What do children love most? Of course, cartoons. It is in this section that we have collected a variety of foreign and domestic cartoons. Among the huge selection, there is sure to be one that your child will especially love. If you have a lot to do or just want to relax, and the child asks for constant attention, and if there is none, then he begins to “mess up”, then cartoons will come to the rescue. By turning on a cartoon for a child, you can distract him for at least half an hour, or even two or three.
An art form such as animation has been around for quite a long time. During this time, the quality has improved, which is good news. Children of any generation absolutely love cartoons; everyone, as a child, loved cartoons. Many adults at one time had to wait on TV and had to watch what was shown. Some people were lucky at one time if their parents bought cassettes or discs. And the new generation can already watch what they want without spending money from their parents’ wallet, because almost every home already has a computer and the Internet, with the help of which a huge card index of cartoons can be opened for every taste and color.
For the little ones, the Soviet classics, which are famous for their simplicity, kindness and pleasant pictures, are perfect. For example, “Crocodile Gena”, “Prostokvashino”, “Well, wait a minute!”, “Musicians of Bremen”, “Flying Ship”, “Winnie the Pooh”, “Baby and Carlson” and many others. You can even sit down with your child and reminisce about childhood. Also for young children there are many modern educational cartoons, which differ not only in brighter pictures, but also in content.
For children who are already finishing kindergarten or studying in primary school, cartoons of an entertaining nature are suitable, where heroes save someone or even the whole world. These include foreign cartoons about superheroes from comic books, about sorceresses or fairies, as well as domestic ones about heroes.
Those kids who are already slowly and surely moving towards adolescence, may already begin to be interested in cartoons that are especially different in plot. In such cartoons, in a relaxed manner, children are forced to think about serious things and experience a lot of emotions. They are suitable for viewing by the whole family, because due to the well-thought-out plot, they will be no less interesting for adults. Such cartoons can be safely placed on the same shelf as family films.
Teenagers, despite the fact that they consider themselves adults, still love to watch cartoons. For teenagers, they are already more daring and not as harmless as children. They are dominated by entertainment, adult jokes, and teenage problems. These are mainly foreign multi-part cartoons, such as “The Simpsons”, “Family Guy”, “Futurama”, etc.
Don't forget about adults. Yes, they also draw for adults, only they are somewhat similar to teenagers, however, they are more rude, there may be curse words, intimate overtones and adult problems are addressed ( family life, work, loans, midlife crisis, etc.).
Cartoons are an art form in which the author’s hands are completely free, because you can depict absolutely anything and at the same time add a charming story. We invite you to watch them right now and have great fun.
The question arose: why have children?
Let's figure out whether every person really need to leave behind offspring.
The child is procreation.
It is believed that women have a maternal instinct, even if she has not yet become a mother.
Evolution has adapted us in such a way that we strive leave behind offspring.
Unconsciously, we understand that humanity must continue to live, which means that for this it is necessary to give birth to children.
This high goals, which many do not think about, but they are, as it were, sewn into our genes.
In addition to preserving humanity on Earth, there are also personal reasons why people strive to have children.
For a woman - the realization of the instinct of motherhood. If you gave birth to a child, it means you are worth something. For a man, it’s to sow his seed, to leave his genes.
The birth of a child is accompanied by sufficient great difficulties. Starting from the need to take care of health, ending with the financial issue of providing for the family.
However, even couples who do not have high earnings still decide to have a child.
Main reasons:
Is it necessary to have children? Is it really necessary to have a baby? Society, your husband, your parents put pressure on you, but you internally resist and don't want to be a mother.
If you look at the percentage of unwanted children and the attitude of parents towards them, you can see that the occurrence in this case is higher than if the child is wanted.
Not all women have it maternal instinct. Sometimes it does not appear even after the baby is born.
This is neither good nor bad, but simply a personality trait.
So this woman can realize yourself in other activities, and it is absolutely not necessary that she needs to give birth to a child.
Children should be desired, then they...
Menstruation begins in girls at the age of 12-13, but this does not mean at all that she is ready to conceive. Unfortunately, statistics in recent years are disappointing, and there are more and more teenage mothers.
There is also the opposite trend - women who decide to give birth after 35 years, when they reach high earnings, have established themselves in their careers.
However, we must remember that the older the woman in labor, the greater the risk for her and the child. This is especially true for those who are about to give birth for the first time.
