home Consultations How many fingers does the uterus open before childbirth? How to speed up the process of childbirth: stages of cervical dilatation, methods of stimulation at different stages

How many fingers does the uterus open before childbirth? How to speed up the process of childbirth: stages of cervical dilatation, methods of stimulation at different stages

The uterus is the most important organ in the female body, which is responsible for bearing and giving birth to a child. In essence, it is a muscular organ, a receptacle for the fetus. It is represented by three parts - bottom, body, neck. The cervix is the part of the uterus that is responsible for both the onset of labor and its prevention. First, it helps to retain the fetus, prevents descent and premature birth. Then the cervix dilates before labor, which facilitates movement through the birth canal. This determines whether childbirth will proceed normally or pathologically. The uterus must be mature.

It is important for every woman to know and understand the causes, signs and mechanism of uterine dilatation, which will make it possible to distinguish the pathological process from the natural one. With at least minimal knowledge, a woman can take timely measures. A lot also depends on a woman’s actions - if you promptly inform your doctor about suspicions and point out pathological signs, you can take measures to prevent many pathologies. At a later date, you can take an active part in the preparatory process.

Causes

Traditionally, there is a division of all possible causes into natural and pathological. The normal course of pregnancy is accompanied by a closed state of the uterus, which contributes to the reliable retention of the fetus, ensures full development, and protection of the effects. Later, the canal is completely freed and allows the fetus to exit. The reason for this is changes in the cervix, leading to a partial replacement of muscle tissue with connective tissue. Collagen fibers are also actively formed, due to which the passage becomes softer and more elastic, as a result of which the tissues acquire greater stretchability.

The reason for the opening is a decrease in the length and other parameters of the neck, as a result of which the structure becomes loose and a gap is formed. Preparation is an advance process that begins at week 33. The uterus becomes looser and softer, and the position of the fetus decreases. From the inside there is constant pressure on the uterus, it begins to gradually open.

But there are many reasons that contribute to the pathological process. If dilatation occurs ahead of schedule, there is a risk of premature birth, in which the baby is completely immature.

How to prepare the cervix for dilatation?

In everyday practice, specialists are increasingly faced with uterine immaturity. Therefore, preparatory measures are needed. This issue becomes especially important at 40 weeks, when labor should begin and the placenta gradually dies. The risk of hypoxia increases sharply. With this turn of events, artificial stimulation is resorted to.

In many ways, the success of preparation for disclosure depends on the woman herself. She must maintain a high level of activity and be sure to exercise. The load must be dosed. There are many programs for pregnant women that promote both physical and psychological preparation for childbirth. Physical exercises, specially designed complexes, stimulate the activity of the uterine muscles and receptors.

The effectiveness of physical activity is explained by the fact that the uterus is a muscular organ, which also requires training. You need to practice breathing exercises, belly breathing, practice relaxation and meditative techniques that make it possible to relax and concentrate. With the help of exercises, you can learn to control the relaxation of some muscles and the relaxation of others. Special means are also used that promote opening, for example suppositories, tablets. Their action is aimed at softening tissues and forming connective tissue layers.

You can also prepare the uterus for childbirth using medicinal or non-medicinal methods. In the first case, drugs are administered in various ways. Most often, local agents are used, the action of which is based on irritation and stimulation of receptors. For example, they use special medications, resort to the use of a stimulating catheter, and kelp sticks.

Symptoms

Once the process of disclosure has begun, it can proceed completely unnoticed. Often, women end up in the maternity hospital already having a dilation of 1-2 cm. It happens so unnoticed that the woman does not even suspect it. This is a sign of physiological maturity. Stretching, tingling, and a feeling of heaviness are rarely observed.

The sign that most accurately and reliably indicates the presence of an opening is the release of a mucus plug.

A dangerous symptom may be the rupture of amniotic fluid, which indicates the need for urgent hospitalization and delivery to the maternity hospital. If labor does not begin within 6-8 hours, dilatation must be stimulated, since a prolonged stay of the fetus without amniotic fluid is fraught with serious consequences for both the baby and the mother. Possible infection, hypoxia, and death.

If the dilatation is pathological and occurs long before birth, symptoms may also not be noticed. Therefore, it is important to consult a doctor in a timely manner so that he can identify possible pathology and prevent it.

The initial stages are completely invisible. Only if the mucus plug has come away is this considered an indicator that most accurately indicates dilation.

How long does it take for the cervix to dilate?

It is determined by whether a woman is giving birth for the first time or repeatedly. In primigravidas, dilation can be achieved after 8-10 hours. For repeat mothers, this process is reduced to 6-7 hours.

Periods and phases of cervical dilatation

Three periods are known. The initial stage is latent. Contractions begin. They are usually irregular and not strong. Contractions are not painful, and no significant sensations occur. Often women who are not in the maternity hospital endure this period on their feet, going about their usual activities and not noticing contractions. The latent period can last from several hours to several days.

At this time, you cannot listen to your feelings. It is also not recommended to wait for contractions. You should try not to notice them, but it is better to be under the supervision of medical personnel. During this time, you should try to relax as much as possible. You can meditate, do breathing exercises, listen to soothing music, or just sleep. There is no need to waste energy in vain, you need to try to preserve and increase it, since a lot of it will still be needed. There is no need for medication yet. But your doctor can take action if there is a risk of complications. Most often they resort to artificial stimulation of labor.

The second period is called the phase of active disclosure, accompanied by the rapidity of the process. Characterized by an increase in the intensity of contractions and a reduction in the interval between them. It is at this stage that the amniotic fluid should pour out and the bladder should burst. The dilatation is 4-8 cm.

Gradually, and sometimes rapidly and quickly, the third stage begins, and the uterus opens to its fullest extent. There should be a doctor nearby who will supervise.

Sensations when the cervix dilates

Changes begin around 38-40 weeks. Aging of the placenta is observed, accompanied by the release of hormones, which stimulate the cervix to open. Significant transformations occur in the body, but no new sensations are experienced. Sometimes there may be pain, a feeling of pressure indicating descent. Sometimes women experience hormonal imbalance, which manifests itself in the form of sudden mood swings, irritability, anxiety, or vice versa, euphoria. But these sensations pass very quickly.

Later, after the fetus has descended sufficiently, painful sensations in the lower abdomen and false contractions may be observed, which represent prenatal hypertonicity of the uterus. During this period, the uterus begins to contract intensively and gradually opens. The first - the latent period of opening usually passes without pain. In the second, active period, pain occurs.

Pain

Opening is divided into 2 phases: latent and active. Usually the latent phase occurs painlessly, while the second, active phase, already passes with a feeling of pain. In fact, this pain is natural, but nowadays not every woman can endure it, so doctors are forced to resort to pain relief. Typically, intense pain occurs when dilation exceeds 5 cm.

Discharge

First the plug comes off. Yellow mucous discharge is also possible. At the end of the active phase, amniotic fluid is released. If the cervix is dilated by about 8-10 cm, this is a timely effusion. If the dilation is approximately 7 cm, the effusion is early. If the cervix is opened by 10 cm or more and there is no rupture of water, it is necessary to perform an amniotomy, at the entrance of which the wall of the bladder is pierced.

Nausea

Nausea is rare: as a reaction to hormonal shifts. Nausea rarely occurs when the cervix is dilated. It can sometimes occur as a reaction to pain, or as a side effect of medications.

Blood

There is no blood when it opens. The appearance of blood indicates a pathological process, a rupture of the perineum, other injuries, bleeding.

