birth

Natural birth of an infant

Sound recording of a birth

Birth ( Latin parturition and Greek γονή ) even childbirth (the mother of a child) or ancient birth (the mother with a child), is the process of delivery of the child from the womb at the end of pregnancy . Under physiological conditions, the birth is initiated by the fetus.

Pregnancy lasts an average of 266 days in humans and ends when the fetus , the uterus of the mother leaves. Most children are born within two weeks before or after the calculated date. To the day for calculated date only four percent of children are born.

The following symptoms can herald the birth :

by the onset of opening labor (duration about 30-60 seconds, every 10 minutes)
by a possibly slightly bloody discharge as a result of the loosening mucus plug from the cervix ( drawing bleeding ), sometimes a few days before the birth
the rupture of the membranes (the bursting of the amniotic sac )
Diarrhea or vomiting

If you exceed the so-called calculated date about 14 days or due to medical necessity can be achieved by induction of labor birth beginning to be artificially induced.

Linguistic

The noun birth is derived from the verb give birth , which goes back to the Indo-European root * bher (ə) - "to carry" and with English to bear "(er) carry, bring forth", Latin ferre , Greek φέρειν (pherein) , both with the meaning "carry, bring", is originally related , literally as "carry out, carry to the end". Other German words that belong to this type of word are u. a. Stretcher , to dispense (actually "not to carry"), burden and the suffix -bar , as in fertile "fruiting, bearing."

Especially in legal parlance is often the birth of the question. The disguised expression of childbearing , which simply meant “to go to bed”, can perhaps be followed by the French accoucher (d'un enfant) . Another synonym is childbirth , which initially specifically referred to the untying from the umbilical cord. In general, one says “the mother will be delivered from the child” and not “the child will be delivered from the mother.” The phrase “the mother delivers a child” is also considered untypical or incorrect, at best the intransitive use of deliver in the sense from "Becoming a mother, giving birth", for example: "My wife gives birth at home, not in the clinic."

In medical terminology, too, a distinction is made between birth from the perspective of the mother - the partus - and birth from the perspective of the child - the natus . For example, the mother is examined in the peripartal diagnosis and the child is examined in the perinatal diagnosis.

Birth process

introduction

Child in the birth canal. The vaginal wrinkles ( rugae vaginales ) are compressed by the head in a normal birth position and thus create a certain reserve space.

The trigger for the birth process was unknown for a long time. Research in animal models suggests that surfactant protein A, which is responsible for lung maturation, can trigger contractions through a number of reactions . This protein is produced by the child, which therefore plays a key role in the beginning of the birth. The child who is ready to give birth also ceases to produce the pregnancy hormone HCG , which suppresses the production of the labor hormone oxytocin via hormonal feedback in the mother's brain in order to maintain the pregnancy.

Birth sequences of an anterior occipital position , which are found in 92–93% of all cases of full term pregnancies.

The duration of the birth is very different. An average of 13 hours is calculated for first-time mothers ( Latin primiparae ) and 8 hours for women who have already given birth. However, the times that are considered normal for a birth have been halved within the last 50 years. The birth process is documented in a partogram .

Subjectively, women often tell of a longer birth time. This results from the fact that they define the moment they begin labor or the moment they enter the hospital as the start of labor. For the obstetrician or midwife , however, childbirth only begins when the contractions contribute to the shortening of the cervix and the opening of the cervix (so-called portio-effective contractions). The chronobiology observed that the distribution of births throughout the day at about three o'clock in the morning reached a high point.

Opening phase

The normal birth (also spontaneous birth) of humans begins with the opening phase , the first stage of birth. It usually begins with irregular contractions with a frequency of 2–3 contractions in 30 minutes. The aim of opening labor is to shorten the cervix uteri (cervix) and widen the cervix . During the opening phase, the frequency of labor usually increases slowly to 2-3 contractions in 10 minutes. The rhythm also usually becomes more regular. The duration of labor in the opening phase averages 60 seconds. However, giving birth is a very individual process, which is why contractions can be very different in terms of distance, duration and intensity and thus the duration of the birth. Opening the amniotic sac sometimes makes labor worse.

