Beginning of the second period of labor
When the child enters the second period, or, as it is also called, the stage of expulsion of the fetus, the woman not only clearly realizes its beginning, but also feels great relief. Now she can take a more active part in childbirth. The pain in the back disappears, everything inside the abdomen moves forward and soon, in an hour or two, if she does a good job, her baby will be born. We can say that with the beginning of the second period, labor begins.
When a second period is established, the order of birth changes. The patient should not be allowed to exert much pressure, she only needs to maintain her breathing at every bout to bend forward to increase pressure on the top of the uterus. A big mistake is to exhaust the woman already in the beginning of the second period with excessive muscular efforts. The uterus will do this job itself, it needs only minimal help. During the second period, attempts and fights that require physical effort become very frequent, relaxation during bouts is possible only for a short time, therefore, once the fight is over, the mother should lean on the support, close her eyes, breathe in and out one or two times, and try to relax as much as possible. Contractions can occur every five to six minutes at the beginning of the second period and two to three at the end.
Often after ten to twelve clashes a woman becomes sleepy between them. This state of indifference to the environment is the only way to maintain a relaxed state. His goal is not to eliminate the pain, since very few women feel it at this stage of birth, no, this is the state by which the thoughts and body of the woman completely rest, creating the conditions under which the body recovers to a greater extent. This is how she prepares for every fight, without getting tired. At such moments it is very important in the patrimonial chamber to preserve the situation of complete silence and tranquility. Discouraged conversations, awkward movements, heavy steps and slamming doors are unpardonable sins in the presence of a woman giving birth.
Soft lighting helps to relax. There are women who even fall asleep between fights, others simply become immune to the environment. It is often difficult to get a mother to understand what she has said, unless she speaks loudly into her ear. By the way, from that moment she will rather react to the commands submitted by her husband, so it is useful to use such tactics: the doctor gives directions, and the husband hands them over to his wife. Usually, there is no need to move the woman in the other ward. By the way, this is a purely American custom. In most other countries, births take place in the same room, in the same bed.
Position. As soon as the second period begins, and the mother helps to push the child out through the birth canal, she should adopt a semi-sitting position, legs bent in the hip and knee joints. Adoption of this position gives the greatest freedom of muscular activity and facilitates easier passage of the presenting part of the fetus through the birth canal.
The parturient should be placed on the bed of birth at an angle of about 45 degrees. The angle varies according to the wishes of the mother. During the fights, she bends forward, knees while next to the armpits. When a woman gives birth to her legs under her knees and starts to swing up and down, her feet should be supported by stirrups or assistants. A pregnant woman may prefer not to be in bed, but lean against a wall in a squat position or kneel - in any case it is necessary to be supported. Swinging the pelvis and hips, standing on the knees or squats is of great help if the child is in the back view or pelvic presentation. Assistants, communicating with the woman in childbirth should do everything possible to determine the most convenient position for her. The doctor or midwife, if necessary, can not be too lazy, kneel and lay a sterile sheet on the floor under the patient.
Established second period of labor
Breath. If the ejection reflex works well, then the woman leans forward and at the peak of each fight makes the exile effort. As soon as the fight begins, she must breathe once or twice, and then push along while the scrum increases, keeping her mouth relaxed, her lips slightly open, exhaling slowly and calmly. She can breathe again, if necessary. There is no need for much effort, the mother in labor should not hold her breath for long, as this reduces the amount of incoming oxygen and increases the carbon dioxide content in the blood, giving the skin a reddish-blue color. If this does happen, then remind the mother to have her breathe and continue to breathe through her mouth. Breathing through the mouth helps to open the perineum. A woman can imagine how her body gently exhales the baby down, about the same way she exhales the air through her mouth. This relaxed, but effective pushing out successfully propels the child forward. Do not accelerate the events.
After each reduction the woman should bend, two or three times take a deep breath, then completely relax and wait for the next bout, remaining at rest.
Both during expulsion and during rest, the woman in labor should be maintained, regardless of the position she chose. Some women are exhausted, it is very difficult for them to keep their body and legs elevated all the time. Remember: the respite time is not the time to force a mother to sit down or raise her legs even higher! The energy of the mother must be preserved only for the expulsion of the child.
There is no need to stretch your legs or rest your feet - this creates additional muscle tension, which can spread to the perineum. The mother must feel how everything in her stomach goes down, legs should be relaxed and apart apart, knees rest on pillows or be supported by assistants. It is very useful that at this time the giving birth holds someone by the hand or by the forearm.
Relaxation. This can not be required from a woman in labor, but one should strive for this - the correct and timely relaxation of the body during the period of exile.