Cervical dilatation without pain or contractions

Painlessness is observed in the latent phase. When the opening moves into the next stage, painful sensations arise. Pathological disclosure is usually painless, so you need to undergo timely examinations. The cervix can open without contractions, especially during the latent period.

Dilatation of the cervix in primiparas

The duration is determined by whether the woman is primiparous or multiparous. Primiparas do not have such experience; the body only adapts to new and unknown conditions. Changes in activity and new conditions cause additional stress in the body, like any other new and unexpected type of activity. The body spends part of its resources on adapting to new conditions. The muscular system and connective tissue are not trained; nerve impulses enter the uterus more intensely, stimulating its contractile activity. This slightly increases sensitivity and pain.

Psychological readiness and self-regulation are at a lower level than in multiparous women. In addition, lack of experience and lack of knowledge of what actions to perform take their toll. Therefore, you need to relax as much as possible and follow the doctor’s recommendations. For first-time mothers, it lasts up to 8-10 hours.

Dilatation of the cervix in multiparous women

For those who have given birth before, the uterus is more prepared, stretched, and activated. In addition, muscle memory is preserved, which reproduces the process of pushing out the fetus, similar to the previous experience. Contractile activity is better regulated by nerve impulses, since the reflex arc has already been laid out and there is experience on which the nervous system can rely to produce reflexes. The process becomes more regulated and automatic with the simultaneous activation of the body’s self-regulation mechanisms. The muscles of the uterus and pelvic area are also more prepared, developed and activated. Therefore, in multiparous women, it takes approximately 6-7 hours to fully dilate, of which the latent phase accounts for 5-6 hours, and the active phase lasts only 1-2 hours. The process is less painful, also due to physical and psychological readiness for the upcoming pain.

Premature dilatation of the uterus in the early stages

It often happens that the uterus cannot cope with its functions and may open prematurely. This is fraught with premature birth and miscarriages. This pathology is called isthmic-cervical insufficiency, in which the functional activity of the cervix and isthmus of the uterus is impaired. The obturator function is not performed, as a result of which the cervix softens and shortens, losing its ability to support the fetus. Most often, this phenomenon is observed in the 2-3 trimester. If at 20-30 weeks the cervix is shortened to 25 mm, we are talking about cervical incompetence.

In this case, measures must be taken to maintain the pregnancy. Usually, measures are taken to prolong pregnancy. This is a wait-and-see strategy, which makes it possible to wait for the fetus to mature and be able to live outside the uterus. Traditional and non-traditional therapy is used.

Cervical dilatation at 30, 40 weeks of pregnancy

The closer the birth is, the greater the likelihood that the fetus is ripe. Accordingly, even premature birth carries less danger. The cervix should gradually dilate. The ideal option is when labor begins immediately after dilatation, but in practice it often happens that the cervix dilates without labor occurring yet. Many women do not even know about dilatation when they get to the maternity hospital. However, most births end successfully. The degree to which the uterus was dilated when entering the maternity hospital does not in any way affect the birth process itself. It is important that it opens during childbirth. Typically, normal dilation occurs at a rate of 1 cm per hour; in multiparous women, the dilation rate is higher. Usually the cervix becomes soft and ready for childbirth at 37 weeks, and the uterus begins to prepare for this at 30-32 weeks.

Degree of cervical dilatation

The initial stage is painless, with contractions. The second stage - the degree of disclosure is approximately 6-8 cm. Lasts 4-5 hours, ends with a gradual transition to the third stage, during which complete rapid disclosure occurs. This stage symbolizes the beginning of labor. Accordingly, there are 3 degrees of disclosure - initial (1-4 cm), medium (4-8 cm), full disclosure (8-10). Sometimes a dilation of up to 12 cm is required.

Dilation of the cervix to half a finger, 1, 2, 3, 4 fingers

Indicators of 10 cm are considered normal for childbirth, which corresponds to 5 fingers. If the uterus is closed, there is no lumen, and during palpation the doctor cannot move the finger deeper. Opening to half a finger means the possibility of passing half of the obstetrician's finger, to 1, 2, 3, 4 fingers - accordingly, there is space for passing 1, 2, 3, 4 fingers. If she misses at least one finger, the uterus can be considered mature.

Full dilatation of the cervix

Full dilation is the third phase, which ensures the baby's unhindered exit. Dilation from 10 cm can be considered complete. Sometimes ruptures occur, requiring stitches. If there is a threat, an emergency caesarean section is performed.

Consequences and complications

Dilation may be complicated by weak contractions, during which the cervix practically does not dilate and remains at the prenatal stage. This often happens with polyhydramnios and multiple births. If the uterus is overstretched, its ruptures, decreased tone and contractile activity are possible. This also leads to a weakening of labor and the risk of fetal hypoxia.

How is cervical dilatation determined and checked?

Since the dilatation is asymptomatic, investigation is required. They are mainly examined by palpation - the obstetrician probes with his finger. Dilation is determined by the number of fingers that can freely pass through the cervix. This method is outdated, but is still used today in almost all institutions. Measurements in centimeters are considered more accurate. Usually, if 1 finger passes freely, this indicates a dilation of 2-3 centimeters, respectively, 2 fingers are equated to 3-4 cm. Full dilation is indicated when the uterus dilates by 4 fingers or 8 cm. Full dilation is determined visually: when smoothing the neck, thin edges and free passage of 5 fingers.

To assess dilation, the Bishop scale is used, a gynecological examination, during which measurements are taken. Then the data obtained is presented in the form of a graph on which the birth process is visualized. The graph is called a birth partogram. It clearly demonstrates changes; a sharp rise indicates the effectiveness of childbirth.

Cervical dilatation on ultrasound

The dilatation may be noticeable on ultrasound. It is necessary to attend scheduled examinations, which will make it possible to identify pathology and take the necessary measures.

Stimulation of cervical dilatation

This involves the use of various methods that speed up the opening process. There are medicinal and non-medicinal methods.

How to speed up cervical dilatation at home?

Promotes high levels of physical activity. Food should contain plenty of fresh vegetables and fruits. You need to take a decoction of raspberry leaves or tea with the addition of raspberry leaves. It is important to stimulate the nipples, massage the earlobe and little finger. Sex helps open the cervix because it is a natural stimulant. In addition, semen contains large amounts of prostaglandins, which are also strong stimulants.

Exercise is important. Squats make a huge contribution. Exercises with special balls and gymnastics equipment have a positive effect. Breathing exercises are very important, as they not only stimulate the uterus and improve blood circulation, but also trigger a number of biochemical transformations. Hormonal levels and neuropsychic state change. At the same time, tense areas relax, and relaxed areas become toned. Correct regulation of the contractile activity of muscles, including the uterine muscles, occurs. Breathing, especially with the stomach, stimulates the production of prostaglandins and nerve impulses, which directly affect the activity of the uterus. Smooth muscles are also trained and strengthened.

Meditation, relaxation practices, staying in silence, concentration and internal contemplation are important. These are the basic techniques of hatha yoga, which allow you to gain control over your own body and consciously regulate your feelings and sensations. Breathing and relaxation practices relieve excess tension and stress. As a result, muscle tension is relieved and pain goes away. Mental attitude plays a vital role. Many women are afraid of pain and consciously or unconsciously slow down the birth process. Breathing and relaxation make it possible to get rid of internal blocks, block fear and reduce the threshold of pain sensitivity.

Also shown are aromatherapy sessions, taking a warm bath with essential oils, color therapy, water treatments, music therapy, and sound-vibration therapy.

