Preparation for childbirth
What are the "terrible" planned births?
At the end of pregnancy, most expectant mothers look forward to the onset of labor. But sometimes there is a need to cause labor activity ahead of schedule. In what cases can doctors make a decision about induction, and how are such births different from natural ones?
Ekaterina Svirskaya Obstetrician-gynecologist, Minsk
Absolutely normal is the appearance of a baby at any time between the 259th and 294th days of pregnancy. However, sometimes there are situations where further continuation of pregnancy threatens the life of the mother or fetus, and it is necessary to accurately plan the date of delivery. In this case, they talk about "planned" or "programmable" births, in which the beginning of labor is completely controlled by a doctor. Such births are triggered by various medications or manipulations at a predetermined day and time. They are conducted in full term pregnancy (at 38-41-st week).
When are scheduled births scheduled?
Indications for planned births are formed from two groups. The first group is the testimony from the fetus, if for some reason the further stay inside the womb is dangerous for the child. The second group of reasons is from the pregnant woman, if this or that disease of the future mother requires detailed observation and rendering of specialized help during labor or does not allow prolonging the pregnancy further without risk for her health.
Indications from the fetus include:
Hypoxia of the fetus - a condition that occurs due to insufficient supply of oxygen and nutrients to the baby. The most sensitive to oxygen deficiency is the nervous system, which suffers first. In addition, metabolic processes are violated and the adaptive capabilities of the newborn are reduced. Severe hypoxia is accompanied by ischemia (areas with a deficiency of blood flow) and necrosis (places of destruction of tissues) in various organs, which causes irreversible consequences.
Mature pregnancy - if after the expected date of delivery, 10-14 days have passed, and births have not occurred. When the child is overweight, the child usually has larger sizes, the fetal head bones become denser, and the joints between them are less mobile, which leads to difficulty in its configuration during childbirth (reduction in size due to the presence of the skull bones on each other). In addition, the baby needs more oxygen and nutrients, and the placenta can no longer supply them in the required quantity. All this leads to a deterioration in the conditions of fetal life, which forces doctors to plan delivery as soon as possible.
Rhesus-conflict may occur during pregnancy, if the Rh-negative mother gets Rhesus-positive red blood cells of the child. In this case, the maternal organism will perceive them as something alien and begin to produce antibodies that destroy "aliens". If for some reason these antibodies get through the placenta into the baby's blood, they will begin to destroy its red blood cells, and the fetus will have hemolytic disease.
Diabetic Fetopathy - a deviation in the development of the fetus associated with high blood sugar in pregnant women (most often it develops in expectant mothers who suffer from insulin-dependent diabetes mellitus). Such children are very large, but not at the expense of good health, but due to puffiness and excess fat. This is due to the fact that the pancreas of the child produces a lot of insulin for processing glucose, coming from the mother's body, thereby changing the metabolism of the baby in the direction of "accumulation". With increasing signs of fetopathy, prolonging pregnancy can lead to fetal death, so birth plans for 38-39 weeks or even earlier.
The testimony from the side of women is:
Gestosis (nephropathy) Is a formidable complication of the second half of pregnancy, which is manifested by increased blood pressure, swelling and the appearance of protein in the urine. This condition can endanger the life of the mother and baby. Gestosis is medically treated, but if therapy is ineffective, scheduled births are prescribed.
Severe chronic diseases of a woman, such as diabetes mellitus, heart disease, hypertension, kidney, lung, blood coagulation disorders. Planned delivery is necessary when pregnancy aggravates the patient's condition or because of the high risk of complications it is necessary to have a presence at the birth or consult other specialists, except for midwives (therapists, hematologists, etc.).
Scheduling can be attributed to delivery by caesarean section, when it is known in advance that the pregnancy will end in this way (for example, with placenta previa when it blocks the exit from the uterus, if the size of the woman does not match the size of the fetus, the serious condition of the future mother and fetus and other). In these cases, the date of the operation is planned.
Scheduled birth: we prepare in advance
To decide whether planned births are necessary and in what way (through natural ways or by cesarean section) they will pass, the obstetrician-gynecologist of a woman's consultation can direct a woman to an antenatal hospitalization in the department of pathology of pregnant maternity homes. In the hospital, the future mother is examined. She passes the necessary tests (general and biochemical blood test, general urine analysis, smear, etc.). CTG (record of fetal heartbeats and uterine contractions) assesses the child's condition, if necessary, ultrasound with dopplerometry (allows to study the nature and velocity of blood flow in the vessels of the placenta and umbilical cord, the violation of which leads to the development of fetal hypoxia). On the basis of the data obtained, taking into account medical indications, contraindications and possible complications, a consultation of several doctors decides on planned births and appoints their date.
After this, the attending physician explains to the woman the reasons for which planned births are needed, tells about the methods of their launch, possible complications in the process of induction. After this conversation, the patient must give her consent to the planned delivery.
Preparation for planned delivery depends largely on the "maturity" of the cervix. Ready for delivery is considered a soft neck 1 cm long or less, while its channel should freely pass one or two fingers of the obstetrician. If signs of maturity are not expressed enough, then conduct special training. For this purpose, different methods are used: intramuscular injections of estrogens (hormones that promote the maturation of the cervix), introduction of laminaria into the cervical canal - special chopsticks from algae that swell and open at the contact with the contents of the vagina. But most often apply gels, containing prostaglandin hormones, which are injected into the cervical canal or into the vagina. They contribute to a change in the structure of the cervical tissue, ensuring its "maturation", as well as causing contractions of the uterine muscles, triggering childbirth. If after the procedures the cervix is ripe, then the next day appoint scheduled births. If not, decide whether to continue its training or on operational delivery.