The very process of exile is already predetermined by nature: the door is wide open, the birth canal is ready for the child to pass through it. The mother, to a certain extent, can help the uterus muscles, forcing them to expel the child. However, this requires considerable physical effort. After every contraction of the second period of labor, a woman may begin to suffocate, she needs to breathe deeply and exhale to quickly fill the lack of oxygen. But between the contractions of the parturient woman it is necessary to completely relax. Relaxation is the most effective way of restoring muscle strength.
Usually at this time there is a rupture of the fetal bladder in which the child is. A woman should be warned about the proximity of this event, because many are frightened by the sudden discharge of a large number of waters.
In the second stage of labor, if there is discomfort, then a small one. When the birth is properly administered, when the pelvis meets the requirements and the child's position is normal, the mother is usually free of fear. If there is pain, it usually speaks or that the child is too large for the mother, or for his wrong intrauterine position.
It often happens that before the second period, women become bored and get tired of feeling that nothing depends on them, that they can not speed up the child's birth. Therefore, when active activities begin, many women in labor experience a sense of relief, they realize that "their hour has come." With honest, good work, with conscientious efforts of pain when expelling the child is not felt. Saying this, I, of course, mean not pathological cases, but natural physiological births.
When the head begins to press on the bottom of the pelvis, the woman is often difficult to relax the muscles of the outlet, as this is a completely new sensation for each of them. If the mother is frightened of these sensations and begins to try to resist at the moment when the child's head, approaching the outlet, is only about three centimeters away from him, provoking the narrowing of the pelvic floor and perineum, then in that case she not only misses a good chance not have pain, but also helps to break the perineum.
At this time, some women have such a strong fear that they uncontrollably want to just stand up and run away. It is very important not to give the woman in childbirth to succumb to such moods, to convince her that even if it is very painful for her, it can be overcome. She must be sure that when the disclosure continues, nothing "breaks." She needs to tell how to transfer the inconvenience. At the next fight she needs to concentrate and try to push the child out as much as she can. As soon as it creates the maximum pressure of the child over the pelvis, the resistance will disappear and the head will quickly and painlessly pass down through the external genitalia.
Completion of the second stage of labor
When the head is shown and the intervals between contractions disappear, a new stage of labor begins, which is called completion. When the external genitalia of a woman (vulva) widen by about five centimeters, you may feel that she has been excessively stretched and she is about to burst.
It is very important that at this moment the woman relaxes completely and breathes with her mouth open. Especially you should pay attention to the relaxation of the jaws - this will help relax the muscles of the perineum. The parous should be told that if she relaxes well, then the head will not tear the perineum. I do not cease to wonder how such a large child passes through such small external organs without any breaks, but that's exactly what happens if a woman does everything right. I'm sure a large number of torn crotches occur because of the resistance of the women to the head exit, when they forcefully squeeze the muscles of the outlet. If the husband notices that his wife's mouth is closed or turned into a gloomy line, then he must immediately remind her of the need to relax and breathe with her mouth open.
As soon as the head appears, all the labor of the parturient should be stopped. Now the uterus itself slowly directs the child forward, while the woman should completely relax, open her mouth and begin to inhale and exhale quickly. In this case, the genitals stretch gradually, without violence, without rupturing the skin, without causing pain. You do not need to strive for a quick result, you do not need to hurry up giving birth.
When the head completely leaves, the assistant should support it and raise above the genitals of the mother. After the appearance of the head, there is often a pause. The child can scream before the shoulders appear. And they appear with the next reduction, which too must be completely controlled by those present in order to prevent too rapid advancement of the child. The assistant may ask the mother to refrain from abruptly pushing out during the contraction or to give birth very gently - to push slightly only if the uterus requires, as a rule, little help.
When a child appears under such conditions, a woman who was conscious and without anesthesia often realizes that her child was born only after hearing his cry. The child passes through the relaxed external genitalia in the absence of any sensations in the mother. There is no doubt that with the relaxation of the external genitalia, a temporary natural anesthesia of the sensitive nerve endings occurs. I remember the birth of a young woman. When she began the second period, I instructed her how to give birth, and asked me to gently and gradually increase the effort. Then I sent for medical students to come and watch. It seemed that they could not believe that you could do this with a smile and calmly go through the first period of childbirth. After the next few fights, the rectum protruded. Soon a head appeared. The woman looked at me inquiringly and said: "Can I push harder?" It feels like something should just about stand out. " I assured her that nothing strange was happening, that this was a temporary feeling, and as soon as the head appeared, it would disappear. She accepted my assurances with confidence, and indeed, after three or four fights in my hands, the child's large head slid easily and painlessly. I hastened to inform my mother that the head had appeared and that she was very pretty. She did not believe me. But I said that she can feel the heaviness of the head on her thigh, moreover, she can see it. She did not believe it until she looked down and saw the child.