Cervical dilatation methods

There are conservative methods that use pharmaceutical agents aimed at stimulation. Radical methods can be used in emergency cases: amniotomy, perineal incision. There are also non-medicinal products: kelp sticks, special catheters, gels and oils, suppositories. Physical exercise, sex, meditation, breathing techniques, and local candles work well.

Catheter and foley balloon to dilate the cervix

A special catheter, which is presented in the form of a tube with a balloon. Injected into the cervix for 24 hours. The balloon is gradually filled with air, which expands the walls of the uterus. Has many disadvantages.

Can be described as a catheter containing a balloon. It is filled with air. It is inserted for a day, and gradual opening occurs due to the expansion of the cervical wall. The likelihood of developing an infection increases significantly.

Cervical dilation gel

A special gel containing prostaglandins is injected into the cervical canal. Hormonal stimulation occurs, the effect can be achieved after 2-3 hours.

Physical exercise

Squats are effective exercises. Twisting and jumping are contraindicated. At the same time, during practice you need to strive for maximum relaxation and control your breathing. You need to perform static exercises that train willpower and endurance. It is better to perform the exercises in a calm environment, with relaxing music. There are many video lessons for pregnant women, where all the exercises are shown clearly, selected in the optimal sequence, and smoothly transition from one to another. Such video lessons effectively combine static and dynamic complexes, breathing exercises and meditative practices.

The best option is yoga, pranayama (breathing exercises and internal contemplation), qigong, meditation, swimming, and water aerobics. You can sign up for special preparatory courses for pregnant women, where physical and psychological preparation of expectant mothers is carried out; training is carried out under the supervision of experienced specialists who can choose an individual pace and exercise regimen. Special gymnastic balls and fitballs are used. At home, you can train even with the help of a regular staircase, making frequent ascents and descents.

Physical exercises will be more effective if you start preparing early. And even better - long before pregnancy. Trained muscles are the key to quick and successful opening of the uterus, since it is also essentially a muscle. But if preparations were not started when planning the pregnancy, it’s okay. It is better to start late than not to exercise at all. They are beneficial even if you start regular practice in the last weeks.

Fitball for dilation of the cervix

In modern clinics, it has long been recommended to take not the traditional position on a horizontal plane, but a vertical one. A sitting position is also recommended. But the surface should not be hard. The ideal fitball is a large inflatable ball, which is used in sports and gymnastics. If you sit on it and perform special exercises, you can relax tense areas and tighten those areas that will be in good shape. It is better to spread your legs apart. Nervous and hormonal activity is activated, and the uterus is more stimulated. At the preparatory courses you can receive special training in exercises and positions on a fitball.

Squats to open the cervix

Squats stimulate the neck, both by activating nervous activity and mechanically. You need to perform regular squats, or squats according to a special pattern. The time gradually increases. First, you need to perform each stage for 10 seconds. Then increase the time to 1 minute for each stage. At the first stage, we slowly squat. The duration of the squat should be 10 seconds, that is, we should completely lower ourselves in 10 seconds. Then we sit in this position for another 10 seconds, and begin to relax as much as possible. Then we rise partially. You need to stop in a position so that your thighs are parallel to the floor. We remain in this position for 10 seconds, then slowly, over the next 10 seconds, we lower ourselves down. We rest, relax in a squat for another 10 seconds. We begin a slow rise for 10 seconds. Then rest for 10 seconds and begin squatting again. After we managed to complete 10 such squats in one approach, we move on to the next stage - the duration of each stage increases to 20 seconds, then to 30, 40, 50 seconds and one minute. After squatting 10 times at a slow pace, you definitely need to squat at a fast pace. The speed should reach 50 squats per minute. If this doesn’t work, it’s better not to squat completely; you can only lower yourself partially. Gradually you need to increase the depth of the squats.

Meditation to open the cervix

The “Shavasana” pose used in yoga is effective. You need to lie on your back, legs and arms slightly apart. Eyes closed. You can turn on relaxing music and an aroma lamp. The sounds of nature are good, especially the sound of a sea wave, the sounds of rain, and a waterfall. Birdsong, animal sounds, and instrumental music may be suitable. You need to try to relax as much as possible, not think about anything. Muscles should be relaxed consciously, directing attention to them. First, let's focus on the legs. We feel how the leg muscles relax, become soft and heavy. Relaxation covers the tips of the fingers, is understood along the shin, along the thigh. The kneecap drops. The pelvic area, perineum, and uterus relax. Both legs are relaxed, the pelvic area is relaxed, gradually relaxation covers the stomach, back, the lower back, and the muscles along the spine relax. The chest and arms relax. Relaxation of the hands rises from the fingertips, glides along the wrist, elbows, forearm, relaxes the elbow, shoulder, collarbone.

Once again, walk your attention throughout your body, feel the relaxation in every area. Particular attention should be paid to the face: feel how your forehead, nose, eyes, ears, cheeks relax. The chin is relaxed, the lower jaw is relaxed and may be slightly open. Eyes closed. You are motionless and relaxed, your whole body is heavy. There are no thoughts in my head. There is only silence. If thoughts come, you need to let them go, not delay them. This meditation should last at least 30 minutes. There is no maximum limit. Ideally, it should be up to three hours. After this, you need to lie down and do not rush to get up. You can drink tea or herbal decoction. Raspberry leaf tea is ideal.

There are also video lessons and audio materials for meditation, which explain in detail all the nuances and provide meditation accompaniment. The slow, calm voice of a specialist smoothly guides your attention, directing it to the right areas, reminding you to relax and not think. The voice does not accompany all meditation: it is effectively combined with moments of silence, a special background and musical accompaniment are selected. The rhythm intensifies and fades, which creates the desired tonality.

Drugs for dilation of the cervix

Various drugs are used. Oxytocin, intramuscular administration of sinestrol, and suppositories with prostaglandin have proven themselves well. Enzaprost is also administered intravenously. The use of synthetic prostaglandin is allowed. The dosage and frequency of administration can only be determined by a doctor, since it is strictly individual and determined by the results of the partogram.

Pills

Miropristone is used. It stimulates the contractile activity of the myometrium. Take 1 tablet every day, under the strict supervision of a doctor.

Oxytocin-MEZ is often used to stimulate uterine dilation and induce labor. This is a solution for intramuscular and intravenous administration.

The opening can be facilitated by no-spa, which is an antispasmodic drug, relaxes the muscles and makes them more elastic. Prescribed 1-2 tablets 2-3 times a day or in the form of injections.

Papaverine can be used both in the form of injections and in the form of tablets. The dosage depends on the speed of dilation and the condition of the uterus, and is determined exclusively after palpation and gynecological examination. Helps reduce blood pressure and relax smooth muscles.

Caulophyllum 30 is a homeopathic remedy that is used to induce labor. It makes giving birth much easier and reduces the pain threshold. A remedy of Indian origin that has long been used in Indian medicine. Significantly reduces the risk of cesarean section, the need for oxytocin disappears. Eliminates trembling, fatigue and thirst, gives strength.

Castor oil, when taken orally, promotes rapid expansion. In the early stages it has abortifacient properties.

Many women, after being discharged from the hospital, say that they were given too many injections. And no one knows what drugs are used for this. In order to avoid unnecessary fears, it is better to understand this.

First of all, drugs are administered for pain relief. These are narcotic drugs that are administered in various ways. Most often - intramuscularly, intravenously. Epidural anesthesia (an injection in the back) is also used. It is the safest type of pain relief, since it does not affect either contractile activity or the fetus, the drug does not enter the blood. Other types are usually used only if there are 2-3 hours left before the baby is born, this eliminates the risk of developing hypoxia.

