Placental photography

20 situations in the process of natural production, see the move! The baby is coming soon, and the prospective parents who are going to give birth naturally must be worried and worried! On the one hand, I look forward to bringing new life, on the other hand, I am worried that there will be many problems in the process of natural production, whether it is waiting for labor or on the delivery platform. I don't know how to deal with and solve them. Therefore, this article by the professional delivery room senior medical team, in view of 20 common problems in childbirth, to relieve the worries of prospective parents and help you happily meet the new life! Situation 1: What should I do in case of emergency? Chen Shengxian, director of gynecology at Chimei Medical Center, said that if the first child goes from routine labor pain to delivery, it will be called an emergency delivery within 3 hours, which will easily lead to serious birth canal laceration, complications and fetal injury. In order to avoid emergency delivery, it is suggested that you must check on time. If the primipara has regular contractions for 5 or 6 minutes, and the primipara has regular contractions within 65 or 438+00 minutes, or has water breakthrough, massive bleeding, falling sensation, sudden drop of fetal movement, and sudden drop after severe fetal movement, you should be admitted to the hospital as soon as possible, but don't panic! When you don't know what to do, you can also call the delivery room to ask. Even if no one is with you, you can call 1 19 for help. In fact, such a hurry is rare, don't panic!

Situation 2: Do you want to have a baby? Director Chen Shengxian pointed out that it is generally born after the expected date of delivery; Or pregnant women with gestational diabetes and pregnant giant babies, who want to give birth naturally, will give birth at 37 or 38 weeks, but in fact the failure rate is quite high, because the cervix is not yet mature. Some overdue pregnancies will not be induced until 4 1 and 42 weeks, but most of them will be induced around 4 1 week, because the placenta will get worse and the fetus will become bigger in the future, which is not good for natural life.

Situation 3: Will natural delivery be invalid? Director Chen Shengxian said that some fertility drugs are * * * plug (including prostaglandin) and some are oxytocin. At present, most of them are blocked by * * *, which is relatively safe. There is a slang in obstetrics called "I can't see the second sunset!" In other words, don't stay for more than 48 hours. If there is such a situation, there is a problem! If it is only 2 or 3 days after 40 weeks of pregnancy, the delivery is invalid and the fetal heartbeat is fine, the mother will be invited home. If the labor process does not progress when the labor progresses to 5 or 6 cm, caesarean section may be chosen.

Basically, it will be delivered 42 weeks ago. If there is no progress in the labor process, it is invalid. Cesarean section should be performed as appropriate. After all, safety is the most important!

Situation 4: Waiting for the parturient: "Keep asking me to go, how can I get a stomachache?" Lu, the deputy head nurse, said that in fact, when the parturient is in labor pains, she will not be asked to walk around. There are railings on the wall of the aisle to help her squat and rest. There are also AIDS at the bedside, such as birth balls. Sitting on it can reduce pelvic pressure. In addition, the pelvis is upright, and the fetus will descend faster. At this time, the husband can help his wife do a back job to relieve the pain, or the wife can put her arms around her husband's shoulders and dance slowly. These will be explained at the time of admission, and the nurse will give guidance when it actually happens.

Moreover, we don't just ask pregnant women to walk, there are many other ways to do it. Nurses will teach at any time, for example, posting health education instructions on the corridor wall of the delivery room of Chi Mei Hospital, and the pregnant women can follow suit. If a fetal monitor is installed, the nursing station can see the status of each bed through the control system, and can know the mother's uterine contraction and fetal heartbeat at any time, so don't worry!

20 situations in the process of natural production, see the move! Situation 5: Do you want to give birth with less pain? Painless delivery is a high-quality mode of production. Because it takes ten or twenty hours from delivery to delivery, if the pain lasts for so long, it may have a bad influence on the baby. For example: hyperventilation causes the concentration of carbon dioxide to decrease and the uterus to contract excessively; It will also increase the secretion of adrenaline. Long-term anxiety and labor pains will affect uterine contraction and reduce the oxygen provided to the fetus.

Recently, people's acceptance of pain-relieving delivery is getting higher and higher, because it can not only relieve pain, but also benefit both the baby and mommy. However, some people worry that after the pain-relieving delivery, there may be no way to exert force during childbirth. Pain-relieving delivery is actually mainly to paralyze the sensory nerve, so that the parturient can't feel the pain, but still retain the motor nerve, so that the parturient can still contribute when working hard. When the sensory nerve is paralyzed, it will relax the blood vessels. At this time, it is necessary to add a few more drops to avoid providing too little blood to the fetus and causing fetal distress.

