How to induce uterine contractions at home: herbs, tinctures and other folk remedies

Why is amniotomy needed? Is it possible to do without it? Will it harm the mother or baby? Let's figure it out together with our expert - Yulia DREMOVA, a medical obstetrician-gynecologist.

According to statistics, amniotomy or, simply put, puncture of the amniotic sac is used in our country in approximately seven births out of a hundred.

Sibmama's data, based on surveys of women who have recently given birth ( ), radically differ from official statistics: last year, puncture of the amniotic sac became the most common intervention in the childbirth process: it was least often resorted to in maternity hospital No. 2 (38% of cases), most often - in the maternity hospital of the 25th medical unit (68% of cases).

In 2020, according to a new survey, 541 women in labor had an amniotomy out of 1,426 who completed the survey (including those who had a caesarean section, meaning at least one in three women have an amniotomy).

What happens to the amniotic sac during childbirth

The amniotic sac, the baby’s first “home,” is a strong, thin and very elastic “sac.” It is filled (in medical language they are called amniotic fluid): a warm (about 37 degrees) comfortable environment that reliably protects the baby from external influences: noise, pressure, ascending infections.

What happens to the amniotic sac when contractions begin? The muscles of the uterus begin to squeeze it with force. The amniotic fluid begins to move and part of the fluid (about 200 ml) moves down, forming a kind of “water cushion”, which with each uterine contraction presses on the cervix and helps it open. Normally, the rupture of the bladder occurs when the cervix is ​​already wide enough - 4-6 cm. The lower part of the bladder penetrates deeper and deeper into the internal os of the cervix, the pressure increases, the bladder ruptures and the amniotic fluid that was below flows out.

From this moment on, the baby’s head begins to press directly on the cervix, dilation accelerates, bringing the moment of the baby’s birth closer. This occurs not only due to increased pressure, but also because the rupture of the bladder is accompanied by the release of biologically active substances - prostaglandins, which stimulate uterine contractions.

Alternative methods for contracting the uterus at home

In the late postpartum period, the following techniques are additionally used to contract the walls of the uterus:

• Frequently adopting the “lying on your stomach” position, as it tones the abdominal muscles;
• Maintaining breastfeeding, since the oxytocin released during this process stimulates uterine contractions;
• Performing therapeutic exercises, Kegel exercises, as it strengthens the muscles of the pelvic organs, perineum, and strengthens the muscles of the whole body;
• Drinking water with honey and lemon juice dissolved in it.

All these measures will accelerate the recovery of the myometrium and have an effective effect on the tone of the uterus and general condition.

Why amniotomy is needed

“Why open the amniotic sac at all if the waters break on their own, what if this stimulation disrupts the natural course of labor?” - many women in labor express similar concerns. But the fact is that when childbirth occurs naturally and without complications, the need for amniotomy does not arise. Simply put, if you can do without puncturing the amniotic sac, then doctors are happy to do so.

The procedure may be required when the condition of the child or mother requires urgent delivery, or when labor is weak. Also, a puncture is a solution in some cases when the natural sequence of the birth process is disrupted. The membranes may be so strong that they do not tear and a puncture is required; another common reason for amniotomy during childbirth is the so-called “flat bladder”, when there is no fluid in its lower part and the membranes tighten around the baby’s head and interfere with its advancement and opening cervix.

However, it is not at all harmful to remember the indications for which this procedure is performed, so that if it is necessary, you can clearly understand what is happening.

Expert commentary

Indications for amniotomy:

• induction of labor during post-term pregnancy;
• weakness of labor;
• , ;
• “flat” amniotic sac (the membranes are stretched on the fetal head, preventing its movement through the birth canal);
• complete opening of the uterine pharynx, if the fetal bladder has not opened on its own (dense membranes);
• in case of multiple pregnancy, after the birth of the first fetus, an amniotomy of the second amniotic sac is performed;
• suspicion of fetal hypoxia and premature placental abruption;
• the condition of the pregnant woman does not allow further prolongation of pregnancy;
• It is advisable to perform an amniotomy before labor anesthesia using the prolonged method.

From the moment the integrity of the bladder is broken, there is no turning back - the clock counts, because the anhydrous period cannot last indefinitely (usually doctors recommend limiting the time period from the moment the bladder opens to the onset of labor to 10-12 hours, but this issue is resolved in each case individually).

Expert commentary

Amniotomy is a fairly common procedure. The urgency of its implementation is determined only by the doctor. It all depends on the condition of the mother and the fetus. The procedure does not have any negative consequences if it is carried out according to indications and all conditions for its implementation are met. The main requirements are the biological readiness of the patient’s body for childbirth (mature cervix) and the qualifications of the doctor, allowing him to carry out this manipulation.