A girl who gives birth before the age of 20 must understand what changes will happen in her life, including social. It is likely that you will have to drop out of school or take a leave of absence, go on maternity leave, and take a career break.
At the age of 18, children most often turn out to be unplanned, and not all parents are psychologically ready for the birth of a child.
By the age of 25 a person already quite mature, is able to set goals and implement them.
Time between 20 and 30 years most favorable for the birth of children - the body is still strong, health allows it, and the salary, as is right, is already acceptable to provide for a child.
Not every woman marries well. It happens that she is already 30, 35, and family life has not worked out. A woman wants a child, and the question arises: should she give birth for herself?
Here it is important to evaluate your capabilities. No one but you will provide for this child financially.
If you need to leave him with someone, you will have to ask not your husband, but your mother, girlfriend, or hire a nanny.
It’s worth giving birth to yourself if you are completely sure that you can raise and provide for a child. No one will decide for you whether it is necessary or not. If the child’s father refuses to participate in raising him, and you want to leave him, then this is your right.
A big misconception of many women is that, having given birth to a child, they thereby keep the man close to them.
Men have a less developed instinct to provide for offspring.
For them, the very fact of the birth of a child is more important, and not.
A very small percentage of men do so precisely because a child was born. And this does not guarantee that when the baby grows up, the man will still not leave.
Moreover, dysfunctional family atmosphere When parents see each other, it negatively affects the development of children.
Why do some people give birth to many children? An interesting fact is that families often give birth to many children. with little income and low social status.
Perhaps this has to do with the ability to competently plan your future and the future of your children.
Every child is large financial costs, but some families don’t think about it; the very fact of his birth is important to them.
Reasons for the emergence of large families:
There are reasons why a child It's not worth giving birth:
Childfree is an ideology, a movement characterized by a conscious reluctance to have children. Translated, the term means “free from children”; it arose quite recently, around the 70s of the last century.
People of this social movement have the belief that they do not need children, they do not want to have them for certain reasons.
The term was coined to distinguish those who are unable to have children for health reasons from those who voluntarily refuses to give birth to offspring.
Why do people make these choices? Conventionally, childfree can be divided into two types:
Childfree may not have children for a variety of reasons:
In any case, life without children is a person’s personal choice, and no one has the right to condemn him.
When choosing whether or not to have a child, you need to understand What are the risks of not having children?
Women have much less time to become a mother than for men to become a father.
A woman's life is limited, while most men are capable of fertilization until old age, and if the husband now says that he does not want a child, this does not mean that he will not have this desire in the future.
To give birth or not - it must be a conscious choice, careful planning. A random child can also become loved, but it is still better when he is born at the right time and at the request of both parents.
Why have children? Psychologists' opinion:
Preparing for the long-awaited birth of a baby, every woman dreams that it will go smoothly - without complications and as quickly as possible, so as not to endure painful contractions for too long.
In fact, the whole process lasts differently for everyone: for some, everything ends in 2 hours, and for some, they are relieved of the burden only at the end of the day. Both are pathologies. And those very quick births that all expectant mothers dream about do not always end well. What is the reason?
First, you need to figure out what quick labor means and whether it is actually dangerous for mother and baby.
Secondly, it is advisable to distinguish between two very similar concepts that exist in gynecology - rapid and rapid labor.
Thirdly, you need to understand that they will be different for first- and multiparous women. For some, the body experiences such stress for the first time, which means that the cervix, birth canal, pelvic bones - everything will diverge much more slowly. For others, the so-called “body memory” is triggered + all the organs involved in this process have already been stretched the last time, so now this all happens with the least amount of time. The birth canal is better prepared, and the cervical canal is stretched along its entire length at once, rather than gradually.
According to medical terminology, rapid labor is one that lasts less than 6 hours for primiparous women and less than 4 hours for multiparous women. People also call them street ones. Normally, this period of time should be from 7 to 15 and from 5 to 12 hours, respectively. It is calculated based on the average normal value for a primigravida woman - the rate of cervical effacement, which is 1 cm per hour. Anything that does not fit into this framework is considered pathology in gynecology.
There are also ones that can last only 4 hours when the first child appears and 2 hours - if the woman in labor already has children.
