Rupture or puncture? When and why is the fetal bladder opened. Indications for puncturing the bladder before childbirth Why is the fetal bladder pierced

In what cases is the fetal bladder punctured, what could be the consequences?

What is an amniotomy

In the womb, the baby is surrounded by amniotic fluid or amniotic fluid, which is inside a dense fetal bladder. The artificial opening of the fetal bladder is called an amniotomy. During labor, when the bubble does not burst on its own, the obstetrician opens it.

What happens to the fetal bladder during childbirth

As labor begins, the uterus opens to allow the fetus to move through the birth canal. At the moment of maximum opening of the cervix, the fetal bladder breaks and the child comes out with the waters. This should ideally be the case, but it doesn't always work out. Sometimes the fetal membrane ruptures prematurely or does not violate its integrity for a long time.

Indications for an amniotomy

The fetal bladder is artificially opened for the following reasons:

• Severe form of gestosis.
• All deadlines for the onset of labor have passed.
• Premature detachment of the placenta.
• Fading of the fetus in the late period of gestation.
• Exacerbation of severe chronic diseases in a pregnant woman.
• Prolonged childbirth.
• The presence of Rh-conflict between the mother and the unborn child.
• The uterus opened, but the bubble did not break on its own.
• Weak contractions during childbirth.
• Incorrect position of the placenta (low).
• Excessive amount of amniotic fluid.
• Insufficient amount of amniotic fluid inside the bladder.
• The presence of two or more embryos.
• A sharp increase in blood pressure in a woman in labor.

How is an amniotomy performed?

• An injection of an antispasmodic is given to a future woman in labor, for example, "Papaverine" or another similar drug.
• The woman is placed on a special gynecological chair.
• The doctor introduces an instrument that looks like a hook.
• After the integrity of the fetal bladder is broken, the woman is observed for about 30 minutes, listening to the heartbeat of the unborn child.

Risks and consequences of a puncture of the amniotic sac

• Infection hits.
• Violations of labor activity - too fast or slow.
• Deterioration of the baby.
• Prolapse of the umbilical cord or some part of the child.
• Profuse bleeding.

Does the woman feel pain during the procedure?

Scratches in a child after a puncture of the fetal bladder

• Too little amniotic fluid.
• The baby's head is very close to the exit and when the bladder is pierced, the instrument may touch it.
• The waters broke earlier, but the doctor did not pay attention.

In general, amniotomy is not a dangerous procedure and is widely used today to speed up labor, even when it is not particularly necessary. However, if there are wounds or scratches on the child's body, contact the doctor for explanations and advice.

All 3 pregnancies I was afraid that the water would break somewhere in a public place ... I slept right and saw that I was standing like that in a full tram, and the water was so wow and poured out like a bucket. Or in the mall.. I woke up in a cold sweat =D

In short, I was “afraid”, the body understood this too literally and my blisters did not want to “burst” by themselves even at 42 weeks.

All 3 pregnancies, the bubble was pierced to me already in the birth process, when the contractions were going on, but the water still did not leave.

DOES IT HURRY?

Actually, it never hurts. Not a bit, not even felt. Perhaps this is because the puncture was made at the time of contractions, and compared to them, it seemed to me that the puncture was just flowers. At least the examination for disclosure was much more painful.

Indications:

1. With a flat shape of the fetal bladder. This means a poor content of the anterior waters, which leads to a delay in labor and even to a stop in labor.
2. Too dense amnion. With strong shells, self-opening does not occur even with a fully open neck. The birth of a child in a bubble can be dangerous, the fetus can suffocate. Mommy has placental abruption or bleeding.
3. Weak labor activity. Unproductive contractions, no opening of the cervix, with multi-day contractions. If labor does not begin within two hours, drug stimulation is performed.
4. With a delayed pregnancy. After 41 weeks of pregnancy, the placenta ages, in connection with this, the fetus begins oxygen starvation. Amniotomy accelerates the start of the process of generic function.
5. With polyhydramnios. The name speaks for itself: the amniotic sac contains a lot of water, this stretches the uterus and it is not able to fully contract. An amniotomy carried out ahead of time, under the supervision of a doctor, will exclude the prolapse of loops from the umbilical cord and limbs of the fetus, if this happened spontaneously.
6. Rhesus conflict between mother and child. If there is a need for urgent delivery in order to save the fetus from death, the amniotomy process is started.
7. Mom has high blood pressure. Due to the decrease in volume after the opening of the bladder, the uterus ceases to exert pressure on the vessels around it.
8. Long course of toxicosis. In the third trimester, toxicosis is a pathology called preeclampsia: protein appears in the urine, a woman has swelling and pressure above normal.
9. Low lying placenta. With placenta previa, the entrance to the uterus itself is blocked, followed by placental abruption and fetal hypoxia.

I had multiple readings.

Amniotomy is performed without anesthesia, the walls of the amniotic bladder are devoid of nerve endings, so there is no need for anesthesia.

As a rule, it is done at the initial stage of labor activity on a gynecological chair with an attached basin. Although, in certain cases, the bubble can be pierced both before the onset of childbirth, and before the attempts themselves.

