Obstetrician-gynecologist, the highest category, endocrinologist, doctor of ultrasound diagnostics, specialist in the field of aesthetic gynecology Appointment
One of the most common causes of complicated labor is sluggish or insufficient labor, which leads to a delay in the labor process and, as a consequence, to fetal hypoxia.
Weakness generic activity manifests itself in weak, short-term contractions, which slow down not only the smoothing and dilation of the cervix, but also the movement of the fetus along the birth canal of the mother.
Weakness of labor forces is more common in primiparous women. Weakness of labor can be primary and secondary.
The primary weakness of labor is the absence of normal opening dynamics uterine pharynx despite the fact that the contractions are already underway.
The reason for the lack of dynamics of childbirth may be a flat bladder, which prevents the child from lowering, general fatigue of a woman, low hemoglobin, some mental abnormalities.
One of the most common reasons for the onset of weakness in labor is the fear of the woman in labor, and simply her unpreparedness for what happens during childbirth. Fear disrupts hormonal balance because the hormones that stop labor are produced by the body in greater quantities than hormones that speed up labor. This often happens when a woman is experiencing severe stress at the very beginning of labor. Sometimes one careless or rude word from the hospital staff can become a factor "knocking down" hormonal balance.
Secondary weakness of labor develops after the onset of labor, when the normally started contractions at some point "fade".
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Secondary weakness of labor develops less frequently than primary, and, as a rule, is the result of prolonged and painful contractions, which lead to fatigue of the woman in labor.
The actions of the obstetrician depend, first of all, on the cause of the weakness of labor. Unfortunately, in order to make childbirth faster, doctors quite often accelerate them artificially, even when it is not necessary. It is clear that the weakness of labor in objective reasons cannot occur in 65% of women in labor. More often than not, childbirth has simply not begun yet, preparatory contractions are underway.
In addition, childbirth, especially the first, can really go on for a long time, and if there is no threat of hypoxia for the fetus, it is not necessary to stimulate labor. Sometimes, in order to restore labor, it is enough for a woman in labor to calm down and rest a little.
However, if prolonged labor really becomes dangerous for the child and the mother, then with the weakness of labor, it is customary to stimulate labor.
The main non-drug method that allows you to enhance labor activity is amniotomy (opening the fetal bladder), which is performed when the cervix is dilated by 2 cm or more. As a result of amniotomy, labor often intensifies, and the woman in labor can cope on her own, without the administration of drugs.
If the amniotomy does not have the desired effect, then the use of medications... Firstly, these include the so-called drug sleep, during which the woman in labor restores the strength and energy resources of the uterus. After waking up, on average after 2 hours, in some women in labor, labor activity intensifies. Medication sleep occurs after the administration of drugs from the group of narcotic analgesics, which should be done only after consulting an anesthesiologist and only in cases where side effects on the part of the fetus are less significant than the danger of delaying labor for the child.
The main method for correcting the intensity of the birth process is the famous stimulants that enhance the contractile activity of the uterus - uterotonics. The most common uterotonics are oxytocin and prostaglandins. The drugs are administered intravenously through a dropper, while carefully dosing them. In this case, the state of the fetus is necessarily monitored using a heart monitor.
The disadvantages of stimulating drugs include the fact that, as a rule, their use clearly requires the use of antispasmodics, analgesics, or epidural anesthesia. This is due to the fact that a sharp increase in labor often increases pain at a woman in labor. Therefore, it is clear that birth-stimulating therapy should be used only for medical reasons, when the harm from its use is lower than the harm from prolonged labor.
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And, finally, if the use of drugs that accelerate labor and enhance labor activity does not work, and the fetus suffers from hypoxia, a choice may be made in favor of using an emergency caesarean section.
Despite the fact that weak labor is a complication that occurs directly during childbirth, you can try to prevent its development even during pregnancy.
TO preventive measures to prevent the weakness of labor is, first of all, correct preparation a woman in labor, when she knows what is happening to her and the baby, and what she needs to do in order for the birth to be successful. It is very important that the conditions during childbirth are comfortable for the woman in labor.
As a prevention of weakness of labor from 36 weeks of pregnancy, pregnant women are advised to take vitamins that increase energy potential uterus (vitamin B6, folic acid, ascorbic acid).
