The ABC of Conception. Natural childbirth: preparation, precursors and main stages Contraindications to independent childbirth

It's no secret that C-section- an operation that ends a significant percentage of pregnancies. Some expectant mothers know in advance that their baby will be born by cesarean section, others are preparing for a natural birth, but problems arise in the process, and a surgical outcome becomes the only possible option. A conscientious doctor will not simply prescribe a cesarean section; there must always be good reasons for such a pregnancy outcome. In this article we will talk about indications and contraindications for cesarean section. Traditionally, indications for CS are divided into absolute and relative, maternal and fetal indications. Below are lists of indications for both elective and emergency caesarean sections.

Absolute indications for caesarean section

The decision on the need for a caesarean section in each specific case is made by the doctor. Despite the unpredictability of the birth process, in a number of situations it is known in advance that giving birth naturally the woman cannot, so a planned caesarean section is prescribed. Indications from the mother and child that physically make natural childbirth impossible are called absolute.

Absolute indications for caesarean section on the maternal side:

Absolutely narrow pelvis - this is a narrowing of the woman’s pelvic bones, through which the child physically cannot pass during natural childbirth. Obstetricians classify the size of the pelvis as either normal or narrowed. An anatomically narrow pelvis has objectively reduced dimensions, and natural delivery in such a situation is impossible. The pelvis is considered to be absolutely narrow if it is in degree II-IV narrowing. In grades III-IV, a cesarean section will be planned, and in grade II, the decision will most likely be made during natural childbirth.

With a normal pelvic size or with the first degree of narrowing, normal childbirth is possible, but if a woman is carrying a large child, there is a possibility that her pelvis will be clinically narrow. The size of the pelvic ring in this case simply does not correspond to the size of the fetal head.

Careful measurement of the true dimensions of the pelvis using ultrasound examination and X-ray pelvimetry (x-rays of the pelvic bones) make it possible to find out whether a woman can give birth on her own or whether a planned caesarean section is required.

Even with a normal pelvic ring size, the baby may turn incorrectly during childbirth. If a vaginal examination reveals frontal or facial insertion of the head, this means that natural childbirth is impossible, since the head cannot pass through the pelvis with its largest size. This situation is an absolute indication for an emergency caesarean section.

Mechanical obstacles for natural delivery (uterine fibroids in the isthmus area, ovarian tumors, deformities of the pelvic bones) are also an absolute indication for a planned cesarean section. This factor is usually diagnosed using ultrasound.
Threat of uterine rupture exists in women who have already undergone a caesarean section or have a history of any uterine surgery. The doctor determines the likelihood of rupture based on the condition of the scar. If it has a thickness of less than 3 mm, uneven contours and inclusions of connective tissue, the risk of uterine rupture along this suture is too great for the woman to give birth on her own. For reliability, the scar is examined both before and during childbirth. Additional factors in favor of cesarean section are the presence of two or more cesarean sections in the past; difficult postoperative period after a previous cesarean section - with elevated temperature, inflammatory processes in the uterus; long healing of the seam on the skin; numerous natural births, which have thinned the uterine wall.

Absolute indications for caesarean section from the fetus:

Placenta previa – extremely dangerous situation, which, fortunately, is easy to diagnose during pregnancy using ultrasound. The placenta previa is not attached to the back of the uterus, as it should be, but in its lower third and sometimes even directly above the cervix, thereby blocking the exit for the fetus. Placenta previa can cause severe bleeding, which poses a risk to the life of both mother and baby. This anomaly, in the absence of blood discharge indicating placental abruption, becomes a diagnosis for a planned cesarean section only at later pregnancy. Earlier - there is no need to panic, the placenta can still rise to its normal position.
Premature placental abruption – separation of the placenta before the onset of labor or during labor is dangerous both for the woman (extensive blood loss) and for the fetus (acute hypoxia). It is an absolute indication for emergency caesarean section.
Umbilical cord prolapse can occur during childbirth with polyhydramnios, when a large volume amniotic fluid pours out (water breaks), but the baby’s head has not yet inserted into the pelvis. The prolapsed umbilical cord becomes compressed between the pelvic wall and the head, which means the blood flow between mother and child is disrupted. If the obstetrician diagnoses this condition during a vaginal examination after the water breaks, this is a reason for an emergency cesarean section.
Transverse position of the fetus becomes an absolute indication for cesarean section already during labor. A baby can be born naturally only if it is positioned with the head or buttocks down, i.e. has a cephalic or breech presentation. Children of multiparous women most often find themselves in a transverse position (due to weakening of the muscles of the uterus and abdominal wall); also factors contributing to the transverse position of the fetus are placenta previa and polyhydramnios. If the baby does not turn over during labor, even with the help of obstetric manipulations, doctors have no choice but to perform an emergency caesarean section.

Relative indications for caesarean section

The name “relative indications” speaks for itself: these include conditions in which natural childbirth is physically possible, but has a theoretical risk to the health and even the life of the mother and baby.

