How labor is induced. Natural stimulation of labor at home. What is the danger of weak labor

Methods of natural stimulation labor activity are used in cases of post-term pregnancy and to prepare the cervix for childbirth. By the approximate date of onset of labor, the cervix is ​​significantly shortened, which causes pain in the pregnant woman in the lumbar region and frequent urination, Natural stimulation helps relieve pain and speed up the process if delivery does not occur on the date prescribed by the doctor. All natural ways labor stimulation absolutely safe for both the child and his mother.

Nipple stimulation

One of the main ways to naturally stimulate labor is nipple massage. It is believed that when massaging and pinching the nipples, the body of a pregnant woman begins to more actively produce the hormone oxytocin, which causes labor pains. Nipples should be stimulated several times a day for 10-15 minutes. When using this method, contractions should begin within three days after the start of stimulation.

Castor oil

Castor oil is primarily known as a natural laxative; this is its main property in stimulating labor. By affecting the intestines, the oil simultaneously stimulates the uterus, accelerating the birth process. To soften the specific taste of the oil, you can add fruit juice or syrup to it. In half the cases of using this method, 100-150 grams of castor oil consumed cause natural contractions immediately after consumption.

Modern traditional medicine does not recommend the use of castor oil, which can cause diarrhea and lead to dehydration.

Walks

Walking at a brisk pace, preferably in the fresh air, also helps to naturally stimulate labor. When the expectant mother takes active walks, the baby's head, under the influence of gravity, begins to put more pressure on the cervix, which stimulates more active production of oxytocin. As a rule, almost all pregnant women take regular walks before giving birth, so the effectiveness of this method is quite difficult to determine. But you shouldn’t give up active walks to the expectant mother, because they contribute to the adoption of the “correct” position of the fetus before childbirth.

Oxytocin is a hypothalamic hormone of oligopeptide structure that has a stimulating effect on the smooth muscles of the uterus.

Homeopathy

This method can also be classified as a natural method of stimulating labor, but when using this method you should still consult a homeopathic specialist. The main homeopathic remedies that enhance the activity of labor are caulophyllum and pulsatilla, which are considered absolutely safe for health. The results of surveys of many women who have already given birth indicate that homeopathic medicines helped them solve various problems that arise during pregnancy.

In addition, natural methods of stimulation include: having sex with the obligatory violent orgasm in a pregnant woman, taking a small dose of alcohol, using tinctures of some medicinal herbs, inflating balloons, acupuncture.

Childbirth is a natural process of bringing a child into the world, carefully thought out and planned by nature. However, there are cases when it is impossible to do without medical assistance and labor stimulation is required.

In what cases is labor induction performed?

Detachment of amniotic membranes

Use of prostaglandins

Puncture of amniotic sac

Use of oxytocin

Tablets to induce labor

If labor does not begin, and the baby is already due to be born, doctors are forced to resort to artificial stimulation using various methods. However, each of these methods has its own indications and contraindications, so asking a doctor to speed up labor for some reason is strictly not recommended.

Types of stimulation

Postterm pregnancy is characterized by oligohydramnios, a decrease in the thickness of the placenta, thickening of the baby’s cranial bones, and so on. The absence of labor on time is fraught with deterioration in the functioning of the placenta, which leads to a significant deterioration in the condition of the fetus. In such cases, induction of labor is prescribed, for which artificial rupture of the membranes or amniotomy is often used, during which the bladder is pierced with a hook-like instrument. This procedure is practically painless (there are no nerve endings in the amniotic sac) and allows you to start the process of delivery due to the discharge of amniotic fluid.

After the amniotomy is completed, labor begins approximately a few hours later.

Labor is also accelerated with the help of a special “prostaglandin” gel, which the obstetrician injects into the cervix of the woman lying on the gynecological chair. This procedure allows labor to begin nine to ten hours after the drug is administered. If labor has begun, but labor is too weak and the cervix is ​​not dilating well, doctors resort to stimulation with droppers of oxytocin or prostaglandins. Oxytocin is a hormone produced by the brain that stimulates smooth muscle and increases uterine contractility. Prostaglandins (hormone-like substances) have similar properties. Four to six hours after inducing labor using one of the above methods, doctors evaluate the benefits of them - if there is no effect, the woman is given C-section.