For labor weakness, stimulation medications are used. An amniotomy is often mistaken for an injection - a puncture of the amniotic sac. Depending on the situation, symptomatic remedies are used - to reduce swelling, pressure, heartbeat, and to stimulate the fetus.

If the contractions are long and painful, but unproductive, the woman weakens. She is given a sleep-rest drug, which allows her to quickly regain strength. This type of sleep lasts 2 hours. After it, labor activity intensifies.

Injections are often used to prevent or stop bleeding. In case of surgery, many injections are also used. Injections are also given to remove the placenta and postpartum rest.

A dropper is used to stimulate opening. It is based on saline solution or glucose, which maintains and nourishes the body. If necessary, drugs of various effects are added to the droppers.

Suppositories for dilation of the cervix before childbirth

Used for intravaginal administration with a high content of synthetic prostaglandin. Their effectiveness is high: the result is achieved within 2-3 hours.

Laminaria sticks for dilating the cervix before childbirth

They are sticks made from sea kelp. Dried algae, small in size, is inserted into the neck. Gradually it becomes saturated with moisture and expands, the cervix also expands. As many sticks are inserted as required to completely fill.

Manual dilatation of the cervix

It involves artificial dilatation by inserting and expanding a finger during a gynecological examination.

Pessary and ball dilation of the cervix

It is used to prevent early dilation and maintain pregnancy. The pessary is presented in the form of a plastic device that provides support for the organs. It is formed from several rings connecting to each other. Provides reliable support and can even be performed on an outpatient basis. Duration – several minutes. For insertion, the ring is lubricated with gel and inserted into the vagina. After the procedure, sex is contraindicated. Every 2-3 weeks you need to monitor the state of the vaginal microflora and conduct ultrasonography.

To mechanically open and stimulate the uterus, a special plastic ball is inserted into the cervix and left for a day.

Raspberry leaf for cervical dilatation

Raspberry leaves are very effective in dilating the cervix. Can be used in tea or as a decoction.

Cervical dilatation according to Rogovin

The full name is the Rogovin-Zanchenko method. This is an external measurement method that allows you to assess the degree of opening of the external pharynx. At the height of the contraction, measure the distance from the xiphoid process to the fundus of the uterus, in centimeters. The resulting indicators are subtracted from 10 cm to obtain height indicators. The method is approximate.

How to prevent cervical dilatation during pregnancy?

Prolongation means are used: bed rest. Emotional peace, medications, especially sedatives. Treatment is required to produce surfactant in the fetal lungs, which accelerates their maturation. Surgical treatment methods are also possible, in particular, suturing the cervix, or using a special obstetric pessary.

Ring on the cervix to prevent dilatation

In order to prevent premature dilatation, a special plastic ring is inserted into the uterus. It reduces the load. Administration can be done on an outpatient basis, on an empty bladder. To prevent the uterus from contracting, you can take an antispasmodic before the procedure. The ring is lubricated with glycerin and inserted into the vagina. Then they are turned in the desired direction. The doctor will do everything necessary. The patient will only need to attend an appointment every 2-3 weeks for a bacteriological examination. You also can't have sex. Dilatation of the cervix before childbirth occurs naturally, since the ring is first removed.

Childbirth is the process of expulsion or extraction from the uterus of a child and placenta (placenta, amniotic membranes, umbilical cord) after the fetus reaches viability. Normal physiological childbirth occurs through the natural birth canal. If the child is removed by caesarean section or using obstetric forceps, or using other delivery operations, then such birth is operative.

Typically, timely birth occurs within 38-42 weeks of obstetric period, counting from the first day of the last menstrual period. At the same time, the average weight of a full-term newborn is 3300±200 g, and its length is 50-55 cm. Childbirth occurs at 28-37 weeks. pregnancy and earlier are considered premature, and more than 42 weeks. - belated. The average duration of physiological labor ranges from 7 to 12 hours for primiparous women, and from 6 to 10 hours for multiparous women. Labor that lasts 6 hours or less is called rapid, 3 hours or less - rapid, more than 12 hours - protracted. Such births are pathological.

Characteristics of normal vaginal delivery

Singleton pregnancy.
Head presentation of the fetus.
Full proportionality between the fetal head and the mother's pelvis.
Full-term pregnancy (38-40 weeks).
Coordinated labor activity that does not require corrective therapy.
Normal biomechanism of childbirth.
Timely release of amniotic fluid when the cervix is dilated by 6-8 cm in the active phase of the first stage of labor.
Absence of serious ruptures of the birth canal and surgical interventions during childbirth.
Blood loss during childbirth should not exceed 250-400 ml.
The duration of labor for primiparous women is from 7 to 12 hours, and for multiparous women from 6 to 10 hours.
The birth of a living and healthy child without any hypoxic-traumatic or infectious damage and developmental abnormalities.
The Apgar score at the 1st and 5th minutes of the child’s life should correspond to 7 points or more.

Stages of physiological childbirth through the natural birth canal: development and maintenance of regular contractile activity of the uterus (contractions); changes in the structure of the cervix; gradual opening of the uterine pharynx up to 10-12 cm; advancement of the child through the birth canal and its birth; separation of the placenta and discharge of the placenta. There are three periods during childbirth: the first is the dilation of the cervix; the second is the expulsion of the fetus; the third is subsequent.

The first stage of labor - dilatation of the cervix

The first stage of labor lasts from the first contractions until the cervix is fully dilated and is the longest. For primiparous women, it ranges from 8 to 10 hours, and for multiparous women, 6-7 hours. In the first period there are three phases. First or latent phase The first stage of labor begins with the establishment of a regular rhythm of contractions with a frequency of 1-2 per 10 minutes, and ends with smoothing or pronounced shortening of the cervix and opening of the uterine pharynx by at least 4 cm. The duration of the latent phase is on average 5-6 hours. In primiparous women, the latent phase is always longer than in multiparous women. During this period, contractions are usually not painful. As a rule, no drug correction is required during the latent phase of labor. But in women of late or young age, if there are any complicating factors, it is advisable to promote the processes of dilation of the cervix and relaxation of the lower segment. For this purpose, it is possible to prescribe antispasmodic drugs.

After the cervix dilates by 4 cm, the second or active phase the first stage of labor, which is characterized by intense labor and rapid opening of the uterine pharynx from 4 to 8 cm. The average duration of this phase is almost the same in primiparous and multiparous women and averages 3-4 hours. The frequency of contractions in the active phase of the first stage of labor is 3-5 per 10 minutes. Contractions most often become painful. Pain sensations predominate in the lower abdomen. When a woman is active (standing, walking), the contractile activity of the uterus increases. In this regard, drug pain relief is used in combination with antispasmodic drugs. The amniotic sac should open on its own at the height of one of the contractions when the cervix opens 6-8 cm. At the same time, about 150-200 ml of light and transparent amniotic fluid is poured out. If spontaneous discharge of amniotic fluid has not occurred, then when the uterine pharynx is dilated by 6-8 cm, the doctor must open the amniotic sac. Simultaneously with the dilation of the cervix, the fetal head moves along the birth canal. At the end of the active phase, the uterine os opens completely or almost completely, and the fetal head descends to the level of the pelvic floor.

The third phase of the first stage of labor is called deceleration phase. It begins after the uterine os is dilated by 8 cm and continues until the cervix is fully dilated to 10-12 cm. During this period, it may seem that labor has weakened. This phase in primiparous women lasts from 20 minutes to 1-2 hours, and in multiparous women it may be completely absent.

