The whole period of pregnancy up to delivery is considered to be a very delicate stage in the life of a woman. Constant efforts are made by both family and friends to ensure utmost care to the expectant mother. Nevertheless, there is no guarantee that a smooth pregnancy could mean a safe delivery.
A pregnancy that has gone smoothly can still have problems at delivery and it is necessary that the expectant parents are aware of possible complications. The entire labour process could last from a few hours to a couple of days. And it is but natural that the doctors are always prepared to expect the unexpected. Hence, a little knowledge on the part of the parents-to-be could help them be mentally calm and confident during these long waiting hours.
The Initial Stage Of Labour
The attending doctor checks the expecting mother at regular intervals to see how much the cervix has dilated and how far has the baby descended. If the cervix is dilating slowly or if the patient is having slow contractions, it means that the person will have a slow labour. In such cases, the patient might be asked to:
- Walk around more often (brisk walking can help the baby move down more quickly and enable contractions)
- Move to a position that is more comfortable
- Have a warm water shower
- Have someone gently massage the back
- Have something mild to eat or drink at frequent intervals
- Have a nap to regain energy
If the progress is still slow, the patient might be given an intravenous drip of Syntocinon to make the contractions more effective.
The Second Stage Of Labour
When one is in the second stage of labour and trying for a natural birth, the mother is expected to push hard during contractions and rest in between them.
The mother might want to shift to a position that seems more comfortable, like lying on the back and squatting or holding the knees. A doctor will closely monitor the baby’s position and ask the mother to push hard once the head can be seen.
In some cases, the doctor might use a medical tool like a pair of forceps or a suction pump to help guide the baby out. Once the baby has been delivered, the medical team (or the birth partner with the help of the medical team) will cut the umbilical cord.
The Final Stage Of Delivery
After the baby has been delivered, there now is one more organ that has to be delivered the placenta. The placenta is the organ that helps nourish the baby with nutrients and oxygen in the womb. Contractions continue till the placenta is ejected. The process should take about 5-30 minutes.
What Happens In A C-section?
There are also a few cases that might call for an emergency C-section delivery. Here the belly of the patient is cleaned and the patient is given fluids and medicines through a vein in the arm or hand. Then, the doctor makes a ‘C’ incision near the pubic bone and continues layer by layer to the womb. The baby is delivered and the placenta is removed. The incisions are then closed up layer by layer. The patient may take a longer time to recover and spend more than 3 days in the hospital. The duration of stay may be decided mutually between the family and the doctor.
However not all labour/deliveries progress smoothly and since all labour/deliveries aren’t smooth, doctors/medical team need to be prepared for tackling any kind of situation. A few of them are:
A. Premature Delivery
Also known a ‘preterm delivery’, it is a condition when the baby is born/delivered before week 37 against the full-term of 40 weeks. Having labour contractions before week 37 is called ‘preterm labour’ and the baby born faces a greater risk of survival outside the womb, as his/her body is not mature enough. A preterm baby is also at a risk of developing respiratory or digestive problems.
In cases where the mother is expected to deliver more than one baby at a time, there are chances that the delivery is preterm or through a C-section.
B. Prolonged Labour
In a few cases, the entire process of labour lasts too long and there is very slow progress. Here the mother and the baby can be at a greater risk of developing complications and infection if the amniotic sac has been broken for too long before the birth. There are also cases where the pregnancy lasts a little more than the actual 40 weeks. The medical team might induce labour or suggest a C-section.
C. Placenta Previa
The placenta blocks the cervix or entry to the birth canal.
D. Umbilical Cord Problems
The umbilical cord is a conduit through which the baby receives nutrients and oxygen in the womb. Since the baby moves itself in the womb, occasionally there are chances that the cord wraps itself around the baby. While most cases are not a cause for concern, an umbilical cord wrapped around the neck can decrease the heartbeat of the baby, and call for an emergency C-section.
E. Abnormal Presentation
This happens when weeks before the due date; the baby (foetus) descends lower in the uterus. The right way for a baby to descend for delivery is with its head down (head exiting first), facing the back of the mother, with his/her chin touching his/her chest. Since the head is the largest and least flexible part of the body, it is safest that it descends first.
An ultrasound examination weeks before the delivery can reveal the position of the baby in the womb and thereby help the doctor to make important decisions. Quite often, it happens that the baby is not rightly placed (Abnormal presentation) in the womb. An abnormal presentation could increase the risk of uterine or birth canal injury in the mother. The baby might be in one of the following positions:
a. Posterior Position
The baby’s head enters the pelvis with its face facing front instead of back. There are chances that the baby could turn around during the delivery or the doctor might use a pair of forceps/vacuum pump to help deliver the baby.
b. Breech Birth
Here the baby presents himself/herself with its bottom or feet facing downwards first. The position of the baby is monitored via ultrasound and if the term is over 36 weeks, the doctor might suggest a planned C-section. There are also situations where the doctor tries to turn the baby (later pregnancy stages) by placing his hand on the abdomen and gently tugging the baby to the head down position.
Types Of Breech Include:
Frank breech (The baby’s buttocks lead the way into the canal with hips flexed and knees extended)
Complete breech (Both knees and hips are flexed with the buttocks or feet entering first)
Incomplete breech (One or both feet enter the canal first)
c. Transverse IE
The baby is found in a position that is horizontal in the uterus such that his shoulder leads the way into the birth canal.
d. Multiple Pregnancy
In cases where the mother is to deliver more than one baby, there are chances that the labour is preterm, that is before the due date.
e. Delicate Condition Of The Baby
Both the mother and the baby are monitored through the entire period of labour and this helps the doctor determine any distress during the process. Sometimes a baby could develop a slower heartbeat or might have a bowel movement. In such cases; the doctor might use the help of a vacuum pump or arrange for an emergency C-section.
f. Abnormal Foetal Heart Rate
If the heart rate of the baby goes outside the normal range of 110-160 beats per minute, or if the rhythm is unusual, the doctors might suggest a C-section.
g. Amniotic Fluid
The Amniotic fluid in the womb acts, as a cushion to keep the baby comfortable before birth. Rupturing of the sac before labour could mean fewer cushions for the umbilical cord or increased chances of infection. Most doctors would induce labour right away to decrease chances of infection to the baby.
Pregnancy and delivery though very delicate and complicated always have to be approached with the right frame of mind and a positive and confident attitude. All the best!