However, if the parturient belongs to hemorrhagic constitution or hemophilia, painless delivery is not recommended. Because the bleeding constitution will make it difficult for the parturient to stop bleeding after bleeding, it may cause too much blood on the spinal cord membrane and oppress the nerves inside. At present, the hospital will check the coagulation function before delivery. If the coagulation function is normal, the anesthesiologist will also ask the medical history in detail to ensure safety.

Nurse Xu said that during the examination, the clinic will provide information about analgesia delivery and make a preliminary inquiry. Parents-to-be can go back and discuss it, and let parents-to-be decide after they are admitted to hospital for labor. However, prospective parents may still be unable to decide, or some family members may refuse to do so because they don't know enough about pain-relieving delivery. At this time, the nursing staff will ask the doctor to explain the conditions suitable for pain-reducing delivery.

Director Chen Shengxian said that the pain is usually relieved after the cervix is opened to 3 or 4 cm. If the first child is opened to 5 cm, it can still be done, but if the fetal head is very low and the pain is frequent and intensive, it is not recommended; If you have a second child, don't do it after the cervix is opened 5 cm, because in the process of preparing for anesthesia, it may be born soon!

Situation 6: Will painless delivery be ineffective? If you give birth in the wrong place, analgesic delivery may be ineffective, but it rarely happens now, because now the technology is mature, and the anesthesiologist will observe to see if the situation will be re-administered or the dose will be increased. But it is "analgesic", not "painless", and personal feelings and reactions are much worse. Some people are so sensitive to pain that they can't stand a little pain! However, once delivery is to relieve pain, anesthesiologists and nurses will also join the production team, and will use the pain scale to observe the changes of maternal pain expression, see the differences before and after delivery, and ask the maternal feelings. An experienced anesthesiologist can know the effect of analgesia delivery from the expression of the parturient (see Figure A).

Therefore, once the pain is relieved, there will be two groups of practical nurse nurses, practical nurse and the anesthesiologist, who will ask the delivery room how many centimeters the labor process has progressed in practical nurse. Is there any progress or delay? If necessary, I will contact the anesthesiologist to see if it is necessary to add medicine. Therefore, there are very few cases in which labor is ineffective!

20 situations in the process of natural production, see the move! Situation 7: Do you want to accompany your baby? How to accompany the baby? In fact, in the delivery room, not only some people may not know how to accompany the baby, but they may also be at a loss, and even there may be situations that are of no help! In response to this problem, Lu, the deputy head nurse, said that the husband or family members of pregnant women should have the knowledge of accompanying the baby, and the prenatal education will provide it. After delivery, the nurse will teach them the knowledge of accompanying the baby again and whether to enter the delivery room to accompany the baby, so it is unlikely that they will be at a loss when accompanying the baby.

Director Chen Shengxian pointed out that because the variables to be delivered are difficult to predict, but pregnant women and their families can't understand them, medical staff will try their best to give different health education guidance according to different weeks before pregnancy, including the cognition of prenatal examination, labor process, breastfeeding and postpartum care, which is continuous. Hospitals often make their own guidance manuals. Therefore, as long as prospective parents follow the procedures and guidance of medical staff, most of them can go smoothly without being too nervous and confused!

It is suggested that the things that can be done with the parturient include: (1) During the delivery room, remind and teach the parturient the skills of breathing and relaxation, give encouragement and care during the contraction, provide psychological support, help relieve discomfort on the back, assist in going to the toilet, wiping sweat, changing pads and changing clothes, moistening lips, and communicate with medical staff to understand the current situation of labor. (2) After entering the delivery room, under the on-site guidance of medical staff, the accompanying staff can help the parturient to maintain the correct delivery posture, help to relax and relieve discomfort, help to make the correct direction of exertion, inform the current progress of labor and give care and encouragement, film important processes and greet the baby together, help the parturient to make the first physical contact and try to suck * * *, so as to prepare for breastfeeding as soon as possible and enhance the parent-child relationship.

However, in some cases, it is better not to go to the delivery room to accompany the baby: (1) People who are easily nervous and have not attended the production education course will not only bring their panic into the delivery room, but also make expectant mothers more nervous. (2) When the "photographer" doesn't understand the true meaning of accompanying delivery, he walks around at will after entering the delivery room, which will interfere with the work of medical staff and affect the aseptic state of the delivery room. (3) When emergency caesarean section is needed. (4) Don't trust medical staff and question professionals at will, which makes it difficult for medical staff to do things, which is likely to delay the opportunity and even increase the danger.