During the entire first stage of labor, the condition of the mother and her fetus is constantly monitored. They monitor the intensity and efficiency of labor, the condition of the woman in labor (well-being, pulse rate, breathing, blood pressure, temperature, discharge from the genital tract). The fetal heartbeat is regularly listened to, but most often constant cardiac monitoring is performed. During normal labor, the baby does not suffer during uterine contractions, and its heart rate does not change significantly. During labor, it is necessary to assess the position and advancement of the head in relation to pelvic landmarks. A vaginal examination during labor is performed to determine the insertion and advancement of the fetal head, to assess the degree of opening of the cervix, and to clarify the obstetric situation.

Mandatory vaginal examinations performed in the following situations: when a woman enters the maternity hospital; when amniotic fluid ruptures; with the onset of labor; in case of deviations from the normal course of labor; before anesthesia; when bloody discharge appears from the birth canal. One should not be afraid of frequent vaginal examinations; it is much more important to ensure complete orientation in assessing the correct course of labor.

Second stage of labor - expulsion of the fetus

The period of expulsion of the fetus begins from the moment the cervix is fully dilated and ends with the birth of the child. During childbirth, it is necessary to monitor bladder and bowel function. Fullness of the bladder and rectum interferes with the normal course of labor. To prevent the bladder from overflowing, the woman in labor is asked to urinate every 2-3 hours. In the absence of independent urination, catheterization is used. Timely emptying of the lower intestine is important (enema before childbirth and during a prolonged period). Difficulty or absence of urination is a sign of pathology.

Position of the woman in labor

The position of the woman in labor during labor deserves special attention. In obstetric practice the most popular are back birth, which is convenient from the point of view of assessing the nature of the course of labor. However, the position of the woman in labor on her back is not the best for the contractile activity of the uterus, for the fetus and for the woman herself. In this regard, most obstetricians recommend that women in the first stage of labor sit, walk for a short time, or stand. You can get up and walk both with intact and emptied water, but provided that the fetal head is tightly fixed at the pelvic inlet. In some cases, it is practiced for a woman in labor to stay in a warm pool during the first stage of labor. If the location of the placenta is known (according to ultrasound data), then the optimal location is position of the woman in labor on that side where the back of the fetus is located. In this position, the frequency and intensity of contractions does not decrease, the basal tone of the uterus remains normal. In addition, studies have shown that in this position the blood supply to the uterus, uterine and uteroplacental blood flow improves. The fetus is always positioned facing the placenta.

It is not recommended to feed a woman in labor during labor for a number of reasons: the food reflex is suppressed during labor. During childbirth, a situation may arise in which anesthesia is required. The latter poses a risk of aspiration of stomach contents and acute respiratory distress.

From the moment the uterine os opens completely, the second stage of labor begins, which consists of the actual expulsion of the fetus, and ends with the birth of the child. The second period is the most critical, since the fetal head must pass through the closed bony ring of the pelvis, narrow enough for the fetus. When the presenting part of the fetus descends to the pelvic floor, contractions are joined by contractions of the abdominal muscles. Attempts begin, with the help of which the child moves through the vulvar ring and the process of his birth occurs.

From the moment the head is cut in, everything should be ready for delivery. As soon as the head has erupted and does not go deeper after pushing, they proceed directly to the delivery. Help is necessary because, as the head erupts, it puts strong pressure on the pelvic floor and ruptures of the perineum are possible. During obstetric care, the perineum is protected from damage; carefully remove the fetus from the birth canal, protecting it from adverse effects. When the fetal head is brought out, it is necessary to restrain its excessively rapid advancement. In some cases they perform perineal dissection to facilitate the birth of a child, which avoids failure of the pelvic floor muscles and prolapse of the vaginal walls due to their excessive stretching during childbirth. Usually the birth of a child occurs in 8-10 attempts. The average duration of the second stage of labor for primiparous women is 30-60 minutes, and for multiparous women it is 15-20 minutes.

IN last years in some European countries the so-called vertical birth. Proponents of this method believe that in the position of the woman in labor, standing or kneeling, the perineum is easier to stretch and the second stage of labor is accelerated. However, in this position it is difficult to monitor the condition of the perineum, prevent its ruptures, and remove the head. In addition, the strength of the arms and legs is not fully used. As for the use of special chairs for vertical childbirth, they can be classified as alternative options.

Immediately after the birth of the child, if umbilical cord is not compressed, and it is located below the level of the mother, then a reverse “infusion” of 60-80 ml of blood occurs from the placenta to the fetus. In this regard, the umbilical cord should not be crossed during a normal birth and the newborn is in satisfactory condition, but only after the pulsation of the vessels has stopped. In this case, until the umbilical cord is crossed, the child cannot be raised above the plane of the delivery table, otherwise a backflow of blood from the newborn to the placenta occurs. After the birth of the child, the third stage of labor begins - the afterbirth stage.

The third stage of labor is the afterbirth

The third period (afterbirth) is determined from the moment of birth of the child until the separation of the placenta and the discharge of the placenta. In the afterbirth period, during 2-3 contractions, the placenta and membranes are separated from the walls of the uterus and the afterbirth is expelled from the genital tract. In all women giving birth in the afterbirth period, to prevent bleeding, intravenous drugs that promote uterine contraction. After birth, a thorough examination of the child and mother is carried out to identify possible birth injuries. During the normal course of the afterbirth period, blood loss is no more than 0.5% of body weight (on average 250-350 ml). This blood loss is physiological, since it does not have a negative effect on the woman’s body. After expulsion of the placenta, the uterus enters a state of prolonged contraction. When the uterus contracts, its blood vessels are compressed and bleeding stops.

Newborns are given screening assessment for phenylketonuria, hypothyroidism, cystic fibrosis, galactosemia. After the birth, information about the characteristics of the birth, the condition of the newborn, and the recommendations of the maternity hospital are transmitted to the antenatal clinic doctor. If necessary, the mother and her newborn are advised by specialized specialists. Documentation about the newborn is sent to the pediatrician, who subsequently monitors the child.

It should be noted that in some cases, preliminary hospitalization in a maternity hospital is necessary to prepare for delivery. In the hospital, in-depth clinical, laboratory and instrumental examinations are carried out to select the timing and method of delivery. An individual birth management plan is drawn up for each pregnant woman (mother in labor). The patient is introduced to the proposed delivery plan. Obtain her consent to the proposed manipulations and operations during childbirth (stimulation, amniotomy, cesarean section).

Caesarean section is performed not at the woman's request, since this is an unsafe operation, but only for medical reasons (absolute or relative). Childbirth in our country is not carried out at home, but only in an obstetric hospital under direct medical supervision and control, since any birth is fraught with the possibility of various complications for the mother, fetus and newborn. The birth is led by a doctor, and the midwife, under the supervision of a doctor, provides manual assistance at the birth of the fetus and carries out the necessary treatment of the newborn. The birth canal is examined and repaired by a doctor if it is damaged.

There are currently many methods on how to prepare the cervix for childbirth; folk methods and, of course, doctor’s prescriptions can help. First, let's figure out why this is necessary and whether it is necessary at all.

Uterus before birth

Before childbirth, the uterus undergoes changes necessary for a successful birth. The shape of the uterus resembles a large egg, with its sharp end directed downwards. Before childbirth, the excitability of the myometrium, the muscular layer of the uterus, increases, and precursors and episodes of uterine tension appear.

This tone of the uterus before childbirth leads to softening and thinning of its lower segment, the myometrium in the upper part of the uterus, on the contrary, thickens, the baby moves lower and its head or other presenting part descends into the pelvis. There is a drooping of the abdomen before childbirth, the abdomen seems to become smaller in size and does not put as much pressure on the mother’s diaphragm as before. The height of the uterine fundus decreases before childbirth; by the end of pregnancy it drops by about 5 cm and reaches a height of 35 cm above the womb.