Features of stimulation

Contraindications to accelerating labor are hyperactivity, hypertension, the presence of chronic fetal hypoxia or uterine scar, as well as cardiovascular or other dangerous diseases of the woman in labor. Ideally, a woman should give birth on her own, since childbirth is a natural process that should be accompanied by proper breathing during pushing and contractions. Doctors say that stimulation is most often needed by women who are trying to control the birth of a child with their heads, while complete and instinctive dedication to the process allows the body to do everything as it should.

Expectant mothers are recommended to undergo special training at a school for pregnant women - then speeding up childbirth is unlikely to be necessary.

Also, natural childbirth is desirable for the reason that a child born without stimulation experiences less stress during the passage of the birth canal. In addition, non-interference in labor prevents oxygen deficiency in the baby. Application medicines for stimulation is also not useful - for example, oxytocin most often gives the skin of newborns a yellowish tint to the skin, since this hormone increases the level of bilirubin in the blood and enters into a chemical reaction with it. Jaundice goes away on its own within a few weeks.

If something does go wrong, rest assured that the doctors will do everything possible for you and your child. When complications arise and all plans are disrupted, it is easy to lose control of yourself, but try not to panic. The doctor will be able to explain the situation, talk about possible consequences and ways out of it. Together you will decide what is best for you and your child.

Once mother and baby finally reach their estimated due date after 40 long weeks, regular check-ups become more frequent.

If the actual due date is a few days later than expected, this will not cause problems, provided that both are in good health.

Using ultrasound, the doctor will periodically monitor the child’s condition and his life support. Only when the examination shows that the baby is too small is delaying the onset of labor considered undesirable. In this case, early artificial induction of labor is recommended. The same applies to the situation when the child is very large and weighs more than 4500 g. And here artificial birth preferable, as otherwise the baby will continue to gain weight and spontaneous labor may become extremely difficult.

More than 20% of births in France take place with the use of stimulant drugs (both for medical reasons and for personal preference). In both cases, the woman receives medications that speed up the process of labor, since labor can be protracted and more painful.

Indications for induction of labor

Here are some of them.

• When labor does not come at the appointed time (41st week of amenorrhea).
• When the water has already broken and there are no contractions for 24-48 hours.
• When problems arise with the normal development of the fetus (intrauterine growth retardation).

A woman in labor can agree on a due date in advance if she lives far from the maternity hospital or has already had a rapid labor.

Terms. Doctors do not often give consent to induced labor if a woman does not have the indications listed above.

The doctor may ask you some questions before making any decisions.

It is advisable that this is not the first birth and that the cervix has already dilated.

Stimulation is not carried out before 39 weeks, as there is a danger of harming the baby’s health.

If there are no indications, do not insist on induction of labor - trust your doctor.

The lower your stress level, the more likely it is that you will not need labor induction.

Post-term pregnancy

• The end of the 9th month (41st week of amenorrhea) is the end of pregnancy.
• If by this time you have no signs of labor, you will be sent to the maternity hospital. The child's condition will be checked there. By this time, the placenta may cease to fully perform all its functions (nutrition and oxygen saturation of the blood).
• The doctor will prescribe an ultrasound and CTG to check the heart rhythm, the amount of amniotic fluid and assess the biophysical condition of the fetus according to the Manning scale. If any abnormalities are detected, the doctor may decide to induce labor.
• In any case, 3-5 days after the deadline that you determined with your doctor, labor will be induced artificially. The deadline for natural childbirth is 42 weeks of amenorrhea.

How is labor induced?

When the decision has already been made, it is necessary to determine the degree of maturity of the cervix. For this purpose, the doctor will perform a vaginal examination and determine the degree according to the Bishop system (scale from 0 to 10). A result of 6-10 points indicates that the cervix is ​​mature: it opens (to the width of 1-2 fingers), shortens (about 1 cm in length), softens and its center falls in the middle of the vagina. The mature cervix will quickly open: labor will soon begin.

If the cervix is ​​immature, 3 cm long, in good shape and located in the back of the vagina, then it is not yet ready to open - you will have to be patient.

If the cervix is ​​mature enough. You will be placed in the delivery room, under a system and a heart monitor, like any other woman in labor. The only difference is that you will be given drugs that provoke contractions (oxytocin). Then the doctor punctured the amniotic sac. You are due to give birth during this day.

