How to stimulate the cervix. Stimulation of labor

Nature made sure that children could be born without outside help. Of course, without medical care any complications can lead to fatal consequences. Fortunately, in modern world Women are not left alone with their problems. Typically, labor begins between 38 and 42 weeks.

At the same time, they develop naturally and culminate in the birth of a child. But if the baby is in no hurry to be born at the appointed time, doctors may prescribe induction of labor.

In what cases may stimulation be required? labor activity? There are several indications for inducing the onset of labor:

1. First of all, induction of labor in case of postmaturity. As you know, full-term birth is considered from the 38th week, and at 42 weeks they speak of a post-term pregnancy. This entails certain risks: the placenta begins to age and can no longer cope with its functions. The amniotic fluid changes color due to toxins accumulated in it, and the child may experience chronic oxygen starvation. Usually, when postmaturity occurs, stimulation is prescribed between 41 and 42 weeks, and if there are signs of post-term pregnancy, at 40 weeks;
2. If the uterus is distended too much because multiple pregnancy or polyhydramnios, most likely it will also come from artificial stimulation childbirth in a maternity hospital;
3. Chronic diseases, such as diabetes, some disorders of the cardiovascular system, kidney disease and other ailments that threaten the health of the mother and child, can also become a reason for stimulation as early as 38 weeks;
4. Stimulation of labor may also be necessary for those who already have The amniotic fluid has broken, but contractions do not start for 12 hours or more. The fact is that after the rupture of the amniotic sac, the child becomes vulnerable to various infections.

In some cases, stimulation may be necessary when labor has begun spontaneously, but for one reason or another does not lead to natural delivery: contractions begin to fade or the cervix does not dilate.

What are the dangers of inducing labor: consequences

Like any intervention in natural history labor, stimulation of labor has consequences, including negative ones.

What are the dangers of inducing labor? First of all, it is worth mentioning that artificially induced contractions are often much more painful, and therefore there is a need for additional pain relief.

Some types of stimulation require the administration of drugs through a dropper, which creates additional inconvenience: the woman is forced to lie on her back, limited in movement. But this is far from the most comfortable position for a woman in labor; it is much more comfortable to walk or lie on her side.

In addition, stimulation in some cases causes the child oxygen starvation, which is unlikely to have a positive effect on his health.

Sometimes stimulation does not produce any results, in which case, depending on which method of stimulation is chosen, it is either postponed to another time, or a caesarean section has to be performed. Taking all this into account, it is necessary to weigh the pros and cons before agreeing to induce labor.

The doctor must be 100% sure that artificial stimulation is really necessary, that it will be more beneficial for the baby to be born right now and in this particular way.

There is evidence that when artificially stimulating labor in the maternity hospital, it is much more common to resort to forceps and other similar instruments. Many experts advocate that the reason for this is the stimulation itself. However, it is quite possible that the same complications that led to the need to stimulate labor lead to such consequences.

Is induction of labor harmful? Absolutely yes. Like any artificial intervention in natural process. But according to the indications described above, such an approach to childbirth is really necessary.

Contraindications to induction of labor

Like any medical procedure, stimulation of labor has a list of contraindications. In particular, stimulation is not carried out if a woman, after a caesarean section in a previous birth, plans to give birth on her own for the second time. Hyperstimulation of the uterus can lead to rupture along the old seam.

In addition, incorrect position of the fetus or its size, in particular, a discrepancy between the size of the fetal head and the size of the small pelvis, can also become a contraindication to induction of labor. The same as the health status of the fetus, based on CTG.

Types of stimulation

Depending on the indications and the stage at which labor is located, if any, various ways stimulation.

Detachment of amniotic membranes

When pregnancy is carried beyond term, doctors sometimes resort to a procedure such as detachment of the amniotic membranes. This is done during a routine gynecological examination. The doctor carefully peels off the amniotic membrane at the very os of the uterus, which causes contractions to begin. This procedure Do not always achieve the desired results the first time.

Sometimes it is necessary to repeat it several times. If the desired effect cannot be achieved, then stimulation is transferred or other methods are used.

Any special risks this method does not provide stimulation. A woman should not experience pain when the membranes detach, since they do not contain nerve endings. However, some unpleasant sensations are still possible.

Prostaglandins

Much more often they resort to another method - the introduction of prostaglandins. Prostaglandins are physiologically active substances, which the human body produces independently, and they are contained in almost all organs and tissues of the body, as well as in all natural secretions. Especially in sperm and amniotic fluid. Prostaglandins act on the cervix, causing it to ripen and dilate.

Prostaglandin preparations are administered vaginally: in the form of suppositories or gel. Neither the gel nor the suppositories hinder a woman’s movements or cause any discomfort. Typically, contractions begin within half an hour after labor is stimulated by the gel, but in some cases labor does not begin after the administration of the gel. If there are no contractions within 24 hours after the administration of drugs to induce labor, they can be reintroduced.

Why do gynecologists prefer to use this method? The fact is that the gel for inducing labor has practically no contraindications and side effects. Of course, the risk of hyperstimulation remains in this case, but it is significantly lower than when using other methods. In addition, it does not penetrate the amniotic sac, which means it does not have any effect on the baby.

Unfortunately, in some cases, prostaglandin can cause a delay in the transition to active labor.

Puncture of the amniotic sac

Puncture of the amniotic sac to stimulate the onset of labor is used extremely rarely, as it is associated with some risks. In particular, a rupture of the amniotic sac leaves the fetus without natural protection, which can lead to infection. In addition, if the burst of the bladder does not cause the development of labor, you will have to resort to other methods of stimulation, or even to caesarean section.

More often, this method is used to speed up labor if contractions are prolonged. A puncture of the amniotic sac is done during a routine gynecological examination using an amino hook - a long plastic hook-shaped instrument that is inserted into the vagina, and through the cervix it is used to pick up the amniotic sac and pierce it, which causes the rupture of amniotic fluid.