I asked her to give birth further easily, so that a corpse appeared. She said: "Just tell me right away whether it's a boy or a girl." My husband and I are waiting for the boy. " And so - I lifted to her a weeping, beautiful boy, whose mass, as we soon established, was three kilograms of seven hundred grams. Oh, you should have seen her joy! At the same time, I can assure you, during all the births the word "pain" was never uttered. We showed the mother how to use the mask for breathing, but she refused, assuring us that there was no need for a mask. When she took the child in her arms, she was too excited to speak at first, but then she said: "I have to look more closely." It's hard to believe, I have a boy. "Oh, how wonderful that is!". She laughed and began to caress her child. Tears of joy rolled down her cheeks.
The third period of childbirth
With natural childbirth, when the child has already appeared, there is no need to relax. Here, if there is some tension, it is nothing more than a wonderful sense of satisfaction. Fatigue from muscle effort instantly disappears from the memory of the mother, as soon as she hears the cry of the newborn child, as soon as she sees it. All this stimulates the uterus to begin the next period of labor - detachment and expulsion of the afterbirth.
Often a mother helps raise a newly born child and takes it directly to her breast. Her husband can also help by putting his hands under the child. Thus, immediately, immediately at the moment of birth, the child feels a simultaneous touch of both parents. Mother and baby cover with a warm blanket. All babies need to be immediately applied to the chest, this action is programmed instinctively and genetically. Do not rush to bandage the umbilical cord. It is better to do this in about five minutes, when its pulsation will disappear. After that, the father can cut the umbilical cord, if, of course, he wants to do it. The child should immediately be cheered, pat and caress.
If the child at this time begins to suck mother's breast, it causes strong reflex contractions of the uterus, leading to faster separation of the placenta and closure of the blood vessels at the place of attachment of the placenta to the uterus. The presence of contractions can be seen if you put your hands on the mother's abdomen at the moment when the baby is first laid on the chest. Thus, here is another great benefit of the newborn's physical contact with his mother - the rapid separation of the afterbirth and the absence of excessive blood loss. How much this is important, I think, it is not necessary to explain.
If small lesions appear on the skin, and midwives believe that they should be sewn, the seams should be applied immediately, while the perineum is still numb - this will create a minimum of inconveniences for the woman and can be performed without anesthesia. When applying seams, women are asked to relax.
As I said, this should be done immediately, because in a very short period of time the natural anesthesia of the external genitalia will disappear.
If, for one reason or another, this procedure is delayed by a quarter of an hour or more, it is recommended to perform a small local anesthesia in the area through which the thread passes, introducing a 1% solution of novocaine. This is a relatively harmless anesthetic for the perineum, you should not give it up categorically. In the treatment of ruptures, it should be borne in mind that the ruptured surfaces brought into contact before coagulation coalesce faster and stronger than those left open. The stitches are imposed by a doctor or midwife.
One can not lose sight of the fact that many women are confident that the procedure for separating the afterbirth is an event even more painful and uncomfortable than giving birth. It is necessary to convince her that this is not so, and constantly observe her psychological state at this final stage of childbirth.
Now the mother does not need to relax. The doctor may ask her to gently relax, and after a while she will push the latter out without any help from the doctor with minimal loss of blood. This very often occurs with natural childbirth - exhaustion and shock are absent.
The placenta is a spongy, soft organ, the size of which depends on the weight of the child's body. It is usually oval or semi-circular, has a width of fifteen to twenty-three centimeters and a thickness of about two centimeters. Tapering and taking the shape of the birth canal, the placenta usually comes out without any difficulties.
More recently, it was not heard about a woman wanting to see the latter. Nowadays, almost everyone in natural childbirth asks to show the placenta. In such cases, I never refuse my mother and show her a bag in which the baby, now peacefully lying in her arms, developed and became such a perfect living being. I show her the umbilical cord, explain how she was attached, and tell me about the method of filtering from the maternal blood of the substances needed to build the body, the child's brain. I myself do not cease to marvel at the amazing properties of the placenta to isolate the necessary substances and to reject harmful ones. There is something to ponder over the inquisitive mind.
"Madam," I say to my patient, "when a person can create the same perfect thing as the placenta himself, he will reach the Creator's foot." I hold this rejected mass in my hands, and I can not help thinking about the imperfection of science in comparison with the power of nature " .
After birth, the external genitalia, crotch and inner thighs are washed with a warm weak disinfectant solution and dried with a sterile napkin prepared in advance.
So, the birth is over. A woman accompanied by her husband returns to bed, where they give her a cup of tea, orange juice or something else and arrange for a rest. A newborn child must be left with the parents.