Postpartum period. First month after birth

I was looking for information about the minimum healthy interval between pregnancies and found that it is at least two years. The article is quite useful, except that it says once a day in the shower with soap you need to wash your nipples, complete nonsense, apparently reprinted from an old book somewhere. There is no special need to wash the nipples, the mother takes a shower (even without soap once a day or a week) and it’s great, nipples not washed with soap will not have any negative impact on breastfeeding or the child or her health, and this is already a proven fact. https://www.gynecologia.info/statya.php?st=311 Postpartum period. The first month after birth. The first month after childbirth is often called the tenth month of pregnancy, thereby emphasizing its importance for the woman’s body. Strictly speaking, the first month after childbirth is only part of the postpartum period, the duration of which is the first 6-8 weeks after childbirth. The postpartum period begins from the moment of birth of the placenta and continues until the end of involution (i.e., reverse development) of all organs and tissues of the woman’s body that have undergone changes during pregnancy. During the same period, the formation of the function of the mammary glands occurs, as well as the formation of a sense of motherhood and associated fundamental changes in the psychology of a woman. What happens in the body
During the postpartum period, the normal tone of the cerebral cortex and subcortical centers is restored.
Pregnancy hormones are removed from the body, and gradually the function of the endocrine system returns to normal. The heart takes its normal position, its work becomes easier, as the blood volume decreases. The kidneys are working actively, the amount of urine in the first days after childbirth is usually increased. The changes are most significant in the reproductive system. The uterus contracts and decreases in size every day; during the postpartum period, its weight decreases from 1000 g to 50 g. Such a significant and rapid contraction is due to several mechanisms. Firstly, contraction of the uterine muscle, both constant tonic and in the form of postpartum contractions. In this case, the walls of the uterus thicken, it takes on a spherical shape. Secondly, contracting muscles compress the walls of blood and lymphatic vessels, many of them collapse, which leads to a decrease in the nutrition of muscle elements and connective tissue, and as a result, the hypertrophy of muscle tissue that occurred during pregnancy disappears. These processes are called involution
of the uterus and are most accurately expressed by the height of its fundus.
By the end of the first day, the fundus of the uterus is at the level of the navel, then daily it drops by approximately 1 cm. On the 5th day it is already in the middle of the distance between the womb and the navel, by the end of the 10th day it is behind the womb. By the end of the 6-8th week after birth, the size of the uterus corresponds to the size of the non-pregnant uterus. Along with the reduction in the size of the uterus, the formation of its cervix occurs. The formation of the pharynx occurs due to contraction of the circular muscles surrounding the internal opening of the cervical canal. Immediately after birth, the diameter of the internal pharynx is 10-12 cm; it will completely close by the end of the 10th day, and by the end of the 3rd week, the external pharynx of the uterus will also close, acquiring a slit-like shape. The inner wall of the uterus after separation of the placenta is an extensive wound surface; there are remnants of glands on it, from which the epithelial cover of the uterus, the endometrium, is subsequently restored. During the healing process of the inner surface of the uterus, postpartum discharge appears - lochia
, which is a wound secretion.
Their character changes during the postpartum period: in the first days, lochia is bloody; from the 4th day their color changes to reddish-brown; by the 10th day they become light, liquid, without any admixture of blood. The total amount of lochia in the first 8 days of the postpartum period reaches 500-1400 g, from the 3rd week their number decreases significantly, and by 5-6 weeks they stop altogether. Lochia has a peculiar musty odor, which gradually decreases. With slow involution of the uterus, the release of lochia is delayed, and the admixture of blood lasts longer. Sometimes there is a partial retention of discharge in the uterine cavity. In the first days after birth, the mobility of the uterus is increased, which is explained by stretching and insufficient tone of its ligamentous apparatus. The uterus easily moves to the sides, especially when the bladder and rectum are full. The ligamentous apparatus of the uterus acquires normal tone by the 4th week after birth. As the uterus involutions, the fallopian tubes also return to their normal position, and their swelling disappears. The ovaries also undergo significant changes. The regression of the corpus luteum, which was formed at the very beginning of pregnancy, ends, and the maturation of the follicles begins. For most non-breastfeeding women, menstruation begins in the 6th to 8th week after childbirth; more often it comes without the release of an egg from the ovary. However, ovulation and pregnancy may occur during the first months after birth. In nursing women, the onset of the first menstruation after childbirth may be delayed for many months. The tone of the pelvic floor muscles is gradually restored. The tone of the vaginal walls is restored, its volume is reduced, and swelling disappears. Abrasions, cracks, and tears that occurred during childbirth heal. The abdominal wall gradually strengthens, mainly due to muscle contraction. The stretch marks on the skin are still purple, they will lighten by the end of the first year after giving birth. Unlike most organs, which undergo reverse development after childbirth, the mammary glands, on the contrary, reach their peak. Already during pregnancy, they begin to secrete a thick yellowish liquid containing protein, fat, and epithelial cells from glandular vesicles and milk ducts. This is colostrum
, which the baby will eat for the first couple of days after birth.
It is rich in proteins, vitamins, enzymes and protective antibodies, but has fewer carbohydrates than milk. On the 2-3rd day after birth, the mammary glands become engorged and painful, and under the influence of the lactogenic hormone of the pituitary gland, the secretion of transitional milk begins. The process of milk formation largely depends on the reflex effects associated with the act of sucking. From the second to third week after birth, transitional milk turns into “mature” milk, which is an emulsion of tiny droplets of fat found in the whey. Its composition is as follows: water 87%, protein 1.5%, fat 4%, carbohydrates (milk sugar) about 7%, salts, vitamins, enzymes, antibodies. This composition may vary depending on the nature of the mother’s diet and regimen. Feelings
Immediately after giving birth, almost all new mothers report severe fatigue and drowsiness.
