Preparation for childbirth: preparing for the first meeting with the baby. Preparing things for the hospital. Home cervical preparation methods

Currently, great importance is attached to the diagnosis of a woman’s readiness for childbirth. The latter can be detected by changes in the female reproductive system in the form of increased tone, excitability and contractile activity of the uterus, as well as in the form of the onset of cervical maturity and changes in the cytological picture of vaginal smears. The most clear idea of \u200b\u200bthe severity of the readiness of the body for childbirth gives a thorough palpation assessment of the maturity of the cervix. The revealed structural and functional changes in the reproductive system indicate the possibility of a spontaneous onset and physiological course of the birth act.

Currently, methods have been developed for both drug and non-drug exposure in order to form a woman’s readiness for childbirth.

Skillful selection and comprehensive application of methods for preparing for childbirth in combination with the psychoprophylactic preparation of pregnant women will help achieve optimally expressed biological readiness, significantly reduce perinatal and maternal morbidity and mortality.

Physiopsychoprophylactic preparation. It should include three components of exposure to create a favorable emotional state, to ensure a conscious attitude to pregnancy and active participation in childbirth:

Individual conversations and lectures - psychoprophylactic preparation;

Group exercises in special gymnastics;

The use of natural factors (light, air, water) to promote health and the use of physical therapy.

Psychoprophylactic preparation. It is aimed at eliminating negative emotions and forming positive conditioned reflex connections - removing a pregnant woman’s fear of childbirth and labor pain, attracting her to actively participate in the birth act.

Psychoprophylactic preparation significantly reduces labor pains, has a multilateral, in particular organizing, effect on a woman, contributes to a favorable course of pregnancy and childbirth.

The method is absolutely harmless to the mother and the fetus, and therefore there are no contraindications to mass use. Its disadvantage is the need for painstaking, lengthy, individual work with the patient.

The method of psychoprophylactic preparation was proposed in our country by I.Z. Velvovsky and K.I. Platonov (1940). Later, the method was improved by G. D. Read (1944), F. Lamaze (1970) and was widely used in many countries of the world.

The main goal of the psychophysiological preparation of pregnant women for childbirth is as follows:

Develop a woman's conscious attitude to pregnancy, teach to perceive childbirth as a physiological process;

Create a good emotional background and confidence in the favorable course of pregnancy and the completion of childbirth;

To educate the pregnant woman in the ability to mobilize her will to overcome the fear of childbirth.

At the first contact with a pregnant woman, it is necessary to find out her attitude to pregnancy, the nature of relationships in the family, education, profession, the presence of mental injuries, to establish the pregnant woman's idea of \u200b\u200bchildbirth, the peculiarity of fear of them, fear of pain. It is important to find out the characterological features of the pregnant woman, her emotional and volitional qualities. It is advisable to distinguish a group of pregnant women with psychological problems, in the presence of which the patient can be referred for consultation with a medical psychologist or psychotherapist.

Along with the individual psychoprophylactic work that the obstetrician-gynecologist carries out at each visit to the pregnant woman, it is recommended to conduct group exercises on the psychoprophylactic preparation for childbirth.

The interior of the office for group classes should create psychological comfort for the patient. It is necessary to have a couch or comfortable chairs, a set of drawings and tables showing the anatomical and physiological characteristics of the birth act, it is recommended to have a slideoscope, tape recorder or installation for showing films about the birth process.

To conduct classes on psycho-preventive preparation, it is advisable to form groups of 6-8 people, preferably taking into account the psycho-emotional status of patients, determined on the basis of the clinical experience of the doctor.

It is advisable to start classes from 33-34 weeks of pregnancy, to conduct them weekly for a month (4 lessons), each lasting 25-30 minutes. The first lesson can last about an hour.

First lessonconsists of introductory and main parts. In the introductory part, they focus on the possibility of training pregnant women to manage their will and activity in childbirth. One form of such training is autogenic training. Self-massage of certain biologically active points also contributes to strengthening the will and relieving psychoemotional stress: the sacral region, the lower abdomen, the inner surface of the upper edge of the ilium. The use of finger self-massage elements in childbirth helps to reduce labor pain, normalize contractions, and immobilize labor efforts.

The main part provides brief information about the anatomical structure of the female genital organs, the development of the fetus, the unified mother-placenta-fetus system, it is emphasized that the mother is the environment for the fetus. It is necessary to present childbirth as a natural physiological act, to characterize all periods of childbirth, to stop the attention of pregnant women on the ability to distribute their strength in childbirth, to follow the instructions of medical personnel.

To consolidate the acquired skills, pregnant women are recommended to repeat classes at home, lasting 7-10 minutes.

On the second lessonthe doctor explains the physiology of the first stage of labor. The mechanism of contractions, which contribute to the opening of the cervix, is described. Techniques are suggested to reduce the pain of contractions; it explains how to breathe properly during contractions and relieve muscle tension between contractions. A woman in labor should apply relaxation techniques and pain relief methods: stroking the lower abdomen with the movements of the palms from the midline to the side; when standing on the side by pressing with thumbs on the sacrum; when positioned on the back, thumbs are raised in front of the crests of the pelvis.

On the third lessonpregnant women are introduced to the course of the second stage of labor. They explain what attempts are and how to promote the correct birth of a child. They inform about the subsequent and early postpartum period, about blood loss in childbirth. They persuade how important it is to follow the recommendations of the midwife during childbirth, conduct training with holding the breath and, conversely, with frequent shallow breathing. They tell how to push.

On the fourth lessonbriefly repeat the entire course of previous classes and consolidate the acquired skills and techniques recommended in childbirth.

Physical exercise. Recommended for early pregnancy. These exercises are aimed at training breathing and muscle groups that have especially hard work to do during childbirth: the abdominals, pelvic floor muscles. Physical training classes are conducted under the guidance of a physiotherapy instructor.

UV exposure. It is carried out for 10 days in the I, II and III trimester, which increases the functional state of the nervous system and endocrine glands, increases immunological activity and normalizes metabolism in the body. Ultraviolet irradiation is especially useful when there is insufficient natural exposure, depending on the climate and seasonal variations.

Mothers who have undergone physioprophylactic preparation for childbirth require a lower dose of drugs to anesthetize labor.

Non-drug methods of exposure.They include intranasal electrical stimulation, electrical stimulation of the nipples of the mammary glands, acupuncture.