Why is the baby in such a hurry to be born, endangering not only his own life and health, but also his mother’s? The main reasons are the features female body, not the fruit. If a pregnant woman pays attention to them from the beginning, she will be able to avoid rapid labor and complications associated with it.
This is interesting. Previously, midwives said that a woman in labor should not see the dawn twice, that is, childbirth should not last more than a day.
As a rule, the reasons for rapid labor in first-time mothers and those who have already given birth are the same. With timely diagnosis and regular monitoring by a doctor, they are detected long before the baby is born. With the correct and coordinated actions of the pregnant woman and the gynecologist, they can be eliminated. These include:
Timely elimination of these causes reduces the risk of rapid labor, and therefore the complications that they are fraught with. If you couldn’t avoid this, you just need to be well prepared for this process in order to help your own body and baby overcome all difficulties without consequences. It is quite possible. And the first step towards this is to understand from the very beginning of contractions that this is happening much more quickly for you than is normal.
According to statistics. Rapid labor is diagnosed in 1% of cases.
What signs may indicate that rapid labor has begun in first-time mothers:
They begin in approximately the same way, but they are much less painful. However, the risk of repeated ruptures, if they have occurred before, increases. With a colossal load on the organs involved in this process, the previous sutures cannot withstand and come apart again, no matter how well they were made the previous time.
To be prepared for all surprises, it is useful for a woman to find out how all this happens in order to behave correctly and reduce the risk of complications.
If you have already realized that a quick birth cannot be avoided, calm down and try to behave correctly at every stage of the difficult process. A lot depends on this: consequences, complications, injuries, ruptures, etc. If you prepare well and do everything that the doctor says, the risks can be minimized.
If this is a very quick birth (rapid), you need to act wisely and without panic. According to statistics, if the pregnancy proceeded without pathologies, there is every chance that the child and the woman’s body will cope with this situation without any problems. Although many experts argue that such childbirth will still have negative consequences for both. Here, much will depend on the actions of the doctor delivering the baby.
With the rapid development of labor, various therapeutic measures are carried out depending on the condition of the mother and child. They are aimed at reducing the activity of the uterus.
A quick birth is always stressful for the mother’s body, for the baby and for the entire team of doctors who take part in it. At each stage, it is necessary to carefully monitor the condition of the fetus in order to avoid tragic consequences.
Despite the fact that this is a great rarity with the modern level of medicine, they still make up a larger percentage than with normal duration birth process.
Is rapid birth good or bad? This question there is no clear answer even among specialists. Most of them are still inclined to the second option, since in 6 hours the body of a young woman who gives birth for the first time cannot prepare for such a stressful and difficult event.
It is increasingly said that the consequences of rapid childbirth may not appear immediately, but only over time. However, no specific research has been carried out in this direction. You need to be prepared for anything.
The most serious consequences for the child are those that are difficult to identify immediately after birth, much less to treat. Knowing about this kind of complications, you need to pay special attention to some points in its development, not miss a single consultation with a pediatrician and carry out maximum examinations for the presence of abnormalities.
This is the only way to eliminate the complications of rapid labor. And, of course, it is best to engage in timely prevention so that the birth of the baby takes place within normal limits.
Prevention of rapid labor is no different from the recommendations for pregnant women, which are known to everyone. If a woman for 9 months (and ideally, several months before conception) leads healthy image life and protect yourself from diseases, everything will be fine, without pathologies. To do this, it is enough to follow the common truths:
So, dear women, you don’t need to dream about giving birth too quickly, which does not always end well and can have a lot of negative consequences for you and your baby. Let everything go well within the normal limits and without complications. And if you had to face such a situation, do everything correctly - this will minimize risks and avoid troubles.
Where it was found out that only 4% of women give birth on their PDA and that the period normal pregnancy varies in women with delta as much as three weeks!
One midwife told us this: “Imagine that two apple trees are growing - one is an early ripening one, and the other is an autumn variety. Both bloom in spring, stand in the rain and bask in the sun. But one is designed in such a way that it will have apples already in July, while the other will have apples no earlier than September. All the apples are tasty and rosy, they just ripen at different times.”
I remember one day a worried dad called me: “How can we speed up the birth? She seems to love being pregnant so much that she won’t even give birth by 45 weeks!”
And sometimes it happens that a woman wants to somehow influence the process and speed up the birth of the baby a little. Sometimes before the recommended medical induction (labor induction), mothers try more soft ways start labor.
