(1) Pregnant women with normal pregnancy and no pregnancy complications need not be admitted to hospital in advance. Before 4 1 week of pregnancy, if there are no signs of delivery, no pregnancy complications, no indications for cesarean section, and no special discomfort, there is no need to be hospitalized in advance. Just make good preparations for hospitalization. Premature hospitalization will lead to prolonged labor waiting time. During hospitalization, there is no medication except daily monitoring, which often leads to insufficient rest and irritability of pregnant women. Pregnant women who are far away from the hospital, because of the long distance, often have no time to transfer to the hospital in case of emergency, and can be hospitalized in advance at an appropriate time.
(2) Generally speaking, most parturients will excrete a small amount of bloody mucus through the vagina 24 to 48 hours before delivery, that is, they will have the 1 contraction soon after seeing the red. The initial contractions are not strong, but as time goes on, the contractions will become more and more regular, the contractions will become shorter and shorter, and the duration will become longer and longer. At this time, the parturient will feel the pain radiating from the abdomen to the waist, and this kind of pain will often surge one after another and then spread around. This is what people call pain. When the onset of labor pains is confirmed, you should realize that you should be ready to go to the hospital. If it is 1 fetus, and the residence is close to the hospital, you can wait a little longer. It usually takes several hours from 1 contraction to cervical opening. You can grasp the time to go to the hospital according to the time of contraction. If the contractions take a long time, there is no need to rush to the hospital. When the contraction interval is reduced to every 10 minute 1 time, you can leave for the hospital. Of course, if the residence is far from the hospital and the transportation is not very convenient, the time for pregnant women to wait for delivery in the hospital should be appropriately advanced.
(3) The parturient can be admitted to the hospital at the slightest sign, and those who are far away from the hospital should also be admitted to the hospital in advance. Due to the experience of childbirth, the parturient's birth canal is slack, and the signs of labor are often not obvious, sometimes only a little backache and lower abdomen; Once in labor, the labor process is often very fast, and there is the possibility of urgent labor, laceration of birth canal and delivery outside the hospital. Therefore, once there are slight signs, you must be hospitalized in advance.
(4) Those who are pregnant for more than 4 1 week and still have no signs of delivery should be hospitalized for labor. When the pregnancy exceeds 4 1 week, the risk of fetal death, amniotic fluid loss, fetal macrosomia and fetal hypoxia increases obviously due to the decrease of placental function. It is necessary to be hospitalized in time and strengthen supervision. Once unfavorable factors appear, induced labor should be induced in time to terminate pregnancy.
(5) Pregnant women find pale yellow or white water flowing out of the vagina, indicating that the water has been broken. Whether it is due or not, whether there are contractions or not, you should go to the hospital immediately to see the emergency department. On the way to the hospital, we should also pay attention to keeping our heads down and our feet up, so as to avoid excessive amniotic fluid outflow and affect the baby's smooth delivery. Vaginal bleeding of pregnant women is more than menstruation; It was found that fetal movement suddenly decreased significantly or disappeared completely; Pregnant women with hypertension or pregnancy-induced hypertension syndrome should be sent to the hospital immediately if they have convulsions.
Three processes of delivery The whole process of delivery is from regular contractions to delivery of fetal placenta. Clinically, the total labor process is divided into three stages, namely, the medical labor process. Under normal circumstances, 1 when a child is born, the whole process from the beginning of regular abdominal pain to the end of delivery generally does not exceed 24 hours.
1 labor process, also known as cervical dilatation, refers to the period from the regular contraction of the uterus to the opening of the cervix 10 cm. Regular contractions refer to contractions every 10 minute 1 ~ 2 times. When the uterus begins to contract, the parturient will feel the hardness of the uterus, pain in the lower abdomen or waist, and a feeling of falling. In the early stage of labor, the uterus contracts every 10 minute/time, and the duration is very short. Gradually, uterine contractions become more and more frequent, about 1 time every 2 ~ 3 minutes, each time lasting about 1 minute, and the contractions are also obviously strengthened. The uterine orifice gradually expands until it is 10 cm wide, which means that the uterine orifice is completely opened. At this time, the delivery of 1 stage has ended.
