If something does go wrong, rest assured that the doctors will do their best for you and your child. When complications arise and all plans are disrupted, it is easy to lose control of yourself, but try not to panic. The doctor will be able to explain the situation, talk about the possible consequences and ways out of it. Together, you will decide what is best for you and your child.
After mother and baby have finally reached their expected due date after 40 long weeks, regular check-ups become more frequent.
If the actual due date is a few days back from the estimated date, it shouldn't be a problem, provided both are okay.
By means of ultrasound, the doctor will periodically monitor the child's condition and life support. Only when the examination shows that the baby is too small, delaying the onset of labor is considered undesirable. In this case, the earliest possible artificial stimulation of labor is recommended. The same applies to the situation when the baby is very large and weighs more than 4500 g. And here artificial childbirth is preferable, since otherwise the baby will continue to gain weight, and spontaneous childbirth can become extremely difficult.
More than 20% of births in France are carried out with the use of stimulants (both for medical reasons and on personal request). And in fact, and in another case, a woman receives drugs that accelerate the process of labor, since childbirth can be protracted and more painful.
Indications for stimulation of labor
Here are some of them.
- When labor does not come on time (41st week of amenorrhea).
- When the waters have already departed, and there are no contractions for 24-48 hours.
- When problems arise with the normal development of the fetus (intrauterine growth retardation).
A woman in labor can agree in advance about a due date if she lives far from the hospital or she has already had a rapid birth.
Conditions... Doctors do not often consent to stimulated labor if the woman does not have the indications listed above.
The doctor may ask you some questions before making any decision.
It is desirable that this was not the first birth and that the cervical dilatation has already occurred.
Stimulation is not carried out until 39 weeks, as there is a danger of harm to the health of the child.
If there is no indication, do not insist on stimulation of labor - trust your doctor.
The lower the stress level, the more likely you will not need stimulation of labor.
Postterm pregnancy
- The end of the 9th month (41st week of amenorrhea) is the end of pregnancy.
- If by this time you do not have any precursors of childbirth, you will be referred to the hospital. The child's condition will be checked there. By this time, the placenta may no longer fully perform all its functions (nutrition and oxygenation of the blood).
- The doctor will prescribe an ultrasound and CTG to check the heart rate, the amount of amniotic fluid and to assess the biophysical state of the fetus according to the Maning scale. If any violations are detected, the doctor may decide to stimulate labor.
- In any case, 3-5 days after the deadline that you decided with your doctor, the labor will be induced. The deadline for natural childbirth is 42 weeks of amenorrhea.
How labor is stimulated?
Once the decision has been made, it is necessary to determine the degree of maturity of the cervix. To this end, the doctor will perform a vaginal examination and determine the degree according to the Bishop system (scale from 0 to 10). The result of 6-10 points indicates that the cervix is mature: it opens (1-2 fingers wide), shortens (about 1 cm long), softens and its center falls in the middle of the vagina. The mature cervix will open quickly: labor will soon come.
If the cervix is immature, 3 cm long, toned and located in the back of the vagina, then it is not yet ready for opening - you will have to endure.
If the neck is mature enough. You will be placed in the delivery room, under the system and heart monitor, like any woman in labor. The only difference is that you will be injected with drugs that provoke contractions (oxytocin). Then the doctor punctured the fetal bladder. You must give birth during this day.
If the cervix is not mature enough... If by the Bishop system you typed not a large number of points, you will need additional stimulation. It may take several days, so bring your book or player with you ... The midwife will insert a hormone-soaked tampon into your vagina. He should cause contractions with the subsequent opening of the neck, shortening it, softening, smoothing and shifting forward. After several hours of monitoring under a heart rate monitor, you can return to the ward. If after a day there are still no contractions, the doctor will examine you again to determine the degree of cervical maturity. With a sufficient degree of maturity, intravenous administration of rhodostimulating drugs and puncture of the fetal bladder can be prescribed. If the cervix is not yet ripe, after six hours you will be given a hormonal gel application.
Be patient... If you are sent to the ward awaiting the onset of contractions, use this to rest, take a shower and walk calmly. Labor may begin at night and you will need strength. It is better to wait for the contractions to begin on their own than to artificially cause them, and then, in case of failure, have a cesarean section.
When labor is stimulated, the fetus is constantly monitored.
Regular monitoring
After the expected date of delivery, the doctor, first of all, will determine the volume of amniotic fluid. Its decrease can adversely affect the blood supply to the umbilical cord and the oxygen supply to the baby. Therefore, in this state of affairs, the challenge of childbirth artificially becomes inevitable. With a normal amount of amniotic fluid, overmaturity of the child is not a problem.
If the ultrasound results say that everything is going well and there are no risks. there is no need to remove CTU The so-called oxytocin test is also an unnecessary measure. Recently, scientists have found that it does more harm than good, and is often the reason for the stimulation of induced labor.
If the pregnancy continues uncomplicated, the doctor should check the amount of amniotic fluid with an ultrasound every three days. During these examinations, the baby's heart sounds are also monitored.
After a week has passed in excess of the calculated due date, CTG is additionally recorded. If the pregnant woman is walking for more than seven days, the doctor discusses with her the possibility of calling for labor with the help of medications.
The absence of deviations in the volume of amniotic fluid and in the cardiac activity of the child allows us to conclude that it is well supplied - under such conditions, further prolongation of pregnancy is possible, if the mother herself is not against it. But now it is advisable to monitor the child's condition, including CTG, every two days. However, the pregnancy must end no later than ”12-14 days after the calculated due date, otherwise the risks to the baby may increase significantly.
Labor cannot start, stimulation is needed
Sometimes labor doesn't start on its own. If this happens to you, your doctor may start (stimulate) labor with medication.
Situations in which labor stimulation is possible:
- The baby is post-term. The gestation period is approaching 42 weeks.
- The water departed (the fetal bladder burst), but labor did not begin.
- An infection has developed in the uterus.
- The doctor fears for the child, since growth has stopped, the child is not active enough, there is little amniotic fluid.
- You have a health problem, such as high blood pressure or diabetes, that could threaten your baby.
- The problem with the Rh factor is that your blood and your baby's blood are incompatible.
If you were hoping that labor would start on its own, and the doctor insists on stimulation, try to look at it in a positive way. It may be more convenient to know exactly when the child will appear than to wait for nature to take its toll. You will be able to better prepare physically and mentally before going to the hospital.