How to give birth?
Birth stimulation is always carried out on weekdays at 6-7 o'clock in the morning, so that the process takes place during the day. On the eve of a woman need a good night's sleep, so that the body was rested, because childbirth is a great physical load. If a woman is worried and can not fall asleep herself, she is prescribed sleeping pills. In the morning, the usual hygienic procedures are performed - shaving the perineum and cleansing enema.
To conduct induction of labor, the future mother is transferred to the maternity ward. There, during a vaginal examination, an autopsy of the fetal bladder (amniotomy) is performed. It is assumed that opening the fetal bladder by decreasing the volume of the uterus, contracting its muscle and pressing the fetal head, promotes mechanical irritation of the birth canal. In addition, amniotomy stimulates the production of prostaglandin hormones, which enhance the activity of the genus. If, after the outflow of water, normal labor begins and the labor proceeds without any significant difficulties, the birth of the child can be expected at 14-18 hours of the day.
If there are no contractions 2 hours after the amniotomy or their strength is insufficient, then artificial activation of labor activity by means of intravenous medication is initiated. Wait longer becomes dangerous, since amniotic fluid no longer protects the baby, and the risk of getting infection to it through the cervix is great. Sometimes there are situations when even these manipulations are ineffective, and births have to be completed by cesarean section.
If a planned cesarean section is planned, a woman will be prescribed sleeping pills for the night before the night, hygiene procedures are performed in the morning, after which the patient is transferred to the operating unit.
Planned births: everything is under control
The advantage of planned births is the possibility of closer monitoring of the patient. Such births take place in the daytime, under the control not only of the duty brigade, but also of the entire staff of obstetricians, medical specialists, pediatricians. In addition, planned birth gives the woman the opportunity to sleep and psychologically prepare for them.
However, after the induction of parental excitement more often than with spontaneous birth, a weakness of labor occurs, which requires drug-induced stimulation. Artificially induced contractions are stronger and more painful than natural ones, and the intervals between them are much shorter. In this regard, a woman does not have time to rest in a break between contractions of the uterus, which often requires additional use of painkillers. In addition, when using a dropper (which is often found in planned births), a woman is forced to be in the most uncomfortable and inefficient position for the birth of a child - lying on her back. This increases the painfulness of contractions and prevents the opening of the cervix.
Uncoordinated, too strong fights can cause a violation of blood circulation in the uterus, which will result in oxygen starvation of the child. Therefore, when stimulating labor, careful monitoring of the fetus is necessary. If possible, the fetal heart rate is recorded continuously using CTG, in which the woman in childbirth should also be lying.
Weakness of labor, not amenable to drug correction, suffering of the fetus and worsening of the condition of the woman in childbirth, are the main reasons why scheduled births are somewhat more often completed by cesarean section than those with a natural beginning. However, experience shows that as a result of planned births in expectant mothers with a high risk of complications in the vast majority of cases, the appearance of the baby is successfully carried out.
If there is a tendency to overstretch, if the mother and child are completely healthy and the gestation period has passed the expected date of birth (PDR), natural stimulation methods can be used:
- walking, light physical exercise - while the child presses on the cervix, which makes it start to unfold;
- sexual intercourse - the sperm contains natural prostaglandin hormones that promote the maturation of the cervix, and orgasm causes muscular contractions of the uterus;
- massage of the nipples - it increases the content of oxytocin in the blood. You can spend it 3 times a day for 10-20 minutes.
The effectiveness of natural methods is lower than that of medical ones, and before their application it is necessary to coordinate their actions with a doctor, since any of them has its contraindications.
Mark Arkadevich Kurtser, Corresponding Member of RAMS, Professor, Chief Obstetrician-Gynecologist, Department of Public Health of Moscow
In the last weeks of pregnancy, almost every future mother thinks about what it would be good to know exactly when a child will be born. However, the child does not check his hours with his mother and doctors, therefore the only situation when the day and time of delivery is prescribed by doctors is scheduled births.
Scheduled deliveries can be carried out only on strict indications, and I, as a professional, fully agree with this. Interfere in a normal pregnancy because the doctor is more comfortable taking birth at a certain time or a woman is tired of being pregnant, absolutely not.
For such a complex procedure as planned births, there are a number of indications from both the mother and the fetus. From the mother's side, such indications can be gestosis, which was formerly known as nephropathy of pregnant women, diabetes mellitus, as well as various extragenital pathologies, for example, heart or lung disease, which require the termination of pregnancy and the onset of labor. In addition to the state of the mother's health, scheduled births can be performed according to indications from the fetus, which for various reasons is dangerous to be in the womb of the mother. Such a need may arise in the event of over-gestation, fetal macrosomia (when its size exceeds the norm), increasing the likelihood of such birth trauma, as hemorrhage or fracture of clavicles, as well as hemolytic disease of the fetus, chronic hypoxia and placental insufficiency. If there is no serious testimony, the best thing for the mother and the baby is the spontaneous onset of labor. Caused fights are more aggressive than natural ones, and the process itself does not always go smoothly, in particular, planned births more often spontaneous end with the operation of cesarean section.