And the second shock after the absence of pain was that the water did not gush out like a bucket, but only began to leak slightly. And if before the opening of the bubble I could at least somehow move, well, in order to increase the load and speed up the opening of the cervix, then after the opening I only had to lie with a diaper between my leg. Panties / pads and other stray items that make life easier for a woman are, of course, prohibited during childbirth))

At that moment, when my bladder was pierced, the baby's head had already rested firmly against the cervix, so the water simply could not "gush". So they actually leaked the whole birth process a little bit. In general, according to the doctors, they should not gush, because this is fraught with a lunge of the umbilical cord or even the arms / legs of the baby, and this is very dangerous. Therefore, together with the hook, the doctor inserts his index finger there and "releases" the water slowly.

The bubble is punctured with a special tool. I don't know what it's called, but it looks like a huge crochet hook. On the Internet, they often show metal sharper hooks, but for me they opened the bubble with a plastic one with a blunt end.

As a rule, after a puncture of the bladder for already five minutes, the contractions become more frequent and stronger, and of course more painful.

The last time I suffered for a long time, the 42nd week of pregnancy was approaching, and the baby was in no hurry to be born. Moreover, according to all analyzes and ultrasound, everything was in order, and the cervix was not at all ready for childbirth.

At the consultation, it was decided: "to give birth", to wait further can already be dangerous. But after an hour spent in the birth hall with small contractions, there was no result in the opening at all. We decided to pierce the bladder and inject oxytocin. And this is just a killer mixture, I realized that now there will be MEAT! And it started.

The fact is that with a whole amniotic bladder, all other methods of stimulation are powerless.

The contractions were getting stronger and more frequent. After the puncture of the bladder, the baby was born in 2 hours. Those were the 2 hellish hours of my life, but thank you for 2, not 12)

In the first and second births, they let me suffer longer, the contractions went on for a long time, 14-15 hours, and only after the bladder was punctured, the process went much faster.

In general, this is a completely standard procedure, which is done in 50% of cases. It is dangerous only in one moment, that an inexperienced doctor can damage the baby's head with a hook. Often, after giving birth, the crumbs have scratches on the top of the head. This fate has bypassed us.

In home births, they prefer not to pierce the bladder if the waters have not broken on their own, but to give birth right in the bag - I have friends of the girls who gave birth to children right in the amniotic bladder, and nothing, everyone is alive and well! Doctors are wary of this method. I have to believe the doctors, so of course I am FOR a bladder puncture if necessary.

They say that among the contraindications there is a point about the weight of the fetus. They say you can not do an amniotomy if the fetus weighs more than 3 kg. And here I can’t agree, all my children are much larger than this figure, and not by 100 grams. Doctors deny this point.

Contraindications:

In any case, there are only pluses from this procedure, so I advise you not to be afraid and not to panic))

In utero, the baby is protected by a special membrane - the amnion, filled with amniotic fluid. They protect it from shock when moving, and the shell prevents the upward penetration of infection from the vagina.

During childbirth, the baby's head is pressed against the cervix and a fetal bladder is formed, which, like a hydraulic wedge, gradually stretches the cervix and forms the birth canal. Only after that it breaks on its own. But there are situations when a bubble puncture is performed before childbirth without contractions.

This procedure is not prescribed at the request of the woman or the whim of the doctor. The success of an amniotomy is possible under certain conditions:

• presenting the head of the fetus;
• full-term pregnancy of at least 38 weeks with one fetus;
• estimated fetal weight over 3000 g;
• signs of a mature cervix;
• normal indicators of the size of the pelvis;
• There are no contraindications for natural childbirth.

Types of amniotomy

The moment of the puncture determines the type of procedure:

1. Prenatal - is carried out before the start of contractions, its purpose is labor induction.
2. Early - before opening the neck by 6-7 cm, it is able to speed up this process.
3. Timely - produced with effective contractions, neck opening 8-10 cm.
4. Belated - in modern conditions it is rarely carried out, it is performed at the time of expulsion of the fetus. An amniotomy is needed to avoid bleeding in a woman in labor or hypoxia in a child.

How is childbirth going after a bladder puncture? The process of the birth of a child in this case does not differ from the natural one. In any case, the condition of the fetus is monitored using the CTG apparatus.

Indications for bladder puncture during childbirth

Bladder puncture stimulates planned labor or is carried out during them.

Labor induction with amniotomy is indicated in the following cases:

• preeclampsia, when there are indications for urgent delivery;
• premature detachment of the placenta;
• fetal death in utero;
• prolongation of pregnancy;
• heavy chronic diseases cardiovascular system, lungs, kidneys, in which delivery is indicated from 38 weeks;
• Rhesus conflict between mother and child;
• pathological preliminary period.

The last condition is the occurrence of small contractions over several days, which do not develop into normal labor activity. This causes intrauterine suffering of the fetus from a lack of oxygen and fatigue of the woman.

How long does it take to go into labor after a bladder puncture? The onset of labor is expected no later than 12 hours later. Although at present, doctors do not take that much time to wait. Prolonged exposure of a child to an anhydrous environment increases the risk of infection. Therefore, 3 hours after opening the amnion, if contractions have not begun, stimulation with medications is used.

