Maternity , also known as labor and delivery , is the end of pregnancy by one or more babies who leave a woman's uterus with a vaginal or cesarean section. By 2015, there are about 135 million births globally. About 15 million were born before 37 weeks of gestation, while between 3 and 12% were born after 42 weeks. In developed countries most deliveries take place in hospitals, while in developing countries most births occur at home with the support of a traditional healer.
The most common mode of labor is vaginal delivery. It involves three stages of labor: shortening and opening of the cervix, offspring and birth of the baby, and delivery of the placenta. The first stage usually lasts twelve to nineteen hours, the second stage is twenty minutes to two hours, and the third stage is five to thirty minutes. The first stage begins with a stiff abdominal pain or back that lasts about half a minute and occurs every ten to thirty minutes. Pain that cramps become stronger and closer with time. During the second stage the push with contractions can occur. In the third stage of delayed cord clamping of the cord is generally recommended. A number of methods can help with pain such as relaxation techniques, opioids, and spinal blocks.
Most babies are born first; But about 4% are born to the first leg or butt, known as a breech. During delivery, a woman can generally eat and move as she wishes, but encouraging is not recommended during the first stage or during the birth of the head, and enema is not recommended. While making a cut on the opening of the vagina, known as an episiotomy, is common, is generally not necessary. In 2012, about 23 million births occur with a surgical procedure known as a cesarean section. Cesarean section can be recommended for twins, signs of distress in infants, or breech position. This delivery method takes longer to heal.
Each year, complications of pregnancy and childbirth result in about 500,000 maternal deaths, 7 million women have serious long-term problems, and 50 million women have negative results after childbirth. Most occur in developing countries. Specific complications include congested deliveries, postpartum hemorrhage, eclampsia, and postnatal infection. Complications in infants may include lack of oxygen at birth, birth trauma, prematurity, and infection.
Video Childbirth
Signs and symptoms
The most prominent sign of labor is a strong repetitive uterine contraction. The degree of distress reported by working women varies considerably. They seem to be affected by fear and anxiety levels, experience with previous births, birth and pain culture ideas, mobility during labor, and support received during labor. Personal expectations, the amount of support from caregivers, the quality of caregiver-patient relationships, and involvement in decision-making are more important in overall female satisfaction with labor experience than other factors such as age, socioeconomic status, ethnicity, preparation, physical environment, pain, immobility, or medical intervention.
Description
The pain in contractions has been described as a feeling similar to that of very strong menstrual cramps. Women are often encouraged not to shout, but moaning and snorting may be encouraged to help ease the pain. Coronation may be experienced as intense stretching and burning. Even women who showed little reaction to labor pain, compared with other women, showed a very severe reaction to coronation.
Back labor is a term for special pain that occurs in the lower back, just above the tail bone, during delivery.
Psychological
During the late stages of pregnancy there is an increase in the abundance of oxytocin, a hormone known to arouse feelings of satisfaction, anxiety reduction, and feelings of calm and security around the couple. Oxytocin is released further during labor when the fetus stimulates the cervix and vagina, and it is believed that it plays a major role in the bonding of the mother to her baby and in the formation of mother's behavior. The act of breastfeeding a child also causes the release of oxytocin.
Between 70% and 80% of mothers in the United States report some feelings of sadness or "baby blues" after childbirth. Symptoms usually occur for several minutes to several hours each day and they should be reduced and disappear within two weeks after delivery. Postpartum depression may occur in some women; about 10% of mothers in the United States are diagnosed with this condition. Preventive group therapy has been shown to be effective as a prophylactic treatment for postpartum depression.
Maps Childbirth
Vaginal birth
Bipedal man with upright position. Upright posture causes the weight of the stomach to push at the pelvic floor, a complex structure that not only supports this weight but allows, in women, three channels to pass through: the urethra, the vagina and the rectum. The head and shoulders of the baby must go through a series of specific maneuvers to bypass the mother's pelvic ring.
Six phases of a common vertex (head-first presentation) presentation:
- Involvement of the fetal head in transverse position. The baby's head is facing the pelvis in one of the mother's hips.
- Descent and flexion from the fetal head.
- Internal rotation . The fetal head rotates 90 degrees to the antipipito-anterior position so that the baby's face leads to the maternal rectum.
- Shipping with extensions . The fetal head is bent, chin on the chest, so that the back or crown of his head leads the way through the birth canal, until the back of his neck presses the pubic bone and his chin leaves his chest, elongated the neck - as if looking up, and the rest of his head out of the birth canal.
- Substitution . The fetal head rotates 45 degrees to restore normal contact with the shoulder, which is still tilted.
- External rotation . The shoulder repeats the movement of the head cap cap, which can be seen in the last movement of the fetal head.
The vagina is called the 'birth canal' when the baby enters this section.
Station refers to the relationship of the fetal presentation portion to the level of the ischial spines. When the presentation section is in the ischial spines, the station is 0 (identical with engagement). If the presentation of the fetal part is above the thorn, the distance is measured and described as a minus station, which ranges from -1 to -4 cm. If the presentation is under the ischial spines, the distance is expressed as a plus station (1 to 4 cm). The 3 and 4 parts of the presentation are in the perineum and can be seen.