Intranasal electrical stimulation is based on the reflex relationship of the upper respiratory tract ("nasogenital zones" of the nasal mucosa) and internal genital organs. The method involves irritation of reflexogenic zones (the tuberculum septi region and the anterior part of the lower shell) with pulsed currents of variable frequency. The duration of each session is 1 hour. The method is effective in terms of cervical maturation in 87% of pregnant women, probably due to the appearance of a large number of uterine contractions of the Brexton-Hicks type, instead of small uterine contractions of the Alvarez type.

Electrical stimulation of the nipples of the mammary glands is carried out in order to accelerate the maturation of the cervix and is based on the fact that the emerging impulses affect the supraoptic region and paraventricular nuclei of the hypothalamus, which in turn leads to the release of oxytocin from the posterior pituitary gland, the appearance of uterine contractions and the maturation of the cervix. There is literature evidence that mechanical irritation of the nipples and areola of the mammary glands leads to the development of regular labor in 45.5% of pregnant women.

Acupuncture is used to relieve fear and tension before childbirth, to anesthetize the latter and regulate labor. The effect of this method is explained by the fact that an artificially induced flow of afferent impulses triggers a reflex reaction.

When choosing exposure points, the recommendations of classical Chinese acupuncture and the principle of segmental innervation of organs are taken into account.

Currently, preference is given to electroacupuncture (ELAP), which provides for the electrical effect of using pulse generators on the needles. Indications for the use of ELA are both a lack of readiness for childbirth of the birth canal, and delivery during premature discharge of amniotic fluid.

4.5. ANTENATAL DIAGNOSTICS OF THE FETAL STATE

At the present stage of knowledge and technical capabilities, the most optimal antenatal tests for assessing the condition of the fetus are ultrasound scanning, examination of the fetal cardiac activity, determination of the biophysical profile of the fetus, Doppler blood flow in the mother-placenta-fetus system, and the study of the gas composition of umbilical cord blood. Some of them (ultrasound fetometry) allow us to assess the physical development of the fetus, its compliance with the expected gestational age, and to exclude the presence of fetal malformations; others (ultrasound placentography, examination of uteroplacental blood flow) - get indirect signs of placental insufficiency; third (the study of the biophysical profile of the fetus and fetal blood flow, cardiotocography, the study of cord blood) - to evaluate the functional state of the fetus.

Ultrasonic fetometry is the most reliable objective method for assessing fetal growth and development, allowing each exact gestational age to accurately determine the conformity of fetal size to gestational age, as well as their degree of deviation from normal values. When studying the development of the fetus in the II and III trimesters of pregnancy, the main attention is paid to measuring the biparietal size of the head (BDP), the size of the abdomen, and the length of the thigh, which increase as pregnancy progresses. Towards the end of pregnancy, the growth rate of fetal biometric indicators gradually decreases: the growth rate of the BDP head decreases from 4 mm / week at 14-15 weeks of pregnancy to 1.3 mm / week at 39-40 weeks; thigh lengths - from 4.8 to 1.7 mm / week. The ratio of the size of the head and abdomen of the fetus is normal in the second trimester of pregnancy exceeds 1, but after 36 weeks of gestation it changes due to the prevalence of the size of the abdomen of the fetus. This indicator is of great clinical importance for the diagnosis of fetal growth disorders.

Valuable information on the condition of the fetoplacental system is provided by a direct study of the placenta: determining its location, structure, and placentometry. Most often, the placenta is located on the anterior or posterior surface of the uterus with a transition to one of the lateral, less often localized at the bottom of the uterus. Data on the effect of localization of the placenta on the growth and development of the fetus is very contradictory, but most studies have shown that the location of the placenta does not significantly affect the intrauterine development of the fetus.

The localization of the placenta at different stages of pregnancy is unstable. It has been established that in most cases, as pregnancy progresses, its “migration” occurs from the lower segment to the bottom of the uterus. Therefore, the final conclusion about the location of the placenta should be done only at the end of pregnancy. It is believed that the displacement of the placenta is due to both a higher growth rate of the uterine body compared to that of its lower segment, and it appears, which appears, due to the specific proteolytic enzymes secreted by the cervix, due to partial atrophy of the placental tissue located in the lower segment.

The thickness of the placenta during physiologically ongoing pregnancy is constantly increasing in a linear relationship from 10.9 mm at 7 weeks to 35.6 mm at 36 weeks (Table 4.6). Depending on the pathology of pregnancy, a decrease or increase in the thickness of the placenta may be observed.

The placenta changes as pregnancy progresses, providing ever-increasing fetal needs. Morphological features of its development at different stages of pregnancy are reflected in echograms. In uncomplicated pregnancy, the boundaries of the transitional period of maturity from 0 to I correspond to 27-30 weeks of pregnancy, from I to II degree - 32-34 weeks, from II to III degree - 35-37 weeks of pregnancy. The development time of a certain degree of placental maturity is not always constant. In some cases, I or II, the degree of maturity of the placenta may persist until the end of pregnancy and not be accompanied by a violation of the fetus. However, premature occurrence of changes of the III degree of placental maturity (up to 36-37 weeks of pregnancy), i.e. its "aging" serves as a marker of chronic fetal suffering (Fig. 4.39).

Table 4.6. The thickness of the placenta during physiological pregnancy

Pregnancy, weeks	The thickness of the placenta, mm	Pregnancy, weeks	The thickness of the placenta, mm
	10,89		25,37
	11,74		26,22
	12,59		27,07
	13,44		27,92
	14,29		28,78
	15,14		29,63
	16,00		30,48
	16,85		31,33
	17,70		32,18
	18,55		33,04
	19,40		33,89
	20,26		34,74
	21,11		35,60
	21,98		34,35
	22,81		34,07
	23,66		33,78
	24,52		33,50

Much attention in assessing the condition of the fetus should be given to the amount of amniotic fluid. As you know, amniotic fluid is a biologically active environment surrounding the fetus, a product of metabolic processes occurring in the mother and fetus. The amount of amniotic fluid with increasing pregnancy progressively increases from 500 ml in 30 weeks to 1500 ml at the end of pregnancy.

Ultrasound examines the amniotic fluid index. For a normal pregnancy, an index of 8.1 to 18.0 cm is characteristic.

A clear relationship was found between a change in the amount of amniotic fluid and an increase in negative perinatal outcomes. Currently, the determination of the amount of amniotic fluid is widely used as one of the most informative parameters in the study of the biophysical profile of the fetus.