N.B.Any, even mild and natural, means to induce labor are an interference in the natural process of the birth of a baby.Check with your doctor and/or midwife before using them.
Is there really cause for concern?
20 ways to speed up labor or what to do if labor doesn’t start?
Why does this work?
Because the specialist stimulates biologically active points associated with the uterus. If it is not possible to visit a trusted specialist, then you can try self-stimulation “based on” in the format of a general relaxing massage with clary sage (a few drops in base oil)
Alcohol
A glass of wine or champagne, if necessary.
Why does this work?
Under the influence of alcohol, the cerebral cortex is inhibited, a pronounced sedative effect appears - in other words, a woman calms down and stops worrying about every issue. The level of stress hormones decreases again.
Most often, women abstain from alcohol during pregnancy, so even a glass of wine is enough to have a clear effect.
**Attention! If you are categorically against alcohol during pregnancy, you do not need to use this method - there are many others!
Conversation
Talk to the child, ask him to quickly go to a meeting with mom and dad; talk to each other and discuss EVERYTHING again possible options"what if"; talk to a specialist you trust.
Why does this work?
Nobody fully understands about talking to a child, but this advice is given not only by traditional midwives, but also by official doctors.
About conversations with adults - the same effect about reducing stress, sharing responsibility and accepting the situation as it is.
Homeopathist
Elizabeth Davis, a Californian midwife with 30 years of experience, in her book “Hearts and Hands” recommends taking Cosimifuga 30C once an hour for 8 hours, and then also Caulophyllum 30C to ripen and soften the cervix. If the cervix is already soft, then Elizabeth advises taking Caulophyllum 200C once at night.
Why does this work?
It is believed that microdoses of the active substance cause a strong response in the body according to the principle of treating like with like.Randomized trialsThe effectiveness of Caulophyllum for inducing labor has not yet been confirmed. However, this may be due to the need for an individual approach when prescribing homeopathic medicines, scientists say.
***Keep in mind : the effect of medications is reduced by consuming caffeine, tobacco, alcohol and mint (tea, paste, chewing gum).
“Shake yourself up” with sex, walking up and down the stairs, walking in the park, swinging on a fitball and yes, washing the floors, thanks to Olga Fokina for the reminder!
Why does this work?
In response to physical activity, uterine contractions are triggered and, if the body is ready for childbirth, there is a chance that contractions will become regular and intensify.
Food
Dates, hot curry, ginger, pineapples, eggplants, licorice, balsamic vinegar, fermented baked milk with cinnamon (thanks to Yulia Karpenko for the recipe).
Why does this work?
If there is already research about dates, then the remaining components of the menu relate to traditional, but not scientifically proven methods. It is believed that the mechanism of action is usually based on two factors: the presence of substances that promote softening and ripening of the cervix, and stimulation of the intestines.
OneAmerican pizzeriathey even serve a special “labor-inducing salad” (green leaves + dressing from olive oil and balsamic).
Class
“Give yourself time...children are born when they are ready for it...” - that’s all true, but how painful it can be to just sit and wait!
Therefore, many women find important and useful things for themselves that are worth finishing before the onset of labor: finding the best-mattress-for-the-crib, learning to bake a Napoleon cake, creating a wardrobe for after childbirth - sale now, watching all parts of the series “Midwives” or “Fizruk”, submit financial statements. Who knows what will be useful for you?
Why does this work?
Because sometimes you just have to wait.
The onset of labor is associated with the baby's readiness to breathe. If everything is fine with mother and child (a test, CTG and regular observation by a doctor/midwife can confirm this), all that remains is to wait for the moment. It is believed that women with a long cycle can add as many days to their cycle as the cycle is longer than 28 days.
Get rid of constipation
Dried fruits (pre-soak in water for several hours) ordried fruit candies , mild laxatives, enemas help cleanse the intestines and stimulate excretory processes.
Why does this work?
As you know, mild diarrhea is one of the harbingers of imminent childbirth. Bowel contractions can stimulate contractions. Emptying your bowels (and bladder) allows your uterus to contract more efficiently.
