It refers to the vaginal delivery (expulsion) of a fetus out of the uterus, along with its membranes and placenta, between the 21st and 42nd weeks. They take the following names according to their weeks.
What is immature (underdeveloped) birth? : birth occurs between the 21st and 27th weeks of pregnancy. Note: If the pregnancy ends before the 20th week, it is called miscarriage.
What is premature birth? : It is called birth occurring between the 28th and 37th weeks. They are divided into two groups: early premature and late premature. The indicator here is the gestational week and the baby's weight.
What is mature birth? : It is the end of pregnancy between the 38th and 42nd weeks. The main desired normal birth period is between these weeks.
What is post-term birth? : It is the termination of pregnancy after the 42nd week.
Pregnancy in humans lasts 280 days, but only 5% of all pregnancies end on the expected day.
The normal termination of a pregnancy depends on three main factors. These; It can be classified as factors related to the uterus, factors related to the baby, and factors related to the mother's bone structure. These three factors;
1- factors related to the uterus (birth pains, contractions)
2- factors related to the mother's bone roof (whether the roof is narrow or wide)
3- factors related to the baby ( baby's weight, way of arrival)
In order for birth to occur, the uterus must contract at regular intervals and there should be no obstacle to the opening of the cervix in the face of these contractions. Contractions that continue after the uterus is opened will push the baby out of the uterus. To ensure this pushing, the baby must be in the appropriate position and there must be no obstacle in front of it.
Finally, in order for normal birth to occur, there must be no incompatibility between the path the baby will travel and the passenger (baby). If the baby is larger than normal or the path is narrower than normal, it will prevent the normal course of birth.
How to understand that labor has started?
1-What is engagement bleeding? : Generally, the first signs that birth is approaching are irregular contractions and what is popularly known as "engagement". The cervix is closed with a slimy plug throughout the entire pregnancy. This plug protects the baby against external factors. Just before the start of labor, there is a slight opening in the cervix and this plug is thrown out of the body in the form of a bloody discharge.
2-What is labor pain? : These are regular uterine contractions. It comes every 3 minutes. It takes 45 seconds. It is 60mm mercury pressure. It does not go away with rest, it progresses.
3-What is water breaking during birth? (breaking of head water): Breaking water is another symptom of birth. Generally, the action begins spontaneously within 24 hours after the membranes are opened. Sometimes it may be necessary to support the labor with artificial pain.
While false labor pains are mild pains that come and go at irregular intervals, are short in duration (15-20 seconds), real labor pains come and go at more regular intervals and increase in severity. These are pains that become shorter in intervals, last for about 45-60 seconds, and cause the uterus to open and fade. To summarize;
What is real labor pain?
Contractions repeat regularly and contraction breaks become more frequent and decrease to every 2-4 minutes.
The intensity of contractions gradually increases 45 -It lasts for 60 seconds.
It causes softening and dilation of the cervix.
What is false labor pain?
Contractions occur at irregular intervals, the intervals are long and they recur regularly.
The intensity of the contractions remains the same, they are temporary pains.
Contractions often pass with rest and do not cause the cervix to dilate.
What is the benefit of the amniotic fluid?
Amniotic fluid is an important ingredient that not only nourishes the baby in the womb but also protects the baby from external traumas and infections. As the water breaks as a result of the rupture of the amniotic membrane, both the baby and the expectant mother may be exposed to infections.
What is artificial labor pain?
Pains usually occur spontaneously within the first 12 hours after the waters break. starts. If labor does not start even though this process is prolonged, it would be appropriate to start the birth with artificial induction (artificial pain with serum) since the risk of infection for the baby and mother increases. Artificial labor also has passed the day (week) (42nd week) It is applied to pregnant women.
There are three basic stages of labor
Phase I of labor (the stage of full opening of the cervix): The cervix begins to open. It is the period from the start of contractions strong enough to cause the cervix to fully dilate (10 cm). At this stage, as the cervical opening increases, the baby's head descends by making some maneuvers inside. Pains that come every 3 minutes, last 45 seconds, and have a pressure strength of approximately 60 mm of mercury; It allows the cervix to dilate more than 1cm every 2 hours and also allows the baby's head to descend around 1cm. If this is not the case, there is either insufficient pushing power of the uterus or there is an incompatibility between the child's head and the mother's roof. Accordingly, after the evaluation is made, preparations for cesarean section begin. The first stage of labor lasts approximately 16 hours in first births and approximately 8 hours in those who have given birth more than twice.
