Delivery

What are possible labor complications?

Although serious complications are rare during labor, some problems can develop during this time. Some of the more common complications include:

• Fetal meconium When the amniotic sac ruptures, the normal color of the amniotic fluid is clear. However, if the amniotic fluid is greenish or brown in color, it may indicate fetal meconium, which is normally passed after birth as the baby's first bowel movement. Meconium in the amniotic fluid may be associated with fetal distress. A woman should consult her physician immediately.

• Abnormal fetal heart rate The fetal heart rate during labor is a good indicator of how the fetus is handling the contractions of labor. The heart rate is usually electronically monitored during labor, with the normal range varying between 120 to 160 beats per minute. If a fetus appears to be in distress, immediate action can be taken, such as giving the mother oxygen, increasing fluids, and changing the mother's position.

• Abnormal position of the fetus during birth The normal position for the fetus during birth is head-down, facing the mother's back. However, sometimes a fetus is not in the right position, making delivery more difficult through the birth canal. There are several abnormal positions for a fetus, including the following:

  • Positioned head-down but facing the mother's front

  • Positioned with the face down into the mother's pelvis, instead of the top of the fetal head

  • Positioned with the brow down in the mother's pelvis

  • Positioned breech (where the buttocks or feet are down first in the mother's pelvis)

  • Positioned with one shoulder in the mother's pelvis

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Depending on the position, a physician may try to deliver the fetus as it presents itself, attempt to turn the fetus before delivery, or perform a cesarean delivery.

Delivery of the baby

Delivery is the moment when the fetus, followed by the placenta, exits the mother's body. In preparation for the delivery, a woman may be moved into a birthing room or delivery room, or she may remain in the same room for both labor and delivery. Fathers or partners are encouraged to be actively involved in the process of childbirth by helping with relaxation techniques and breathing exercises.

Positions for delivery may vary from squatting, sitting, to semi-sitting positions (between lying down and sitting up). With semi-sitting positions, gravity can help the mother in pushing the baby through the birth canal. The type of position for delivery depends on the preference of both the mother and the physician, as well as the health of the fetus.

During the delivery process, the medical personnel will continue to monitor the mother's vital signs (i.e., blood pressure and pulse) and the fetal heart rate. The physician will examine the cervical opening to determine the position of the fetus' head and will continue to support and guide the mother in her pushing efforts.

Delivery can be accomplished either vaginally or by cesarean section (also called c-section).

What is a vaginal delivery?

During a vaginal delivery, the physician will assist the fetus' head and chin out of the vagina when it becomes visible. Once the head is out of the vagina, the physician usually rotates the fetus to the side and eases the shoulders out, followed by the rest of the body.

In some cases, the vaginal opening does not stretch enough to accommodate the fetus. If there is a risk of tearing, the physician may perform an episiotomy -- an incision through the vaginal wall and the perineum (the area between the thighs, extending from the anus to the vaginal opening) to help deliver the fetus. Episiotomies are not needed for every delivery and are not routinely performed.

After the delivery of the baby, the mother is asked to continue to push during the next few uterine contractions to deliver the placenta. Once the placenta is delivered, any tear or episiotomy is repaired. The mother is usually given oxytocin (a drug administered either by an injection into the muscles or intravenously that is used to contract the uterus) and the uterus is massaged to help it contract, and to help prevent excessive bleeding from occurring.

What is a cesarean section (c-section)?

If a woman is unable to deliver the fetus vaginally, the fetus is delivered surgically, by performing a cesarean section. Cesarean sections are usually performed in an operating room or a designated delivery room. Some cesarean sections are planned and scheduled accordingly, while others may be performed as a result of complications that occur during labor.

Once the anesthesia has taken effect, an abdominal incision is made, and an opening is made in the uterus. The amniotic sac is opened, and the baby is delivered through the opening. The woman may feel some pressure and/or a pulling sensation.

Following the delivery of the baby, the physician will stitch the abdominal incision and the mother is given oxytocin (either by an injection into the muscles or intravenously) to contract the uterus, thereby preventing bleeding from occurring.

Conditions for a cesarean section

There are several conditions which may make having a baby by cesarean section more likely. These include, but are not limited to, the following:

• Previous cesarean section

• Fetal distress

• Abnormal delivery presentation (i.e., breech, shoulder, face)

• A labor that fails to progress or does not progress normally

• Placental complications (i.e., placenta previa, in which the placenta blocks the cervix and presents the risk of becoming detached prematurely from the uterus)

• Twins or other multiples