At the present stage of development of world obstetrics, great attention is paid to the quality of medical care. In Russia, too, laudable attempts are being made to bring outdated norms in line with European standards.
However, at the moment in different cities and regions of the country there are significant differences in approaches to the provision of obstetric care during childbirth. The traditional approach based on the ideas of half a century ago is still in use. There are also frequent cases of unjustified use of drugs and procedures that have become routine for a long time, but often not at all.
With all these minuses in the year 20011 in the Scientific Center of Obstetrics, Gynecology and Perinatology them. IN AND. Kulakov was a protocol in which the order and the amount of medical care during childbirth.
According to the new postulates, obstetrician-gynecologists should reduce the drug load and eliminate the likelihood of unreasonable interventions. For any actions of the doctor there must be a strict indication, and no operation can be performed only at the request of the woman.
So, at one of the scientific congresses, the medical community decided whether a woman has the right to insist on a cesarean section. By a majority of votes it was decided that only a doctor should make such a verdict.
Normal childbirth is a natural process that does not require medical intervention, but help for a woman is still necessary. More precisely, delicate support, which the doctors themselves call manual. Its meaning is that during birth the midwife only gently heels the baby with her hands: she holds her head with head biases, legs with the pelvic without changing their position or turning, otherwise birth injuries cannot be avoided.
Some manual manipulations serve to prevent perineal tears. So, at the right moment, the midwife with one hand pulls the tissues of this zone up a little to reduce their tension, and puts the other on the baby’s head, thus preventing premature neck extension (this movement of the baby brings trouble to the mother).
It is noteworthy that at vertical births that are gaining popularity, midwives cannot provide manual allowance, therefore ruptures of the perineum in this position occur more often than in the classical one.
If childbirth is abnormal, a woman may need various types of obstetric surgery. Moreover, these manipulations do not always imply the use of surgical instruments and tissue dissection. These, in addition to cesarean section, include the opening of the fetal bladder (amniotomy), dissection of the perineum (episiotomy, perineotomy), manual examination of the uterine cavity immediately after childbirth.
In addition, in some, albeit very extreme, cases, to extract the baby into the world, doctors are forced to resort to obstetric forceps or a vacuum extractor. There are other operations to extract the fetus through the birth canal, but they are currently rarely used.
That’s because doctors often prefer cesarean section. Thanks to the modern approach, the baby is born only 5 minutes after the start of this operation. Another innovation concerns the operation to remove the uterus with bleeding and rupture of the uterus.
If earlier physicians resorted to this radical measure quite often, today effective methods have appeared that make it possible to preserve the genital organ. Anesthesia during childbirth also refers to “medical interventions.”
In recent years, epidural (epidural) anesthesia has been widely used throughout the world. This type of pain relief is recommended for painful contractions and the onset of fatigue.
It is also prescribed to patients with extragenital pathology (hypertension, heart disease, diabetes, etc.) and complications during pregnancy (gestosis).
What exactly and why doctors do is easier to understand with specific examples. We selected 7 of the most frequent cases from obstetric practice.
1) Amniotic fluid is gone, and contractions do not begin.
According to the new protocol, doctors are not in a hurry to start labor with the help of medicines, but are waiting for it to begin naturally. The only condition: control for the presence of infections. Generic activity is stimulated with the help of drugs only if the risk of infection of the baby is high.
For a start, doctors will prepare the cervix for dilation with prostaglandin tissue hormones (they are inserted into the vagina). If it is too hard, help algae (kelp).
They are introduced into the cervix, they swell and thus expand it in diameter. The next few hours, doctors watch the development of labor.
If, after 3-4 hours with the dilated neck of the contraction, do not start independently, the woman is injected with a pituitary hormone oxytocin or prostaglandins in the vein. These measures stimulate generic activity.
2) Against the background of fatigue, contractions became weaker. The cervix is no longer open.
In this case, the expectant mother needs to rest. Medication will help you sleep for 1-2 hours. By the time of awakening, labor will gain momentum, and the woman’s actions will become more effective.
If the measures taken are not enough, the doctor will begin to stimulate labor.
3) The woman began to push, and there was a threat of a rupture of the perineum.
You need to act without delay. The optimal way out of the situation is dissection of the perineum (perineo- or episiotomy).
The operation is performed with special scissors at the time of the fight. Impose seams after the birth of the child and the placenta.
4) Gestosis developed in the third trimester.
Gestosis is a complication of pregnancy. Its main symptoms are: high blood pressure, the presence of protein in the urine and edema. In this case, the disease affects the health of both mother and baby.
The danger lies in the fact that preeclampsia progresses rapidly and the condition of both can suddenly worsen. Against the background of the disease, placental insufficiency and hypoxia develops above all: the baby begins to receive less nutrients and oxygen, and therefore, lag behind in physical development. For a woman, a severe form of preeclampsia is fraught with loss of consciousness and convulsions, and then the scenario can be sad.
The decision about preterm delivery with the help of medical stimulation is made by doctors if the treatment did not work in 2-3 weeks.
5) The contractions became weak in the second stage of labor.
If the attempts are not effective, the muscles of the uterus can “get tired” and relax, leading to bleeding. In addition, against the background of weak contractions, the child’s heartbeat worsens and hypoxia begins.
If birth is not stimulated, the baby may die.
6) It’s been 30 minutes since the baby was born, and the placenta does not appear.
Sometimes the placenta is so tightly attached to the wall of the uterus that it cannot independently leave its “post”. In this situation, the doctor has to resort to special surgery.
It is called “manual separation of the placenta.” Manipulation is performed under general anesthesia for 5–10 minutes.
7) The child was born, the last, too, but suddenly bleeding opened.
This is usually due to the fact that the muscles of the uterus after a few hours of active contractions get tired and relaxed, instead of actively contracting. Manual examination of the uterus helps the doctors to understand the cause of what is happening and correct the situation.
Usually, this obstetric operation also leads to the cessation of bleeding due to reflex irritation of the uterus walls, due to which it begins to decrease.