What is Delivery?
A normal partum is the unique physiological process in which the woman finalises her gestation at term, in which psychological and sociocultural factors are involved. It begins spontaneously, and develops and ends without complications, culminating with the birth and does not involve any more interventions other than its integrated and respectful support.
Types of Delivery
- Vaginal. Vaginal delivery is the most common and physiological. Within the vaginal deliveries, there may be an instrumental delivery, which is one that is performed with the use of forceps, spatulas, or vacuum-assisted.
- Caesarean. Incision or cut in the abdomen and in the uterus in order to extract the baby. It may be scheduled for a fixed date for health reasons of the mother or the foetus, or it may be necessary during the course of the delivery.
Normal partum is that which is triggered spontaneously between weeks 37 and 42 of gestation, starts with an increase in the number of contractions or their intensity, or may be due to the waters breaking, without having contractions. You must go to the emergency department if:
- The contractions are regular. 1 every 5 minutes during 2 hours in the first partum, or 1 every 5 minutes during one hour in subsequent deliveries.
- Rupture of the amniotic sac (waters breaking). If the waters are clear, you can go the emergency department calmly. If the colour of the waters is a green or brown colour you should go quickly to the emergency department.
A midwife or gynaecologist carries out the initial assessment in the emergency department, and decide whether to admit you or send you back home. It may happen that you have contractions but still do not meet the requirements for admission.
Induction of labour
The induction of labour is a procedure intended to trigger the delivery artificially using mechanical or medical means, or both, in an attempt to allow vaginal delivery to take place. The indications for the induction of labour may be for a maternal reason or foetal reason.
Cervical ripening is part of the induction of labour. It is a procedure that is used to improve the conditions of the neck of the womb. The aim is to improve the outcome of the induction, which leads to reducing the time in labour and the number of caesareans.
The provoking of the ripening of the neck of the womb may include mechanical or pharmacological means.
Mechanical methods of induction of labour
- Hamilton manoeuvres. It consists of the gynaecologist or midwife peeling of the lower pole of the amniotic sac using the fingers in order to help in the release of prostaglandins and trigger contractions. It is performed by vaginal examination and there is usually a little discomfort, subsequently leaving the vagina sore. It is sometimes accompanied by small losses of blood or cervical mucous.
- Amniotomy. It is the rupturing of the membranes of the amniotic sac. This rupture is not painful, except for the vaginal examination that is required. The rupturing of the membranes stimulates the secretion of prostaglandins and then oxytocin.
Pharmacological methods for inducing labour
- Prostaglandins. They are drugs that are applied locally at the back of the vagina and the neck of the womb. It is administered by a gynaecologist. The most used prostaglandin is dinoprostone (PGE2) and is in the form of a gel or a slow-release vaginal pessary.
- The prostaglandin gel is introduced into the canal of the cervix and is left for at least 6 hours before applying the oxytocin.
- The slow-release tampon-like pessary is placed near the neck of the womb and has the advantage that it can easily be withdrawn if there is any complication in the mother or foetus (foetal distress or excessive contractions). This pessary is usually left for 12 hours before starting administering the oxytocin.
In one form or another the administration of prostaglandins is intended to ripen the cervix and provoke contractions.
- Oxytocin. Administration of intravenous oxytocin with continuous external monitoring.
If the birth is before week 37, the newborn is considered premature.
Methods to relieve the labor pain
Epidural analgesia. Epidural anaesthesia consists of introducing a local anaesthetic into the epidural space, so that the nerve endings are blocked at spinal level, particularly at their exit. It is administered by an anaesthetist through a very thin catheter, which is introduced into the lumbar region of the spine and later, into the area that covers the spinal cord.
It is the technique that helps to control the pain during delivery.
The analgesic effect starts after 15 or 20 minutes. If delivery is imminent there is no sense in performing this technique.
Complications are rare and are usually mild, such as a temporary decrease in blood pressure or headache or backache for a few days. As regards the serious complications, they include a feeling of breathlessness, the anaesthesia extending to the chest and arms, infection, or bleeding in the epidural space, and an allergic reaction.
In the event of a caesarean the already introduced catheter may be used to administer the appropriate dose.
Nitrous oxide. It is a mixture of an anaesthetic gas, nitrous oxide, and oxygen in a fixed proportion of 50%. The patient only has to breathe it before each uterine contraction, so that the gas enters the body and takes effect. A disposable mask or mouth piece is required for each patient, through which it is intermittently inhaled. It is used to control the pain of the contractions, but does not eliminate it, as it has a moderate analgesic effect. On rare occasions there may be serious problems. It can cause nausea and vomiting, drowsiness, and changes in memory.
Hydrotherapy. Hydrotherapy in labour consists of the immersion of a pregnant women in water at any stage of labour, submerging the abdomen completely in the water. Among its benefits are: a decrease in pain, increase in maternal satisfaction, a reduction in the use of epidural analgesia, and less perineal injuries and episiotomies.
It consists of performing a surgical incision in the female perineal region, which comprises skin, muscle plane, and vaginal mucosa. Its aim is to widen the “soft” canal in order to shorten labour and speed up the exit of the foetus. It is performed with scissors or a scalpel and requires stitches.
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