LECTURE № 8 CHILDBIRTH. BEHAVIOR OF THE WOMAN IN LABOR. Dr. Nagayeva S. FOREWORD The outcome of labor depends from woman's behavior and management ability of a body and breath. The given lecture represents brief instruction to correct woman's behavior in childbirth. WHAT YOU MUST TO DO, WHEN CONTRCTIONS HAS BEGUN STAGE № 1 AT HOME You are on the 40th week. You began to notice that an uterus strains more often than before. Listen to yourselves and to your sensations. The true contractions are felt as feeling of an increasing pressure in an uterus. Normally it arises in the bottom of uterus and spreads to lower parts of it. At first pauses between contractions are long ,about 30-40 minutes. Then, with each hour the intervals between contractions decrease, it's intensity increase. It should not be very painful. It is necessary to go to maternity home as soon as the interval between contractions becomes 10 minutes. The movement you have felt, that at you this longawaited moment a has come - REJOICE! Collect things, which will be necessary for you and your kid at maternity home calmly. Necessary list, you have to take is in your medical exchange card of the pregnant woman. It is obligatory to take medical exchange card of the pregnant woman, passport and insurance policy. Cut nails, shave genitals, give an enema to yourselves by means of Esmarh's mug and 2 litres of boiled warm water, take a shower. You can get all just listed procedures at maternity hospital, if you not sure how to do it. If you are worry very much , the following actions can help: Lie down on a bed , take the control over breath. Stroke a tummy, talk to the baby, calm him. It is not smaller stress for him, than for you. Do not do sharp hasty movements, it can scare your baby. Gather to the childbirth as for a holiday. Give to yourselves positive aim at all process of the labor. STAGE № 2 AT THE MATERNITY HOSPITAL. You have got to the maternity hospital. There, at reception ward, midwife will ask a documents (an exchange card, the passport and an insurance policy), will measure the blood pressure, the pulse. Doctor on duty will familiarize with data of your exchange card, will talk to you. You must tell him openly, how and when the contractions has begun, with what interval they are followed one by one, which intensity and how much painful it has had, how your baby moves, your complaints). The doctor will listen and palpate to your baby, will measure a circle of an abdomen, height of the uterus, the sizes of a basin. Then he'll examine you, to familiarize with the changes from maternal passages, to estimate the water bag After examination you'll get an enema, shaving of a genitals, shower , if you certainly hasn't made it at home . During sanitary processing with the advent of contraction strike the comfortable attitude, breathe deeply, correctly. Apparently, the muscular effort causes waste of forces, that's why you should stay in slackness during the moment of contraction. But this relaxation - not passive, but active, it is subordinated to your will. During this period you should use the formula of autohypnosis : " I am quiet. Contractions is a parameter of the birth activity. Gradually it'll become stronger. Breath is deep and steady. Muscles are weakened. Contraction comes to the end. After that there will be a period of rest ". After procedures you will be moved to the prenatal ward. Here you will spend the time expecting, when contractions will make their business and the cervix of the uterus will opens completely. That is in obstetrical language - 5 fingers. Getting to the end, the contractions become stronger and more often. The interval between them decreases up to 4-3-2 minutes. Between contractions, woman can apply receptions of relaxation, beginning from face's muscles and finishing by the muscles of lower extremities. Auto-suggestion between contractions is carried out by mental repetition of formulas: " I am quiet. I supervise myself. My breath is stead and quiet. Muscles of the face are weakened. Muscles of shoulders, forearms, hands are weakened. All muscles of my hands are weakened completely and also warm. Muscles of the perineum and buttocks are weakened. Muscles of the hips, shins are weakened completely.. Between contractions my organism has a rest. My childbirth has been proceeding safely. I am quiet. I feel movements of the child very well. A condition of the child is good. I am quiet for him" . PROCEDURES USED MOSTLY OFTEN IN THE MATERNITY WARD. There may suggest to make a spasmolytics and a metabolic complex, for the improvement of processes of contractions and relaxation of muscular fibers of the uterus and preventive measures of fetal hypoxia during the labor. Besides, of procedures which may be offered in the maternity home is amniotomy - artificial laceration of the extraembrionic membranes. This procedure has been made