Typically, puncture of the amniotic sac is performed when the baby’s head has already dropped into the pelvic area. In such a situation, the amniotic sac is compressed, and the vessels of the amniotic sac are also compressed. Otherwise, if punctured, there is a risk of damage blood vessel

and cause bleeding. In addition, there is a risk of the umbilical cord falling out, which also leads to risks for the child: when passing through birth canal

The fetus will press on the umbilical cord, thereby depriving itself of oxygen. This is another reason why puncture of the bladder, as a way to provoke the onset of labor, is extremely rarely resorted to.

Oxytocin Oxytocin is an artificially synthesized analogue natural hormone

, which stimulates uterine contractions. It is produced by the pituitary gland under the influence of other hormones. Oxytocin is usually used if labor is attenuated or the intensity of contractions decreases. It is administered intravenously using a dropper. An overdose of oxytocin very quickly leads to oxygen starvation

fetus and even hyperstimulation of the uterus, so this is done under the supervision of a doctor. In parallel with the administration of oxytocin, the child’s condition is monitored, as well as the intensity of contractions. If symptoms of fetal hypoxia begin to be observed, the administration of oxytocin is immediately stopped, and in some cases, special drugs

, reducing contractile activity of the uterus.

It is with oxytocin that, as a rule, the main complaints of women about excessive pain in contractions are associated. Therefore, very often, in parallel with the administration of the hormone, pain-relieving procedures or epidural anesthesia are practiced.

IN Lately doctors began to use pills to induce labor containing artificially synthesized antigestogens. These drugs block a number of uterine receptors that are responsible for blocking progesterone.

As a result, the balance of the hormones progesterone and estrogen changes in favor of progesterone, which leads to the development of labor. In addition, hormones have positive impact on the cervix, accelerating its ripening and opening.

Previously, such drugs were used for emergency contraception and termination of pregnancy in the early stages, up to 5-7 weeks. In these cases, effectiveness is achieved due to the same increase in progesterone levels.

Because these drugs are known to be abortifacients, many women are afraid to take them, believing that they will have a negative effect on the fetus. However, this drug has virtually no effect on the condition of the mother and child.

In terms of ease of use, effectiveness and number of side effects, at this stage this method of stimulating labor and preparing the cervix for dilatation can be considered the most preferable.

The number of caesarean sections when using antihistogen drugs, such as mifepristone and miropriston, to induce labor is significantly lower than with other methods of induction.

Contraindications for the use of this drug may be liver and adrenal failure, asthma, diabetes, blood clotting disorders, as well as individual intolerance to the drug.

It is quite natural to be afraid of new and untested, unfamiliar methods of influence. If you are offered this method of stimulation and are still wary of using it, consult with several good doctors, ask them about the pros and cons of the pills, and only then make a decision.

Natural methods of stimulation

We have looked at methods of stimulation in the maternity hospital, but in fairness it is worth mentioning that you can also stimulate at home. If, after talking with your doctor, you already understand the need to speed up the onset of labor, and you have already been assigned a day of stimulation, you can try to resort to one of the methods of natural stimulation of labor. However, it is still recommended to consult your doctor first.

The simplest, most obvious and natural way to induce labor at home is sex. It is also jokingly called husband therapy. During sex and especially orgasm, the uterus contracts, which can become the natural beginning of labor. In addition, during sex, natural oxytocin is released into a woman’s blood, and sperm, as already mentioned, contains a large number of prostaglandins. As a result, the stimulation turns out to be truly natural and complex.

Of course, having sex for a long time is not very convenient; you will have to choose positions in which both partners can relax and enjoy. In addition, some men find it psychologically difficult to have sex with a woman before giving birth. However, all these problems are quite easily overcome.

Some use Castor oil to simulate childbirth. There is no data on how this method actually works, or whether it actually works. In general, castor oil is a fairly strong laxative. It is assumed that the increased work of the intestines affects the uterus, which causes labor. Castor oil for inducing labor is a rather controversial remedy, as it can cause nausea and diarrhea, which is not very pleasant, and is also fraught with large water loss.

Walking and lungs physical exercise can also induce labor, so they can also be used to stimulate labor at home. It often happens that in recent weeks a woman has been eager to wash the floors, rearrange some things in the house, but her relatives dissuade her from this. Now is the time to satisfy your need to improve your own home. This will help you realize your instincts and calm down at the same time, and will also speed up the birth of your baby.

Acupuncture can also be a way to naturally stimulate labor. As you know, such a doctrine as acupuncture claims that there are points on the body that are responsible for the functioning of different organs and body systems. An injection with a fine game into a correctly chosen point, which is responsible for the uterus and its condition, can contribute to the onset of labor.

In conclusion, I would like to say that you should not be afraid of stimulation, although it is important to understand how necessary it really is in your case. Remember that without your consent, doctors do not have the right to carry out any intervention in the natural process of childbirth. And no one has the right to force you.

Replies

Before inducing labor on her own, a pregnant woman must be sure that the gestational age is correctly assessed. Consult your doctor about the consistency of changes detected on ultrasound and CT deadline. When the body is ready for childbirth, it can be used natural methods obstetrics.

Reasons for inducing labor

• Pregnancy is more than 40 weeks. After this period, the placenta ages, and the child’s nutritional efficiency decreases.
• Multiple pregnancy after 38 weeks. By this time, children have already matured, and their further intrauterine development can provoke problems during childbirth.
• By medical indications in case of Rh conflict, heart problems, diabetes.
• Presence of scars on the uterus.
• Narrow pelvis.
• Allergy to prostaglandins.
• Leakage of amniotic fluid.
• Increased intraocular pressure.

