Sudden birth. First aid during childbirth: stages and sequence of actions Childbirth at home

3246 0

Despite a wide network of maternity hospitals and thorough medical examination of pregnant women, sometimes it is necessary to provide first aid to women giving birth at home, by train, or by plane.

First aid

The newborn baby is placed on a clean sheet (diaper) ironed with a hot iron. After the pulsation of the umbilical cord has stopped, it is tied twice at a distance of 5 and 10 cm from the child’s navel with thread, ribbon or a strip of bandage, and then cut between the ligatures (Fig. 65).

The end of the umbilical cord must be treated with an antiseptic solution and secured with a sterile bandage, fixing it with a thread to the umbilical cord.

Rice. 65. Ligation (a) and intersection of the umbilical cord (b)

The mother and the newborn child should be taken to the maternity hospital as quickly as possible.

After the baby is born, within the first hour, the baby's place (placenta) should leave the birth canal along with the remains of the umbilical cord. The separated baby's place must be shown to a doctor, who will determine the completeness of the placenta's separation.

A retained placenta can cause serious illness. After childbirth, the perineum should be covered with a clean diaper or piece of cloth.

Buyanov V.M., Nesterenko Yu.A.

Partner childbirth is always a big responsibility: whether the expectant mother is accompanied by a friend, husband or one of her relatives, he should become a support and, if possible, alleviate the suffering of the woman in labor. Teachers in prenatal training courses often mention ways to alleviate a woman’s suffering due to contractions, but we decided to systematize this information.

1. Facial massage helps relieve stress and relax;

2. Remind the expectant mother to go to the toilet every hour: a full bladder is not only very unpleasant, but also increases the feeling of contractions;

3. Place a cold compress on the mother’s neck and face or lightly moisten it with cool water;

4. If doctors do not prohibit it, you can offer the woman water and light snacks - they will help replenish the energy that the expectant mother loses during labor;

5. Help the woman in labor change her position to speed up the process of cervical dilatation. Some positions will be painful, others will provide a short respite from the pain, your task is to find the best option for it;

6. During contractions, the expectant mother suffers from back pain: massage her lower back, lightly press on the sacrum. The position “on all fours” also helps to cope with pain;

7. Be close: Even if a woman does not want to be massaged during contractions, feeling the presence and support of a loved one is very important. Encourage her with words, hold her hand;

Light shower. Many doctors agree that water perfectly relaxes muscles and relieves pain, so if there are no contraindications, you can help a woman take a warm shower;

9. Try to distract the woman from the pain: if her condition allows, talk to her, listen to her favorite music, read something interesting. Be a mediator between the woman in labor and the medical staff;

10. Remind her that soon the painful sensations will pass, and the expectant mother will be able to hold her baby in her arms - this always works.

Video: Childbirth without pain

The appearance of contractions

Many women who will become mothers for the first time are worried that they will miss the onset contractions. In the last weeks of pregnancy, false contractions are observed, which are mistaken for harbingers of labor, but real contractions cannot be confused with anything. Harbingers of contractions can be: the passage of amniotic fluid, the appearance of a mucus plug that clogs the cervix, dull pain in the hips or back. The first contractions are similar to the pain and cramps during menstruation, but soon these sensations intensify. When contractions become regular, it's time to rush to the hospital. When the situation stabilizes, the duration of contractions ranges from 40 seconds.

This is the beginning of the first stage of labor, when the cervix begins to dilate. If this is your first birth, your uterine muscles may contract for 10-12 hours, so don't be alarmed or worried. You will have a formal interview and first examination at the maternity hospital; you may be asked to take a test for the presence of protein and sugar. If your water hasn't broken yet, you can take a shower.

Video: How to survive a fight

Comfortable positions during contractions

You can relieve pain or at least get a little distraction by changing body positions - your birth partner can help you with this.

