Here also ended nine months of disturbing expectation. Having appeared in postnatal office, newly made mothers at once begin to be interested estimated date of an extract. However before releasing you on “the house mode“, doctors have to make sure of your readiness for an extract completely.
the Concept of “readiness“ is defined by a satisfactory condition of health of the young mother who is well restored after the delivery. From the kid readiness for an extract is equivalent to readiness for independent life together with mother without medical assistance. There are certain terms of an extract from maternity hospital recommended on the OMI (obligatory medical insurance) system. For the woman these terms vary depending on a rodorazresheniye method (physiological or expeditious childbirth), application in labor and the early postnatal period of additional operational grants (an epiziotomiya - a section on crotches, imposing of obstetric nippers, manual office of an afterbirth). The term of stay of the woman in childbirth (that is the given rise woman) in maternity hospital can be increased in case of development of various complications of the postnatal period or at the prolonged period of restoration. In each case the decision on an extract is made by the ward doctor - the obstetrician and the manager of postnatal office individually.
the Term of an extract of the kid is defined neonatolog and the manager of children`s office. Time which the newborn needs to spend under supervision of doctors also depends on a rodorazresheniye method (at an operational rodorazresheniye the period of adaptation of the kid can longer last, than at physiological childbirth). Before an extract the baby has to get stronger, pass the first medical examination and receive necessary inoculations. The time of carrying out these procedures can be postponed in dependence because, quickly or slowly the kid is restored after the birth. Naturally, in case of development of postnatal complications or in need of a medical additional examination the newborn can “be late“ in maternity hospital longer.
mother`s Extract: criteria and termsAfter physiological (the natural, complicated by nothing childbirth) the woman in childbirth can be written out by
home on 3 - 4 - e days. Existence of seams increases the term of stay in maternity hospital till 5 days by crotches (consequences of an epiziotomiya or a trauma of patrimonial ways). The operational method of a rodorazresheniye (Cesarean section) assumes the earliest term of an extract on 7 - 8 - e days.
It is unconditional, besides the general recommendations, there are quite concrete criteria allowing doctors to judge restoration of an organism of mother after the delivery. The doctor at the solution of a question of the woman in childbirth extract is guided by these criteria:
Speed of reduction of a uterus. Really, this indicator is the most important condition of postnatal restoration of an organism. Satisfactory reduction of a uterus, in fact, is a guarantee of absence of the majority of the complications which are found in the postnatal period.Normal the uterus has to be reduced by
(to decrease in sizes) evenly. At the same time uterus walls in all departments have an identical consistence (density), and the uterus cavity in process of reduction is exempted from surplus of a mucous membrane unnecessary after completion of pregnancy.the uterus has to be reduced by
Right after the birth of the kid approximately by 8 times, after office of an afterbirth - by 2 - 3 times. Then there is a gradual involution of a uterus (it comes back to the former, “doberemenny“ sizes), decreasing in volume by 2 - 3 cm a day. Speed of reduction of a uterus and, respectively, its sizes for the days first, second etc. after the delivery can individually change. So, for example, at childbirth by a large fruit, at expressed to a mnogovodiya or polycarpous pregnancy, at frequent repeated childbirth the uterus is reduced longer (that is not considered as complication). If the rest is safe, then in this case all the same write out on 3 - 4 - e days. The sizes and a consistence (density) of a postnatal uterus are determined by a palpation - probing through a forward belly wall, and also by ultrasonic diagnostics.
of Lokhiya - by such term designate postnatal allocations from a genital tract of the woman in childbirth. Allocations of lokhiya can continue long enough - till 40 days after the delivery. Character of lokhiya at various stages of the postnatal period significantly changes. The first three days after the delivery disturb young mother very plentiful bloody allocations with clots (much more plentifully than allocations in the first day of periods). Then character of lokhiya gradually comes nearer to sanious (pinkish), and in one or one and a half weeks of allocation have to accept character serous separated (rozovato - yellow, as when healing a wound). All this time of a lokhiya have a characteristic smell of “rotten leaves“. Behind character and the number of vaginal allocations of the woman in childbirth, and also the speed of reduction of a uterus is watched by the ward doctor, daily examining the patient during round.
