Lead A Normal Birth

Many delivery rooms are now using a combined Wehen-, maternity, wake-up and Nachgeburtsraum, so that the woman, a caregiver and the newborn when staying at one and the same space remain. Some departments use a traditional labor room and a separate birth room into which the woman is transferred as soon as the birth is imminent directly. The father or another caregiver the opportunity should be offered to accompany the woman. In the delivery room, the dam is washed and covered with towels and delivered the newborn. After birth, the woman can stay there, or it is brought into a Nachgeburtszimmer. The treatment of complications during childbirth requires additional measures (abnormalities and complications during birth). Anesthesia is a choice of regional anesthesia, local anesthesia and general anesthesia. In general, local anesthetics and opioids are used. Because these drugs cross the placenta, they should be given an hour before birth only in small doses (eg. As CNS depression, bradycardia) in order to avoid poisoning of the newborn. Opiates alone does not provide sufficient anesthesia and are therefore often used in conjunction with anesthetics. Regional anesthesia Several methods are available. The lumbar epidural injection of a local anesthetic (analgesia) is the most commonly used method. The epidural injection is becoming more common for the birth, including the delivery by Caesarean section, applied and Pudendus- and Parazervikalblockade has largely replaced. Local anesthetics, which are often used for epidural injection (eg. As bupivacaine), have a longer duration and a slower onset of action than the one applied for the Pudendusblockade (z. B. lidocaine). Spinal injection (into the paraspinal subarachnoid space) can be used in a Caesarean section. In vaginal deliveries but it is used less frequently because their effect lasts only briefly (which use during the opening phase prevented) and her adhering the small risk of subsequent spinal headache. When using a spinal injection, the patients have to constantly cared for and vital signs every 5 minutes are checked to detect a drop in blood pressure and treat können.Lokalanästhesie The methods include Pudendusblockade, perineal infiltration and Parazervikalblockade. Under the Pudendusblockade that is rarely used because of the epidural, refers to the injection of a local anesthetic through the vaginal wall so that the anesthetic the pudendal nerve lapped where it passes over the ischial spine. This nerve block anesthesia, the lower vagina, the perineum and the posterior vulva; the front vulva, which is innervated by lumbar nerves of the skin, is not stunned. The Pudendusblockade is a safe, simple method for uncomplicated spontaneous vaginal deliveries if women feel strong pressing urge and want to give in to, or if the birth has progressed and there is no time for an epidural injection. The infiltration of the perineum with an anesthetic is often used, although this method is not as effective as a well-applied Pudendusblockade. The Parazervikalblockade is rarely appropriate for a birth because the incidence of fetal bradycardia is> 15%. It is v. a. used in abortion 1st or 2nd trimester. In this technique, 5-10 ml of a 1% lidocaine solution are respectively injected into the 3 and 9 o’clock position of the cervix. The effect of this anesthetic is short-lived. a significant respiratory depression of the mother and the fetus (n. d. Talk .: In Germany, the use of this form of anesthesia in living fetus after numerous court decisions is obsolete.) cause anesthesia As potent, volatile, inhalation drugs (eg. as isoflurane) can that general anesthesia for a routine delivery is not recommended. Rarely of 40% nitrous oxide (laughing gas) is mixed with oxygen (O2) used for analgesia during vaginal delivery as long as a verbal contact with the pregnant woman can be maintained. Thiopental, a hypnotic seditatives, is usually administered i.v. together with other drugs (. for example, succinylcholine, nitrous oxide plus O2) used for the induction of general anesthesia during a caesarean section; used alone thiopental leads to inadequate analgesia. With the introduction of thiopental is quick and waking up is immediate. Thiopental is concentrated in the fetal liver, thereby preventing high levels are in the brain; high levels in the CNS can cause depression of the newborn. The growing interest in childbirth has increased the demand of such drugs – except for caesarean section – reduced. Delivery of the fetus is performed a vaginal examination to determine attitude and ride height of the fetal head; usually the head is the presenting himself body part (expiration birth in cephalic presentation.). If the cervix depleted completely and the cervix is ??fully opened, the pregnant woman is asked to press with each contraction and spend all the strength to push his head through the pelvis and the introitus ever dilate, so gradually the head appears , When seen in first-time mothers during a contraction 3-4 cm of the head are (somewhat less at multiparas) can be facilitated with the following handle the birth and the risk of injury of the dam be reduced: The doctor (translator’s note… : in German-speaking usually the midwife) shall, if he is right-handed, left palm during Woe to the child’s head to control the exit and possibly to slow somewhat. At the same time, the doctor puts the slightly bent fingers of the right hand over the taut dam, through the forehead or chin of the child are palpable. In order to move the head forward, the physician can wrap a towel around a hand and with fingers diffracted pressure against the underside of the forehead or chin exercise (modified Ritgen handle). Therefore the physician controls the exit of the head to