The fetal head may change temporarily substantially (becomes more elongated) as it travels through the birth canal. This change in the shape of the fetal head is called molding and is much more pronounced in women who give birth to their first vagina.
Cervical ripening is a term used to describe the physical and chemical changes in the cervix to prepare it for the stretch that will occur when the fetus moves out of the uterus and into the birth canal. A scoring system called the Bishop score can be used to assess the rate of cervical ripening to predict the timing of labor and delivery or for women at risk of preterm labor. It is also used to assess when a woman will respond to labor induction for a pregnancy that has passed or other medical reasons. There are several methods to encourage cervical ripening that will allow uterine contractions to dilate the cervix effectively.
Start of work
There are various definitions of onset of labor, including:
- Routine uterine contractions at least every six minutes with evidence of changes in cervical dilatation or cervical dilution between consecutive digital examinations.
- Regular contractions that occur less than 10 minutes apart and progressive cervical dilatation or cervical dilution.
- At least 3 painful painful uterine contractions over a 10-minute period, each lasting longer than 45 seconds.
To take advantage of a more uniform terminology, the first stage of labor is divided into "latent" and "active" phases, in which latent phases are sometimes included in the definition of labor, and sometimes not.
Common signs that labor will begin soon may include "relief". Lightening describes the baby moving down from the rib cage with the baby's head involved deep within the pelvis. Pregnant women may find breathing easier because the lungs have more room for expansion, but the pressure on the bladder can lead to a more frequent need to cancel (urinate). Relief may occur several weeks or several hours before labor begins, or even until labor has begun.
Some women also experience a whitish increase a few days before labor begins when the "mucus plug", a thick mucous plug that blocks the opening to the uterus, is pushed out into the vagina. The mucous plug may be the days off before labor begins or not until the onset of labor.
When living in the womb the baby is flanked by a fluid-filled membrane called the amniotic sac. A moment before, at the beginning, or during the labor of the sac broke. Once the sac breaks, termed "water pause", the infant is at risk of infection and the maternal medical team will assess the need to induce labor if it has not started in a time that is believed to be safe for the baby.
Many women are known to experience what is called a "nest instinct". Women report an energy boost just before delivery.
Folklore has long stated that most babies are born late at night or early in the morning and recently (2018) research has found this to be true in the US, but only for babies born at home or on Saturdays or Sundays. All other births are most likely to occur between 8 am and noon, a reflection of the fact that the planned C round is generally scheduled for 8 am. Likewise, births from induced births rise during the morning hours and peak at 3 pm. The most likely day of the week for a baby's birthday in the US is Monday, followed by Tuesday, possibly linked to scheduled delivery as well.
First stage: latent phase
The latent phase is generally defined as the beginning at the point where women feel a routine uterine contraction. In contrast, Braxton Hicks contractions, whose contractions may start around 26 weeks of pregnancy and are sometimes called "fake labor", are rare, irregular, and involve only mild cramps.
Cervical thinning, ie thinning and stretching of the cervix, and cervical dilatation occur during the final weeks of pregnancy. Handling is usually complete or almost complete and widening about 5 cm at the end of the latent phase. The degree of depletion and widening of the cervix can be felt during vaginal examination. The latent phase ends with the onset of the first active stage.
First stage: active phase
The active stage of work (or "first phase active phase" if the previous phase is called "first stage latent phase") has a geographically different definition. The World Health Organization describes the first active phase as "a period of time characterized by painful regular uterine contractions, a substantial degree of cervical thinning and cervical dilatation that is faster than 5 cm until full dilatation for the first and subsequent labor." In the US, the working definition is active changing from 3 to 4 cm, to 5 cm from cervical dilatation for multiparous women, women who gave birth before, and to 6 cm for nulliparous women, who had never given birth before attempting to increase vaginal delivery rates.
Healthcare providers can assess the progress of working mothers in labor by performing cervical examinations to evaluate cervical dilution, depletion, and station. These factors make up the Bishop score. Bishop scores can also be used as a means to predict the success of labor induction.
During thinning, the cervix becomes inserted into the lower segment of the uterus. During contraction, uterine contraction of the uterus causes shortening of the upper segment and drawing on the lower segment, in the expulsive movement gradually. The part of the present fetus is then allowed to go down. Full widening is achieved when the cervix has widened enough to allow through the baby's head, about 10 cm widening for the baby enough months.
The standard duration of the latent first stage has not been established and can vary greatly from one woman to another. However, the duration of the active first stage (from 5 cm to full cervical dilatation) usually does not exceed 12 hours in the first labor ("primiparae"), and usually does not exceed 10 hours in the next (multiparae). The average duration of the first active stage is 4 hours in the first labor and 3 hours in the second and subsequent labor.
Labor disturbance , also called dysfunctional labor or failure to develop, is defined as labor that is difficult or late in labor progress. This term is used to describe the lack of progressive cervical dilatation or lack of fetal offspring. Friedman's Curve, developed in 1955, has been used for years to determine labor dystocia. However, more recent medical research suggests that the Friedman curve may not be applicable at this time.