Stimulation of labor. The doctor can stimulate labor in several ways, but the cervix must soften, thin, and open. If this does not happen, the doctor can take steps to start the process.
Medicines. Medicines can be used to soften and dilate the cervix. These drugs also often induce labor, so that other stimulants, such as oxytocin, are not needed. If cervical preparation is required, you can go to the hospital the day before stimulation for the medication to take effect.
Mechanical methods. One way is to insert a thin balloon catheter filled with water through the cervix into the uterus. This irritates the uterus, and she begins to push the balloon through the cervix, softening and expanding it from 2 to 4 cm.
Rupture of membranes. In this case, the amniotic fluid that envelops the baby bursts and the fluid begins to flow out. Normally, this is a sign that the child will be born very soon. One of the results of this rupture is an increase in uterine contractions.
One way to speed up labor is to artificially rupture the membranes. In this case, the doctor inserts a long and thin plastic hook through the neck and makes a small tear in the membranes. You will feel the same as during a normal examination, and warm liquid will flow out. It is not dangerous for you or the baby.
Oxytocin - a way to stimulate labor
A common way to induce labor is with the drug oxytocin, a synthetic analogue of the hormone oxytocin. Normally, during pregnancy, the body produces a small amount of oxytocin. With active childbirth, its level increases.
Oxytocin is usually given intravenously after the cervix has thinned and dilated slightly. A catheter is inserted into a vein in the arm, and small doses of medication are regularly released into the blood using a special pump. These doses can be altered during stimulation to adjust the strength and frequency of contractions until they stabilize. If the dose is correct, you should feel a contraction in about half an hour. Contractions can be more regular and violent than natural labor.
Oxytocin is one of the most commonly used drugs. It can stimulate labor that might not have started on its own, and it can also push contractions if they slow down during labor and are not progressing. The baby's uterine contractions and heart rate are monitored to reduce the risk of complications.
If the stimulation is successful, you will feel the signs of an active, progressive labor, such as prolonged contractions that get stronger and more frequent, dilatation of the cervix and rupture of the amniotic fluid - if it has not ruptured earlier.
The reasons for stimulating labor must be serious. If your or your child's health is at risk, the doctor may decide on further intervention, a cesarean section. Stimulation can take several hours, especially during the first birth.
Oxytocin
- It is a natural hormone produced by the hypothalamus, which is located in the neurohypophysis. Its function is to stimulate the muscles of the uterus at the time of delivery. It also contributes to the contraction of the mammary glands during lactation.
- There is also a synthetic oxytocin, it is administered intravenously to stimulate labor. Its use must be carried out under certain conditions and strict dosage control. Continuous monitoring of the fetus allows you to see if the baby is suffering when contractions begin or intensify.
- Synthetic oxytocin is sometimes given immediately after childbirth to shrink the uterus, displace the placenta, and reduce bleeding.
Artificial labor stimulation
Artificial labor induction (induction).
Most births start with spontaneous contractions and a healthy baby is born. However, during preventive examinations in the last weeks of pregnancy, it sometimes turns out that the child's life support is already far from optimal. In this case, the doctor must, after weighing all the circumstances, decide whether the pregnancy should be maintained until the onset of spontaneous labor pains, or it will be better for the mother and child if, with the help of medications, premature birth is induced artificially.
Whether early delivery is the best way out depends on
of what week of pregnancy the woman is in. If complications appear shortly before the calculated date, then labor is induced artificially, even if there is a relatively small risk. All organs of the child have already formed, and he can breathe on his own with his small lungs. If the danger to the baby arises at an earlier stage of pregnancy, the doctor will try to delay the birth of the baby as long as possible.
Grounds for artificial induction of labor
There are various reasons for invoking labor with medication.
- The most common of them and far ahead of all others in frequency is oxygen starvation of the child, for example, due to placental insufficiency.
- If preventive examinations, such as ultrasound, CTG or Doppler sonography, indicate a threat to the further successful development of the child, then premature birth gives him a great chance to be born healthy.
- In some cases, the child reaches a very large size even before the 38th week. If the observed developmental process gives grounds to conclude that in the remaining two weeks the child's weight will still significantly increase, the challenge premature birth with the consent of the expectant mother may be highly appropriate. This solution reliably guarantees that the baby is born healthy and without major complications.
- In case of premature rupture of the membranes and the absence of contractions, stimulation of labor activity with medication helps to avoid the risk of infection of the child.
- Gemini themselves are often born earlier than expected. In case of insufficient supply of one or both of them, labor is induced ahead of schedule.
- If the baby is sick and cannot be treated in the womb, a premature delivery will improve his health. First of all, this applies to children suffering from severe anemia.
- Maternal diseases such as pregnancy hypertension or diabetes may also require early induction of labor.
- If the expectant mother suffers greatly from various physical and mental disorders, it is possible to artificially induce premature birth when the child has finished maturing, that is, after the 37th week of pregnancy. The reason for making such a decision may be, for example, severe back pain, severe sleep disturbances or severe physical exercise.
Labor is stimulated either by prostaglandins or by the administration of oxytocin.
Methods of artificial induction of labor
Which method of artificial stimulation of labor will be chosen by the doctor depends on the well-being of the fetus and the state of the cervix. If the child is already under threat, and the uterine pharynx is still closed, childbirth most often occurs by caesarean section.
- Stimulation of labor by the introduction of oxytocin is performed provided that the uterine pharynx is already sufficiently soft and slightly open. This means that the uterus is ready for the onset of contractions. The advantage of this method: stimulation does not last long, and you can fairly accurately calculate how long it will take to give birth. With the beginning of the introduction of oxytocin, the child's heart contractions are continuously monitored with CTG; for this, a portable cardiotograph is usually used.
- In the case of immature uterine pharynx, prostaglandins are used to induce labor. A pregnant woman does not receive these medicines in the form of injections. They are used locally in the form of a gel, pessaries or tablets, which must be absorbed in the area of the uterine pharynx. Under the influence of prostaglandins, the uterine pharynx softens and begins to open. Contractions usually come in two to three hours. If there are no contractions, then after six hours the procedure is repeated.
With this method of stimulation, constant monitoring of the child through CTG is not required. It is quite enough to remove CTG every two hours, starting from the moment the contractions appear.