Generally, the cervix of primipara is tight and the cervix dilates slowly, which takes about 1 1 ~ 12 hours. It takes about 6-8 hours for the lying-in woman's cervix to relax and expand rapidly. The rate of uterine orifice expansion is inconsistent. There is a latent period before the cervix dilates 3 cm, with an average opening of 65438 0 cm every 2 hours and the slowest opening of 65438 0 cm every 4 hours. The active period is 3 ~ 10 cm, and the cervical dilatation is accelerated, with an average opening of 2 cm per hour, and the slowest opening is 1 cm per hour. Cervical dilatation is a slow process. If the cervix is never completely opened in a short time, it will be accompanied by a strong sense of contraction, the pain will be heavier, and fetal distress may occur. Don't worry. When the uterine orifice is completely or nearly open, the fetal membrane will naturally rupture, commonly known as water breakthrough, followed by clear and transparent amniotic fluid outflow, and the amniotic fluid before the fetal presentation will generally flow out, about100 ml; If the fetus is exposed first and fixed, the fetus has already entered the basin. After the amniotic fluid flows out, the amniotic fluid will no longer flow out in large quantities, and there will be no dry amniotic fluid.
The second stage of labor, also known as the delivery period of the fetus, refers to the period from the opening of the cervix to the delivery of the fetus. With the strong and frequent contractions of the fetus, the parturient will feel the pain of contractions relieved. When the exposed part of the fetus falls to the bottom of the parturient's pelvis to press the rectum, the parturient will feel defecation during the contraction, and can exert force involuntarily with the contraction. After about 1 ~ 2 hours, the fetus will follow the birth canal and be delivered from the fully opened cervix, thus ending the second stage of labor. The primipara needs about 1 ~ 2 hours; It usually takes several minutes to complete a puerperal delivery, but it may also take 1 hour.
The third stage of labor, also known as placenta delivery period, refers to the whole process from fetal delivery to placenta delivery. Generally, it takes about 10 ~ 20 minutes, not more than 30 minutes. At this time, the parturient feels relaxed, the uterus drops to umbilical level, and the contractions recover after a few minutes. The uterine body becomes hard and spherical, the bottom of the uterus rises to the umbilical cord, there is a little bleeding in the vagina, and the umbilical cord exposed at the vaginal opening automatically descends and becomes longer. These signs indicate that the placenta has been exfoliated. Shortly after the delivery of the fetus, the placenta is exfoliated and discharged with slight abdominal pain, or the midwife gently presses the bottom of the uterus and pulls the umbilical cord to deliver the placenta. After the placenta is delivered, the delivery recipient should smooth the placenta and carefully check whether the placenta membranes are complete. If the placenta membranes are intact, check the perineum, the inside of labia minora, around the urethral orifice, vagina and cervix for lacerations. If there is a tear, the wound should be sutured immediately.
Only when the parturient understands the characteristics of each labor process and begins to make positive psychological preparations before delivery can the parturient be full of confidence and actively cooperate to ensure the smooth delivery and the safety of mother and baby.
The three elements of natural childbirth are nothing more than productivity, birth canal and fetus. All women of childbearing age who have no pelvic abnormalities, normal fetal size, no uterine inertia and normal fetal position have the conditions for vaginal delivery.
Create necessary conditions for vaginal delivery. Studies have shown that anxiety and tension can cause chain changes in the mental and endocrine systems, affect blood perfusion in the uterus, or increase the secretion of nerve mediators, affect the blood oxygen supply of the fetus and uterine contractility, and cause intrauterine distress and prolonged labor. Therefore, the parturient must be fully prepared during pregnancy, maintain a good attitude during labor, give full play to the positive subjective initiative, and cooperate with the doctor to complete the delivery.