Second stage: expulsion of the fetus
The eviction stage begins when the cervix is ​​fully dilated, and ends when the baby is born. When the pressure on the cervix increases, the woman may have a pelvic pressure sensation and the urge to start pushing. At the beginning of the second normal stage, the head is fully involved in the pelvis; the widest head diameter has passed below the level of the pelvic inlet. The fetal head then continues down into the pelvis, under the arch of the genitals and out through the vaginal opening (the opening). This is aided by additional mom efforts to "lower" or encourage. The appearance of the fetal head in the vaginal opening is referred to as "coronation". At this point, women will feel an intense burning or stinging sensation.
When the amniotic sac does not rupture during labor or pushing, the baby can be born with a complete membrane. This is called "sending en caul".
Complete expulsion of the baby signifies the successful completion of the second stage of labor.
The second stage varies from one woman to another. In the first labor, birth is usually completed within 3 hours while in the next delivery, the birth is usually completed within 2 hours. Labor for more than 3 hours was associated with reduced rates of spontaneous vaginal delivery and increased rates of infection, perineal laceration, and obstetric haemorrhage, as well as the need for intensive neonatal care.
Third stage: delivery of placenta
The period from right after the fetus is removed until after the placenta is released is called the third stage of labor or the stage of involution . The expulsion of the placenta begins as a physiological separation of the uterine wall. The average time from childbirth to complete expulsion of the placenta is estimated to be 10-12 minutes depending on whether active or pregnant management is used. In as much as 3% of all vaginal deliveries, the duration of the third stage is longer than 30 minutes and raises concerns for placental retention.
Expulsion of the placenta can be managed actively or can be managed hopefully, allowing the placenta to be removed without medical help. Active management is described as administering a uterotonic drug within one minute of fetal delivery, controlled traction of the umbilical cord and fundus massage after delivery of the placenta, followed by a uterine massage performance every 15 minutes for two hours. In a joint statement, the World Health Organization, the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives recommends active management of the third stage of labor in all vaginal deliveries to help prevent postpartum hemorrhage.
Delaying the cord clamping for at least a minute or until it stops throbbing, which may take a few minutes, improves results as long as there is the ability to treat jaundice if it occurs. For many years it was believed that umbilical cord cutting caused a mother to experience significant bleeding after childbirth, called postpartum hemorrhage. A recent review, however, found that delayed cord cuts in healthy long-term infants resulted in higher baseline hemoglobin concentrations and higher birth weight and increased iron reserves up to six months after birth without changes in postpartum hemorrhage rates.
Fourth stage
"The fourth stage of labor" is the period that begins immediately after the birth of a child and extends for about six weeks. Postpartum and postnatal terms are often used to describe this period. The female body, including hormone levels and uterine size, returns to a state of non-pregnancy and newborns adjust to life outside the mother's body. The World Health Organization (WHO) describes the postnatal period as the most critical and most neglected phase of maternal and infant life; most deaths occur during the postnatal period.
After birth, if the mother has an episiotomy or perineal rupture, she is stitched. The mother has regular assessment for uterine contractions and fundal height, vaginal bleeding, heart rate and blood pressure, and temperature, during the first 24 hours after birth. The first pass urine should be documented in 6 hours. Afterpains (pain similar to menstrual cramps), uterine contractions to prevent excessive blood flow, continue for several days. Vaginal discharge, called "lokia", can be expected to continue for several weeks; initially bright red, gradually becomes pink, turns brown, and eventually becomes yellow or white. Some women experience episodes of chills or uncontrolled postpartum, after birth.
Most authorities advise the baby to skin-to-skin contact with the mother for 1-2 hours immediately after birth, placing regular care until later.
Until now, babies born in hospitals are expelled from their mothers shortly after birth and taken to mothers only when breastfeeding. Mothers were told that their newborns would be safer in the nursery and that separation would offer the mother more time to rest. As attitudes begin to change, some hospitals offer an "in-room" option where after a period of procedure and routine observation at the hospital, infants may be allowed to share a mother's room. However, more recent information has begun to question the standard practice of issuing newborns shortly after delivery for routine postpartum procedures before being returned to the mother. Beginning around 2000, some authorities began to suggest that early skin-to-skin contact (placing a naked baby in the mother's chest) could benefit both mother and baby. Using animal studies that have shown that intimate contact attached to skin-to-skin contact promotes neurobehaviors that result in the fulfillment of basic biological needs as a model, recent research has been done to assess what, if any, benefits can be attributed to skin-to- premature skin for human mothers and their babies. The 2011 medical review observes existing research and found that early skin-to-skin contact, sometimes called kangaroo treatment, results in improved breastfeeding, cardio-respiratory stability, and decreased crying. The 2016 Cochrane Review found that skin-to-skin contact at birth encourages the possibility and effectiveness of breastfeeding.