Stimulation with prostaglandins should always be carried out in a hospital setting, since it is rather difficult to predict when the contractions will begin. When the uterine pharynx is mature, the further labor process can be supported by the administration of oxytocin. If, after two days, there are still no contractions, you should consider whether it is advisable to try again or whether it is better to take a break. Sometimes a caesarean section may be required in this situation - especially if it turns out that your child's health is at stake.
- Stimulation of labor with misoprostol. This drug was originally approved only for the treatment of stomach tumors. But for 20 years now, in some countries, it has been recommended for stimulating childbirth, although, in fact, it has not received the appropriate admission.
Misoprostol almost does not cause side effects and has the advantage that it can be taken in pill form. Before starting stimulation, the doctor should inform you in detail about the effect of this medicine - be sure to ask again if you do not understand anything!
Alternative ways to induce labor
Artificial opening of the fetal bladder
When the fetal bladder opens and amniotic fluid begins to flow, their volume in the uterus decreases. As a result, contractions often occur, from which labor pains develop. But this method can only be recommended for multiparous and only if the cervix is dilated.
Sexual intercourse
Regular intercourse at the end of pregnancy reduces the likelihood that you will have to postpone your baby. Sex is thought to have a twofold effect: firstly, it promotes the production of the contraction hormone oxytocin, and secondly, semen contains prostaglandins, which also cause contractions. However, the amount of prostaglandins in a single ejaculation is very small - significantly less than the dose used for drug induction of labor.
Separation of the ovum
Even before artificial induction of labor through medication became widespread, the best way to induce spontaneous contractions was considered to be the separation of the ovum in the lower pole. Such an operation can be performed only after the onset of the 40th week of pregnancy and provided that the cervix is already slightly open. In this case, the obstetrician penetrates it with his finger. With rotating movements, he massages the internal uterine pharynx and carefully separates the membranes from the uterine wall. The use of this method requires extreme caution, since the manipulation, which is very painful in itself, can also cause bleeding. Therefore, you should think carefully before embarking on it at all.
Nipple stimulation
When the nipples are stimulated, the hormone oxytocin is released, which causes contractions. But the action of the hormone is manifested only in the case of maturation of the uterine pharynx. Studies have shown that the effect is so insignificant that it is not worth resorting to this method at all.
Exercise stress
Excessive physical exertion, such as climbing stairs, leads to a more intense redistribution of blood supply (blood from the placenta rushes to the muscles) and in some cases provokes the onset of contractions. However, this method hardly deserves a recommendation. A leisurely movement, such as a short walk, is much more enjoyable in the initial phase of labor. It is better not to resort to physical activity that requires high energy costs - you need to save your strength for the upcoming birth.
Additional therapeutic measures
Some women enjoy additional treatments such as preparatory acupuncture or reflex zone massage. Unfortunately, however, it cannot be said that this is a reliable way to induce contractions.
The use of herbs that stimulate contractions
Sometimes a decoction of cinnamon, ginger and cloves is prepared and used to soak tampons. With an immature uterine pharynx, such actions lead to prolonged contractions of the uterus, which can result in oxygen starvation of the child. Therefore, we will not recommend this method. However, the herbs listed above can be used as aromatic oils for an aroma lamp or mixed with almond oil for massage purposes. If you apply this mixture to the abdominal wall and massage the uterus from the top end, it will help your baby finally hit the road.
Stimulating bath
A contraction-stimulating bath can make you feel better. It takes four drops essential oil, for example, oil of clove, cinnamon leaves or ginger root, add to 250 ml of cream, stir and pour into a filled tub. The water temperature should not exceed 37 ° C.
Castor oil
Castor oil, which is used in the industry in the manufacture of varnishes and dispersion paints, is also used in the production of cosmetics.
If taken internally, this oil will cause intestinal upset, which in turn will lead to contractions. Contractions provoked in this way with an immature uterine pharynx do not bode well. They will not become the beginning of labor, but will manifest themselves only in prolonged contractions of the uterus, which negatively affect the oxygen supply of the fetus. Therefore, an attempt to stimulate labor in the absence of monitoring the child through CTG can be very dangerous for him.
Nausea, diarrhea, and bowel cramps are common side effects.
Among other things, the taste of castor oil is so unpleasant that it is usually taken with wine or vodka, and on top of that, the child has to fight the negative effects of alcohol.
To summarize, we can say that this method is unacceptable.
Onset of labor with artificial stimulation
Doctors have several methods of stimulating labor. What your doctor chooses will depend on various reasons, such as the readiness of the cervix and the health of the baby.
Separation of membranes
The doctor will examine the cervix and use a finger to separate the amniotic sac from the walls of the uterus. For many women, after this, water leaves and cramps begin. After the membrane is removed, prostaglandin is released and contractions begin. This method is only suitable for you if the cervix is open.
Preparation of the cervix
Before you induce labor, your doctor may use what is known as the Bishop Scale to find out if your cervix is ready for labor. The doctor will examine the cervix to see how much it has opened and smoothed out and whether the baby has dropped into the pelvic area. Studies show that induced labor is more effective if the cervix is open, so if your cervix is not ready for this, your doctor may use certain substances to speed up the process, such as suppositories with prostaglandin E, a gel containing prostaglandin, prostaglandin on a special device or prostaglandin tablets. Some women who use these products begin to give birth within 24 hours without any further intervention. Other drugs that help open the cervix are kelp (algae sticks that absorb water from the cervix, causing it to open) or a catheter flask (which is inserted into the uterus and gradually dilates the cervix).
Amniotic bladder puncture
The doctor may use a gynecological instrument, similar to a crochet hook, to poke a small hole in the amniotic sac. (This is called an amniotomy.) The procedure mimics what sometimes happens on its own when water drains before labor begins. It can be frustrating if the cervix is less than a centimeter open, but other times it doesn't hurt at all. If the contractions do not start within 24 hours after the water is withdrawn, the doctor will most likely stimulate labor with pitocin or other means to reduce the risk of infection.
Dropper with pitocin
Pitocin is a synthetic form of oxytocin, a contraction-inducing hormone. Most pregnant women start labor in part because of high levels of oxytocin in their blood; your doctor wants to simulate this process with Pitocin.
