Mom-to-be 

What to do if there is no labor. Objective and subjective reasons. Preliminary stimulation of labor

How sad it is to talk about it, but not all childbirth proceeds without complications, one of which is the weakness of the birth forces, which belongs to a large group of birth forces anomalies. All anomalies of the birth process are found in 12-15% of cases, and the proportion of weakness of the birth forces is 7%. It is noted that the weakness of contractions and attempts more often occurs in primiparous women than in multiparous women.

Weakness of birth forces

What are the weaknesses of the generic forces

Weakness of labor is divided into primary and secondary... The primary weakness of the labor forces is said when contractions of insufficient intensity and duration have arisen from the very beginning of the labor act and continue throughout the entire first period until the end of labor. If there was a period of good labor, in which there was a positive dynamics of cervical dilatation, but then the contractions lost their strength and became shorter, there is a picture of the secondary weakness of labor.

In addition, in some situations, there may be a weakness of attempts (in the period of expulsion of the fetus), which is also primary and secondary.

Causes of weakness of labor

Many factors that can provoke weakness of labor forces are associated either with structural insufficiency of the uterus, impaired hormonal regulation of the labor process, or with various chronic diseases, complications of pregnancy, fetal pathology, and others. All the reasons for this complication of childbirth can be divided into three large groups:

Maternal

  • transferred childhood infections;
  • too young (under 18) or late (over 28);
  • late onset of menarche;
  • problems with the menstrual cycle in the past;
  • anomalies in the development of the uterus (intrauterine septum, saddle, two-horned, and others) and genital infantilism (hypoplasia of the uterus);
  • tumors () and inflammatory processes (endometritis, adnexitis);
  • endometriosis of the uterus;
  • disturbed structure of the uterine wall (many and diagnostic curettage of the uterine cavity, conservative myomectomy, uterine scar after other operations, etc.);
  • parity: high number of births;
  • the course of previous labor with complications (manual separation of the child's place and manual control of the uterine cavity);
  • cicatricial-deformed cervix after treatment of cervical diseases (diathermocoagulation, cryodestruction);
  • extragenital pathology (obesity, thyroid pathology, and others);
  • physical and mental overwork, constant stress;
  • fear of childbirth;
  • narrow pelvis due to its anatomical narrowing;
  • diastasis of the muscles of the anterior abdominal press (contributes to the weakness of attempts).

Fruit

  • the estimated weight of the fetus reaches 4 kg or more;
  • multiple pregnancy;
  • incorrect presentation / position of the child and insertion of the head;
  • clinically narrow pelvis.

Factors associated with pregnancy

  • lack of water and multiple pregnancy;
  • bottom location of the placenta;
  • intrauterine fetal malformations;

How is the weakness of the birth forces manifested and diagnosed?

The course of the birth process with primary weakness can have a different picture. Contractions can be very rare, but of good intensity, or very frequent, but unsatisfactory intensity and short. A more favorable prognosis has a primary weakness, which occurs with rare but good contractions. There is a delayed smoothing of the neck, and the opening of the uterine pharynx is not more than 1 - 1.2 cm per hour. Also, during the vaginal examination, the doctor states that the presenting part (head or pelvic end) for a long time remains either movable above the entrance to the small pelvis, or fixed to the entrance, even if the dimensions of the presenting part correspond to the size of the pelvis. As a result, the duration of labor is lengthened, resulting in fatigue of the woman in labor. Quite often, with the existing primary weakness of the birth forces, an early rupture of the amniotic fluid occurs, which increases the anhydrous gap, increases the risk of infection of the uterus, cervix and vagina of a woman, hypoxia and fetal death. As a result of prolonged immobility of the head or pelvic end in one of the planes of the small pelvis, soft tissues are compressed, blood circulation in them is disturbed, which leads to the formation of fistulas between the vagina and the bladder and intestines, an increase in the risk of hypotonic bleeding in the early postpartum period and infectious and inflammatory diseases ...