And already from the second day, with the normal course of the postpartum period, the woman feels well. Body temperature is usually normal. In the first days, pain in the area of ​​the external genitalia and perineum is possible, even in the absence of ruptures. This is due to the strong stretching of tissues during childbirth. Usually the pain is not very intense and goes away after a couple of days, in case there were tears or cuts in the perineum, up to 7-10 days. If a caesarean section was performed, there will be pain in the area of ​​the postoperative sutures. Uterine contractions periodically occur, feeling like weak contractions. After repeated births, the uterus contracts more painfully than after the first. Contractions intensify during breastfeeding, this is due to the fact that when the nipple is stimulated, the level of a substance that promotes uterine contractions, oxytocin, increases in the blood. On the first day after childbirth, a woman does not feel the urge to urinate. This is due to a decrease in the tone of the abdominal wall, swelling of the bladder neck as a result of its compression by the fetal head. A psychological block plays a certain role when a woman is in a horizontal position, as well as an unpleasant burning sensation when urine comes into contact with the area of ​​tears and cracks. To stimulate the bladder, you need to move more, sometimes the sound of water flowing from a tap helps. If there is no urination within 8 hours, it is necessary to empty the bladder using a catheter. In the first days after childbirth, a woman may experience constipation. Their cause is most often relaxation of the abdominal wall, limitation of physical activity, poor nutrition and fear of the sutures in the perineum coming apart. There's no reason to worry about seams. You just need to move more and adjust your diet. From the second or third day after birth, there is a sharp increase in the amount of milk in the breast. At the same time, the mammary glands enlarge, harden, become painful, and sometimes the body temperature rises. Sometimes the pain radiates to the axillary region, where nodules are felt - swollen rudimentary lobules of the mammary glands. To avoid severe engorgement, it is recommended to limit fluid intake to 800 ml per day from the third day after birth and try to feed the baby more often. Within 1-2 days, with proper attachment and feeding regimen, engorgement gradually disappears. Psychology of the postpartum period
Could anyone be happier than a woman who gives birth, feeds and kisses her baby?
Why do we so often see tears of despair on the faces of young mothers who have been waiting for their baby for so long? Why are they depressed, irritable and exhausted? Let's try to figure it out. During pregnancy, the level of female sex hormones reaches its maximum values ​​in a woman's entire life. Immediately after the birth of the placenta, the level of these substances decreases significantly. A drop in hormones in a woman’s blood is observed every time before the onset of menstruation, “thanks to” this, many women monthly have a mini-depression in the form of the so familiar premenstrual syndrome (PMS). Now let’s multiply PMS ten times (in comparison, this is how much hormone levels drop after childbirth) and we get “postpartum blues” - the psychological state of a new mother. It is not surprising that 70% of women after childbirth report irritability, a feeling of unreality of what is happening, devastation, unrelenting anxiety about any reason, and sleep disorders. These phenomena occur on the third or fourth day after birth and reach their apogee on the fourth or fifth day and disappear without any medical intervention after two weeks. In 10% of women, these phenomena drag on and become painful. It is impossible to prevent the occurrence of postpartum depression. The most important thing is to remember that this will soon pass. The worst advice that can be given in this situation is the advice to “pull yourself together.” There is no need to fight with yourself, much less blame yourself for being a bad mother. Your body has done a lot of work, you are physically and mentally exhausted and have every right to rest. No need for parental feats! Let the baby sleep on the balcony, and the sink is overflowing with dishes, use any extra minute to sleep. Accept any help from your loved ones, do not pay attention to the fact that they will do something not exactly the way you read in a respected magazine or book. Everything will gradually get better. Be sure to find minutes to clean yourself up and talk with your husband on topics not related to the child. If symptoms of depression persist for longer than two weeks, this may be a sign of a disease for which it is better to seek help from professionals. Signs that depression is getting out of control are: - an acute feeling of fear, fear of the next day; - apathy, refusal to eat, desire for complete loneliness; - constant hostility towards the newborn; - insomnia, recurring nightmares; - constant a feeling of inferiority, a feeling of guilt towards the child. With such severe depression, drug therapy may be needed. And in mild cases, the best medicine is love. Love for your baby, in whose eyes the whole world is reflected for the mother. Possible deviations from the norm
Unfortunately, the first month after childbirth does not always go smoothly.
Situations may arise when medical assistance is necessary. Monitor your health and regularly measure your body temperature, as an increase in temperature is most often the first sign of complications in the postpartum period. All complications of the postpartum period can be divided into several groups: 1. Complications from the uterus.
The most serious complication of the first day after childbirth is
postpartum hemorrhage
.
They begin immediately after childbirth, are not accompanied by any pain and are very abundant, so they can pose a danger to a woman’s life. The causes of bleeding are various injuries during childbirth, disturbances in the separation of the placenta and membranes, as well as disturbances in uterine contraction. To treat bleeding, various surgical interventions, medications and donated blood products are used. In order to monitor the woman, she is left in the maternity ward during the very dangerous first couple of hours after giving birth. In the following days, the risk of bleeding decreases, but other problems arise. Subinvolution of the uterus
is a decrease in the rate of contraction of the uterus due to retention of postpartum discharge in the uterus.
The disease most often occurs 5-7 days after birth, due to the closure of the cervical canal by a blood clot or a piece of membranes, as well as kinking of the uterus due to relaxation of the ligamentous apparatus. Infection of the contents of the uterus can lead to an inflammatory process of the uterine mucosa - endometritis
.
Predisposing factors for the occurrence of endometritis are difficult childbirth, disturbances in the separation of the placenta during childbirth, genital tract infections during pregnancy, immunity disorders, and abortions. Symptoms of the disease are: increased body temperature, unpleasant odor in lochia, aching pain in the lower abdomen. To clarify the diagnosis, an ultrasound examination and, if necessary, surgery are performed, during which the contents are removed from the uterine cavity (washing or curettage of the uterus). After surgery, antibiotics are required. 2. Complications from the mammary gland. Lactostasis
is stagnation of milk in the mammary gland.
In this case, the breast swells and becomes painful, pockets of compaction appear, and a short-term rise in body temperature is possible. Lactostasis itself is not a disease, requiring only careful pumping of the breast, limiting fluid intake and frequent feeding of painful breasts. However, when an infection occurs, it turns into lactation mastitis
, which requires immediate medical attention, antibiotic therapy, and sometimes surgery.
The question of the possibility of breastfeeding with mastitis is decided individually, depending on the stage of the disease. Another complication from the breast is the appearance of cracks in the nipples
.