In 2014, early postnatal skin-to-skin contact is supported by all major organizations responsible for infant welfare, including the American Academy of Pediatrics. The World Health Organization (WHO) states that "labor is not completed until the baby is safely transferred from the placenta to milk nutrition." They suggested that newborns be placed in the skin with the mother, delaying routine procedures for at least one to two hours. WHO recommends that any early baby observation can be performed when the infant remains close to the mother, saying that even a short separation before the baby has the first food can disrupt the bonding process. They more often suggest skin contact to the skin as much as possible during the first days after delivery, especially if it is disrupted for some reason after childbirth. The National Institute for Health and Nursing Excellence also recommends delaying procedures such as weighing, measuring, and bathing for at least 1 hour to ensure the initial period of skin-to-skin contact between mother and baby.
Induction of labor and elective cesarean section
In many cases and with increasing frequency, labor is achieved through labor induction or caesarean section. Caesarean section is the removal of the neonate through a surgical incision in the abdomen, not through vaginal birth. Childbirth by C-Sections increased 50% in the US from 1996 to 2006. In 2011, 32.8% of US births were performed by cesarean section. The birth of induction and elective cesarean delivery before 39 weeks can be harmful to the neonate as well as harmful or without benefit to the mother. Therefore, many guidelines recommend the necessary non-medical induced birth and elective caesarean section before 39 weeks. The 2012 level of labor induction in the United States is 23.3%, and has more than doubled from 1990 to 2010. Pitocin is commonly used to induce uterine contractions. A large review of induction methods was published in 2011.
The American Congress of Obstetricians and Gynecologists (ACOG) guidelines recommend a full evaluation of the mother-fetus status, cervical status, and at least 39 weeks of completion (full term) of pregnancy for optimal health of the newborn when considering elective induction of labor. According to this guideline, the following conditions may be indications for induction, including:
- Abruptio placentae
- Chorioamnionitis
- Fetal compromise such as isoimmunization that causes hemolytic disease in newborns or oligohydramnios
- Loss of the fetus
- Gestational hypertension
- Mother's condition such as gestational diabetes or chronic kidney disease
- Preeclampsia or eclampsia
- premature rupture of membranes
- Postterm pregnancy
Induction is also considered for logistical reasons, such as distance from the hospital or psychosocial condition, but in this case confirmation of gestational age should be performed, and fetal lung maturity should be confirmed by testing. ACOG also noted that contraindications to labor induction are similar to spontaneous vaginal deliveries, including vasa previa, complete preeval placenta, cord prolapse or active genital herpes simplex infection.
Management
Delivery is assisted by a number of professionals including: obstetrician, family doctor and midwife. For low-risk pregnancies they produce similar results.
Get started
Eating or drinking during labor is an area of ​​ongoing debate. While some argue that eating in labor does not have a harmful effect on outcomes, others continue to have concerns about the possibility of increased aspiration events (choking on freshly eaten food) in terms of emergency delivery due to increased esophageal relaxation in pregnancy, upward pressure of the uterus on the abdomen, and the possibility of general anesthesia in the event of an emergency cesarean section. The 2013 Cochrane Review found that with good obstetric anesthesia there was no change in the danger of allowing eating and drinking during labor in those who did not need surgery. They also admit that not eating does not mean there is an empty stomach or the contents are not sour. They therefore concluded that "women should be free to eat and drink in labor, or not, as they wish."
At one time shaving the area around the vagina, it is a common practice because of the belief that hair removal reduces the risk of infection, makes an episiotomy (surgical cut to enlarge the vaginal entrance) easier, and helps with instrumental delivery. It is currently less common, although it is still a routine procedure in some countries although a systematic review found no evidence to recommend shave. Side effects appear later, including irritation, redness, and some superficial scratches of the razor. Another effort to prevent infection is the use of antiseptic chlorhexidine or providone-iodine solution in the vagina. Evidence of benefits with chlorhexidine is lacking. Decreased risk was found with providone-iodine when caesarean section was performed.
Active work management
In 2013 a review of active management effectiveness to reduce caesarean section rates in low-risk women was performed. The active management of labor consists of a number of treatment principles, including "strict labor diagnosis", rupture of membranes routinely, oxytocin for slow progress, and one-to-one support. This study reported that when compared with routine care there was no difference in the use of drugs for pain, maternal or newborn complications, or the rate of pervaginam assisted delivery. There was a slight decrease in caesarean section, but active management was seen as "highly prescriptive and interventional."
The World Health Organization recommends: "Avoid systematic use of intervention packages (" active management of labor ") to prevent possible delivery delays because it is highly prescriptive and may undermine women's choice and autonomy during treatment."
Pain control
Non-pharmaceutical
Some women prefer to avoid analgesic drugs during childbirth. Psychological preparation may be helpful. Relaxation techniques, soaking in water, massage, and acupuncture can ease the pain. Acupuncture and relaxation were found to reduce the number of cesarean sections required. Water immersion has been found to relieve pain during the first stage of labor and to reduce the need for anesthesia and shorten the duration of labor, but the safety and efficacy of immersion during birth, water birth, has not been established or associated with the mother or the benefit of the fetus.