If the cervix is ​​not mature enough. If you score low on Bishop's system, you will need additional stimulation. This may take several days, so bring a book or player with you... The obstetrician will insert a tampon soaked with hormones into the vagina. It should cause contractions followed by opening of the cervix, shortening, softening, smoothing and moving forward. After a few hours of being monitored on a heart monitor, you will be able to return to your room. If after 24 hours there are still no contractions, your doctor will examine you again to determine the degree of maturity of the cervix. If the degree of maturity is sufficient, intravenous administration of birth-stimulating drugs and puncture of the amniotic sac may be prescribed. If the cervix is ​​not yet ripe, after six hours you will have an application with hormonal gel.

Be patient. If you are sent to the ward to wait for labor to begin, take advantage of this to rest, shower, and move around calmly. Perhaps labor will begin at night and you will need strength. It is better to wait until the contractions begin on their own than to induce them artificially, and then, if unsuccessful, have a caesarean section.

When labor is induced, the fetus is under constant monitoring.

Regular control

After the expected due date, the doctor will first determine the volume of amniotic fluid. Its decrease can negatively affect the blood supply to the umbilical cord and oxygen supply to the child. Therefore, in this state of affairs, inducing labor artificially becomes inevitable. With a normal amount of amniotic fluid, post-term pregnancy is not a problem.

If the ultrasound results say that everything is going well and there are no risks. there is no need to remove CTE. The so-called oxytocin test is also an unnecessary measure. Recently, scientists have found that it does more harm than good, and is often the reason for inducing artificial labor.

If the pregnancy continues uncomplicated, the doctor should check the amount of amniotic fluid with ultrasound every three days. During these examinations, the child's heart sounds are also monitored.

After a week has passed beyond the estimated due date, a CTG is additionally recorded. If the pregnant woman is nursing for more than seven days, the doctor discusses with her the possibility of inducing labor with the help of medications.

The absence of deviations in the volume of amniotic fluid and in the cardiac activity of the child allows us to conclude that it is well supplied - under such conditions, further post-term pregnancy is possible, if the mother herself is not against it. But now it is advisable to monitor the child’s condition, including CTG, every two days. No later than 12-14 days after the calculated date of birth, the pregnancy, however, must end, since otherwise the risks for the child may increase significantly.

Labor cannot begin, stimulation is needed

Sometimes labor does not start on its own. If this happens to you, your doctor may start (induce) labor with medications.

Situations in which labor stimulation is possible:

• The baby is post-term. The pregnancy is approaching 42 weeks.
• The waters broke (the membranes burst), but labor did not begin.
• An infection has developed in the uterus.
• The doctor fears for the child, since growth has stopped, the child is not active enough, and there is little amniotic fluid.
• You have a health condition, such as high blood pressure or diabetes, that could put your baby at risk.
• The problem with the Rh factor is that your blood and the baby's blood are incompatible.

If you were hoping that labor would begin on its own, but the doctor insists on induction, try to look at it positively. It may be more convenient to know exactly when the baby will appear than to wait for nature to take its course. You will be better prepared physically and mentally before heading to the hospital.

Stimulation of labor. The doctor can induce labor in several ways, but the cervix should soften, thin and dilate. If this does not happen, the doctor can take steps to start the process.

Medicines. Medicines may be used to soften and dilate the cervix. These drugs also often help initiate labor, eliminating the need for other stimulants such as oxytocin. If cervical priming is required, you may want to go to the hospital the day before the stimulation to give the medications time to take effect.

Mechanical methods. One method is to insert a thin catheter containing a balloon filled with water through the cervix into the uterus. This irritates the uterus, and it begins to push the balloon through the cervix, softening and expanding it from 2 to 4 cm.

Rupture of membranes. In this case, the amniotic sac enveloping the baby ruptures and fluid begins to flow out. Normally, this is a sign that the baby will be born very soon. One result of this rupture is increased uterine contractions.

One way to speed up labor is to artificially rupture the membranes. In this case, the doctor inserts a long and thin plastic hook through the neck and makes a small tear in the membranes. You will feel the same as during a normal examination, and warm liquid will flow out. This is not dangerous for you or the child.

Oxytocin - a way to stimulate labor

The usual way to induce labor is to use the drug oxytocin, a synthetic analogue of the hormone oxytocin. Normally, during pregnancy, the body produces small amounts of oxytocin. During active labor, its level increases.