With already developed labor activity, a puncture is performed according to the following indications:

1. The cervix dilated 6-8 cm, but the water did not break. Their further preservation is impractical, the bubble no longer fulfills its function.
2. Weakness of labor activity. Puncture of the bladder in most cases leads to its activation. After amniotomy, they wait 2 hours, if there is no improvement, then they resort to stimulation with oxytocin.
3. Polyhydramnios overstretches the uterus and prevents normal contractions from developing
4. With oligohydramnios, a flat fetal bladder is observed. It covers the baby's head and does not function during childbirth.
5. A low-attached placenta may begin to slough off after contractions develop. And opening the amnion will allow the fetal head to cling tightly to the lower segment of the uterus and hold back the detachment.
6. At multiple pregnancy perform a puncture of the bladder of the second child 10-15 minutes after the appearance of the first.
7. High blood pressure is reduced after the opening of the waters.

Bladder puncture technique for a woman in labor

• 30 minutes before the stimulation of labor by puncturing the bladder, the woman is injected with the antispasmodic Drotaverine.
• Later, an examination is performed on the obstetric chair, the doctor evaluates the cervix, the location of the head.
• With a sliding movement of the fingers, a special branch is inserted into the vagina - a hook.
• With its help, during the fight, the shell clings, and the gynecologist inserts a finger into the resulting hole. The tool is removed.
• Holding the head of the fetus through the abdomen with the other hand, the membranes are gently separated and the anterior amniotic fluid is released.

They are collected in a tray, visually assess the condition. Green waters with meconium flakes indicate intrauterine fetal hypoxia. This state of affairs deserves further attention. The pediatric service is warned in advance about the possible condition of the child.

If a large volume of water is drained at once, this can lead to prolapse of umbilical cord loops or small parts of the fetal body.

After the procedure, the woman in labor is connected to the CTG apparatus for 30 minutes to assess the condition of the child.

Is it painful or not to perform a bladder puncture before childbirth? The shells are not penetrated by nerve endings, so the procedure is absolutely painless.

However, complications sometimes develop:

• traumatization of the umbilical cord vessel, if it was attached to the membrane;
• prolapse of the loops of the umbilical cord or parts of the body of the fetus (handles, legs);
• deterioration of the fetus;
• violent labor activity;
• secondary generic weakness;
• child infection.

How long does labor last after a bladder puncture? The duration depends on their parity or number:

• In primiparas, the normal duration of labor is 7-14 hours.
• Multiparous people need less time - from 5 to 12.

Contraindications to bladder puncture in a pregnant woman

Despite the ease of implementation and a small number of complications of manipulation, there are serious contraindications for its implementation. Most of them coincide with contraindications for natural childbirth:

1. Herpetic eruptions on the perineum will lead to infection of the child.
2. Pelvic, foot, transverse or oblique presentation of the fetus, loops of the umbilical cord in the head area.
3. Complete placenta previa. Childbirth in this case is impossible - the placenta is attached above the internal pharynx and prevents the lower segment of the uterus from turning around.
4. Insolvency of the scar on the body of the uterus after caesarean section or other surgical interventions.
5. Narrowing of the pelvis of 2-4 degrees, bone deformities, tumor processes in the small pelvis.
6. Fetal weight over 4500 g.
7. Rough scars causing deformation of the cervix or vagina.
8. Triplets, conjoined twins, breech presentation of the first child of twins.
9. High myopia.
10. Delayed fetal development of the 3rd degree.
11. Acute fetal hypoxia.

In the absence of these contraindications, amniotomy is a safe procedure and does not affect the condition of the fetus.

Yulia Shevchenko, obstetrician-gynecologist, specially for the site

Useful video

The culture of birth shapes practices and absorbs established rituals. Now there is a movement from hospital births to natural births with a midwife; this is happening as women and birth professionals re-evaluate some of the practices and interventions that are typical of hospital births. Amniotomy is a long-standing practice that is considered acceptable for the purpose of reducing the length of labour. There are practically no publications on the effect of amniotomy on the child. This article explores the pros and cons of amniotomy, its role as a ritual for birth attendants, and its possible psychological effects on the baby.

Membrane puncture or amniotomy is a common, if not routine, practice in North American childbirth culture. Amniotomy is perceived as a useful technique to improve labor if it weakens (1). During pregnancy, amniotic fluid is the baby's natural habitat. In the aquatic environment, the child masters the first movements, learns to breathe and swallow; all this prepares him for extrauterine life. During childbirth, the amniotic fluid acts as an "airbag" for the baby during labor and during passage through the birth canal (2). The decision to pierce the bladder or, conversely, to wait for the natural rupture of the membranes is an important part of the birth plan. But since amniotomy has long been a common practice and is perceived as such even in pro-natural birth circles, this issue is often overlooked altogether.
When the doctor or midwife decides on an amniotomy, the puncture is carried out using a special tool that looks like a hook; the instrument is inserted into the birth canal, the fetal membranes are picked up and pierced. As a result, it is assumed that the baby's head will put pressure on the expanding cervix, which will speed up the opening and the birth itself. Some studies (3-6) have found that amniotomy does not speed up labor too much, by an hour or two at the most. Another study (7) claims that amniotomy makes contractions more painful and interferes with the formation of maternal attachment immediately after birth, as many women feel that the natural course of the birth process has been severely disrupted (8). However, in some women, especially multiparous, amniotomy reduces pain in the second stage of labor (9). There are practically no contraindications to amniotomy in case of fetal distress (10). Amniotomy is routinely used to access the fetal head when distress is suspected, to confirm or refute this suggestion (11). Puncture of the amniotic sac helps doctors examine the water for the presence of meconium or blood. The amniotomy also allows you to attach monitor sensors directly to the baby's head when there are signs of distress. However, scientific data on the advisability of puncturing the bladder on early stages childbirth for the purpose of examining amniotic fluid in case of suspected fetal distress is not enough. An early amniotomy can increase distress as it reduces the amount of water, which can lead to partial compression of the umbilical cord, reducing the oxygen supply to the baby, and as a result, there is often even a need for an emergency caesarean section.