Secondary weakness of the labor force is characterized by a long duration of the labor act, usually due to the second period. Contractions that were intense, long and rhythmic at first become short and weak, and the gaps between them increase. The complete cessation of contractions is not excluded. The baby moves slowly through the birth canal or stops moving. Elongation of labor leads to fatigue of the woman in labor. Secondary weakness of the birth forces is dangerous by the development of chorioamnionitis in childbirth, suffocation and death of the fetus.

How labor is carried out with weak contractions

Primary weakness of labor

When diagnosing the primary weakness of labor, it is necessary, if possible, to eliminate the causes that led to this complication. With polyhydramnios and oligohydramnios, in the case of a mature cervix or opening of the uterine pharynx, which is 4 - 5 cm, an amniotomy is performed. Also, the opening of the fetal bladder is performed when it is non-functional (weak, flaccid or flat). If the woman in labor is tired, and the end of labor is not yet close, she is provided with medication sleep-rest, which lasts 2 to 3 hours. Usually, the intensity of the contractions increases after sleep. If, after the therapeutic sleep, the contractions did not gain sufficient strength, then the question of rhodostimulation is raised, which is produced by uterotonic drugs (drugs that cause and enhance uterine contractions). Rhodostimulation by intravenous administration of oxytocin (5 units per 400 ml of saline solution or 5% glucose) begins with 6-8 drops per minute, gradually increasing the number of drops by 5 every 5-10 minutes (but not more than 40 drops per minute). If the effect is positive, the intravenous infusion of oxytocin is not stopped until the end of labor. Oxytocin can be replaced by infusion of prostaglandins F2a and F2, which not only enhance uterine contractions, but also participate in the process of opening the uterine pharynx. If there is no positive dynamics during delivery of stimulation for two hours, an emergency issue is resolved.

Secondary weakness of labor

Childbirth with secondary weakness of the labor force is carried out identically to childbirth with primary weakness. If the opening of the cervix is \u200b\u200bsmall, the woman in labor is given sleep-rest, then, if necessary, drug stimulation of labor is carried out. With weakness of attempts, which is due to a reduced tone of the abdominal muscles, either use a Werbov bandage (roughly speaking, squeezing out the fetus), or use obstetric forceps or a vacuum extractor.

The article discusses weak labor activity. We talk about the causes, symptoms and consequences of this condition. You will learn what to do in such a situation and whether it is possible to intensify the contractions.

Weak labor is a state of the body characterized by insufficient strength of contractile uterine activity, frequency and duration. As a result, contractions are rare and short and ineffective. All this leads to a slow opening of the cervix and the passage of the fetus through the birth canal.

Weak labor can lead to negative consequences

This condition refers to anomalies of the birth forces. It is observed in 10% of all unfavorable labor. As a rule, pathology is diagnosed at the first birth, less often it is observed at the second or third.

Classification

Pathology is classified depending on the time of its appearance, there are two types: primary and secondary. The primary form is characterized by short, ineffective contractions from the onset of the labor process, while the uterus relaxes for a long time. The secondary form is diagnosed with the weakening and shortening of contractions after some time of their sufficient intensity and duration.

The primary form is more common, with a frequency of 8-10 percent. Usually, the secondary form is detected at the end of the opening period or during the expulsion of the fetus, it occurs in only 2.5% of all births.

Also, experts note the weakness of attempts that is observed in pollen or in women with obesity and segmental and convulsive contractions. Convulsive uterine contraction is characterized by a prolonged contraction of the uterus (more than 2 minutes), segmental - the uterus does not contract all, but only in separate segments.

Who is at risk

The risk of developing pathology increases in the following cases:

  • too young age (up to 18 years old) and women in labor over 35 years old;
  • a large number of abortions with a history of curettage;
  • prolificacy;
  • a large number of births in the anamnesis;
  • failure of hormonal levels and violation of menstrual function;
  • overweight;
  • hypertrichosis;
  • the presence of uterine hyperextension due to multiple pregnancies, polyhydramnios, or a large fetus.