**Attention! Drink thirstily, as severe diarrhea causes dehydration, which, on the contrary, interferes with labor.
It is often recommended as a “home” method of inducing labor. In Russia they usually recommend an “obstetric cocktail” (a glassapricot juice and brut or soda mixed with a couple of tablespoons of ground almonds and castor oil), in America it is more often mixed with orange juice. Dosages vary greatly - from 10 to 100 ml. Accordingly, the effect occurs within 3-12 hours. Before the era of synthetic prostaglandins, castor oil was quite officially used for induction in maternity hospitals.
Why does this work?
Castor oil increases the production of prostaglandins, causing the cervix to soften, and the accompanying diarrhea and bowel contractions further stimulate the uterus.Researchshow that castor oil did not affect either the duration of labor or the health of the mother or child.
**Attention! Modern midwives are divided in their attitude to inducing labor with castor oil. Many consider its use unjustified, since severe diarrhea causes dehydration, which leads to loss of strength and the prospect of childbirth on the toilet. Also, contractions caused by castor oil may subside within a few hours, which in a maternity hospital will most likely lead to additional interventions to stimulate labor.
Evening primrose oil
Typically used as food supplement(500-2000 mg per day) and as an oil for perineal massage.
Why does this work?
It is believed that gamma-linoleic acid, which is rich in evening primrose oil (evening primrose), helps the production of prostaglandins, which are responsible for cervical ripening.
Scientific researchThere are few evening primrose oils and they are contradictory. Some show no effect, others - faster ripening of the cervix, others - a bunch of side effects from increased risk of bleeding and premature rupture amniotic fluid to increase the duration of labor and more frequent stimulation with oxytocin.
Yes, at least just sit quietly for 10 minutes. You can download a special application for meditation. Why does this work? It is believed that meditation helps relieve stress, calm the mind and trigger relaxation mechanisms in the body. This is confirmed by a number of studies (for example, a professor from Harvard even created a special
Tenderness and everything that helps you find yourself in bliss and bliss.
A four-hand massage, a bath with foam and essential oils of lavender and rose, lying in bed all day, going to the opera, gourmet eating or going to the bathhouse - everything that previously gave you a feeling of absolute happiness will work now.
Why does this work?
When we relax and enjoy ourselves, the level of stress hormones decreases and oxytocin is produced more easily.
Osteopath
This is not manual therapy, all manipulations are very gentle. So if you're going for the first time, prepare to be surprised. In most cases, the effect occurs within 2-3 days, and before that many people wonder: did I just spend 3-5-7 thousand on gentle strokes? Give yourself time, it works!
Why does this work?
A gentle effect on muscles and ligaments that helps balance tension and relaxation in the body. Sometimes the baby won’t take any action and the contractions start and then subside again. An osteopath can help relax the ligaments that support the uterus, allowing the baby to finally get into the best position for birth.
Some women find that alternating physical activity with intense relaxation helps them calm down and relieve stress. For example, a swimming pool and yoga nidra practice. Or maybe a sauna or just an endless bath with jasmine
Attention! essential oil Jasmine causes uterine contractions
Why does this work?
Sometimes labor does not begin because the woman is tired, worried and afraid. When stress hormones and adrenaline accumulate in the body, the production of oxytocin becomes difficult. Exercise and relaxation help relieve tension and get a rush of endorphins. From this state, starting labor is much easier and more enjoyable.
Sex
Yes, cunnilingus counts too. Yes, you can do it without a condom. Yes, orgasm is important.
Why does this work?
Firstly, blood flows to the pelvic organs.
Secondly, during orgasm, the hormone oxytocin is released, which, as is known, is also responsible for uterine contractions during childbirth. If the uterine receptors are already sensitive enough, an additional portion of oxytocin can be a trigger.
Thirdly, semen contains prostaglandins, which promote the ripening and softening of the cervix.
Nipple stimulation
The movements should be quite active, similar to pumping. Some moms even use a breast pump to stimulate their nipples.
Why does this work?
The uterus contracts in response to the release of oxytocin during nipple stimulation. Yes, yes, oxytocin is also needed during breastfeeding - it is responsible for the milk release reflex. Don't be alarmed if you see droplets of colostrum - many mothers already have it in their breasts before giving birth.
Creation
Termination of pregnancy between 28 and 37 weeks is called premature birth. Termination of pregnancy between the 22nd week and 28 weeks, according to the rules of the World Health Organization, is classified as very early preterm birth. In our country, termination at this stage of pregnancy is not considered premature birth, but at the same time they provide assistance in maternity hospital, and not in a gynecological hospital, they take measures to nurse deeply premature newborn. A child born as a result of such births is considered a fetus for 7 days; only after a week such a baby is considered not a fetus, but a child. This feature of the terminology is due to the fact that children born before the 28th week of pregnancy are often unable to adapt to the conditions environment outside the womb, even with the help of doctors.