Spontaneous rupture of the membranes
Spontaneous rupture of the membranes before the onset of labor occurs in about 12% of cases (12). Premature discharge of water can create a critical situation, as there is a risk of prolapse of the umbilical cord. If the umbilical cord is pressed against the bones of the maternal pelvis, then there is a risk of fetal hypoxia. If labor is uninterrupted, two-thirds of women with healthy term pregnancies achieve good dilatation with an intact amniotic sac (13). In an online obstetrical discussion, one midwife states that out of 300 unstimulated labors without intervention, about 15% of women had an intact bladder almost until the end of the second stage of labor (14). One of the advantages of trusting nature and expecting spontaneous rupture of the membranes is that in this case the entire body of the child experiences only hydrostatic pressure and thus receives protection during contractions, and the head does not change configuration so much when passing through the pelvic bones (15 ). In addition, whole membranes reduce the chance of intrauterine infection.
The presence of meconium in the water does not necessarily mean an increased risk to the baby. A full-term healthy baby can pass meconium in utero and even swallow it (16). Routine bladder puncture “just in case” is unwise and unethical (17, 18). On the other hand, some studies show that sometimes the presence of meconium in the waters lowers their pH and then the child's APGAR score. Dr Marsden Wagner says: Early puncture of the bladder as a routine procedure is not scientifically substantiated" (19). Amniotomy is a procedure that robs a woman of part of the experience of childbirth and reinforces the subconscious belief that childbirth is not natural (20).

Hormonal, chemical and physiological adaptation During childbirth, there is a biochemical and hormonal adaptation of the mother and child to each other. The pH level of the baby is influenced by the pH of the mother and changes over the course of labor (21). The pH indicator measures the acidity of the environment (acidic, neutral or alkaline) and determines the body's ability to get rid of decay products. A neutral pH of 7 is optimal and the body works to keep the pH at that level. Blood levels of catecholamines (adrenaline and norepinephrine) increase as the stress that accompanies normal childbirth increases and facilitates its progress (22). Optimal changes in hydrostatic pressure and pH (in the direction of decrease) have a beneficial effect on the heart activity of the child and his cardiovascular system prepare adaptation to extrauterine life. However, excessive stress and worry raises hormone levels above functional limits, which causes a drop in pH and delays labor. The second stage of labor is marked by changes in the pressure, position and position of the child, when he leaves the aquatic environment, unbends and experiences the action of gravity.
The level of anxiety and stress experienced by a woman in childbirth depends on the culture of birth in a given society. Women need accurate, unbiased, and complete information so that they can become active participants in their births. Uninformed women are often passive and fearful (23). The medical model of childbirth places more trust in machines than in the woman's body, and in this model there is more chance of interventions and unnecessary procedures. Ultimately, women do not participate in the decision-making during childbirth at all, and all that remains for them is to worry about what happens to them and their children.

Functions of the amniotic fluid
There is a huge amount of research on chemical composition amniotic fluid and its role in the maturation of the fetus, as well as during childbirth. Although the hormonal, chemical, and physiological adaptation mechanisms of mother and child have been largely studied, the composition of the amniotic fluid, its changes during the first and second stages of labor, and how the child uses the amniotic fluid during such an important period for its development as childbirth, all this has not yet been fully explored (24). There is recent research on the carbohydrates, proteins, fats, electrolytes, enzymes, and hormones found in amniotic fluid and how these correlate with birth weight, onset of labor, and progression of pregnancy (25).
The study suggests that early spontaneous rupture of the bladder may be related to the composition of the amniotic fluid. Another study points to an increase in the concentration of prostaglandins in the amniotic fluid, suggesting that this increase triggers labor; this postulate contradicts the conventional wisdom that prostaglandin concentrations rise as a consequence of the onset of labor (26). Other studies (27, 28) are investigating the association of the presence of one of the parathyroid peptides (PTHrP) in the amniotic fluid and its effect on labor and the functioning of the membranes on later dates pregnancy (29). Another study (30) examines the role of interleukin-2 in immune system"mother fetus" early dates pregnancy and possibly during childbirth. Amniotic fluid, the baby's natural habitat, is taken for granted and manipulated without fully understanding its function in childbirth. Research points to the need for further study of the chemical changes in the composition of the amniotic fluid during labor and the impact of these changes on the child's birth experience. Although everyone knows that amniotic fluid provides a protective layer for the baby during childbirth, bladder puncture continues to be a routine procedure. It is possible that there are still important, but not yet known to us, functions of the amniotic fluid that help the child adapt to new living conditions after birth.

