Labor and delivery complications
Premature birth
One of the biggest dangers babies
face is that they are born too early, before their bodies are mature enough to
survive outside the womb. The lungs, for example, may not be able to breathe
air, or the child's body may not produce enough heat to keep warm.
A full-term pregnancy lasts about 40
weeks. The presence of labor pains before 37 weeks of pregnancy is called
preterm labor. In addition, a baby born before 37 weeks is considered a
premature baby who is at risk for complications of prematurity such as immature
lungs, respiratory distress, and digestive problems.
Medications and other
treatments may be used to stop preterm labor (delivery before 37 completed
weeks of pregnancy). If these treatments don't work, intensive care could save
the lives of many premature babies.
Prolonged labor
Prolonged labor refers to an
abnormally slow opening of the cervix or an abnormally slow descent of the
fetus. This means that the birth is not going as fast as it should.
This can happen with a large
baby, a baby in a breech position (buttocks down) or other abnormal position,
or with a uterus that doesn't contract enough. Often there is no specific
reason for prolonged labor.
If your labor is taking too
long, your doctor may give you intravenous fluids to help prevent dehydration.
If your uterus isn't contracting enough, your doctor may give you oxytocin, a
drug that makes contractions stronger. And if the cervix no longer dilates
despite strong uterine contractions, a caesarean section may be required.
Abnormal presentation
By the end of the third trimester,
the doctor will check the baby's presentation and position by palpating the
abdomen or with an ultrasound. If the fetus remains in a breech position a few
weeks before due date, your doctor may try to "rotate" the baby into
the correct position with a procedure called "external version".
One way to try to turn the
baby over after 36 weeks is the external head version, in which the doctor
manually turns the baby by placing his hands on the mother's stomach and
turning the baby over. These manipulations work in about 50-60% of cases and
are usually more effective in women who have already given birth, because their
uterus stretches more easily. The procedure is usually done in a hospital if an
emergency caesarean section is needed. To make the procedure easier, safer for
the baby, and more tolerable for the expectant mother, doctors sometimes
administer a uterine muscle relaxant and then use the ultrasound and electronic
fetal monitor as guides.
If the first attempt is not
successful, you can try turning the baby over again with an epidural to help
relax the uterine muscles. Since not all doctors are trained to make
variations, you may be referred to a different obstetrician.
There is a very small risk
that the maneuver will entangle the baby's umbilical cord or separate the
placenta from the uterus. There's also a chance (about 4%) that the baby might
flip back into a breech position before delivery, which is why some doctors
induce labor immediately. The closer you are to the due date, the lower the
risk of returning to the fetal presentation. But the larger the child, the more
difficult it is for him to roll over.
The procedure may be
uncomfortable for the mother, but if successful, it may avoid a caesarean
section, which is more likely if the baby cannot be moved to the correct
position.
Premature rupture of membranes
If the baby is mature enough
to be born, the doctor will induce labor or, if necessary, perform a caesarean
section. If the baby is not mature enough, you may be given antibiotics to
prevent infection, as well as other medicines to try to prevent or slow
premature rupture of the membranes.
Umbilical cord prolapse
Umbilical cord prolapse is more likely to occur in a small, premature baby,
in a breech presentation, or if its head has not yet entered the mother's
pelvis. Umbilical cord prolapse can also occur if the amniotic sac ruptures
before the baby settles in the pelvis. Umbilical cord prolapse is a medical
emergency. If you are not in the hospital when this happens, call an ambulance
to take you there. Until help arrives, get on all fours, pressing your chest to
the floor and lifting your buttocks. In this position, gravity will prevent the
baby from putting pressure on the umbilical cord and cutting off the baby's
blood and oxygen supply. The hospital performs a caesarean section.
Umbilical cord compression
Umbilical cord compression can occur if the cord wraps around the baby's neck or limbs or is caught between the baby's head and the mother's pelvic bone. You may be given oxygen to increase the amount of oxygen available to your baby. Your doctor may speed up labor by using forceps or a vacuum extractor, or, in some cases, by caesarean section.