Causes

Why is there a weak labor activity? The main factors causing this condition are:

  • polyhydramnios;
  • large-fruited;
  • post-term pregnancy;
  • overweight;
  • hormonal disorders;
  • fear of the first birth;
  • multiple pregnancy;
  • metabolic disease;
  • problems with the endocrine system;
  • physiological features, for example, a narrow pelvis of a woman in labor, a flat bladder;
  • pathological processes that occur in the uterus;
  • overwork;
  • lack of sleep.
  • any stress experienced.

Many pregnant women ask themselves the question, if weak labor is observed during the first birth, then what to expect from the second? No specialist can definitely answer this question, since each new birth may differ from the previous ones. Even if you are giving birth for the fourth or fifth time, the whole process may be different from your previous experience.

The right mindset for childbirth is essential for every woman.

Symptoms

The clinical picture of weak labor is manifested as follows:

  1. Primary weakness - with it, the contractions immediately have a short duration and low efficiency, almost painless. The relaxation periods are quite long, almost do not cause the uterine pharynx to open. Most often, these signs occur after a pathological preliminary period. Usually, expectant mothers complain of water drainage and weak contractions, which means premature or early rupture of amniotic fluid.
  2. Secondary weakness - this symptom is less common, its hallmark is the weakening of contractions after an interval of effective labor and cervical dilatation. As a rule, it occurs at the end of the active phase when the uterine pharynx opens up to 5-6 cm or during attempts. Initially, contractions are intense and frequent, but gradually lose strength and become shorter, the movement of the presenting part of the fetus slows down.
  3. Weakness of pushing - this condition is usually characteristic of women who have given birth a lot and often, suffer from obesity or divergence of the abdominal muscles. Also, this symptom can provoke physical or nervous exhaustion. They appear as ineffective and weak contractions and attempts, as a result of which it is difficult for the fetus to move along the birth canal, which causes hypoxia.

Diagnostics

To diagnose "weak labor", doctors take into account:

  • the nature of the uterine contractions - their strength, the duration of the contractions and the relaxation time between them;
  • how the neck opens - there is a slowdown in this process;
  • advancement of the presenting part - the absence of translational movements, the head is for a long time in each plane of the small pelvis.

An important role in the diagnosis of weak labor forces is played by maintaining a partogram of labor, thanks to which the process of cervical dilatation and its speed are clearly shown. In firstborns in the latent phase in period 1, the pharynx of the uterus opens approximately at 0.4-0.5 cm per hour, in multiparous - 0.6-08 cm per hour. As a result, the latent phase in women who give birth for the first time lasts about 7 hours, in multiparous women - up to 5 hours. Weakness is diagnosed when the delay in cervical dilation is about 1-1.2 cm per hour.

Contractions are additionally evaluated. In the case when in 1 period their duration is less than half a minute, and the intervals between them exceed 5 minutes, this means primary weakness. Secondary weakness is spoken of when contractions last less than 40 seconds at the end of the first period and during the expulsion of the child. It is also important to monitor the condition of the fetus, since prolonged labor leads to hypoxia.

What to do

How does labor start? If the pregnancy is post-term, but the woman's body is ready for delivery, then the specialist first performs an amniotomy. This procedure is performed only if the cervix has opened by 2 cm or more.

As a rule, after opening the fetal bladder, labor increases. After the procedure, the woman in labor is watched for several hours, after which, if the amniotomy has not yielded any result, drug stimulation is used.

The main method of drug stimulation of uterine contractions is the use of uterotonics: oxytocin and prostaglandins, which are administered intravenously. At the same time, the state of the fetus is monitored using CTG.

In some cases, medication sleep can be used, which is aimed at restoring the strength of the woman in labor, its duration is about 2 hours. It is carried out with the help of analgesics and only after consultation with an anesthesiologist. This technique is used quite rarely and only when the benefits outweigh the potential harm.