Physical, psychological and material preparations should be made before delivery, and reasonable nutritious diet should be paid attention to during pregnancy, and food types should be diversified to meet the needs of various nutrients to meet the needs of fetal growth and development; Avoid malnutrition or lack of fetal growth and development abnormalities; Avoid excessive nutrition or unreasonable intake, resulting in a huge fetus, so that delivery can not be completed smoothly. Pay attention to moderate exercise during pregnancy, promote the elasticity and softness of muscles and ligaments, and prepare for delivery.
During pregnancy, we should constantly understand the knowledge about childbirth, including the way of childbirth and its advantages and disadvantages, the process of childbirth and its influencing factors, the possible problems during childbirth and the medical care measures that doctors may give, so as to understand childbirth, eliminate fear and tension, and establish confidence in natural childbirth. In the progress of the delivery process, we should adjust our mentality at any time and cooperate closely with doctors or midwives to make the delivery smooth and complete. Ensure the health and safety of mothers and children.
Some parturients lack a correct understanding of childbirth, shout when they are in pain, and consume a lot of physical strength and energy, which may easily lead to secondary uterine inertia, slow expansion of cervical orifice, prolonged labor process and severe postpartum hemorrhage. Maternal women don't use it when they should exert their strength, which hinders the delivery of the fetus, leads to the lack of oxygen in the mother, and the neonatal asphyxia rate is high. At the same time, yelling is also easy to cause flatulence and vomiting and diarrhea. Shouting during childbirth is not only harmful to the mother herself, but also harmful to the unborn child.
In the process of waiting for labor, the parturient can tell her feelings to the doctor at any time. Especially when the pain is unbearable, you feel extremely scared, and you are worried about the problem of childbirth, you should seek the help of a doctor to find out whether the progress is normal or not, and you can get the encouragement of a doctor. When there is a problem in the progress of labor, the doctor may seek the opinions of the parturient and their families, tell them what to do, and ask in detail the advantages and disadvantages of these treatment methods in order to choose.
In short, childbirth should be interactive. With the help of doctors, husbands and family members, parturients must have a positive, active and cooperative attitude, and they will certainly be able to give birth smoothly.
Advantages of natural childbirth Natural childbirth is a natural instinct of human beings, and it is also the most reliable mode of childbirth, which is especially conducive to promoting the respiratory function of the fetus.
1. Natural delivery is beneficial to the parturient, with little harm to the parturient, less complications such as postpartum hemorrhage and postpartum infection, which is beneficial to postpartum physical recovery; Natural childbirth has less bleeding, little influence on surrounding organs, early going to the ground, early exhausting, early eating, and quick recovery after childbirth; After natural delivery, the pain is obviously relieved, and there is no need to insert a catheter, which is conducive to outdoor activities and feeding the baby; Natural delivery is beneficial to the recovery of postpartum body shape, and postpartum exercise can be carried out earlier.
2. A natural delivery is beneficial for the baby's fetus to live from the womb that depends on the mother to live independently after birth, which is a huge change, and the baby must have an adaptation process to this change. The stress caused by the severe contraction of the uterus during natural childbirth will force the fetus to prepare for life outside the uterus. During vaginal delivery, the fetal head is squeezed by uterine contraction and birth canal, and the head is congested, which can improve the excitability of the brain respiratory center and help the newborn to establish normal breathing quickly after delivery. When the fetus passes through the vagina, its chest is squeezed. The sudden decompression and expansion of the chest after delivery is beneficial to the establishment of natural respiration after birth. When the fetus is delivered through vagina, the rhythmic contraction of the uterus will compress and expand the fetal chest, making the baby's alveoli elastic and easy to expand, and hyaline membrane disease will rarely occur after birth.
There is a certain pressure when the fetus passes through the birth canal, which will stimulate the stress response of the fetus and cause a series of endocrine changes, especially the increase of adrenocortical hormone, which can promote the production of immune factors and enhance the body's disease resistance; Immunoglobulin can be passed from mother to fetus in the process of natural delivery, and newborns with natural delivery have stronger resistance.
During natural delivery, although the fetal head will be elongated and deformed due to vaginal extrusion, this deformation is an adaptive change, which can return to normal within 1-2 days after birth, without damaging the brain or affecting the intelligence of the fetus.