Relative indications for cesarean section on the maternal side:

Extragenital pathologies – concomitant diseases of a woman not related to her gynecological health and pregnancy. The significant stress that a woman in labor experiences during childbirth can cause an exacerbation of existing pathologies that is dangerous to her health. Therefore, doctors classify a number of diseases as relative indications for a cesarean section:

cancer of any location;
cardiovascular diseases;
diabetes;
high myopia with a risk of retinal detachment;
kidney disease;
diseases nervous systems s and a number of others.

In addition, relative indications for cesarean section include diseases that can be transmitted from mother to child as it passes through the birth canal, for example, genital herpes.

Preeclampsia in pregnant women is a dangerous pathology that occurs in some women in the second half of pregnancy. With gestosis, the functioning of the kidneys, blood vessels and brain is disrupted expectant mother. Manifests this deviation high blood pressure, the appearance of protein in the urine, swelling, headaches, flashing “spots” before the eyes and sometimes convulsions. Preeclampsia in its severe forms (preeclampsia and eclampsia) is a medical indication for emergency cesarean section, as it causes fetal hypoxia.
Clinically narrow pelvis – this is a discrepancy between the size of the woman’s pelvic ring and the size of the presenting part of the child (head). In this case, the baby's head does not enter the birth canal when the cervix is fully dilated and active contractions are present. The danger of this pathological condition is the risk of uterine rupture, acute fetal hypoxia (which can even lead to its death). The size of the baby’s head cannot be absolutely accurately determined before birth, and in addition, incorrect insertion or distortion of the head is possible, so a clinically narrow pelvis is diagnosed already during childbirth and is an indication for an emergency cesarean section.
Woman's age over 30 or 35 years and first birth . The dangerous factor in this case is not the age, but the health status of the mother in labor. It is logical that a 20-25-year-old primigravida is most likely healthier than one who is already 30-35 or more. However, not everything is so simple, and doctors know this. Age over 35 can only be a relative indication for cesarean section. If a woman is healthy at 35, and the pregnancy is easy and safe, it is likely that she will be able to give birth naturally.
Persistent weakness of labor . If a natural birth that has already begun has subsided for some reason, contractions have not intensified or they have completely disappeared, and medical assistance does not bring results, doctors talk about persistent weakness of labor. If the child suffers in this case (devices show the presence of hypoxia), a cesarean section will seem to doctors a more favorable outcome than waiting for the resumption of natural childbirth.
Scar on the uterus in itself is only a relative indication for caesarean section. But this is a risk factor for uterine rupture, which the obstetrician always pays attention to. Scars on the uterus are not always associated with a previous cesarean section; they may be a consequence of induced abortion or removal of fibroids. The condition of the scar must be monitored, especially after 36-37 weeks of pregnancy, and if it is full, the woman has every chance of giving birth naturally.

Relative indications for elective caesarean section on the part of the child:

Breech presentation of the fetus allows a woman to give birth on her own, but it is still considered pathological. Natural childbirth with breech presentation carry a risk of fetal hypoxia and birth injuries. The situation gets worse if the child is large (more than 3.6 kg) and the mother has an anatomically narrowed pelvis.
Large fruit (more than 4 kg) is an indication for caesarean section only if there are other relative indications.
Detected chronic or acute fetal hypoxia (oxygen starvation) can serve as a fairly compelling reason for surgical delivery. The causes of hypoxia can be different: chronic hypoxia usually caused by gestosis in pregnant women and leads to delayed fetal development; acute hypoxia can occur during prolonged or, on the contrary, too fast and active labor, during placental abruption or prolapse of the umbilical cord. To diagnose oxygen starvation, which is extremely dangerous for a child’s life, the following is used:

listening with an obstetric stethoscope,
Ultrasound with Doppler (study of blood circulation between the fetus, placenta and uterus),
cardiotocography (registration of the fetal heartbeat and movements using a special device),
amnioscopy (examination amniotic fluid using an optical instrument).

If hypoxia is detected and treatment does not bring results, a decision is made on the need for a cesarean section to preserve the health of the child.

Each of the relative indications separately cannot serve as a reason for prescribing a cesarean section, however, when deciding on the outcome of the pregnancy, the doctor weighs all the pros and cons of each option. If the operation seems to the doctor to be a safer method of delivery for the health of the woman and child, the choice will be made in its favor, taking into account only relative indications. In addition, there are so-called combined indications for cesarean section. They represent a combination of factors, each of which in itself is not an indication for a cesarean section, but together they turn into a real threat to life and health during natural childbirth. For example, this is a post-term pregnancy and identified hypoxia; large fetus and breech presentation; age over 35 years and the presence of a serious illness.

Conditions for caesarean section

A caesarean section can only be performed if a number of conditions are met. These include:

fetal viability;
consent of the woman or her legal representatives (relatives) to the operation;
presence of an operating room equipped with all necessary tools and a qualified surgeon;
no infections.

Contraindications to caesarean section

Like any operation, caesarean section has a number of possible contraindications. However, they are not absolute, since the reasons for surgery are usually quite compelling. Surgical delivery is undesirable in the following cases:

the possibility of a woman developing purulent-septic complications in the postoperative period;
intrauterine fetal death;
the presence of deformities and malformations in the fetus that are incompatible with life;
severe prematurity of the fetus (accordingly, its non-viability outside the uterus);
prolonged severe fetal hypoxia, when the possibility of stillbirth or death of the newborn can no longer be denied.