in the cases, when it has done his function or it is pathological. The procedure is absolutely painless. If you have fears of a procedure, ask your doctor interesting questions . After the amniotomy contractions become more intensively and more often than before. You should breathe during all contractions as you studied during all pregnancy, mentally tell endearing words to your baby , so as he can felt your support. Close your eyes between contractions, relax completely, leave in itself. Feel as heat spreading throughout body, as though you lay in a warm bath. You'll feel pressure on perineum , after the next series of contractions. Character of contractions has been changed, you'll want to make an effort. Inform your doctor about it. The doctor will look you and if the cervix of an uterus has opened completely, you will be dressed on a sterile shirt, a cap and shoe covers. Then will suggest to accept convenient position in Rakhmanov's armchair. The most important to take the position, which is convenient for you, thus legs should rest against special supports, you will find handles, to hold on , when you will strain. STAGE OF PUSHING So you on the armchair already, there are a doctor and a midwife near you. You should strain in doctor's or the midwife's order. It is the most important and responsible moment, collect all your forces. It is necessary to strain 3 times, during the labor pushing. Therefore you should forethought your forces and the air-supply. So you feel that the labor pushing begins. Take a deep breath , bend a head to a breast (your sight should fall on your navel), press a waist to a table and strain. Then on a doctor's sign do a smooth exhalation and take a deep breath , bend a head to a breast press a waist to a table and strain again. You must do it 3 times in that way. During the moment of labor pushing repeat following formula: " Breath. To strain the muscles of an abdomen. To strengthen the pressure to the bottom smoothly. Pressure is more strongly and more strongly. The child moves ahead through maternal passages . A smooth exhalation ". When the labor pushing ends you can to relax, to close an eyes, to feel as heat spreads throughout your body. Pauses between labor pushing are about 1 - 1,5 minutes. Mentally tell to your baby an endearing words. The new labor pushing will take you out from relaxation. As soon as the head of your baby begins to come through , you will feel the pressure sense in the perineum. Listen to the midwife attentively ,she will release a head of your baby accurately. You should strain in a half of a force to prevent the rupture of the perineum. Thus you gave a birth to the head, and then you might to do the same with the baby’s body. It is smaller than a head ,therefore it can't make a problem. So take a full breath and strain. MIRACLE! My congratulations to you. You are a mom now, your baby lays on your abdomen, feels your heat, your love! Rewarding your diligence . Here is it your miracle, you just have made it. LABOR HASN'T ENDED YET! It is necessary to give birth to a children's place, that is placenta. While you observe your child on a special warming little table, the children's place is separated from a place of the attachment. When it will be separated completely, the doctor or the midwife will ask to strain again. Then cargo will be placed on the bottom of an abdomen. This action is necessary to prevent postnatal bleeding. Your baby is examined by neonatolog (the expert on newborn baby’s) at this moment, an umbilical cord is processed by the disinfectant, will put on a bracket and a bandage. Eyes, and a vulva at newborn girls are processed with a special antimicrobic drops. THE FINAL STAGE It is an examination of maternal passages by the mirrors. Certainly it is not such pleasure as the childbirth, but you can tolerate it. Genitals will be washed with the warm water, then will be drained. Now you can relax and enjoy the dialogue with the child. FIRST FEEDING Baby can't see well yet, can't concentrate a sight, but has a well developed sucking reflex. And you'll engage with it now. The midwife or doctor will bring the newborn to you, will show how to hold the baby at feeding. At the first feeding, you will transfer nutrients , immune complexes, which will protect your baby from infections, your love, by the first drops of colostrum. And in the answer you'll get a love of the baby, his boundless trust, and also reliable prophylactic of the postnatal bleeding (as during the moment of breast feeding ,there in woman's organism hormon oxytocin develops and causes the uterine contractions). During feeding hidden strings are stretched and communicate from soul to soul. THE CONCLUSION You'll spend 2 hours at the maternity ward. You and your newborn will be under medical personnel's supervision and then will move to" Mother and the child " ward . Enjoy your motherhood!