Rituals surrounding birth The process of birth is reflected in the culture of any society, and any culture uses various rituals to overcome the fear of the unknown. Childbirth can be unpredictable, carry elements of spiritual mystery. With the help of rituals, it is possible to avoid dangers and come to a good ending. Medical interventions, explains childbirth anthropology researcher Robbie Davis-Floyd, give clinicians a psychological sense of power over the forces of nature and help them overcome their fears (31). The ritual includes symbolic objects (for example, a bladder hook), ideas (for example, "amniotomy speeds up labor, which is good for a woman"), and actions, such as taking responsibility, explaining the meaning of the procedure. The imagery associated with the amniotomy suggests the forces "releasing the waters and bringing life," while in the hands of the one who delivers. Such rituals convey an unconscious message that a woman feels rather than consciously perceives. The effect is incredibly powerful. The culture of hospital births is based on technical symbols and procedures that try to transcend nature and individuals, as if telling us that the woman's body is imperfect and that, with the help of tools, doctors can control nature.
The obstetrician, who mobilizes the forces of the woman in labor, gives natural process develop independently, he understands that the woman's body itself knows what to do (including the moment when it is time to get rid of the amniotic fluid). Such an obstetrician accepts that the amniotic fluid helps to dilate the cervix by pushing outward in the bladder, working like a wedge, using hydrostatic pressure to gently and evenly dilate the cervix (32). This is the progress that mother and child make together, not that hasty mechanical intensification of labor that is caused by amniotomy and that robs mother and child of the experience of childbirth that is rightfully theirs.

Types of influences and behavior
Childbirth is a biological frontier. Recent studies on the prenatal causes of adult illness indicate that during the prenatal and early postpartum period, more changes than in any other age period. By studying the interaction of the organism with its environment during critical periods of development, research concludes that the child makes compensatory efforts in utero that increase its susceptibility to disease (33). The researchers also found that this type of reprogramming can be passed down from generation to generation. One cannot help but wonder: is the sharp change in the conditions of the child’s existence during a bladder puncture the reason for the increase in the number of children with sensory integration difficulties, who then receive such neurological diagnoses as “attention deficit hyperactivity disorder” (this diagnosis is more often made in boys of preschool and early school age). ). It is hypothesized that the effects of the bladder puncture in girls appear later, as the eggs in her body register this interference at the level of cellular memory, and when she grows up and becomes pregnant, this will change the properties of the membranes in her children. From a prenatal and perinatal point of view, it is known that how our heredity and our personality traits manifest themselves depends, among other things, on the events that accompanied conception, intrauterine life and birth (34). The effect of amniotomy on early psychological development is unfortunately not taken into account, while the ritual of puncturing the bladder to enhance labor is universally thriving. Amniotomy is routinely used to speed up labor and to diagnose fetal distress, while amniotomy itself contributes to the appearance of an irregular heart rate in the fetus (which is just a sign of distress!), reducing the amount of water in the uterus, which means compressing the umbilical cord and reducing access of placental blood and oxygen to the child. When the membranes are not touched, the child has much less violations in childbirth heart rate. Part of the irregular heart rate is caused by the birth itself, and this is natural (35). Probably, amniotomy is used to diagnose fetal distress much more often than is really necessary. The amniotomy forces the child to urgently adapt to the fact that his body is subjected to strong mechanical compression, and the head passes through the bony ring of the mother's pelvis without any protection. The sudden drop in hydrostatic pressure and sudden compression of the head in the bone ring that the child experiences in connection with the amniotomy is perhaps too much stress on the child's body. When the bladder is punctured, he experiences a symbolic, physiological and psychological loss (36). When the child's environment—the amniotic waters that protect and nourish him—suddenly overflows, the child instantly experiences a sense of irretrievable loss. He passes through the birth canal on command, his first "losing himself". " The stress matrix” is a conceptual model to help us better understand the shock and trauma that a baby experiences during childbirth (37). As the physiological increase in shock changes may be unbearable for the child, excessive. Shock is a “sudden disturbance of psychological balance” (38), and it certainly affects behavior. The body will remember the experience of childbirth on motor, vestibular, emotional and social levels (39). Some physical signs that have been noted in children who have experienced birth stress are limb twitches, muscle hyper- or hypotonia, manifestations of rage, fear, or lack of response to the world around them (40). Their condition is often explained as infantile colic, ignoring the trauma they suffered. While these signs must be noticed and accepted while working with them, if we do not want them to be fixed and affect the development of the personality throughout life.
Young children are often diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) when their nervous system aggressively resists environmental stimuli. Or the child may be less receptive, non-contact - this is a reaction of "escape" from environmental stimuli. Such children are at risk of depression in the future, as teachers and parents often misjudge their condition. As they grow up in the modern high-tech world, these children often isolate themselves from society and immerse themselves in computer games, which, of course, negatively affects their behavior. Technology influences a child's social life from the very beginning, it has such a strong impact that stressed children and later choose to connect with the world through technology. At worst, the underlying desire for human contact with oneself and others (and rage at one's impotence to establish these contacts) is fueled in such children by electronic games that glorify violence and murder. Accordingly, these contacts are carried out in the form of aggression directed at oneself or others.