If labor is caused by this drug, you will be admitted to the hospital where a IV needle will be inserted into your arm. Pitocin usually takes about 30 minutes to take effect, so your doctor will likely take your time and monitor your and your child's reactions to the drug. There is no guarantee that childbirth will take place quickly with Pitocin; contractions can be violent, and each contraction can last 1 minute or longer. Many women have said that breathing exercises help with this kind of childbirth. Stimulating labor is a long process and if this is your first baby, you may need several treatments. For example, recently, the uterus is often prepared and only after that Pitocin is injected. Ask your doctor what procedures will be done for you, and be prepared to wait patiently.
My midwife wants to stimulate labor. What is the reason for this?
Stimulation of labor
There are many reasons why you need to stimulate an early birth. In some cases, a caesarean section is practiced. A priori, the child and the mother can perfectly tolerate childbirth and, if the obstetrician-gynecologist believes that the birth will take place naturally, no stimulation is required. But sometimes there are reasons for the stimulation of labor.
- The fetus has stopped developing: it receives little nutrition. Examination shows that the placenta is not fully functional and the uterus is no longer a healthy defense for the baby.
- The due date for childbirth has passed, the amount of amniotic fluid is reduced, the baby is moving less.
- The time has come, the fetal bladder is ruptured, the amniotic fluid is colored.
- The expectant mother has diabetes, she is being treated with insulin. All the prerequisites are that when the time comes, the child will be too big.
- The mother suffers from preeclampsia. She is not helped by either complete rest or medication, her life and / or the life of a child is in danger.
- The baby (Rh positive) is anemic because the mother (Rh negative) produces antibodies against the red blood cells.
- The obstetrician-gynecologist is afraid that the mother will enter the hospital too late due to the distance of residence or too rapid previous births.
Stimulation of labor- This is the artificial induction of labor at various stages of pregnancy and the activation of labor activity already during childbirth. First of all, we note urgent childbirth (childbirth on time) occur in the period from 37 to 42 weeks. And with normal flowing childbirthstimulationchildbirth not required.
It was laid down by nature to childbirth began at 39-40 weeks of gestation. But sometimes it happens that childbirth are late ... After 40 weeks, the doctors insistently suggest that Mom go to the hospital for an artificial stimulationchildbirth.
Stimulation of labor is used only as a last resort, when the child or his mother is in danger. Also, if you "walk" the due date, and labor still does not start, doctors may offer you stimulation. From some of the reasons leading to "overdue", and hence to stimulation, you can get rid of yourself, without resorting to the help of doctors. For example, fear of childbirth, as well as the use of drugs, including painkillers, can lead to artificial stimulation.
All stimulation methods can be divided into two types, which stimulate the ability of the uterus to contract, and which accelerate the process of cervical dilatation. Stimulationchildbirth is a fairly common procedure in modern maternity hospitals. Sometimes at a normal start generic activity, weakening or complete attenuation of contractions is noted. And with normal flowing childbirthstimulationchildbirth not required. Medication stimulationchildbirth At home, stimulation of labor (in the absence of an experienced obstetrician-gynecologist nearby) is contraindicated.
Amniotomy- opening the fetal bladder, is one of the most popular means that affect the active contraction of the uterus. The essence of this method of stimulation lies in the fact that the doctor, with a special instrument, similar to a hook, pierces the fetal bladder, after which the water leaves. After that, the pressure inside the uterus drops sharply, the child begins to press on the pelvic bones, the cervix opens and provokes childbirth. This method is considered safe and does not in any way affect the child's condition. In addition, amniotomy is an absolutely painless procedure, and only in rare cases it can be unpleasant. It is worth considering that for medical reasons, this stimulation can be used only after the child's head enters the small pelvis. Otherwise, you may need a contraction-stimulating drug. Now, for these purposes, Oxytocin is used in medicine.
Oxytocin Is an analogue of a hormone produced by the pituitary gland. The action of this drug is aimed at stimulating the contractions of the muscle tissues of the uterus, but does not in any way affect the readiness, for disclosure, of the cervix. It is mainly administered intravenously, although there are solutions for intramuscular injections, and even tablets. When exposed to oxytocin, labor pain increases, so it is used together with antispasmodics. For each woman, the doses are selected individually. The action of oxytocin is based on its ability stimulate contraction of the muscle fibers of the uterus.
Prostaglandins- hormones that affect the readiness of the cervix to open. These hormones are found in large quantities in semen and amniotic fluid. For artificial stimulation, prostaglandin suppositories and gels are used, their action is also aimed at stimulating uterine contractions.
The decision on the need for stimulation is made by the doctor, taking into account the conditions of the pregnancy.
The 40th week is approaching, but labor does not start in any way, or maybe they do not want to continue, what to do? Whether it is worth resorting to arousal or stimulation of labor. How does this happen and what are the consequences for the child?
When the due date of birth is approaching, doctors conduct studies (ultrasound, cardiotocography, etc.), according to the results, they determine whether there is a prolonged pregnancy or not?
The doctor looks at such signs: a decrease in the thickness of the placenta, a relative lack of water, a thickening of the bones of the skull. In such cases, it is recommended to carry out labor induction. Labor induction is done not only with prolongation, but also with gestosis, fetoplacental insufficiency. And only after all these studies is it concluded that need to whether to cause an artificial stimulationchildbirth.
So what are the ways stimulationchildbirth do doctors have in their arsenal? To stimulate labor, doctors use:
- amniotomy - an artificial rupture of the fetal bladder. A puncture is made in the fetal bladder with an instrument that looks like a hook. This procedure is almost painless, since the fetal bladder has no nerve endings, the painlessness of the procedure depends on the professionalism of the doctor who performs the amniotomy. As a result of amniotomy, amniotic fluid begins to drain, after 2-3 hours the process of childbirth starts
- The use of a special gel that includes prostaglandins. The obstetrician inserts it into the cervical canal. Prostaglandins contribute to the fact that the cervix "ripens" faster, these hormones stimulate the process of uterine contraction. The procedure is painless, the procedure takes no more than 5 minutes. Labor begins 9-10 hours after the procedure.
Medication stimulationchildbirth carried out strictly according to indications, in the presence of a threat to the life of the fetus or mother.
Stimulation of labor - why is it needed?
Stimulation of labor is needed when labor is weak, when labor has already begun, there are contractions, but they are weak, the cervix opens slowly.
12 hours is the time spent by those who give birth for the first time; in the second - 8 hours. If childbirth is delayed, the child may suffer, then they resort to stimulation.
The main drugs used to induce labor are prostaglandins and oxytocin.