Thinning of the lower segment of the uterus occurs simultaneously with ripening of the cervix. This is called softening of the uterus before childbirth.

Preparing the uterus for childbirth

A woman’s body does not always prepare for childbirth effectively enough on its own, and then there is a tendency to carry the pregnancy to term. It happens that labor begins despite the fact that the birth canal and the pregnant woman’s uterus are not ready for it, which leads to the fact that it takes a long time, is accompanied by injuries and ruptures of the cervix, and sometimes even ends with a caesarean section.

If the gynecologist at 39-40 weeks of pregnancy does not see any symptoms in you that the necessary processes of preparation for the birth of the baby are taking place in the body, and there are no signs of uterine dilatation before childbirth, they will begin to prepare you specially for childbirth.

Fortunately, there are now enough ways to soften the uterus before childbirth, but it is more correct to talk about preparing the cervix, rather than the uterus itself.

Cervix before childbirth

A prenatal cervical examination is carried out in the last weeks at each consultation visit. During pregnancy, the cervix is hard and long, the cervical canal is tightly closed, and is additionally blocked by a mucus plug. Such an immature cervix before childbirth in the last weeks is not the norm; its changes should begin at least 2 weeks before the due date.

What's happening to the neck?

It becomes softer and more elastic, the length of the cervix before childbirth is reduced by at least half. Softening of the cervix and its opening is accompanied by the passage of the mucus plug, mucous discharge from the genital tract and contractions - harbingers. The cervix unfolds anteriorly due to the softening of the lower segment of the uterus, becomes short and elastic, and now nothing prevents the birth of the baby; with the onset of labor, the mature cervix will easily open, its edges will be elastic enough for the baby to be successfully born.

Immature cervix

The term immature cervix before childbirth is used in cases where the due date has already approached, but the cervix is still hard, long, its cervical canal is closed, and it itself has not turned along the wire axis of the pelvis and is turned slightly posteriorly.

An immature cervix is a diagnosis.

It will interfere with childbirth. It is useless to stimulate labor when the cervix is immature; contractions will not be effective enough, the woman will only be exhausted, and labor will drag on for a day or more, and is unlikely to result in the birth of the baby without the help of doctors.

Of course, for the fetus, a long, painful, difficult birth is also not a benefit, but a harm; very often children suffer from a lack of oxygen during such births and are injured, just like their mothers - because the immature cervix before childbirth is a common cause of its ruptures during childbirth This is how a woman’s body works, even if the cervix does not open normally, the uterus will contract until either the cervix or the wall of the uterus ruptures, and the baby will crawl forward, once labor has begun, it must end, and no one has remained pregnant forever.

Preparing the cervix for childbirth

Preparing the cervix for childbirth becomes an urgent necessity if a woman is nursing. There are also situations when it is necessary to advance the due date for medical reasons, for example, if continuing pregnancy threatens the health of the mother due to gestosis, heart disease, or the baby experiences hypoxia and it is better for him to be born earlier.

How to prepare the cervix for childbirth?

Methods to prepare the cervix for childbirth can be divided into medical and folk. Despite the fact that there are many well-known folk methods that describe how to prepare the cervix for childbirth at home and without drugs, we do not recommend using any of them without consulting a doctor, because many are simply dangerous and can harm you and the baby.

Medical methods:

Softening of the cervix before childbirth occurs under the influence of prostaglandins. They can be obtained naturally or introduced externally.

Physical irritation of the cervix by pressure on the walls of the cervical canal, massage, stimulates the production of its own prostaglandins.

Examples of methods for stimulating cervical ripening:

In order to help the cervix ripen, kelp is introduced into its canal. These are thin sticks, no thicker than a match, which can expand tenfold when exposed to moisture. Kelp is made from seaweed. They are inserted into the woman’s cervical canal on a gynecological chair. The procedure is unpleasant and painful, but the next day or two will be even more fun. Rapidly increasing, the kelp exerts constant, ever-increasing pressure on the neck, swelling in its canal. The cervix quickly matures and softens, which is accompanied by contractions, pain in the lower abdomen, and mucous discharge.

The dilatation of the cervix before childbirth accelerates... during examinations by a gynecologist in the chair. You can hear from many successful mothers that after an examination to check the patency of the cervical canal, their mucous plug came away, and the process of preparing for childbirth accelerated.

The opening of the cervix before labor occurs quickly, although quite painfully, when using a gel containing prostaglandins. It is injected directly into the cervical canal, and it quickly softens, which is characterized by increased training contractions and precursors, which tires the pregnant woman.

The hard cervix before childbirth also softens with the use of antispasmodics and beta-blockers, these are tablets and injections, such treatment is used less frequently.

Traditional methods:

Sex before childbirth promotes the opening of the cervix, both due to mechanical stimulation and due to the fact that the man’s sperm is rich in prostaglandins. Orgasm itself, if the woman is ready, can trigger labor. Sex is contraindicated in the presence of placenta previa, as well as if the plug has come out or the water has broken.

Some herbs can also help cervical ripening, such as evening primrose oil, raspberry leaf, strawberry leaf, rose hips. Any traditional methods are fraught with pitfalls, there may be an allergy or intolerance to herbs, unusual reactions, so you should always consult a gynecologist to determine whether you need this or that treatment.

Increasing physical activity, walking up stairs, squatting and other similar recommendations require no less careful approach than taking medications or herbs. In case of pregnancy pathology, they can cause complications, for example, placental abruption.

Well, and most importantly, remember that an immature cervix is a diagnosis, that is, if you are told that everything is going well for you, you definitely don’t need to do anything. The body itself knows when to prepare for childbirth and how, everything happens naturally. And no matter how tired you are of pregnancy, no matter how tired you are of your stomach, there is no need to stimulate the onset of labor without clear indications for this; rely on the opinion of your doctor when making decisions.

Normal and timely labor never begins suddenly and violently. On the eve of childbirth, a woman experiences their precursors, and the uterus and its cervix are prepared for the birth process. In particular, the cervix begins to “ripen” and expand, that is, it enters the stage of opening of the uterine pharynx. Childbirth is a complex and lengthy process and largely depends on the interaction of the uterus, cervix and hormonal levels, which determines its successful completion.

The cervix is...

The lower part of the uterus is called its cervix, which looks like a narrow cylinder and connects the uterine cavity to the vagina. Directly in the cervix, the vaginal part is distinguished - the visible part, which protrudes into the vagina below its fornix. There is also a supravaginal part - the upper part located above the arches. The cervical (cervical) canal passes through the cervix, its upper end is called the internal os, and the lower end is called the external os. During pregnancy, there is a mucus plug in the cervical canal, the function of which is to prevent infection from entering the uterine cavity from the vagina.

The uterus is a female reproductive organ, the main purpose of which is to bear a fetus (fetal receptacle). The uterus consists of 3 layers: the inner one is represented by the endometrium, the middle one is muscle tissue and the outer one is the serosa. The bulk of the uterus is the muscular layer, which hypertrophies and grows during gestation. The myometrium of the uterus has a contractile function, due to which contractions occur, the cervix (uterine os) opens and the fetus is expelled from the uterine cavity during labor.

Periods of labor

The labor process lasts quite a long time, and normally in primiparous women it lasts 10–12 hours, while in multiparous women it lasts approximately 6–8 hours. Childbirth itself includes three periods:

I period – the period of contractions (opening of the uterine pharynx);
The second period is called the period of pushing (the period of expulsion of the fetus);
The third period is the period of separation and discharge of the child's place (placeholder), therefore it is called the afterbirth period.