• Vertical position. Effective in the initial stages of contractions: you can lean against a wall or bed. You can sit on a chair (facing the back), leaning on a pillow. To make sitting softer, another pillow can be placed on the surface of the chair. Lower your head into your hands, breathe calmly and measuredly, spread your knees to the sides;
• Kneeling or supported position. During contractions, you can put your hands on your husband's shoulders and lean on him while standing. Ask for a relaxing massage. You can also kneel down, spread your legs, and place your hands on the pillow. Try to keep your back straight;
• "On knees". It is most convenient to take this position on a mattress: make forward movements with your pelvis, try to relax between contractions, resting your head on your hands. If you put your weight on your arms, you will reduce the back pain caused by the baby's head during cephalic presentation (it rests directly on the mother's spine). In the intervals between spasms, you can walk, your partner can massage - pressing in a circular motion on the base of the spine is especially effective;
• Movement helps to cope with the pain from contractions - you should walk at intervals, keeping your back straight, then the baby's head will rest against the cervix and the dilatation process will go faster. Try to relax during breaks, focus on breathing. Visit the restroom more often - a full bladder is not the best feeling, and it can interfere with the progress of the fetus.

Second stage of labor or pushing

For a woman, the most difficult time is the end of the first phase, contractions become long and painful, and also very frequent. At this moment, the woman needs help and support, since you may encounter tears, depression, the expectant mother may begin to feel chills or begin to fall asleep. Breathe with her, support her, wipe away the sweat. If you see that the woman in labor is cold, take care of a warm robe and socks. If you start pushing, call your midwife.

The second period is the expulsion of the fetus, so in addition to contractions, the woman in labor needs to make her own efforts, listen to the guidance of the midwife. The duration of this period is up to several hours.

Video: Breathing during contractions and pushing

Positions for the second phase of labor:

• "On knees". Gravity opens your pelvis faster, but you may feel tired quickly. It is best if your husband sits on the edge of the chair and spreads his knees, and you can sit comfortably between them and rest your hands on his thighs;
• On the knees. The position is less tiring and reduces pain. It is best to have your spouse support you to make your body more stable. If you feel tired, lean on your hands, but keep your back straight;
• Sitting on the bed. If it’s not very comfortable, surround yourself with pillows. As you begin to push, you can lower your head down and clasp your legs with your hands; do not forget to rest in the interval.

Childbirth

During this period, all the expectant mother needs is to listen to the doctors’ instructions. As soon as the baby's head appears, you will no longer need to push, relax, catch your breath. After a few contractions, the baby’s body will appear: after the little miracle is placed on the woman’s stomach, the torment is quickly forgotten. Then the baby is taken for examination: the neonatologist makes a control weighing, takes measurements, and cuts the umbilical cord.

After giving birth, women often receive an injection that increases the contractions of the uterus to help the placenta come out faster, otherwise, if you wait until it comes out naturally, you can lose a lot of blood. This issue is discussed in advance with the doctor, as is pain relief.

Childbirth is a tiring and difficult process, but all unpleasant sensations are forgotten when you hold your baby for the first time.

Home birth, which has become extremely popular in recent years, is not encouraged by official medicine. But there are cases when emergency childbirth occurs and, due to various circumstances, a woman is deprived of timely medical care. In such a situation, her loved ones need to be prepared to competently deliver the baby themselves.

Essentials

If there is little time left before the due date, it is more prudent to refuse trips to hard-to-reach places (for example, to a dacha, where the nearest medical center is hundreds of kilometers away) or long flights. If such a trip is vital, you should always have on hand things that may be needed during an emergency birth:

• sharp scissors or knife
• alcohol (or vodka)
• boiled water (at a minimum - a supply of clean water and an electric kettle)
• iodine (or manganese)
• bandages and cotton wool
• strong threads
• a small rubber bulb (or a clean, small-diameter straw, such as a cocktail straw)
• clean diapers or sheets (to ensure their sterility when traveling, it is better to have a cordless iron with you)
• shaving accessories

Algorithm of behavior during emergency childbirth

Remember: only in the movies, during an emergency birth, does someone take responsibility, ask in a stern voice to warm the water and bring clean linen, close the door behind the woman in labor, and after a short period of loud screams coming from behind the door, we are shown a happy mother with a beautiful baby on hands.
In real life, things are different. You must be mentally prepared for the sight of blood (and other unsightly things from an aesthetic point of view), and the birth itself can take from 15 minutes to several hours. Therefore, your main task before the ambulance arrives (and you must call it, even if you see that it will not arrive by the time labor starts!) is not to worry (otherwise your excitement and uncertainty will be passed on to the woman in labor) and strictly adhere to consistency in your actions.

