Breaks
According to statistics, various injuries of the birth canal are found in every fifth woman who gave birth. The most common form is spontaneous rupture of the perineum. It occurs in 7-15% of parturient women.
Risk factors
Whether the perineal muscles can withstand fetal pressure during childbirth and stretch out enough to miss the baby's head, depends on how flexible they are. Reduce the elasticity of the following factors: high crotch with developed musculature - the distance between the anus and the entrance to the vagina is more than 7-8 cm; the age of a woman is more than 30 years; anatomically narrow pelvis; a large fruit; inflammatory process in the vagina during childbirth; fast and rapid delivery; swelling of the perineum (weakness of labor and prolonged attempts).
What to expect from the second birth?
Factors that increase the risk of rupture of the perineum include scars after injuries sustained during previous births. The connective tissue from which these scars are composed is practically incapable of stretching and, because of its inelasticity, tears at second births, usually in the old seam. But you can not talk about it as an iron rule. Obstetricians, who know about such complications in previous births, will with special carefulness protect the perineum. If the scars on the site of the previous ruptures were small and healed in time, they may not interfere with normal repeated labor without breaks, especially if the fetus is not large. If there were no ruptures in the first kind, then in a mating woman the risk of getting them is small, since the perineal muscles after the first delivery become more elastic.
Prevention
As mentioned above, one of the causes of ruptures is a large fetus. It is possible that if your first baby was born weighing more than 4000 g, then the second one will not be so large, and hence the birth will be less traumatic. In order not to overfeed another child in the womb, pay more attention to proper nutrition. The best diet for a future mother is a combination of proteins and vitamins. But the use of foods rich in carbohydrates, glucose, should be limited. At the same time in the last months of pregnancy, meat is better not to eat - it enslaves the tissues and prevents their elasticity. Replace it with fish or chicken. A good prevention of ruptures during labor is a perineum massage with a special oil. It is recommended to do it from the 33rd week of pregnancy. Pour a little oil of animal origin on the fingers and stretch movements lead along the skin of the perineum, as if mimicking the stretching of the vagina: the more often, the better. Good and intimate gymnastics helps - a set of exercises that strengthen the muscles of the perineum. In the absence of the threat of premature birth, regular intimate life is recommended in the last weeks of pregnancy. It is worth noting that this prophylaxis is more suitable for the preparation for the first birth, but also quite effective for maternity mums.
Sections
The cut of the perineum during labor can also be called a violent break. This is a surgical dissection of the tissues surrounding the orifice of the vagina. It is produced at the stage when the baby's head is partially shown in the aperture of the birth canal. The perineal incisions are performed quite often, and the greater part - at the first birth: from 50 to 70%. The perineum is dissected along the median line or laterally from it, depending on the anatomical features. The incision along the middle line, or in another way - perineotomy, heals faster and less noticeable after childbirth. That's why midwives often prefer it.
When necessary?
If there is a threat of a rupture or if a rupture has begun, the smooth edges of a cut wound, in comparison with the torn edges of a ruptured one, are easier to repair and heal faster. If an early completion of labor is necessary at fetal hypoxia or in abnormalities of its development (hydrocephalus). With premature birth. To increase the vaginal opening, when the baby is difficult to overcome the birth canal (for example, during birth in pelvic presentation or with a large fetus).
What to expect from the second birth?
The probability that a new rupture will occur at the site of the scar, which was formed during perineotomy in the first birth, is great. But not 100%. Depending on the circumstances, the doctor decides whether a woman can give birth for the 2nd time without a cut. If the probability of rupture on the rumen is high, it is considered that it is better to make a cut than to get a break. Meanwhile, some doctors try to avoid as far as possible the dissecting of the perineum during repeated childbirth, even if they usually practice them at the first.
Prevention
Since the incisions, in fact, are the same ruptures, only performed surgically, everything that the future mother does in order not to "tear" is suitable for preventing cuts. Remember the diet and exercises for intimate muscles! You can train them anywhere: on a walk, in front of the TV, lying in bed.
Kegel Gymnastics
1. Slow compression. Tighten the muscles of the perineum, hold them in this state for 3 seconds, then relax. You can complicate the exercise if you clamp your muscles for 5-20 seconds.
2. Step-by-step gymnastics. Pinch the muscles for 3-5 seconds, then relax. Now tighten the muscles a little more, hold, and so - up to 4-7 stages. Relax gradually, lingering for 2-3 seconds at each stage.
3. Reduction. Strain and relax your muscles as quickly as possible. Repeat several times.
4. Popping out. Stretch down like in a chair or childbirth. This exercise, except the muscles of the perineum, causes tension and some abdominal. Training can begin with 10 slow contractions, 10 cuts and 10 pops 5 times a day. Repeat exercise at least 25 times for one day. This is very simple, because such activities are completely unnoticed for others.
Premature birth
These include cases where labor activity begins between 28 and 37 weeks of pregnancy and when the cervix is opened before the due time. The frequency of preterm labor is 6-8% of all births.