20 situations in the process of natural production, see the move! Situation 8: What should I do if the fetal heartbeat is fast and slow? Is it fetal distress? Director Chen Shengxian said that the fetal heartbeat is fast and slow, sometimes because of the shift of the fetal monitor. Practical nurse will go to the bedside to check and adjust the monitor to a suitable position. If there is fetal distress, the fetal heartbeat frequency will decrease. If there is early deceleration, it is mostly fetal head compression, or it may be that the cervix is about to open completely. The most important thing is to judge the variability of fetal heart sound. If the variability is good, you can observe it again. If there is a delay in deceleration, it is mostly because the conditions are not good, or the umbilical cord is compressed, which will also cause variable speed deceleration.

If variability persists or drags on for too long, the doctor will take the initiative to have an emergency caesarean section when necessary! Take Chimei Hospital as an example, as long as the emergency laparotomy instruction is issued and the operating room receives the instruction, an operating room should be vacated at any time to receive the caesarean section knife, and the relevant medical staff should be ready at any time to rescue the mother and baby at any time in the shortest time!

Situation 9: What about cervical dilatation stagnation? Director Chen Shengxian said that the first thing to look at is whether the cervical dilatation speed and uterine contraction reach a certain level. Generally speaking, 4P determines whether natural delivery can be successful: (1) Motivation: Is the labor intensity enough? (2) Access: Is the birth canal spacious enough? (3) Passenger: refers to the fetus or placenta. If placenta previa or fetal position is not correct, it is not easy to give birth! (4) Psychology: refers to the confidence in maternity. If she is not strong enough, she may not be able to bear the pain and want surgery! As long as one of these 4Ps doesn't work, natural production will not be easy! Therefore, prenatal health education will be given to these 4Ps.

However, experienced doctors still have the following series of methods to help women give birth naturally:

● If the cervical dilatation is not progressing smoothly, we will look at the uterine contraction. If it is not enough, we will add medicine to increase the uterine contraction. The so-called contractions are good. If it contracts every 2 or 3 minutes during the rapid progress period (after the cervix is opened 3 or 4 cm) and the intensity exceeds 60mmHg, it is an effective contraction.

● If the cervical dilatation is still not progressing smoothly, such as the incubation period (which means that the cervix is 0-3 cm open) is more than 20 hours, it means that the incubation period is delayed. If the uterine contraction progresses rapidly and well, the primipara should theoretically expand 1 cm within 2 hours. If the dilatation is still delayed after 3 or 4 hours, it means that there is something wrong with cervical dilatation.

● If the fetal head does not descend, it may be that the pelvic cavity is too narrow, or the fetal head position is not good, such as the occipital posterior position is stuck (the occipital anterior position can pass through the birth canal with the shortest head diameter, which is better); Or 8 before the cervix is completely opened? 10 cm (called delay period), sometimes it will swell for a long time; If the primipara can't give birth for 2 or 3 hours after the cervix is fully opened, it is a delay in the second stage of labor (that is, from the cervix to the delivery of the baby). In all these cases, we should try to speed up the descent of the fetus, such as using vacuum aspirator or forceps to assist delivery in the delivery room. However, if you have given birth to a second or third child or more, the cervix has been enlarged by 4 or 5 cm. Although there is pain, but the progress is not good, we should consider caesarean section.

● If necessary, artificial water breakthrough can be used to speed up the labor process, but it can only be done after the cervix is opened 4 cm (entering the rapid progress stage), and the fetal head must have been stuck, otherwise the fetal head will go up when the water is broken, and what is more troublesome is that the umbilical cord may prolapse, which will be troublesome!

There are many other ways to help the progress of the labor process, depending on the personal situation. Try not to let the parturient "pay once and enjoy twice", that is, the pain is painful, and the result is still laparotomy!

20 situations in the process of natural production, see the move! Status 10: Where is the progress? Why don't you come for an internal inspection? Because both the parturient and their families want to know the progress of the labor process, they often ask, "How many fingers have you reached? But medical staff will not help pregnant women too intensively, because it will make pregnant women uncomfortable and increase the risk of infection! Therefore, medical staff will not help pregnant women to do internal diagnosis because of family requirements.

Lu, the deputy head nurse, said that the timing of the internal diagnosis is basically that the mother is admitted to the hospital for delivery once. If suppositories are used, the doctor will make an evaluation of the internal diagnosis in advance, and then the internal diagnosis will be carried out after 2 hours of dissolution, and then it will be adjusted according to the maternal situation.