The main reason for their appearance is improper attachment of the baby to the breast, when the baby grasps only the nipple, and not the entire areola. Such a grip is very painful for the mother - and this is the main danger signal. Feeding your baby shouldn't be painful. Breastfeeding consultants provide good advice and practical assistance for lactostasis and cracked nipples. Treatment of cracks involves treating the nipple with wound-healing preparations. Hypogalactia
is insufficient milk production.
In order to increase the amount of milk, a mother needs to increase the frequency of feedings, not skip night feedings, offer the baby both breasts at one feeding, drink more, eat well and sleep a lot. 3. Complications from the tissues of the cervix, vagina and skin.
Inflamed wounds of these tissues are called
puerperal ulcers
.
When infection occurs, these wounds swell, become covered with purulent plaque, and their edges are painful. For the purpose of treatment, they are treated with various antiseptics, sometimes requiring surgical treatment. 4. Complications from the venous system. Hemorrhoids
(
varicose veins
of the rectum) also cause pain.
When pinched, they enlarge, become swollen, tense and painful. Careful hygiene (showering after each visit to the toilet) and applying ice to the perineum helps reduce pain. Some medications can be used as prescribed by your doctor. Thrombophlebitis
is a venous disease characterized by inflammation of the venous wall and thrombosis of the vein.
After childbirth, thrombophlebitis of the pelvic veins most often occurs. This disease usually occurs in the third week after childbirth. The symptoms are very similar to endometritis, but require different treatment. Surgeons treat complications from the venous system. Complications after childbirth require immediate treatment, as they can lead to generalization of the process - postpartum peritonitis
or
sepsis
.
Therefore, if anything bothers you about your condition, be sure to consult a doctor. Rules of conduct In the first week after childbirth, while the woman is in the maternity hospital, she is monitored daily by a doctor and midwife. They evaluate the general condition of the novelty, measure the pulse, blood pressure, body temperature, determine the condition of the mammary glands, the involution of the uterus, and the nature of the logs. In most cases, after normal genera, you can do without medication, only with very painful abbreviations is the use of painkillers is possible. With complications of the postpartum period, the doctor will prescribe the necessary treatment. They write a napsman on the 5-6th day after uncomplicated births. One of the most important rules that must be followed by a newly made mommy is a sufficient sleep. Its total duration should be at least 8-10 hours a day. Such a duration of sleep will allow you to recover after childbirth and give strength to care for the baby. Naturally, it is impossible to provide a long sleep at night, because you will have to repeatedly feed the baby, so try to give any free minute and day to bed. They ask for a bed after normal birth six hours after childbirth. At first, get out of bed carefully, avoiding sudden movements, otherwise your head may diz. Already on the first day after childbirth, you can do breathing gymnastics and help reduce the uterus with self -massage. To do this, you need to lie on your back, relax the stomach as much as possible, gently feel the bottom of the uterus (just below the navel) and gently stroke from the sides to the center and up. To sleep and lie for the first 2-3 days after childbirth (before milk arrives), it is better on the stomach. The periodic attachment of a heights with ice on the lower abdomen also helps to reduce the reduction. In order to avoid hypothermia, the heating pad must be wrapped in a diaper and hold for no more than 20 minutes in a row. On the second day after childbirth, you can proceed to therapeutic gymnastics. Daily and more often perform light exercises to compress and relax the muscles of the pelvic floor. This will help get rid of involuntary urination, will contribute to the healing of seams on the perineum. To train the abdominal muscles, pull alternately and take the feet, as if by pressing the bicycle pedal. Exhale and draw a stomach by holding your breath; Then relax. You need to perform these simple exercises several times every hour when you do not sleep. They are also recommended for women who have suffered a cesarean section. From the second week, expand the set of exercises, adding turns, tilting the body, and by the end of the month and exercises on the abdominal press. It is very important to carefully observe the rules of personal hygiene. You are still too weak to resist the surrounding microbes well, so get rid of them constantly. Wash with soap, especially if there are seams on the perineum, it is necessary after each visit to the toilet. Twice a day, the seams are additionally treated with special antiseptics. It is necessary to monitor the cleanliness of the gaskets. For this period, special postpartum gaskets are best suited, in extreme cases, ordinary, but with a cotton surface. In the hospital, you can not use gaskets with a top layer of synthetic material. Regardless of fullness, it is necessary to change the gasket every 2-3 hours. Shower must be taken 2 times a day, then wash the mammary gland with soap. It is not necessary to wash the chest after each feeding, it is enough to leave a drop of milk on the nipple and let it dry out in the open air. It is impossible to take a bath in the first month after childbirth. The underwear and bedding should be cotton. We change the underwear daily, bed - at least once every three days. The chair should be within the first three days after childbirth. In the presence of seams on the crotch, the first emptying causes fear that the seams can “disperse”. This fear is completely unreasonable, but the defecation time can be held by the seam area with a napkin, which will reduce tissue stretching, defecation will be less painful. To facilitate this process, include dried apricots in your diet, prunes, drink a glass of mineral water without gas or kefir on an empty stomach. If there is no chair on the 4th day, then you need to use a laxative or put a cleansing enema. The food of the nursing mother should be high-calorie (2500-3000 kcal). In the first 2 days after childbirth, food should be easily digestible. From the 3rd day, a regular diet with a predominance of lactic acid, cereals, fruits and vegetables is prescribed. Sharp, fatty, smoked dishes, canned food, alcohol and potential allergens for the child should be excluded from the diet. The amount of protein should be about 100 g, mainly due to animal proteins, fats of 85-90 g, of which a third are vegetable, carbohydrates-300-400 g. Daily try to drink milk or kefir (at least 0.5 l), There are cottage cheese (50g) or cheese (20g), meat (200g), vegetables, fruits (500-700g each), bread and vegetable oil. Pure water with the established lactation, you should additionally drink 1.5-2 liters per day. Polish life after childbirth can be resumed after 6 weeks. By this moment, the woman’s body is already completely returning to normal. In the same period, you must undergo a physical examination in a antenatal clinic or with your doctor. They will weigh, measure blood pressure, take urine analysis, examine the mammary glands. A vaginal examination will be carried out to determine the size and position of the uterus, check how the seams heal, take a smear from the cervix. The doctor will advise you with contraceptive means. In order to completely restore after childbirth, before the next pregnancy should pass at least two years.