Psychology of early development
Amniotomy is rarely (if ever) mentioned as an intervention that could potentially be psychologically traumatic for the mother or child. An abrupt change in intrauterine conditions is stressful for the baby, and the mother may perceive the amniotomy as a gross intrusion into the birth process. Without a doubt, a baby can be born in a state of shock and no one will notice it, this procedure has become so routine in our culture of childbirth. One of the principles of early developmental psychology, relating to the development of human potential, refers us to the capabilities of the infant, which include intellectual, sensory and energy adaptation. It seems quite clear that the decision to perform an amniotomy will have a lot of consequences for the child. From the very beginning of his nascent life, the child is influenced by the thoughts and feelings of his mother, and at the time of birth he is also influenced by the thoughts and feelings of those taking delivery. The foundations for the growth and development of a child are laid during pregnancy and childbirth. He reacts to the sensations and emotions of the mother and her environment, and this affects his development. The behavior and thoughts of others during childbirth can have a lasting effect on him. Amniotomy means that a stranger appears with an instrument that grossly violates the child's environment and causes its drastic changes, for which the child is completely unprepared. This is an invasive procedure that violates the child's innate need for belonging, security, and care. Bladder puncture makes contractions more painful for both mother and baby, and can disrupt their telepathic communication. The sudden changes caused by the outpouring of water cause the release of stress hormones that affect the sympathetic nervous system, and this process can be reproduced whenever the child finds himself in a stressful situation throughout his life.

Problem Solving Strategies
To overcome the widespread use of amniotomy, it is necessary to open our minds to statements that are unusual for us and break through stereotypes. We are moving forward as educational texts already indicate that amniotomy is not useful in reducing the duration of labor (41, 42). It is also recognized that a “just in case” amniotomy to assess the condition of the fetus does not justify itself. It is necessary to educate and educate people working with children on how to recognize the symptoms of shock in infants, children, and parents in order to facilitate recovery from its effects. It will take enthusiastic people to carry this information about every baby and every parent and parents personally, and those who work with such children and parents will need many people to organize conferences and publish reliable research. We need environment which gives a sense of security. It will be able to heal the trauma that we received in the early stages of development. As laborers in childbirth, we must slow down, reduce our activity, to allow the child's body to turn on its self-regulation and adaptive mechanisms (43). Slowing down helps us connect." Here and now and form fulfilling relationships. A calm state increases our empathy for infants and allows us to recognize their unique bodily manifestations of trauma.
We have a long way to go to create and maintain a gentler birth culture. To do this, it is necessary to convey to the public, pregnant women, childbirth trainers and politicians the need for changes in the system of childbirth in order to give women more strength. We must recognize the value of the art of midwifery and support it everywhere, as it makes our society better.

Verna Oberg received her Master's degree from the Faculty of Prenatal and Perinatal Psychology of the Institute in Santa Barbara in 2010. She works as a consultant for early development, tracks the developmental stages of newborns and children early age, promotes the formation of parent-child attachment and advocates that newborns and young children are full-fledged people with consciousness and feelings. Verna expresses her deep gratitude to Dr. Jean Rhodes for her assistance in writing this article.