If there is a possibility of fetal death, the choice of delivery method is aimed primarily at preserving the life and health of the woman. The operation, especially in the presence of risk factors, can cause infectious and septic complications (inflammation of the uterus or appendages, purulent peritonitis - acute inflammation in the peritoneum), since the dead fetus becomes a source of infection.

Doctors identify the following risk factors for the development of purulent-septic complications:

Various immunodeficiency conditions (HIV, weakened immunity after taking potent medicines and etc.).
Availability of a woman infectious disease in acute or chronic form (inflammatory processes in the appendages, caries, chronic pyelonephritis, cholecystitis, upper respiratory tract infections, etc.).
Gynecological diseases and complications of pregnancy that worsen blood microcirculation (gestosis in pregnant women, anemia, hypotension and hypertension, etc.).
The duration of labor is more than 12 hours or the anhydrous period (after amniotic fluid) more than 6 hours.
Significant blood loss that was not replaced in a timely manner.
High frequency of vaginal (especially instrumental) examinations.
The presence of a corporal incision on the uterus (across the muscle fibers).
Unfavorable infectious situation in the maternity hospital.

However, if there are absolute indications for cesarean section, even with an acute infectious process that threatens septic complications, the woman must still undergo surgery. Until recently, in such a situation, only one option was possible - removing the fetus with simultaneous removal of the uterus to avoid purulent peritonitis. However, now there is a more favorable technique that allows you to save the uterus - caesarean section with temporary isolation abdominal cavity(extraperitoneal caesarean section).

Myths about caesarean section

In modern medicine, unfortunately, there has been a dangerous trend of increasing the number of cesarean sections. This is especially true for developed, prosperous countries. Some women actually dream of a caesarean as the easy way delivery. The reason for this attitude is ignorance or misunderstanding of what a caesarean section is. Let's dispel popular myths about this operation:

1. It is painless, unlike natural childbirth . Not true. A caesarean section is an operation during which several layers of tissue are cut. Yes, general anesthesia or epidural anesthesia “turns off” pain during surgery (by the way, not always completely). But after recovering from anesthesia, pain in the suture area can make the postoperative period, especially its first days, completely unbearable. But you need to get up to go to the shower and toilet, and take care of the baby - feed him, pick him up. Some women feel pain for several months.

2. It's even better for the child – he does not need to go through the narrow birth canal, risking birth trauma. Absolutely false. Children born as a result of cesarean section receive birth trauma by default. Neurologists always classify them as at risk for speech disorders and other developmental delays. Nature created the mechanism of natural childbirth for a reason. A sharp change in the pressure acting on the child during the operation, the influence of anesthesia, the baby’s passivity during the birth process, less contact with the mother due to restrictions after cesarean section, high probability artificial feeding– all this cannot but influence the child’s adaptation to environment. It is more difficult for him to learn to scream, breathe, suck. There is no talk about any advantages of a caesarean section for a baby (unless, of course, we are talking about saving life and health).

3. At 30 or 35 years old, health is no longer the same as giving birth yourself, especially for the first time . This is wrong. Age is only a relative indication for cesarean section, which cannot be decisive. The doctor must take into account the health status of a particular patient, and not her passport age.

4. After cesarean - always cesarean . The presence of a scar on the uterus from a previous delivery operation also refers to relative indications for cesarean section. Modern diagnostics make it possible to establish the consistency of the scar and predict the possibility of natural childbirth.

As you can see, a caesarean section is not something you should strive for at any cost. However, if there are indications for surgery, there is no need to panic. The method of delivery is undoubtedly important, but what is even more important is that the mother and newborn baby are alive and healthy. This should be the priority goal of the doctor who prescribes a cesarean section for you or gives the go-ahead for a natural birth. We wish you health and a happy meeting with your baby soon!

Childbirth in water. What are the advantages and what should you be wary of?

The main purpose of water birth

Warm water removes nervous tension, acute pain during contractions and pushing. The purpose of childbirth in water is to help the baby be born in more comfortable and natural conditions for him. At the same time, it is much easier for a woman in labor to take any comfortable position to bring a baby into the world

What do the doctor's say

Doctors are not enthusiastic about such undertakings due to a number of potentially dangerous aspects. Also, doctors do not insist that women completely refuse childbirth in water. They contain a lot positive qualities. Today, there are maternity hospitals where you can optionally use baths or swimming pools. At the same time, staff assistance is provided in case something goes wrong.

Pros of water birth

The advantages of this method of producing children are as follows:

Less stress than a normal birth.
The child gradually “integrates” into the world around him.
The first period of labor is significantly shortened.

In addition to the advantages of this method of childbirth, there are also negative aspects that you need to know:

Disadvantages of water birth

TO negative aspects“water births” include:

Managing childbirth is sometimes more difficult than usual.
Labor is delayed indefinitely.
Various bacteria multiply quickly in water.
Pain relief is almost impossible to do.
The unborn baby's temperature may rise.
Immediately after the baby is born, he should reflexively inhale. Water does not allow you to breathe fully.
Possible complications.

In addition to the fact that water birth has a lot of negative aspects, there are also complete contraindications.

