afterbirth
In humans and most other mammals, the afterbirth is the placenta ( placenta ( placenta ) that is still to be born after the actual birth of a young animal or child , the membranes and the remains of the umbilical cord . The process of rejection as such is also called the afterbirth. It takes place in the early puerperium .
Afterbirth in humans
After the birth , the afterbirth must be checked for completeness by a midwife or doctor. In special cases, scraping is necessary to prevent complications.
Possible complications from residual placenta include inflammation of the uterus ( endometritis ) and puerperal fever . Sonography can generally be used to determine whether there is any residual tissue in the uterus after birth ; In particular, the Doppler method can be used to determine very easily whether there is still placental tissue in it that is supplied with blood.
The period from the birth of the child to approx. 2 hours after expulsion of the placenta is called the postpartum period or placental period. Their duration is usually 10 to 20 minutes. The womb ( uterus ) is determined by the release of prostaglandins contracted. This causes a detachment of the placenta through the shrinking adhesive surface. Often the placenta dissolves first centrally, less often the solution starts at its edge. If the detachment time exceeds 30 minutes or if there is significant blood loss, manual or instrumental help is provided (see postnatal procedures ).
The postpartum hemorrhage is the 250-500 ml of blood that is physiologically lost in the postpartum period. Any excess blood loss is referred to as postoperative bleeding . To prevent greater blood loss, a bolus of 3 IU oxytocin can be administered intravenously after the cord has been removed . Oxytocin causes a strong uterine contraction and thus promotes hemostasis.
The puerperium begins with the birth of the full placenta, and the resulting hormonal changes set in motion milk production .
Afterbirth handles
The following steps are used to manually loosen the placenta:
- Baer handle (most common method):
- Use if there are two positive signs. The contraction is rubbed by massaging the uterus. The midwife or doctor then gathers the abdominal wall of the woman giving birth and pushes the placenta downward during the contraction. The woman giving birth can help to make the process easier.
- Credé handle : From the outside, the uterus is gripped with the hand in such a way that four fingers slide behind the uterus while the thumb comes to rest on the front. Now, with the next contraction the placenta replaced by pressure.
- Cord traction (detachment by pulling on the umbilical cord):
- Indication: rapid release of the placenta is required, for example if there is an increased tendency to bleed or if the woman is anemia
- Procedure: At the same time as a contraction, an attempt is made to detach the placenta by applying pressure to the abdominal wall and pulling on the umbilical cord.
- Risks: incomplete collection of the placenta, especially if the contraction is insufficient
Basically, a wait-and-see approach is advisable in the postpartum phase. Every intervention requires an indication. The diagnosis of most of the signs of the problem and the early removal of the cord are measures that violate the principle of manipulating the uterus as little as possible. Cord traction is not possible without cutting the cord. “Rubbing” a contraction is harmful, as it may provoke partial contraction, partial detachment of the placenta and thus increased bleeding. If controlled cord traction is used at all, the abdominal wall hand should hold back and up above the symphysis to prevent uterine inversion (turning the uterus outwards).
Placental detachment signs
The following signs allow conclusions to be drawn as to whether the placenta is already beginning to loosen postpartum (after birth):
- Küstner sign (also umbilical cord sign):
- Push behind the symphysis with your hand . If the placenta has not yet loosened, one can observe that the umbilical cord withdraws back into the uterus.
- Schröder symbol ("figure eight" / "hourglass" shape of the uterus):
- If the placenta is loosened, the base of the uterus ( fundus uteri ) rises above the navel, becomes narrow and hard and is often distorted to the right, sometimes to the left. The result is an often easily palpable, hourglass-shaped uterus.
- Ahlfeld symbol type II:
- A marking (a clamp or a ribbon) is attached directly to the vulva in order to be able to precisely follow the advancement when the mother cake is detached. Above a distance (vulva marking) of about ten centimeters one speaks of a placenta detachment.
- Straßmann sign (rather uncertain):
- The umbilical cord must be kept taut. If the placenta is detached, vibrations that are generated by careful tapping on the uterus are not transferred to the umbilical cord (the umbilical cord does not vibrate).
- Anal burden:
- When the placenta is loosened, the woman giving birth often indicates renewed pressure on the intestine. This is due to the fact that the detached placenta has slipped out of the uterus into the vaginal vault.
Use of the afterbirth
In the past, cosmetic preparations were made from the placenta.
During the lotus birth , the placenta and umbilical cord remain attached to the baby until the umbilical cord has dried and falls off by itself. The placenta is treated with salt and herbs.
Some people bury the afterbirth in the ground, usually under a tree or in a pot ( afterbirth burial ). This custom was and is widespread in various regions of the world.
Placentophagy , eating the placenta, is controversial in terms of benefits and risks and has not yet been researched.
Afterbirth in animals
As with humans, most mammals also reject the placenta and amniotic sac after the actual birth of one or more young animals . The afterbirth can be delayed up to a few days after the birth, depending on the species, but it is often born immediately and eaten together with the umbilical cord by the mother, even in animals that normally only feed on plants. The mother animal benefits from the high protein content of the placenta. Placentas that are not consumed by the mother can also later be eaten by the fox or scavengers .
In the case of pets, as in humans, attention must be paid to possible complications ( postpartum retention ) in connection with the afterbirth, such as deer in horses . The transmission of various diseases through an infectious afterbirth is also possible.
Individual evidence
- ↑ Maternal and Newborn Health / Save Motherhood Unit, Family and Reproductive Health, WHO, 1211 Geneva 27, Switzerland and German Midwives Association (DHV) "Birth work", Hippokrates 2010
- ↑ Placenta - Customs around the mother cake , hebammenblog.de, April 6, 2017
- ↑ Charles Poladian: Umbilical Cord trend: Lotus Birth Practices Keeping placenta On Baby, 'Umbilical Nonseverance' , International Business Times , April 12, 2013
- ↑ Madeline Scinto: Lotus Birth, craziest trend yet - Don't cut that umbilical cord! , New York Post , April 10, 2013
- ↑ Désirée Dal Pian: Lotus Birth . Frauenheilkunde aktuell (Switzerland) 2007, edition 2 of February 2007, pages 35–36, lotus birth: case report as PDF , accessed on December 27, 2018
- ↑ Nachgeburtsbestattungen: "Where neither sun nor moon Hinsch one" - an almost forgotten tradition , museum in stone Hauss , accessed on 30 December 2018
- ↑ Udo Pollmer: Nutritional ethics: Placenta - too good for the garbage? , Deutschlandfunk Kultur , June 17, 2017
- ↑ Eating the Placenta - A New Trend? , faz.net, July 15, 2015