Literature: 1. Goer, H. 1999. The Thinking Woman's Guide to a Better Birth. New York: The Berkeley Publishing Group. 2. Simkin, P. 2001. The Birth Partner, 2nd ed. Boston: The Harvard Common Press. 3. Davis-Floyd, R., and C.F. Sargent, eds. 1997. Childbirth and Authoritative Knowledge: Cross-cultural Perspectives. 3rd ed. Berkeley and San Francisco: University of California Press. 4. Enkin, M., et al. 2000. A Guide to Effective Care in Pregnancy and Childbirth, 3rd ed. New York: Oxford Press. 5. May, K.A., and L.P. Mahlmeister, eds. 1994. Maternal & Neonatal Nursing, 3rd ed. Pennsylvania: J. B. Lippincott Company. 6. Wagner, M. 2006. Born in the USA. Berkley, CA: University of California Press. 7. Robson, K.M., and R. Kumar. 1980. Delayed Onset of Maternal Affection. Br J Psychiatry 136: 347-53. 8. Mayes, M. 1996. Mayes Midwifery, 12th ed. Oxford: Bailli?re Tindall. 9. Brenda. 2001. Artificial rupture of membranes: breaking the waters. Message posted to UK Midwifery Archives at http://www.radmid.demon.co.uk/arm.htm. Accessed 2 Jun 2010. 10. See Reference 6. 11. See Reference 4. 12.Childbirth Graphics. 1993 Directional Learning. Wasco, Texas: A Division of WRS Group, Inc. 13. See Reference 6. 14. Rehana. 2001. Artificial rupture of membranes: breaking the waters. Message posted to UK Midwifery Archives at www.radmid.demon.co.uk/arm.htm. Accessed 2 Jun 2010. 15. See Reference 2. 16. See Reference 5. 17. Ibid. 18. See Reference 6. 19. See Reference 3. 20. Davis-Floyd, R. 1987. Hospital birth routines as rituals: Society's messages to American women. J Prenat Perinat Psychol Health 1(4): 276-96. 21. See Reference 5. 22. Ibid. 23. McKay, S. 1991. Shared power: The essence of humanized childbirth. J Prenat Perinat Psychol Health 5(4): 283-95. 24. See Reference 5. 25. Gotsch, F., et al. 2008. Evidence of the involvement of caspase-1 under physiologic and pathologic cellular stress during human pregnancy: a link between the inflammasome and parturition. J Matern Fetal Neonatal Med 21(9), 605-16. 26. Lee, S.E., et al. 2008. Amniotic fluid prostaglandin concentrations increase before the onset of spontaneous labor at term. J Matern Fetal Neonatal Med 21(2): 89-94. 27. Ferguson II, J.E., et al. 1992. Abundant expression of parathyroid hormone-related protein in human amnion and its association with labor. Proc Nati Acad Sci USA. 89:8384-88. 28 Wlodek, et al. 1992. Abundant expression of parathyroid hormone-related protein in human amnion and its association with labor. Reprod Fertil Dev 7(6): 1560-13. 29. Ibid. 30. Zicaria, A., et al. 1995. Interleukin-2 in human amniotic fluid during pregnancy and parturition: implications for prostaglandin E2 release by fetal membranes. J Reprod Immunol 29(3): 197-208. 31. Davis-Floyd, R. 1990. Obstetrical rituals and cultural anomaly: Part I. J Prenat Perinal Psychol Health 4(3): 193-211. 32. See Reference 12. 33. Nijland, M.J., S.P. Ford and P.W. Nathanielsz. 2008. Prenatal origins of adult disease. Curr Opin Obstet Gynecol 20(2): 132-38. 34. Odent, M. 2008. New Criteria to Evaluate the Practices of Midwifery and Obstetrics. J Prenat Perinat Psychol Health 22(3): 181-89. 35. Barrett, J.F.R., et al. 1992. Randomized trial of amniotomy versus the intention to leave membranes intact until second stage Br J Obstet Gynecol 94: 512-17. 36 Emerson, W.R. 1997. Birth Trauma: The Psychological Effects of Obstetrical Interventions. Petaluma, CA: Emerson Seminars. 37. Castellino, R. 2005. The Stress Matrix: Implications For Prenatal and Birth Therapy. Santa Barbara, CA: Castellino Prenatal and Birth Therapy Training. 38. Ibid. 39. Perry, B. 2009. On the brain: How we remember. CYC-Online (122) http://www.cyc.net.org/cyc-online/cyconline-apr2009-perry.html. Accessed 14 Apr 2009. 40. See Reference 37. 41. See Reference 3. 42. See Reference 6. 43. Glenn, M. 2002. The use of body-centered psychotherapy in working with prenatal and perinatal imprints within a group. Paper presented at Third United States Association of Body Psychotherapy Congress and Emergence in Body Psychotherapy. http://www.sbgi.edu/cont_edu/glenn/glennceuya.html. Accessed 30 Sep 2009.

There is no pregnant woman who does not worry about the birth of her baby. Everyone is waiting for his appearance and is afraid of pain. Sometimes women who have given birth report that they had a puncture of the bladder before giving birth without contractions. Gynecologists call this procedure an amniotomy. It is tolerated by up to 10 percent of women in labor. Those who find out about this situation start to get scared. They do not have specific ideas and knowledge about the need for this process and set themselves up negatively. There is no reason for fear, since it is organized for the good and will not bring harm to the crumbs.

The discharge of water sometimes precedes the onset of labor. It can occur partially or completely, which happens in about 12% of all women. Such a deviation is considered premature rupture of amniotic fluid. This is a very noticeable phenomenon, since it is associated with their large volume.

Normally, they are light or pink and should not have a smell. If a brown, green, or black color is found, then this indicates the presence of a newborn's feces in them. So the fetus has oxygen starvation and he needs a quick delivery. When a yellow tint is mixed in, then there is a Rh conflict. Here, too, urgent action is needed.

When the waters break at home, the woman in labor should urgently go to the hospital. Upon arrival, she reports the exact time of the outpouring. When the body is completely ready for childbirth, contractions occur immediately or after a certain period of time after the water breaks.

What is an amniotomy?

This is an operation to open the amniotic sac. The fetus in the mother's body is protected by a special shell - the amnion. It is he who is filled with amniotic fluid. Protects the baby from bumps and penetration of vaginal infections. It is a kind of "shelter" for the baby. If it is opened or a rupture occurs naturally, then the uterus begins to expel the fetus. As a result, the contractions grow, and the baby is born.

Surgical intervention - a puncture of the bladder before childbirth without contractions is organized with a special device that looks like a hook. It is carried out at the moment of its greatest severity, so as not to touch the soft tissues of the child's head.

Varieties of amniotomy

There are several types, depending on the period of the operation:

1. Prenatal. It is organized before the onset of contractions to cause labor induction.
2. Early. It is carried out at the opening of the cervix by seven centimeters.
3. Timely. When there is an opening up to 10 cm.
4. Belated. It takes place during the expulsion of the fetus. The procedure is needed to exclude hypoxia in a baby, or bleeding in a woman in labor.

The passage of childbirth occurs without changes and in accordance with the natural state. The well-being of the baby is observed by the KGT apparatus.