1. If a woman’s water breaks and contractions become regular, help her undress and lie down (or sit with her back leaning against some support).

2. Place a clean sheet or diaper under the woman.

3. Lay out everything you might need within arm's reach on a clean diaper.

4. Wash your hands with hot water and soap and wipe them with alcohol (or vodka).

5. If possible, sterilize the tools at hand (boil for 5 minutes or wipe them twice with alcohol or vodka).

6. Wash the woman’s perineum with warm water and soap, shave off the hair and treat the perineal area with iodine or a light pink solution of potassium permanganate without touching the mucous membrane.

7. Spread the woman’s legs and watch the eruption of the head, supporting the woman psychologically.

8. When the baby's head appears, place your hands under it, gently supporting it.

9. If the baby is born “with a shirt” (in the membranes), cut them immediately, otherwise he may suffocate.

10. If a baby is born with the umbilical cord wrapped around the neck, do not panic and carefully remove it through the baby's head, but do not pull at all.

11. The newborn needs to remove mucus from the mouth and nose using a small rubber bulb or simply suck out the liquid through a thin tube.

12 . As soon as the baby takes his first independent breath, you will hear his cry, and his body will change color from bluish to pinkish. After this, you need to put it on your mother’s stomach so that she attaches it to her chest.

13. Tie the umbilical cord in two places at a distance of 2-3 cm from each other and cut it with a knife (or scissors).

14. Wait until the afterbirth (placenta) is born, pack it (for example, in a plastic bag) and be sure to take it with you to the maternity hospital.

15. Remember: even if the birth went without complications, the mother and baby feel well, and you are sure that “you did everything right,” the woman and child MUST be taken to the nearest maternity hospital to be examined by specialists.

note

Emergency births performed outside a medical facility by people unrelated to medicine can lead to the following complications for mother and child:

• fetal hypoxia (lack of oxygen) or aspiration (blood, mucus, or amniotic fluid entering the respiratory tract)
• a child sustaining cervical spine injuries
• bleeding from the umbilical wound;
• child infection
• ruptures of the cervix, perineum and vagina in the mother
• uterine bleeding
• infection of the birth canal

The appearance of cramping pain in the last stages of pregnancy, in combination with or without copious watery vaginal discharge, indicates the onset of labor. Pre-medical care during childbirth includes the following stages:

1. Decide on the period of birth;
2. Decide on the possibility of transporting a woman in labor to the nearest maternity hospital;
3. Organize conditions for childbirth outside the hospital.

What you need to give birth

If such an emergency arises that a woman in labor is forced to give birth outside a medical institution, pre-medical care should consist of:

1. Organize a separate clean room;
2. Conduct psychological preparation of the woman by creating such an atmosphere so that she is tuned in to a positive outcome;
3. Prepare the necessary materials:

Important to remember! Similar periods of labor in primiparous and multiparous women differ in their duration. This must be taken into account when choosing tactics regarding first aid and transportation. For multiparous women, the birth of a child can happen very quickly!

Sequence of actions when labor begins

Pre-medical first aid during childbirth in the second stage (when labor has begun) is as follows:

The period of childbirth is very important

The possibilities of pre-medical care during childbirth are determined by its period. If they have just begun, it is possible to transport the woman in labor to a medical facility. But if the cervix is ​​already dilated, although regular contractile activity has not yet begun, it is not recommended to transport the woman. The same pre-medical tactics must be followed in the second and third periods until the placenta comes out. If problems arise at this stage, the woman in labor should definitely see a specialist. If the placenta has separated, the mother, baby and placenta are taken to the maternity hospital, where their condition will be assessed.

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

A doctor, paramedic or midwife of emergency and emergency medical care (E&E) may be faced with any period of labor: dilation, expulsion, the afterbirth and early postpartum period.

A health worker must be able to diagnose periods of labor, assess their physiological or pathological course, find out the condition of the fetus, choose rational tactics for managing labor and the early postpartum period, prevent bleeding in the placenta and early postpartum period, and be able to provide obstetric care for cephalic presentation.