However, the most important is considered psychological condition readiness for childbirth, the mother's confidence in herself and those who help her during childbirth, awareness of her responsibility for everything to go well. It is known that if of unprepared women in labor, weakness of labor occurs in 65%, then women in labor who during pregnancy attended preparatory courses for childbirth or schools of future parents face this complication only in 10% of cases, and they are usually caused by objective reasons.
At the Euromedprestige medical center, obstetricians-gynecologists are confident that in order to avoid complications during childbirth, it is necessary to undergo a complete medical examination during pregnancy, follow the advice of your doctor. Only in this case, the doctor will be able to assess the risk of developing certain complications and take measures to minimize their consequences for the mother and the child.
Also, according to the doctors of our center, it is important to undergo preparation for childbirth, master exercises, various techniques... It is this knowledge that will help you both in the prenatal and postnatal periods.
This is an insufficient contractile activity of the uterus in terms of duration, frequency and strength, caused by its hypotonic dysfunction. The main manifestations of weakness in labor are rare, ineffective and short-lived contractions, which are accompanied by slow fetal movement and poor uterine dilatation. To diagnose pathology, vaginal examination and cardiotocography are used. Treatment for weakness in labor is limited to radio stimulation. Quite often used cesarean section, since the fetus cannot be born on its own.
What it is?
Childbirth is the final and most anticipated stage of the entire pregnancy period. But childbirth does not always go well. One of the forms of violation of the contractile function of the uterus is the weakness of labor. This pathology is characterized by the fact that contractions are rare and irregular, the tone of the myometrium is pronouncedly low, and the amplitude of contractions is weak. The diastole of contractions (relaxation period) significantly exceeds the systole (contraction period), which negatively affects uterine dilatation, and the fetus cannot move normally. The uterus ceases to function properly, which poses a threat to the baby.
In gynecology and obstetrics, the weakness of labor is called one of the most common disorders and complications of the childbirth process. It is the weakness of labor that most often leads to the occurrence of pathologies in the fetus and mother. Among all birth pathologies, according to statistics, the weakness of labor activity accounts for about 7% of cases. It is worth noting that this anomaly is more common in first-time births than in women who are not in labor for the first time.
Types of weakness of labor
In modern gynecology, primary and secondary weakness of labor is distinguished. The first type of weakness of labor is characterized by the fact that the contractions from the very beginning are not strong enough, inactive, irregular and prolonged. In turn, the secondary weakness of labor activity, the reasons for which may be different, occurs when the contractions weaken at the beginning of the 2nd or at the end of the 1st stage of labor, and initially labor activity is quite active and violent.
Convulsive and segmental contractions are also one of the varieties of labor weakness. Convulsive contractions are protracted and last no more than 2 minutes. In turn, segmental contractions are characterized by contraction not of the entire uterus, but only of its individual parts. The effect of this kind of contractions is practically nil.
Causes of weakness of labor
The development of weakness of labor is influenced by a large number of factors that are associated with a lack of hormonal regulation of the birth act, morphological inferiority of the uterus, functional inertness of nervous structures, pathology of pregnancy, extragenital diseases, etc.
Weakness of labor can occur under the influence of pathologies of the uterus: hypoplasia, fibroids, chronic endometritis, saddle or bicornuate uterus. Structural failure of the myometrium, caused by diagnostic curettage, conservative myomectomy, abortion and other similar interventions earlier. Cicatricial changes as a result of radical treatment of cervical erosion can also contribute to the development of weakness of labor.
Quite often, the reason for the weakness of labor is hidden in the imbalance between the factors that are responsible for active labor (mediators, estrogens, calcium, prostaglandins, oxytocin, etc.) and factors that inhibit labor (magnesium, enzymes that destroy mediators, progesterone, etc.) NS.).
Women with autonomic metabolic disorders are at risk of developing weakness in labor: hypothyroidism, hypothalamic syndrome, hypofunction of the adrenal cortex, obesity.
Young or late age primipara significantly increases the risk of weakness in labor. In addition, the anomaly may be due to:
- gestosis;
- post-term pregnancy or premature birth;
- overstretching of the uterus with polyhydramnios, large fetuses, multiple pregnancies;
- imbalance between the mother's pelvis and the size of the fetus;
- early discharge of water;
- placenta previa;
- fetal pathology (anencephaly, hypoxia);
- chronic placental insufficiency, etc.
Weakness of labor is aggravated by:
- overwork;
- excessive mental, physical stress;
- insufficient sleep;
- unsatisfactory nutrition;
- excessive mental disorders;
- fear of a woman in labor;
- rude or inattentive service;
- uncomfortable environment.