Which posture is most conducive to natural childbirth? The pelvis is the only bone birth canal that the fetus must pass through during natural delivery. The pelvis is not a straight tube, and the sacrum at the back is bent backwards by a certain arc. The axis of the pelvis, that is, the line connecting the pelvic population, the middle pelvis and the midpoint of each plane at the exit, is a curve from back to down and then forward to down, and the fetus should do adaptive movement along this line during delivery. The correct posture of the fetus in the mother's uterus is the longitudinal delivery mode consistent with the mother's longitudinal axis, that is, the fetal head is down; Hip is on it, fetal back is on one side of mother, and limbs are on the other side of mother.
During delivery, the fetal head keeps falling. If the mother is standing, the fetus can easily press the cervix downward with the help of gravity, which is beneficial to the expansion of the cervix and can promote the progress of labor, especially when the fetal head is not in the basin. Standing or walking helps the fetal head to enter the pelvic entrance. It is the most unnatural position to take the supine position as soon as you enter the ward, which should be avoided. In the second stage of labor, when the uterus is fully open and the parturient holds her breath and exerts downward force, the posture of standing or sitting is the same as that of exerting force, which can accelerate the descent of fetal head and shorten the time of the second stage of labor.
Everyone feels comfortable in different postures, so you can exercise in various ways to find a posture that suits you. When lying on your back, you will feel particularly painful uterine contraction, but changing your posture and moving your body, such as grasping the bed with your hands and doing exercises such as bending over, stretching your waist and turning your hips, will relieve the pain. At present, some hospitals have been equipped with equipment to help pregnant women adopt various postures, such as walkers, delivery chairs, fitness balls, etc., which can be selected according to their own needs. In a word, standing, squatting, sitting or walking should be adopted during delivery, which can not only relieve pain, but also be beneficial to the progress of labor.
How should the parturient closely cooperate with delivery in the three stages of natural delivery? 1. 1 How should the labor process be coordinated 1 What is the longest labor process? In the early stage of labor, the duration of uterine contraction is short, the rest interval is long, the uterine contractility is weak, and the parturient feels mild abdominal pain, which is tolerable. At this time, if the fetal membrane has not yet broken, if the doctor agrees, you can get out of bed properly. If the fetal membrane has been broken, you should stay in bed immediately to prevent the baby's umbilical cord from coming out. With the progress of labor, contractions become more and more frequent. Because of the pain of uterine contraction and the long questioning time, primiparas tend to be nervous and afraid. At this time, we should treat contractions correctly, and don't always think about how long it will hurt next. We should think that uterine contraction brings pain and hope, and every contraction is a step forward for the fetus.
With the continuous opening of the cervix, the contractions will become stronger and stronger. Maternal abdominal pain is getting heavier and heavier, and the interval between questions is gradually shortened, often feeling that there is no chance to breathe. If the parturient feels unbearable pain during contraction, she can take some relaxing actions, such as taking a deep breath evenly and rubbing her lower abdomen gently with her hands; When the lumbosacral pain is serious, you can press the pain with your hand or fist until the pain is relieved; It can also be assisted by family members or nursing staff. You can also sing, moan, etc. In order to relieve pain, and try to change various postures, find a comfortable posture that suits you and avoid supine position.
1 At the end of labor, when the cervix is about to open, the parturient will feel involuntary downward force due to the oppression of the fetal head on the rectum, but at this time, the doctor will remind the parturient not to exert force too early to avoid adding unnecessary burden to the fetal head and cervix. It is suggested that pregnant women can lift their chin, so it is easy to exert force in the direction of throat and exhale slowly to avoid excessive abdominal pressure.
Delivery requires physical exertion, so women should pay close attention to the interval between contractions to replenish energy. When contractions are tight and slack, you must rest during contractions, relax yourself, pay attention to eating, drinking and sleeping well, defecate on time, and cooperate closely with medical staff. At this time, the diet can eat some digestible porridge, eggs, milk, vegetables, fish and lean meat. Many pregnant women like to eat chocolate because it is high in calories. Also pay attention to replenish water in time to ensure abundant energy and physical strength. Pay attention to frequent urination, because bladder swelling not only affects the decrease of the first exposure, but also affects the contraction. If there are no contraindications, the doctor should give the parturient an enema. After enema, the parturient should try to defecate.