Childbirth outside a hospital most often occurs during premature pregnancy or during full-term pregnancy in multiparous women. In such cases, they usually proceed rapidly.

There are premature, urgent and delayed births.

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

Childbirth that occurs during a gestational age of 40 ± 2 weeks and ends with the birth of a live, full-term fetus weighing approximately 3200-3500 g and a length of 46 cm is considered urgent.

Childbirth that occurs during a gestation period of more than 42 weeks and ends in the birth of a fetus with signs of postmaturity (dense skull bones, narrow sutures and fontanelles, pronounced desquamation of the epithelium, dry skin) is considered post-term. Childbirth with a post-term fetus is characterized by a high percentage of birth injuries.

There are physiological and pathological childbirths. A complicated course of labor develops in pregnant women with extragenital pathology, a burdened obstetric-gynecological history, or a pathological course of pregnancy.

Therapeutic and tactical measures for workers of the S&NMP

1. Resolve the issue of the possibility of transporting a woman in labor to the maternity hospital.
2. Assess general and obstetric history data: the number of pregnancies and births in history, their course, the presence of complications.
3. Determine the course of this pregnancy: threat of miscarriage, general weight gain, blood pressure dynamics, changes in blood tests (according to the exchange card).
4. Analyze data from a general objective study.
5. Assess the period of labor: the onset of contractions, their regularity, duration, intensity, pain. Carry out 4 external examinations and determine the height of the uterine fundus, the position and position of the fetus, the nature of the presenting part and its relationship to the plane of the entrance to the pelvis (movable above the entrance to the pelvis, fixed by the small segment, the large segment at the entrance to the pelvis, in the cavity of the small pelvis, on the pelvic floor). Auscultate the fetus.
6. Assess the nature of the discharge: the presence of bloody discharge, leakage of amniotic fluid, the presence of meconium in it.
7. If necessary, perform a vaginal examination.
8. Diagnose childbirth:
   • first or repeated;
   • urgent, premature or late;
   • period of childbirth - dilation, expulsion, afterbirth;
   • the nature of the rupture of amniotic fluid - premature, early, timely;
   • complications of pregnancy and childbirth;
   • features of obstetric and gynecological history;
   • concomitant extragenital pathology.
9. If conditions and transportation possibilities are available, hospitalization in an obstetric hospital.

If it is not possible to transport the woman in labor to the maternity hospital, labor management should begin. The woman is given a cleansing enema, the pubic hair is shaved, the external genitalia are washed with boiled water and soap, the bed linen is changed, under which an oilcloth is placed, and a homemade pad is prepared - a small pillow wrapped in several layers of sheets (preferably sterile). During childbirth, the pad is placed under the pelvis of the woman in labor: thanks to the elevated position, free access to the perineum opens.

From the moment of complete or almost complete dilatation of the cervix, the forward movement of the fetus begins along the birth canal (biomechanism of childbirth). The biomechanism of childbirth is a set of translational and rotational movements that the fetus produces as it passes through the birth canal.

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

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

The rotation of the head is completed when it reaches the exit cavity from the pelvis. The fetal head is installed with a straight arrow-shaped suture: the third moment of the biomechanism of childbirth begins.

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

The fourth point is the internal rotation of the shoulders and the external rotation of the head. After the birth of the head, internal rotation of the shoulders and external rotation of the head occur. The fetal shoulders produce an internal rotation, as a result of which they are installed in the direct size of the pelvic outlet in such a way that one shoulder (anterior) is located under the pubis, and the other (posterior) is facing the coccyx.

The born fetal head turns with the back of the head towards the mother's left thigh (in the first position) or towards the right thigh (in the second position).

A fixation point is formed between the anterior shoulder (at the point of attachment of the deltoid muscle to the humerus) and the lower edge of the pubis. The fetal body flexes in the thoracic region and the posterior shoulder and arm are born, after which the rest of the body is easily born.

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

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

The most painful, albeit short-lived, moment of childbirth begins: when pushing, the forehead and face pass through the genital slit, from which the perineum slides off. This ends the birth of the head. The latter makes its outer turn, the head being followed by the shoulders and torso. The newborn takes its first breath, screams, moves its limbs and begins to quickly turn pink.