In addition to studying the anatomical features of the fetoplacental system, in clinical practice, it is important to assess the functional state of the fetus, primarily its cardiac activity. With auscultation, the normal heart rate of the fetus is 120-160 beats / min. More accurate information about the nature of the cardiac activity of the fetus can be obtained on the basis of ECG, FCG, CTG.

With antenatal electrocardiography, in addition to the heart rate, it is possible to determine the ventricular complex QRS.Normal tooth Rit is pointed, the duration of the ventricular complex is 0.03-0.07 s, the voltage ranges from 9 to 65 μV, with an increase in the duration of pregnancy, a gradual increase is noted.

With phonocardiography, fluctuations in the duration and amplitude of the fetal heart tones are very variable in the III trimester, averaging: I tone - 0.09 s, II tone - 0.07 s; III and IV tones are rarely recorded. It is possible to conduct a phase analysis of cardiac activity while simultaneously registering the ECG and FKG of the fetus. With a physiologically ongoing pregnancy, the duration of the asynchronous contraction phase is 0.02-0.05 s, mechanical systole lasts 0.15-0.22 s, total diastole 0.17-0.26 s, ventricular diastole 0.15-0 , 25 p. The ratio of the duration of total systole to the duration of total diastole at the end of an uncomplicated pregnancy averages 1.23.

In modern obstetrics, cardiomonitor observation, or cardiotocography (CTG), is widely used to assess the condition of the fetus during pregnancy. During pregnancy, CTG allows you to dynamically monitor the condition of the fetus, evaluate the effectiveness of the therapy, predict the course of the upcoming birth and choose the optimal method of delivery. With a normal pregnancy, the basal heart rate is 120-160 beats / min, the amplitude of instant changes in heart rate is from 10 to 25 beats / min and their frequency is 7-12 oscillations per minute. In the physiological course of pregnancy, slightly undulating (5-10 beats / min) and undulating (10-25 beats / min) types of basal rhythm variability are most often observed. Particular attention should be paid to the appearance of silent and saltatory types of variability, especially in combination with tachycardia or bradycardia. With a physiologically ongoing pregnancy, a mute type of basal rhythm variability (0-5 beats / min) may be due to exposure to drugs and sedatives.

In an uncomplicated pregnancy, acceleration is observed almost constantly with a frequency of 4-5 or more over a 30-minute interval, no deceleration. Sporadic acceleration is most often associated with motor activity of the fetus. A decrease in the frequency of acceleration or their absence, the appearance of deceleration are an unfavorable prognostic sign.

Functional tests are of great help in assessing the condition of the fetus. In the normal course of pregnancy, in response to fetal movement, the heart rate increases on average by 10 per minute or more - a positive non-stress test. In more than 99% of cases, a positive non-stress test is a reliable criterion for a healthy fetus. The absence of a reaction of the cardiac activity of the fetus in response to movements indicates intrauterine suffering. The test can be false negative during the period of physiological rest of the fetus, in this case, a second study is required.

To assess the condition of the fetus during pregnancy, it is advisable to take into account the motor activity of the fetus. Counting the most pregnant number of fetal movements for 30 minutes in the morning and evening hours allows you to assess the condition of the fetus. Normally, the average frequency of fetal movements is about 3 in 10 minutes; their increase and amplification, as well as a sharp decrease in the frequency of fetal movements, may indicate fetal suffering and serve as the basis for a more detailed examination of the pregnant woman. Along with a subjective assessment of the movements of the fetus of the pregnant woman, their assessment by ultrasound is possible.

Respiratory movements of the fetus (DDP), determined by ultrasound, are albeit indirect, but quite valuable information about the state of the central nervous system of the fetus, whose role in the regulation of respiratory activity has been convincingly proven. It is believed that respiratory movements are one of the factors supporting the fetal blood circulation and thereby regulating the amount of blood flowing per unit time through the vessels of the placenta. Hemodynamic changes are associated with DDP: increased blood pressure, increased heart rate, increased blood flow in the umbilical cord vessels, as well as blood flow in the aorta and inferior vena cava. Some authors perceive the physiological significance of intrauterine DDP in the preparation of the respiratory apparatus for the implementation of respiratory function in the future; it is believed that DDP is necessary for the normal development of the lungs in the fetus.

The fact of the presence or absence of respiratory movements within 15-30 minutes is considered to be the main parameter of DDP. By the end of an uncomplicated pregnancy, the fetal respiratory rate is about 50 in 1 min. Normally, DDPs are combined with periods of apnea, the duration of which is more than Bay. The duration of DDP in the physiological course of pregnancy is on average 50-90% of the study time. A significant decrease in respiratory activity in the fetus was established in the complicated course of pregnancy.

The combined registration of several biophysical indicators of the fetus (BFPP) allows for reliable diagnosis and significantly improves antenatal monitoring. A combined determination of the respiratory and motor activity of the fetus, its cardiac activity and muscle tone, i.e. indicators under the regulatory influence of the central nervous system of the fetus, with greater reliability reflect its functional state. At the same time, the frequency of false positive and false negative results is reduced in comparison with the study of each of these parameters separately. Normally, the fetal BFPP score is 8-12 points.

Since BFPP is a valuable diagnostic criterion for the intrauterine state of the fetus, his study has found widespread use in a number of pregnancy complications. At the same time, the degree of decrease in BFFP assessment does not depend on the nature, but on the severity of pregnancy complications.

One of the most promising diagnostic methods used to assess hemodynamics in the mother-placenta-fetus system is dopplerometry. The blood flow in the arterial vessels of the fetus and uterine artery in uncomplicated pregnancy is characterized by continuous curves that reflect the translational blood flow throughout the cardiac cycle, without zero and negative values \u200b\u200bin the diastole phase. A qualitative analysis of blood flow in the umbilical artery, fetal aorta, and uterine artery during the third trimester of uncomplicated pregnancy revealed a gradual decrease in peripheral vascular resistance, which is manifested by a decrease in blood flow indices (Table 4.7).

With an uncomplicated pregnancy, the values \u200b\u200bof the systolodiastolic ratio (SDS) in the uterine arteries after 18-20 weeks should not exceed 2.4. A decrease in the indices of vascular resistance in the umbilical artery during the II and III trimesters of pregnancy indicates a decrease in the vascular resistance of the placenta, which is caused by the intensive growth of its terminal bed, associated with the processes of development and vascularization of the terminal villi of the placenta.