During a contraction or contraction , the uterine wall pulls back upwards over the previous part of the child, i.e. usually the head. This process is called retraction . As a result of the retraction, the lower part of the uterus is stretched. The child is pressed by the uterus in the direction of the pelvic outlet, at the same time the lower part of the uterus with the cervix is withdrawn over the leading part of the child. This is known as distraction. As a result, the cervix opens. The opening of the cervix also depends on other factors, mainly psychological and hormonal. If the woman giving birth is relaxed and feeling well, the opening of the cervix is made easier and usually takes place faster than if she is tense. Visualizations and certain breathing techniques can contribute to relaxation and easier opening of the cervix.

Transition phase

The last third of the opening phase is also called the transition phase. In it, the frequency of labor often increases, the contractions usually become stronger and the pain more intense. The child's head passes through the mother's pelvis. To do this, the child must make a 90-degree turn: First, the child lying in the skull position "looks" at the mother's right or left hip in order to be able to enter the transverse oval pelvic entrance. During the transition phase, if the birth proceeds properly, it turns face back, towards the tailbone.

Expulsion phase

See also birth mechanics

When the cervix is almost or completely opened (8-10 cm), the expulsion phase begins, the third stage of labor. In it the character of the contractions changes again. There is an average rate of 6–7 contractions in 15 minutes. When the child's head goes deep into the pelvis, it presses on the maternal bowel . The consequence of this is that the woman giving birth is reflexively triggered to press. The woman then inevitably has the need to have to press along and thus supports the uterine forces with her abdominal muscles . However, this urge to press can be weakened or even completely suppressed with epidural anesthesia.

The child's head is bowed during normal birth. As the head overcomes the pelvic floor and emerges, it goes into hyperextension. Once the head is born, there is usually a pause in labor and with the next labor the child turns 90 ° again, so then looks to the right or left again so that the shoulders can exit the longitudinally oval pelvic outlet. Once the shoulders are born, the rest of the child's body follows immediately.

The membranes surrounding the child are called the amniotic sac . This can jump either before the start of labor or at any stage of labor. Very rarely does the amniotic sac remain intact during the birth of the child's head. One then speaks of a " lucky hood ".

Postpartum phase

Mother with newborn daughter

The final stage of labor is the placental phase (afterbirth phase) with expulsion of the afterbirth. The duration of this phase of childbirth can vary widely, with natural birth accompaniment it is a few minutes to an hour or longer, while with active medical birth accompaniment it should not exceed 30 minutes. This phase of labor ends with the birth of the mother cake and the amniotic sac ( afterbirth ). This is checked for completeness by a midwife or doctor. If the placenta does not dissolve or only partially or if parts of it remain in the uterus ( placenta accreta ), manual removal of the placenta or scraping is necessary to prevent infections and tissue growth.

After the birth, the healthy newborn baby can be placed on her breast or stomach by the obstetrician or the mother herself and covered warm to enable bonding and initial breastfeeding or to facilitate the birth of the placenta. If the mother does not want to breastfeed , the child can first be handed over to the father during this time in order to confirm or strengthen his bond with mother and child.

Up until a few years ago, the umbilical cord was cut immediately after delivery. Nowadays obstetricians often wait for the umbilical cord to stop pulsing. However, some obstetricians do not cut the umbilical cord until the placenta is born.

Following delivery, the condition of the newborn is clinically assessed after one, five and ten minutes and the Apgar score is determined.

Medical interventions

A perineal incision can be useful during the expulsion phase . A preventive perineal incision (precautionary perineal incision without a compelling reason) is performed less often today than it was a few years ago. Usually such a perineal incision was justified by the fact that it could protect the pelvic floor from worse injuries. However, this has been refuted. However, a perineal incision is now performed when the child is not feeling well during the birth, as it can shorten the expulsion phase by valuable minutes. Before a perineal incision, the doctor can give an imperceptible injection into the perineum during a compression contraction to provide local pain relief.