Most women love to have someone to support them during labor and birth; such as a midwife, nurse, or doula; or a layman like a baby father, family member, or close friend. Research has found that ongoing support during labor and delivery reduces the need for treatment and caesarean delivery or vaginal delivery, and results in an increased Apgar score for infants.
Pharmacy
Different measures for pain control have varying degrees of success and side effects in women and their infants. In some European countries, doctors usually prescribe inhaled nitrous oxide gas to control pain, mainly because 53% nitrous oxide, 47% oxygen, known as Entonox; In the UK, midwives can use this gas without a prescription. Opioids such as fentanyl may be used, but if given too close to birth there is a risk of respiratory depression in infants.
Popular medical pain controls in hospitals include regional epidural anesthesia (EDA), and spinal anesthesia. Epidural analgesia is a generally safe and effective method for relieving labor pain, but is associated with longer labor, more operative interventions (especially instrument delivery), and increased costs. Generally, pain and stress hormones increase during labor for women without epidurals, while pain, fear, and stress hormones decrease after epidural analgesia, but rise again later. Drugs given through the epidural can cross the placenta and enter the fetal bloodstream. Epidural analgesia has no statistically significant effect on the risk of caesarean section, and does not appear to have a direct effect on neonatal status determined by Apgar score.
Augmentation
Augmentation is the process of stimulating the uterus to increase the intensity and duration of contractions after labor has begun. Some augmentation methods are usually used to treat delayed labor progress (dystocia) when uterine contractions are considered too weak. Oxytocin is the most commonly used method for increasing the rate of vaginal delivery. The World Health Organization recommends its use either alone or with amniotomy (breakage of the amniotic membrane) but suggests that it should be used only after it has been confirmed correctly that labor does not work properly if danger should be avoided. WHO does not recommend the use of antispasmodic agents to prevent delay in labor.
Episiotomy
Vaginal tears can occur during labor, most often at the opening of the vagina as the baby's head passes, especially if the baby goes down quickly. Tears may involve the perineal skin or extends to the muscles and anal and rectal sphincters. While making a cut on the opening of the vagina, known as an episiotomy is common, it is generally not necessary. When required, the midwife or obstetrician makes a cutting operation in the perineum to prevent a severe tear that can be difficult to repair. The Cochrane 2017 review compares the episiotomy as needed (restrictive) with routine episiotomy to determine the possible benefits and hazards for both mother and baby. The review found that restrictive episiotomy policies appear to provide some benefits compared to routine episiotomy use. Women had less severe perineal trauma, less posterior perineal trauma, less sewing and fewer healing complications in seven days with no difference in the occurrence of pain, urinary incontinence, painful sex or severe vaginal/perineal trauma after birth.
Submission instrumental
An obstetric tool or ventouse can be used to facilitate labor.
Many births
In the case of the first head-presenting the first twin, twins can often be delivered through the vagina. In some cases, twin delivery is done in the larger maternity room or in the operating room, in case of complications eg
- Both twins are born normally - this can happen either the first head or where one head comes first and the other is a breech and/or assisted by the delivery of forceps/ventouse
- One twin is born through the vagina and the other with a cesarean section.
- If the twins join any part of the body - called conjoined twins, most deliver by caesarean section.
Support
Historically women have been attended and supported by other women during labor. But today, as more women give birth in hospitals than at home, ongoing support has been the exception rather than the norm. When a woman is pregnant before the 1950s, the husband will not be in the delivery room. It does not matter if it is the birth of the house; husband is waiting downstairs or in another room at home. If you are in hospital then the husband is in the waiting room. "Her husband is caring and kind, but, Kirby concludes, Every good woman needs her own sex constituency." Obstetric care often directs women to institutional routines, which may have adverse effects on the progress of labor. Supportive care during labor may involve emotional support, comfort measures, and information and advocacy that can improve the physical process of labor and feelings of female control and competence, thus reducing the need for obstetric intervention. Ongoing support can be provided by either hospital staff such as nurses or midwives, doula, or by women's preferred friends from their social networks. There is increasing evidence to suggest that the participation of the father of the child in birth leads to better birth and also postpartum results, giving the father no show of excessive anxiety.
A recent Cochrane review involving more than 15,000 women in various settings and circumstances found that "Women who receive continuous support work are more likely to give birth spontaneously," ie giving birth without cesareans or vacuum or forceps. tend to not use pain medication, are more likely to be satisfied, and have a slightly shorter job.Their babies tend to have a low five-minute Apgar score. "
Fetal monitoring
External monitoring
For fetal monitoring during labor, a simple fetal pinard or doppler stethoscope (" doptone ") can be used. The noninvasive (noninvasive) fetal monitoring method (EFM) during delivery is cardiotocography, using a cardiotocograph consisting of two sensors: The cardiovascular (sensorio) sensor is an ultrasonic sensor, similar to a monitor Doppler fetus, which continuously emits ultrasound and detects fetal heart movement by reflected sound characteristics. The pressure-sensitive pressure-sensitive pressure transducer, called the tocodynamometer (toco) has a flat area fixed on the skin by a band around the abdomen. The pressure required to flatten part of the wall correlates with internal pressure, thus providing a contraction estimate. Cardiotocographic monitoring may be performed intermittently or continuously. The World Health Organization (WHO) recommends that for healthy women continuously undergoing continuous cardiotocography is not recommended for fetal well-being assessment. WHO states: "In countries and settings where continuous CTG is used defensively to protect against litigation, all stakeholders should be made aware that this practice is not based on evidence and does not improve birth outcomes."