Table 4.7. Blood flow in the aorta of the fetus, umbilical artery and uterine artery in the third trimester of uncomplicated pregnancy

For a comprehensive assessment of blood flow in the mother-placenta-fetus system, it is necessary, in addition to the umbilical artery, fetal aorta, and uterine artery, to study the blood flow in the fetal brain vessels. When comparing the blood circulation in the fetal-placental unit and the cerebral blood flow of the fetus, the relative stability of the cerebro-placental relationship in uncomplicated pregnancy was established, which indicates the preservation of a constant level of blood supply to the fetal brain.

To assess the condition of the fetus allows the study of fetal blood obtained by cordocentesis.

Normally, as pregnancy progresses in the fetus, P about in the artery, umbilical cord vein, and intervillous vessels gradually decrease. Despite the decrease in P about, the oxygen content in the umbilical vein remains constant due to a compensatory increase in hemoglobin concentration. The content of CO 2, bicarbonates, bases and lactate in the umbilical cord vein increases as the gestational age of the fetus increases. The pH value of the blood of the fetus during physiologically ongoing pregnancy does not significantly change (7.38 ± 0.04).

Indirect information on the condition of the fetus is given by the study of amniotic fluid during pregnancy. With uncomplicated pregnancy during amnioscopy, a sufficient amount of bright, transparent opalescent amniotic fluid with the presence of a white cheese-like lubricant is determined. In full-term pregnancy, the pH of amniotic fluid is from 6.98 to 7.23; P about varies from 120 to 78 mm RT. Art.

1 1 kcal \u003d 4187 10 3 J (4187 kJ).

Content:

The excitement of pregnant women is a natural and understandable phenomenon. In order for the baby to be born as seamlessly and without complications as possible, early, thorough and well-thought out preparation for childbirth, which should begin almost from the moment of conception, is very important. The sooner the expectant mother thinks about it, the calmer and more comfortable she will feel immediately before the sacrament of birth itself. So, what do you need to know for those who, with bated breath, are expecting a baby so that delivery will be successful?

Throughout pregnancy, physical preparation for childbirth is needed, which helps the body cope with the burden that has befallen it. He himself is being rebuilt, as evidenced by the serious future mother. But a woman should take a number of measures to minimize the stressful situation for individual organs and systems.

This can be done using special exercises. The best option is to sign up for pregnant courses, where regular classes are held with a professional trainer. He will select individual exercises to prepare for childbirth, which together will contribute to a successful and successful delivery. Although each woman is able to independently carry them out at home.

General strengthening exercises

Within one minute walking on the spot.
Starting position: position the legs shoulder-width apart, with the feet parallel to each other, arms extended forward.
Half squats with a straight back. Hands should be raised and lowered in time with squats. Perform slowly. Breathe smoothly. Repeat 10 times.
Starting position. Hands to the side. Tilt your torso forward, touch with your hands first to the left, then to the right toes of the legs. Keep your breathing steady, pace - medium. Repeat 12 times.
Starting position. Bend the torso slightly, arms at the seams, tilt your head forward, relax the muscles of the arms and the upper part of the body. After 5 seconds, straighten, take your shoulders back, bend. Keep breathing uniform, pace slow. Repeat 8 times.
Starting position: to place the legs wider than the shoulders, hands to the side. Lean forward, turn the body first to the right, then to the left, while touching the left sock with the right hand, the right sock with the left hand. After 10 exercises, straighten up, relax the muscles of the shoulders, forearms. Repeat 4 times.
Starting position. Tilt the body to the right, holding the left hand above the head, the right - behind the back. When torso is tilted to the left, the right hand should be above the head, the left - behind the back. Repeat 12 times, keeping the average pace.
Starting position. Stand straight, feet together, arms along the body. Tilt the body to the right and left with the sliding of the hands: when leaning to the right, right - down, left - up; when tilted to the left with the left hand - down, with the right - up. Perform 12 times, trying not to hold your breath.
Take 10 deep breaths through the nose, exhale through the mouth.

Such preparation of muscles for childbirth will allow them to maintain their elasticity and will be equally useful for mother and baby. Exercise stimulates blood circulation, does not allow you to gain excess weight (see the norm), facilitate the delivery process in the future. Regular classes help maintain a beautiful prenatal form. However, there are not only general strengthening exercises, but also complexes designed specifically for a specific organ or muscle group, which play an important role at the time of birth.

Perineal muscle exercises

Stand sideways to the back of the chair. Put your hands on it. Keep your leg as high as possible. Repeat for each leg 10 times.
Starting position, as in the previous exercise. Raise a leg bent at the knee to the stomach.
Spread your legs wide. Sit down slowly. Hold in this position for several seconds. To spring. Rise as slowly as possible. To relax. Repeat 5 times.
To squat. Straighten one leg, set it aside. Transfer weight to the other leg. Maintain balance with outstretched arms. Run 5 times.
Get on your knees, put them together. Gently roll back, sit on your heels.

In addition to the above exercises, preparing the perineum for childbirth includes certain postures that a pregnant woman needs to take daily. They train muscles, do not let them relax, so that at the time of birth, there are no gaps. These include:

tailor's pose: sitting, cross legs in front of you;
butterfly: sitting, connect the heels, pull them to the crotch;
frog: sitting on your heels, spread your knees, sit between your heels;
try to do squatting household chores (mopping floors, peeling potatoes, etc.);
go from room to room in one file.

Qualitative preparation for childbirth without breaks includes the regular implementation of these exercises and the daily use of special poses.

Kegel exercise

To avoid tearing, preparing the vagina for childbirth should include the famous Kegel exercise. It increases muscle tone, which is so important for the safe birth of a baby. You need to perform it daily, there are no restrictions on the number of times. Classes may be as follows:

Lying down, tighten several times and relax the intimate muscle.
Increase the number of repetitions daily.
It will be possible to proceed to the next stage of classes when without applying special efforts you can perform the Kegel exercise 50 times.
Complicate the exercise. Reduce muscle as much as possible and hold it for such a certain amount of time. Then start relaxing, but with stops.
One week after these daily activities, contract and relax your muscle at a fast pace.

The regular implementation of the above exercises consists in the quality preparation of the birth canal for childbirth, which is better to start not a month before a significant event, but already from the first days of pregnancy. In addition, during all 9 months, special attention should be paid to the breast.