How is amniotomy performed?

The amniotomy itself, although it has the status of an obstetric operation, is considered a simple procedure and takes literally a couple of minutes. It is carried out by an obstetrician-gynecologist directly in the gynecological chair: first he treats the external genitalia with an antiseptic, and then carefully pierces the bladder with a special sterile instrument. By the way, it doesn’t look scary at all: it’s made of plastic and looks like a crochet hook.

What is amniotomy during childbirth? This question is asked by almost every pregnant woman who has heard such a definition.

Artificial opening of the amniotic bladder is not a rare occurrence in obstetric practice. Approximately 7% of all births are accompanied by this procedure.

Despite its apparent simplicity, amniotomy is performed only for medical reasons. As a rule, it is carried out to activate labor.

What are the indications for amniotomy? What to do if the baby was born in the amniotic sac?

What it is

Amniotomy or puncture of the amniotic bladder is a procedure for artificially breaking the integrity of the fetal membrane during childbirth.

As a rule, this process occurs independently during the normal course of labor. The outpouring of water is accompanied by complete dilatation of the uterine cervix. This serves as a signal that the baby is beginning to move along the birth canal.

However, in some cases the bubble does not burst on its own. In this case, medical attention is required.

Using a special tool that resembles a hook, the bubble is pierced.

The procedure does not cause pain to the woman. For a child, amniotomy is usually also safe.

Types of punctures:

• prenatal;
• early amniotomy;
• timely;
• belated.

Uterine prolapse

The pelvic muscles, which are responsible for maintaining the uterus and other organs in a normal position, are sometimes injured and overstretched during labor. Displacement of all pelvic organs occurs, including prolapse of the uterus (prolapse).

The causes of prolapse are considered to be

• injuries and ruptures during childbirth;
• heavy lifting in the postnatal period;
• general weakness of the abdominal muscles;
• change in the natural position of the uterus;
• severe stretching of the uterine ligaments;
• unbalanced diet leading to constipation;
• hereditary predisposition.

Prolapse of the uterus can provoke

• a sharp decrease in estrogen in the blood;
• difficult and multiple births;
• large baby or multiple births;
• chronic inflammatory diseases.

Uterine prolapse may not be noticed immediately. The disease can develop over years and only appear in old age.

Symptoms of prolapse include

1. feeling of heaviness, pain in the lower abdomen, lower back;
2. feeling of swelling of the uterus;
3. chronic constipation;
4. spotting in different phases of the menstrual cycle;
5. urinary incontinence;
6. pain during sexual intercourse;
7. discomfort while walking (in later stages of the disease).

Treatment of uterine prolapse can be of 2 types: 1. Conservative (at the initial stage of prolapse)

2. Surgical (when the uterus descends to the genital slit).

When necessary

The amniotomy procedure is performed solely for medical reasons.

These include:

• post-term pregnancy beyond 42 weeks;
• diagnosing a woman with severe forms that threaten the child;
• presence in mother and fetus;
• insufficient activity of labor;
• insufficient amount of amniotic fluid, oligohydramnios;
• during pregnancy;
• pathological preliminary period, which refers to prolonged and irregular contractions.

The decision on the need for artificial opening of the amniotic sac is made by the doctor after examining the woman. This procedure cannot be done without compelling reasons.

How it goes

The procedure for puncturing the amniotic sac is quite simple. It does not require additional anesthesia or complex medical equipment.

As a rule, amniotomy is performed in an obstetric chair.

The doctor uses a special gynecological instrument that resembles a hook in appearance.