How to induce labor using folk recipes

• Prostaglandins (biologically active substances) stimulate the cervix to ripen and promote its opening. They are contained in sperm, so labor can be activated intimacy. Contraindications: infections in the sexual partner, low position placenta. It is possible that it may detach during a strong orgasm in a woman, so this method must be used very carefully.
• Walking up stairs, cleaning the house, washing windows - traditional methods approaching birth.
• The release of the uterine contraction stimulator, the hormone oxytocin, in a woman’s body occurs when the nipples are massaged. The procedure should be performed carefully so that cracks do not form on the mammary glands, which over time will lead to the development of mastitis.
• Contraction of the uterine muscles can be triggered by daily bowel cleansing with a salt enema.
• After dinner, drink 50 g of castor oil and do an enema with a salt solution (1 spoon per liter of water).
• Acupuncture using thin needles stimulates the accumulation of energy in the pelvic area - activates labor in a pregnant woman.
• Castor oil has a laxative effect, but in case of overdose, side effects are observed - vomiting, nausea, and intestinal pain.
• The substance bromelain contained in pineapples softens the cervix and provokes labor.
• Spicy food activates work gastrointestinal tract and the uterus - they contract.
• "Pulsatill" - homeopathic medicine, which allows you to induce labor.
• Raspberry tea has a birth-stimulating effect.
• A hot bath increases blood supply to the pelvic area and cervix, which promotes its relaxation and possible opening.
• The production of oxytocin is enhanced by pressure from the fetal head on the cervix, which occurs when the mother is in an upright position.
• If you inflate balloons often and for a long time, then abdominal cavity Blood pressure increases, which stimulates labor.
• Chocolate contains adrenaline, a substance that stimulates the sympathetic system. nervous system. Its action leads to contraction of the muscular system of the body, including the uterus.
• Aromatherapy with jasmine and roses will lead to the onset of labor in a pregnant woman with prolonged inhalation of their aromas.
• When deciding how to stimulate labor, it is advisable to include large amounts of parsley and beets in your diet and wash them down with raspberry tea.
• In England, midwives recommend that women next remedy to speed up the opening of the cervix. Mix 50 g of castor oil with 100 grams of apricot juice and 40 grams of vodka. A pregnant woman's intestines will begin to clear their contents quite quickly. The uterus contracts behind it.
• Evening primrose oil prepares a woman's path for childbirth, but does not have a direct birth-stimulating effect. It is natural analogue hormones folliculin and sinestrol, which are obtained synthetically. Before childbirth, substances are prescribed to accelerate cervical ripening. Primrose oil, unlike them, does not have side effects and is prescribed 2 weeks before the expected date of birth.
• Olive oil has a laxative effect and can increase elasticity muscle tissue. If you take 1 spoon of it daily, it will become easier to artificially induce labor.
• Setting up for childbirth. All processes in the body are under the control of the brain. If a woman subconsciously prepares herself for childbirth, it will soon begin.
• Frequent singing and talking with a child contribute to tension in the abdominal and pelvic muscles. During childbirth, singing reduces pain.

Physical exercises help lower the baby and put pressure on the baby's head on the cervix.

• Walking should be done in the morning, when the surrounding air is as free from pollution as possible. It is advisable for a pregnant woman to take an umbrella with her to lean on if she experiences back pain. It will also come in handy if it rains.
• Climbing up staircases helps the fetus move down quickly. Due to the constant movements of the hips, the small pelvis expands, and the child takes the most comfortable position.
• Swimming breaststroke helps contract the abdominal and back muscles. Staying in water additionally helps relieve swelling in the legs.
• Squatting long time. The baby will begin to move through the birth canal faster with an open pelvis. The method is used in case of a high position of the child on later pregnancy.
• Induce labor by rocking on a swing. To use this method, you need to find a safe swing and swing on it for a few minutes a day.

Kinds medical methods stimulation of labor:

1. Stimulating uterine contractions
2. Affecting the dilation of the uterus.

Stimulation of uterine contraction by prostaglandin E2 (enzoprost). The substance is inserted into the vagina, but does not enter the near amniotic sac. When the cervix dilates, the process of labor begins. Prostaglandin suppositories stimulate the production of prostaglandin in the body. Their action begins within 30 minutes, which gives the woman the opportunity to prepare for childbirth.

The opening of the amniotic sac is carried out with a special hook. The procedure is painless, since the bladder does not have nerve endings. The effusion of water leads to increased pressure inside the uterus, which stimulates labor. Amniotomy does not affect the child’s condition, since the fetus is not affected during the manipulation.

The drug Oxytocin is used to stimulate contractile activity. Most often administered intramuscularly or intravenously. The hormone does not affect the dilatation of the cervix. It only enhances labor. Contraindications to the use of oxytocin: impossibility of childbirth naturally, increased sensitivity to the drug, the presence of scars and placenta previa.

When labor is not induced

• If the baby's head exceeds the lower size of the mother's pelvis.
• Poor fetal condition as assessed by cardiac monitor.
• Hypertension or other health problems in a pregnant woman.
• Incorrect position of the child.

Before inducing labor, a woman should get a good night's sleep and psychologically prepare for labor.

You should not induce labor until at least 40 weeks. Once it starts, you can apply natural ways, which will not harm, but will only set the body up for the process.

Dosed physical activity after 40 weeks - yoga, Nordic walking, breathing exercises and exercises gymnastic ball very useful, but only with the permission of a doctor. You can simply do some general cleaning or walk up and down the stairs.

If physical activity causes severe discomfort, fatigue, swelling, increased blood pressure or other unpleasant symptoms, their intensity should be reduced or abandoned altogether to avoid more serious consequences.

Sex is especially useful on the eve of childbirth for two reasons:

• A man's sperm contains prostaglandins, which have positive influence on the cervix. Under their influence, it softens, shortens, and opens.