Generally speaking, if there is no abnormality in the pelvis and fetus, the speed of delivery is directly proportional to the degree of abdominal pain. The stronger the contraction, the heavier the abdominal pain, the faster the cervical opening and the faster the progress of labor. It is not a bad thing that the frequency and intensity of abdominal pain increase at this time. After knowing the situation, the parturient must try to control her emotions, don't shout loudly, and cooperate closely with the doctor to successfully spend the long first stage of labor.
2. How to cooperate with the second stage of labor is the most tense and exhausting period, and it is also the key period to ensure the safety of mother and baby. Whether the progress is smooth or not depends on whether the parturient can cooperate closely. Maternal women should always tell their feelings to doctors and companions and listen to suggestions and guidance. At this time, in addition to strong contractions, there is also the pressure of abdominal muscle contraction, and the two must cooperate with each other, so that the strength will be strong and the fetus will be delivered smoothly. Therefore, it is very important for parturient to exert force correctly and increase abdominal pressure. When entering the second stage of labor, because the fetal head compresses the pelvic floor muscles, the parturient will begin to feel flatulence like defecation and will involuntarily push down. At this time, the mother should learn to exert force again during contraction.
At the beginning of uterine contraction, the pregnant woman takes a deep breath first, and then holds her breath with the rhythm of uterine contraction until the contraction is over. When uterine contraction requires rest, the parturient should pay attention to rest and stop exerting force. This repeated uterine contraction combined with abdominal muscle pressure can accelerate the delivery of the fetus and shorten the second stage of labor. Sometimes the pain of perineal tear will affect the maternal exertion. At this time, the mother should relax and not worry too much. Because the midwife is going to give birth, she will try her best to protect the perineum and help the fetus give birth smoothly.
Breathing in the second stage of labor is characterized by breath-holding, so women should adjust their breathing, inhale before contraction, hold their breath at the peak of contraction, and keep their mouths closed so as not to leak. The frequency of breathing is not easy to be too fast, and 10 ~ 15 times/minute is appropriate. Although rapid deep breathing increases the ventilation volume per minute, it is prone to hyperventilation, and the carbon dioxide in the blood is quickly discharged, causing temporary cerebral vascular contracture and cerebral ischemia, leading to physical discomfort, dizziness and even numbness of limbs.
After the uterine orifice is completely opened in the second stage of labor, you should hold your breath correctly and exert yourself reasonably under the guidance of a doctor, that is, inhale deeply and hold your breath during contractions, and exert yourself toward the anus with a sense of defecation. Be careful not to lift your hips, pull the handle when exerting yourself, stop exerting yourself when contractions are intermittent and have a rest. When the fetal head is about to be delivered, pregnant women should open their mouths to breathe and avoid exerting force to prevent the fetal head from being delivered too fast and the perineum from tearing.
3. How to cooperate with the third stage of labor? After the fetus is delivered, it will enter the third stage of labor. The third stage of labor is generally short, generally less than 30 minutes. The parturient does not have a strong feeling, even pain, as long as she cooperates with the doctor to check whether there is any wound in the vagina. If there is a laceration, she should immediately cooperate with the doctor to sew it up. If the placenta is not delivered in time or only a part is delivered, the doctor will take measures, and the mother will rest quietly and cooperate.
What happened to cesarean section? Cesarean section is an operation to cut the uterus through the abdomen and take out the viable fetus after birth. Proper application of this operation can make the mother and baby safe, but it should not be carried out rashly. After all, cesarean section is an operation, and there is more maternal bleeding. Peripheral organ damage may occur during the operation, and complications such as infection and late postpartum hemorrhage may occur after the operation. Because there are scars on the uterus, it is easy to rupture the uterus when pregnant again, so be careful to determine. Delivery is a physiological process and natural. Cesarean section is only a means to solve dystocia and cannot be implemented blindly.