If all the measures taken do not give a positive result, an emergency caesarean section is prescribed.

To minimize the possible negative consequences of weak labor, it is important to listen to the doctor's recommendations and follow them clearly.

How to intensify contractions

Sometimes the following actions will help strengthen the contractions:

  • Calm down, breathe correctly, take certain postures during contractions, and, if possible, do self-massage.
  • Move or jump on the fitball as much as possible.
  • If you need to be in a horizontal position, then lie on the side where the fetal back is located - this will increase the contraction of the uterus.
  • Monitor the condition of the bladder, empty it every 2 hours.
  • An empty bladder increases contractions. If you can't go to the bathroom on your own, use a catheter.

Contraindications

Conservative therapy is prohibited in the following cases:

  • the presence of a scar on the uterus, for example, after a cesarean section;
  • narrow pelvis of a woman in labor;
  • large-fruited;
  • true post-term pregnancy;
  • individual intolerance to uterotonic drugs;
  • the child is in the breech, not the cephalic presentation;
  • intrauterine fetal hypoxia;
  • if the woman in labor is over 30 years old and this is her first birth;
  • burdened gynecological history;
  • burdened obstetric history.

In such cases, childbirth is performed using an emergency caesarean section.

Cleaning the house in the last weeks of pregnancy will help bring the onset of labor closer

Prophylaxis

Is it possible to make childbirth go without complications? You cannot directly influence the delivery process, but you can prepare for it. For this:

  1. From the last month of pregnancy, start taking vitamins B6 and B9 (), as well as vitamin C.
  2. Begin to mentally tune yourself to the successful outcome of childbirth.
  3. If possible, attend courses for expectant mothers.
  4. Remember, during childbirth, not only you, but also the baby are experiencing difficulties.

If, among your relatives, someone has experienced prolonged labor, then follow these recommendations (but only after the permission of the doctor):

  1. From 34-36 weeks of pregnancy, do what was forbidden during pregnancy: actively cleaning, wash the floors on an incline, lift heavy objects, take a hot bath.
  2. Drink 2 to 3 cups of raspberry leaf tea a day.

Effects

Weakness of labor forces can lead to various unpleasant consequences, including disability in the child, as well as the death of the fetus or mother. But this happens quite rarely, usually a timely cesarean section saves both the mother and the child.

Remember, the right mindset for childbirth and compliance with all the recommendations of the obstetrician will allow you to give birth to a healthy and strong baby!

Video: Weak labor

There are abnormalities in labor, such as poor labor, which, in the absence of adequate medical care, can lead to tragic consequences, including the death of a child from infectious complications or hypoxia. What is this weak labor, how do doctors treat it?

Normally, the first childbirth lasts no more than 11-12 hours, and the second - no more than 8 hours. If they are delayed as a result of the slow opening of the cervix, violations of its contractility, then this is a weak labor activity, in which in some cases a cesarean section is performed.

Childbirth is divided into 3 periods: dilatation of the cervix, expulsion of the fetus and delivery of the placenta. Moreover, problems usually arise precisely in the first period. The rate of dilatation of the cervix, until the dilatation has reached 4 cm, is approximately 0.5 cm per hour. And then it accelerates to 1-2 cm per hour. At the same time, with almost full disclosure, 8-9 cm, the speed may decrease slightly. Many believe that this is a weak labor activity during the first birth, but this is not the case. This situation is the norm, and does not require the introduction of any medications designed to intensify the contractions. It should be noted that this is rarely seen in multiparous women. And if there is a weak labor activity in the second birth, then it is often due to more serious reasons, not psychological discomfort, fear or fatigue, but very specific reasons, such as uterine fibroids.