Chest exercises

So that there are no problems with lactation, stretch marks on the mammary glands, and nipple cracks, preparation of the breast for childbirth is required, which also includes special exercises.

Take a small ball. Raise your arms to chest level. Throw the ball up from this position with your hands in turn.
Get on all fours, bend your arms, then simultaneously straighten all limbs.
Stand facing the wall, rest against it at the level of the shoulders with your palms, push out 15 times.
Dilute arms at shoulder level. Perform swing movements, crossing arms in front of you.
Keep your hands apart. Swing backward while keeping your arms straight.

Each exercise is recommended to be done 5 times. Such preparation of the mammary glands for the birth of a child will preserve the shape of the breast, prepare its muscles for the upcoming loads, prevent, as far as possible, its sagging in the future and the appearance of stretch marks.

However, physical, restorative preparation of the body for childbirth is not limited to exercises alone. It involves toning the muscles and improving blood circulation through massage, as well as maintaining proper nutrition.

Massage

To strengthen the muscles of the perineum and chest, it is necessary to do massage to prepare for childbirth, which stimulates blood circulation, improves tissue metabolism, prepares muscles for proper relaxation, reduces the likelihood of ruptures and cracks. It can begin to be done about a month before the expected date of birth of the baby. The scheme may be as follows:

from the 34th week once every 3 days;
from the 36th week to massage every other day;
from the 38th week of the procedure can be performed daily.

For such a massage, you need to purchase natural oil, excluding synthetic, mineral, alcohol-containing products.

Crotch massage

In order to avoid tears, we need comprehensive preparation for the delivery of the perineal muscles: not only exercises, but also massage, which can be easily done at home. The technique is simple:

Take a comfortable position. For example, put your foot on a chair or the edge of the bath.
Lubricate the labia and perineum with a massage agent.
Insert fingers (1 or 2) into the vagina, but shallow (1-2 cm).
To relax.
Move your finger inside the vagina towards the anus down. Movements should be performed with a different rhythm: acceleration should alternate with deceleration.
Press with swaying movements on the back wall of the perineum. Hold your finger in this position for a minute, release and start over.
Massage the perineum on the outside for a minute.
Repeat all over again.

Such massage is especially relevant for preparing the vagina for childbirth to those whose first child was born with breaks. In order not to repeat the situation, it is imperative to comply with all the above recommendations.

Be careful! Do not massage the perineum before childbirth for those pregnant who suffer from fungal infections.

Breast massage

A special breast massage before childbirth will help to avoid stretch marks after childbirth, which is a mandatory point in preparing the body for childbirth. The technique of its implementation is as simple as possible:

In a circular stroking motion, without affecting the nipples, simultaneously massage both breasts from top to bottom to the nipple.
Then from the sides.
After that, stroke the breast from the bottom up to the nipples.
Raise and support the chest with your right hand, press on top with your left hand.

During this massage, oxytocin is released, which in the last days of pregnancy will help to start childbirth, improve the opening of the cervix.

Please note that ...
Breast massage before childbirth can be easily entrusted to a man: it will bring the couple closer and give pleasure to both.

Physical preparation of the body for childbirth is very important, because the body without support will not be able to cope with the load that has fallen on it. In addition to special exercises and massage, a woman needs to eat properly throughout her pregnancy.

Nutrition before childbirth

Without a rational, wholesome diet, proper preparation for childbirth is impossible. A woman throughout her pregnancy should competently draw up her menu for every day in order to support the body from the inside. If neither he himself nor the baby will lack nutrients, they will be prepared as much as possible for such an important event. You need to stock up on reserves to deal with stress, blood loss and restore energy. At the same time, 2 months before the cherished date, the diet should be facilitated, not condensed.

Exclude fried, fatty foods, sausages, offal.
You need to consume vegetable oil in sufficient quantities daily. It makes the tissues of the birth canal more elastic and contains many vitamins.
Mandatory products a month before birth should be fresh vegetables, fruits, herbs, hot soups, boiled or stewed sea fish, dried fruits, kefir.
In this period, fractional nutrition is recommended, but 4 times a day.

Attention! Despite the fact that vegetable oil is so useful for pregnant women, about a month before giving birth, it is worth stopping the use of sesame oil, which does not have the most beneficial effect on the woman’s body during this period.

Regular exercise, physical activity, competent massage and proper nutrition - these are a set of measures guaranteeing a successful, safe birth of a healthy baby without any complications. Moreover, such should be both preparation for, and in the event that a woman is prepared for cesarean. For several days or weeks, doctors may advise you to go to the hospital to be safe. At this point, you also need to prepare in advance.

Preparing for the hospital

Young parents should keep in mind that includes preparation for childbirth in the hospital, which should begin 3 weeks before the desired date. Firstly, this is the collection of all necessary documents, which then in a hurry to collect will simply have no time. Secondly, a bag with things that a woman needs in a hospital.

Preparation of documents

passport;
a map with the results of analyzes and examinations;
contract with a personal doctor or referral to the hospital;
insurance policy.

Gathering things for childbirth

Nightgown.
Warm socks.
Slippers.
Mineral still water.
Entries made at the school for young mothers.
Wet wipes.
A small terry towel.
Shampoo, soap, toothbrush, paste, comb.
Toilet paper.
Cosmetic bag.
Mobile phone with charging.
A player with your favorite music.
Money.

A set of things necessary after childbirth

A robe or shirt fastened in front.
Gaskets.
Cream for the nipples.
Nursing bras with front closure.
Gauze sterile wipes.
Laxatives, enema.
Plastic bag for dirty laundry.

Preparing things for the baby

diapers;
cream or powder;
wet wipes;
baby cleansing oil;
body;
hats;
socks;
sliders;
blouses;
diapers.

This list helps you decide what you need to buy before you go to the hospital to relieve anxiety and not worry about anything. When all the things are already collected, the young mother feels much more confident and calmer. When the cherished day comes, she will be able to focus only on the process itself, without being distracted by the little things. If something goes wrong, doctors will always be able to make the right decision and ensure timely preparation of the body for the upcoming birth.

Medical training of the birth canal

There are special modern methods for preparing the birth canal for childbirth, which doctors use in the case of immaturity of the neck, prenatal discharge of amniotic fluid, or pregnancy.

Prostaglandins

Prostaglandins - physiologically active substances that play an important role in the reproductive system of the female body. A woman in labor is introduced to prepare the birth canal for the fetus to pass through them in several ways:

in the vagina;
into the cervical canal;
with the help of the obstetric pessary.

