Release of work

The release of work is the whole of the methods making it possible to lead to the Naissance of the Enfant without awaiting the startup spontaneous of the Accouchement.

the release of work is sometimes necessary because a disease or a pathology during the Grossesse risk to cause serious consequences for the mother or the Fœtus in the event of prolongation of the pregnancy
It is sometimes required by the woman for strictly personal reasons not having any relationship with a medical problem, for example husband present only such day.

Definition

Medical intervention aiming at inducing work before nature did not do it spontaneously. One distinguishes:

the release of suitability or childbirth programmed carried out always in the long term
the release of medical indication carried out sometimes before the term

Release of medical indication

Indications

The principal medical indications of release are:

a going beyond of term (with or without suspicion of Postmaturité) beyond 41 weeks + 6 days.
premature rupture of the Pocket of water which involves a infectious risk. The time of expectancy varies, according to the obstétricales teams, typically from 24 to 96 hours.
a Diabetes gestationnel badly balanced
a twin Pregnancy
a stop of growth of the Fetus (which one should not confuse with an intra-uterine delay of growth )
the arterial Hypertension with functional signs, or Pre-eclampsia.

Interests

Interruption of a potentially dangerous pregnancy for the mère/l' child
From where reduction of morbidity/materno-fetal mortality (releases of medical indication)

Disadvantages

longer Work and more painful
Increase in the rate of Cesarean and instrumental extractions

Conditions

Absence of counter-indications, satisfactory confrontation foetopelvienne
well evaluated fetal Maturity. The dating of the pregnancy must be certain
fetal Surveillance during release
complete biological Bilan

Programmed childbirth

To follow this bond for a talk of the motivations.

Some observations

the rate of releases (others that for the premature ones) doubled in less than 20 years in France: from 10,3% in 1981 to 20,3% in 1998, according to the perinatal national survey of 1998, to decrease in a nonsignificant way in 2003 (19,3%).
a significant proportion of these releases (very variable from one maternity to another) are practiced without any medical indication:

“release of suitability” defined like a childbirth of principle, programmed, on go: the release of suitability indicates any release of work, in the long term, whereas there do not exist maternal pathologies nor fetal justifying it, i.e. without medical indication.
In the study of Goffinet and colleagues realized near 38 maternities, bearing on 1192 consecutive cases of release, the total rate of release for nonmedical indication was of 24,8% (n=295). The primary reasons of release were the request of the patient (85,3%), the distance of the residence (8,5%), the organization of maternity (2,0%), other reasons (4,2%).

Variability of the rates

For a rate of release ranging between 10 and 20% in the maternity of exercise, the rate of release of suitability is approximately 20%; for a rate of release higher than 30%, the rate of release of suitability is approximately 50%.
maternities of level 1 and the 2 which do not have permanently all means as a personnel and technical equipment seem more to anticipate the risks related to the childbirth what would result in more started childbirth. Contrary, insofar as maternities of level 3 are equipped as a personnel and into average techniques they seem to have less recourse to the techniques of childbirth programmed by release.

Research on the Physiologie of the Parturition provides other reasons to wait of the term of the Grossesse and thus not to carry out releases in the absence of medical reason. Researchers of INSERM indeed showed that the mother informs and prepares the Fœtus with the Accouchement thanks to the Ocytocine, Hormone responsible for which has occurred for the contractions. Under the action of this Hormone, the fetal Neurons are anaesthetized and thus ready to face the traumatism or the lack of Oxygène inherent in the birth. These results also have implications on the prevention of the premature births. The substances usually managed to counter the action of the Ocytocine could indeed prevent the fetal Neurons from being protected in the event of complications.

Technique

There exist several means of starting work. The method used depends on the Score of Bishop of the woman.

The Oxytocin

The oxytocin perfusion can be used only if the local conditions are favorable (score of high Bishop). This method requires an heightened surveillance of the fetus by monitoring.

The Prostaglandins

The prostaglandins are used when the local conditions are unfavourable. The prostaglandins are presented in the form of freezing which one puts at the bottom of the vagina.

The misoprostol (Cytotec®)

The cytotec is toxic for the fetus, it is thus taken only in the event of termination of pregnancy.

These are tablets that one can:

to take by ways oral examination
to introduce possible further into the vagina.

It is caught 3 has 4:00 before the intervention.

The possible side effects are:

abdominal Cramps,
vaginal Bleedings,
Nauseas,
Diarrhea,
Irritation of the mouth

The intracervical small baloon

August 1st

Internal bonds

External bonds

Blandine Poitel. Programming of the childbirth: Sirens of the any power. Files of Obstetrics, 2003; 316/317/318. (Document pdf)

http://naissance.ws/docs/programmationBP.pdf

Turned Claude-Emile. Release. (Document pdf)

http://www.quellenaissancedemain.info/images/stories/declenchement/declenchement1.pdf

Workshop “Release” with the General states of the birth 2006

http://www.quellenaissancedemain.info/archives/enregistrements/atelier_11.html

Bibliography on release (AFAR)

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