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Normal labor lasts on average from twelve to fourteen hours

Normal labor lasts on average from twelve to fourteen hours

Childbirth is a natural and physiological event, the result of the termination of a pregnancy. We say that a woman is in "labor" (TP) when the phenomena that will lead to the arrival of a baby are triggered. Its diagnosis is given when uterine contractions arise, obeying desirable intervals and intensities capable of promoting progressive dilation of the uterine cervix (cervix), a narrow inferior portion of the uterus, a type of valve composed of interlocking muscle fibers that seals the uterine cavity in the fundus

Labor is a dynamic process, dependent on uterine contractions, and which, according to the speed of cervical dilatation, is divided into two phases.

The first is the latent phase, in which the cervix is ​​dilated more slowly (initial phase of the work). At this stage, which can last from 12 to 20 hours, the contractions are irregular, less intense, and often only noticeable. In these hours, very commonly, the pregnant woman only refers "that the belly is hard, but that is not feeling pain". The progression is still slow and the dilation of the cervix is ​​less than 1 centimeter per hour. The cervix gradually loses its stiffness and softens. Each contraction promotes pulls on the muscular fibers of the cervix and press down the pouch of the waters and the baby, in the great majority, by the "cephalic pole" (head). Under the action of these two forces, the cervix is ​​shortened and dilates more and more, and the baby tends to descend and surpass it, migrating through the vaginal canal and bone basin until it appears in our "outside world."

It is important that the so-called false labor - "false alarm" - is recognized and differentiated from the Latent Phase. In the "false alarm", the contractions are irregular, the "pains" are of low intensity, they can occur in salvos, without a suitable rhythm, it does not have progressive pattern - often they cease with the simple rest - and it does not observe dilation of the neck . It is the biggest cause of "going-and-coming" maternity of the "first-time" pregnant women. For proper identification, we must repeat the obstetric examination and, above all, the "vaginal touch" after the interval of two hours of observation.

From the four centimeters of dilation, diagnosed by the vaginal touch, the so-called active phase, or when the parturient presents, on average, 3 to 5 contractions lasting between 20 and 60 seconds, within 10 minutes of observation and that promote progressive dilation of the cervix ("cervical dilatation") around of one centimeter per hour, with or without rupture of the "bag of waters". Through the vaginal touch, the descent of the fetal presentation (part of the fetus offered to the birth canal) is evaluated based on certain bone reference points of the maternal basin. The baby's head, in ideal conditions, "fits", "sets", and descends through the bony basin.

Under normal conditions, alternating contractions and pausing times shorter, the "active phase" evolves between six and twelve hours, from when the neck reaches 10 cm of dilatation until the moment of expulsion, that is, the exit of the child out of the maternal body. Under normal conditions, the "expulsive period" should not exceed 30 minutes to an hour and all conditions and positions should be offered to make the efforts that will help the baby to be born. The pulls come instinctively, coinciding with the good contractions that are repeated every one or two minutes, interspersed by phases of relaxation, when the parturient should be free of stimuli that take her out of her "special state of consciousness."

In the active phase, the most painful and prolonged contractions occur when compared to the first hours of labor. We can ease these moments by using breathing exercises, reassurance with relaxation techniques, hot tub or shower baths, but what is usually observed is that at this moment the woman has an attitude as if she were "full" in "state of grace "in the face of the supreme realization of motherhood and foreseeing the first time she will welcome and embrace her child.

The last act is represented by the" bonding "or" deconditioning ", name given to the expulsion of the placenta, 30 minutes after birth.

Throughout labor, control of the baby's vitality is essential through intermittent auscultation of his / her heart rate for one to two minutes and repeated every 15 to 30 minutes, as be pregnant with high or low risk.

The auscultation should be done at intervals, during and shortly after the contractions. The regularity, rhythm and sound characteristics inform us about fetal well-being. If necessary, continuous fetal cardiac monitoring may be performed associated with a graph of uterine contractions (fetal cardiotocography). Auscultation should be performed more frequently - every 5 to 10 minutes - as labor progresses.

During the evolution of the TP, the pregnant woman - the main protagonist - should have ample physical and emotional support from the obstetrical team, respecting her privacy and whenever possible , with freedom of position and mobility. The vertical position, especially while walking, is aided by gravity and increases the efficiency of the contractions and the effort of the mother, speeding up the procedure and significantly shortening the time of labor.

Contrary to the horizontal position, at delivery of squatting the process is faster, much more comfortable and the woman does not suffer compression of important blood vessels, which could lead to the suffering of the fetus. Another advantage is that the area of ​​the pelvis is increased by up to 40% and the elasticity of the perineum is less compromised (maintaining its integrity), which facilitates the passage of the baby; already in the horizontal position, the fetus is obliged to "rise" during the expulsion to overcome the shape of the pelvic curve, and demands of the mother a much greater effort for the same purpose. All these encouraging factors, including the occasional use of analgesia, accompanied by a competent and involved team, lead to a much more serene evolution, with a reduction in labor time and with great tolerance to discomforts, even at times when " contractile waves "present with greater pain sensitivity. In women who have previously given birth (multiparous), there is a reduction in labor time compared to those who have never given birth (nulliparous), when all the dynamics occur between 8 and 9 hours instead of an average of 12 to 14 hours Childbirth is a critical, uncontrolled, irreversible moment, and the obstetrician, when "everything is evolving well," has an obligation to allow the parturient to participate freely and lucidly in the birth experience. This moment belongs to her and to her offspring, much more than to the doctor and her team.

According to the World Health Organization, the woman should be well oriented to adopt the position and movement that will give her comfort and the presence of a companion of your choice is highly beneficial, either for the warmth of solidarity of the simple presence or for collaborating with the use of relaxation techniques or massages.


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