The disadvantages of prostaglandins in the process of preparing for childbirth: a powerful effect on the body, allergic reactions, "prostaglandin pain" and hyperstimulation in some cases. These drugs do not affect the fetus in any way. Advantages: the risk of prolonged labor is reduced, the likelihood of natural ones increases.

Foley's catheter

The use of the Foley catheter is an effective alternative to prostaglandins for preparing the birth canal. This is a mechanical way of influencing the cervix when a woman is diagnosed with a flat fetal bladder. The instrument is inserted into the cervical canal for a day. There are special contraindications for this method: vaginitis or cervitis.

Kelp

In preparation for childbirth, kelp is introduced into the cervical canal. Expanding, open the neck from the inside. Slightly affect the excretion of prostaglandins. The main effect is the mechanical stretching of muscle fibers, which provokes a reduction in uterine myocytes. Do not lead to hyperstimulation and pain. One of the drawbacks is an unpleasant sensation when the sticks with algae are only injected.

During delivery, doctors evaluate the condition of the cervix (more about its preparation) and decide to use one or another method of preparing the birth canal for the baby to pass through them. Each of them has its own disadvantages and advantages. Cases are different, purely individual, so the methods will also not be the same. And in some situations, preparation for childbirth should be especially careful.

Special birth

If this is the first birth or the couple is expected to have twins, the preparation should be special so that there are no complications.

First birth

As a rule, preparation for the first birth is no different from everyone else. All the above tips and tricks can be fully used by those women who expect a first-born. The only caveat - a more serious moral is required,. Future mother is overwhelmed by fears and doubts, because she still does not know what awaits her. Therefore, all relatives and friends must necessarily surround the woman in labor with care and attention. She needs to rest more and calm down as much as possible, to be sure that everything will end happily.

Twins

But the preparation for the birth of twins should be more thorough. This extraordinary case involves much greater loads on the female body and on the children themselves. The risk of toxicosis increases several times, which can occur in both early and late pregnancy in the form of bleeding, placental abruption, gestosis. Here, a young mother needs more personal responsibility and medical control. You need to go to the hospital more often with an ultrasound scan and test. The decree will need to leave earlier.

Preparation for any childbirth - simple and complex, natural and through cesarean, first and second - should be comprehensive and include all aspects: physical, psychological, material. The sooner the couple begins to prepare for such an important event, the more successful and successful it will end, the calmer and more confident the woman will feel at the most crucial moment.

Basically, if you believe the statistics, then thoughts about the upcoming birth in pregnant women arise after 30 weeks. Of course, more questions arise in primiparous women. The most frequently asked questions: how to prepare for childbirth, when to go to the hospital and what to take there? How to behave during childbirth? And how soon should the birth begin? Also, an issue related to the maternity hospital will be such an important issue.

If it comes to preparing things, then there may be differences in this matter. But the most important thing that should be with you is a passport, an exchange card and a referral to the hospital or an agreement that was drawn up in advance. If the birth will take place with, for example, a husband, then he must also capture a passport, test results and fluorography.

Other things may correspond to the list of the hospital. It would also be good to find out about this in advance. In addition, you may want to take an MP3 player, personal hygiene products, a book or something else in order to keep yourself busy while your baby is sleeping. And of course, do not forget about things for the child: diapers, cream or oil for newborns, clothes, diapers and the rest. If you have forgotten something, do not immediately get nervous. After all, everything else can be brought directly to the hospital.

What symptoms indicate an early birth?

If during pregnancy there were no complications, then the birth is likely to begin at the end of 39 weeks. By this time, the body will already be ready for the birth of a child. Some time before the birth, you can notice some signs that say that childbirth is very close. For example, strong pressure of the uterus on internal organs, minor spotting, mucous plug, weight loss, diarrhea and appetite. When childbirth begins, severe pain appears in the lower abdomen, and contractions will occur all at shorter intervals. Before the start of fights, or afterwards, water should flow away.

Poses as an element of preparation for childbirth

If you are tired of doing the same pose, then change it to another or do them all in turn.

Exercises that will help during childbirth

Throughout pregnancy, you need to do exercises that will help stretch the muscles and ligaments of the perineum. Of course, Kegel exercises, which can be performed with the help of a gymnastic ball, will be most effective. To do this, you need to stand sideways to the back of the chair and rest on it with your hands, then you need to slowly take your foot to the side, while trying to do it as high as possible. Repeat the exercise 6-10 times on each leg. An exercise will be effective during which you need to pull the bent leg to the stomach.

Some women choose the Plie exercise: they should have their legs wide apart and squat slowly. Try to sit in this position for as long as possible, and then just as slowly rise. The exercise must be repeated 5-7 times.

Preparation of the cervix for the birth process

From about 36 weeks of pregnancy, all doctors recommend having sex without a condom, of course, if there is no danger. There is a special substance in semen that very quickly makes the cervix soft and perfectly prepares it for childbirth.

Nipple preparation for childbirth

You need to massage your nipples daily, take a contrast shower, wipe with a harsh terry towel and be sure to take air baths. If everything is normal and there is no increased uterine tone, then you can delay the nipples - this will make them more elongated and you will not have problems during feeding.

How to psychologically prepare yourself for childbirth?

In order to get rid of the panic fear of an upcoming event, you need to learn as much as possible about what awaits you. Courses where preparation for childbirth is taught would be very good. This of course will not reduce the pain during childbirth, but being calmer will definitely help.

Preparation of a pregnant woman for childbirth begins long before the onset of the ninth month. From the moment of conception to hospitalization, it is necessary to learn how to properly "tune" your body, thereby facilitating the entire outcome of pregnancy - childbirth. All effective and useful tips from professionals, experienced moms and midwives are used. How not to become a hostage of fear of childbirth and enjoy waiting for the birth of the most precious man?

Pregnancy is not only pleasant jolts from the inside of the baby, languid expectation, enjoyment of its “special” status, but also the active preparation of the expectant mother for the most important day in her life and the child’s birth.

The well-being and ease of the process of the birth of a child depends on how thoroughly a woman in labor and her relatives approached such a process. Preparation for childbirth is a set of processes that will help to better adapt the uterus and the whole body during a period of complex physical activity.

The whole process of birth is a difficult and very difficult physical activity for mom and baby. The woman’s body knows how and when to react to any “signals” of the child and each individual organ, but in any case it is important to prepare the body to respond to contractions and attempts “correctly”, adding all its reserve forces to this process.