Factors leading to premature birth can be divided into socio-biological and medical.
It should be noted that in the autumn and spring months the frequency of this complication increases. This is due to changes in weather conditions, in particular frequent changes in atmospheric pressure, which can affect the frequency of premature rupture of amniotic fluid. Heavy colds with a high rise in body temperature and a strong cough can increase and cause labor prematurely. An adverse effect on the course of pregnancy of a number of production factors has been noted: exposure to chemicals, vibration, radiation, etc. Premature births are more common in young, student, unmarried women, with a lack of proteins and vitamins in the diet, as well as in women with bad habits.
Medical factors include severe infectious diseases, including those suffered in childhood, abortions, and inflammatory diseases of the genital organs. Chromosomal abnormalities of the fetus - damage to the hereditary apparatus of the fetus under the influence of unfavorable external and internal factors (ionizing radiation, industrial hazards, taking certain medications, smoking, drinking alcohol, drugs, unfavorable environmental situation, etc.) - can lead to premature birth, but more often in In such cases, pregnancy is terminated in the early stages. In most cases the reason premature birth are diseases of the endocrine system, for example, dysfunction of the thyroid gland, adrenal glands and ovaries, obesity, in which the functioning of all endocrine glands changes. Anatomical changes in the genital organs include genital infantilism (underdevelopment of the female genital organs), malformations of the uterus, traumatic injuries to the uterus during abortion and curettage, and uterine tumors. In almost one third of cases, the cause of premature birth is isthmic-cervical insufficiency, in which, as a result of mechanical effects (cervical trauma after abortion, previous births, other gynecological manipulations) or a lack of certain hormones, the cervix does not perform its obturator function.
Often the cause of premature birth is cervical-vaginal infections (trichomoniasis, mycoplasma, chlamydia, etc.) and viral infections (cytomegalovirus, herpes, influenza, adenoviral infection, mumps), especially those that occur latently. The presence of a chronic genital infection contributes to the disruption of the local protective barrier and damage to the fetus. Severe forms of extragenital diseases (not related to the female genital organs) and pregnancy complications can also lead to miscarriage. Such diseases include, for example, hypertension, cardiovascular diseases, anemia, chronic diseases of the lungs, kidneys, liver, etc.
When premature labor begins, regular labor and smoothing or dilatation of the cervix appear. The onset of labor is accompanied by the appearance of regular cramping pain in the lower abdomen, which increases in intensity over time, and the intervals between contractions decrease. Quite often, premature birth begins with the rupture of amniotic fluid, and their amount can be from a few drops to several liters. In addition, the appearance in a woman of mucous discharge streaked with blood or bloody discharge in case of premature pregnancy indicates emerging structural changes in the cervix, i.e. its smoothing. The appearance of any of the above symptoms requires urgent hospitalization in an obstetric hospital.
At the slightest suspicion of a deviation from the normal course of pregnancy, you must seek qualified help.
If these symptoms appear, you must immediately call an ambulance, which will deliver expectant mother to the hospital. In some cases, it is possible to prolong the pregnancy; if this is not possible, then the hospital creates conditions for a gentle delivery—birth, during which a very fragile baby experiences the least stress possible.
With premature birth, premature rupture of amniotic fluid, weakness and dysfunction of labor, rapid or impaired regulatory mechanisms, and fetal hypoxia are more often observed.
Premature rupture of amniotic fluid often occurs with isthmic-cervical insufficiency or the presence of infection. The lower pole becomes infected and, as a result of inflammation, the membranes rupture easily. Normally, the amniotic sac ruptures closer to the full dilatation of the cervix, that is, already during labor. A woman’s sensations can vary: from a small wet spot on her underwear to large quantity water flowing from the vagina and flowing down the legs. The waters should be light, but can be cloudy or dark brown (if infection is present). Births that occurred ahead of schedule, very often occur quickly or even rapidly. The woman experiences rather painful contractions, their frequency increases, the intervals between contractions are less than 5 minutes and quickly decrease to 1 minute, the first stage of labor (until the cervix is fully dilated) is reduced to 2-4 hours. Due to the fact that the head of a premature fetus is smaller, expulsion of the fetus begins when the cervix is not fully dilated. A smaller baby moves through the birth canal faster.