If the mother is weak in contractions or exhausted during the expulsion phase, the " Kristeller handle " is sometimes used to press the upper edge of the uterus vigorously from outside during the contraction. However, this procedure is controversial because it involves a certain risk of injury to the mother's internal organs and the risk of premature placental detachment, especially if it is used incorrectly. Uterine ruptures can also occur during "Kristellern". In order to intensify a too weak labor activity, the labor hormone oxytocin can be given intravenously , the so-called "contraction drip". Such measures are only used if the heart rate of the unborn child becomes too slow, as they can later have side effects (see also labor induction ).

Further aids for faster vaginal labor are the suction cup and forceps , their use is called vaginal-operative delivery. Here, too, a worrying child's condition is primarily an indication. Furthermore, the inability to press of the laboring women of various origins (exhaustion, epidural anesthesia) are reasons for completing the birth with artificial assistance.

Medical aspects

Basics

The medical discipline that deals with childbirth is obstetrics . A midwife is specially trained to provide obstetrics. According to German and Austrian law, she is the only one who is allowed to lead a birth alone. Except in emergencies, a doctor in Germany always has the duty to call a midwife.

Different birth positions are possible at birth . In an upright position (e.g. four-footed position, squatting, kneeling, knee-elbow position, standing) or lying down (lying on your back or on your side) or sitting. The water birth should also be mentioned.

In the past, a large number of women died during childbirth, mostly due to excessive blood loss or in the puerperium , often due to wound infections as a result of poor hygiene (see child bed fever ) and poor nutrition. Even today, half a million women in developing countries die annually during pregnancy or in connection with childbirth. The largest group, about 25 percent, in postpartum blood loss; Infections, birth complications, gestoses are further causes. The maternal mortality in developing countries reaches the 1 percent threshold, the infant mortality rate - the birth - often higher than 5 percent. In addition, the nearest hospitals that offer help such as hemostatic medication or a caesarean section are often very far away or the medical intervention is priceless for those affected.

In industrialized countries, maternal and infant mortality is low. The main causes of maternal mortality are peripartum bleeding due to uterine atony , HELLP syndrome and amniotic fluid embolism .

In the first six weeks after birth, the mother is at increased risk of a thrombotic event, especially if other risk factors such as previous thrombosis, primary hypercoagulability, or smoking are present . In a retrospective crossover cohort study in California of over 1.6 million primiparous women of all races, there were 22.1 more thrombotic events per 100,000 women in the first six weeks compared to the six weeks the following year, and in weeks 7–12 3.0 more thrombotic events. The odds ratio in the first six weeks was 8.5 for a stroke , 13.0 for a heart attack and 12.1 for a deep vein thrombosis.

Birth pains

A human birth can be far more painful than in the animal kingdom, also compared to the apes that are close to humans. The reasons for this are two human peculiarities: the large head circumference, due to the relatively large brain , and the upright gait . The small pelvis , or more precisely the pelvic floor , must therefore fulfill two contradicting tasks: on the one hand, it must be tight enough to keep the bowels from falling out (see also uterine prolapse ), on the other hand, it must be so flexible that it can be a child with a head diameter of approx. 10 cm can slide through. Since the birth canal and pelvic floor have to be stretched a lot for this, there is a misconception that the stretching would cause pain. However, in a normal natural birth, pain only occurs during labor. In the pauses between labor, the woman is not in pain, she can consciously enjoy these pauses and use them to relax. Pain before and during childbirth can be reduced using intravenously administered painkillers, epidural anesthesia (PDA), or various relaxation techniques. Even homeopathic means and acupuncture are used. The feeling of pain during childbirth also depends largely on the release of certain hormones. If the woman giving birth is relaxed and feels safe and secure, serotonin and more oxytocin are released in her body . The serotonin decreases the sensation of pain, whereas the oxytocin increases the contractions. If the woman does not feel well, if she is afraid and tense, the stress hormone adrenaline in particular is released as a result , which inhibits labor and increases the sensation of pain. In birth preparation courses , expectant mothers can learn and practice the relaxation techniques etc. necessary for the most "pleasant" natural birth possible.