The longest stage of labor is the period of opening of the uterine pharynx. It is caused by uterine contractions, during which the amniotic sac is formed, the fetal head moves along the pelvic ring and cervical dilatation is ensured.

Period of contractions

First, contractions arise and become established - no more than 2 in 10 minutes. Moreover, the duration of uterine contraction reaches 30–40 seconds, and uterine relaxation reaches 80–120 seconds. Long-term relaxation of the uterine muscles after each contraction ensures the transition of the cervical tissues into the structure of the lower segment of the uterus, as a result of which the length of the visible part of the cervix decreases (it shortens), and the lower uterine segment itself stretches and lengthens.

As a result of the ongoing processes, the presenting part of the fetus (usually the head) is fixed at the entrance to the pelvis, separating the amniotic fluid, and as a result, anterior and posterior waters are formed. A fetal bladder is formed (contains anterior waters), which acts like a hydraulic wedge, wedges into the internal os, opening it.

In first-time mothers, the latent phase of dilatation is always longer than in women giving birth for the second time, which determines the longer total duration of labor. The completion of the latent phase is marked by complete or almost complete effacement of the cervix.

The active phase begins with 4 cm of cervical dilation and continues up to 8 cm. At the same time, contractions become more frequent and their number reaches 3 - 5 in 10 minutes, periods of contraction and relaxation of the uterus are equalized and amount to 60 - 90 seconds. The active phase lasts for primiparous and multiparous women for 3–4 hours. It is during the active phase that labor becomes intense, and the cervix dilates quickly. The fetal head moves along the birth canal, the cervix has completely moved into the lower uterine segment (merged with it), and by the end of the active phase the opening of the uterine pharynx is complete or almost complete (within 8 - 10 cm).

At the end of the active phase, the amniotic sac is opened and the water is released. If the cervical opening has reached 8 - 10 cm and the waters have broken, this is called timely rupture of water, the release of water when the opening is up to 7 cm is called early, with 10 or more cm of opening of the pharynx, amniotomy is indicated (the procedure for opening the amniotic sac), which is called delayed rupture of water.

Terminology

Dilatation of the cervix does not have any symptoms; only a doctor can determine it by conducting a vaginal examination.

To understand how the process of softening, shortening and smoothing of the cervix progresses, you should define obstetric terms. In the recent past, obstetricians determined the opening of the uterine pharynx in the fingers. Roughly speaking, how many fingers the uterine os allows through, so is the opening. On average, the width of the “obstetric finger” is 2 cm, but, as you know, everyone’s fingers are different, so measuring the opening in cm is considered more accurate. So:

if the cervix is dilated by 1 finger, then they speak of an opening of 2 - 3 cm;
if the opening of the uterine pharynx has reached 3–4 cm, this is equivalent to the dilation of the cervix by 2 fingers, which, as a rule, is diagnosed already at the beginning of regular labor (at least 3 contractions in 10 minutes);
almost complete opening is indicated by the opening of the cervix by 8 cm or 4 fingers;
full dilatation is recorded when the cervix is completely smoothed (thin edges) and is passable for 5 fingers or 10 cm (the head descends to the pelvic floor, turning with an arrow-shaped suture to a straight size, an irresistible desire to push appears - it’s time to go to the delivery room for the birth of the baby - the beginning of the second period childbirth).

How does the cervix ripen?

The appearing harbingers of labor indicate the imminent onset of labor (approximately from 2 weeks to 2 hours):

the fundus of the uterus descends (for 2 - 3 weeks before the onset of contractions), which is explained by the pressing of the presenting part of the fetus to the pelvis, a woman feels this sign by easier breathing;
the pressed head of the fetus puts pressure on the pelvic organs (bladder, intestines), which leads to increased urination and constipation;
increased excitability of the uterus (the uterus “turns to stone” when the fetus moves, the woman moves suddenly, or when the abdomen is stroked/pinched);
possible appearance - they are irregular and sparse, drawn-out and short;
The cervix begins to “ripen” - it softens, allows the tip of the finger to pass through, shortens and “centers.”

Dilatation of the cervix before childbirth occurs very slowly and gradually over the course of a month, and intensifies on the last day or two before birth. In primiparous women, the opening of the cervical canal is about 2 cm, while in multiparous women the opening exceeds 2 cm.

To establish cervical maturity, a scale developed by Bishop is used, which includes assessment of the following criteria:

consistency (density) of the neck: if it is dense - this is regarded as 0 points, if it is softened along the periphery, but the internal pharynx is dense - 1 point, soft both inside and outside - 2 points;
length of the neck (the process of its shortening) - if it exceeds 2 cm - 0 points, the length reaches 1 - 2 cm - score 1 point, the neck is shortened and does not reach 1 cm in length - 2 points;
patency of the cervical canal: a closed external pharynx or allows the tip of a finger to pass through - score 0 points, the cervical canal is passed to a closed internal pharynx - this is scored as 1 point, and if the canal allows one or 2 fingers to pass beyond the internal pharynx - scored as 2 points;
how the neck is located tangentially to the wire axis of the pelvis: directed posteriorly - 0 points, displaced anteriorly - 1 point, located in the middle or “centered” - 2 points.

When summing up the points, the maturity of the cervix is assessed. An immature cervix is considered with a score of 0 - 2 points, 3 - 4 points are regarded as an insufficiently mature or ripening cervix, and with 5 - 8 points they speak of a mature cervix.

Vaginal examination

To determine the degree of readiness of the cervix and not only, the doctor conducts a mandatory vaginal examination (upon admission to the maternity hospital and at 38–39 weeks at an appointment at the antenatal clinic).

If the woman is already in the maternity ward, a vaginal examination to determine the process of opening of the uterine pharynx every 4 to 6 hours or for emergency indications:

discharge of amniotic fluid;
carrying out a possible amniotomy (weakness of labor, or flat amniotic sac);
with the development of anomalies of labor forces (clinically narrow pelvis, excessive labor, incoordination);
before performing regional anesthesia (EDA, SMA) to determine the cause of painful contractions;
the occurrence of bloody discharge from the genital tract;
in the case of established regular labor (preliminary period, turning into contractions).

When conducting a vaginal examination, the obstetrician assesses the condition of the cervix: its degree of dilation, smoothing, thickness and extensibility of the cervical edges, as well as the presence of scars on the soft tissues of the genital tract. In addition, the capacity of the pelvis is assessed, the presenting part of the fetus and its insertion are palpated (localization of the sagittal suture on the head and fontanelles), the advancement of the presenting part, the presence of bone deformities and exostoses. The amniotic sac must be assessed (integrity, functionality).

Based on subjective signs of dilatation and vaginal examination data, a partogram of labor is compiled and maintained. Contractions are considered subjective signs of labor, in particular the opening of the uterine pharynx. The criteria for assessing contractions include their duration and frequency, severity and uterine activity (the latter is determined instrumentally). The partogram of labor allows you to visually record the dynamics of the opening of the uterine pharynx. A graph is drawn up, the horizontal length of which indicates the duration of labor in hours, and the vertical dilatation of the cervix in cm. Based on the partogram, the latent and active phases of labor can be distinguished. A steep rise in the curve indicates the effectiveness of the birth act.