It is inserted through the vagina and cervix into the uterine cavity, the bladder is pierced and thus removed from the woman’s body.

During the procedure, the woman does not experience discomfort. There is also no pain felt.

Once the integrity of the bladder has been compromised, amniotic fluid begins to leak.

Based on their appearance, the doctor assesses the condition of the woman and child, and determines the further plan of action.

The next stage after the puncture is the onset of contractions and the transition of labor to the active phase.

Possible complications

The amniotomy procedure is practically safe for mother and child. Serious complications and pathologies are very rare.

There is a possibility of the following risks:

Thus, the procedure can be performed exclusively in a hospital setting and under strict medical supervision.

Currently, control over amniotomy has been significantly tightened. Doctors decide on its necessity only in extreme cases.

Feel

For a woman, the procedure for puncturing the amniotic sac is painless and does not cause discomfort. In rare cases, a woman may experience minor discomfort.

A doctor can pierce the amniotic sac only with the woman’s consent.

The expectant mother may feel tension along the puncture and the movement of the instrument along the genital tract.

After the water has poured out, contractions begin, and the woman feels muscle contractions and pain.

Puncture of the amniotic bladder is a common procedure in obstetric practice. There are quite a lot of indications for its implementation.

As a rule, with a violation of the integrity of the membranes, amniotic fluid is released and labor is activated.

This manipulation is possible only in case of urgent need and under close medical supervision.

If a woman does not want her bladder to be pierced, then she can refuse.

What does the uterus look like after pregnancy and childbirth?

From the inside, the uterus looks like a large balloon from which the air has been released, but it still retains its shape and partly its size. The surface inside the organ is damaged, especially in the place where the placenta was attached - there is generally a continuous bleeding wound. Healing and involution of the uterus begins with its contraction to normal size and cleansing of the endometrium.

Contraction begins when the baby is first applied to the mother's breast - sucking movements towards the nipple provoke the release of the hormone oxytocin, which is responsible for the correct and timely reduction of the organ.

Reduction of the uterus in size, renewal of the inner layer (endometrium), its path to its normal prenatal state can be quite painful for a woman. Some people experience pain similar to what they feel during contractions. Other women report symptoms that resemble menstrual cramps. If a woman suffers greatly from discomfort, she can consult a doctor for pain relief. However, if she is breastfeeding, it is preferable to avoid taking any medications.

Bloody discharge of varying density should occur during the first 4-6 weeks after birth. They may look like menstrual blood, clots of various sizes, bundles of blood vessels, or pieces of soft porous tissue. For many women, such discharge, if it is abundant, is very frightening.

Some new mothers admit that the feeling during the release of clots is as if they are giving birth for the second time. In fact, this is all completely normal. Such discharge is called “lochia” and the uterus after childbirth will not be completely cleansed until it gets rid of it.

By the end of the 6th week, the suckers should become light-colored, their number gradually disappearing. If suckers remain in the uterus longer than intended, or blood clots have clogged the cervix, cleaning may be necessary so as not to provoke the onset of the inflammatory process.

The uterine os, which immediately after birth was approximately 12 cm in diameter, returns to normal on the third day; its complete closure should occur by the end of the 3rd week. However, the pharynx will not return to its previous prenatal appearance; by this sign, the gynecologist can always determine whether the woman has ever given birth.

The weight of the uterus immediately after birth is approximately 1 kg, and at the end of the 3rd week it is already a third of this figure. She will finally reach her prenatal state when her weight is approximately 50 grams, usually at the end of the postpartum period.

It is believed that after 6-8 weeks, the entire reproductive system of a woman should be in complete order. At this stage, she is again ready to have sexual relations with her partner and may even become pregnant.

Amniotomy - what is this procedure?

Amniotomy before childbirth is an obstetric procedure in which the membrane surrounding the fetus is surgically opened (more details in the article:). The waters where the baby is safe are released. At the same time, the expectant mother’s body produces active substances that stimulate labor and uterine contractions. Amniotomy activates the process of delivery, after which the baby is inevitably born.

Many women in labor are interested in how much pain they will experience during an amniotomy. The amniotic sac does not contain nerve endings, so the expectant mother will not experience any discomfort. They can be compared to the feeling of a balloon deflating in the stomach.

Opening the amniotic sac is possible only under the following conditions:

• absence of scars on the body of the uterus (from cesarean section, myomectomy);
• mature cervix;
• readiness of the birth canal;
• cephalic presentation;
• baby weight up to 4.5 kg;
• normal pelvic parameters;
• gestation period - from 38 weeks;
• no contraindications to natural delivery.

Types of surgery

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Opening the amniotic sac before labor begins is necessary in obstetric practice to avoid complications when the baby is born naturally. Depending on the time of manipulation, the following types of amniotomy are distinguished:

• Prenatal. The procedure without the onset of contractions is carried out if it is time for a woman to give birth according to all terms, but labor does not occur. After the water bladder is punctured, the baby is carried to the birth canal; the production of prostaglandins stimulates uterine contractions.
• Timely. When a baby is born, it may happen that the cervix is ​​not fully dilated, but the baby is already trying to come out. In this case, the obstetrician independently punctures the bladder, which restores the natural course of labor.
• Early. A rupture of the dense amniotic membranes is carried out in the presence of two conditions: full labor and dilation of the cervix by 7 cm (or more).
• Belated. Necessary to prevent postpartum hemorrhage if, after the head enters the birth canal, the baby is still in the fetal sac. If the bladder is not punctured in time, the baby will not be able to breathe independently after birth.