Situations are considered especially dangerous when the amniotic fluid has long since departed, possibly even before the onset of real contractions, and signs of weakness in labor in a woman have appeared. After all, a long anhydrous interval threatens the child's life due to the possible development of an infectious process due to the penetration of pathogens into the uterus, and a woman with postpartum endometritis. Doctors agree that an anhydrous interval of up to 6 hours is safe. The maximum is up to 24 hours. But usually they do not reach this time and begin to inject drugs with weak labor, such as oxytocin (usually given in droppers).

If the amniotic fluid has not departed, but the cervical dilation is very slow, then the doctor performs an amniotomy - this is a procedure in which the amniotic fluid is pierced through the vagina. Often its shape is flat, which in itself lengthens the delivery. The procedure is absolutely painless and safe when performed by a doctor. Usually, the fetal bladder is pierced when it is more than 2 cm wide, when a medical instrument can be easily inserted into the uterus.

There are other options for what to do if labor is weak, and many women in labor do not agree with this technique. They are injected with painkillers and strong sedatives and even narcotic analgesics approved for use in women in labor in hospitals, so that they get a little sleep. Everything can be restored in just 2 hours. The woman is resting, and the process of childbirth starts more actively. This option is preferable to medication stimulation of labor, since contractions with it are much more painful than natural ones. The woman is forced to lie under a drip for hours with short breaks.

Often a situation arises when a woman, who has already come to a due date, comes to the hospital with complaints of irregular but exhausting contractions. And then the doctors give her antispasmodics and pain relievers, with which these contractions are removed. Many women consider this to be wrong, in their opinion, labor does not come precisely because of the drugs administered. This opinion is erroneous. The fact is that such false or preparatory contractions, if they are prolonged, exhaust the woman. And, by the way, they are also the reasons for weak labor, and of course, real labor pains cannot be removed with the help of the same "No-shpa" or magnesium sulfate. Therefore, you should not worry.

It remains to figure out how to avoid weak labor without the help of doctors. How should you prepare for childbirth? Experts recommend watching more good, kind films, not reading, watching or listening to stories about unfavorable childbirth. Perhaps some women should think about joint childbirth with a loved one. This will also have a positive effect on the mood. It will be useful to attend school for expectant mothers, especially for those women who are carrying their first child.

In the conditions of hospitals, the prevention of weakness in labor consists in taking light sedatives like motherwort and valerian, ascorbic acid, vitamin B6 and folic acid. Epidural anesthesia also in many cases avoids this complication in childbirth.

The cause of the weakness of labor most often the same factors are present as with pathological precursors, sometimes the weakness of labor is a continuation of the pathological preliminary period.

So, the weakness of labor is promoted by:
insufficient production of factors contributing to the development of labor (low concentration of estrogens, prostaglandins, oxytocin, mediators, calcium, etc.), or an increased concentration of factors that inhibit the development of labor (progesterone, magnesium, enzymes that destroy mediators, etc.) ;
asthenization of a woman (overwork, excessive physical and mental stress, poor nutrition, insufficient sleep);
overstretching of the uterus (due to a large fetus, polyhydramnios, multiple pregnancies);
pathology of the uterus, which occurs as a result of abnormalities, tumors, cicatricial changes, the consequences of abortion;
physical inactivity of a woman, insufficient physical development can also lead to weakness of labor.

Weakness in labor most often occurs with premature, delayed childbirth, in women with a burdened obstetric-gynecological and somatic history, in young or elderly primiparous.
Fear, uncomfortable surroundings, and poor service to women exacerbate risk factors. Often the weakness of labor occurs in the case of premature or early discharge of water.

Prevention. In the last week of pregnancy, and even more so during childbirth, it is necessary to assess the risk factors and the woman's readiness for childbirth. In the presence and identification of predisposing factors, it is necessary to carry out preventive preparation - both medication and psychophysio-prophylactic (see the section "Post-term").