cause a slow, easy delivery. Expiry of birth in cephalic presentation. Forceps or ventouse (Operative vaginal delivery) are often used for vaginal birth, when the second stage of labor appears to delay (z. B. because the pregnant woman is too exhausted to mitzupressen enough or because a regional epidural anesthesia prevented a significant reduction) , In local anesthesia (Pudendusblockade or infiltration of the dam) forceps or ventouse are not necessarily required, unless it complications arise; Local anesthetics do not affect the press mostly. The indications for forceps and ventouse are basically the same. As an episiotomy performed and repairt method by Will Stone, MD and Kate Leonard, MD, Walter Reed National Naval Medical Center Residency of Obstetrics and Gynecology; and Shad Deering, COL, MD, Head of the Department of Obstetrics and Gynecology, Uniformed Services University. With the help of Elizabeth N. white bread, MA, CMI, Eric Wilson, 2LT and Jamie Bradshaw in Val G. Hemming Simulation Center at the Uniformed Services University. var model = {videoId: ‘5504384189001’, playerId ‘H1xmEWTatg_default’, imageUrl ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_5504404283001_5504384189001-vs.jpg?pubId=3850378299001&videoId=5504384189001’, title: ‘As an episiotomy performed and repairt’ description: ” credits’ method by will stone, MD and Kate Leonard, MD, Walter Reed National Naval Medical Center Residency of obstetrics and Gynecology; and Shad Deering, COL, MD, Head of the Department of Obstetrics and Gynecology, Uniformed Services University. With the help of Elizabeth N. white bread, MA, CMI, Eric Wilson, 2LT and Jamie Bradshaw in Val G. Hemming Simulation Center at the Uniformed Services University ‘hideCredits. True hideTitle: false, hideDescription: true loadImageUrlWithAjax: true} ; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); An episiotomy is not part of routine in most normal births and is only performed if the dam is not sufficiently expands and blocks the delivery, which is normally only first births at term the case. If the epidural anesthesia is not sufficient, may be infiltrated with local anesthetic. An episiotomy prevents a strong overexpansion and a possible irregular tearing of the perineal tissue u. a. also front cracks (z. B. Labien- and Vaginalrisse), above. A dam section extending only through the skin and the dam body without interruption of the anal sphincter (episiotomy 2nd degree) extends is usually easier to repair as a dam strain. The most common Episotomie is a median incision of the center of the rear Schamlippenkommissur directly posteriorly toward the rectum. While there is the risk of extending into the anal sphincter or rectum at a mittellinigen Episotomie, but if the crack is detected immediately, it can be powered successful and usually heals well. Cracks or widening of a section in the rectum can usually prevent by well bent keeps the child’s head until the occipital come forth under the symphysis pubis. Another type of episiotomy is a medio-lateral section, starting from the center of the rear Schamlippenkommissur at a 45 ° angle to one of the two sides. This type of episiotomy is not normally expands into the sphincter or rectum, but it causes greater postoperative pain and need the healing process longer than a median episiotomy. Therefore, the median section is preferred for an episiotomy. Because of concerns about expansion or tear in the anal sphincter or rectum but the episiotomy is less and less used. A Episioproktotomie (intended incision into the rectum) is not recommended because of the risk of a rectovaginal fistula. As a spontaneous vaginal delivery occurs process by Will Stone, MD and Kate Leonard, MD, Walter Reed National Naval Medical Center Residency of Obstetrics and Gynecology; and Shad Deering, COL, MD, Head of the Department of Obstetrics and Gynecology, Uniformed Services University. With the help of Elizabeth N. white bread, MA, CMI, Eric Wilson, 2LT and Jamie Bradshaw in Val G. Hemming Simulation Center at the Uniformed Services University. var model = {videoId: ‘5504359601001’, playerId ‘H1xmEWTatg_default’, imageUrl ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_5504407925001_5504359601001-vs.jpg?pubId=3850378299001&videoId=5504359601001’, title: ‘As a spontaneous vaginal delivery is done’, description: ” credits’ method by Will stone, MD and Kate Leonard, MD, Walter Reed National Naval Medical Center Residency of obstetrics and Gynecology; and Shad Deering, COL, MD, Head of the Department of Obstetrics and Gynecology, Uniformed Services University. With the help of Elizabeth N. white bread, MA, CMI, Eric Wilson, 2LT and Jamie Bradshaw in Val G. Hemming Simulation Center at the Uniformed Services University ‘hideCredits. True hideTitle: false, hideDescription: true loadImageUrlWithAjax: true} ; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); Episiotomy var model = {thumbnailUrl: ‘/-/media/manual/professional/images/episiotomy_high_blausen_de.jpg?la=de&thn=0&mw=350’ imageUrl: /-/media/manual/professional/images/episiotomy_high_blausen_de.jpg ‘? lang = en & thn = 0 ‘, title:’ episiotomy ‘description:’ ‘credits”, hideCredits: false, hideTitle: false, hideFigure: false, hideDescription: true}; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘image-element-panel.’). ko.applyBindings (model, panel.get (0)); During the birth of the head is checked whether the umbilical cord wrapped around his neck. If this is the case, it tries to wrest the umbilical cord; is not to remove them quickly, it can be clamped and cut. After the birth of the head of the child’s body rotates so that the shoulders reach a Geradstand; a gentle pressure on the head downward frees the front shoulder of the symphysis. The head is