Childbirth is the moment when the child leaves the body that was his mother’s host to start his life as an independent being. Childbirth can be done by vaginal (natural) or by cesarean surgery.
Birth by vaginal way is preferable in all cases where there are no maternal and foetal contraindications for this path. It entails careful monitoring of the course of labor in the birthing room by midwife and the obstetrician, in order to avoid any complications.
Labor shall be deemed to have been triggered when painful, rhythmic, periodical intensity and frequency-intensive contractions occur and which have the effect of progressively erasing the cervix and the occurrence of a dilatation of at least 2 cm. The amniotic membranes can be intact or broken. The fetal expulsion will be done after the cervix dilatation reaches 10 cm. There is the possibility of childbirth in the conditions of an incomplete dilatation in the case of premature fetuses or aborted. Once pregnant arrives in the birthing room, it will be monitored in terms of tension, pulse, temperature and from obstetrical point of view the intensity and frequency of painful uterine contractions and the rhythm of Fetal beating heart. Any time when a sign of fetal and maternal suffering appears indicates the need for emergency cesarean operation. For maternal comfort but also depending on the condition of the labor and the indication of the obstetrician who will determine the opportunity and the time of imposition, the anesthesiologist will make peridural anesthesia.
At first birth, Labor can take between 8 and 20 hours, which is shortened as the woman gives birth to more children (8 hours at Secundiparous).
Labor is also structured in four main phases:
- Cervix dilatation,
- The expulsion of the fetus,
- placenta expulsion
- The confinemet period lasts about 2 hours, during which time the mother must be kept under observation.
During fetal expulsion the contractions have a frequency of 2/3 contractions in 5 minutes, each of 50 seconds and the patient must be taught to coordinate their effort with breath. Breathing must induce both mother’s relaxation as well as proper oxygenation of the brain. Two types of breaths are used, the slow one that assumes a deep breath followed by an exhale comparable to a sigh and the quick or shallow breath with quick and short breathing.
Under fetus conditions or, on the contrary, when it comes to premature fetus where expulsion is to be facilitated, episiotomy is practiced; This implies the cutting of perineal and vaginal tissues for the relief of childbirth with their subsequent relocation by the physician assisting the birth.
Once in the world, the newborn is taken over by the neonatologists doctors, presenting it to the mother (establishing a first affective attachment and with very much psychological significance between the mother and her child), and then being taken to the salon for newborns, where monitoring is continued.
The vaginal birth is possible in most of the tasks in which the fetus is in the cranial breech (upside down), sometimes in the pelvic breech (with the pelvis down and the skull at the upper level) especially if the fetus is not very voluminous. It is not possible in the case of Presentation.
The C-section operation may be made urgently, in labor, when it is assessed by the doctor that maternal or fetal suffering occurs (disproportions between the fetus and the breast basin, bleeding in the case of the lower placenta inserted or premature takeoff of placenta, impending of uterine rupture in the case of the scar uterus, abnormal and difficult dilatation of the cervix, circular cord, severe maternal hypertension, etc.) or is elective when there are medical conditions that require intervention from the outset ( Maternal strength myopia, maternal bone pool with important changes, serious maternal cardiovascular disease, pregnancy in breech or pelvic with voluminous child, uterine fibroid, twins pregnancies with abnormal fetal presentation, maternal desire, etc).
In the event of one of the cases listed, the operation will take place and assume the cutting of the abdominal wall and the uterus. This bucking can be carried out or vertically in the direction of the navel, or horizontally, below the navel, in the pelvis area (incision Pfannenstiel). Through this breach, the surgeon extracts the newborn, following the clamping and cutting of the navel and the subsequent remake of the uterus and the abdominal wall layer with layer, with various surgical techniques.
Anesthesia can be spinal, peridural or general anesthesia and the decision of the type of anesthesia is done in conjunction with the anesthesiologist and depends on each individual case and the technical possibilities at the time of intervention. The post-operative patient will be maintained for 24 hours under the attention of the anesthesiologist for post-anesthesia recovery, but also for the pursuit of any complications. The required number of days of hospitalization is approximately 3-5 days and may be shortened according to the patient. Throughout this time of admission, the mother can breastfeed and nurse the child.
About Corneliu Zaharia