Amniotomy is part of the birth management plan, so the patient's consent to the intervention is not required. It all depends on the doctor. Many people do not consider it necessary to talk about this to the mother in labor. Others, on the contrary, describe in detail why and how the procedure is performed, and how it will help during childbirth.

Slow contraction of the uterus

Very often, postpartum discharge and painful sensations drag on and do not stop even after the normal 8 weeks have passed. In this case, a whole problem arises: how to speed up the contraction of the uterus after childbirth and help your own body recover faster. First, you need to contact the observing gynecologist and follow his advice. Secondly, with his permission, perform various exercises specially designed for this purpose and use folk remedies.

Health care

If in the first 1-3 days after the birth of the baby, a woman does not begin to discharge and there are no painful, cramping sensations, this indicates that for some reason the process does not start. In this case, the doctor decides what to do to contract the uterus after childbirth: give injections or prescribe pills.

• Oxytocin

In order to speed up uterine contractions after childbirth, prevent severe bleeding and normalize lactation, oxytocin, an artificial hormone, is prescribed. It is administered by injection, most often by injection. But if a woman is very weak after childbirth, an IV may be prescribed, especially after a caesarean section.

• Uterine oxytocics

Very often, drugs for uterine contractions from the same group of oxytocins are prescribed, but not in pure form, but with pharmacological additives that enhance and weaken the effect of the main substance. These include hyfotocin, demoxytocin, dinoprost, dinoprostone, cotarnine chloride, methyloxytocin, methylergometrine, pituitrine, ergometrine, ergotal, ergotamine hydrotartrate. These could be pills or injections.

Any medicine is prescribed only if poor uterine contractions after childbirth are diagnosed (no discharge or cramping pain in the lower abdomen). However, the attitude towards oxytocin even among doctors is ambiguous. Most of them believe that this process should start naturally. Therefore, some gynecologists recommend turning to folk remedies for help.

Folk remedies

There are also folk remedies for contracting the uterus. However, you should not get carried away with them and it is recommended to use them only with the permission of a doctor.

• Nettle

Dry nettle (4 tablespoons) is brewed with boiling water (500 ml). Let it sit until it cools down. Drink 100 ml three times a day.

• White lily

Pour the flowers of the plant (2 tablespoons) with cold boiled water (500 ml). Leave overnight. Strain. Drink 100 ml 3 (or 4) times a day.

• Shepherd's Purse

The herb is brewed (4 tablespoons) with boiling water (2 glasses). Wrap up, leave in a warm place, strain. Drink the entire prepared dose during the day.

• Yarutka field

Brew the dry plant (2 tablespoons) with boiling water (a glass), leave overnight, strain. Drink 1 teaspoon 5 times a day.

• Blood red geranium

Pour 2 teaspoons of herb into 2 glasses of boiled, but cold water, leave overnight, drink everything during the day.

Folk remedies for uterine contractions are good because they force the body to actively recover during the postpartum period on its own, without the use of synthetic drugs, the effect of which on the child (through breast milk) and on the health of the young mother has not yet been fully studied.

Massage

In some cases, uterine contraction is stimulated from the inside when the doctor gives the woman a special massage every two hours in the first two days after childbirth. Smooth movements apply pressure to the uterus. Depending on the individual characteristics of the body, this procedure can be very painful, but useful.

Homeopathy

In order for the uterus to contract faster, homeopathy is used, the main advantage of which is that it mobilizes the body’s own forces and does not contain any synthetic, chemical substances.

Among the well-proven drugs, the following can be noted: Millefolium, Hina (excessive bleeding), Ergot (perfectly contracts the uterus, but can provoke the development of thrombosis, phlebitis, abscess), Sabina (distinguished by the absence of side effects), Ipecac (helps cope with weakness after childbirth ), Sekale, Phosphorus, Hamamelis, Ferrum phosphoricum, Staphysagria (promotes healing of the uterus).

Exercises

If the doctor allows it, from the first day after childbirth you can perform simple but very useful physical exercises to contract the uterus after childbirth, which will not require much effort and time from the woman. The sooner you start doing them, the lower the risk of a protracted recovery period.

1. Lie on the floor on your back. Relax. Bring your legs together. Bend and unbend them at a calm pace. Do 10 times.
2. At any free time, tuck and relax your toes.
3. Lie on the floor on your back. Relax. Straighten your legs. Pull your toes toward you as much as possible.
4. Breathing exercises for contracting the uterus help well, which can be done several times daily. Lie on your back. Bend your legs. Breathe deeply and evenly. Connect your abdominal muscles to this process. Raise the abdominal wall as you inhale and lower it as you exhale. Help yourself with sliding movements of your hands towards the pubic bone from the navel.
5. Exhaling, squeeze your pelvic muscles and pull your navel as close to your chest as possible. Concentrate on the sensations in your lower abdomen. Hold your breath for 10 seconds.
6. Such exercises must necessarily include Kegel exercises: alternately strain (squeeze as much as possible) the muscles of the anus and vagina.
7. Exercise regularly to promote postpartum uterine contractions. Prepare an exercise ball. You will need to perform the exercise on a non-slip floor. Sit on the ball, squeeze your intimate muscles. In this position, raise your leg and hold it suspended for about 10 seconds. Repeat the same movements with the second leg.
8. Sitting on a gymnastic ball, perform circular movements with your pelvis in both directions.
9. Sitting on the ball, swing in different directions.