Director Chen Shengxian said that because the incubation period is slow, there is no need for frequent internal diagnosis. If there is no severe pain, the labor process will naturally proceed; However, if it is found that the labor process is not progressing well, the doctor will suggest adding birth control pills to see the progress. Once it reaches the stage of rapid progress (after the cervix is opened for 3 or 4 cm), it will be 1? Go to the internal medicine clinic every 2 hours to avoid sudden delivery. It is not good to stay in the maternity bed all your life! Medical staff will have a professional balance.

Situation 1 1: The medical staff will come occasionally, but you are embarrassed to keep calling? Lu, the deputy head nurse, said that she kept calling the medical staff because she didn't understand the delivery process. In fact, the health education manual has been written, and the prenatal clinic has also said it, and the hospital has also said it again, so that the pregnant women and their families can be more calm and correct. If you are still worried, the nurse is at the nursing station. If you have any questions, you can consult the nursing staff. When necessary, practical nurse will contact the doctor. They will feel more at ease after the doctor explains. It is best for medical staff to explain clearly at each stage and estimate the delivery time, so that mothers and their families will be more at ease. According to the ratio of nurse 1 4 in the medical center, the nurse will visit the parturient every 30 minutes, and the nursing station also has a monitoring system for uterine contraction and fetal heartbeat, so the parturient and their families need not be too nervous.

20 situations in the process of natural production, see the move! Situation 12: What if the parturient doesn't use force or always uses the wrong force? Some women will be hysterical, easy to cry and scream, and use the wrong strength! Lu, the deputy head nurse, said that at this time, she should be taught that if the cervix is not fully opened, she should relax when she feels comfortable, inhale and exhale slowly, and don't exert any force, so as not to cause edema at the cervix and hinder the delivery of the fetus. Generally, it is only after the cervix is completely opened that the method of exerting force is taught to the parturient. At this time, the nurse will teach her with a password and an action. The technique is: "When the head of the bed is raised, there will be a feeling of tight mouth when the uterus contracts. At this time, the fetal head will feel depressed and convenient. Teach lying-in women to pull the bedside railing, open their knees outward and step on the railing with their feet. After taking a deep breath, she will hold her breath and push as hard as defecation, about 6. Wait for the next pain, and then start the cycle of "inhaling, holding your breath and exerting force".

You can also change your posture between pains, such as sitting on the ball in the bed, grasping the railing of the bed or lying on the edge of the bed. At this time, the encouragement of the attending physician is very important. Internal inspection will be carried out after the force is exerted. If there is progress, it shows that the method of exertion is correct and encourages pregnant women to continue to use this method.

Director Chen Shengxian said that nurses will also teach family members and parturients how to exert themselves, so it is very important to participate in childbirth. But if the fetus still doesn't come down after 2 or 3 hours, you should go to the delivery table in the delivery room to push the abdomen (abdominal pressure), or use vacuum suction, forceps and other midwifery methods, or consider caesarean section!

Situation 13: What should the parturient do if she has no strength? First of all, I will teach the parturient not to cry, wasting energy! The parturient said that she had no strength, so she rested, gave water and wiped her sweat. In fact, as long as she has pains at first, she will naturally exert her strength and encourage her to say, "You can do it, come on! Therefore, although I often hear my mother say weakly, "I have no strength!" "But most of them will exert reflex force with the pain until the baby is born!

20 situations in the process of natural production, see the move! Situation 14: Why are delivery rooms and delivery platforms not promoted? After seeing the lying-in woman's cervix completely open, she cried with pain. The most distressed family members always ask, "Can I enter the delivery room?" If they haven't reached the standard for entering the delivery room, the medical staff will tell them to wait for 15,30 minutes, and the nursing staff will stay by for a while and teach them how to exert themselves, or come back after15 minutes to make the parturient and their families feel more secure.

Director Chen Shengxian said that if the fetal head is not very low, it will be more dangerous to go to the delivery room too early. If you arrive at 1 or 2 hours, you will almost have a caesarean section. When you go in, your abdomen will be compressed. The doctor will look at the situation and check the perineum when the parturient exerts force. Experienced doctors will know whether the fetus can be born.

