Encyclopedia of Family Medicine

Chapter 38 Sexual knowledge and eugenics (10)
3. Cooperate with delivery
Childbirth is a natural physiological process, so there is no danger in normal childbirth.In the first stage of labor, the mother feels pain in the lower abdomen during contractions, which indicates that the cervix is ​​gradually opening.The tighter the contractions, the faster the cervix dilates.The mother should remain quiet during this phase.Take a deep breath during contractions, and use both hands to massage from the sides of the abdomen upwards to the center of the lower abdomen to the sides.This reduces pain.After the uterine contraction, relax the whole body, seize the opportunity to rest, encourage and urge the parturient to urinate frequently, prevent the bladder from being overfilled, and prevent the fetal head from descending.The puerpera should eat on time and eat more soft rice or semi-liquid diet, otherwise the progress of labor will be affected due to excessive physical exertion and fatigue.In the second stage of labor, the parturient lies flat on the delivery bed, with her legs separated, holding the armrest on the west side of the delivery bed with both hands, taking a deep breath when the contraction begins, and holding her breath downward as if defecating with the contraction. Exhale long and hold your breath for as long as possible.During the interval between uterine contractions, stop exerting force, so that the correct use of abdominal pressure can shorten the labor process.When the fetal head is about to be delivered, you must follow the guidance of the midwife, keep your buttocks fixed, and do not move down or up with force during uterine contractions.Do not use too much force during the contraction, and continue to use abdominal pressure when the contraction weakens, so that the fetal head will be delivered slowly under the protection of the midwifery staff.Prevents the fetal head from being delivered too quickly and tearing the perineum.After the baby is delivered, the mother immediately feels relaxed in the abdomen and the whole body, but very tired.Pay attention to rest at this time.

4. Dystocia and cesarean section
The cause of dystocia may be that any one or more of the three factors of productivity, birth canal, and fetus are abnormal, which hinders the process of childbirth.However, natural labor and dystocia cannot be divided mechanically, because under certain conditions, physiological activities may be transformed into pathological processes, and natural labor may become dystocia, and some possible dystocias may be transformed into give birth.The main means of preventing dystocia is to do a good job of prenatal examination, and go to the hospital for delivery in time according to the doctor's order.

A cesarean section (also called a cesarean section) can be performed when a doctor's examination proves that vaginal delivery is difficult, or the mother and the fetus have an emergency that must deliver the fetus immediately to terminate the pregnancy.Circumstances that require a cesarean section include:

(1) Birth canal abnormalities (including narrow or deformed pelvis, abnormal development of uterus and vagina).

(2) Pregnant women are short in stature and less than 145 cm in height.

(3) Abnormal uterine development or poor development of uterine myometrium, poor ability of uterine muscle stretching, or uncoordinated uterine contraction.

(4) The fetus is too large or the fetal position is abnormal.

(5) The parturient has other serious diseases at the end of pregnancy.

(6) The fetus has already experienced intrauterine distress, abnormal fetal heart rate or meconium in the amniotic fluid.

(7) Other circumstances in which the doctor believes that cesarean section is necessary.

Proper application of cesarean section can save the life of mother and baby.But after all, it is an unnatural delivery process, which may bring side effects to mother and baby, such as accidents in anesthesia, damage to other organs in the abdomen during surgery, and urinary, cardiovascular, respiratory and other systems after surgery. Complications, poor healing of uterine incision, non-healing abdominal incision, intestinal adhesion, etc.Neonates delivered by cesarean section may develop respiratory distress syndrome.Therefore, cesarean section has both advantages and disadvantages, and it is not absolutely safe.If it is not necessary, natural childbirth should be done as far as possible.It is unreasonable to think that the child born by cesarean section is smart, and to ask for cesarean section for fear of the pain of childbirth.

5. Expired product

Pregnant women with regular menstrual cycles, whose pregnancy is more than 2 weeks beyond the expected date of delivery, are called post-term pregnancy.The hazards of overdue pregnancy are: the placental function declines, which can easily cause hypoxia or even death in the fetus; the fetus is obviously ossified, the bone seams are narrowed, the fontanel is small, and the head of the baby becomes hard, so that it cannot pass through the birth canal well during childbirth. Deformation increases the chance of dystocia.Therefore, when the puerpera still has no signs of labor after 40 weeks of pregnancy, she should go to the hospital for necessary examinations, and perform induced labor, labor induction or cesarean section according to the doctor's opinion.

