Department of Gynecology, Peking University People's Hospital
Delivery refers to the period and process during which the fetus leaves the mother and becomes an independent individual.The whole process of delivery is divided into three stages, also known as three stages of labor.First stage of labor, that is, dilatation of uterine orifice.Second stage of labor, that is, the fetal delivery period.The third stage of labor, Placenta delivery period.
Also called dilatation of uterine orifice.It is intermittent for 5-6 minutes from the beginningRegular contractionsFrom to when the cervical opening is completely expanded to 10 cm.This process takes 11 to 12 hours for primipara,MenopauseIt takes 6-8 hours.
Cooperation in the first stage of labor:
(1) Eliminate fear and keep calm and optimistic;
(2) Eat on time and supplement adequate nutrition;
(3) Urine regularly every 2-4 hours to make the bladder empty so as not to hinder the descent of the fetal head;
(4) IfFetal membraneIf not broken, you can walk in the waiting room with the doctor's consent;
(5) Some auxiliary pain reducing actions can also be performed during uterine contraction.
2. Second stage of labor
It is also called the fetal delivery period.It is from the complete expansion of the cervical opening to the delivery of the fetus.It takes 1~2 hours for the primipara, and it can be completed in a constant minute for the parturient, but it can also take up to 1 hour.
The baby is about to be born when the peak of childbirth comes.Tire head moves closeorificium vaginae, vulva and anus due to fetal head compressionPelvic floorIt looks puffy.Soon you will see the fetal head, which moves forward with each contraction. When the contraction disappears, it may slide back a little.
When the top of the tire head is visible,midwifeRegular meetingsTell pregnant women not to exert too much force, because if the fetal head is delivered too fast, the perineum skin of pregnant women may be torn, so pregnant women should relax and take a few seconds to breathe.If there is a danger of serious tearing or the fetus is in danger, the pregnant woman will acceptEpisiotomy。When the fetal head expands the vaginal orifice, the pregnant woman will feel tingling, followed by numbness, which is caused by the blocking of nerve conduction when the vaginal tissue expands very thin.
When the head is delivered, the baby's face is downward.The midwife may want to checkumbilical cordTo ensure that the baby's neck is not entangled by the umbilical cord (when the fetal head is delivered, the umbilical cord often covers the head).The baby's head is then turned to one side so that the head is in line with the shoulders.The midwife should clean the baby's nose and mouth. If necessaryrespiratory tractLiquid inAspirate。
During the following two contractions, the baby's body will slide out of the mother's body, and the baby is still connected to the umbilical cord. The midwife will cut the umbilical cord.In addition, the midwife will clean the baby's respiratory tract again and give oxygen if necessary.
Also called placental delivery period.It takes 5 to 15 minutes from the delivery of the fetus to the delivery of the placenta, and should not exceed 30 minutes.
After the delivery of the fetus, there will still be uterine contractions to promote the delivery of the placenta, but at this time the uterine contractions are relatively painless.Later, the doctor will clean up the pregnant woman. If there is a crack in the vulva, local sutures will be made.
Delivery process[1]
Example[1]
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1. Natural vaginal delivery
Natural vaginal delivery refers toFetal developmentNormally, the pelvic development of the pregnant woman is also normal, and the pregnant woman is in good physical condition. At the same time, under the premise of safety guarantee, it is usually a delivery mode that the fetus is delivered by vagina without manual intervention.Pregnant women are decidingNatural childbirthThe whole production process should be understood first.Natural vaginal delivery is the most ideal mode of delivery, without much damage to the mother and fetus, andpostpartum recovery It's also fast,complicationLess, you can get out of bed and walk on the day of production.And for babies, frombirth canalWhen coming outPulmonary functionGet exercise, skinNerve endingsGet massage through stimulation, and its nerves and sensesPhylogenyBetter, with strongerResistanceThe squeezing of the baby's head when passing through the birth canal is also conducive to the rapid establishment of normal breathing after birth.
(1) Advantages and disadvantages of natural childbirth
1. Advantages① The fetus is squeezed naturally through the birth canal and can be excretedPulmonary interstitiumInamniotic fluid, to avoid neonatal disease“Wet lung”Symptoms, etc. ②Can reduce maternitySurgical complicationsIt can also reduce trauma. ③Naturally born babies are physically activeCoordination capacityIt is better than other delivery methods. ④It can enhance the communication and cooperation between mother and son, and strengthen women's ability to be mothersHappinessAnd sense of responsibility. ⑤It also helpsPostpartum lochiaExclusion: the uterus recovers quickly after delivery, and it will not affect the future fertility. In addition, milk production is also faster.
2. Disadvantages① There is some damage to the vagina. ②Uterine contraction pain is severe. ③encounterdystociaMay need to be converted intocaesarean birth, causing double damage.