How to prepare for childbirth: the period before conception

In fact, preparation for childbirth and everything you need to know about such a process is a complex event that does not start exclusively at the moment when the pregnant girl finds out about her situation. Indeed, during this period, changes are already occurring that provoke your hormonal and reproductive system.

Preparation for the birth of a child occurs long before it appears in the world. The first preparatory stage is the period of family planning. Before getting pregnant, ideally, you need to examine your body, eliminate possible problems, prepare mentally, in the end. After all, wanting does not mean giving birth without pain and complications. In many ways, childbirth without breaks and cuts is not an accident and luck, it is a whole complex of body measures that was carried out before conception.

How to prepare for childbirth before conception, and what is such preparation? It must be remembered that preparing the body for childbirth before pregnancy is:

Quitting smoking and alcohol. Complete removal of nicotine from a woman’s body takes 3 years, but if you do not take such harmful substances a year before pregnancy, this reduces the risk of ruptures and bleeding after childbirth.
Healthy sex life. Irregular sex, a frequent change of partners - this is harmful not only for pregnant women, but also for girls who plan to raise a healthy and beautiful child.
Calorie control. Eating the right food is not starvation, it is a complete diet with the necessary amount of all useful macro and micronutrients, vitamins, fats, proteins. A positive and uncomplicated pregnancy is greatly affected by exhaustion, or vice versa - obesity. Proper nutrition is a supply of useful vitamins and elements for the development of a full and healthy child in all senses.
Emotional mood. The most important thing for a woman is to be mentally prepared for motherhood. “It is necessary, it is time, it is necessary, the mother will say” - this is all that a woman who wants to give birth to a healthy child and enjoy motherhood should not have it. Only full awareness and harmony of the body and soul will help the body endure and give birth to a baby.

Preparing pregnant women for childbirth: important points

Conscious motherhood is the emotional, physiological and psychological readiness of a woman to become the most important person in the life of her child. To prepare the body for childbirth, and at the same time remain all the same attractive - this is a whole art. In addition to preparing the birth canal, uterus and the whole body, you need to understand the importance of conducting exercises for women in labor, the relevance of moderate exercise. And therefore, proper preparation is a quick and safe birth for mother and baby.

Planned birth: how to prepare correctly?

The planned birth and preparation for them is the best option for a woman: she knows where to go, who will take birth, and how the whole process will go around. Therefore, in order to be ready for the start of delivery, you should first clarify the following points:

The choice of the hospital. Pre-agree all questions with your obstetrician: in which hospital will you be taken if you are hospitalized in an ambulance, what is the reputation of the institution, what doctors are there. You can pre-visit the maternity ward (not earlier than 36 weeks). As a rule, employees of the hospital even allow you to see the conditions of the ward (in the absence of women in labor).
Generic "alarm bag". The entire package of documents (passport, outpatient book), diapers, vests and all the necessary list provided by the leading obstetrician should be ready and assembled.
Money. If you are planning to give birth in a private maternity ward, then it is important to clarify how much your birth may cost. But, and in the case when childbirth is planned at the place of registration, money should also be even for the most basic: taxi, first aid, medications if necessary.
Transportation of women in childbirth. It is necessary to agree on how you will get to the hospital: planned or urgently at the beginning of contractions. In any case, it is necessary to clarify such a moment as free spare transport that can deliver a woman in labor at the right time of day or night.

These are important organizational issues that must be agreed upon before delivery. Among other things, it is worth remembering that a planned birth and preparation of the body increases the quick outcome of the baby's appearance. And in order to prevent such unpleasant consequences as tears, cuts, section and bleeding, it is necessary:

prepare for childbirth - exercises for pregnant women;
in women who are expected to have a large fetus, additional research needs to be done, if necessary, stimulation ahead of time;
so that there are no gaps in childbirth, you need to do special intimate exercises (preparation of the cervix);
prevention of sprains (stretch marks on the abdomen, chest, hips) - frequent lubrication (oiling) of the skin.

Mothers who are preparing for childbirth approach thoroughly to the beginning of labor activity from the moment of conception or long before its onset, they know everything about childbirth, moreover, they are ready mentally and physically. To improve labor activity independently at home is a feasible task for every pregnant woman.

Preparation of the cervix for childbirth

The most painful birth is the opening of the cervix. The closed pharynx of the uterine cavity at the onset of labor is gradually revealed (from one finger during palpation to 10 cm). In the process of this expansion, the uterine cervix is \u200b\u200b“erased” before childbirth, cork detachment, water discharge (before delivery, in about 2-3 weeks). After this, the most painful begins - the contraction of the uterus, which is ready to push the baby out.

In some women in childbirth (especially the birthright), this process lasts longer for the reason that the uterus did not know such processes before, and the moment of opening is slower. The faster the cervix opens, the easier and faster the baby appears. Therefore, the main task of a pregnant woman is to prepare the cervix for childbirth long before they occur.

Nature worried about the woman in childbirth during childbirth: the release of hormones that occurs starting from the 36th week of pregnancy erases the cervix, increases its elasticity, which reduces the risk of ruptures. However, this requires a complete and proper nutrition, a healthy body.

Although nature independently worried about the hormonal preparation of the uterus before childbirth, a woman in labor is still worth carrying out some auxiliary procedures that will facilitate labor. There are several methods of such preparation: from massage to intimate exercises. The choice of preparation methodology depends on the desire of the woman in labor and her time, which she is ready to devote to such preparatory procedures.

Preparing the perineum for childbirth - oiling

Preparing the perineum for childbirth is also an extremely necessary procedure, because the small and large external labia may not stretch to the required size, and the obstetrician will perform a perineal incision.

To carry out such an intimate procedure for preparation before childbirth, you need to buy linseed and peach oil in a pharmacy, mix them in equal parts. After bathing, instead of cream, it is necessary to apply the composition of the oils to the perineum. Do not be zealous: an increased amount of oil is also not necessary.

Interesting!

There is an opinion that if a baby is born early or prematurely, and its weight is below 3 kg, then the mother transfers the birth easily, without breaks. In fact, the crotch until the 37th week is not ready for stretching, and therefore the woman in labor is at risk of bursting even with the weight of the child 2.5 kg.

In addition, such oiling should be carried out in places where stretch marks can form: hips, sides at the waist, thighs and chest. All manipulations should be carried out only after bathing, rub and wait a little while the oil is absorbed. You will be surprised how quickly the skin absorbs the oily mixture.