Internal monitoring
Mother's water should be solved before internal (invasive) monitoring can be used. More invasive monitoring may involve fetal scalp electrodes to provide an additional measure of fetal heart activity, and/or intrauterine pressure catheter (IUPC). It could also involve fetal scalp pH testing.
Complications
Per number is taken in 2015, since 1990 there has been a 44 percent decline in maternal mortality. However, by 2015, the figure of 830 women dies daily due to pregnancy-related causes or delivery and for every woman who dies, 20 or 30 are injured, infected or disabled. Most of these deaths and injuries can be prevented.
In 2008, it noted that every year more than 100,000 women die from complications of pregnancy and birth and at least 7 million have serious health problems while 50 million more have adverse health consequences after childbirth, the World Health Organization (WHO) has urged midwife training to strengthen maternal and newborn health services. To support increased midwifery skills, WHO established a midwife training program, Action for Maternal Safety.
Increasing maternal mortality in the US is of concern. In 1990, the US was ranked 12th out of 14 developed countries analyzed. However, since that time, the level of each country has continued to rise while the US level has soared dramatically. While every other developed country of 14 analyzed in 1990 showed a 2017 mortality rate of less than 10 deaths per 100,000 live births, the US rate had risen to 26.4. By comparison, England ranks second highest in 9.2 and Finland is the safest at 3.8. Further, for every one of 700 to 900 US women who die each year during pregnancy or childbirth, 70 have significant complications such as bleeding and organ failure, totaling more than 1 percent of all births.
Compared to other developed countries, the United States also has a high infant mortality rate. The Trust for America's Health reports that in 2011, about a third of births in America have multiple complications; many of which are directly related to maternal health including increased rates of obesity, type 2 diabetes, and physical activity. The US Centers for Disease Control and Prevention (CDC) has led initiatives to improve women's health before conception in an effort to increase neonatal mortality and maternal mortality.
Complications of labor and delivery
Delinquent labor
The second stage of labor may be delayed or prolonged by poor or uncoordinated uterine action, abnormal uterine position such as the breech or shoulder dystocia, and cephalopelvic disproportion (small pelvis or large baby). Prolonged labor may cause maternal fatigue, fetal distress, and other complications including obstetric fistula.
Eclampsia
Eclampsia is an early seizure (seizure) in women with pre-eclampsia. Pre-eclampsia is a pregnancy disorder where there is high blood pressure and either a large amount of protein in the urine or other organ dysfunction. Pre-eclampsia is routinely screened during prenatal care. Onset may be before, during, or rare, after delivery. About one percent of women with eclampsia die.
Maternal complications
Puerperal disorders or postpartum disorders are complications that occur mainly during the puerperium, or puerperium. The postpartum period can be divided into three distinct phases; early or acute phase, 6-12 hours after delivery; a subacute postpartum period, which lasts 2-6 weeks, and a delayed postpartum period, which can last up to 6 months. In the subacute postpartum period, 87% to 94% of women report at least one health problem. Long-term health problems (persisting after delayed postpartum period) were reported by 31% of women.
Postpartum haemorrhage
Postpartum haemorrhage is the leading cause of maternal mortality in the world, especially in developing countries. Globally it happens about 8.7 million times and produces 44,000 to 86,000 deaths per year. Uterine atonia, the inability of the uterus to contract, is the most common cause of postpartum hemorrhage. After delivery of the placenta, the uterus is left with a large area of ​​open blood vessels that must be narrowed to avoid blood loss. Retention of placental tissue and infection may contribute to uterine atony. Severe blood loss results in hypovolemic shock, inadequate perfusion of vital organs and death if not treated quickly.
Postpartum infections
Postpartum infections, also known as postpartum fever and puerperal fever, are bacterial infections of the reproductive tract after delivery or miscarriage. Signs and symptoms usually include fever over 38.0 ° C (100.4 ° F), chills, lower abdominal pain, and possibly whitish odor. Infection usually occurs after the first 24 hours and within the first ten days after delivery. Infection remains a major cause of maternal mortality and morbidity in developing countries. Ignaz Semmelweis's work is seminal in the pathophysiology and treatment of puerperal fever and his work saved many lives.
Psychological complications
Childbirth can be an intense event and strong emotions, both positive and negative, can be brought to the surface. An abnormal and persistent fear of childbirth is known as tokophobia. The prevalence of fear of childbirth worldwide ranges from 4-25%, with 3-7% of pregnant women having clinical fears during childbirth.