Often, the weakness of labor is nothing more than a continuation of the pathological preliminary period of labor.
Symptoms of weakness of labor
The main symptoms of primary weakness of labor can be called:
- the duration of contractions is not painful 15-20 seconds;
- frequency of contractions 1-2 within 10 minutes;
- decreased tone and excitability of the uterus;
- amplitude of contractions of the myometrium 20-25 mm Hg. v;
- short period of uterine contraction;
- lengthening the relaxation period by 1.5-2 times, etc.
With primary weakness of labor, contractions can be irregular or regular, slightly painful or painless. The cervix undergoes delayed structural changes (shortening, smoothing and opening of the uterine pharynx and cervical canal).
Slow contraction of the uterus is accompanied by early postpartum which can cause hypotonic bleeding. The primary type of weakness in labor tires the woman in labor, leads to lengthening of the anhydrous gap, prolongation of the duration of labor, untimely effusion amniotic fluid.
Secondary weakness of labor is characterized by the following symptoms:
- initially effective contractions weaken;
- each contraction is getting shorter;
- decreased tone and excitability of the uterus;
- the fetus does not move through the birth canal;
- the opening of the uterine pharynx stops at around 5-6 cm.
The danger of weakness in labor is as follows:
- the risk of infection of the uterus;
- the occurrence of numerous birth injuries;
- development of fetal asphyxia;
- intrauterine death of a child.
Diagnostics of the weakness of labor
It is possible to determine the nature of the weakness of labor through diagnostics, which includes a clinical assessment of the dynamics of labor, the tone of the uterus, and the effectiveness of contractions.
During childbirth, the doctor monitors how the birth process develops and monitors how long each contraction takes. All results are checked against the norm, this is the only way to understand how labor activity occurs. The active phase of the first period is characterized by contractions for 30 seconds every 5 minutes, for the second period - shorter than 40 seconds.
The opening of the cervix with weakness of labor occurs by less than 1 cm per hour. The speed and degree of dilatation is assessed using a vaginal examination.
The diagnosis of weakness of labor is confirmed if the primary labor period in a woman in labor lasts more than 12 hours. If we talk about multiparous, then for them this figure is more than 10 hours.
It is necessary to distinguish between discoordinated labor and weakness of labor, the treatment of which will be different.
Treatment of weakness of labor
The treatment regimen for weakness in labor will depend on the causes of the anomaly, the period of labor, the degree of weakness in labor, assessment of the condition of the mother and fetus. Also, a lot will depend on what kind of pregnancy a woman has.
In some cases, one catheterization session is sufficient to stimulate the intensity of contractions. Bladder... If the reason for the weakness of labor is in polyhydramnios, then an amniotomy procedure is performed. Medication sleep is prescribed when the woman in labor is tired, but there is no risk of fetal asphyxia and hypoxia. With asthenization, it is advisable to create an estrogenic calcium background as a treatment.
Treatment of weakness in labor cannot be imagined without birth-stimulating therapy, this is the main method in the fight against deviation. Is the introduction of prostaglandin F-2 (Enzaprost), prostaglandin E-2 (Prostenone) and intravenous infusion of oxytocin. If birth stimulation does not help, a cesarean section is prescribed. In this process, a lot depends on how the pregnancy went.
In the case when the fetal head is in the pelvic cavity, they resort to the imposition of obstetric forceps or to dissection of the perineum (episiotomy, perineotomy).
Prevention of weakness of labor and its complications
The doctor who leads the pregnancy should assess the risk of developing weakness in labor. If such risks exist, the specialist should take care of conducting psychophysical and preventive drug training.
Weakness of labor always leads to a deterioration in the condition of the fetus, therefore, delivery stimulation and prevention of fetal asphyxia are carried out simultaneously and in mandatory.
- the contractile activity of the uterus, insufficient in strength, duration and frequency, due to its hypotonic dysfunction. Weakness of labor is manifested by rare, short and ineffective contractions, a slowdown in cervical dilatation and fetal advancement. Pathology is diagnosed by observation, cardiotocography, vaginal examination. In the treatment of weakness of labor, rhodostimulation is used; according to indications, a cesarean section is performed.