Bladder puncture before childbirth without contractions

It is carried out in the following cases:

1. Postponed pregnancy. It usually lasts forty weeks. But if it increases, then obstetric care is required. The placenta begins to age and loses its functionality. The child experiences suffering due to oxygen starvation.
2. Preeclampsia is a disease characterized by edema, increased blood pressure and the presence of protein in the urine. It has a negative impact on the health of the fetus and mother.
3. Rhesus conflict. Brings complications and causes stimulation of labor activity.
4. Hypertension, diabetes in a pregnant woman.
5. Weakness of contractions, impossibility of self-delivery.

When wondering why the bubble is pierced before childbirth, you should trust a professional specialist. After all, he does this when he sees a real threat to the life of the baby and mother.

If childbirth has begun, then the operation is done when there is:

• the opening of the cervix by six to eight centimeters, but the water does not depart. Keeping them does not make sense, since the bubble does not fulfill its purpose;
• impotence in childbirth. When the contractions fade, the neck slows down the activity and, so that the birth does not stop, the bladder is punctured. Organized monitoring of the mother. In the absence of positive dynamics, oxytocin is administered within two hours;
• polyhydramnios. The presence of a large volume of amniotic fluid does not allow the uterus to contract naturally;
• high blood pressure in preeclampsia, liver and kidney diseases, has a negative effect on childbirth and the fetus;
• flat fetal bladder. In this state (oligohydramnios) there are almost no frontal waters. This contributes to the difficulty of labor and its complete cessation;
• low location of the placenta. It can cause detachment and bleeding.

Implementation of the procedure

An amniotomy is considered a surgical intervention, but the surgeon and anesthesiologist may not be present. The doctor does a vaginal examination (gives an assessment of the cervix, the location of the head), then opens the bladder. The process consists of several stages:

1. Before the start of the operation, the woman's genitals are treated with antiseptic agents, they are offered to take an antispasmodic or no-shpu. After the effect of the drug begins, she is placed on the gynecological chair and must lie motionless, not interfere with the doctor's manipulations.
2. The healthcare professional puts on gloves and gently inserts the instrument into the vagina. Hooks on the amniotic sac and pulls it until it bursts. The outflow of amniotic fluid begins.
3. After the action is completed, the woman in labor remains in a horizontal position for another half hour. The fetal condition is monitored by the KGT apparatus.

Opening is carried out only in the absence of contractions, which ensures the convenience and safety of the operation.

How long after the bladder is punctured does labor begin?

The start is expected no later than twelve hours later. But today doctors don't wait that long. The child increases the risk of infection with prolonged exposure to an anhydrous environment. Therefore, when three hours pass, and there are no contractions, they resort to drug stimulation.

Duration of labor after the procedure

Women respond as follows:

• for those who gave birth for the first time, this activity continued until fourteen hours;
• in multiparous from five to twelve.

Contraindications and consequences

The procedure has some limitations and is not performed when:

• a pregnant woman has herpes on the genitals in an acute stage;
• loops of the umbilical cord create obstacles for the operation;
• natural childbirth is not recommended;
• there is a low location of the placenta;
• the fetus occupies an oblique, transverse, or pelvic presentation;
• pelvic constriction of 2-4 categories, a tumor in the small pelvis;
• the baby has a weight of more than 4.5 kg;
• deformation of the vagina or cervix due to rough scars;
• twins that have grown together, triplets;
• myopia of a high degree;
• acute suffocation of the baby.

There is a ban on heart disease.

Possible Complications

There are a few exceptions leading to negative consequences after amniotomy:

• injury to the umbilical cord vessel when it is attached to the sheath. This will lead to blood loss;
• deterioration in the well-being of the baby;
• prolapse of arms or legs;
• baby heart disease
• restless childbirth and their secondary weakness;

Such completion is rare, but sometimes there is a danger that the desired result will not occur when the fetal bladder is punctured. As a result, doctors may use drugs that cause contractions. There are cases when they resort to a caesarean section. Since the prolonged presence of the child without water will have a negative impact.

How does a woman feel during an amniotomy?

Does it hurt or not? Any mother will be afraid because of possible appearance pain. But it will not be, because the amniotic sac does not contain nerve endings.

The woman in labor should simply relax and lie down in a comfortable position. With the right procedure, she only feels how the water flows out. They have a warm temperature. If the muscles tense up, then discomfort and adverse outcomes, such as damage to the walls of the vagina, may occur.

Compliance with the rules

There are certain requirements for this operation. To avoid complications, you should adhere to some provisions:

• head presentation,
• pregnancy at least thirty-eight weeks,
• delivery on your own and the lack of prohibitions in this,
• readiness of the birth canal,
• having only one fetus.

Of great importance is the maturity and readiness of the uterus. To perform the operation, it must be in accordance with six points on the Bishop scale.

The famous doctor M. Oden tells his view on this procedure with medical point of the European countries - "this is a relic of the past":

Each operation, which includes the puncture of the bladder before childbirth without contractions, does not always lead to a positive outcome. The organization of amniotomy, carried out in compliance with all requirements, reduces the risk of various complications. Therefore, when there is a need for it, the pregnant woman must agree to surgery.