Birth Periods

Birth Periods

  Autor School of future mothers Data: 11.04.2005

Birth Periods

1. Cervical removal and dilation
2. Fetal expulsion
3. Placenta expulsion.

The first period of birth - cervical cleaning and dilation

Active phenomena from this period are uterine contractions. They work on the cervix producing its softening, cleaning and dilation. The uterus is composed of two types of muscles: longitudinal, which act on the uterine body, helping the descent of the fetus, and circular, which gradually act on the cervix, dilating it to 10 cm. Depending on the dynamics of the uterus, the contractions are painful, increasing their rate from 25 to 20, 15, 10, 5, 3, 2, 1 per minute and increasing as intensity and duration from 20 to 30, 40, 45, 50 seconds.

When dilatation reached 4-5 cm, usually labour accelerates, contractions become more powerful; if membranes were not ruptured spontaneously, and this is the moment you can break them artificially, using a special for this manoeuvre sterile instrument. Throughout labour, uterine contractions are watched (monitored), the baby's heartbeat, the woman's overall health (blood pressure, pulse, respiration).

When the cervix was fully diluted, that is approximately 10 cm; it is large enough to accommodate the fetal head, so birth can take place. Now appears that the screaming sensation that helps fetal head progression to exit. It is not good for the pregnant to scream unattended, unless dilation is complete, under the supervision of the nurse (midwife), in order to prevent cervical fractures or other soft tissues.

The first period of delivery varies from patient to patient in what regards the period of time, it can take between 8-10 hours in primiparous or 6-8 hours at multiparous, depending on uterine contractility of the muscle fibre. After "removing" cervix, dilation is about 1 cm per hour, from 0 to 10 cm; the fetus gradually descends into the basin, returns with its face to the rear of the mother, preparing to exit.

What we see in this period:

  • Minor contractions (pains) that alternate with severe back pains that are succeeding in series at more or less regular intervals.
  • Feeling of heaviness in the uterus, pains in the lower abdomen (pelvic region), or in the lower back (sacral region).
  • The water bag may crack or break (10-15% of all births begins with spontaneous rupture of membranes) followed by contractions. Normally, the amniotic fluid is clear, opalescent, with specific odour in appreciable amounts, 500-700 ml; if the fluid is brown or green, it is a sign of fetal distress, and you should immediately go to hospital. If you are already in hospital, immediately inform the midwife or doctor who supervises you.

Birth pains psihoprofilaxia

It is a physiological method, which does not require any treatment, considered today in the world as an effective method analgesia, being not harmful to mother and child. Psychological factor produces the extraction of pain existing objectively during childbirth, making it unbearable. This factor is explained by personal emotions, ideas and experiences related to birth moment. All these become chains of complexes, conditioned reflexes, which cause outbreaks of excitation in the cortex. Fear of childbirth is the dominant component, as the pregnant approaches this moment. First uterine contractions trigger conditioned reflex, causing the woman to perceive exaggeratedly her condition. So-called paradoxical reactions occur, very strong reactions to minimum painful excitants, which normally should not produce pain sensation.

Psihoprofilactic method aims to remove these harmful conditioned reflexes and their replacement with other positive, favourable to the development of a normal labour, through a physical training and proper education of the woman and couples in general.

The means by which it is acted upon the central nervous system is the word that proves to be an exciting as strong as other external or internal, physical or chemical excitant at a human being. The word forms the second signal system, which exists only in humans.

The method consists in removing the fear and replacing it with confidence, by explaining the physiological mechanism of birth, the sensations that go through the labour, the means of pain relief and preventing complications. Fear produces an intense stimulation of the sympathetic neurovegetative system, giving rise to a hipercontractility, uterine muscle hypertonic. As a result, uterine fibre gets tired; labour prolongs and maintains the fear of something that seems to have no end. A vicious circle is formed: fear - hypertonia - pain - fear. Psycho prophylaxis role is precisely to break this chain's strongest point: pain.

Physiological processes of pain relief are added to these psychological methods:

  • Breath regularization - this involves increasing the amount of oxygen that has an analgesic effect.
  • Painful area massage - skin tactile arousal inhibit pain impulses left from deep areas.
  • Alternating the periods of contraction with periods of relaxation.

The second period of birth - fetal expulsion

It is shorter at multiparous, 10-15 minutes, than at primiparous, 30-45 minutes. Uterine contractions succeed in this period at 1-2 minutes and lasts 60 seconds, being called expelling contractions. Second period of delivery begins when the dilation is complete and the feeling of screaming appears.

Sometimes there might be a rest period between the first period and the moment when screaming sensations occur; it is better to be used for relaxation and rest, the pregnant woman is learning how to breathe actively in the pause between contractions and screaming during contraction.

The most comfortable position during this period of time is that preferred to by the pregnant, being the most appropriate position being semi sitting or standing, since gravity force comes to the aid of contraction force and contributes to shorten that period. Another preferable position is that of left lateral decubitus (lying on your left), a position that favours fetal placental circulation.

With each contraction, accompanied by 2-3 screamings, child's head progresses in the pelvis, the pregnant feeling pressure on the bladder and the rectum, having the sensation of urgent urination and stool.

Screaming feeling occurs at each contraction, caused by lowering the fetal skull to pelvis; the pregnant will scream three times during a contraction, breathing air through the nose into her lungs, then, with her mouth closed she screams to the end of contraction. In the break between contractions, pregnant woman will rest relaxing.

Fetal skull reaches in the pelvis, pressing the perineum and the surrounding tissue, which gradually begins to relax, that's why the screaming must be potentiated, conducted, in order to allow skin and muscles to gradually relax avoiding unnecessary disruptions.

After anesthesia with 1% Xilina was done in the perineal area, the practice of episiotomy (cutting the perineum) to protect and assist the fetal skull come out. The shoulders, body and legs come out, the umbilical cord is clamped between two pincers and then it will be sectioned.

The third period of birth - the placenta expulsion

It takes between 15-30 minutes immediately after birth, umbilical cord pulsations ceasing after a few minutes. It is clipped, sectioned and a sterile clamp is put over. Uterus contracts on the content (placenta), which starts to come unstrung from the uterus, sliding into vagina. In some contractions,with the support of umbilical cord, the placenta is expelled, together with membranous sac in which the fetus stayed.

The placenta and the membranes are examined in order to verify their integrity, to see if placental debris or membranes remained in the uterus. The soft parts are examined also, i.e. tissues where child went through: perineum, vagina, cervix, to see if there are tears to be stitched (sutured). Tissue and perineum repair is passed to.

Read the English version of this article: Birth Periods