• Each maternity hospital creates its own 
• Tour of the maternity ward 
• Paid / free 
• The main goal: to inform the expectant mothers about the care that the hospital is able to offer

• Registration („Check-in“) at the maternity hospital
• Consultations - every week either in the maternity hospital or at the district gynaecologist
• Sampling to determine the presence of streptococcus, blood sampling
• CTG examination of the fetus
• Securing a pediatrician
• Obtaining information about cord blood collection
• Determination of paternity

Birth plan

• written list of the mother´s demands
• prepared by midwife 
• correct preparation is not easy
• no one can know in advance and guarantee a smooth delivery

• Individual 
• Force inappropriate
• Things recommended to have:
  • Comfortable clothing 
  • Changing shoes
  • Food
  • Drink
  • Cell phone, camera, camcorder

When to go to the maternity hospital

1. Contractions 

• Regular pains every 5 minutes lasting 1 minute for more than an hour 
• Finding relief position

2. Drainage of amniotic fluid

• Record time, colour and contractions

3. Bleeding

4. Moves 

• Poor / no perception 
• Intense perception

What to take to the maternity hospital - 
Mother

• medical reports and pregnancy results
• toiletries 
• mesh postpartum panties (do not be afraid to buy a large size) 
• 2× towel 
• bathrobe 
• slippers 
• cell phone charger 
• glasses (if needed) 
• grape sugar
• medicines you normally take 
• still water

Documents needed•Identity card (passport)

• pregnancy card 
• health insurance card 
• examination results, ultrasounds, monitor records, etc. 
• completed questionnaire about the child's name signed by both parents 
• consents

Preparation of the body for childbirth

• Lowering of the abdomen (improved breathing) 
• More pronounced watery discharge 
• Departure of the mucus plug 
• Diarrhea 
• Messengers 
  • irregular hardening of the abdomen
  • mainly in the lower abdomen and lower back
  • the intensity of the pain does not increase
  • shower / bath helps, calmness 

Physiological childbirth 

I. stage of labour - 
Onset of regular uterine activity with an opening effect -> disappearance of birth cervix (10 cm)

• Arrival and admission to the maternity ward
• Preparation for childbirth 
  • Shower, enema
• Drainage of amniotic fluid

• Warm water                                               
• Warm compress                                                                   
• Aromatherapy                                                                    
• Strengthening contractions: rosemary, sage, cloves, jasmine
• Mood enhancing and calming: citruses, mint

Pharmacological:

• Actynox/entonox
• Nalbuphine
• Epidural analgesia

II. stage of labour -  birth cervix disappeared – 10 cm (the woman indicates pressure on the anus)
 -> delivery of the fetus

What happens in woman's body ?

• birth cervix disappears
• baby enters the birth canal, checking the baby's heart sounds
• intensification of uterine contractions, pressure appears on the anus
• active pushing
• birth of baby - expulsion of baby through the birth canal
• labour positions - possible choice of any position

III. stage of labour  - delivery of the fetus -> delivery of the placenta


What happens during III. stage of labour?

• Collections from the umbilical cord BWR, ASTRUP, blood type and RH factor
• Detachment of the placenta from the uterine wall and expelling it from the body using gentle uterine contractions / active guidance using oxytocin injection
• Inspection of birth canal, possible treatment of birth injuries under local anesthesia

First moments with the baby

• Laying on mother's belly 
• End of pulsing of the umbilical cord and subsequent cutting of the umbilical cord by the father
• Bonding skin to skin (necessary to maintain the baby's body temperature) - wiping, cap, heated diaper, blanket 
• First attachment to the breast 
• Baby's first treatment - APGAR score, general examination, measurement, weighing, umbilical cord treatment 
• 3x marking

• 

  Non-physiological childbirth 

Artificial induction of labour - Reasons:

• Post-term pregnancy – pregnancy should be terminated no later than 42+0 weeks 
• Large fetus 
• Diabetes 
• Non-thriving fetus 
• Diseases associated with pregnancy: preeclampsia, liver disorders, etc 
• Other diseases existing before pregnancy: heart disease, blood disease, etc 
• Drainage of amniotic fluid, if contractions do not occur spontaneously (so-called provocation of labour) 
• Non-medical reasons: so-called programmed birth

What does it mean for the woman?
It depends on the readiness of the vaginal findings:

• Mechanical methods 
• Pharmacological methods
• Classic induction of labour

Duration of labour induction:

• Individual
• Possible 2 induction days
• In the event of an unsuccessful attempt to induce labour, a caesarean section is performed

Induction day

• Arrival of the patient in the delivery room
• Admission, vaginal examination and initial CTG are recorded
• According to the vaginal findings, the doctor will determine the appropriate method of induction to induce uterine activity
• Gradually, contractions begin and the birth canal begins to open. If the first administration of the drug does not induce strong enough uterine contractions, it is possible to repeat the induction.
• The staff monitors the condition of the mother and the fetus and the progress of the birth at all times.
• With regular uterine contractions, a preparation (enema) can follow and then the so-called disruption of the sac of membranes
• Important education of the mother and explanation of the individual steps that awaits her

Delivery by pelvic end
•We refer to it as a physiological position

• The only birth that can be performed by caesarean section at the woman's request
• Childbirth can be carried out naturally if:
  • Weight estimate of the fetus is 2,500 - 3,500 g according to ultrasound
  • The fetus enters the pelvis with the buttocks or buttocks and bent legs at the same time

• Spontaneous childbirth
• It lasts less than 2 hours from the first contraction
• Is this a precipitous childbirth?
  • Sudden onset of strong contractions that come quickly one after the other and do not allow you to rest between them.
  • Pain that may appear as one long, painful contraction.
  • Strong pressure in the pelvis and a sudden urge to push.
  • Call for help or go to the maternity hospital.

• The most common surgical delivery
• It cannot be performed on request, the exception is the position of the fetus at the pelvic end
• Performed:
  • If the health of the mother, the child or both are at risk
  • It is either planned or acute
• The choice of anesthesia depends on the reason for the caesarean section:
  • On time urgency
  • At the request of the mother and her partner

• Advantages:                         
  • The woman is conscious, communicating, the partner may be present in the operating room.
  • Immediately after birth and during the operation, the baby can be with her, there is no disruption of the first contact.
  • Possibility of first attachment
• Disadvantage 
  • Slower onset of anesthesia effect

    

Anesthesia during caesarean section

•Advantages:                         

• Fast and reliable effect, quick solution to an acute problem endangering the health of the mother and child.
  • Disadvantage
• The woman is sleeping.
  • Possible depression of the child by drugs given to put the mother to sleep.
  • Missing first contact and first attachment upon regaining consciousness.
  • The partner is not present at the birth.

Manual removal of the placenta

Indication:

• he placenta does not separate spontaneously within 30-60 minutes after the birth of the fetus.
• Short-term performance that does not prevent contact with the baby.
• After induction of anesthesia or local anesthesia, under a stream of disinfectant solution, the hand penetrates through the vagina into the uterine cavity, where the placenta is manually separated (by the hand of the obstetrician) and removed from the uterine cavity. The uterine cavity is then checked to see if it is empty and its shape and any deviations are checked.