Unlike timely births, there are more complications with premature births. Firstly, the baby’s head does not have time to adapt to the mother’s pelvic bones and configure. The configuration of the head is the possibility of displacement of the bones of the fetal skull during childbirth to reduce its volume as it passes through the birth canal. This mechanism allows you to reduce pressure on the head and cervical spine of the newborn baby. The bones of the skull of a premature baby are quite soft and cannot provide protection to the brain; the risk of trauma and hemorrhages under the membranes into the fetal brain tissue during childbirth increases. As a result, the child may experience hemorrhages, he does not have time to adapt to environmental changes, and his regulatory system is disrupted. Secondly, a woman often suffers ruptures in the birth canal (cervix, vagina and external genitalia), since the tissues do not have time to adapt to the stretching.
When labor threatens and begins, the woman is urgently hospitalized.
Much less common in premature birth is weakness of labor. Weakness may manifest itself as weak, infrequent or short contractions. The labor time increases significantly, the woman gets tired, and the child also begins to suffer. Other anomalies of labor are possible, for example, the strength and frequency of contractions is sufficient, but the cervix does not dilate. All this is associated with a violation of regulatory systems during premature birth; there is no sufficient hormonal preparation for childbirth. Infectious complications during childbirth and postpartum period occur an order of magnitude more often in both the mother and the fetus. Among such complications are suppuration of sutures (if any), postpartum metroendometritis (inflammation of the mucous membrane and muscular layer of the uterus), peritonitis (inflammation of the peritoneum) and the maximum spread of infection (sepsis). This is due to the presence of a latent or obvious infection that the pregnant woman had before giving birth, which is often the cause of miscarriage. An infection can occur during childbirth, due to its duration (with weakness), for example, chorioamnionitis (inflammation of the membranes of the fetus). Premature babies have reduced immunity and, accordingly, are more susceptible to infections.
Due to the peculiarities of obstetric tactics and different birth outcomes for the fetus, it is considered appropriate to divide premature birth into three periods, taking into account the timing of gestation (pregnancy): premature birth at 22-27 weeks, premature birth at 28-33 weeks, premature birth at 34-33 weeks. 37 weeks gestation.
Premature birth at 22-27 weeks (fetal weight from 500 to 1000 g) is most often caused by isthmic-cervical insufficiency (due to trauma in previous births), infection of the lower pole of the membranes and premature rupture of the membranes. Therefore, in this group of women, as a rule, there are few primigravidas. The presence of infection in the genital tract excludes the possibility of prolonging pregnancy in most pregnant women. The fetal lungs are immature, and it is not possible to accelerate their maturation by prescribing medications to the mother in a short period of time. Such children belong to a high-risk group and are more often subject to urgent resuscitation. They are in incubators, under the strict supervision of a neonatologist and qualified nurses. Children almost always need a further stage of nursing and are registered for a long time in perinatal centers or clinics at their place of residence.
Premature birth at a gestational age of 28-33 weeks (fetal weight 1000-1800 g) is caused by more diverse reasons than earlier premature births. There are more than 30% of first-time pregnant women in this category of births.
More than half of women undergo expectant management and continue pregnancy. In such children, the lungs do not have time to “mature”, and the production of surfactant is disrupted. Surfactant is a mixture of fats and proteins that is synthesized in the large alveoli (the building blocks of the lungs), coating them, promoting their opening and preventing them from collapsing during inspiration. In the absence or deficiency of this substance, the child’s breathing is impaired. A surfactant drug can be administered to newborns if necessary, it significantly facilitates breathing, but this drug is very expensive and is not always available. Therefore, in order to prevent breathing problems, women are prescribed glucocorticoids. They stimulate the production of surfactant and the “maturation” of the fetus’s lungs within 2-3 days when there is a threat of premature birth. With the onset of labor, glucocorticoids are administered intravenously at intervals of 3-4 hours.
Premature birth at a gestational age of 34-37 weeks (fetal weight 1900-2500 g or more) is caused by even more diverse reasons, the percentage of infected women is much lower than in previous groups, and primigravidas - more than 50%. However, due to the fact that the fetal lungs are practically mature, administration of drugs that stimulate the maturation of surfactant is not required.