Most new mothers may experience a mild and worrying feeling of unhappiness after childbirth. Babies need a lot of care, so it's natural for the mother to worry, or tired of, to provide that care. That feeling, often called "baby blues", affects up to 80 percent of mothers. They are mild, last for a week or two, and usually disappear by themselves.
Postpartum depression is different from "baby blues". With postpartum depression, feelings of sadness and anxiety can be extreme and may interfere with a woman's ability to care for herself or her family. Because of the severity of symptoms, postpartum depression usually requires treatment. The condition, which occurs in nearly 15 percent of births, can begin shortly before or after childbirth, but usually begins between one week and one month after delivery.
Delivery of post-traumatic stress disorder is a psychological disorder that can develop in women who have just given birth. Causes include problems such as C-section emergencies, premature labor, inadequate care during labor, lack of social support after childbirth, and others. Examples of symptoms include intrusive symptoms, flashbacks and nightmares, as well as avoidance symptoms (including amnesia for the whole or part of the event), problems in developing maternal-child attachments, and others similar to those commonly experienced in post-traumatic stress disorder ( PTSD). Many women who experience PTSD symptoms after delivery are misdiagnosed with postpartum depression or adjustment disorder. This diagnosis can lead to inadequate care.
Postpartum psychosis is a rare psychiatric condition in which high mood symptoms and racial thoughts (mania), depression, severe confusion, loss of inhibition, paranoia, hallucinations and delusions occur, begin suddenly in the first two weeks after giving birth. Symptoms vary and can change quickly. It usually requires hospitalization. The most severe symptoms last from 2 to 12 weeks, and recovery takes 6 months to a year.
Complications of the fetus
Five causes account for about 80% of newborn deaths. They include prematurity and low birth weight, infection, lack of oxygen at birth, and trauma during birth.
Premature birth
Premature birth is the birth of infants at gestation less than 37 weeks. It is estimated that 1 in 10 babies are born prematurely. Premature birth is the leading cause of death in children under the age of 5 although many survivors experience disabilities including learning disabilities and vision and hearing problems. The causes for early childbirth may be unknown or may be associated with certain chronic conditions such as diabetes, infections, and other known causes. The World Health Organization has developed guidelines with recommendations to improve the possible outcomes of life and health for premature infants.
Neonatal infection
Newborns are prone to infection in the first month of life. S. agalactiae (Group B Streptococcus) or (GBS) organisms are most often the cause of this sometimes fatal infection. The baby contracts the infection from the mother during labor. By 2014 it is estimated that about one in 2,000 newborns have bacterial GBS infections within the first week of life, usually proven to be respiratory disease, general sepsis, or meningitis.
Untreated sexually transmitted infections (STIs) are associated with congenital and infections in newborns, especially in areas where infection rates remain high. The majority of STIs have no symptoms or only mild symptoms that may not be recognized. The mortality rate for some infections may be high, for example the overall perinatal mortality rate associated with untreated syphilis is 30%.
perinatal asphyxia
Perinatal asphyxia is a medical condition resulting from the deprivation of oxygen to the newborn that lasts long enough during the birth process to cause physical damage, usually to the brain. Damage to hypoxia can occur in most of the baby's organs (heart, lungs, liver, intestine, kidneys), but the brain damage is most worrying and probably the most likely to heal quickly or completely heal.
Mechanical mechanical injury
Risk factors for fetal birth injury include fetal macrosomia (large baby), maternal obesity, need for instrumental delivery, and inexperienced officers. Specific situations that may contribute to a birth injury include a butt presentation and shoulder dystocia. Most fetal birth injuries heal without long-term injury, but brachial plexus injury may lead to Erb's paralysis or Klumpke's paralysis.
Society and culture
Childbirth regularly occurs in hospitals in most Western societies. Before the 20th century and in some countries to this day more often occur at home.
In Western and other cultures, age is calculated from the date of birth, and sometimes birthdays are celebrated each year. East Asian age calculations start newborns at "1", incrementing every Lunar New Year.
Some cultures view the placenta as a special part of birth, since it has been a child's life support for months. The placenta can be eaten by newborn, ceremonial families, for nutrition, or vice versa. (Some animal mothers eat their births: this is called placentophagy.) Recently there is a category of available birth professionals who will process the placenta for consumption by postpartum mothers.
The exact location where childbirth takes place is an important factor in determining citizenship, especially for births on planes and ships.
Facilities
The following are facilities primarily intended to accommodate women during labor:
- A labor ward , also called delivery ward or labor and delivery , is usually a hospital department focused on providing care health for women and their children during labor. This is generally closely related to the neonatal intensive care unit of the hospital and/or the midwifery surgery unit if any. A maternity ward or maternity unit may include facilities for both labor and for postpartum rest and maternal observation in both normal and complicated cases.
- Maternity hospitals are hospitals that specialize in treating women while they are pregnant and during delivery and provide care for newborns,
- The delivery center generally presents a simulated home environment. The birth center may be located on the hospital page or "free standing" (ie, not affiliated with the hospital).
- In addition, it is possible to give birth at home, usually with the help of a midwife. However, some women choose to give birth at home without any professional presence, which is referred to as unaided childbirth.