If the cervix dilates prematurely

Dilation of the cervix during pregnancy, that is, long before childbirth, is called isthmic-cervical insufficiency. This pathology is characterized by the fact that both the cervix and the isthmus do not perform their main function during gestation - obturator. In this case, the cervix softens, shortens and smoothes, which does not allow keeping the fetus in the sac and leads to spontaneous abortion. Termination of pregnancy usually occurs in the 2nd – 3rd trimesters. The incompetence of the cervix is indicated by the fact that it shortens to 25 mm or less at 20–30 weeks of gestation.

Isthmic-cervical insufficiency can be organic and functional. The organic form of pathology develops as a result of various cervical injuries - induced abortions (see), cervical ruptures during childbirth, surgical methods for treating cervical diseases. The functional form of the disease is caused either by a hormonal imbalance or by an increased load on the cervix and isthmus during pregnancy (multiple pregnancy, excess water or a large fetus).

How to maintain pregnancy when the cervix is dilated

But even with cervical dilatation by 1 - 2 fingers at a period of 28 weeks or more, it is quite possible to maintain the pregnancy, or at least prolong it until the birth of a completely viable fetus. In such cases, the following are prescribed:

bed rest;
emotional peace;
sedatives;
antispasmodics (magne-B6, no-spa,);
tocolytics (ginipral, partusisten).

Treatment is mandatory aimed at producing surfactant in the fetal lungs (glucocorticoids are prescribed), which accelerates their maturation.

In addition, treatment and prevention of further premature dilatation of the cervix is carried out surgically - sutures are placed on the cervix, which are removed at 37 weeks.

The cervix is immature - what then?

The opposite situation is possible, when the cervix is “not ready” for childbirth. That is, hour X has arrived (the expected date of birth), and even several days or weeks have passed, but no structural changes are observed in the cervix, it remains long, dense, deviated posteriorly or anteriorly, and the internal pharynx is impassable or allows the tip of the finger to pass through. What do doctors do in this case?

All methods of influencing the cervix, leading to its maturation, are divided into medicinal and non-medicinal. Medicinal methods include the introduction of special gels and suppositories with prostaglandins into the vagina or cervix. Prostaglandins are hormones that accelerate the process of cervical ripening, increase the excitability of the uterus, and during childbirth their intravenous administration is practiced in case of weakness of labor forces. Local administration of prostaglandins has no systemic effect (no side effects) and contributes to the shortening and smoothing of the cervix.

Non-medicinal methods of stimulating cervical dilatation include:

Sticks – kelp

The sticks are made from dried kelp seaweed, which are highly hygroscopic (they absorb water well). A number of sticks are inserted into the cervical canal so that they fill it tightly. As the sticks absorb liquid, they swell and stretch the cervix, causing it to dilate.

Foley catheter

The catheter for dilating the cervix is represented by a flexible tube with a balloon attached to one end. A catheter with a balloon at the end is inserted by the doctor into the cervical canal, the balloon is filled with air and left in the cervix for 24 hours. Mechanical action on the cervix stimulates its opening, as well as the production of prostaglandins. The method is very painful and increases the risk of infection of the birth canal.

Cleansing enema

Unfortunately, some maternity hospitals have refused to perform a cleansing enema for a woman admitted to give birth, but in vain. Free intestines, as well as its peristalsis during defecation, increase the excitability of the uterus, increase its tone, and, consequently, accelerate the process of cervical dilatation.

Question answer

How can you speed up cervical dilatation at home?

long walks in the fresh air increase the excitability of the uterus and the production of prostaglandins, and the presenting part of the baby is fixed at the entrance to the pelvis, further stimulating the opening of the cervix;
take care of your bladder and intestines, avoid constipation and prolonged abstinence from urination;
eat more salads made from fresh vegetables dressed with vegetable oil;
take a decoction of raspberry leaves;
stimulate the nipples (when they are irritated, oxytocin is released, which causes uterine contractions).
Are there any special exercises for opening the cervix?

At home, cervical ripening is accelerated by walking up stairs, swimming and diving, bending and turning the body. It is also recommended to take a warm bath, massage the ear and little finger, breathing exercises and exercises to strengthen the perineal muscles, and do yoga. In maternity hospitals there are special gymnastic balls, the seat and bounces on which during contractions accelerate the opening of the uterine pharynx.

Does sex really help prepare your cervix for childbirth?

Yes, having sex in the last days and weeks of pregnancy (provided the amniotic sac is intact and there is a mucus plug in the cervical canal) contributes to the ripening of the cervix. First, during orgasm, oxytocin is released, which stimulates uterine activity. And, secondly, sperm contains prostaglandins, which have a beneficial effect on the process of cervical maturation.

At what opening does pushing begin?

Pushing is a voluntary contraction of the abdominal muscles. The desire to push arises in women in labor already at 8 cm. But until the cervix is fully dilated (10 cm) and the head drops to the bottom of the pelvis (that is, it can be felt by a doctor by pressing on the labia), you cannot push.

Cervix, this is a very important component of this main organ during gestation, and it mainly depends on the cervix. The cervix is something in the form of a tube connecting the uterus and vagina; the cervical canal is not located inside.

The cervix must be securely closed for almost the entire period of pregnancy in order for the fetus to hold tightly for the entire nine months.

However, in the final stage of pregnancy, the cervix undergoes changes that allow the baby to move through the birth canal without problems and, as a result, to be born with the least trauma for the mother. Such changes in the body of the expectant mother can begin early, and or premature birth.

Why does the cervix sometimes not dilate before childbirth?

However, conditions are more often observed when the cervix does not open. If this happens, doctors talk about insufficient preparation of the birth canal. That is, perhaps the contractions are not strong enough to trigger the dilatation process, or due to neuro-reflex disorders, a spasm of the cervical muscles develops, and this is always fraught with the risk of non-dilatation of the cervix.

During normal contractions, the uterus opens to such an extent that the fetus is able to cross the birth canal. to assist a woman in labor in such a situation, she must identify the reason for non-dilation and immediately prescribe adequate treatment, which is usually one of the methods of stimulation.

However, stimulation should not be carried out independently under any circumstances, since it is very easy to harm the child.

To prepare the uterus for childbirth, the doctor who has diagnosed non-dilatation of the cervix prescribes premature stimulation of the uterus, and in this case, childbirth usually occurs without complications. This question is especially relevant in the fortieth week of pregnancy, since at this stage the placenta begins to deplete and “grow old.”

Prenatal stimulation methods

Currently, two main methods of prenatal cervical stimulation are used: non-drug and medicinal, in which medications are prescribed, which can only be used in a hospital setting. These drugs initiate dilatation of the cervix.

In some cases, special algae are introduced into the canal of the neck - kelp sticks, which swell under the influence of liquid, which leads to the opening of the canal. In addition, these rods secrete endogenous prostaglandins, which contribute to the ripening of the cervix and prepare it for imminent childbirth. True, many women, trying to maintain the health of their child, try to use non-drug methods of stimulation.

With the non-drug method of stimulation, drugs are not used. It can also be used at home, however, it is preferable to consult a gynecologist to prevent any possible dangers. For example, a cleansing enema is used, which can initiate uterine contractions. After such a procedure, the mucous plug is released and the process of opening the uterus begins. It should be noted that an enema is done only when the scheduled date of birth has already passed. A natural stimulation for the opening of the cervix is sex, during which uterine contractions occur and blood flow quickly increases. In addition, prostaglandins are present in sperm. However, if the mucous plug has come off, sexual intercourse is strictly prohibited, as it can lead to infection.

Another non-drug home method is physical activity - house cleaning, walking up the stairs, long walks. For hypertension, gestosis or placenta previa, this method is not applicable. In any case, in such a situation, you should consult a doctor.