strength of contractions. A sensor is attached to a woman's stomach, which allows you to record the fetal heartbeat on a paper tape. During the examination, a woman is usually asked to lie on her side, because in a standing position or while walking, the sensor is constantly shifted from the place where fetal heartbeats can be recorded. The use of cardiac monitoring makes it possible to timely detect fetal hypoxia (oxygen deficiency) and anomalies in labor, evaluate the effectiveness of their treatment, predict the outcome of childbirth and choose the optimal method of delivery.
In the rodblock
The birth block consists of prenatal wards (one or more), birth wards (delivery rooms), intensive observation wards (for monitoring and treating pregnant women and women in labor with the most severe forms of pregnancy complications), a manipulation room for newborns, an operating block and a number of auxiliary rooms.
In the prenatal ward (or maternity ward), details of the course of pregnancy, past pregnancies, childbirth are clarified, an additional examination of the woman in labor is carried out (physique, constitution, abdominal shape, etc. are assessed) and a detailed obstetric examination. Be sure to take an analysis for blood group, Rh factor, AIDS, syphilis, hepatitis, make a study of urine and blood. The condition of the woman in labor is carefully monitored by a doctor and a midwife: they inquire about her health (degree of pain, fatigue, dizziness, headache, visual disturbances, etc.), regularly listen to the fetal heartbeat, monitor labor activity (duration of contractions, the interval between them, strength and soreness), periodically (every 4 hours, and if necessary - more often) blood pressure and pulse of the woman in labor are measured. Body temperature is measured 2-3 times a day.
In the process of monitoring the birth process, a vaginal examination becomes necessary. During this study, the doctor uses his fingers to determine the degree of opening of the cervix, the dynamics of the fetal movement along the birth canal. Sometimes in the maternity ward during a vaginal examination, a woman is offered to lie on a gynecological chair, but more often the study is carried out when the woman in labor is lying on the bed.
Vaginal examination in childbirth is necessarily carried out: upon admission to the hospital, immediately after the discharge of amniotic fluid, and also every 4 hours during childbirth. In addition, there may be a need for additional vaginal examinations, for example, when carrying out anesthesia, deviating from the normal course of labor or the appearance of spotting from the birth canal (one should not be afraid of frequent vaginal examinations - it is much more important to provide full orientation in assessing the correctness of the course of labor). In each of these cases, the indications for conduct and the manipulation itself are recorded in the birth history. In the same way, in the history of childbirth, all studies and actions carried out with a woman in labor during childbirth are recorded (injections, measurement of blood pressure, pulse, fetal heart rate, etc.).
During childbirth, it is important to monitor the functioning of the bladder and intestines. Overflow of the bladder and rectum interferes with the normal course of labor. To prevent overflow of the bladder, women in labor are asked to urinate every 2-3 hours. In the absence of independent urination, they resort to catheterization - the introduction of a thin plastic tube into the urethra, through which urine flows.
In the prenatal ward (or individual maternity ward), the woman in labor spends the entire first stage of labor under the constant supervision of medical personnel. In many maternity hospitals, the presence of the husband is allowed. With the onset of the laboring period, or the period of exile, the woman in labor is transferred to the birth ward. Here they change her shirt, kerchief (or disposable hat), shoe covers and put her on Rakhmanov's bed - a special obstetric chair. Such a bed is equipped with footrests, special handles that you need to pull towards yourself during attempts, adjusting the position of the head end of the bed and some other devices. If childbirth takes place in an individual box, then the woman is transferred from an ordinary bed to Rakhmanov's bed, or, if the bed on which the woman lay during contractions is functional, it is transformed into Rakhmanov's bed.
Normal childbirth with uncomplicated pregnancy is taken by a midwife (under the supervision of a doctor), and all abnormal childbirth, including childbirth with a fetus, is taken by a doctor. Such operations as caesarean section, the application of obstetric forceps, vacuum extraction of the fetus, examination of the uterine cavity, suturing of soft tissue tears of the birth canal, etc., is carried out only by a doctor.
After the baby is born
Once the baby is born, the delivery midwife will cut the umbilical cord with scissors. A neonatologist, who is always present at childbirth, aspirates the newborn's mucus from the upper respiratory tract using a sterile balloon or catheter connected to an electric suction, and examines the baby. The newborn must be shown to the mother. If the baby and mother feel good, the baby is laid out on the stomach and applied to the breast. It is very important to attach the newborn to the breast immediately after childbirth: the first drops of colostrum contain the vitamins, antibodies and nutrients necessary for the baby.
For a woman, after the birth of a child, childbirth does not end yet: an equally important third stage of labor begins - it ends with the birth of an afterbirth, therefore it is called successive. The afterbirth includes the placenta, amniotic membranes and umbilical cord. In the subsequent period, under the influence of subsequent contractions, the placenta and membranes are separated from the walls of the uterus. The birth of the placenta occurs approximately 10-30 minutes after the birth of the fetus. The expulsion of the placenta is carried out under the influence of attempts. The duration of the subsequent period is approximately 5-30 minutes, after its end the labor process ends; during this period, a woman is called a puerpera. After the birth of the placenta, ice is placed on the woman's abdomen so that the uterus contracts better. The ice pack remains on the stomach for 20-30 minutes.
After the birth of the placenta, the doctor examines the birth canal of the postpartum woman in the mirrors, and if there are ruptures of soft tissues or an instrumental dissection of tissues was performed during childbirth, restores their integrity - sutures. If there are small tears in the cervix, they are sutured without anesthesia, since there are no pain receptors in the cervix. Tears in the walls of the vagina and perineum are always restored against the background of anesthesia.
After this stage is over, the young mother is transferred to a gurney and taken out into the corridor, or she remains in an individual maternity ward.
The first two hours after giving birth, the woman in labor should remain in the maternity ward under the close supervision of the doctor on duty due to the possibility of various complications that may arise in the early postpartum period. The newborn is examined and treated, then swaddled, put on a warm sterile undershirt, wrapped in a sterile diaper and blanket and left for 2 hours on a special heated table, after which a healthy newborn is transferred with a healthy mother (postpartum woman) to the postpartum ward.
How is pain relief carried out?
Pain relief may be necessary at some point in labor. For drug pain relief during childbirth, the following are most often used:
- nitrous oxide (gas that is supplied through a mask);
- antispasmodics (baralgin and similar agents);
- promedol is a narcotic substance that is administered intravenously or intramuscularly;
- - a method in which an anesthetic substance is injected into the space in front of the dura mater surrounding the spinal cord.
Madina Esaulova,
Obstetrician-gynecologist, maternity hospital at IKB No. 1, Moscow