Contraindications for water birth

You cannot give birth “in water” if:

Labor is complicated by various diseases of the mother.
The fetus is large and inconsistencies are felt, for example, its head is larger than the birth canal or the space between the pelvic bones.
Incorrect placenta previa.
The child is coming booty forward.
Disturbances in the functioning of the cardiovascular system.
Mental instability of the woman in labor is observed.

Not everything about water birth seems so wrong. Doctors do not deny the many advantages of this type of labor, but before deciding to give birth in water, you should first undergo a diagnosis and think through all the possible risks.

Caesarean section or natural childbirth - most postpartum women are at a loss before this question. Doctors advocate that pregnancy be resolved using a method invented and thought out by Mother Nature herself. But sometimes women undergo surgery themselves, worrying about the well-being of the baby. Caesarean or natural birth, which is better? In the article you will find out the answer.

Harbingers of childbirth

As the due date approaches, a woman increasingly encounters new sensations that indicate the imminent birth of a child. Precursors usually manifest themselves in the form of nagging pain, false contractions, and the passage of a mucus plug. A few days before giving birth, you may want to be alone, away from the hustle and bustle.

About a day before birth, the warning signs disappear abruptly, then contractions begin.

It is worth taking a closer look at how natural childbirth occurs.

First stage of labor

This short lull is interrupted by contractions, the strength and duration of which are constantly increasing. They become regular, and the time between their episodes is constantly decreasing. At this time, a gradual opening of the uterine pharynx occurs, which should be sufficient for the passage of the fetus. At this stage, it is important for the woman in labor to start breathing in rhythm with the contractions. This period is quite long and can take from several hours to a day. During contractions, gynecologists must assess the degree of cervical dilatation to assess fetal position.

This stage of labor is usually divided into the following periods:

Second stage of labor

When the cervix is fully dilated, the fetus begins to move along the birth canal. The woman in labor must push to help him be born. Pushing leads to contraction of the diaphragm and abdominal muscles, their duration does not exceed 1 minute, frequency is 3-5 minutes.

The baby's head emerges first, then the shoulders appear. Doctors gently turn the baby around so that he can come out completely and reduce the risk of injury. The baby is then placed on the mother's stomach. Only then does the doctor begin to cut the umbilical cord.

Third stage of labor

The birth of the afterbirth (placenta, membrane) occurs. If ruptures occur, the doctor applies stitches.

The duration of labor is purely individual. The total time directly depends on the duration of the first stage and the psychological state of the woman in labor. That is why it is important to create comfortable conditions for a woman to stay.

The indoor environment should not cause discomfort or nervous tension. Partner support during contractions will be important.

It is important to remember about natural childbirth that it contributes to the development of the maternal instinct. And the birth of a child according to natural canons allows us to lay a reliable foundation for the development of the relationship between mother and child.

Contents:

Is natural childbirth justified and is it not better to agree to a caesarean section at the slightest deviation? Modern women want to get by with “little blood” and not feel anything, but doctors sound the alarm in such situations and, despite fears of pain, strongly recommend giving birth to a child on their own in the absence of indications for surgical intervention. When preparing for such an important event, expectant mothers must weigh the pros and cons, listen to all the doctors’ recommendations and make the right and informed decision.

If you have the choice of giving birth on your own or by caesarean section (read which is better), you need a detailed consultation with a doctor. He must highlight to the woman all the advantages and disadvantages of both methods of childbirth in her particular situation. Parents of the future baby must weigh the pros and cons and understand that all responsibility for decision will fall on their shoulders. The undoubted advantages of natural childbirth are as follows:

rapid establishment of lactation;
the birth of a child is a process programmed by nature itself, any outside interference in which can end detrimentally;
through natural childbirth, a newborn gains difficult but useful experience in overcoming difficulties and obstacles;
natural adaptation of the baby to new conditions is guaranteed;
hardening of the small organism occurs;
a close, unbreakable bond is ensured between the mother and the newly born child;
rapid postpartum recovery of the female body;
the mother’s ability to independently care for the newborn immediately after discharge.

Of course, natural childbirth has many advantages. However, the young mother will need to consider all the pros and cons of this process in order to represent the other, not entirely attractive side of the coin. After all, this method of delivery also has disadvantages.

Minuses

Compared to the advantages, the disadvantages of natural childbirth are few and far between. These include:

severe pain when contractions and pushing occur;
painful sensations in the perineum after childbirth;
frequent ruptures of the perineum, which dictates the need for application in this place.

Many also consider frequent birth injuries of mother and child to be a disadvantage, but this is a controversial point. According to statistics, with a caesarean section the risk of such consequences is also very high. Surgical intervention in this natural process requires serious medical indications.

Contraindications to natural childbirth

A situation may arise where the birth of a child without surgical intervention may threaten not only the health, but also the life of the woman and the baby. There are certain contraindications to natural childbirth, which at the same time serve as indications for cesarean section.