Types of weakness of labor. Distinguish between primary and secondary weakness. You can also distinguish between the weakness of contractions (in the first stage of labor) and attempts (already in the second stage of labor). A situation is considered primary when the contractions were not active enough from the very beginning, sometimes pathological precursor contractions turn into weakness of labor.
There may be a secondary weakness of labor, when, after normal or even violent labor, its weakening occurs. Weakness in the II stage of labor (weakness of attempts) may be the result of weakness that developed in the I period.

Diagnostics of the weakness of labor. The diagnosis is established on the basis of an assessment of contractile activity, which is judged by the subjective feelings of the wife, objective observations carried out by a midwife or doctor, as well as on the basis of tokometry or hysterography. The frequency, duration, strength of the fleece and the correspondence of these data to the period and phase of labor are taken into account in comparison with the indicators of normal labor.

For example, for the active phase of the I stage of labor, grips shorter than 30 s with intervals of more than 5 minutes are considered insufficient.
For the end of labor and period II, contractions shorter than 40 seconds are weak. The speed of neck opening is taken into account, which should not be less than 1 cm in 1 hour. The degree of dilatation is assessed objectively by vaginal examination data and indirectly by the height of the contraction ring and the advancement of the head. If the duration of labor is more than 12 hours in primiparous and 10 hours in multiparous, we can talk about the weakness of labor. Partograph recording can facilitate the diagnosis of abnormalities in labor.

Treatment of weakness of labor. The methods of treatment depend on the cause that caused it, the individual characteristics of the woman, the degree of weakness, the period and phase of labor, the likelihood of complications for the mother and fetus, and the conditions in which the birth takes place. It is impossible, without special indications, to accelerate the course of labor in order to avoid other complications. If the cause of the weakness of labor is overwork, a sleepless night, then in the latent phase, especially with whole waters, drug-induced sleep-rest is prescribed. When the reserves of strength are depleted, the creation of an estrogenic-vitamin-glucose-calcium background is shown. Even in ancient times, broth, strong sweet tea with lemon, coffee, decoctions and infusions of tonics were used.

To replenish energy costs, the following means can be used:
Khmelevsky's method. In a modified form, this method involves intravenous administration of 20 ml of 40% glucose solution, 10 ml of 10% calcium chloride solution, intramuscular administration of 1 ml of 6% vitamin B1 solution.
The triad of Professor Nikolaev and its modifications. This is not only a method of preventing fetal hypoxia, but also energy support for a woman, a means to improve microcirculation.
To replenish energy costs, the use of ATP, cocarboxylase, Essentiale, Actovegin is effective.

Earlier, decoctions of plants containing contractile substances (ergot, shepherd's purse, chin) were used to stimulate labor. However, ingestion of poorly managed drugs can cause serious complications.
From the second half of the XX century. the following methods were common:
Stein-Kurdinovsky scheme and its various modifications, in which:
- a hormonal estrogenic background was created by introducing folliculin or synestrol in a dose of 30 to 60 thousand units. actions. 1 ml of a 0.1% solution of sinestrol contains 10,000 IU of the drug. Therefore, it is necessary to enter 3 ml (30,000 units). A 2% solution is injected at a dose of 0.15-0.30 ml intramuscularly. For a quick action add 0.3 ml of ether;
- an hour later, agents were used to stimulate the activity of the intestines (castor oil orally in a dose of 30 to 50 ml) and after another hour, a cleansing enema;
- after cleansing the intestines, contractile agents were prescribed: chin in powders at a dose of 0.05-0.1 g (from 4 to 6 powders after 30 minutes); oxytocin (or pituitrin to oxytocin) at a dose of 1-1.25 IU 4-5 times after 30 minutes. Pure oxytocin (1 ml or 5 ME) was diluted to 4-5 ml with saline or no-spa and 1 ml of the already diluted solution was injected once every 30 minutes. Proserin and pachikarpin were used as contractile substances, but now these drugs, as well as quin, are not used without special indications.