- Establishment of a lactation. The first days after the birth of the kid from a breast of the woman in childbirth colostrum - substance, very valuable to the kid, being the predecessor of breast milk is emitted. Milk “comes“ on average on 3 - y days after the delivery and a little later - on 5 - 6 - e days - after planned operation of Cesarean section. At approach of a lactation it is very important to achieve uniform depletion of mammary glands during feeding, it is correct to give a breast to the baby and if necessary to decant excess milk. During establishment of a lactation doctors and paramedical staff of postnatal office train the woman in childbirth in skills of the correct care of mammary glands. The acquired knowledge will help mother to avoid such complications as laktostaz (stagnation of milk in channels of gland), cracks of nipples and mastitis (an inflammation of tissue of mammary gland). Mammary glands are examined by the attending physician of postnatal office during daily round.
- Existence of seams. Seams at the woman in childbirth can settle down on a crotch (a consequence of a patrimonial trauma or an epiziotomiya) or on a forward belly wall in the lower third (after Cesarean section). Depending on indications, a condition of integuments, thickness hypodermically - a fatty layer and other factors at the discretion of the doctor in obstetrics use catgut suture (the resolving sutural material) and its synthetic analogs or silk threads demanding subsequently removal. The area of a seam is daily processed by solution antiseptics - “potassium permanganate“, iodine or “brilliant green“ (this duty lays down on shoulders of the procedural nurse). For the purpose of prevention of suppuration of seams radiation of a crotch (stomach) is made by a bactericidal lamp (an exposition of 3 - 5 minutes). The replaceable aseptic bandage which is replaced at each processing of a seam is applied area of a seam after Caesarian.“ Removable“ seams from a crotch are removed normal on 5 - e days after the delivery, from a forward belly wall - on 7 - 8 - e days. The decision on removal of sutural material is made by the ward doctor, he removes seams.
Seams do not remove in time at development of any complications (suppuration etc.) . In this case the extract is postponed until elimination of a problem. Before an extract to the woman in childbirth conduct final examination. “The diagnostic minimum“ of postnatal office includes ultrasonography of bodies of a small pelvis, clinical blood test, the general analysis of urine. Young mother can be written in due time out home at a satisfactory condition to which the following signs testify:
- normal body temperature;
- the uterus size corresponding to normal terms of involution;
- the quantity and character of lokhiya corresponding to the term of involution of a uterus;
- the established lactation, lack of cracks on nipples with symptoms of suppuration and a laktostaz; with
- area of seams without inflammation signs, sutural material is removed; the cavity of a uterus is closed by
- according to ultrasonography, there are no clots, the size corresponds to involution term;
- results of laboratory analyses within norm.
Expressed laktostaz, the infected cracks of nipples can delay an extract. Lack of milk at the time of an estimated extract postpones its time only in case of an insufficient increase of weight the kid.
the Extract of the kid
If for mother childbirth - one of the most important events in life, then for the kid the birth - the main thing and the first event with which actually his independent life also begins. Therefore before allowing to go home the little person, doctors have to be convinced of full readiness of the newborn to live independently authentically.
the First three days the kid is in maternity hospital under continuous supervision of experts. Such minimum term is necessary for a children`s organism for end of the period of adaptation. The adaptation period - a transition state between the embryonic (pre-natal) and already completely established independent life of the kid. During this time bodies and systems of an organism of the newborn begin to work completely independently from a maternal organism.
the Period of adaptation of the newborn demands constant medical control as at this particular time manifestation of the latent defects in a structure and work of internals is the most probable. Some congenital anomalies of a structure of bodies and systems can remain unnoticed at primary survey of the newborn (right after the birth of the kid). And the reason here at all not in negligent survey of a neonatolog - some defects cannot be revealed only after external survey, they can prove not at once. To the malformations revealed in 1 - 3 - and days after the birth, belong anomalies of a structure zheludochno - an intestinal path, heart diseases, kidneys.
as Criteria for the newborn`s extract from maternity hospital serve the following indicators:
- normal (it is pale - pink) skin color and mucous membranes, absence of rashes and a peeling on skin;
- the disappeared umbilical cord stump without infection signs (the umbilical cord independently disappears on 3 - 5 - e days, now in the majority of maternity hospitals the stump of an umbilical cord is cut off on 1 - 2 - e days after the birth);
- the termination of physiological loss of weight, the begun weight increase (during the adaptation period the kid loses flesh); the urination adequate to feeding (to 20 times a day; confirms normal work of kidneys);
- chair transitional (brownish) or yellow;
- active sucking, lack of vomiting;
- at a consent of parents to vaccination - the hepatitis B, BTsZh inoculations made without complications, the carried-out screening - the test (the result is ready after an extract, if it positive - report in policlinic at the place of residence and/or parents by phone);
If pregnancy or childbirth were heavy, the period of adaptation of the newborn can drag on. As it is not sophisticated: the more difficult process of birth was given to the kid, the more time will be required to gain strength and to get used to new life.