Oxytocin is usually given intravenously after the cervix has thinned and dilated somewhat. A catheter is inserted into a vein in the arm, and small doses of medication are regularly released into the blood using a special pump. These doses may be adjusted during stimulation to adjust the strength and frequency of contractions until they stabilize. If the dose is chosen correctly, you will feel contractions in about half an hour. Contractions may be more regular and stronger than during natural childbirth.

Oxytocin is one of the most commonly used drugs. It can stimulate labor that might not start on its own, and it can also push contractions forward if they slow down during labor and the process does not progress. Uterine contractions and the baby's heart rate are monitored to reduce the risk of complications.

If stimulation is successful, you will feel signs of active, progressing labor, such as prolonged contractions becoming stronger and more frequent, cervical dilatation and rupture. amniotic sac- if it didn't burst earlier.

The reasons for inducing labor must be serious. If your or your child’s health is at risk, the doctor may decide on further intervention, a caesarean section. Induction may take several hours, especially during the first birth.

Oxytocin

• This is a natural hormone produced by the hypothalamus, which is located in the neurohypophysis. Its function is to stimulate the muscles of the uterus at the time of childbirth. It also promotes contraction of the mammary glands during lactation.
• There is also synthetic oxytocin, which is administered intravenously to stimulate labor. Its use must be carried out in accordance with certain conditions and strict dosage control. Continuous monitoring of the fetus allows you to see if the baby is suffering when contractions begin or intensify.
• Synthetic oxytocin is sometimes given immediately after birth to shrink the uterus, expel the placenta, and reduce bleeding.

Artificial induction of labor

Artificial stimulation of labor (induction).

Most births begin with spontaneous contractions and a healthy baby is born. However, during preventive examinations in the last weeks of pregnancy, it sometimes turns out that the child’s life support is no longer at an optimal level. In this case, the doctor must, after weighing all the circumstances, decide whether the pregnancy should be maintained until spontaneous labor contractions occur or whether it would be better for the mother and child if premature labor is induced artificially with the help of medications.

Whether early delivery is the best option depends on

what week of pregnancy the woman is in. If complications appear shortly before the calculated due date, then labor is induced artificially even if there is a relatively small risk. All the child’s organs have already formed, and he can breathe independently with his small lungs. If danger to the baby arises at an earlier stage of pregnancy, the doctor will try to delay the birth of the child as long as possible.

Reasons for artificial induction of labor

There are various reasons for inducing labor with medication.

• The most common of them and far outpacing all others in frequency is oxygen starvation of the child, for example, due to placental insufficiency.
• If preventive examinations, such as ultrasound, CTG or Doppler sonography, indicate a threat to the further successful development of the child, then premature birth gives him an excellent chance to be born healthy.
• In some cases, the baby reaches a very large size even before the 38th week. If the observed developmental process gives reason to conclude that the baby's weight will increase significantly in the remaining two weeks, inducing a premature birth with the consent of the expectant mother may be very appropriate. This solution reliably guarantees that the child will be born healthy and without major complications.
• If there is premature rupture of the membranes and there are no contractions, stimulating labor with medication helps to avoid the risk of infection of the child.
• Twins themselves are often born earlier than expected. If there is insufficient supply of one or both of them, labor is induced prematurely.
• If the baby is sick and cannot be treated in the womb, premature delivery will improve his health. First of all, this applies to children suffering from severe anemia.
• Maternal diseases such as gestational hypertension or diabetes may also require early induction of labor.
• If the expectant mother suffers greatly from various physical and mental disorders, it is possible to artificially induce premature birth when the child has finished maturing, that is, after the 37th week of pregnancy. The reason for making such a decision may be, for example, severe back pain, severe sleep disturbances or heavy physical exertion.

Labor is induced either by prostaglandins or by the administration of oxytocin.

Methods of artificial stimulation of labor

Which method of artificial stimulation of labor the doctor will choose depends on the well-being of the fetus and the condition of the cervix. If the child is already in danger and the uterine os is still closed, childbirth most often occurs by caesarean section.