During pregnancy

As a rule, this is a narrow pelvis, when the baby cannot pass the birth canal on his own. Tumors and deformities in this part female body.
Threat of uterine rupture due to thinning or scar failure.
Abnormal incorrect position placenta, when it is fixed above the cervix, thereby blocking the baby's exit.
Pathologies (tumors, fibroids) in the development of the uterus or vagina.
Symphysitis is a separation of the pubic bones.
Severe form of gestosis.
Some chronic diseases of the cardiovascular and nervous systems, diabetes, myopia, etc.
Plastic surgery on the vagina, cervix, suturing of enterogenital and genitourinary fistulas.
Severe perineal rupture in previous births.
Dilatation of vaginal veins.
Conjoined twins.
Transverse position in the baby's womb.
Chronic, its malnutrition.
Long-term infertility.
Exacerbation of genital herpes.

During childbirth

Early discharge of amniotic fluid.
Various anomalies of labor.
Fetal hypoxia in the acute stage.
Placental abruption.
Prolapse or presentation of umbilical cord loops.
Incorrect position of the fetal head (in an unbent state, high straight standing).

These are absolute contraindications for natural childbirth, when even the desire of the woman herself is not taken into account. In all other cases possible alternative options, but at the same time the young mother will have to in writing take full responsibility for the outcome of what is happening. This situation may arise in the presence of the following factors, which in gynecology are called relative contraindications for independent childbirth:

breech presentation (its causes and signs);
more than 35 years;
the fruit is too large or small;
previous cesarean section;
pregnancy pathologies.

Contraindications for natural childbirth are identified either during pregnancy, and then a caesarean section is performed as planned, or immediately before the onset of labor, when a decision is made on an urgent, unscheduled operation. If carrying a baby goes without any problems, you need to gradually prepare for independent delivery so that everything goes smoothly with minimal losses and complications.

Preparation

Even at the stage of pregnancy it is very important and physical training to natural childbirth, which allows you to avoid complications and unforeseen situations.

What things to prepare

A month before giving birth, collect 3 packages: for childbirth, after birth, for discharge.
Purchase in advance a crib, bathtub, stroller, diapers, diapers, undershirts, a first aid kit and other items necessary to care for a newborn for the first time.
While you are away, prepare food for your husband and children.
Prepare all necessary documents.

Psychological preparation

Be confident that everything will go well. Do not doubt the successful outcome of the matter.
Don't allow bad thoughts.
Do only the things you love.
You need to get ready for a natural birth as early as possible: calm down, don’t be nervous, don’t get irritated, don’t get upset, don’t cry.
Treat contractions as the next step towards meeting your long-awaited baby.

About psychology and childbirth. Until now, scientists have no data on what exactly serves as the trigger for the onset of labor. It is believed that the answer should be sought in the woman’s brain.

Physical training

During pregnancy, you need to physically prepare for natural childbirth: regularly perform Kegel exercises, do special gymnastics, lead an active lifestyle, walk more, drink multivitamins and follow exactly all the doctor’s recommendations.
During contractions, it is recommended to give yourself a massage of the sacrum and lower back, which relieves pain, and also learn how to breathe correctly during natural childbirth.
When pushing, you need to do what doctors and midwives say.

As practice shows, if the preparatory stage was completed competently, without fuss and with confidence of a successful outcome, the birth will take place naturally without complications or difficulties.

Stages

Any woman preparing to become a mother awaits this event with trepidation and wants to be as prepared as possible for this process. Therefore, you need to accurately understand how natural childbirth takes place, what stages it involves.

Stage 1: contractions

Rare, painless, almost imperceptible contractions begin (the uterus contracts). A woman can be at home, even doing everyday activities.
The contractions intensify, become painful, and occur every 3-5 minutes. The waters are receding. It's time to go to the maternity hospital. Here it is immediately important to install a device that will help reduce pain and ensure oxygen supply to the baby.

For your information...

Many scientists consider the uterus to be a unique organ. During the 9 months that a woman is carrying a baby, the uterus enlarges 10 times, and after childbirth it safely returns to its previous size.

Stage 2: pushing

After complete dilatation of the cervix, as a rule, there is desire push.
You need to take a comfortable position.
You can do a pain-relieving lower back massage.
Establish proper breathing.
Listen to the doctor and follow all his instructions exactly.

Stage 3: Delivery of the placenta

Within a few minutes the placenta comes out.
The woman feels weak contractions.
The doctor must make sure that the placenta is delivered entirely.
After this, if there are any tears, stitches are applied.
The baby is measured, weighed, and placed on the mother's breast.

These stages are typical for normal natural childbirth, but each of them may have its own difficulties and difficulties, which are overcome through the joint efforts of the woman in labor, doctors and the child. In some cases, pain relief may be required.

Epidural anesthesia

Many women in labor are afraid of pain, which can be simply unbearable during labor. Today, epidural anesthesia for natural childbirth is used as one of the methods of pain relief, which is highly effective. It involves the introduction medicinal product with a thin needle directly into the spinal canal, between the spinal discs. Indications for its mandatory implementation are:

kidney and lung diseases;
myopia;
heart pathologies;
toxicosis in late stages;
premature birth;
incorrect placement of the fetus.

Advantages of epidural anesthesia used during natural childbirth:

it can be prolonged as pain occurs, thanks to the catheter;
blood pressure does not drop with this method of pain relief (as with spinal anesthesia, for example).