During this period of labor, the condition of the woman in labor, the nature of labor, and the fetal heartbeat are monitored. The heartbeat must be heard after each effort; You should pay attention to the rhythm and sonority of the fetal heart sounds. It is necessary to monitor the progress of the presenting part - during the physiological course of labor, the head should not stand in the same plane of the small pelvis for more than 2 hours, as well as the nature of the discharge from the genital tract (during the period of opening and expulsion of bloody discharge from the genital tract there should be no).

As soon as the head begins to cut in, that is, at the moment when, when an attempt appears, it appears in the genital slit, and with the end of the effort it goes into the vagina, you must be ready to give birth. The woman in labor is placed across the bed, her head is placed on a bedside chair, and a homemade pad is placed under the pelvis. Another pillow is placed under the mother's head and shoulders: it is easier to push in a semi-sitting position.

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

The person delivering the baby thoroughly washes his hands with soap and treats them with a disinfectant solution; It is advisable to use a sterile disposable obstetric kit.

Accompanying childbirth involves providing obstetric care.

In case of cephalic presentation, obstetric aid during childbirth is a set of sequential manipulations aimed both at promoting the physiological mechanism of labor and at preventing injuries to the mother and fetus.

As soon as the head crashes into the genital slit and maintains this position even outside the contraction, the eruption of the head begins. From this moment, the doctor or midwife, standing to the right of the woman in labor, sideways to her head, with the palm of her right hand with her thumb held wide apart, clasps the perineum, covered with a sterile napkin, through which she tries to delay the premature extension of the head during contractions, thereby facilitating the emergence of the back of the head from under the symphysis . The left hand remains “ready” in case the forward movement of the head turns out to be too strong and the right hand alone would not be able to hold it. As soon as the suboccipital fossa fits under the pubic arch (the person delivering the baby feels the back of the head in the palm of his hand), and the parietal tubercles are palpated from the sides, they begin to remove the head. The woman in labor is asked not to push; with the palm of the left hand they clasp the protruding part of the head, and with the palm of the right hand with the thumb abducted they clasp the perineum and slowly, as if removing it from the head (from the face), at the same time with the other hand they carefully lift the head up - at the same time, first the forehead, then the nose are shown above the perineum , mouth and finally chin. It is absolutely necessary to withdraw the head until the perineum “comes off” from the chin, that is, until the chin comes out. All this must be done outside of a contraction, since during a contraction it is very difficult to slowly remove the head, and with rapid withdrawal the perineum is torn. At this moment, the flowing mucus should be sucked out of the fetal mouth, since the child may take the first breath, as a result of which the mucus can enter the respiratory tract and cause asphyxia.

After the head is born, a finger is drawn along the fetal neck to the shoulder: check whether the umbilical cord is wrapped around the neck. If there is an entanglement of the umbilical cord, the loop of the latter is carefully removed through the head.

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

If the front shoulder does not fit under the womb, help is provided: the turned head is grabbed between both palms - on one side by the chin, and on the other - by the back of the head, or they place their palms on the temporo-cervical surfaces and carefully, easily rotate the head with the back of the head towards the position, at the same time carefully pulling it down, bringing the front shoulder under the pubic symphysis.

Next, they clasp the head with their left hand so that its palm rests on the lower cheek and lift the head, and with their right hand, just as they did when removing the head, they carefully move the perineum from the back shoulder.

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

The principle of “protecting the perineum” in anterior occipital presentation is to prevent premature extension of the head; only after the back of the head comes out and the suboccipital fossa rests on the lunar arch, the head is slowly released above the perineum - this is an important condition for preserving the integrity of the perineum and the birth of the head in the smallest size - small oblique. If the head erupts in the genital slit not at a small oblique size (with an occipital presentation), it can easily rupture.

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

If obstetric manual assistance during the eruption of the head is carried out roughly (or the person delivering the baby presses on the head with his fingers), this can lead to these complications. To avoid such complications, it is recommended to eliminate the excessive back pressure of the stretching perineum on the fetal head, for which the operation of dissecting the perineum is used - perineo- or episiotomy.