The second is whether the maternal nutrition is reasonable and the weight is qualified. The ideal pregnancy weight is: increase 2 kg in the early pregnancy (within 3 months),Second trimesterPregnancy (3-6 months) andLate pregnancy(7 to 9 months of pregnancy).That is, it is appropriate to add about 12kg in total.If the whole pregnancy period increases by more than 20 kg.It is possible to make the baby grow too big, so it is not appropriate to choose natural birth at this time.
In addition, it also depends on whether the puerpera have the strength to deliver. Generally, the labor process is about 14 hours, which requires enough physical strength to complete. Systematic exercise will be very helpful to ensure the physical strength during delivery.Finally, it depends on whether the puerpera have the psychological preparation to bear the pain of childbirth. Not enough psychological preparation is bad for the smooth delivery.
2. Cesarean delivery
Often called cesarean section, it is to open the abdominal wall and uterus and take out the fetus.yesNarrow pelvis、Placental abnormality、Abnormal birth canalOr the pregnant women who break water prematurely and have abnormal fetus need to end the delivery as soon as possible.If the case is properly selected and the operation is performed in time, the mother and child can be saved.Cesarean section can avoid the pain of the mother. If there are other diseases in the abdomen, it can also be dealt with at the same time. However, the caesarean section has a greater damage to the mother, and the recovery after childbirth is relatively slow, and there may also be operationssequelahappen.
Post caesarean section nursing:
(1) You should turn over more after surgery
anaesthesiaDrugs can inhibitIntestinal peristalsis, causing different degrees ofFlatulence, thusabdominal distention。Therefore, it is advisable to do more turning movements after delivery to promote the early recovery of paralyzed intestinal muscle peristalsis function, so that the gas in the intestinal tract can be discharged as soon as possible, and some can be soaked 12 hours after the operationSenna leafDrink water to help relieve abdominal distension.
(2) Pay attention to exercise
About 10 days after the caesarean section, if the body recovers well, you can start exercising.The method is: lie on your back, lift your legs alternately, first perpendicular to the body, then slowly put them down, and do 5 times on both legs respectively;Lie on your back, place your arms on both sides of your body naturally, flex and lift your right leg, and make its thigh close to the abdomen as much as possible, and its heel close to the hip as much as possible. Do it alternately with the left and right legs, 5 times each;Lie on your back with knees bent, arms folded in front of your chest, and slowly sit in halfSeating, then restoreSupine position；Supine, knees flexion,Two arms upStraighten, doabdominal curl；In the prone position, bend your legs to your chest, keep your thighs perpendicular to the bed and lift your hips, keep your chest close to the bed, do it once in the morning and once in the evening, and gradually extend it from 2 to 3 minutes to 10 minutes each time.
The recovery of the parturient after caesarean section is slow and cannot be the same as that of the natural vaginal delivery24 hoursThen you can get up and exercise.Therefore, caesarean section is easy to occurLochiaIt is not easy to expel, but if you take the semi recumbent position and turn over more, it will promote the discharge of lochia, prevent lochia from accumulating in the uterine cavity, causing infection and affecting uterine restoration, which is also conducive to the healing of uterine incision.
(4) Try to get out of bed early
As long as physical strength allows, you should get out of bed as early as possible after delivery and gradually increase the amount of activity.In this way, it can not only increase the function of intestinal peristalsis, promote uterine reset, but also avoid the occurrence ofIntestinal adhesion、Thrombophlebitis。
(5) Pay attention to urination after delivery
For the convenience of surgeryCesarean sectionPlace beforecatheter。24-48 hours after the operation, the influence of narcotic drugs disappears, and the bladder muscle regains urination function. At this time, the catheter can be pulled out, as long as there isUrination intention, we should try to urinate by ourselves and lower the catheterretention time Too longUrinary tract bacterial infectionRisk.
(6) Keep vaginal and abdominal incisions clean
Within 2 weeks after the operation, avoid wetting the abdominal incision, and clean the whole body withScrub bathAfter that, you can take a shower, but you must not take a bath until the lochia is drained;Flush the vulva 1~2 times a day, and be careful not to let dirty water enter the vagina;If the wound is red, swollen, hot, or painful, do not apply it by squeezing yourself. You should seek medical advice in time to avoidwound infectionProcrastination does not heal.
After caesarean sectionnarcoticThe effect ofsense of painIt starts to recover. Generally, the wound begins to ache violently within a few hours after the operation.In order to have a good rest and recover as soon as possible, the doctor can be asked to give some pain relief drugs on the day or night of the operation.After that, it is better not to use too much medicine to relieve pain, so as not to affect the recovery of intestinal peristalsis.Generally speaking, the pain of the wound will disappear after 3 days.
6 weeks after cesarean section, if the vagina no longer bleeds, the doctor should checkwound healingIt is in good condition and can be recoveredsex life。However, we must adopt strictcontraception measuresAvoid pregnancy.Otherwise, there arescarYour uterus is easy to doCurettageSometimes perforation or even rupture occurs.