However, doctors still rarely resort to this method and recommend natural childbirth without the use of anesthesia, since it has a number of significant disadvantages:

such side effects and consequences as hematoma formation, leakage of cerebrospinal fluid, headaches, unconsciousness, spasms, fluid retention in the body and others;
slow action of the drug, which begins to work only 20 minutes after administration.

If it is possible to give birth to a baby without the use of epidural anesthesia, you need to take advantage of this chance. Some are very strong-willed women make up their minds naturally, but at the same time they must imagine what they are getting into.

Home birth

In some cases, natural childbirth is carried out at home, which can be either emergency, when the ambulance team does not have time to deliver the woman in labor to the hospital, or independent decision parents of the future baby. Before making such a choice, you need to weigh the pros and cons.

Benefits of home natural childbirth

appropriate psychological atmosphere;
naturalness of the process without outside interference;
To relieve pain, you can take any position;
absence of harmful hospital microflora;
independent control over the entire birth process;
bringing parents closer together and with the baby.

Disadvantages of natural childbirth at home

the midwife may not be able to cope with the complications that arise alone;
under unforeseen circumstances, the woman may not have time to be taken to the maternity hospital;
lack of medical equipment;
the inability to legally hold someone responsible if something goes wrong;
the future dad will find himself in a stressful situation, he may get lost and cannot stand the tension;
At home, a woman has no time to gain strength after childbirth; she will have to care for the child immediately;
It is very difficult to organize a comfortable and safe place for childbirth at home: household microorganisms are dangerous for the baby.

If the pregnancy proceeded without complications and an experienced midwife was hired for the birth at home, everything goes without complications or consequences.

Consequences

Negative consequences of natural childbirth can occur if a timely decision to have a cesarean section is not made. In this case, due to unforeseen circumstances or medical error, complications are possible, including a tragic outcome:

various birth injuries in mother or baby;
the death of one of them;
perineal ruptures;

Such complications during natural childbirth are rare. To avoid them, you need to follow all doctor’s instructions during pregnancy and during the birth process.

Unusual natural birth

In some situations, natural childbirth may be complicated by maternal illness or unusual intrauterine development of the fetus. In this case, you need to either perform a caesarean section, or still give birth to the baby yourself, having previously familiarized yourself with all the possible consequences.

Twins

Despite numerous conversations about the need for cesarean section multiple pregnancy, it is quite possible to give birth to twins naturally with a successful outcome. You just need to keep in mind all the pitfalls of this process:

after the birth of her first baby, a woman may experience weakness in the birth process;
the heavy weight of two bodies can cause premature rupture of the bladder, the water may break too early;
babies often lie in the womb incorrectly;
interweaving of umbilical cords.

During a natural birth of twins, doctors must be prepared for all these pitfalls and be able to provide timely assistance to the mother and babies.

Interesting fact. In the 18th century, a Russian peasant woman gave birth to 69 children in 27 times: these were 16 twins, 7 triplets, and 4 times 4 babies were born at once. Given the timing, the woman gave birth on her own.

With breech presentation (breech)

Natural ones can be allowed if:

the fruit is small;
the pelvis is normal;
at breech fetus

With mixed or leg presentation, the medical prognosis can be significantly worse. Natural childbirth in these cases can result in fetal asphyxia, severe injuries, umbilical cord prolapse, premature placental abruption and other complications. To avoid all this, the doctor must make a timely decision about a caesarean section.

After IVF

Today, natural childbirth after IVF (in vitro fertilization) is no longer something out of the ordinary. If quite recently, after this procedure, a woman was offered only one option - a cesarean section, now she is allowed to give birth on her own in the absence of the following factors:

if a woman insists on a cesarean section;
age over 35 years;
multiple pregnancy;
some chronic diseases;
duration of infertility more than 5 years;
gestosis;
risk of miscarriage.

If a woman who has undergone IVF is healthy and young, and the reason for her infertility, according to a medical examination, was the deviations of her partner, she is quite capable of giving birth naturally.

With symphysitis

Symphysitis is an inflammation in the pubic symphysis of the pelvis that can occur during pregnancy or postpartum period. Natural childbirth with symphysitis is possible in the following cases:

with a mild clinical picture (absence of severe pain in the joints);
if the expansion of the pubic fissure is up to 10 mm;
with pelvic sizes corresponding to the norm;
if the fruit is not large.

With a scar on the uterus (after myomectomy and laparotomy)

Doctors today allow natural childbirth even with a scar on the uterus after surgery, myomectomy or a previous cesarean section, subject to certain conditions:

repeat pregnancy occurred a couple of years after the previous operation;
Ultrasound showed the consistency of the scar: it is smooth, without tears or overstretching;
the weight of the fetus does not exceed 3.5 kg;
cephalic presentation;
location of the placenta along the posterior uterine wall;
normal sizes pelvis;
the presence of no more than 1 scar on the uterus;
absence of pathologies in intrauterine development fetus

If these conditions, according to the results medical examination, are not followed, the woman will be asked to have a caesarean section. If these conditions are met, independent delivery is allowed even after removal of fibroids by laparotomy, when an incision is made in the abdominal cavity.