Prostaglandins are used when the weakness of labor is observed when the cervix is dilated up to 4 cm. Oxytocin is used at the stage of uterine dilatation from 5 cm to 10-12 cm, during the period of attempts. Prostaglandins and oxytocin are given intravenously. Oxytocin begins to act, pain intensifies, it should be used in combination with antispasmodics (drugs that relax the muscles of the uterus). There are no standard regimens for the use of oxytocin, different women respond to the same dose in different ways, the doses must be selected individually.
Note that the child's condition should be assessed more often than usual (in period 2 after each attempt) using cardiotocography or a conventional obstetric tube.
Within 4-6 hours after the introduction of stimulating substances, doctors assess whether there is any benefit from the drugs, but if not, then they consider the option of a cesarean section.
In some cases, doctors do not use stimulants, but sedatives, which are required in cases where a woman is physically tired from prolonged contractions. There is still a period of pushing ahead, when a woman is pushing to give birth to a child. In such situations, doctors inject a woman with sedatives so that she can rest a little, gain strength before the upcoming attempts.
Is labor stimulation necessary?
Stimulation of labor is an emergency option of obstetrics, it is necessary that a woman gives birth herself and she does not need a serious medical intervention... The expectant mother needs to know how to act correctly during childbirth, how to breathe during contractions and attempts. It is advisable that the expectant mother is trained in a school for pregnant women and knows what childbirth is. Then it is likely that she will not need stimulation.
It is better for the baby if the birth takes place without stimulation. When labor is natural and does not accelerate, the baby experiences less stress when passing through the birth canal. With childbirth stimulation, a child may experience hypoxia - a lack of oxygen, which is very bad for the baby.
Contractions may not occur, the cervix may not "mature", and these stimulation agents are guaranteed to provide hypoxia to the child. The child's brain suffers from hypoxia, but how severe the damage is - is visible only after birth. The consequences may be disruption to the activities of the central nervous system: regurgitation, speech delay, autism syndrome, ADHD, cerebral palsy, visual impairment, hearing impairment, epileptic syndrome
Children who are born as a result of labor stimulation have a yellowish skin color. This is neonatal jaundice that resolves within 2–3 weeks. The reason for the appearance of jaundice is an increase in the substance of bilirubin in the blood, which enters into a chemical reaction with oxytocin.
Labor induction points
Stimulation, or stimulationchildbirth at home Is a procedure that provokes contractions (contractions of the uterus) during pregnancy, but before the natural onset of labor.
Stimulate the point between the thumb and forefinger, the point at the height of 4 fingers from the ankle, and the point at the corner of the little toe on the foot. Each point is 20 seconds long, a 2 minute break, and so on 3 times.
Methods for approaching childbirth with folk remedies at home:
If the due date set by the doctors is behind, and labor has not started yet, you can try the following actions.
- Take 3 times a day 1 tablespoon of vegetable oil: it contains semi-saturated fatty acids, which contribute to the production of its own prostaglandins in the body. These substances help prepare the cervix for the upcoming process and trigger the birth mechanism.
- Drink any vegetable oils (olive, flaxseed, wheat germ, etc.) that are rich in vitamin E and omega 3 and 6 acids. Start with 1 tablespoon and work up to 3 tablespoons per day. It is better to drink it on an empty stomach, but you can also drink it in salads and with bread. The oil helps tissues and muscles to be elastic, prevents tears.
- We must drink tea from raspberry leaves. Brew 1 tbsp per 0.5 l. Start drinking no earlier than 36 weeks, because can provoke childbirth. Start drinking 1 glass a day, from 38 weeks to 2 glasses, from 39 weeks to 3 glasses. Drink instead of tea and always drink warm or hot.
- Have sex: during intercourse, the nerve cells of the cervix are irritated, a signal is sent to the pituitary gland, which "gives the command" for the body to produce oxytocin, a hormone that starts labor. Manual or oral stimulation the clitoris, even without an orgasm, can also be effective to begin with childbirth... The semen contains prostaglandins, which cause the uterus to contract.
- Increase your physical activity, such as walking up stairs, cleaning floors, all of which help to bring labor closer. Excessive exertion must be avoided, otherwise it can lead to placental abruption.
Remember that giving birth at home and stimulating labor is undesirable if you want to give birth to a healthy baby.
Childbirth is a natural process due to human nature. However, no one is immune from pathologies and complications, so in some cases it is difficult to do without medical intervention. Often, doctors stimulate labor: what is it and how dangerous it is for the baby and mother, interests all women in labor.
This concept means the artificial induction of childbirth and their activation, if the natural process cannot, for some reason, go on its own.
The doctor may suggest this procedure if there are indications for the induction of labor, which pose a risk to the further continuation of the pregnancy. These include:
- overmaturity: gestational age exceeds 41 weeks;
- the absence of contractions within 24 hours after the passage of water;
- chronic or acute diseases: kidney failure, diabetes, preeclampsia, heart problems;
- multiple pregnancy (read about the features of such childbirth);
There are also unforeseen situations when a pregnant woman herself insists on giving birth with stimulation, but the decision in each such case remains only with the doctor. For the safety of the mother and child, the possibility of natural labor should be used, since drugs that stimulate it can lead to complications and side effects. Therefore, it is often said that this procedure is harmful. Is it so?
Why is stimulation dangerous?
Many fears of women are exaggerated, since few people know specifically what the danger of stimulation of labor is and what consequences it can turn out to be for the mother and baby. In most cases, it goes away without complications and saves the situation. The negative aspects include:
- painful contractions, which are much more felt by a woman than during natural childbirth - therefore, the question of the use of epidural anesthesia often arises ( full list indications for her);
- an uncomfortable position that complicates the process of childbirth: stimulants are often injected through an IV, which forces a woman to lie mainly on her back, severely restricting her movements;
- in rare cases, but still it sometimes happens, the procedure causes oxygen starvation of the fetus with all the ensuing consequences.
As for everything else, the correctly chosen drugs to stimulate labor and the timely decision of the doctor to carry out the procedure most often save the lives of the mother and the baby, and not cripple their health. In this case, all pros and cons are weighed, which may be different in each individual case.
The answer to the question whether stimulation of labor is harmful is rhetorical. This is an artificial interference with the natural process, and therefore it is undoubtedly harmful. But according to the available indications, this method is necessary. It happens that stimulation is useless, the mother's body does not respond to it. In such cases, the last chance is only a cesarean section.