Nipple stimulation on the chest sends signals to the brain to release oxytocin, the level of which quickly increases in the blood. It is also useful for preparing the body for childbirth. It is recommended to irritate both nipples alternately or together several times a day for 3-5 minutes.

The nerve plexuses of the intestines and uterus are interconnected. Irritation of some leads to activation of others. This can be used to “wake up” the uterus. It is recommended to include the following foods in your diet:

• pineapple fruit;
• garlic cloves;
• hot spices - pepper, etc.;
• liquorice root;
• vegetables – cabbage, carrots, beets;
• raspberries are suitable for berries;
• caraway oil or tea.

Exist active points, massage which will also be favorable for the onset of labor. It is recommended to do this several times a day for 3-5 minutes. Here are the two most commonly used points:

Can be used at home device for DENAS therapy, influencing the abdominal area, cervical-collar area.

Homeopathy medications will help based on Pulsatilla and Caulophyllum. However, they should be used only as prescribed by a homeopathic doctor or at least a gynecologist.

Indications for induction of labor in the maternity hospital:

• post-term pregnancy - after 41 weeks;
• if there is no need for a caesarean section;
• complications of pregnancy that require delivery in the absence of labor, for example, with oligohydramnios, suspicion of some malformations in the fetus;
• somatic diseases of a woman that require earlier delivery, for example, cardiovascular pathologies.

Conditions for holding:

• live fruit;
• absence of significant bleeding from the genital tract, detachment;
• the size of the fetus and the woman’s pelvis corresponds to the normal course of natural childbirth;
• readiness of the birth canal for the onset of contractions, especially for the cervix - its length should be no more than 2 cm and the opening should be no less than 1.5-2 cm.

• After stimulation, contractions are somewhat more painful, so additional pain relief is often required.
• More than 1/3 of inductions ultimately result in a caesarean section. "
• The incidence of complications such as weak contractions, placental abruption, fetal hypoxia, and injuries to the birth canal of the woman and child is higher during induced labor than during natural labor. However, the use of drugs and some methods is carried out on an initially abnormal pregnancy.
• All medications reach the fetus. The baby still experiences a lot of stress in utero.

Methods of inducing labor:

• Amniotomy. This is a stimulation method as close as possible to the physiological process. It can be performed both before the onset of contractions and during them. When performing an amniotomy, the membranes of the fetal bladder are opened with a special instrument. At this moment the front waters pour out. By their number, color, smell, one can judge the intrauterine state of the baby. This is a painless procedure that is performed on a gynecological chair.

• Cook's catheters(you can replace them with regular urine ones if you don’t have them). The doctor inserts a catheter into cervical canal to the internal pharynx and fills its end part saline solution. A part of the catheter remains outside and hangs freely. For convenience, it is attached to the pregnant woman’s thigh. Thus, the filled catheter puts pressure on the cervix, promoting its structural changes. The catheter is installed for 12 hours, after which it is removed. Sometimes it can fall out on its own - this means that the cervix has opened to such an extent that it can no longer hold it. Usually after the catheter it is necessary to use additional methods stimulation.
• Laminaria– pressed seaweed. Kelp is introduced into the cervical canal and left for 8-12 hours, after which it is removed. During this time, they gradually swell, as they are in a humid environment, exerting mechanical pressure on the cervix and leading to its opening.

Stimulation drugs in the maternity hospital:

• Prostaglandins. In addition to stimulating contractions, they promote transformation of the cervix, therefore they are used when the birth canal is not yet completely ready for childbirth (for example, a long or tight cervix, a small opening). The effect is mild, contractions are not so painful.
• Oxytocin. It is used if the cervix is ​​already ready for contractions, since the drug only stimulates its contractions. It is administered intravenously or via lineamate, a special device that regulates the rate at which the drug enters the bloodstream.

• Desaminooxytocin. It is usually used to stimulate contractions during pushing or as an addition to basic medications. The drug is not used alone to induce labor, as it is difficult to dose and control contractions, and it is less effective compared to other drugs.

If oxytocin drugs, prostaglandins are used, and an amniotomy is performed, then three hours are given for the development of effective labor. After this time, if it is insufficient, other drugs can be added, or some drastic decision is made, for example, indications for a cesarean section are identified.

Read more in our article about inducing labor in the maternity hospital.

Read in this article

Methods of natural stimulation of labor

Once the 37th week has arrived, you don’t have to worry about labor starting. But you shouldn’t try to stimulate labor, as there may still be almost five weeks ahead—day 42, inclusive.

After the 40th week has arrived, you can think about methods of natural stimulation of labor. They definitely won’t harm, but can help the body tune in to the birth process.

Dosed loads are useful throughout pregnancy. They will help control body weight and make the body more resilient. After 40 weeks, it is still possible and beneficial to do yoga, Nordic walking, breathing exercises and perform exercises on an exercise ball. But this is all with the doctor’s permission and if the pregnancy proceeds physiologically. Any deviations may result in a ban on this type of activity.

If you don't want to do something special exercises, you can simply do some general cleaning at home or walk up and down the stairs, for example, if a pregnant woman is in the hospital.

Expert opinion

If physical activity causes severe malaise, fatigue, swelling, increased blood pressure or other unpleasant symptoms, you should reduce its intensity or even stop altogether to avoid more serious consequences.

Sexual contact

Sex is allowed throughout the entire gestation period if the pregnancy proceeds without complications. Intimate relationships on the eve of childbirth are especially useful for two reasons:

• A man's semen contains prostaglandins, which have a positive effect on the cervix. Under their influence, it “prepares for childbirth” - it softens, shortens, and opens. This effect is only possible with a certain hormonal background women, so you should not be afraid of sexual intercourse until full-term pregnancy.
• During arousal, oxytocin is released in a woman's body. It promotes contraction of the uterus, which will thus prepare for real contractions.