For uterine fibroids

Natural childbirth with uterine fibroids (this is a tumor neoplasm) is quite possible, since this disease itself is not an indication for cesarean section. However, the pregnancy should proceed normally, there should be no complications with the health of the mother and child, and the placenta and fetus are located correctly.

For hemorrhoids

Giving birth to a child naturally with hemorrhoids is a complex and quite painful process. As the fetus passes through the birth canal, the pressure in the pelvic cavity and peritoneum increases, the veins are compressed and pinched. As a result, there is an increase in hemorrhoids. However, in the presence of this disease, doctors do not recommend cesarean section. The only way to avoid painful complications is to regularly engage in hemorrhoid prevention throughout pregnancy.

For high myopia

Natural delivery with high myopia is possible with a favorable course of myopia and the following conditions:

the presence of positive dynamics in terms of vision;
regular preventive actions(taking special medications, vitamins, calcium);
normal, without pathologies, pregnancy;
lack of surgery to correct vision.

So natural childbirth is not recommended after laser vision correction and after retinal coagulation. They can lead to severe hemorrhage in the eye tissue, retinal detachment and even blindness. Is it worth the risk?

After conization of the cervix

Giving birth on your own after cervical conization (an operation in which a cone-shaped part of the uterus is cut out) can usually be very difficult. This is due to the fact that the scar after such a procedure most often prevents the opening of the cervix. In this case, an emergency caesarean section is performed.

With low placentation

Natural childbirth with low placentation (when the edge of the placenta is only 6 cm from the internal os) is very dangerous, since partial placental abruption often occurs when the cervix dilates. This is very dangerous for the life of the fetus. In this case, an emergency caesarean section is performed.

After 40 years

Natural childbirth is quite possible even after 40 years of age in the absence of abnormalities and complications in the condition of the mother and child. Age (all women in labor should know this) is not an indication for a cesarean section.

When entwined with the umbilical cord

A caesarean section is not always performed. If it is one-time, doctors professionally help the woman give birth on her own without consequences. Surgery is prescribed if the following factors are identified before the onset of labor:

delayed development of the baby in the womb;
his heart rate increases;
double or even triple entanglement with the umbilical cord.

With this complication, everything will depend on how dangerous the umbilical cord is entwined for the life and health of the child.

Herpes and natural childbirth

Now everyone is actively discussing the question of how compatible herpes and natural childbirth are: many women are afraid that in this case there will be a mandatory infection with this dangerous virus baby, the immune system which is not yet ready for such an attack. However, according to recent studies, with recurrent herpes female body by the time of birth, she had already developed antibodies that are able to penetrate the placenta. By this time, the child is completely protected, so he is not at risk of infection.

With a narrow pelvis

Giving birth to women with a narrow pelvis is also very difficult. It is such if one of the following indicators is 1.5-2 cm less than the norm. Deviations complicate the process of natural childbirth, presenting insurmountable obstacles and difficulties for them. So, when registering for consultation, as well as when a pregnant woman enters the maternity hospital, a mandatory measurement of this part of the female body is carried out. Doctors call the following normal pelvic sizes for natural childbirth, which will not complicate the child’s passage through the birth canal.

Lumbosacral Michaelis rhombus (Figure 1): vertically - 11 cm, horizontally - 10 cm.
The distance between the iliac superior anterior spines (number 1 in Figure 2a) should be at least 25-26 cm.
The gap between the points of the iliac crests that are most distant from each other (number 2 in Figure 2a) should normally be 28-29 cm.
The distance between the greater trochanters (tubercles) of the femurs (number 3 in Figure 2a) is approximately 30-31 cm.
The distance between the fossa above the sacrum and the upper edge of the pubis in gynecology is called the external conjugate (Figure 2b) and is normally 20-21 cm.
The Solovyov index (circumference length at the wrist joint) should not be more than 14 cm, since in this case the conclusion is drawn about the massiveness of the pelvic bone and its small size.

Even if the norm for all these indicators is met, the doctor must additionally find out whether the size of the pelvis corresponds to the size of the child’s head and check for deformation of the bone joints. For this purpose, an ultrasound (less often x-ray) examination is performed.

With enterococcus fecalis

There is no need to be afraid to give birth naturally and with enterococcus fecalis, which is part of the normal microflora of the human digestive tract. If the tests are in order and doctors do not recommend a cesarean section, there is no threat of infection to the baby.

With inguinal hernia

Pregnant women with an inguinal hernia may be offered to give birth naturally if the following conditions are met:

small protrusion;
wearing a bandage during pregnancy;
During pushing, the obstetrician must support the hernia with his hand to prevent strangulation.

According to statistics, an inguinal hernia after childbirth disappears without a trace for some time.

As practice shows, modern doctors are reconsidering their views on caesarean section and treat it only as a necessity when the life of the mother and child is really in danger. In the absence of medical indications for surgical intervention, preference should be given to natural childbirth.

Olga Nechaeva believes that the majority medical problems, because of which women are advised to give up natural childbirth, can be avoided. The main thing is to find the necessary information in time. Therefore, the mother of two children in her blog spoke about facts about natural childbirth that will be useful for pregnant women and which will help to avoid many troubles.