Weakness in labor may be due to late or young age primiparous; gestosis; premature birth or post-term pregnancy; overstretching of the uterus with multiple pregnancies, large fetuses, polyhydramnios; imbalance between the size of the fetus and the mother's pelvis (narrow pelvis); early discharge of water. The development of weakness of labor can lead to placenta previa, pregnancy in conditions of chronic placental insufficiency, fetal pathology (hypoxia, anencephaly, etc.).
In addition, the weakness of labor can be aggravated by asthenia of a woman (overwork, excessive mental and physical stress, inadequate nutrition, insufficient sleep); fear of a woman in labor, an uncomfortable environment, inattentive or rude service. Weakness of labor is often a direct continuation of the pathological preliminary period of labor.
Types of weakness of labor
By the time of occurrence, they distinguish between primary weakness of labor and secondary. Primary weakness is considered a situation in which, from the very beginning of labor, insufficiently active (weak in strength, irregular, short) contractions develop. Secondary weakness is spoken of if there is a weakening of contractions at the end of the 1st or beginning of the 2nd stage of labor after the initially normal or violent nature of labor.
The varieties of weakness of labor include segmental and convulsive contractions. Convulsive contractions are characterized by prolonged (more than 2 minutes) contractions of the uterus. With segmental contractions, not the entire uterus is reduced, but its individual segments. Therefore, despite the continuity of segmental contractions, the effect of them is extremely small. Definition clinical form weakness of labor allows you to choose a differentiated tactics in relation to the treatment of disorders.
Symptoms of weakness of labor
Clinical manifestations of primary weakness of labor are: decreased excitability and tone of the uterus; frequency of contractions - 1-2 for 10 minutes; the duration of the contractions is no more than 15-20 seconds; amplitude (force) of myometrium contractions - 20-25 mm Hg. Art. The period of contraction of the uterus is short, the period of relaxation is lengthened by 1.5-2 times. An increase in the intensity, amplitude, frequency of contractions does not occur over time.
Contractions with primary weakness of labor can be regular or irregular, painless or slightly painful. The course of structural changes in the cervix (shortening, smoothing and opening of the cervical canal and uterine pharynx) is slowed down. The weakness of the contractile activity of the uterus often accompanies the period of expulsion, as well as the subsequent and early postpartum period leading to hypotonic bleeding. The primary weakness of labor leads to a delay in the duration of labor, fatigue of the woman in labor, untimely discharge of amniotic fluid, and lengthening of the anhydrous gap.
In the case of secondary weakness of labor, the initially effective contractions weaken, become shorter and less frequent, up to complete cessation. This is accompanied by a decrease in the tone and excitability of the uterus. The opening of the uterine pharynx can reach 5-6 cm without further progression; the movement of the fetus through the birth canal stops. The danger of weak labor is an increased risk of ascending infection of the uterus, the development of fetal asphyxia or its intrauterine death... With prolonged standing of the fetal head in the birth canal, birth trauma to the mother (hematomas, vaginal fistulas) may develop.
Diagnostics of the weakness of labor
To determine the nature of labor, a clinical assessment of the effectiveness of contractions, uterine tone, dynamics of labor is carried out. During childbirth, monitoring of uterine contractions is carried out (tokometry, cardiotocography); analysis of the frequency, duration, strength of contractions and their comparison with the norm. So, in active phase In the 1st period, contractions lasting less than 30 seconds are considered weak. and at intervals over 5 minutes; for the 2nd period - shorter than 40 sec.
With weakness of labor, the cervix dilates by less than 1 cm per hour. The extent and speed of dilatation is assessed during the vaginal examination, as well as indirectly by the height of the contraction ring and the advancement of the head. The weakness of labor is said if the first stage of labor lasts more than 12 hours in primiparous, and in multiparous - more than 10 hours. Weakness of labor forces should be differentiated from discoordinated labor, since their treatment will be different.
Treatment of weakness of labor
The choice of a treatment regimen is based on the reasons, the degree of weakness of labor, the period of labor, an assessment of the condition of the fetus and mother. Sometimes, to stimulate the intensity of the contractions, it is enough to catheterize the bladder. If the weakness of labor is due to the obstetrician-gynecologist during pregnancy, it is necessary to assess risk factors for the development of weakness in labor, and if such factors are identified, preventive medication and psychophysical training is required. Weakness of labor almost always leads to a deterioration of the fetus (hypoxia, acidosis, cerebral edema), therefore, simultaneously with delivery stimulation, prevention of fetal asphyxia is carried out.