Related jobs
Different categories of birth attendants can provide support and care during pregnancy and childbirth, although there are important differences across categories based on training and professional skills, exercise regulation, as well as the nature of care provided. Many of these jobs are very professional, but there are other less formal roles.
"Childbirth teacher" is an instructor whose aim is to educate pregnant women and their partners about the nature of pregnancy, signs and stages of labor, techniques for childbirth, breastfeeding and newborn care. Training for this role can be found in hospital settings or through independent certification organizations. Each organization teaches its own curriculum and each emphasizes different techniques.
Doula is an assistant who supports mothers during pregnancy, labor, birth, and postpartum. They are not medical helpers; Instead, they provide emotional support and non-medical pain relief for women during labor. Just as educators give birth and unlicensed escort personnel, certification to become a doula is not mandatory, so anyone can call themselves as doulas or birth educators.
Caregiver caregivers are individuals who are hired to provide assistance and live with mothers in their homes after childbirth. They usually have mothers taking courses on how to care for mothers and newborns.
Midwives are autonomous practitioners who provide basic and emergency health care before, during and after pregnancy and childbirth, generally for women with low-risk pregnancies. Midwives are trained to assist during labor and delivery, either through direct-entry or nurse-midwifery education programs. The jurisdiction in which midwifery is a regulated profession will usually have a regulatory and disciplinary body for quality control, such as the American Midwifery Certification Council in the United States, the College of Midwives of British Columbia (CMBC) in Canada or the Nursing and Midwifery Board (NMC) in the UK.
In jurisdictions where obstetrics are not a regulated profession, traditional or laywoman midwives can help women during labor, although they usually do not receive formal health care education and training.
Medical doctors who practice midwifery include special obstetric specialists, family practitioners and general practitioners whose training, skills and practice include obstetrics, and in some contexts of general surgeons. These doctors and surgeons vary by providing care throughout the normal birth spectrum and abnormal birth and pathological work conditions. Specialist obstetricians are qualified surgeons, so they can perform surgical procedures related to delivery. Some family practitioners or general practitioners also perform obstetric surgery. Obstetric procedures include cesarean section, episiotomy, and assisted childbirth. Categorical specialists in obstetrics are generally trained in obstetrics and gynecology (OB/GYN), and can provide other medical and surgical gynecological treatments, and can incorporate elements of primary care more commonly, well-women, in their practice. Mother-fetus medical specialist is a subspecialist gynecologist in managing and treating high-risk pregnancies and deliveries.
Anesthetist or anesthesiologist is a doctor specializing in pain relievers and drug use to facilitate surgery and other painful procedures. They may contribute to the care of a woman in labor by performing an epidural or by administering anesthesia (often spinal anesthesia) for caesarean section or forceps.
Midwifery nurses assist midwives, doctors, women, and infants before, during, and after birth, in the hospital system. Midwifery nurses hold various certifications and usually undergo additional obstetric training in addition to standard nursing training.
Paramedics are health care providers capable of providing emergency care for mothers and babies during and after childbirth using a wide range of drugs and tools in the ambulance. They are able to provide babies but can do very little for babies that become "stuck" and can not be born through the vagina.
Lactation consultants help mothers and newborns to successfully breastfeed. A health visitor comes to see them at home, usually within 24 hours of returning home, and checks for maternal healing and infant development.
Collecting stem cells
It is currently possible to collect two types of stem cells during labor: the amniotic stem cells and stem cells of the umbilical cord. They are being studied as possible treatment of a number of conditions.
Cost
According to a 2013 analysis conducted by the New York Times and conducted by Truven Healthcare Analytics, the cost of labor varies dramatically by the state. In the United States, the average amount paid by insurance companies or other payers in 2012 averaged $ 9,775 for unconventional conventional delivery and $ 15,041 for cesarean delivery. The total cost of health facilities for 4 million annual births in the United States is estimated at more than $ 50 billion. The total cost of prenatal, natal, and nursing care of the newborn reaches $ 30,000 for vaginal delivery and $ 50,000 for the cesarean section.
In the United States, maternity hospitals still have some of the lowest ICU utilization. Vaginal delivery with and without complications of diagnosis and caesarean section with and without major comorbidities or comorbidities has resulted in four of the fifteen types of fixed hospitals with low levels of ICU utilization (less than 20% of visits were admitted to ICU). During stay with ICU service, about 20% of the cost is due to ICU.
A 2013 study published in BMJ Open found many different costs by facilities for labor costs in California, ranging from $ 3,296 to $ 37,227 for vaginal birth and from $ 8,312 to $ 70,908 for caesarean birth.
Beginning in 2014, the UK National Institute for Health and Nursing Excellence began recommending that many women deliver at home under midwife care than obstetricians, citing lower costs and better health care outcomes. The average cost associated with home births is estimated to be around $ 1,500 vs. about $ 2,500 at the hospital.
See also
References
External links
- Spontaneous Vaginal Delivery, Video by Merck Professional Edition Manual
- [1] Morbidity/Maternal Mortality in Media
Source of the article : Wikipedia
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