Besides medical supervision and (in need of) medicamentous support, during stay in maternity hospital the kid passes the recommended list of preventive medical procedures. The purpose of these actions - check on the latent congenital diseases and protection against acquisition of dangerous infections.by
Within 12 hours after the birth to the kid with the consent of mother makes vaccination (inoculation) from hepatitis B. This incurable viral disease which is transferred with blood and biological liquids (saliva, a lymph, sperm, a vaginal secret) puts considerable, sometimes irreparable harm to health. On 3 - y days (48 - 72 hours after the birth) to the kid enter BTsZh - a tuberculosis inoculation. BTsZh develops in an organism of the kid immunity against this disease, helping a weak organism to resist to a surrounding infection. In recent years with increase in our country of number of visitors - refugees from epidemiologically unsuccessful regions of Asia and the North Caucasus incidence of tuberculosis among the population sharply increased. First of all the children, elderly people and also weakened or socially unsuccessful persons are subject to a disease of tuberculosis.by
On 4 - e days (72 - 96 hours after the birth) makes screening - the test for detection of the latent congenital pathologies of a proteinaceous and hormonal exchange in an organism of the kid.
Research allows to reveal quickly and authentically such diseases as a fenilketonuriya, a hypothyroidism, a galactosemia, mukovistsidoz and an adrenogenital syndrome. Screening has huge diagnostic value. All listed diseases “passed“ at infantile age cause the hardest violations in health and the child`s lives subsequently, lead to lag in intellectual and physical development and an invalidization. At identification in the first days of life and in due time begun treatment the forecast for life and health of the kid will be favorable. That is these terrible diseases give in to medicamentous correction, but the effect of treatment directly depends on how early it was begun. For screening - the test use capillary blood of the kid: it is taken from a finger or patches.by
Recommended by the Ministry of Health lechebno - preventive actions (BTsZh, a hepatitis B inoculation, screening - the test) are carried out strictly in absence of contraindications from health of the newborn and only with the consent of parents.
What can delay an extract?
the Term of stay of mother in postnatal office can last under the following circumstances:
- fever (high temperature);
- laktostaz (milk outflow violation);
- the infected cracks of nipples;
- mastitis (suppuration of a mammary gland);
- postnatal bleeding;
- delay of involution of a uterus (its bad reduction); for
- of a lokhiometr (a delay of blood clots in a uterus cavity) - in this case it is necessary vacuum - extraction of clots or washing of a uterus for removal of clots;
- of a piometr (infection of the clots which were late in a uterus cavity);
- infection, divergence of seams;
- unsatisfactory results of laboratory analyses.
from the kid the delay of an extract can be caused by the following problems:
- the prolonged period of adaptation, the general weakened condition of the kid;
- the progressing loss of weight (after 4 days); the expressed jaundice of newborns (after 4 days) indicates
- massive destruction of erythrocytes (red blood cells) in blood of the kid. The physiological (natural) alfalfa butterfly connected with destruction of embryonic erythrocytes normal arises on 3 - 4 - e days of life of the newborn, passes through 1 - 2 weeks. At intensive jaundice make a blood test on bilirubin - a pigment which is formed as a result of destruction of erythrocytes;
- inactive sucking, refusal of a breast;
- plentiful vomiting;
- infection of an umbilical wound;
- fever (high temperature), skin rash, other signs of infection;
- unsatisfactory results of laboratory analyses.
At identification of the problems with health of mother and the kid which are not allowing to make in due time an extract, terms of an extract are defined by individually treating doctor.
Should not fall apart if the term of an extract is late. It is necessary to be healthy and vigorous, ready to independent, full care of the kid at home. In health of the child and a possibility of further care of it without continuous medical supervision it is necessary to be convinced too. Otherwise too hasty extract can cause whole “tail“ from undetected problems.
in conclusion wants Pojelat to young mothers and newborns of health and happiness.