• Stimulation of labor by administration of oxytocin is carried out provided that the uterine os is already sufficiently soft and slightly open. This means that the uterus is preparing for the onset of contractions. The advantage of this method: stimulation does not last long, and you can quite accurately calculate how long labor will take. With the start of oxytocin administration, the child’s heart contractions are constantly monitored using CTG; for this, a portable cardiotocograph is usually used.
• In the case of an immature uterine os, prostaglandins are used to stimulate labor. A pregnant woman does not receive these medications in the form of injections. They are used locally in the form of a gel, pessaries or tablets, which must be absorbed in the area of ​​the uterine pharynx. Under the influence of prostaglandins, the uterine pharynx softens and begins to open. Contractions usually occur within two to three hours. If there are no contractions, then after six hours the procedure is repeated.

With this method of stimulation, constant monitoring of the child via CTG is not required. It is quite enough to take a CTG every two hours, starting from the moment contractions appear.

Stimulation with prostaglandins should always be carried out in a hospital setting, since it is quite difficult to predict when contractions will begin. When the uterine os is ripe, the further process of labor can be supported by the administration of oxytocin. If after two days there are still no contractions, you should consider whether it is advisable to try again or whether it is better to take a break. Sometimes a caesarean section may be necessary in this situation - primarily if it turns out that your baby's health is at stake.

• Induction of labor with misoprostol. This drug was initially approved only for the treatment of stomach tumors. But for 20 years now, in some countries it has been recommended for inducing labor, although, strictly speaking, it has never received the appropriate approval.

Misoprostol causes few side effects and has the advantage that it can be taken in tablet form. Before starting stimulation, your doctor should inform you in detail about the effect of this medicine - be sure to ask again if anything is unclear to you!

Alternative methods of inducing labor

Artificial opening of the amniotic sac

When the amniotic sac ruptures and begins to recede amniotic fluid, their volume in the uterus decreases. As a result, contractions often occur, from which labor contractions develop. But this method can only be recommended for multiparous women and only if the cervix is ​​dilated.

Sexual intercourse

Having regular intercourse late in pregnancy will reduce the likelihood that you will have to carry your baby to term. It is believed that sex has a dual effect: firstly, it promotes the production of the contraction hormone oxytocin, and secondly, semen contains prostaglandins, which also cause contractions. However, the amount of prostaglandins during a single ejaculation is very small - significantly less than the dose used for drug stimulation of labor.

Separation of the fertilized egg

Even before the artificial stimulation of labor through medications became widespread, the best way to induce spontaneous contractions was considered to be the separation of the fertilized egg in the lower pole. This operation can be performed only after the 40th week of pregnancy and provided that the cervix is ​​already slightly dilated. At the same time, the obstetrician penetrates her with his finger. Using rotating movements, he massages the internal uterine os and carefully separates the membranes from the uterine wall. The use of this method requires extreme caution, since the manipulation, which is very painful in itself, can also cause bleeding. Therefore, you should think carefully before starting it at all.

Nipple stimulation

When nipples are stimulated, the hormone oxytocin is released, which causes contractions. But the effect of the hormone is manifested only in the case of maturation of the uterine pharynx. Studies have shown that the effect is so insignificant that it is not worth resorting to this method at all.

Physical activity

Excessive physical stress, for example, climbing stairs, leads to a more intense redistribution of blood supply (blood from the placenta rushes to the muscles) and in some cases provokes the onset of contractions. However, this method is unlikely to be recommended. Slow movement, such as a short walk, is much more pleasant in the initial phase of labor. It is better not to resort to physical activity that requires large energy expenditures - you should save your strength for the upcoming birth.

Additional therapeutic measures

Some women enjoy additional treatments, such as prenatal acupuncture or reflex zone massage. But, unfortunately, this cannot be said to be a reliable way to induce contractions.

Using Herbs to Stimulate Contractions

Sometimes a decoction of cinnamon, ginger and cloves is prepared and used to soak tampons. With an immature uterine os, such actions lead to prolonged contractions of the uterus, which can result in oxygen starvation of the child. Therefore, we will not recommend this method. However, the herbs listed above can be used in the form of aromatic oils for an aroma lamp or, mixed with almond oil, used for massage. If you apply this mixture on the abdominal wall and massage the uterus from the upper end, it will help your baby to finally hit the road.

Stimulating bath

A bath that stimulates contractions can make you feel better. To do this, add four drops of essential oil, such as clove oil, cinnamon leaves or ginger root, to 250 ml of cream, mix and pour into a filled bath. The water temperature should not exceed 37 °C.

Castor oil

Castor oil, which is used industrially in the production of varnishes and dispersion paints, is also used in the production of cosmetics.