Puerperium

1.Maternal changes during puerperium
After the fetus is delivered, the placenta is expelled from the mother. From then on to 6-8 weeks after delivery, it is called the puerperium.During this period, the maternal reproductive organs and various systems of the whole body are gradually adjusting and recovering.

reproductive organs.Including the uterus, vagina, perineum and pelvic floor musculature, among which the uterus is the organ that changes the most during the puerperium and can be directly felt by the mother.On the first day after delivery, the fundus of the uterus is generally flat to the umbilicus, and then drops by 1 to 1 cm every day. Generally, the uterus returns to the pelvic cavity in 2 to 7 days. At this time, the upper part of the pubic symphysis is not easy to touch.At 10 weeks postpartum, the uterus basically returns to its pre-pregnancy size.Generally, primiparous women feel pain in the lower abdomen, which is actually caused by uterine contraction and does not need to be treated.If the pain is severe, analgesics may be given for symptomatic treatment.

General condition of the whole body.It is normal for the mother to feel very tired and fall asleep soon after delivery, as the mother is physically exhausted throughout the delivery process.

Body temperature and postpartum fever.The body temperature may rise slightly within 24 hours after delivery, generally not exceeding 38°C, which is due to physical exertion and excessive fatigue.If you still have fever after 24 hours after delivery, you should check in detail to find out the cause of the fever (such as whether there is redness and swelling of the breast, whether there is urogenital tract infection), and deal with it accordingly.

Stool and constipation.The postpartum abdominal wall is loose, intestinal peristalsis is weakened, and there is less activity. Sometimes the mother eats less cellulose-containing food, which often causes constipation.

The solution is: get out of bed frequently after giving birth, drink plenty of water, eat more vegetables and other crude fiber foods, and defecate regularly.When constipation occurs, Kaisailu can be used.

Urination and urinary retention.The first urination should be done 4 to 8 hours after delivery, but some pregnant women have difficulty urinating or even unable to urinate after delivery (ie urinary retention).The main reasons are: the fetal head presses the bladder during delivery, causing bladder edema and poor contractility, which affects urination; wound pain in the vulva, dare not to urinate, and is not used to lying down to urinate.The solution is: ①Drink plenty of water after delivery, and urinate by yourself 4~6 hours after delivery; ②If the parturient still cannot urinate by itself or only urinates a small amount 8 hours after delivery, you can wash the vulva with warm water to make Water slowly flows down from the vestibule to promote the urge to urinate; ③ Place a hot water bottle in the lower abdomen to stimulate bladder contraction; ④ When the above methods are ineffective, use a reserved catheter and give antibiotics to prevent infection. Generally, the catheter is removed after 2 to 3 days , you can urinate by yourself.

Lochia and postpartum hemorrhage.Postpartum vaginal discharge is called lochia.Under normal circumstances, lochia is red in the first 3 to 4 days postpartum, and the amount is large.Afterwards, the amount of bleeding decreases and the color fades to pink.10 to 14 days postpartum, the lochia turns yellowish-white or white, which contains a large number of white blood cells, decidual cells, etc., and it lasts for about 3 weeks.When the lochia is accompanied by a putrid odor or a cloudy earth-brown color, it indicates that there is an infection and should be treated with antibiotics.

If the amount of vaginal bleeding reaches or exceeds 24 ml within 500 hours after delivery, it is called postpartum hemorrhage.Common causes: ① uterine atony.Mostly due to the mental stress of the parturient during childbirth, or the long labor process, great physical exertion and extreme fatigue, or the excessive expansion of the uterus due to multiple pregnancy, polyhydramnios, macrosomia, etc., the postpartum uterine muscle fibers cannot be effectively contracted; ② before Placenta placement or placental abruption, retained placenta, birth canal injury, or pre-existing bleeding disorders.

After 24 hours postpartum, vaginal bleeding at any time during the puerperium, called late postpartum hemorrhage, is most common in the placental remnant and incomplete involution of the placental attachment surface of the uterus.