Obstetric manual assistance during eruption of the head should always be as gentle as possible. It aims, first of all, to help the birth of a healthy child, without causing any trauma to him, and at the same time to preserve the integrity of the pelvic floor as much as possible. This is the only way to understand the term “perineal protection.”

Immediately after the birth of the head, mucus and amniotic fluid must be sucked out from the upper parts of the pharynx and nostrils using a pre-boiled rubber bulb. To avoid aspiration of stomach contents, the newborn's throat is first cleared, and then the nose.

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

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

A score from 4 to 6 indicates that these children are cyanotic, have arrhythmic breathing, weakened muscle tone, increased reflex excitability, a heart rate above 100 beats/min and can be saved.

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

0 points corresponds to the concept of “stillborn”.

Assessment at 1 minute after birth (or earlier) should identify infants who require immediate care, and assessment at 5 minutes correlates with neonatal morbidity and mortality rates.

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

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

The woman in labor is drained of urine using a catheter and begins to manage the third stage of labor.

Management of the afterbirth period

The afterbirth period is the time from the birth of the child until the birth of the placenta. During this period, the placenta, along with its membranes, is detached from the uterine wall and the placenta with membranes is born - the placenta.

During the physiological course of labor in the first two periods (dilation and expulsion), placental abruption does not occur. The succession period normally lasts from 5 to 20 minutes and is accompanied by bleeding from the uterus. A few minutes after the birth of the child, contractions and, as a rule, bloody discharge from the genital tract occur, indicating detachment of the placenta from the walls of the uterus. The fundus of the uterus is located above the navel, and the uterus itself, due to gravity, deviates to the right or left; At the same time, there is an elongation of the visible part of the umbilical cord, which is noticeable by the movement of the clamp placed on the umbilical cord near the external genitalia. After the birth of the placenta, the uterus goes into a state of sharp contraction. Its bottom is located in the middle between the pubis and the navel and is palpated as a dense, round formation. The amount of blood lost in the afterbirth period should usually not exceed 100-200 ml.

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

Management of the subsequent period of labor is conservative. At this time, you cannot be away from the woman in labor for even a minute. It is necessary to monitor whether everything is fine, that is, whether there is any bleeding - both external and internal; it is necessary to monitor the nature of the pulse, the general condition of the woman in labor, and signs of placental separation; urine should be removed, since a full bladder interferes with the normal course of the afterbirth period. To avoid complications, it is not allowed to perform external massage of the uterus or pull the umbilical cord, which can lead to disruption of the physiological process of placenta separation and severe bleeding.

The baby's place coming out of the vagina (placenta with membranes and umbilical cord) is carefully examined: it is laid out flat with the maternal surface facing up. Attention is paid to whether all placenta lobules have come out, whether there are additional placenta lobules, whether the membranes have completely separated. Retention of parts of the placenta or its lobules in the uterus does not allow the uterus to contract well and can cause hypotonic bleeding.

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

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

After childbirth, the external genitalia are toileted and disinfected. The external genitalia, vaginal opening and perineum are examined. Existing abrasions and cracks are treated with iodine; ruptures must be repaired in a hospital setting.

If there is bleeding from soft tissues, it is necessary to apply sutures before transport to an obstetric hospital or apply a pressure bandage (bleeding from a rupture of the perineum, clitoral area), vaginal tamponade with sterile gauze pads is possible. All efforts during these manipulations should be aimed at urgent delivery of the postpartum woman to the obstetric hospital.

After giving birth, the postpartum woman should be changed into clean linen, placed on a clean bed, and covered with a blanket. It is necessary to monitor the pulse, blood pressure, condition of the uterus and the nature of the discharge (bleeding is possible); you should give the woman hot tea or coffee. The placenta, the mother and the newborn must be taken to the obstetric hospital.

A. Z. Khashukoeva, Doctor of Medical Sciences, Professor
Z. Z. Khashukoeva, Candidate of Medical Sciences
M. I. Ibragimova, Candidate of Medical Sciences
M. V. Burdenko, Candidate of Medical Sciences
RGMU, Moscow