If this oil is taken internally, it will cause intestinal upset, which in turn will lead to contractions. Contractions provoked in this way with an immature uterine os do not bode well. They will not be the beginning of labor, but will only manifest themselves in prolonged contractions of the uterus, which negatively affect the oxygen supply of the fetus. Therefore, an attempt to induce labor without monitoring the child via CTG can be very dangerous for him.

Nausea, diarrhea and intestinal cramps are common unwanted side effects.

On top of everything else, the taste of castor oil is so unpleasant that it is usually taken with wine or vodka, and on top of that the child has to deal with the negative effects of alcohol.

To summarize, this method is unacceptable.

Onset of labor with artificial stimulation

Doctors have several methods to induce labor. What your doctor chooses depends on various reasons, such as the readiness of your cervix and the health of the baby.

Separation of membranes

The doctor will examine your cervix and use your finger to separate the amniotic sac from the walls of the uterus. For many women, after this, their water breaks and cramps begin. Once the membrane is separated, prostaglandin is released and contractions begin. This method is only suitable for you if your cervix is ​​dilated.

Cervical preparation

Before inducing labor, your doctor may use something called the Bishop Score to find out if your cervix is ​​ready for labor. The doctor will examine your cervix to see how much it has dilated and effaced and whether the baby has descended into the pelvis. Research shows that induced labor is more effective if the cervix is ​​dilated, so if your cervix isn't ready for it, your doctor may use some substances to speed up the process, such as prostaglandin E suppositories, prostaglandin gel, prostaglandin on a special device, or prostaglandin tablets. Some women who use these products go into labor within 24 hours without any further intervention. Other medications that help dilate the cervix are kelp (kelp sticks that absorb water from the cervix, causing it to dilate) or a catheter flask (which is inserted into the uterus and gradually dilates the cervix).

Amniotic sac puncture

The doctor may use a gynecological instrument, similar to a crochet hook, to make a small hole in the amniotic sac. (This is called an amniotomy.) The procedure mimics what sometimes happens on its own when your water breaks before labor begins. This can be uncomfortable if your cervix is ​​less than a centimeter dilated, but otherwise it doesn't hurt at all. If contractions do not start 24 hours after your water breaks, your doctor will likely induce labor with Pitocin or other medications to reduce the risk of infection.

Pitocin drip

Pitocin is a synthetic form of oxytocin, the hormone that causes contractions. Most pregnant women go into labor in part due to high levels of oxytocin in the blood; your doctor wants to simulate this process by using Pitocin.

If labor is induced by this drug, you will be admitted to the hospital where an IV needle will be inserted into your arm. Pitocin usually takes about 30 minutes to start working, so your doctor will likely take your time and monitor how you and your child respond to the drug. There is no guarantee that labor will go quickly with Pitocin; contractions may be strong and each contraction may last 1 minute or longer. Many women said that breathing exercises help during such births. Inducing labor is a long process, and if this is your first baby, several procedures may be needed. For example, in lately Often the uterus is prepared and only then Pitocin is administered. Ask your doctor what procedures will be performed on you and be prepared to wait patiently.

My obstetrician wants to induce labor. For what reason does this happen?

Induction of labor

There are many reasons why it is necessary to induce the birth of a baby earlier than expected. In some cases, caesarean section is practiced. A priori, the child and mother can tolerate childbirth well and, if the obstetrician-gynecologist believes that childbirth will take place naturally, no stimulation required. But sometimes there are reasons to stimulate labor.

• The fetus has stopped developing: it receives little nutrition. Examination shows that the placenta is not fully performing its functions, and the uterus is no longer a healthy protection for the baby.
• The due date for childbirth has passed, the amount of amniotic fluid is reduced, and the baby moves less.
• The due date has arrived, the amniotic sac is ruptured, and the amniotic fluid is colored.
• The expectant mother has diabetes and is treated with insulin. All the prerequisites are that when the due date comes, the child will be too large.
• The mother suffers from preeclampsia. Neither complete rest nor medications help her, her life and/or the life of the child is in danger.
• The baby (Rh positive) is anemic because the mother (Rh negative) produces antibodies against red blood cells.
• The obstetrician-gynecologist is afraid that the mother will arrive at the maternity hospital too late because of the distance from where she lives or the previous birth was too rapid.