Excessive postpartum hemorrhage reduces the maternal systemic resistance, increases the chance of puerperal infection, and prolongs the recovery period.If the bleeding is urgent and severe, it can cause hemorrhagic shock and endanger the life of the parturient.Therefore, it should be sent to the hospital for diagnosis and treatment in time.

sweating.It is easy to sweat after giving birth, especially after going to bed or when you wake up, you are often covered with sweat.This is because a large amount of water accumulated in the body during pregnancy needs to be eliminated through the skin, which is a normal physiological phenomenon.This kind of sweat is also called "bed sweat".Sweating usually subsides naturally within a few days of delivery and does not require treatment.But always dry the sweat with a dry towel to prevent colds.It is best to take a bath with warm water every night, and change underwear frequently.

2.Colostrum and initiation of lactation

Most women have a little milk, called colostrum, coming out of their nipples the day after giving birth.Later, due to breastfeeding, the secretion of milk increased.Regarding the time to start breastfeeding, it is now more advocated to let the baby suck the nipple 4 to 6 hours after delivery to stimulate the mother's milk secretion.Breastfeeding benefits both mother and baby.However, mothers with the following conditions are not suitable for breastfeeding: active tuberculosis, diabetes, hepatitis B, serious heart disease, kidney disease, diabetes, and severe anemia.

3. Maternal personal hygiene
Regarding the personal hygiene of pregnant women, there are many "clear rules and precepts" among the people.Some of them are scientific and some of them are irrational.From a medical point of view, the following recommendations can be made:
(1) You can eat within 1-2 hours after giving birth. Before eating, you should wash your hands, face, brush your teeth, and rinse your mouth.In the future, personal hygiene should be the same as that of normal people, and it should be carried out as usual every day.Just pay attention to washing your face and brushing your teeth with warm water.

(2) You can sit up 6-8 hours after giving birth, you can go to the toilet to urinate by yourself after 12 hours, and you can move and walk freely the next day.

(3) Pregnant women can eat fruits. If they are afraid that the fruits will be cold, they can scald them with boiling water.The salt content in food should also be the same as that of normal people.

(4) Pregnant women who have a smooth delivery can take a bath after resting after delivery.Those who are too weak or have unhealed abdominal and genital wounds can rub their bodies with warm water.

(5) You can read books, newspapers, listen to music, and watch TV after giving birth, but don't be too tired.

(6) The mother's room should be clean and ventilated, and the doors and windows must not be closed to "cover the confinement".

(7) Normal work can be resumed 8 weeks after childbirth, and it can be extended to 10 weeks for caesarean section.

4. Postpartum exercise
After proper rest after childbirth, when you feel that your physical strength has recovered, you can exercise through some exercises, strengthen your physique, and restore your body.Here is a set of postpartum exercise aerobics.

The first section: Lie on your back, straighten your back and feet, contract your abdominal muscles, try to keep your back close to the bed, keep this position for a while, then relax, and do it 5 times in a row.

Section [-]: Lie on your back, bend your legs upwards, bring your knees together, and separate your feet left and right, then use your feet and shoulders to support the bed, straighten your body, and contract your abdominal muscles at the same time.

Section [-]: Lie on your back, stretch your arms close to the bed, lift them up slowly until your palms touch each other, and then restore.

Section [-]: Lie on your back, bend one leg until the heel touches the buttocks, and slowly restore.Do the same with the other foot, alternating.

Section 35: The chest is close to the bed, the knees are bent, the feet are about [-] cm apart, and the hips are raised.

Section [-]: Lie on your back, cross your arms in front of your chest, sit up with your upper body, and after sitting down, stand upright, put your hands behind your head, and intersect your fingers.

Section 90: Lie on your back, straighten your arms, and lift your left and right legs alternately up to [-]°. When your physical strength increases slightly, you can practice lifting both legs at the same time.

Section [-]: Lie on your back, raise your head, and make your jaw touch your chest. During the movement, try to keep your body and feet in the same posture.

5.postpartum checkup

After recuperation during the puerperium, the puerpera generally feels good recovery.However, it is still necessary to do a postpartum examination to know how the various organs of the body are recovering.At the same time, the growth and nutritional status of the baby also needs to be understood.Postpartum examination should generally be carried out 42 to 56 days after delivery.

(End of this chapter)