The second stage of labor lasts approximately 16 hours. Stage (birth of the baby): It refers to the period from the full opening of the uterus (approximately 10cm) until the baby is fully born. This period should not be more than 2 hours for first births. If the baby is still not born even after more than 2 hours, some help should be given. In the meantime, it is necessary to prevent the baby's heart sounds from deteriorating and to prevent him from becoming stressed due to lack of oxygen. The second stage of labor lasts at most half an hour for multiparous mothers (mothers who have given birth more than once). As soon as the head comes out, an episiotomy is made to the vagina and perineum (the part between the vagina and the anus) with local anesthesia, allowing the baby to come out easily. After the placenta and its appendages are removed, the tears in the cervix and vagina are checked, and the bleeding is determined to be normal, the episiotomy (incision) made with self-dissolving stitches is aesthetically stitched. Stage (birth of the placenta): It is the process from the birth of the baby to the complete expulsion of the placenta (wife) and its appendages. As a result of this stage, birth is completed. If the placenta and its appendages do not come out spontaneously after waiting for 30 minutes, they are removed by entering the uterus manually. Bleeding is checked. Bleeding amount less than 500cc after a normal birth is. Some evaluations are made for bleeding above this. These may include failure of the uterus (atony), remaining parts of the placenta and its appendages, stitching of tears in the cervix or vagina, or evaluation of blood clotting problems.
By what mechanism does birth occur?
The most valid theory; It is caused by the stimulation of the reproductive center when the uterus reaches a certain size and the pains begin.
Uterine contractions are provided by the hormone called "oxytocin" secreted from the pituitary gland of the brain. Additionally, changes in the concentration of some substances called "prostaglandins" in the body can trigger contractions. Knowing these mechanisms gives us the chance to start uterine contractions or stop early labor pains.
When is it necessary to apply to the hospital for birth?
As stated above, pains become more frequent and severe after birth. You should go when it increases. In the first births, it is sufficient to apply to the hospital when the pains occur every 20 minutes, lasting for 30-40 seconds and becoming more frequent, and in the second and subsequent births, when the pains occur every 30 minutes. When real labor pains begin, the pregnant woman may perceive that it is different from others.
A snot-like discharge ("engagement") when the pains begin is almost a harbinger of birth. There is no need to panic in this engagement bleeding. In the first birth, labor pains begin approximately 6 hours after the engagement bleeding.
Sometimes, amniotic water (breaking of head water, breaking of water at birth) may occur before labor pains even begin. The breaking of water may occur gently but continuously, or it may suddenly wet the legs. In this case, call your doctor immediately.
Pregnancy and bleeding are risky situations during pregnancy. Any bleeding should be evaluated carefully. Although a little or a lot of bleeding is a sign of birth, it may also indicate a pregnancy-related problem.
What is the importance of baby movements during birth?
There has been a decrease in the baby's movements for the last 2-3 days or If the baby has not played for the last 24 hours, you should also apply to the hospital. This is the baby It could be a sign that you are in trouble. In this case, the decision is usually made by taking an NST (non-stress test) and performing an ultrasound evaluation. A caesarean section plan is made accordingly.
POSTPARTUM FOLLOW-UP AND QUESTIONS
Puerperium begins with the birth of the placenta (the baby's partner). is the period until the uterus returns to its pre-pregnancy state. This period is approximately 6 to 8 weeks. During postpartum follow-up, close follow-up and information are required in terms of breastfeeding, newborn baby care, family planning (prevention) options, postpartum bleeding and postpartum infection, postpartum bathing and postpartum sexual intercourse.
Postpartum Observation
Following up Postpartum Hemorrhage
In terms of postpartum hemorrhage, blood pressure is measured every 15 minutes in the first hour and every 30 minutes in the next 2 hours. Bleeding is monitored by checking whether the uterus has hardened. Monitoring bleeding in early puerperium is very important to save the woman's life. It should be known that the biggest cause of postpartum maternal deaths all over the world is postpartum hemorrhage. These bleedings occur for several reasons.
1-Atony bleeding: Bleeding due to the inability of the uterus to collect (not contracting but remaining loose) constitutes the biggest cause of postpartum bleeding. In cases of bleeding over 700cc, immediate blood transfusion is necessary. Additionally, uterine massage and pressure are performed. Uterine contracting drugs such as oxytocin and methylergonin are given as medication. If it does not respond to all these, the hypogastric artery is surgically ligated. If this does not provide a solution, a suptotal hysterectomy (removal of 2/3 of the uterus) is performed.
2- Bleeding due to vulva (external genital organ), vagina, cervix (cervix) tears: birth It constitutes the second group of bleeding. As soon as tears are detected here, they must be checked under anesthesia and stitched.
3-Postpartum bleeding due to remaining placental fragments: In case of excessive bleeding, especially after the patient is discharged from the hospital, it is necessary to consider placenta residues. The patient is checked again under general anesthesia, curettage is performed and presantal residues are cleaned. By the way, it is called placenta acreata.
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