Methods for stimulating labor
For many women, this procedure is associated with painful and dangerous methods, again only because most do not know how to induce labor. It all depends on the stage at which generic activity is, whether it exists at all. After analyzing the state of the pregnant woman and the child, the question is decided which method of stimulation will be useful in this or that case.
- Detachment of the amniotic membranes
The technique is used for prolongation of pregnancy. The doctor exfoliates the amniotic membrane by hand, and this provokes the onset of contractions. The difficulty is that the procedure often does not work due to various reasons (inexperience of the doctor, thick walls of the shell, etc.). Therefore, you have to do it several times or resort to other methods. At the same time, the risk to the health of the mother and baby is minimal, there is no pain.
- Prostaglandins
Prostaglandins are physiologically active substances independently produced by the human body. They cause ripening and dilatation of the cervix. The drug is administered in the form of a gel or suppositories vaginally, and after half an hour, labor usually begins. The procedure does not hinder movements, does not cause discomfort, has no side effects and contraindications, and has no effect on the fetus.
- Amniotic fluid puncture
A puncture of the amniotic fluid is dangerous due to infection. It is used when the contractions are too long. An aminohook (a long, plastic, hook-like instrument) is inserted into the vagina, engages the amniotic membrane through the cervix and pierces it, causing the amniotic fluid to drain.
- Oxytocin
Oxytocin is a synthetic drug analogous to a natural hormone that stimulates uterine contraction. It is used in case of attenuation of labor, a decrease in the intensity of contractions. Introduced intravenously using a dropper. This method of stimulation is fraught with an overdose of the drug, which can lead to oxygen starvation of the child, as well as too painful contractions.
- Tablets
Modern drug stimulation of labor involves the use of special tablets that contain artificially synthesized antihistogens. They block the receptors of the uterus, accelerate the maturation and opening of its cervix. The advantage of pills is that they do not have any effect on the condition of the woman and the baby.
For ease of use, maximum efficiency and minimum number of side effects, this method of labor stimulation is considered the most preferred today. However, it has many contraindications: hepatic and renal failure, diabetes, asthma, problems with blood coagulation, individual intolerance.
- Natural methods of stimulation
The most courageous women, realizing the need to speed up labor and the inability to do this in the hospital, conduct stimulation at home. At the same time, a preliminary consultation with a doctor, at least by phone, is simply necessary. Natural stimulation methods include:
- sex, during which the uterus contracts, which becomes the starting point of natural childbirth;
- castor oil, taken orally, leads to increased bowel function, which provokes labor; the method is dubious, as it causes diarrhea, nausea and dehydration;
- light physical activity will speed up the appearance of the baby;
- acupuncture also promotes the onset of labor.
Artificially induced childbirth with stimulation is a necessity, assistance to the female body and the child. Do not be afraid of this, as doctors know what they are doing. Trust them. Moreover, without the consent of the woman in labor, no one has the right to interfere with the natural process of childbirth - not even a doctor.
They do not come on their own, and medical indications force doctors to stimulate their onset. Stimulation of labor is a phrase that all pregnant women are afraid of. Let's see if it's so scary.
Stimulation of labor in the hospital
The most common scenario for stimulating labor is hospitalization of a woman in the department of pregnancy pathology. It is there, after examination and examination, that a decision is made on the indications, timing and methods of stimulation.
Indications for the stimulation of labor
The reasons why obstetricians are forced to provoke the onset of labor are divided into maternal and fetal.
Causes from the mother:
- The presence of complications of pregnancy, in which its continuation is dangerous for the life and health of a woman: preeclampsia, eclampsia, gestational diabetes mellitus in severe form, liver damage, coagulopathy caused by pregnancy;
- Exacerbation of chronic diseases in severe form: bronchial asthma, diabetes mellitus, arterial hypertension, kidney disease, cardiovascular pathology;
- Increasing polyhydramnios;
- Pathological preliminary period, when the general condition of the woman, her sleep is disturbed;
- Acute situations: acute appendicitis, cholecystitis, cerebral aneurysm, trauma, bleeding. Although in this case, such a stimulation of labor does not occur. Doctors in such situations go for an early delivery by caesarean section, since sometimes the count goes not for hours, but for minutes;
- Post-term pregnancy over 42 weeks according to the date of the last menstrual period.
There are fewer reasons for the fetus:
- Hemolytic disease of the newborn with Rh-conflict;
- Intrauterine infection of the fetus and amniotic membranes;
- Fetal growth retardation with good CTG results and fetal biophysical profile.
If the child, for one reason or another, suffers in utero, it is preferable not to overload the artificially provoked childbirth, but to prompt delivery. For the stimulation of labor in the interests of the fetus, they go only after a thorough examination of it using ultrasound, Doppler and CTG.
Methods for stimulating labor
Initially, one or another method of labor stimulation is selected based on the readiness of the pregnant woman's body for childbirth. With good readiness of the birth canal, "mature" cervix, you can use:
- Kelp sticks. This is a fairly ancient method in obstetrics. Kelp is seaweed, dried and pressed in the form of pencils. Several of these sticks are inserted into the slightly opened cervix. In a humid environment, algae swell and mechanically open the cervix, stimulating the onset of labor;
- Balloon dilatation of the cervix is similar to the previous method. Instead of kelp, special balloons are used for mechanical stimulation, gradually filling them with air or liquid;
- Amniotomy or artificial opening of the fetal bladder. With the discharge of amniotic fluid, the volume of the uterine cavity decreases, the fetal head descends and presses on the lower segment of the uterus. These factors provoke the onset of labor.
Preparations for the stimulation of labor
If the woman's body is not ready for childbirth, the cervix is immature, it is impossible and even dangerous to use non-drug methods. In such cases, a more thorough preparation of the woman and the use of special preparations are necessary:
- Oxytocin is a hormone produced by the pituitary gland and is directly responsible for contractions of the uterus during labor. Administration of oxytocin intravenously or in the form of tablets will trigger the onset of labor. However, with an immature cervix, the use of this drug is unjustified. More about;
- Preparations of the prostaglandin group (Prostin, Prepidil and others). These are biologically active substances that contribute to the softening, opening and maturation of the cervix. This group of drugs is the best for preparing and stimulating labor. Prostaglandins come in the form of injections, tablets, vaginal and cervical gels;
- Mifepristone is a relatively new drug for inducing labor. Its action is to block progesterone receptors. Progesterone, whose main function is to maintain pregnancy, stops working. Pregnancy is left without hormonal support and labor begins.