Natural birth according to Dick-Read

According to Dick-Read's teaching, fear and ignorance are the worst enemies of natural childbirth. That is why the woman should not stumble into something unknown to her as a passive victim. She must be drawn to active participation in all phases of birth. In his view, childbirth is not pain but work. The women should know their job. They learned to understand and use nature's intentions instead of resisting. In a normal birth it is not the pain in labor that influences the state of mind of the woman, but, conversely, the state of mind affects the pain. Women should understand childbirth as their personal achievement. His claim: there is no pain in childbirth, or rather, there shouldn't be. He replaced the term labor pain with muscle feeling .

Dick-Read developed the system of prenatal psycho prophylaxis, later named after him by Read's method . Psychological and physical influences on the expectant mother reduce the pain in childbirth. Influencing could take place through systematic gymnastic relaxation and loosening exercises, education and instruction about the birth process and by eliminating the fear of childbirth that leads to cramps and pain ( birth preparation ).

According to Dick-Read's theory, much of the fear and pain arises from pre-birth expectations. He called this phenomenon fear-tension-pain syndrome . Dick-Read did not reject pain medication as a matter of principle, as fears cannot always be relieved. Dick-Read also considered the father's role in childbirth for the first time.

Different perspectives on childbirth

Natural birth

Home birth

The birth is a very emotional experience for the pregnant woman and possibly other parties involved (mostly the father). It is sometimes associated with great pain, but also with great joy. As a rule, childbirth is perceived more positively, the more familiar or pleasant the environment is to the woman giving birth.

In European culture, births currently take place in a hospital on the gynecological ward in the delivery room under the direction of a midwife and a doctor, and occasionally in a delivery room that is only managed by midwives.

There are also birth centers run by midwives and home births . In 2008, around 2 percent of births in Austria, Germany and Switzerland were home births, in the Netherlands over 30 percent. Very rare individual cases of home birth are completely without prior medical assistance, a so-called in the United States unassisted childbirth (German about: alone birth ). Water births are particularly gentle because the mother can relax better in the warm water. Damage to the perineum is less common in water births and bleeding after birth is less on average, and the warmth of the water also stimulates labor.

The general approach and atmosphere during childbirth is very different depending on the location, environment and requirements. The most important goal is to maintain health and to recognize deviations from normality during childbirth. How this can be achieved, however, is controversial. There are two basic points of view that must always be combined:

On the one hand, childbirth is seen as a medical event that involves a number of risks. One goal is therefore to protect the child and mother from as many risks as possible and, above all, from permanent damage through timely intervention at birth.

On the other hand, childbirth is seen as a natural physical process that in most cases takes place without complications. Therefore, medical interventions such as narcotics or perineal cuts are rarely required.

How the birth is viewed and how it takes place in individual cases varies. Significant differences can be observed depending on the maternity hospital, the treating doctors and the midwives. Responsible midwives carefully examine whether a birth at home or in the birthing center seems acceptable. Otherwise, they advise giving birth in a clinic.

Benefits of vaginal birth

Similar to natural breastfeeding , natural childbirth offers numerous benefits. The microflora also affects the child's body odor.

A detailed comparison of arguments can be found in the requested caesarean section

The socio-cultural birth in sociology

In sociology , René König and Dieter Claessens speak of the “second, sociocultural birth” of humans, also referred to as the transition from “humanization” to “ socialization ”.

During humanization, the newborn is dependent on the anthropological (also: biosociological ) and socially influenced dyad between the infant and the “permanent carer” for about a year in order to gain the special “ basic trust ” with which it can later learn socially (socialization becomes capable). In zoology , humanization is called the “extra-uterine spring” (Portmann; uterus (Latin) = the uterus ).

Legal aspects of childbirth

In Germany

The onset of labor pains is considered in criminal law as a "turning point for the beginning of human life". The beginning of the legal capacity ( § 1 BGB) of the person is connected with the completion of the birth . The birth is considered complete when the child leaves the womb completely without the umbilical cord being severed. The parents' legal responsibility also begins in the context of custody . In the first week after the birth, the data for the creation of the birth certificate are sent to the local registry office .