The mom-to-be needs to be always on the alert. Even with a favorable pregnancy during childbirth, some abnormalities may appear that will cause an emergency caesarean section. The most common of them is the weakness of labor, and the following signs indicate it:
- Insufficient duration of uterine contractions
- Increasing time periods between contractions
- Violation of their rhythm
- The dilatation of the cervix is less than 1 cm per hour in primiparous and less than 1.5-2 cm in the rest
- Excessive labor: 12 to 18 hours.
This is such a pathology of childbirth, when rare, weak, fading contractions delay or stop the movement of the fetus along the birth canal. The frequency of surgical intervention, injuries to the mother and the fetus increases, and the quantitative probability of bleeding increases.
Types and their features
There are two types of weakness of labor:
- Primary weakness of labor. She makes up about 9% of all births. Already at the beginning of labor, it manifests itself through a sluggish tone of the uterus and ineffective contractions, turning into a weakness of attempts. Natural labor is impossible: the protracted nature of the process (12 or more hours) exhausts the body of the woman in labor, which affects the condition of the fetus. Undesirable early withdrawal of amniotic fluid happens. This increases the risk of transmitting infectious diseases, if any, to the mother's unborn baby. Primary weakness of labor is fraught with oxygen deficiency of the fetus (hypoxia), in some cases fatal for it, as well as bleeding in the third birth period, which is dangerous to the life of the mother.
- Secondary weakness of labor. This phenomenon accounts for about 2% of all genera. Initially, the uterus is in a healthy tone, the contractions themselves are intense, but gradually weaken and do not lead to disclosure of the uterus. Most often, the premises of this form are provoked large fruit and the disproportion of its size and birth canal. Breech presentation also affects the weakening of attempts: the fetus does not "press" enough on the birth canal, so the maternal nervous system is not ready for childbirth. Possible option the reasons for the violation may be obstetric incompetence: incorrect prescription of stimulants can also cause birth weakness. It is necessary to be guided by the appointment rule from the very beginning effective drugs rather than replacing them later. This leads to a lengthening of labor, which is unsafe for the mother and fetus.
Causes of birth weakness
The causes of weak birth forces can be divided into the following groups:
Disorder natural mechanisms responsible for normal childbirth:
- Violation nervous system due to stress, due to which the psychological state of the woman in labor suffers
- Hormonal imbalance, endocrine changes
- Previously observed menstrual irregularities
- Diseases of an autoimmune nature.
Various pathologies of the uterus:
- Pathology of the uterine wall
- Congenital underdevelopment of the uterus
- Chronic inflammatory diseases.
Physiological features:
- Narrow pelvis
- Defective fetal bladder
- Large fruit
- The presence of multiple pregnancies
- High water
- Delayed labor due to post-term pregnancy.
In some cases, insufficient contractile activity is caused by a history of cesarean section or a tumor in the small pelvis.
At-risk groups
For reasons, a risk group can be identified, which includes pregnant women with the following characteristics:
- Women in labor under 18 and over 35
- Women in labor with overstretching of the uterus (large fetus, polyhydramnios or multiple pregnancies)
- Have given birth and are pregnant many times
- Women with multiple abortions with curettage
- Women with severe obesity or wasting.
Diagnostics and management of childbirth
It is possible to diagnose the primary form of weakness of labor after 2 - 3 hours of observation of the woman in labor. It is important to distinguish in time primary weakness from a deviation similar in symptoms - a pathological preliminary period. The main rationale for the diagnosis is the dynamics of contractions and the cervix (it is mature, although it slowly opens up). During a vaginal examination during the period of contraction, the edge of the uterine pharynx remains soft, does not strain. It is easily stretched by the fingers of the obstetrician rather than by force of contraction. It happens that hysterography is used - x-ray fixation of uterine contractions. Fetal heartbeats are necessarily monitored by phonocardiography. The same methods are used to diagnose secondary weakness of labor.
The tactics of labor management are influenced by such factors as:
- The condition of the woman in labor and the fetus itself
- Cervical dilatation level
- Dynamics of fetal movement along the birth canal.
With the integrity of the fetal bladder, it is opened, which helps to normalize childbirth with primary weakness of labor. Now obstetricians give priority to oxytocin and prostaglandins, they are administered intravenously through a drip.