Exercises for rapid contraction of the uterus after childbirth should not be performed by those who have had stitches. First you will need to wait for them to heal completely.

Indications for surgery

Indications for surgery arise before the onset of contractions (antenatal) and during labor (early amniotomy). Before birth, the procedure is carried out under the following circumstances:

• post-term pregnancy;
• gestosis: swelling, cramps, protein in urine, high blood pressure;
• early placental abruption;
• fetal death;
• Rh conflict, rapid increase in antibodies in the mother’s blood;
• chronic diseases of the mother (diabetes, hypertension, pathologies of the kidneys and other internal organs), which make it impossible to continue pregnancy;
• a long period of false contractions, which cannot progress to a further phase - the appearance of periodic contractions of the uterus, turning into pushing.

After amniotomy, natural labor begins within 12 to 18 hours and ends with the successful birth of the baby. In the absence of uterine contractions, labor is stimulated with medications.

Amniotomy during childbirth is performed in the following situations:

• weak labor activity - in 90% of cases after a puncture, labor takes place within 2 hours; in the absence of contractions, stimulation is indicated;
• rapid labor;
• absence of natural opening of the membranes and leakage of amniotic fluid when the cervix is ​​dilated from 7 cm;
• polyhydramnios, which is often associated with incoordination and weakness of labor;
• in case of oligohydramnios, when contractions are usually weak, a puncture is made after the cervix is ​​dilated by 4 cm;
• labor during gestosis, post-term pregnancy;
• multiple pregnancy: the bladder where the second fetus is located is pierced 10 minutes after the birth of the first baby;
• low position of the placenta, in which bleeding developed due to contractions (after puncture of the bladder, the baby’s head presses the damaged vessels of the placenta, which stops the bleeding).

Inflammation of the uterus and its appendages

One of the most common postpartum diseases is endometritis (endomyometritis) - inflammation of the uterus.

. As a rule, it is accompanied by inflammation of the fallopian tubes, ovaries and uterine appendages (salpingoophoritis).

Endometritis can be caused by cesarean section, placenta remains, complicated childbirth, or curettage of the uterine cavity. Microbes entering the uterus from the vagina cause inflammatory processes. This happens especially often if a woman suffers from bacterial vaginosis, chlamydia, or cytomegalovirus is present in the blood.

The infection appears approximately 1-5 days after birth, sometimes on 6-7 days. Women in labor experience hyperthermia up to 38-39C, chills, deterioration of general tone, nausea and vomiting, increased pulse and heartbeat. Inflammation is accompanied by severe pain in the lower abdomen, radiating to the anus and lumbar region. The genital tract discharge changes from bloody to serous-purulent, sometimes bloody, with a characteristic unpleasant odor. The uterus is enlarged and painful.

Sometimes the infection spreads beyond the pelvis, then sepsis and peritonitis occur.

The duration of treatment for inflammation is from 7 to 10 days. The specialist prescribes intravenous antibiotics (clindamycin, metronidazole, gentamicin), biostimulants, immunostimulants (decaris), hormones and vitamins.

Methodology

If amniotomy is performed as planned (for example, with oligohydramnios), half an hour before the intervention the woman needs to take an antispasmodic (No-Shpu, Drotaverine, Papaverine). The expectant mother is located on the gynecological chair. The procedure is performed outside of contraction. An obstetrician-gynecologist wearing sterile gloves treats the external genitalia with an antiseptic. Next, he conducts an intimate examination, dilates the vagina and inserts a jaw (half of a tweezer with a hook).

Using a hook, the doctor carefully grabs the membrane of the bladder and gradually pulls it towards himself until a puncture is made. He moves the parts of the bladder apart and releases the water slowly to prevent particles of the placenta and the baby’s arms from falling out.

What is pathology

Prolapse of the genital organs is a change in the relative location of the uterus, appendages, vaginal walls, pelvic floor muscles and nearby structures - the bladder, rectum, etc.

Normally, the uterus is held almost in the center of the pelvic cavity with the help of ligaments and a frame. The latter consists of the muscles of the perineum. The ligaments support the uterus both above and in the middle, and also fix it in a certain relationship to the bladder and rectum. That is why, when the position is disturbed, various disorders of urination, defecation, etc. occur.

Most often, the uterus descends, “prolapses” through the pelvic cavity, i.e. The level of the cervix gradually becomes lower, followed by the body of the organ itself. As a result, you can even palpate the parts yourself without inserting your fingers into the vagina. At the final stage, the uterus falls out completely and almost constantly outside the genital slit, between the inner surfaces of the thighs, and a “sac” is determined. Its surface is the walls of the vagina, and inside is the uterus, often along with the appendages.

Consequences and possible complications

Any interference in the natural course of childbirth is undesirable and can lead to serious consequences for the mother and fetus. This also applies to amniotomy. Complications of the operation are associated with the disruption of the integrity of blood vessels, which is stressful for the body, as well as the stress experienced by the fetus.

Complications lead to the following conditions:

• weak or rapid labor, which will require drug therapy;
• bleeding due to touching large blood vessels when opening the bladder;
• infection of the fetus, which is no longer protected from the outside world;
• prolapse of the baby’s umbilical cord, arms or legs;
• deterioration of the child’s well-being due to a sudden, unplanned rupture of water.