Currently, labor-stimulating therapy is carried out most often with the help of intravenous drip of oxytocin in a dose of 5 ME (1 ml), diluted in 400-500 ml of saline, the rate of administration at the beginning of 4-6 drops per minute can gradually increase to 12, up to a maximum of 20 drops per minute. Increasingly, prostaglandins, sometimes called intracellular hormones, are being used. Prostaglandins E-2 (protenone at a dose of 1 mg) are used more often in the latent phase of the opening period, prostaglandins F-2a (enzoprost at a dose of 5 mg) are used in the active phase of labor. The drug is diluted in 400-500 ml of saline and injected intravenously, just like oxytocin. Simultaneous administration of both oxytocin and prostaglandins is possible, but at a lower dose.

In some clinics, obzidan or anoprilin, which are beta-blockers, were used for rhodostimulation (5 mg, diluted in 500 ml of saline, are injected intravenously at a rate of 20 drops per minute). It should be borne in mind that these drugs contribute to a decrease in the pulse rate and a decrease in blood pressure, therefore, they are used only for special indications, taking into account hemodynamic parameters.

Of the surgical methods with persistent weakness of labor, when conservative methods are not effective and complications for the mother and fetus are possible, the most rational is a cesarean section, and in the II stage of labor - obstetric forceps. For late miscarriages, scalp forceps are used.
The previously used Werbov bandage, when the uterus was covered with a thick towel, the ends of which were pulled by two assistants, pushing the fetus out of the uterus, is practically not used, since it is a traumatic and ineffective method. ,
The Kresteller method is also traumatic, in which in the II stage of labor during a contraction, to enhance the movement of the fetus, the dorsum of the forearm was pressed on the bottom of the uterus. With the wrong and excessive use of this method, there can be an injury to the uterus, fetus, there have been cases of rib fractures and liver injury.

Complications with weakness of labor:prolongation of the anhydrous period, development of infection, fetal hypoxia, delayed afterbirth, postpartum hemorrhage, subinvolution of the uterus in the postpartum period and postpartum inflammation of the uterus. With the wrong use of rhodostimulation, the weakness of labor can turn into another type of anomaly - violent labor or discoordination. Therefore, the midwife should know well the stimulation techniques and carefully observe all the changes that occur.

The midwife should understand that when a dropper is installed, a woman is often deprived of the opportunity to move and take care of herself. Prolonged horizontal position does not contribute to the normalization of labor. Therefore, it is necessary to install a flexible catheter, which makes the intravenous infusion safer and also allows the mother to walk.

Both pregnant women and doctors want the birth to take place without any complications. However, despite this, abnormalities of labor still occur, and one of them is the weakness of labor. This complication is characterized by weakening and shortening of contractions, slowing down the opening of the cervix and, accordingly, the movement of the baby's head along the birth canal. If a woman has a second birth, weak labor is unlikely, more precisely, in multiparous women, it is twice less common than in primiparous. Why is this happening and how to correct the weakness of the birth forces?

· Abnormalities of labor: classification of the weakness of labor forces


Weakness of labor activity can occur both in the first stage of labor and in the second, therefore it happens:

1. primary weakness of the birth forces;

2. secondary weakness of labor;

3. as well as the weakness of pushing.

· Weak labor: causes

The causes of weakness in childbirth can be divided into three conditional groups: on the part of the woman in labor, on the part of the child, and complications of pregnancy.

The reasons for the weakness of labor on the part of the mother:

  1. infantilism of the genitals (uterine hypoplasia);
  2. diseases of the uterus (endometriosis, chronic endometritis, uterine fibroids);
  3. extragenital diseases (obesity, diabetes mellitus, hypothyroidism);
  4. anatomically narrow pelvis;
  5. operations on the uterus (myomectomy, cesarean section);
  6. lack of mental preparation for childbirth, nervous overstrain of the woman in labor;
  7. the age of the woman (under 18 and over 30);
  8. rigidity of the genital tract (reduced elasticity).