Stimulating labor at home
In cases where the due date has already passed, but both the mother and the baby are feeling well, there is no need for active action. The doctor lets the pregnant woman go home, where she immediately rushes in search folk methods accelerate the onset of the cherished day. There are many of these methods, some of them have medical roots and common sense, while some are absolutely devoid of them and even dangerous.
Dangerous methods include hot baths, taking alcoholic beverages, lifting weights, jumping, taking decoctions of unknown herbs and dietary supplements, any vaginal manipulations at home.
Of the permitted ways to speed up the onset of labor:
- Exercises, which include the notorious walking up stairs and washing floors. Any moderate physical activity can bring neither harm nor benefit. But systematic yoga, swimming or aerobics for pregnant women are very useful for muscle development, proper breathing, weight control and the development of generic dominance.
- Castor oil or the well-known castor oil is considered a panacea for stimulating labor. There is a grain of common sense in this. Castor oil has a hormone-like effect and can help ripen the cervix when used regularly, such as in suppositories. The laxative effect of castor oil can have the effect of rhodostimulation only when the birth canal is already ready. A cleansing enema has a similar effect.
- Sex life is perhaps the most scientifically proven way to induce labor. The semen contains the same prostaglandins that were discussed. With regular sexual activity, the action of these substances on the cervix and its mechanical irritation contribute to the onset of labor.
Before using any of these “grandmother's” methods, be sure to check with your doctor if he permits such experiments in your particular case.
Alexandra Pechkovskaya, obstetrician-gynecologist, specially for site
Useful video:
Nature has made sure that children can be born without outside help. Of course, without medical attention, any complications can lead to fatal consequences. Fortunately, in modern world women are not left alone with their problems. Labor usually begins at 38 to 42 weeks.
At the same time, they develop naturally and end with the birth of a child. But if the baby is in no hurry to be born at the appointed time, doctors may prescribe stimulation of labor.
In what cases may stimulation of labor be required? There are several indications for stimulating the onset of labor:
- First of all, the stimulation of labor when overdue... As you know, full-term childbirth is considered from 38 weeks, and at 42 weeks they speak of a post-term pregnancy. This entails certain risks: the placenta begins to age and can no longer cope with its functions. The amniotic fluid changes color due to the accumulated toxins in them, the child may experience chronic oxygen starvation. Usually, when prolonged, stimulation is prescribed between 41 and 42 weeks, and if there are signs of overmatteness, and at 40 weeks;
- If distended uterus too much due to multiple pregnancies or polyhydramnios, most likely, it will also come from artificial stimulation of childbirth in the hospital;
- Chronic diseases, such as diabetes, some disorders in the work of the cardiovascular system, kidney disease and other ailments that threaten the health of the mother and child, can also become a reason for stimulation as early as 38 weeks;
- Stimulation of labor activity may also be needed for those who already have the amniotic fluid has departed, and the contractions do not start within 12 hours or more. The fact is that after the rupture of the amniotic fluid, the child becomes vulnerable to various infections.
In some cases, stimulation may also be needed when labor began spontaneously, however, for one reason or another, it does not lead to natural delivery: the contractions begin to fade or the cervix does not open.
Why is the stimulation of childbirth dangerous: the consequences
As with any intervention in the natural course of labor, stimulation of labor has consequences, including negative ones.
Why is labor stimulation dangerous? First of all, it is worth mentioning that artificially induced contractions are often much more painful, and therefore there is a need for additional pain relief.
Some types of stimulation require the introduction of drugs with a dropper, which creates additional inconvenience: the woman is forced to lie on her back, limited in movement. But this is far from the most comfortable position for a woman in labor, it is much more convenient to walk or lie on her side.
In addition, stimulation in some cases causes the child oxygen starvation, which is unlikely to have a positive effect on his health.
Sometimes stimulation does not give any results, in this case, depending on which method of stimulation is chosen, it is either postponed to another time, or you have to perform a cesarean section. Considering all this, it is necessary, before agreeing to stimulate labor, to weigh the pros and cons.
The doctor must be 100% sure that artificial stimulation is really necessary, that it will be more useful for the baby to be born right now and in this way.
There is evidence that when artificially stimulating labor in the hospital, forceps and other similar instruments have to be used much more often. Many experts argue that stimulation itself is the reason for this. However, it is quite possible that the same complications lead to such consequences that led to the need to stimulate labor.
Is stimulation of labor harmful? Of course, yes. As well as any artificial interference in a natural process. But according to the indications described above, such an approach to childbirth is really necessary.
Contraindications to labor induction
Like any medical procedure, labor induction has a list of contraindications. In particular, stimulation is not carried out if a woman after a cesarean section in a previous birth is planning to give birth on her own a second time. Hyperstmulation of the uterus can lead to rupture along the old suture.
In addition, the wrong position of the fetus or its size, in particular, the discrepancy between the size of the fetal head and the size of the small pelvis can also become a contraindication to stimulate labor. As well as the state of health of the fetus, based on CTG.
Types of stimulation
Depending on the indications and the stage at which labor activity is, if any, various methods of stimulation are used.
Detachment of the amniotic membranes
When pregnancy is prolonged, doctors sometimes resort to such a procedure as detachment of the amniotic membranes. This is done during a routine gynecological examination. The doctor gently exfoliates the amniotic membrane at the very throat of the uterus, which causes the onset of contractions. This procedure do not always lead to the desired results the first time.
Sometimes it is necessary to repeat it several times. If the desired effect is not achieved, then the stimulation is transferred or resorted to other methods.
This method of stimulation does not carry any special risks. A woman should not experience painful sensations during the detachment of the membranes, since there are no nerve endings in them. However, some discomfort is still possible.
Prostaglandins
Much more often resort to another method - the introduction of prostaglandins. Prostaglandins are physiologically active substances that the human body produces on its own, and they are contained in almost all organs and tissues of the body, as well as in all natural secrets. Especially theirs in semen and amniotic fluid. Prostaglandins act on the cervix, causing it to ripen and dilate.