Risk factors:
- the age of the pregnant woman is younger than 16 years and over 30 years of age
- The presence of infections in the body of a future mother
- failure of the cervix, when it opens without fights more than 3-4 cm
- previous spontaneous miscarriages or abortions
- surgical operations on the organs of the abdominal cavity with this pregnancy
- some malformations of the fetus accompanied by polyhydramnios
- multiple pregnancies
- occupation requiring physical activity or accompanied by psychological stress
- Smoking, drug and alcohol use
Pregnant women who have already given birth before the term, the risk of recurrence of the situation - 3-4 times higher than the rest. It is known that in this case the chances of reporting the second pregnancy are about 80%. And with the experience of two premature births, the risk of repeating the scenario is increased by 6 times. The likelihood of regular preterm labor is also increased when a miscarriage threatens during pregnancy. Weakness of labor in women over 30 years of age is twice as common as at the age of 20-25. About 60% of twins, more than 90% of triplets, and almost all 4-5 or more twins appear before the term
Prevention
1. To avoid repeated premature birth, it is necessary to find out the cause that led to such complication. Non-promotion of pregnancy is very often due to intrauterine infection. In this case it is necessary to pass a test for the presence of bacteria before the onset of a second pregnancy. If they are detected in a pregnant woman already, the doctor will prescribe the treatment starting from the second trimester.
2. Doctors also conduct preventive reduction of other risk factors.
3. A future mother who previously had experienced premature pregnancy may recommend refusing physical activity and limiting activity right up to bed rest during the second and third trimesters of pregnancy.
4. The onset of premature birth can provoke sex. Therefore, during the last three months of pregnancy, the expectant mother should refrain from sexual intercourse, so as not to cause an active contraction of the uterus.
Weakness of labor
This complication in childbirth is characterized by weak, short contractions, which slow the opening of the cervix and the fetal movement along the birth canal.
Risk factors:
- endocrine disorders and metabolic disorders in a future mother (obesity, deficiency of thyroid function)
- overgrowth of the uterus, characteristic of multi-fetus, large fetus and polyhydramnios
- malformations of the uterus
the woman's age is more than 30 years
excessive excitement, fear, negative emotions before childbirth
What to expect from the second birth?
Weakness of labor is more common in primiparous women. But the risk of a recurrence is great enough, especially with age. The doctor determines the readiness of the birth canal at the 38-39th week of pregnancy. If necessary, this method of induction is prescribed, such as amniotomy (or autopsy of the bladder). This procedure is performed in the maternity ward and is completely painless for the mother, since there are no nerve endings in the membranes. After the amniotomy, the production of prostaglandins - biological substances responsible for the activation of labor activity - should be activated. Also, the irritation of the tissues of the birth canals intensifies, which leads to their reflex reduction, and hence to intensification of contractions. If, 3 hours after the amniotomy, contractions do not begin, the doctors prescribe an intravenous injection of prostaglandins.
Obstetric forceps
Their superposition is a labor-giving operation, in which the full-term baby is extracted through the birth canal with the help of obstetric forceps. The doctor covers them with the head of the child, taking on the expelling force of the uterus and the abdominal press of a woman giving birth. The operation of applying forceps is prescribed by the obstetrician in those cases when the natural continuation of labor is impossible because of the danger of serious complications. Quite often it is accompanied by an operation to cut the perineum to expand the birth canal to prevent the formation of extensive gaps in the woman.
When appoint?
Indication for the operation of obstetrical forceps can be divided into two groups: maternal and fetal obstetric indications associated with pregnancy and childbirth, and somatic indications associated with a woman's diseases that do not allow attempts.
Prevention
Despite the fact that the weakness of labor is a complication, manifested directly in the process of birth, you can try to prevent its occurrence during pregnancy. This is especially true for women who are already facing this problem. Physiopsychic preparation for childbirth plays an important role here. It is good before the re-conception to cure endocrine diseases, if they are, to normalize weight and give up bad habits. From the 36th week it is recommended to take vitamins, which increase the energy potential of the uterus: they include vitamin B6, folic and ascorbic acid. If at first births the cause of weakness of labor was the fear of childbirth, it is advisable to master the complex of special exercises and physical exercises conducted by teachers of schools of future parents.
Obstetric evidence:
- severe forms of preeclampsia, requiring exclusion and strain of the parturient woman
- persistent weakness in attempts (lack of baby's head advance over 2 hours)
- premature placental abruption at the end of labor
- acute fetal hypoxia of the fetus (oxygen starvation), when procrastination can lead to the death of the baby
Somatic indications:
- cardiovascular disease, heart failure
- respiratory distress due to lung disease
- threat of detachment of the retina
- severe forms of neuropsychic disorders
- an operation on the organs of the abdominal cavity carried out on the eve of labor
- exacerbation of infection, high temperature in mom
If for the first time there was talk about the planned application of forceps on the somatic indications, then the natural repeated delivery is possible only with the permission of the doctors. For example, it is likely that between the pregnancies the woman has done a corrective operation for the eyes, and the ophthalmologist, who previously prohibited natural childbirth due to possible retinal detachment during attempts, will now give permission. But obstetric evidence is transient and may not appear in subsequent births.