In Austria

In Austria, the legal capacity of the newborn essentially begins with the beginning of the opening labor. At this point in time, the legal consequences that apply to the killing of the womb also change, from termination of pregnancy (Section 96 StGB ) to murder ( Section 75 ), manslaughter ( Section 76 ), killing of a child at birth (Section 79 StGB) or negligent homicide (Section 80 StGB). If a potential testator dies after conception, but before the birth of the child, the “nasciturus” (child-bearer) is to be accepted as already born and a corresponding portion of the inheritance is to be reserved. If the result is a stillbirth, this portion of the inheritance is divided among the living heirs as if the pregnancy had not occurred (nullity ex tunc).

Special birth terms

Premature birth - birth of a child before the 37th week of pregnancy
a prolonged pregnancy beyond the completed 42nd week of pregnancy (42 weeks + 0 days) is referred to as transference .
rushed birth - an unusually rapid birth.
Miscarriage is the term given to giving birth to a fetus of less than 500 g if it dies before or during birth; the birth of a dead fetus with a birth weight over 500 g is called stillbirth
High-risk birth - birth with increased risk to the child or mother
vaginal birth: birth through the female birth canal
Caesarean section or caesarean delivery, commonly known as cesarean

Statistical data

Birth rate (birth rate) - live births per year based on 1000 inhabitants
Infant mortality - percentage of children who die in the first year of life

Deliveries in German hospitals
year	given birth Women	of which by caesarean section	Share (in percent)
1991	822.842	126.297	15.3
1992	797.784	128.991	16.2
1993	785.183	132,334	16.9
1994	757.693	131,351	17.3
1995	749.086	131,921	17.6
1996	778,900	140.184	18.0
1997	795.724	147.314	18.5
1998	766.508	149,723	19.5
1999	750.617	152.612	20.3
2000	746.625	160.183	21.5
2001	715.136	161,548	22.6
2002	698.410	170.249	24.4
2003	687.508	175.341	25.5
2004	682.767	183.122	26.8
2005	664,597	183,346	27.6
2006	652,642	186,889	28.6
2007	664.454	194,526	29.3
2008	662.783	200,452	30.2
2009	644.274	201,480	31.3
2010	656.390	209,441	31.9
2011	642.791	206.791	32.2
2012	653.215	208.254	31.9
2013	661.138	210,570	31.8
2014	692.794	220,540	31.8

Source: Federal Statistical Office

In 2013, 682,069 children were born alive in Germany. Of these, 49.8 percent of the children were first-born in the mother's life, 33.7 percent were second-born, 11.3 percent third-born and 5.2 percent were the fourth or subsequent child. The mean ( median ) between the first and second child was 3.3 years, and between the second and third child 3.9 years. In 2012 there were 673,544 children, in 2009 665,126. The reason for this increase is particularly a positive development among second-giving mothers.

The average age of first-time mothers in Germany in 2013 was 29.8 years. The total fertility rate was 1.41 children per woman.

In 2003 there were 589 hospitals in Germany with an obstetric department, in 2013 a total of 430. In clinical births in Germany, the average length of stay in 2003 was 5.2 days, in 2012 it was 4.1 days. An outpatient hospital birth (with a maximum of one day's stay) is reimbursed by the statutory health insurance companies in Germany with an average of 922 euros . In Germany, the flat-rate catalog of health insurances for vaginal births without complications provides a national average of 1700 euros, for a primary caesarean section (without complications) 2600 euros. A midwife was present in 99.2 percent of hospital births in Germany in 2013.

Movie

Birth , documentary by Silvia Haselbeck and Erich Langjahr (Switzerland, 2009)

literature

Guidelines

S1 guideline for the prevention of infections during childbirth . In: AWMF online (as of 2012)
S1 guideline for vaginal-operative deliveries of the German Society for Gynecology and Obstetrics (DGGG). In: AWMF online (as of 2007)

Web links

Commons : Birth - collection of pictures, videos and audio files

Wiktionary: Birth - explanations of meanings, word origins, synonyms, translations

Wikiquote: Birth - Quotes

Wikisource: Birth - Sources and Full Texts

Birth - information at Gesundheitsinformation.de (online offer of the Institute for Quality and Efficiency in Health Care )
WHO: Care in Normal Birth - a practical guide
WHO: Birth Complications

Individual evidence

↑ give birth. In: Digital dictionary of the German language .