Watch this video about whether sex will help speed up labor:

Nipple stimulation on the chest

The areola areas of the breasts are very sensitive. When they are irritated, signals are sent to the brain to release oxytocin, the level of which quickly increases in the blood. It is also useful for preparing the body for childbirth.

Special diet

The nerve plexuses of the intestines and uterus are interconnected. Irritation of some leads to activation of others. This can be used to “wake up” the uterus. It is recommended to include the following foods in your diet:

• pineapple fruit;
• garlic cloves;
• hot spices - pepper, etc.;
• liquorice root;
• vegetables - cabbage, carrots, beets;
• raspberries are suitable for berries;
• caraway oil or tea.

Acupuncture and similar methods

There are active points, massage of which will also be favorable for the onset of labor. Here are the two most commonly used:

• on palmar surface hands between the thumb and index fingers;
• outside the ankle at a distance of 5-7 cm from the “bone” upward.

You can also use such a device for DENAS therapy at home, affecting the abdominal area and the cervical-collar area.

Herbal infusions and decoctions

Plants can also help stimulate labor. The most commonly used are the following:

• nettle;
• ergot;
• shepherd's purse;
• barberry.

Recipes can be for preparing infusions, tinctures, and decoctions. Sometimes it is recommended to add castor oil to the prepared solutions or make microenemas with it. It irritates the intestinal walls, and this in turn leads to reflex stimulation of the uterus. However, it should be borne in mind that castor oil can provoke intestinal colic.

Other methods

Homeopathy medications are also used to stimulate contractions. For example, based on Pulsatilla and Caulophyllum. However, medications should be used only as prescribed by a homeopathic doctor or at least a gynecologist.

Indications for induction of labor in the maternity hospital

After 40 weeks, and in some cases even earlier, women are sent as planned to the maternity hospital for hospitalization, where doctors draw up a plan for future labor and determine its time, if it has not occurred before this point. The main indications for inducing labor are as follows:

• post-term pregnancy - after 41 weeks;
• gestosis, if there is no need for a cesarean section;
• complications of pregnancy that require delivery in the absence of labor, for example, stimulation is often used for polyhydramnios and oligohydramnios, suspicion of some malformations in the fetus;
• somatic diseases of a woman that require earlier delivery, for example, diabetes mellitus, cardiovascular pathologies.

Conditions for holding

Any method of inducing labor is used if there are conditions from the obstetric situation for implementation.

• live fruit;
• They are as follows:
• stable, controlled condition of the woman;
• absence of significant bleeding from the genital tract; the size of the fetus and woman's pelvis corresponds to normal course
• natural childbirth;

readiness of the birth canal for the onset of contractions, especially for the cervix - its length should be no more than 2 cm and the opening should be no less than 1.5-2 cm.

Advantages and disadvantages

Almost all women are quite categorical about any kind of stimulation of contractions, as they consider it a non-physiological process. Indeed, each method has its own advantages and disadvantages.

• The advantages of inducing labor include the following:
• it is possible to reduce the duration of labor;
• in case of weak contractions, they become stronger, which prevents possible suffering of the fetus, and the risk of complications for the woman becomes less;

This way, in many cases, a caesarean section can be avoided.

• The disadvantages of the procedure are the following: After stimulation, contractions are somewhat more painful, so additional pain relief is often required. This is due to the fact that during natural childbirth without the use of any drugs muscle fibers
• They are not reduced all at once, but one by one. When stimulated, it immediately affects more than 50% of the myometrium, which sometimes even provokes unbearable pain. More than 1/3 of inductions ultimately result in a caesarean section. “Forced fights” are not always productive. After long trials with contractions, a woman can be operated on different indications
• The frequency of complications such as weak contractions, placental abruption, fetal hypoxia, and injuries to the birth canal of the woman and child is higher during induced labor than during natural labor. However, it should be noted that the use of drugs and some methods is carried out in an initially abnormal pregnancy - after all, labor is induced if there are some indications for this.
• All medications used to enhance uterine contractions reach the fetus. The baby still experiences a lot of stress in utero.

According to scientific data, induced by medicines childbirth several times often have the following consequences:

• placental abruption during childbirth;
• fetal hypoxia (lack of oxygen);
• serious injuries to the birth canal;
• often end with a cesarean section.

Considering that any stimulation of labor has not only advantages, but also significant disadvantages, in each case one should take a differentiated approach to determining the indications.

Watch this video about what stimulation of labor leads to:

Methods of inducing labor and how it all happens

There are many stimulation options. In each case, it is necessary to choose the most optimal, “soft” one - this is the doctor’s task.

Amniotomy

This is a stimulation method as close as possible to the physiological process. It can be performed both before the onset of contractions and during them. The role of the amniotic sac is important until approximately 6-7 cm of cervical dilatation; it works “like a wedge”, exerting gentle pressure on the cervix, causing it to open.

When performing an amniotomy, the membranes of the fetal bladder are opened with a special instrument. At this moment the front waters pour out. By their number, color, smell, one can judge the intrauterine state of the baby. Amniotomy is a painless procedure that is performed in a gynecological chair.

What kind of catheter is used

The essence of this effect is as follows:

• The doctor inserts a catheter into the cervical canal to the internal os and fills its end part, which expands into a balloon, with saline solution.
• A part of the catheter remains outside and hangs freely. For convenience, it is attached to the pregnant woman’s thigh.
• Thus, the filled catheter puts pressure on the cervix, promoting its structural changes.

The catheter is installed for 12 hours, after which it is removed. Sometimes it can fall out on its own - this means that the cervix has opened to such an extent that it can no longer hold it.

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

Before installing the catheter, two hours later, and immediately after its removal, it is necessary to record a CTG (fetal heartbeat) to prevent possible complications.