In the secondary form, when the fetal head is facing the entrance to the small pelvis, and there is no fear of hypoxia, sodium oxybutyrate is prescribed to induce obstetric sleep for 2-3 hours. After awakening, rhodostimulating therapy is performed. In the case when the presenting part of the fetus is fixed in the birth canal, stimulation is prescribed immediately, in order to avoid oxygen starvation, as well as the development of fistulas for the mother herself. Sometimes the method of vacuum extraction or the operation of applying obstetric forceps is used, which is possible if there is a doctor who exclusively knows this technique.
Despite lengthy research and searches effective ways treatment of primary weakness, carried out by obstetricians, this pathology is the most common reason, according to which the surgical intervention is carried out. At grave condition an emergency cesarean section is performed for a woman in labor or a fetus.
Prevention of weakness of labor
In modern practice, they came to the conclusion that in most cases, the specifics of the development of generic forces is determined by psychophysical readiness. female body to childbirth, which is formed in the prenatal period. All pregnant women should pay due attention to the prevention of birth weakness. You should start with psychological attitude, schools and courses for expectant mothers help in this.
In addition to psychophysiological training, to minimize the likelihood of this unpleasant phenomenon it is important to follow the daily regimen, diligently take the recommended by the doctor vitamin complexes... Folic acid and vitamin C are essential components from the thirty-sixth week. From the thirty-fourth week, experts recommend moderate physical exercise and having sex.
After the onset of contractions, you can use the wall bars and fitball. Maximum information and concentration of your own efforts will help to form the right approach To birth process and confidence in a favorable outcome.
Weakness in labor is a very common pathology, especially in women giving birth for the first time, which often becomes the reason for the use of serious drugs to stimulate labor and even an emergency caesarean section.
Primary weakness in labor is often the result of many days of preparatory labor, which physically and psychologically exhaust a woman. With such symptoms, it is better to be in the hospital, where they can gently remove unproductive contractions with the help sedatives and antispasmodics. Weakness of labor forces in the future does not cause, does not provoke "fixation" of the cervix, only improves the well-being of the expectant mother. And doctors at this time monitor the child's condition. Other possible reasons weak labor:
- hormonal imbalance (lack of estrogen, prostaglandins, oxytocin and excess progesterone);
- polyhydramnios;
- multiple childbirth, as a result of this hyperextension of the walls of the uterus;
- large fruit;
- excess weight;
- neoplasms of the uterus;
- early discharge of amniotic fluid;
- premature or late birth;
- too early or late age of the woman in labor.
But it so happens that problems arise already during childbirth: secondary weakness can arise during childbirth in impressionable women, even because of one rude word honey. staff. But more often because of fatigue. Indeed, for most primiparous women, the first stage of labor lasts more than 8 hours. That is 8 hours of constant contractions. And the cervix does not open as quickly as we would like.
Obstetricians-gynecologists are well aware of the types of weakness of labor and diagnose without problems if this pathology occurs during childbirth. An examination is usually sufficient to make this diagnosis. The doctor notes a very slow opening of the cervix, the absence of hypertonicity. In addition, contractions are diagnosed using a CTG apparatus. With the help of this device, not only are they looking for symptoms of weakness in labor, but also the fetal heartbeat is monitored so as not to miss the possible onset of hypoxia. A bad symptom is the duration of the first stage of labor in primiparous more than 12 hours and in multiparous more than 10 hours. Timely diagnosis of the weakness of labor allows doctors to take timely measures and normalize the situation so that the child does not suffer and an emergency cesarean section does not have to be performed.
Possible complications of weakness of labor are not only operative delivery, but even fetal death, especially if there is a long, more than 12 hours anhydrous interval. In addition, women with this diagnosis very often have profuse postpartum bleeding, the uterus is poorly reduced and restored to a pre-pregnant state.
Treatment of weakness in labor usually begins with drug sleep, which is administered with the help of narcotic analgesics to the woman in labor. Of course, this is not always possible. Usually only at the beginning of labor, and before the amniotic fluid has departed.
If, after awakening, active contractions did not begin, labor is stimulated with the help of drip injection of prostaglandins E-2 and (or) oxytocin. And only in last resort surgical delivery is performed. Some maternity hospitals continue to practice "squeezing" the fetus, the forbidden Kresteller method, and the application of obstetric forceps. The most gentle methods of accelerating labor, or rather, their second period, expulsion, is episiotomy - an incision of the perineum.
Prevention of weakness of labor activity consists in strict adherence to all medical recommendations. Like limiting weight gain during pregnancy. As well as a positive attitude and, if necessary, taking light herbal sedatives - motherwort and valerian.