1. Childbirth is a natural process that is triggered by a mechanism in a woman’s brain. Doctors still cannot argue what exactly triggers labor, so their attempts to intervene in this process are, to say the least, unprofessional.

2. The earlier your birth is intervened, the greater the chance of a disastrous outcome. It's like a domino effect.

16. A water-free period of 24 hours when the water naturally breaks and the mother does not have a fever is considered risk-free in the West. A water-free period of 24-48 hours requires regular monitoring of maternal temperature and fetal heart rate, but is normal. Labor usually begins naturally during this period. There is no data beyond 72 hours because everyone gives birth by then.

17. The baby does not suffocate during the anhydrous period; the placenta continues to produce amniotic fluid.

18. The only danger of a waterless period is infection, which is monitored by measuring the mother's temperature. Vaginal examinations increase the risk of infection.

19. Chemical intervention during labor (induction) disrupts the natural hormonal chemistry of labor.

20. Oskitocin, produced during childbirth and feeding, starts and promotes labor, and then the separation of milk. It also stimulates the expression of feelings of love and care.

Adrenaline and norepinephrine in the early stages of labor suppress and stop labor. Therefore, examinations, questions, moving, enemas, placement in a ward with other panicking and screaming women in labor, intimidation by doctors can lead to a halt in labor.

21. Artificial oxytocin inhibits the production of natural oxytocin.

22. Beta-endorphins (natural opiates) are produced in the brain during labor and help achieve a state of “altered consciousness” that is necessary for a quick and easy labor. They also act as a natural pain reliever, and some even provide the opportunity to experience sensations comparable to orgasm. Their deficiency, which occurs as a result of stimulation, makes childbirth significantly more painful.

23. Beta-endorphins stimulate the secretion of prolactin, which contributes to the onset. Their absence can negatively affect the ability to feed a child. Their absence, let me remind you, occurs as a result of stimulation of labor.

24. Beta-endorphin promotes the final formation of the baby's lungs during the birth process. Its deficiency entails potential respiratory and related problems in the child.

25. Beta-endorphin is present in breast milk and causes a feeling of satisfaction and calm in the newborn.

26. Adrenaline and norepinephrine in the early stages of labor suppress and stop labor. Therefore, examinations, questions, moving, enemas, placement in a ward with other panicking and screaming women in labor, intimidation by doctors can lead to a halt in labor. If a woman in labor is scared or nervous, adrenaline is released, which suppresses the action of oxytocin, acting as its antagonist. Logical thinking(activation of the neocortex) has the same negative effect on oxytocin production. Calls to think, remember, fill out a map, sign papers, answer questions and any other stimulation of the neocortex slow down labor.

27. In this case, adrenaline and norepinephrine are released at the late stage of labor, triggering the “expulsion of the fetus” reflex, when the baby is born in 2-3 attempts. Artificial stimulation does not allow them to develop naturally. Their deficiency makes the period of pushing long, exhausting and traumatic.

28. Animal studies have shown that a deficiency of noadrenaline in the last stage of labor caused a loss of maternal instinct.

29. The level of adrenaline and norepinephrine in a newborn is also high, it protects the child from hypoxia and prepares for contact with the mother.

30. Contractions caused by artificial oxytocin differ from natural ones, since it is not the woman’s brain that determines the desired volume. They can lead to impaired blood circulation in the walls of the uterus, and as a result, hypoxia.

31. When stimulation is used, labor often proceeds quickly, with forceful passage of the birth canal and an “assault” nature of the child’s movement along the birth canal.

32. Neurosonography on the third day of birth revealed a huge combination of ischemia and cerebral edema around the ventricles of the brain with hemorrhages, cephalohematomas of the parietal region and hydrocephalus of the cistern only in children whose mothers received stimulation (all children were full-term). No such injuries were identified in children born naturally.

36. Medical induction and stimulation of labor are the main cause of diseases of the central nervous system.

37. Artificially administered oxytocin increases the risk of bleeding after childbirth, since the brain, having received a signal about high level oxytocin in the blood during childbirth, cuts off the supply of its own.

38. The popularity of medical anesthesia is associated with widespread interference in the birth process and, as a result, more painful childbirth. occurring under the right conditions (calm, darkness, safety, relaxation) do not require anesthesia for most healthy women. Moreover, it is the presence of one or another level pain leads to the production of the necessary and timely amount of hormones necessary for childbirth to be natural, soft, and non-traumatic for both the mother and the child.

39. A direct relationship has been identified between the mother's intake of opiates and barbiturates for pain relief during childbirth and the tendency of the born children to become addicted to opiates. The risk of drug addiction is almost 5 times higher in children whose mothers used opiates (pethidine, nitrous oxide).

Clamping the umbilical cord immediately after birth deprives the baby of up to 50% of its blood. Clamping for a minute - up to 30%.

40. The drugs included in epidural anesthesia (cocaine derivatives and sometimes opiates) inhibit the production of beta-endorphins and prevent the transition to an altered state of consciousness necessary for childbirth.

45. An episiotomy takes longer to heal and disrupts tissue worse than a natural tear. During repeated births, sutures from an episitomy are more likely to break than from a previous natural rupture.

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