After the catheter is removed, the issue of further stimulation is decided. Rarely do women experience spontaneous contractions; additional methods are usually required. For example, if the result is good and the cervix is ​​open, an amniotomy is performed. Prostaglandins, oxytocin and other stimulants may be prescribed.

Laminaria

They are compressed algae. They have an effect similar to a catheter. Kelp is introduced into the cervical canal and left for 8-12 hours, after which it is removed. During this time, they gradually swell as they are in a moist environment, exerting mechanical pressure on the cervix and leading to its opening.

A drug

This hormonal drug, is available in the form of tablets for oral administration and placement into the vagina or rectum, a gel for vaginal or cervical use, and a solution for intravenous infusion.

Prostaglandins, in addition to stimulating contractions, promote the transformation of the cervix, therefore they are used when the birth canal is not yet completely ready for childbirth (for example, a long or tight cervix, a small opening).

The effect of prostaglandins is milder, contractions are not as painful.

How long will it take for it to work?

Each case of labor stimulation has its own criteria by which one can judge whether the method works or not.

If oxytocin drugs, prostaglandins are used, and an amniotomy is performed, then three hours are given for the development of effective labor. After this time, an examination is carried out and the effectiveness of stimulation is assessed. If it is insufficient, other drugs can be used, or some drastic decision is made, for example, indications for a cesarean section are identified.

The effectiveness of installing a cervical catheter and laminaria is assessed by structural changes in the cervix. If she is already ready for real birth, further stimulation is carried out, but with medications.

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Watch this video about stimulating labor in the maternity hospital:

When the pregnancy becomes post-term, it is necessary to hasten the birth of the child - stimulation of labor in inpatient conditions- it is safe and effective procedure. So that our readers have a rough idea of ​​what awaits them in the maternity hospital, what kind of manipulations and medications, we have prepared this material.

How to understand that your body is ready for childbirth

A woman will never understand this on her own. She may often experience preparatory contractions - but this is not at all a sign that the cervix is ​​ready for childbirth. The most important thing is that it is mature enough. In this case, childbirth will be as safe, comfortable and natural as possible.

But in last years Doctors are observing a tendency that in women, especially first-time mothers and those with various chronic diseases and obstetric pathologies, by the expected date of birth the cervix is ​​completely unprepared for dilatation. This happens, among other things, due to hormonal imbalance, too high progesterone - a hormone that prolongs pregnancy. Doctors use this information for drug stimulation of labor; it is carried out exclusively in the maternity hospital, since the drugs used for this are very serious and are not sold freely in pharmacies.

But besides this kind drug preparation Other methods are also used. We will describe them in our material. But let's return to our neck.

At 39-40 weeks all women expect gynecological examination in a antenatal clinic or maternity hospital in order to determine the degree of maturity of the cervix. If the cervix is ​​not at all mature, you need to take measures to prepare it now, otherwise you will face great difficulties in childbirth, and possibly a caesarean section.

During the examination, the doctor pays attention to the length of the cervix (he can determine the length of the vaginal part only, but this is quite enough), the degree of its dilatation, and softness. If the neck is closed, tight and long, it’s time to take action. Many women think that an examination to diagnose the condition of the cervix is ​​not necessary (after all, it is very painful), and that an ultrasound measuring its length with a vaginal sensor is quite enough. But that's not true. To be ready for childbirth, it is important to feel the cervix. Yes, it's a little painful. But what else will happen during childbirth... Try to relax during the examination, and painful sensations will be minimal.

How to stimulate labor with antispasmodics

Experienced women know that in the third trimester of pregnancy they need to use antispasmodics as little as possible, since they most likely will not be a preventive measure premature birth with frequent hypertonicity, but, on the contrary, they will be provoked. The thing is that antispasmodics relax muscles, reduce their tone, including a very tight cervix.

The most effective and well-known substance used for this purpose in Russia is Hyoscine butyl bromide - this is a drug familiar to many under the name “Buscopan”. Can be prescribed from 38-39 weeks in the form of rectal suppositories for prenatal preparation of the cervix. Many studies and statistics prove their effectiveness. For the majority of expectant mothers who used Buscopan before childbirth, their first period proceeded quickly and easily, the cervix dilated without problems. Buscopan is also sometimes prescribed in the form of intramuscular injections, but already in a hospital setting.

In second place in terms of efficiency are rectal suppositories with belladonna. They have antispasmodic, analgesic and anti-inflammatory effects. Well reduces the tone of the abdominal organs. Prescribe 1-2 suppositories per day.

And finally, “Papaverine Hydrochloride” (rectal suppositories) and “No-shpa” (droverine) - orally and intramuscularly. Weaker drugs for almost natural stimulation of labor, which also have a blood pressure-lowering effect.

If all this does not help or time is running out, more serious measures are taken in the hospital. Read about them below.

Induction of labor with a Foley catheter

The Foley catheter is a urological instrument, but it has long been “favored” by obstetricians and gynecologists, who use it to dilate the cervix. Cheap and cheerful, as they say. And it can be carried out in any maternity hospital remote from civilization. This is the way to mechanical impact on the cervix.

A catheter is inserted into the woman's cervical canal. The procedure is not painful, but it may be a little unpleasant. Next, it is filled with 30-60 grams of liquid. This leads to dilation of the cervix. And if the effect is persistent, then within 12-24 hours the catheter falls out on its own, and the cervix, dilated by 3-4 cm, turns out to be sufficiently mature for doctors to begin active stimulation of labor. Unfortunately, contractions do not always appear on their own after such mechanical action on the cervix. The pregnant woman has her amniotic sac pierced and, if necessary, given an IV with Oxytocin.

Modern Foley catheter maternity hospitals to stimulate labor, it is used quite rarely, since after it there is a high risk of weak labor and cesarean section. In addition, there is almost always a need for other types of stimulation.