The medical staff injects some liquid into the pregnant woman's intestines to empty the feces and stimulate uterine contractions.
Procedure: The enema is performed by the medical staff, which may cause some discomfort, and can be adjusted by breathing easily.After injection, you need torestroomWait 10~20 minutes for troubleshooting.This action sometimes needs the help of family members.
2. Skin preparation
Shaving pubic hair is convenient for medical staff to deliver babies, and can prevent bacterial infection, making perineum incision wounds easy to care and recover.It should be noted that the skin preparation process is likely to cause minor wounds, which requires careful care to prevent bacterial infection.
If there is no naturalflow of amniotic fluid at child birth, medical staff will do artificial water breaking before or during childbirth.This process does not make the mother feel pain.
Fetal heart sounds are usually used during laborTester, until the end of childbirth.This instrument providesUterine contractionThe pressure, frequency and heartbeat of the fetus and baby are recorded continuously, and the contractions and heartbeat are plotted.
Medical staff need to use thisContinuityTo learn the heartbeat of the fetus and baby during the whole delivery process (especially during uterine contraction).
Generally, intravenous injection will be carried out before entering the delivery room.Drop someglucoseperhapsnormal saline, replenish energy and moisture.This can keep the mother and the baby in good condition.In addition, the intravenous drip can also prevent the puerpera from dehydration, supply body heat, and facilitate the intravenous injection of pain relief and uterine contraction related drugs.
Labor pain
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Pain caused by uterine contraction will run through the whole delivery process.Uterine contraction painMainly inLower abdomenSometimes it also occurs on the inside of two strands or on the spine.Most women feel uterine contraction pain and menstruationPainful spasmSimilar, but stronger.When the fetus is about to be born, due to the expansion of perineum and vulva, the puerpera will also feel burning and intense pain in these parts.Looking for a comfortable position and taking deep breath in a relaxed state can relieve the pain of childbirth.
Be fully prepared for the pain of childbirth.Delivery is a natural physiological phenomenon, and delivery pain is a physiological pain that can be tolerated by ordinary people.However, a period of severe pain must pass during childbirth. Without adequate mental preparation, pregnant women will be overwhelmed by unexpected pain.
During childbirth, shouting can makeProlonged labor。Good physical and mental preparation helps to endure pain.
Pain should be treated withPositive attitude, without fear and anxiety, you can carry out self suggestion and self comfort.In addition, before pregnancy, we should get familiar with the environment of the hospital preparing for delivery, communicate with doctors more, determine the most suitable delivery method, and ask doctors to guide the preparations for delivery, such as breathing exercises, according to the situation.
You can also ask the doctor about pain free delivery, drug analgesia and other reliefLabor painThe mode of delivery can also be selectedGuided delivery, or choose a family ward, husband's accompany or sitting delivery.
The hospital stopped obstetric services
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On March 11, 2024, Jiangxi Ganzhou Fifth People's Hospital will stop obstetric services.
Also in Ganzhou, Dingnan Nanfang Integrated Hospital of Traditional Chinese and Western Medicine said that after the hospital president's office meeting studied and decided and reported to Dingnan County Health Commission for approval, the hospital's midwifery technical services will be stopped from February 1, 2024, and will no longer issue the Medical Certificate of Population Birth according to the spirit of the document, and will no longer carry out four-dimensional color ultrasound diagnosis and prenatal screening business during pregnancy,The business of general prenatal examination and general obstetric color ultrasound is reserved.Zhejiang Jiangshan Hospital of Traditional Chinese Medicine also announced that, according to the actual situation of the hospital's obstetric business, from February 1, 2024, the hospital will no longer carry out obstetric (ordinary birth, cesarean section) business, and other prenatal examinations, maternity clinics (ring release, ring removal, abortion, pregnancy protection, pre pregnancy consultation), gynecology and other businesses will be carried out normally.
Shiqiao Hospital of Panyu District, Guangzhou said in the Announcement on the Suspension of Maternity Hospital Delivery Service that from January 6, 2024, it has entered into an obstetric alliance with He Xian Memorial Hospital of Panyu District. The hospital's obstetrics and gynecology department suspended obstetric hospital delivery service. After risk assessment, it reasonably arranged pregnant and lying in women who visited the hospital to go to He Xian Hospital for follow-up obstetric examination and delivery,So that pregnant women can receive continuous prenatal care services to ensure the safety of pregnant women.
Huikang Hospital in Huizhou, Guangdong Province introduced that hospital delivery services for obstetrics will be stopped from February 1, 2024.
The Second Hospital of Traditional Chinese Medicine in Huangdao District, Qingdao, Shandong Province also said that due to the needs of the hospital's business adjustment, in line with the purpose of serving the people wholeheartedly, in order to adapt to the new situation of maternal health management, ensure the safety of mothers and infants, in combination with our hospital's actual situation, our hospital will suspend obstetric hospital delivery services from January 1, 2024.[2]