What circumstances require cesarean section, mainly head and pelvis asymmetry, such as pelvic stenosis or pelvic malformation, giant fetus and so on. Abnormal soft birth canal, such as soft birth canal atresia, tumor, scar, severe varicose vulva, etc. Threatened uterine rupture; Weak uterine contraction, ineffective after treatment, leading to prolonged or stagnant labor; Abnormal fetal position, such as breech position and transverse position; Fetal intrauterine distress; Oligohydramnios; Umbilical cord prolapse; Prenatal bleeding, such as placenta previa and placental abruption; Pregnancy again after cesarean section; After myomectomy; Failure to induce labor; Older primiparas; Breech position of primiparas over 35 years old; Maternal systemic complications, such as heart disease, hypertension, diabetes, etc. Obstetric complications, such as severe pregnancy-induced hypertension, gestational diabetes, twins, intrauterine growth retardation, etc.
What accidents are prone to cesarean section? Some pregnant women think that cesarean section is the most convenient, and both children and adults are easy and safe. But for pregnant women, cesarean section is a major operation, because the mother is overworked in order to give birth to the fetus, coupled with the stimulation of surgery, the probability of complications will be higher than that of natural delivery:
(1) Anesthetics must be used in cesarean section, and occasionally maternal anesthesia allergy will occur, resulting in irreparable consequences. In addition, epidural anesthesia is generally used for anesthesia, and the mother will not have surgery if she has no feeling at all. Listening to the sound of the collision of surgical instruments will inevitably lead to nervousness and cardiovascular abnormalities. If you want to operate without feeling, you need to add some sedative and hypnotic drugs, and these drugs and some anesthetic drugs may inhibit fetal breathing and cause neonatal hypoxia. The decrease of blood pressure during anesthesia will cause fetal hypoxia or aggravate fetal hypoxia.
(2) Cesarean section is more complicated than natural delivery, and the level of incision and suture of abdominal wall and muscularis is also higher than natural delivery; Opening the naturally closed abdominal cavity will lead to more blood loss than natural delivery, and the probability of postpartum hemorrhage and infection will be higher than natural delivery. For example, the average blood loss in natural delivery is 50-200 ml, while the average blood loss in cesarean section is more than 200-300 ml.
(3) Due to the interference of cesarean section, the parturient needs to gradually restore gastrointestinal peristalsis after operation. When the gastrointestinal peristalsis function has not recovered, the parturient's abdomen is often prone to flatulence and can't eat normally. On the one hand, it takes longer for the body and uterus to return to the prenatal state than natural delivery, and the hospitalization time is often longer and the cost is higher; On the other hand, the pain, discomfort and mobility of abdominal wounds will affect the mood of parturient women, thus affecting their lactation and nursing of newborns.
(4) Women who have had cesarean section should not be pregnant again in the short term. Because the uterus will leave a big scar, once pregnant, induced abortion will be more difficult, which will easily lead to some complications, such as incomplete abortion and uterine perforation. If the unfortunately pregnant embryo sac happens to be planted in the surgical scar of the uterus, it may lead to the rupture of the old scar of the uterus, and if it is not rescued in time, it will threaten the life of the pregnant woman. Therefore, cesarean section patients must be strictly contraceptive after operation, but there is no perfect contraceptive method at present. Because of the fear of getting pregnant again, women's sexual life will be affected for a long time after delivery.
(5) For most newborns, cesarean section has no obvious disadvantage. However, a small number of babies delivered by cesarean section are unable to adapt to the new environment after birth because they are not squeezed by vagina, and are prone to atelectasis or integration disorder, so they need treatment in childhood.
Natural vaginal delivery is very beneficial to both pregnant women and fetuses. For a long time, most women have a wrong understanding of natural childbirth, thinking that natural childbirth will widen women's pelvic floor and enlarge their buttocks, which will affect their physical beauty and even their sexual life; In fact, natural vaginal delivery is more conducive to uterine contraction and lactation. Healthy pregnant women should choose a natural mode of production that is beneficial to them.