Preparing the cervix with kelp

This is the same as with a Foley catheter, mechanical method dilation of the cervix. But it is preferred. Laminaria - ordinary seaweed, or rather two types of them, used in obstetrics. The doctor injects these algae in the form of several sticks into the woman’s cervical canal. There they are saturated with moisture and increase in volume during the day by about 3-5 times, thereby slowly expanding the cervix. The length of one stick is 6-7 cm, and the initial diameter is 2-3 mm. The length of kelp does not change under the influence of moisture. Only the volume is growing.

The disadvantages of kelp for stimulating labor are the following:

• severe pain experienced by many women during the introduction of algae into the cervical canal;
• unpleasant sensations during the entire time they are there;
• sometimes the sticks become dislodged in the vagina, making them useless;
• it takes a lot of time to achieve the effect - about a day;
• there is a risk of uterine infection and algae allergy.

But all these complications are quite rare, so kelp is one of the most commonly used means of induction (stimulation) of labor by obstetricians.

Gel for inducing labor

The gel contains prostaglandins - substances that induce labor. Yes, exactly those contained in male sperm. It’s not for nothing that they say that sex during advanced pregnancy often provokes childbirth.

However, prostaglandin in the form medical product should only be used in conditions maternity hospital because it has a number of side effects. For example, blurred vision, drowsiness, tinnitus, change heart rate, dizziness, racing blood pressure etc. Prostaglandins have a lot of contraindications in the form of chronic heart disease, kidney disease, asthma, glaucoma, etc.

Prostaglandins are prescribed for an immature cervix. Administered intramuscularly or in the form of a gel. The second option is preferable, as it is effective in small doses. Typically, the gel begins to be administered one day before the expected birth. And the onset of labor is stimulated by amniotomy (puncture of the amniotic sac) and oxytocin.

The gel is quite effective, but sometimes it does not work... For example, it is ineffective during pregnancy less than 37 weeks (sometimes there is a need for stimulation for such early), obesity in the expectant mother, over 30 years of age.

How labor is stimulated with pills in the maternity hospital

Mifepristone is a so-called antigestagen drug. It is used not only to induce labor, but also for abortion in the first weeks of pregnancy, emergency contraception, and in some countries for the treatment of uterine fibroids.

For stimulation, mifepristone (miropristone) tablets are given in the maternity hospital, which the woman takes only in the presence of a doctor. This drug is strictly prescription and quite dangerous if you use it yourself in violation of the instructions. Since mifepristone is used for medical termination of pregnancy, all expectant mothers who want to keep the child should stay away from it, according to at least, up to 40 weeks - full term.

The regimen for taking the drug is as follows: 1 tablet of the drug with a dosage of 200 mg is taken on the first day and exactly 24 hours later another tablet is taken. How long after the second dose does mifepristone cause labor in women? Usually within 2 days, maximum within 3 days. If, after this time, the birth canal remains immature, the woman is given prostaglandins (gel) vaginally. Although in this case there are often failures and a caesarean section has to be performed, since time is running out and the cervix does not ripen.

Mothers who have already given birth so often talk about stimulating labor, scaring their pregnant friends, that it seems to them that no childbirth can proceed without forcing the process of dilation of the cervix. In fact, it is not so often necessary to “push” childbirth - according to official statistics, in about seven women out of a hundred. How does this happen and why might induction of labor be needed?

The indications for inducing labor are obvious - labor does not begin, although it is high time, does not progress once it has begun, or for medical reasons it is necessary for the child to be born earlier due date. Stimulation can be natural or artificial.

With a natural expectant mother some simple actions accelerates the onset of labor. If this happens beyond 40 weeks, doctors most likely will not object. But, of course, you should consult with them first. As for artificial stimulation, it is performed only by doctors and only in a maternity hospital.

Administration of oxytocin

Why is it necessary? Oxytocin is a hormone that is responsible for triggering labor and enhancing the contractile activity of the uterus. Its synthesized analogue is administered to prepare the uterus for dilation if labor does not occur in the case of post-term (more than 42 weeks) pregnancy.

How is it administered? The hormone is administered intramuscularly or subcutaneously by injection.

Advantages and disadvantages. If labor begins, but then labor suddenly stops, oxytocin will start contractions again. But they will be powerful and therefore very painful, so the woman must be given painkillers. There is a possibility of an overdose of the drug, and some women may develop increased sensitivity to it.

When should it not be used? In case of placenta previa, abnormal fetal position, narrow pelvis and other pathologies that complicate natural childbirth. Oxytocin should not be used after a previous cesarean section when there is a scar on the uterus.

Administration of prostaglandins

Why is it necessary? In order to release the baby without injury, the cervix must ripen before birth - become soft, elastic, begin to stretch and open. If the due date has arrived, but the cervix is ​​not yet ready, its maturation is accelerated by prostaglandins - analogues of the hormones responsible for this process.

How is it administered? Gel or suppositories containing prostaglandin are injected deep into the vagina and cervical canal.

Advantages and disadvantages. The advantage is that prostaglandins do not penetrate the amniotic sac and do not affect the baby in any way. In addition, even with the drug administered, the woman is not limited in her movements in any way. But at the same time, prostaglandins can slow down the transition to the active stage of labor. Some women experience intolerance to the drug, resulting in headache or vomiting.

When should it not be used? As with any induction of labor, the administration of prostaglandins should not be used when a woman is experiencing endocrine disorders, diabetes, after a caesarean section, as well as when vaginal delivery is not possible due to abnormal position, size of the fetus or deteriorating state of its health.