Prostaglandin preparations are administered vaginally: in the form of suppositories or gel. Neither gel nor candles hinder the woman's movements, do not cause any unpleasant sensations. Contractions usually begin within half an hour after stimulation of labor with the gel, but in some cases labor does not start after the introduction of the gel. If there are no contractions within 24 hours after the administration of drugs to stimulate labor, they can be re-administered.
Why exactly this method is preferred by gynecologists? The fact is that the labor stimulation gel has practically no contraindications and side effects. Of course, the risk of overstimulation remains in this case, but it is much lower than when using other methods. In addition, it does not penetrate the amniotic membrane, which means that it does not have any effect on the baby.
Unfortunately, in some cases, prostaglandin can cause a delay in the transition to active labor.
Amniotic fluid puncture
A puncture of the amniotic sac as a stimulation of the onset of labor is used extremely rarely, as it is associated with some risks. In particular, a ruptured amniotic fluid leaves the fetus without natural defenses, which can lead to infection. In addition, if the bursting of the bladder does not cause the development of labor, you will have to resort to other methods of stimulation, or even to caesarean section.
More often this method is used to speed up labor if the contractions are prolonged. A puncture of the amniotic sac is done during a routine gynecological examination using an aminhook, a long plastic instrument in the form of a hook, which is inserted into the vagina, and the amniotic membrane is grasped through the cervix and pierced, which causes the amniotic fluid to flow out.
Usually, a puncture of the amniotic sac is carried out when the child's head has already sunk into the pelvic area. In such a situation, the amniotic membrane is compressed, and the vessels of the amniotic bladder are also squeezed. Otherwise, the puncture runs the risk of damaging the blood vessel and causing bleeding.
In addition, there is a risk of the umbilical cord falling out, which also leads to risks for the child: when passing through the birth canal, the fetus will squeeze the umbilical cord, and thereby deprive itself of oxygen. This is another reason why bladder puncture, as a way to provoke the onset of labor, is rarely resorted to.
Oxytocin
Oxytocin is an artificially synthesized analogue of a natural hormone that stimulates uterine contraction. It is produced by the pituitary gland under the influence of other hormones. Oxytocin is usually used if there is attenuation of labor, a decrease in the intensity of contractions. It is administered intravenously using a dropper.
An overdose of oxytocin very quickly leads to oxygen starvation of the fetus and even to hyperstimulation of the uterus, so this is done under the supervision of a doctor. In parallel with the introduction of oxytocin, the child's condition is monitored, as well as the intensity of contractions.
If symptoms of fetal hypoxia begin to be observed, the administration of oxytocin is immediately stopped, and in some cases, special drugs are introduced that reduce the contractile activity of the uterus.
Given that some women are hypersensitive to oxytocin, the doses of the drug are selected strictly individually, in accordance with preliminary analyzes.
It is with oxytocin that, as a rule, the main complaints of women about excessive pain in contractions are associated. Therefore, very often, in parallel with the administration of the hormone, analgesic procedures or epidural anesthesia are practiced.
Recently, doctors have begun to use pills to stimulate labor, containing artificially synthesized antigestogens. These drugs block a number of receptors in the uterus that are responsible for blocking progesterone.
As a result, the balance of the hormones progesterone and estrogen changes in favor of progesterones, which leads to the development of labor. In addition, hormones have a positive effect on the cervix, accelerating its maturation and dilation.
Previously, such drugs were used for emergency contraception and termination of pregnancy for early dates, up to 5-7 weeks. In these cases, the effectiveness is achieved due to the same increase in the level of progesterone.
Due to the fact that these drugs are known as abortive, many women are afraid to take them, believing that it will adversely affect the fetus. However, this drug has practically no effect on the condition of the mother and child.
In terms of ease of use, effectiveness and the number of side effects, at this stage, this method of stimulating labor and preparing the cervix for opening can be considered the most preferable.
Quantity caesarean section when using antihistogen drugs, for example, mifepristone and miropristone to stimulate labor, it is significantly lower than with other methods of stimulation.
Contraindications for the use of this drug can be hepatic and adrenal insufficiency, asthma, diabetes, bleeding disorders, as well as individual intolerance to the drug.
It is quite natural to be afraid of new and untested, unfamiliar methods of influence. If you are offered this method of stimulation, and you are still afraid to use it, consult with several good doctors, ask them about the pros and cons of pills, and only then make a decision.
Natural methods of stimulation
We examined the methods of stimulation in the hospital, but in fairness it is worth mentioning that you can also be stimulated at home. If, after talking with your doctor, you yourself already understand the need to speed up the onset of labor, and you have already been assigned a day of stimulation, you can try one of the methods of natural stimulation of labor. However, it is recommended that you consult with your doctor beforehand.
The easiest, most obvious and natural way to stimulate labor at home is sex... It is also jokingly called muzherapy. During sex and especially orgasm, the uterus contracts, which can become the natural onset of labor. In addition, during sex, natural oxytocin is released into the woman's bloodstream, and semen, as already mentioned, contains a large amount of prostaglandins. As a result, the stimulation turns out to be really natural and complex.
Of course, having sex for a long time is not very convenient, you will have to choose such positions in which both partners will be able to relax and enjoy. In addition, it is psychologically difficult for some men to have sex with a woman before giving birth. However, all of these problems are fairly easy to overcome.
Some apply Castor oil to simulate childbirth. There is no data on how this method actually works, and whether it really works. In general, castor oil is a pretty strong laxative. It is assumed that the increased work of the intestines has an effect on the uterus, which causes labor. Castor oil for labor stimulation is a rather controversial remedy, as it can cause nausea and diarrhea, which is not pleasant, and is also fraught with a large water loss.
Walking and light exercise can also induce labor, so they can be used to stimulate labor at home. It often happens that in recent weeks a woman has been rushing to wash the floors, rearrange some things in the house, and her relatives dissuade her from doing so. Right now is the time to satisfy your need to improve your own home. This will help to simultaneously realize your instincts and calm down, and also speed up the birth of the baby.
Acupuncture can also be a way to naturally stimulate labor. As you know, such a teaching as acupuncture claims that there are points on the body that are responsible for the functioning of various organs and systems of the body. An injection of a delicate game into the correctly chosen point, which is responsible for the uterus and its condition, can help the onset of labor.
In conclusion, I would like to say that you should not be afraid of stimulation, although it is important to understand how much it is really necessary in your case. Remember that doctors are not allowed to interfere with the natural birth process without your consent. And nobody has the right to force you.
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