Situation 15: Is it ok to give birth by pushing your stomach with your hands? Usually, when the medical staff pushes the pregnant woman's stomach with their elbows, it means that the baby is already at the delivery crossing and has not yet been born, but the pregnant woman is running out of strength. At this time, the doctor will ask the pregnant woman if she agrees to push her stomach to shorten the labor process. Pushing your stomach with your elbow is actually pushing your baby forward by a centimeter or two. If you don't do this, it may take half an hour to two hours to give birth. Although there have been cases where pregnant women are pushed into their stomachs and cause uterine rupture, this probability is actually very low. If the uterus ruptures, it can be recovered, so don't worry too much.

However, if the uterus has undergone surgery, such as caesarean section or hysteromyoma surgery, etc. If there is a scar in the uterus, you won't push your mother's stomach with your hand.

Situation 16: Is negative pressure suction or forceps better for midwifery? When the fetal head has passed through the ischial ridge, auxiliary tools (such as vacuum aspirator or forceps) can be used to help deliver the fetus. Because if the fetus stays in the birth canal for too long, it will lack oxygen. The most important thing at this time is how to help the fetus be born as soon as possible. Using these tools will not cause fetal head deformation, sometimes it may be slightly elongated, and it will recover itself. Don't worry, after all, it is most important to give birth to a baby safely as soon as possible!

20 situations in the process of natural production, see the move! Situation 17: Shoulder stuck. What should I do? Director Chen Shengxian said that this is a situation that obstetricians and gynecologists dare not encounter. Fortunately, the probability of occurrence is not high, and prenatal ultrasound can be evaluated. If it is found that the abdominal circumference of the fetus is greater than 37 cm, the probability of fetal shoulder sticking during delivery is relatively high; Or pregnant women are obese (there are many fat disorders in the birth canal), and the expired fetus is too big.

In case the doctor finds that the baby's shoulder is stuck, he will pull the maternal thigh in the direction of the body to widen the diameter of the pubic bone, or press it on the upper edge of the pubic bone, because most of the babies are stuck here, and then other doctors will pick up the child below; Most of them can be solved by turning the fetal shoulder to the inclined plane or turning the back shoulder to the front shoulder; Or pull out the fetal hand without damaging the brachial plexus. Although doctors will try to avoid it, sometimes it is inevitable, and there is no way to break the clavicle (some fetuses will break themselves during childbirth). Let's talk about it later, most of them will recover on their own, and a few need rehabilitation or surgery! But no doctor wants to do this. Mom and family should know that the doctor will take some necessary measures to help you give birth safely as soon as possible!

Status 18: Oh, my God! It hurts. Do you want to change it to caesarean section? ! This is a problem that many pregnant women are worried about! Director Chen Shengxian said that before delivery, pregnant women who can try natural delivery can be told: "At present, there is no need for surgery, but 15% of natural delivery may not progress well, such as fetal heartbeat decline, delayed labor, placental abruption, etc., and may need to switch to caesarean section! Let the parturient know that caesarean section is another option, which is taken for the safety of the mother and the fetus without any way! Because doctors are not gods, it is impossible to predict when the labor process will stop or there will be an emergency. You can tell the parturient that it may be a little difficult to give birth naturally, so you can try. However, if the mother has no confidence, she has to choose caesarean section at her own expense. The probability is 3? 5%。

20 situations in the process of natural production, see the move! Conditions 19: What conditions are suitable for caesarean section? 20 "Indications of Cesarean Section" Covered by Health Insurance

1. Fetal distress (with fetal monitoring report)

2. The labor process is slow.

3. Prenatal bleeding

4. Abnormal fetal position

5. umbilical cord prolapse

Step 6 give birth to losers

7. Patients with genital herpes

8. Previous caesarean section (the reason of previous caesarean section must be indicated. If the previous caesarean section was requested by yourself, if there is no special reason, you must have another caesarean section, and you can only declare your own caesarean section).

9. Those who have had uterine surgery before.

10.*** or * * condyloma acuminatum

1 1. Fetal congenital anomalies can be treated.

12. Preeclampsia

(1) Severe and uncontrollable preeclampsia

(HELLP syndrome failed to induce labor for 6 hours.

(3) induced labor for 6 hours, but the labor process did not go smoothly.

13. Fetal weight is less than1500g (limited to hospitals with NICU equipment in neonatal intensive care unit).

14. Pelvic malformation (including polio or car accident injury)

15. The fetal weight exceeds 4000 grams.

16. Head-pelvis asymmetry

17. Obstructive delivery (such as uterine fibroids or ovarian masses)

65438+

19. People diagnosed with HIV-positive

20 other special indications, but must be specified.