The reasons for the weakness of labor on the part of the fetus:

  1. incorrect insertion or presentation of the fetal head;
  2. multiple pregnancy;
  3. large size of the fruit;
  4. discrepancy between the size of the pelvis and the fetal head.

Complications of pregnancy:

  1. anemia, preeclampsia in a pregnant woman;
  2. polyhydramnios (overstretching of the uterus can reduce its contractility);
  3. oligohydramnios and flaccid, flat fetal bladder.
  • Primary weakness of labor


There is a primary weakness of labor activity with the onset of labor, it is characterized by weak, painless contractions, their low frequency (within 10 minutes no more than 1-2 contractions), and duration (no more than 15-20 seconds). If labor is weak, the opening of the uterine pharynx occurs very slowly or does not occur at all. In primiparous women, the opening of the cervix to a size of 2-3 cm in diameter (or 2-3 fingers, as obstetricians often "measure") takes longer than 6 hours from the beginning of labor, and in multiparous women - longer than 3 hours.

Such a weak, ineffective labor activity greatly tires the woman in labor, depletes the energy reserves of the uterus and leads to intrauterine fetal hypoxia. Due to weakness, the fetal bladder does not function properly, the baby's head does not move along the birth canal. Childbirth threatens to be seriously delayed and end in the death of the fetus.

· Secondary weakness of labor

Usually, secondary weakness of labor occurs at the beginning of the second or at the end of the first stage of labor, it manifests itself in the form of a weakening of labor after the intensive onset and course of labor. Contractions slow down and may eventually stop altogether. The opening of the cervix is \u200b\u200bsuspended, as is the advancement of the fetal head, to this all are added signs of intrauterine suffering of the child, if the fetal head stands in one place of the small pelvis for a long time, this can result in cervical edema and the appearance of rectovaginal or urevaginal fistulas in a woman in labor.

· Weakness of pushing

As a rule, weakness of pushing occurs in repeatedly or multiparous women (due to weakening of the abdominal muscles), with divergence of the muscles of the anterior abdominal wall (in the case of a hernia of the white line of the abdomen), with obesity of the woman in labor. The weakness of attempts is manifested by their inefficiency and short duration (the implementation of attempts is due to the muscles of the abdominal press), nervous and physical exhaustion of the woman in labor. As a result, signs of fetal hypoxia may appear and the child's movement through the birth canal may stop.

· Weakness of labor: treatment

Treatment of weakness in childbirth forces should be carried out individually in each case, taking into account the anamnesis of the woman in labor and the clinical picture, that is, the state of the woman in labor and the child and the current situation.

Good help is provided by medication sleep-rest, especially with severe fatigue of a woman. For this, pain relievers, antispasmodics and hypnotics are used. On average, the duration of drug sleep is no more than 2 hours, and labor activity is usually restored after that and becomes intense.

If weak labor occurs due to a flat fetal bladder, a prolonged course of labor or polyhydramnios, then they can resort to help- open the fetal bladder, pierce it. It is also recommended for a woman in labor to lie on the side where she is, i.e. the back of the fetus is presented - thus additional stimulation of the uterus occurs.

In case of ineffectiveness of all measures, treatment of weakness of labor is carried out intravenous administration of uterotonics (funds that enhance uterine contraction). Uterotonics drip very slowly, in parallel, the diagnosis of the condition of the fetus is necessarily carried out - the child's heartbeat is constantly monitored. The drugs of this series include. In addition to its contractile properties, simple strokes also stimulate cervical dilatation. Moreover, it is impossible to stop the intravenous infusion of reducing agents, even when good labor has been established. In addition to the treatment of weakness of labor, the prevention of fetal hypoxia is carried out with the help of such medicines as "Actovegin", "Sigetin", glucose preparations, cocarboxylase. If the effect of treatment, in the form of activation of labor activity, intensification of contractions, promotion of the child through the birth canal, is absent, it is necessary to carry out an emergency.