Pregnancy

Differences and characteristics of eutocic and dystocic delivery

Eutocic birth is a natural birth, while dystocic birth involves the use of some tools that facilitate birth.

It is easy to say childbirth: there are many possible types, ranging from the most common terminologies (natural, cesarean, induced) to the most complicated ones, which are difficult for non-experts to know but which sometimes the future mother has to face. When we talk about natural childbirth, however, the biggest difference is one: there is eutocico childbirth and there is dystocic childbirth.

What does eutocic childbirth mean? It means that the baby is expelled through the vaginal canal without the use of instruments such as the suction cup or the forceps and without the mother being induced into labor; on the contrary, during a dystocic delivery, instruments are used that can speed up and/or facilitate expulsion (evaluating dystocia on a case by case basis, which could sometimes require surgery). But let’s see together in detail how these two types of births take place.

The four phases of eutocic delivery

Eutocic birth is the most natural birth that a mother can have, since the baby comes to life spontaneously, without obstetricians and gynaecologists having to resort to the use of instruments and without the administration of oxytocin to induce labor. And this is a birth that takes place in four phases, as explained by the experts of the Angelini group.

The first phase, called prodromal or preparatory, sees the uterus contract initially in an irregular manner and then the occurrence of increasingly regular contractions as the hours pass. When the contractions are preparatory, we speak of “Braxton Hicks contractions”: the woman feels pain in the suprapubic area, with the intensity, duration and frequency of movements that vary from case to case. It is during the prodromal phase that the expulsion of the mucous plug can occur and that labor begins: however, when you are in the presence of contractions of Braxton Hicks (which can last up to 5 or 6 hours) is not necessary, unless otherwise directed by the doctor, go immediately to the hospital.

The second phase of eutocic delivery is the dilating phase, and it is the phase in which the actual labour begins: the contractions are regular (they occur every 3-4 minutes) and stronger, they last about 30-40 seconds and it is therefore time to go to the hospital. In fact, doctors suggest to start already when the contractions occur at a distance of five minutes from each other and last at least thirty seconds.

The third phase is the expulsive phase, which begins when the dilation of the uterine cervix is complete. It is during this phase that all those rotations and all those movements that the baby must make to come to light occur and – during an eutocic birth – everything happens with great naturalness, in a time between 20-30 minutes and an hour and without the help of forceps, suction cups or other instruments.

Finally, the fourth phase, known as the second phase: after the expulsion of the baby from the mother’s uterus, the placenta is expelled. If the mother has not expelled the placenta within an hour of the birth, the gynaecologist will surgically remove the placenta and sedate the patient under general anaesthesia.

Eutocic delivery with episiotomy

When natural childbirth becomes complicated, and the baby cannot get out, it is possible that the mother is made an incision of the perineum: in this case we speak of eutocico childbirth with episiotomy. To help expel the fetus, the gynaecologist makes a small incision in the vaginal wall and on the muscles of the perineum, when the child’s head appears (and therefore immediately before the expulsive phase).

Why do you opt for episiotomy? This is explained by Dr. Alessandro Bulfoni of the Humanitas Medical Centre. In general, the reason is that the head of the unborn child is too big, and it is necessary to speed up the exit of the child to prevent it from suffering excessively. If the mother has given birth under the epidural, the cut is stitched immediately; if not, the doctor will ask for local anesthesia before putting the stitches on the perineum cut. Among the most unpleasant consequences of an episiotomy are slow healing and the possibility of suffering from urinary or faecal incontinence: this is why we tend to use it only when absolutely necessary.

During the first week after an eutocic birth with episiotomy, the mother may suffer from pain due to the wound: her recovery could be quite long and annoying, especially when the woman is sitting. To alleviate the discomfort you can use a “donut” so as not to sit directly on the scar, while it is essential to carefully dry the points after the shower or bath.

Diastolic delivery: what it is and when it is used

Dystocic delivery, on the other hand, is a delivery that does not occur naturally and which, on the contrary, to be carried out requires manual maneuvers to reposition the fetus or the use of instruments such as forceps or suction cups: in this case, we speak of an operational delivery. When surgery is necessary, however, it is referred to as caesarean section.

The need to have a delivery that is not eutocico and spontaneous is ascertained by an objective examination, ultrasound and/or excessive duration of labor. In general, it is in fact the fetal dystocia, described here by Dr. Julie S. Moldenhauer, that causes it: the child is too big compared to the pelvic size, or it is positioned in an abnormal way.

In the first case, that of the fetal-pelvic disproportion, delivery can occur naturally if the increase in the duration of labor restores a normal progression and the weight of the fetus is less than 5 kg in women without diabetes or 4.5 kg in women with diabetes; if the progression is slower than expected, it is considered whether to give an operational delivery by forceps or suction or whether it is necessary to resort to caesarean.

The case in which the fetus is abnormally positioned is different. If you have taken an occipito-posterior position (when the occiput and therefore the posterior fontanelle of the child is turned backwards, towards the spine of the mother), it is necessary to intervene with forceps or suckers or with a caesarean section, because its neck is generally a little ‘flexed; if it has taken the “position of the chin” (presentation of face or front) the rotation of the head is more difficult because the chin is posterior, and in all likelihood the doctor will opt for a caesarean section.

Finally, there is the breech position which can be of three different types: frank (the fetus’ hips are flexible and the knees are extended), complete (the fetus seems to be sitting with bent thighs and knees) or single or double foot (one or both legs are completely extended and present before the buttocks). In all cases, the risk of a vaginal birth is that the child’s head remains stuck. Not only that: the breech position can compress the umbilical cord causing fetal hypoxia, and it is therefore essential that this condition is detected before the birth to go to plan a cesarean section (usually around 39 weeks).

Dystocia, therefore, can be maternal or fetal. For example, there may be a cervical dystocia, which concerns the uterine neck and which – caused by a rigidity generally connected to a scarring stenosis due to surgery or cauterisation – may cause anomalies in the contraction of the uterus or a failure to open the uterine neck; or there may be a dynamic dystocia, due to an anomaly in the uterine contraction, which leads to too weak or too distant contractions. This condition is solved by the administration of oxytocin.

Other dystocias can be an obstacle (due to the presence in the small pelvis of an ovarian cyst or a fibroid in front of the fetus, or placenta previa) or of a bone type, which can be linked to the abnormal shape of the maternal pelvis or its small size. Or, again, there may be soft tissue dystocia (caused by vaginal or perineal obstacles), usually solvable with an episiotomy that widens the orifice allowing the passage of the child.

How does the operative delivery happen?

But what tools does that particular type of dystocic delivery, which is operational delivery, use? In the past, forceps were used a lot, but today they are no longer in use because unwise use can cause head compression and distortion, skull fractures, nerve-facial paresis or lacerations of the uterus. This tool consists of two branches mounted on a pivot that hook the head and allow the doctor to extract the child, enhancing the thrust of the mother.

The most used is the suction cup, a silicone or plastic cup that – through a system to make traction and suction – adheres to the head of the child. It is a risk-free system, both for the mother and the child: the latter could at most present a slight swelling or artificial abrasions that resolve within a week.

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