Amniotomy - puncture of the amniotic sac

Why is it necessary? A puncture of the amniotic sac is done when the pregnancy is postterm, when the condition of the placenta worsens and, as a result, there is a high risk of developing hypoxia in the child. An amniotomy can also be performed when a woman quickly develops gestosis - in this state, the rupture of water speeds up the process and alleviates the condition of the woman in labor, simultaneously preventing labor complications that can develop in the case of prolonged labor. Sometimes the indication for amniotomy is the risk of developing Rh conflict.

How do they do it? The operation is completely painless and safe, but, like any other operation, it is performed only by an experienced doctor and only for medical reasons. A special hook is inserted into the vagina, the amniotic sac is grabbed and opened, which causes the amniotic fluid to leak.

Advantages and disadvantages. The rupture of amniotic fluid starts the process and intensifies contractions. But sometimes contractions may not come even after this manipulation, and the water-free period should not last more than 12 hours. So women in labor will sometimes need the same oxytocin to still stimulate labor. In addition, if you do an amniotomy without compelling indications, the process can only be slowed down. The anterior waters, which are located above the baby's head in the amniotic sac, are a wedge that gently opens the cervix from the inside. Normally, water flows out only after the cervix is ​​almost completely dilated and the baby is ready to be born.

When should it not be used? Amniotomy can be performed only after the baby’s head has passed into the pelvis, compressing the amniotic sac and the vessels located on its surface. If the puncture is made earlier, there is a high risk of bleeding and prolapse of the umbilical cord, as well as infection.

How do they do it? During long walk the baby puts pressure on the cervix, which causes it to begin to dilate. Others also contribute to this active actions. However to the expectant mother Extreme loads should be avoided; they should be feasible and light.

Advantages and disadvantages. The method only works if the cervix has already begun to prepare for childbirth - to soften and smooth out. In addition, it is difficult for a woman who wants to give birth “as soon as possible” to refrain from overexertion, and washing floors in a half-bent position and conquering skyscrapers without the help of an elevator clearly belongs to them. All such actions may cause premature detachment placenta!

When should it not be used? For gestosis and other complications of pregnancy, for indications for cesarean section, for up to 40 weeks of pregnancy, for chronic diseases, not related to pregnancy.

Sexual intercourse

Why is it necessary? Semen contains natural hormones prostaglandins, which soften the cervix, and orgasm promotes its muscle contractions. Massaging the breasts (especially the nipples) increases the level of oxytocin in the blood.

How do they do it? The old fashioned way and taking into account interesting situation mothers: a woman undergoing pregnancy should not feel pain, but be comfortable and pleasant.

Advantages and disadvantages. What if the couple doesn’t want anything at all? Then the spouses will have to give up sex (and the woman will only have to go for a long walk). As for nipple massage, it’s not so simple either: in order for it to work, it needs to be done three times a day for 10-20 minutes. Not everyone is able to withstand such foreplay.

When should it not be used? The most obvious is if one of the partners has an STD. After all, contact protected by a condom may be pleasant, but it is an almost meaningless “stimulant”. If the couple was prescribed complete sexual rest during pregnancy, they should also consult a doctor.

Sometimes women resort to natural (but unconventional) methods of inducing labor such as acupuncture, aromatherapy and homeopathy. We must remember that, like any other medical procedure, stimulation of labor can be beneficial or harmful, especially when it is done unjustifiably and illiterately.

Comment on the article "Induction of labor: 5 methods. Drug administration or sex?"

Discussion

What do you mean by stimulation - oxytocin? it gives continuous contractions, which are not only difficult for the mother, but also for the child, as he experiences constant and excessive compression for which he may not be ready. Natural contractions are always softer and intermittent.
opening the bubble? The cervix does not always open after it; often the entire ECS ends. or it opens, but the tissues are not elastic enough, hence ruptures and/or episiotomy. By the way, in cases of premature birth they almost always do an episiotomy, although the babies are tiny, but the tissues are not ready yet.
It’s better to prepare for childbirth and give birth when the due date comes. You can always monitor the condition of the baby, umbilical cord and placenta using additional ultrasounds.
I gave birth at almost 41 weeks, a large baby 4250g, without tears or incisions. I was preparing for childbirth, breathing correctly, pushing correctly, helping my baby, and he helping me. I wish you an easy natural birth too:)

Now half of the children, if not more, have hypoxia without any walking or stimulation. Plus, not every woman will agree to stimulate and for this you need to go to the maternity hospital in advance, and there is not always room there. Everything is individual

Induction of labor without indications.... Medical issues. Pregnancy and childbirth. Induction of labor without indications... Almost a horror story, but knowing is better than not knowing!!!

Discussion

So, Arisha and I were very lucky... We had piercings, and she had hypoxia, and a huge headache...

perhaps that is why in most RDs they are now waiting until the victory and do not stimulate. I was actually surprised when I started reading this conference that so many people were being stimulated. I remember last time, the doctor very clearly told me that now they are trying not to interfere, when there are no more options...

Labor with stimulation. Zamyatnina Tatyana. Stimulation of labor. This is exactly the sex I have with my firstborn >. methods of natural stimulation of labor: 1. walk high, lifting...

Stimulation before childbirth. Medical issues. Pregnancy and childbirth. At the moment I have been in the maternity hospital for 41 weeks and they decided to give me stimulation.

Discussion

may be reflected. An acquaintance reached 42 weeks and gave birth to a boy of 3500 (the girl herself is tall and big) - without stimulation.
If there is no “crime” - aging of the placenta, meconium in the water, etc. - then you probably shouldn’t be stimulated. IT ITSELF knows best - when...

I was stimulated after my water broke. A drip with an analogue of oxytocin, just called differently. The only effect of it was that it was painful, and there were no effective contractions to open the cervix.

Natural stimulation. I’m already 38 weeks old, the baby weighs 3350g. And the doctor is going on vacation for the duration of my birth. Tell me how to persuade the baby to be born quickly.

Discussion

you can't persuade