Preparing the perineum for childbirth - intimate gymnastics

You can also prepare the crotch for childbirth with the help of intimate gymnastics, which, apart from the woman in labor, no one will see. For exercise, you need to take the "lotus" position, fully relaxing the back muscles. To do this, you can lean your back on a soft sofa.

Then you need to squeeze the vagina, in such a way as during the period of waiting for urination. So do 50 times in one exercise. The amount of gymnastics per day depends on the desire of the pregnant woman. Only the muscles of the vagina and buttocks should work. The back and stomach are completely relaxed.

The second option is exercise during urination. At the time when a pregnant woman urinates, it is necessary to delay urination several times. At such a moment, the muscles of the vagina are involved, training before childbirth occurs.

Physical preparation for childbirth

To understand how to properly and efficiently prepare the body for childbirth, you need to use all the forces and resources. It’s unlikely that you can immediately get the results and see them, but upon the onset of labor, your body will “thank” you very much. As practice shows, childbirth in women who performed the correct preparation before childbirth tolerates pain more easily, and childbirth itself lasts several hours less, since the cervix is \u200b\u200belastic and trained.

Delivery exercises

To facilitate labor pains, professionals have developed special exercises to prepare for childbirth, which help improve the effectiveness of labor pains without arrogant pain.

No. 1 - Kegel exercises before childbirth

To properly prepare for childbirth without gaps, you can use the Kegel method. To do this, periodically compress the muscles of the vagina and anus to the maximum possible strength. Do this at any convenient time: before going to bed, in the bathroom, when preparing to eat. The more exercise you do, the better for you.

No. 2 - charging pregnant

To prevent damage to childbirth without gaps, gymnastics from gaps will help. To do this, you must take the dog's pose on a stable surface. First put a pillow on the floor, which will be a kind of insurance. Then lift and try to align one leg, then the other. After - arching the back of a cat like an “arc”. And so alternate several times.

No. 3 - training the vagina in water

A simple exercise that can be done with every bath. It is important to pre-steam the body well, but remember that a hot bath is contraindicated. Before you leave the bathtub, gently lie on your back, leaning your legs forward. Then stand on your toes, stretching your legs as much as possible. So 5-10 exercises. After such gymnastics, do Kegel exercises initially in a lying position, and then sitting.

Psychological preparation for childbirth

Psychological readiness for childbirth is perhaps the most important aspect that helps to spend the baby’s birthday as comfortably as possible. Of course, the pain during childbirth is very severe, only one who has never experienced such pain can say that you can enjoy this process. But, to simplify labor activities and prepare mentally - this is already half the success.

You can learn a lot of information, go to seminars for expectant mothers and do Kegel exercises every day. But, all this preparation is reduced to zero if the woman in labor begins to panic in the first minutes of childbirth. In moments of fear, panic and tears, all the muscles of a pregnant woman are compressed, the access of oxygen to the baby is blocked, and therefore such a process as childbirth only becomes more complicated.

It will hurt, but you need to understand that without this pain you cannot enjoy motherhood. You just need to be able to approach this issue thoroughly, not forgetting about proper breathing, moral rest in the intervals between contractions and the doctor’s recommendations. And if you prepared your body for childbirth in advance, then the whole process will pass as quickly as possible.

Currently, methods have been developed for both drug and non-drug exposure in order to form a woman’s readiness for childbirth.

Individual conversations and lectures - psychoprophylactic preparation;

Group exercises in special gymnastics;

The use of natural factors (light, air, water) to promote health and the use of physical therapy.

Psychoprophylactic preparation significantly reduces labor pains, has a multilateral, in particular organizing, effect on a woman, contributes to a favorable course of pregnancy and childbirth.

The main goal of the psychophysiological preparation of pregnant women for childbirth is as follows:

Develop a woman's conscious attitude to pregnancy, teach to perceive childbirth as a physiological process;

Create a good emotional background and confidence in the favorable course of pregnancy and the completion of childbirth;

To educate the pregnant woman in the ability to mobilize her will to overcome the fear of childbirth.

It is advisable to start classes from 33-34 weeks of pregnancy, to conduct them weekly for a month (4 lessons), each lasting 25-30 minutes. The first lesson can last about an hour.

The first lesson consists of introductory and main parts. In the introductory part, they focus on the possibility of training pregnant women to manage their will and activity in childbirth. One form of such training is autogenic training. Self-massage of certain biologically active points also contributes to strengthening the will and relieving psychoemotional stress: the sacral region, the lower abdomen, the inner surface of the upper edge of the ilium. The use of finger self-massage elements in childbirth helps to reduce labor pain, normalize contractions, and immobilize labor efforts.

To consolidate the acquired skills, pregnant women are recommended to repeat classes at home, lasting 7-10 minutes.

In the second lesson, the doctor explains the physiology of the first stage of labor. The mechanism of contractions, which contribute to the opening of the cervix, is described. Techniques are suggested to reduce the pain of contractions; it explains how to breathe properly during contractions and relieve muscle tension between contractions. A woman in labor should apply relaxation techniques and pain relief methods: stroking the lower abdomen with the movements of the palms from the midline to the side; when standing on the side by pressing with thumbs on the sacrum; when positioned on the back, thumbs are raised in front of the crests of the pelvis.

In the third lesson, pregnant women are introduced to the course of the second stage of labor. They explain what attempts are and how to promote the correct birth of a child. They inform about the subsequent and early postpartum period, about blood loss in childbirth. They persuade how important it is to follow the recommendations of the midwife during childbirth, conduct training with holding the breath and, conversely, with frequent shallow breathing. They tell how to push.

In the fourth lesson, the entire course of previous classes is briefly repeated and the acquired skills and techniques recommended in childbirth are consolidated.

Mothers who have undergone physioprophylactic preparation for childbirth require a lower dose of drugs to anesthetize labor.

Non-drug methods of exposure. They include intranasal electrical stimulation, electrical stimulation of the nipples of the mammary glands, acupuncture.

When choosing exposure points, the recommendations of classical Chinese acupuncture and the principle of segmental innervation of organs are taken into account.

Currently, preference is given to electroacupuncture (ELAP), which provides for the electrical effect of using pulse generators on the needles. Indications for the use of ELA are both insufficient readiness for delivery of the birth canal, and delivery during premature discharge of amniotic fluid.