↑ give birth. In: Digital dictionary of the German language .

↑ Jennifer C. Condon, Pancharatnam Jeyasuria, Julie M. Faust, Carole R. Mendelson: Surfactant protein secreted by the maturing mouse fetal lung acts as a hormone that signals the initiation of parturition . In: Proceedings of the National Academy of Sciences of the United States of America . tape 101 , no. April 14 , 2004, p. 4978-4983 , doi : 10.1073 / pnas.0401124101 , PMID 15044702 , PMC 387359 (free full text).

↑ § 4 HebG

↑ Unicef: Maternal Mortality ( Memento from June 18, 2010 in the Internet Archive ).

↑ Hooman Kamel, Babak B. Navi, Nandita Sriram, Dominic A. Hovsepian, Richard B. Devereux, Mitchell SV Elkind: Risk of a Thrombotic Event after the 6-Week Postpartum Period. In: New England Journal of Medicine . 2014, Volume 370, Edition 14 of April 3, 2014, pp. 1307-1315, doi: 10.1056 / NEJMoa1311485 .

^ Jürgen Brater: Lexicon of mysterious body processes. 8th edition, Piper, 2008, ISBN 3-492-23940-4 .

↑ Birth work: Midwifery knowledge to support physiological birth , Georg Thieme Verlag, 2010, ISBN 978-3-8304-5399-4 . P. 16 .

^ G. Dick-Read: Becoming a mother without pain. The natural birth. 12th edition, Hoffmann & Campe, Hamburg 1963.

↑ A. Stiefel, C. Geist, U. Harder: Midwifery. Textbook for pregnancy, childbirth, postpartum and work. 5th edition, Hippokrates Verlag, Stuttgart 2013, ISBN 978-3-8304-5493-9 .

^ Birth in Nature: Natural Birth. January 10, 2013, www.earthbirthmethod.com youtube.com

↑ The birth method shapes bacterial flora. Science.ORF.at , accessed on July 10, 2010 . The fragrance of birth. Research News - Deutschlandfunk , accessed on July 10, 2010 .

↑ BGHSt 32, 194

↑ Palandt . 64th edition § 1.

↑ ^a ^b ^c ^d Federal Statistical Office (ed.): 682,000 children were born in 2013 . Press release No. 434/14 dated December 8, 2014.

↑ German Bundestag (ed.): Answer of the federal government to the small question of the MPs Nicole Maisch, Kordula Schulz-Asche, Harald Ebner, other MPs and the parliamentary group BÜNDNIS 90 / DIE GRÜNEN - Printed matter 18/2555 - 20 years of the National Breastfeeding Commission - status promoting breastfeeding . tape 18 , no. 2706 , October 2, 2014, ISSN 0722-8333 , p. 11 ( dip21.bundestag.de [PDF]).

↑ German Bundestag (Ed.): Answer of the Federal Government to the minor question from the MPs Cornelia Möhring, Birgit Wöllert, Sabine Zimmermann (Zwickau), other MPs and the DIE LINKE parliamentary group. - Printed matter 18/738 - Economic situation of midwives and obstetricians . No. 18/900 , March 21, 2014, ISSN 0722-8333 , p. 3, 9 ( dipbt.bundestag.de [PDF]).

↑ German Bundestag (ed.): Answer of the federal government to the small question of the MPs Birgit Wöllert, Sabine Zimmermann (Zwickau), Katja Kipping, other MPs and the parliamentary group DIE LINKE. - Printed matter 18/2249 - Development of the Caesarean section rate . tape 18 , no. 2365 , August 18, 2014, ISSN 0722-8333 , p. 7, 11 ( dip21.bundestag.de [PDF]).

↑ langjahr-film.ch

[1] give birth. In: Digital dictionary of the German language .

[2] ve birth. In: Digital dictionary of the German language .