Children are less likely to be transferred to the intensive care unit, but round-the-clock care and observation are necessary in all cases until the child’s condition is completely stabilized.
In case of threatening and beginning labor - when there is no dilatation of the cervix or it is insignificant - tactics are aimed at prolonging pregnancy. The woman is urgently hospitalized, placed on strict bed rest, prescribed sedatives, and the causes that led to premature birth are eliminated (if possible). For example, suturing the cervix for isthmic-cervical insufficiency, treating vaginal infections, restoring the natural microflora of the vagina or prescribing antibiotics in the presence of an infectious process, treatment is carried out together with a therapist or endocrinologist (if necessary). An obligatory component is drugs that reduce the tone of the uterus (tocolytics), improve the functioning of the placenta, increase immunity, vitamin therapy, as well as drugs that improve the intrauterine nutrition of the child and accelerate the “maturation” of the fetal lungs.
In each case it is necessary individual approach, however, the efforts of doctors do not always lead to the desired results, and the process progresses to the onset of premature birth.
Round-the-clock care and observation are necessary in all cases until the child’s condition is completely stabilized.
Premature birth requires a qualified obstetrician-gynecologist, nurse and a neonatologist. Constant monitoring of the woman and the condition of the fetus is necessary. The woman is regularly examined, her blood pressure and body temperature are measured, and urine and blood tests are monitored. In addition to cardiac monitoring data, the development of labor is monitored, the fetal heartbeat is listened to, and the position of the fetus is determined. Fetal cardiac monitoring is the study of heart rhythm. It is performed on a special apparatus at rest, with the pregnant woman lying on her side for 30-60 minutes. Recording sensors are placed on the anterior abdominal wall of the pregnant woman using an elastic band, which record the fetal heartbeat, as well as the frequency and strength of contractions.
Most complications during childbirth, both on the part of the mother and the fetus, are caused by a violation of the contractile activity of the uterus. To identify the characteristics of the contractile activity of the uterus during premature birth, it is recommended to maintain a partogram (a graphical representation of the frequency and strength of contractions) and record the contractile activity of the uterus. The partograph can be carried out without any equipment, by touch, with a stopwatch, recording the frequency, strength and duration of contractions, and then depicting them on a graph. However, all specialized centers have cardiac monitoring, which clearly displays the condition of the child during the birth process, as well as the tone of the uterus and the effectiveness of contractions in dynamics, which allows timely correction and provision of qualified medical care in case of any deviations.
To determine the degree of dilatation of the cervix, the doctor examines the woman on a gynecological chair. Due to the possible negative impact on the condition of the fetus, labor stimulation or inhibition of labor is carefully considered, and often the issue must be resolved within a short time, with the decision being made by several doctors. Hypoxia (lack of oxygen) of the fetus is prevented; in most cases, narcotic painkillers are avoided (as they adversely affect the fetal respiratory center). Childbirth is carried out in the lateral lying position, because it is easier to control labor in this position, the head does not move quickly along the birth canal, the health of the woman and the fetus remains satisfactory, in contrast to the supine position, in which the pregnant uterus compresses large venous vessels and worsens blood circulation of mother and fetus. Anesthesia and epidural anesthesia accelerate the process of dilation of the cervix, which is often too fast. The fetal head does not have time to adapt to the birth canal, and often a poorly distensible perineum aggravates the situation, so it is approached individually.
It is within the power of the woman herself to reduce the likelihood of premature birth. There is no need to hide previous abortions and inflammatory processes in the past from the doctor with whom the woman is registered. You must immediately inform your doctor about any changes in your body and attend special classes to prepare for childbirth. If a pathology is detected, you should not refuse the treatment prescribed by the doctor. It is necessary to limit physical activity and monitor your diet, which should be varied and well-balanced. Excessive consumption of spicy, salty or fatty foods leads to exacerbations of chronic diseases of the digestive system, which can cause premature birth. If symptoms of pregnancy appear, you should avoid sexual activity during the last two months of pregnancy. If you have the slightest suspicion of a deviation from the normal course of pregnancy, you must seek qualified help.
Nadezhda Egorova,
obstetrician-gynecologist, assistant at the department of obstetrics and gynecology,
Astrakhan State Medical Academy, Astrakhan
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