then raised slightly to the rear shoulder slides over the dam and the rest of the body follows without difficulty. Nose, mouth and throat are aspirated with a syringe to remove mucus and amniotic fluid and stimulate breathing. The umbilical cord should be double-clamped and cut between the clamps and a plastic clip attached about 2-3 cm distal to the umbilical cord insertion on the infant. In cases of suspected impairment of the fetus or newborn a portion of the umbilical cord is disconnected twice, so that an arterial blood gas analysis (BGA) may be performed. An arterial pH> 7.15 to 7.20 is considered normal. The child is thoroughly dried, then on the mother’s abdomen or, if resuscitation is required to put in a preheated Inkubatorbettchen. Delivery of the placenta after the birth of the child puts the doctor a hand lightly on the mother’s abdomen over the uterine fundus to feel contractions. The solution of the placenta usually occurs during the first or second woe, often accompanied by a gush of blood from the area of ??the dissolving placenta. In most cases the mother can help by Mitpressen in the development of the placenta. If they can not, or a strong bleeding occurs, the placenta can be normally ejected (expelled) are, by placing a hand on the abdomen and strong downwards (caudal) directed pressure exerted on the uterus; this method can only be carried out when the uterus feels tight, since pressure applied to a flaccid uterine pressure can invert this (. d. e with the inside to the outside return). If this measure is not effective, the umbilical cord is held taut while the hand lying on his stomach, the fixed uterus away upward from the placenta (towards the head) pushes. Fixed train at the umbilical cord must be avoided because this could invert the uterus. If the placenta is not released within 45 to 60 minutes after birth, a manual removal may be required. An appropriate analgesia or anesthesia is required. For manual removal, the doctor performs a whole hand into the uterine cavity, separating the placenta from its attachment and then extracts this. In such cases the suspicion of an unusually adherent placental consists (placenta accreta; Placenta accreta). The placenta should be examined for completeness, since placenta residues remaining in the uterus later can cause bleeding or infection. If the placenta is incomplete, the uterine cavity must be blanked manually. Some obstetricians palpate the uterus routinely made after each birth. However Nachtastung is very unpleasant and is therefore not recommended as a routine procedure. As the placenta is expelled and studies methods by Will Stone, MD and Kate Leonard, MD, Walter Reed National Naval Medical Center Residency of Obstetrics and Gynecology; and Shad Deering, COL, MD, Head of the Department of Obstetrics and Gynecology, Uniformed Services University. With the help of Elizabeth N. white bread, MA, CMI, Eric Wilson, 2LT and Jamie Bradshaw in Val G. Hemming Simulation Center at the Uniformed Services University. var model = {videoId: ‘5504400014001’, playerId ‘H1xmEWTatg_default’, imageUrl ‘http://f1.media.brightcove.com/8/3850378299001/3850378299001_5504400703001_5504400014001-vs.jpg?pubId=3850378299001&videoId=5504400014001’, title: ‘As the placenta is expelled and tested’, description: ” credits’ method by will stone, MD and Kate Leonard, MD, Walter Reed National Naval Medical Center Residency of obstetrics and Gynecology; and Shad Deering, COL, MD, Head of the Department of Obstetrics and Gynecology, Uniformed Services University. With the help of Elizabeth N. white bread, MA, CMI, Eric Wilson, 2LT and Jamie Bradshaw in Val G. Hemming Simulation Center at the Uniformed Services University ‘hideCredits. True hideTitle: false, hideDescription: true loadImageUrlWithAjax: true} ; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘video element panel..’); ko.applyBindings (model, panel.get (0)); Immediately after the birth of the placenta, a blow stimulating drug (oxytocin i.m. 10 I.U., or as an infusion of a saline solution containing 20 I.E./1000 ml in 125 ml / hour) was added to induce strong uterine contractions. To an active control of the third stage of labor includes administration of oxytocin after the child’s birth and before the birth of the placenta. Active control should be considered for women with anemia or at high risk for postpartum hemorrhage into consideration, because the risk of postpartum hemorrhage under active control is lower. Oxytocin should not as an i.v. Bolus be administered because it can lead to cardiac arrhythmias. Immediate postnatal care cervix and vagina are examined for injuries, which, if present, as a possible episiotomy are to be supplied with a seam. Then can the mother and child when they have recovered easily start their inner sense connection (so-called. Bonding) to develop. Many mothers want to start very soon after birth with breastfeeding, and this should be supported. Mother, child and father or partners should be together in a warm, personal atmosphere for 1 hour or longer to experience the intimacy of the parent-child relationship more intense. Depending on the needs of the mother, the child is then placed in the children’s room or left in the mother. During the first hour after birth the mother should be closely monitored to be sure that the uterus is well contracted (found on palpation of the abdomen), and to pay attention to bleeding, blood pressure problems and general well-being. The time between the delivery of the placenta to 4 hours after birth is called the fourth stage of labor. Most complications, especially bleeding (postpartum), occur during this time, which is why frequent checks are required.

Health Life Media Team

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