Birth often cannot proceed normally because of a defect of the cervix or weak uterine contractions; breech births, in which the feet or buttocks emerge first, and transverse births, in which the child is positioned across the uterus, usually require obstetrical intervention, such as forceps delivery, manually turning the baby, or performing a cesarean section.
About 10% of pregnancies terminate in deliveries that are too early, producing (after at least 200 days of gestation) premature infants requiring special care. Birth of a fetus prior to about 200 days of gestation is termed a miscarriage; birth within the first three months, an abortion. Stillbirth is the delivery of a dead child.
Slow progress of labour
Your midwife or doctor can tell how labour is progressing by checking how much the cervix has opened and how far the baby has dropped. If your cervix is opening slowly, or the contractions have slowed down or stopped your midwife or doctor may say that your labour isn’t progressing. It’s good if you can relax and stay calm – anxiety can slow things down more. Ask what you and your partner or support person can do to get things going.
The midwife or doctor may suggest some of the following:
- change to a position you’re comfortable in
- walk around – movement can help the baby to move further down, and encourage contractions
- a warm shower or bath
- a back rub
- have a nap to regain your energy
- have something to eat or drink.
If progress continues to be slow your midwife or doctor may suggest inserting an intravenous drip with Syntocinon to make your contractions more effective. If you’re tired or uncomfortable, you may want to ask about options for pain relief.
When the baby is in an unusual position
Most babies are born headﬁrst, but some are in positions that may complicate labour and the birth.
This means the baby’s head enters the pelvis facing your front instead of your back. This can mean a longer labour with more backache. Most babies will turn around during labour, but some don’t. If a baby doesn’t turn, you may be able to push it out yourself or the doctor may need to turn the baby’s head and/or help it out with either forceps or a vacuum pump. You can help by getting down on your hands and knees and rotating or rocking your pelvis – this may also help ease the backache.
This is when a baby presents bottom or feet ﬁrst. In Australia about 2% of babies are in the breech position by the time labour starts. Sometimes a procedure called ‘external cephalic version’ will be discussed – this is where a doctor gently turns the baby in late pregnancy by placing their hands on your abdomen and gently coaxing the baby around so it can be born headﬁrst. This turning is done at around 36 weeks, using ultrasound to help see the baby, cord and placenta. The baby and the mother are monitored during the procedure to make sure everything is ok. There’s a small risk that turning the baby may tangle the cord or separate the placenta from the uterus. This is why the procedure is done in hospital, in case an emergency caesarean is needed.
Your midwife or doctor will discuss with you the best way of managing a breech labour and birth. If the baby is still in the breech position at the end of pregnancy, a caesarean may be recommended.
When there is more than one baby, labour may be preterm. When the last baby has been born, the placenta (or placentas) is expelled in the usual way. If the babies are premature, they are likely to need extra care at birth and for a few days or weeks afterwards. At term, you may be induced if your babies are in the correct position. Often the obstetrician will suggest that you have an epidural. This is because after the ﬁrst twin is born the second twin can get in an unusual position and the obstetrician may need to manoeuvre the second twin into position for birth.
Concern about the baby’s condition
Sometimes there may be concerns that the baby is distressed during labour. Signs include:
- a faster, slower or unusual pattern to the baby’s heartbeat
- a bowel movement by the baby (seen as a greenishblack ﬂuid called ‘meconium’ in the ﬂuid around the baby).
If a baby is not coping well, its heart rate will usually be monitored. If necessary, the baby will be delivered as soon as possible with vacuum or forceps (or perhaps by caesarean).
Can I give birth vaginally after a c-section?
That answer depends on a number of issues, but many women are able to give birth vaginally after having a previous c-section (a process nicknamed VBAC, vaginal birth after c-section). The main risk of having a VBAC is uterine rupture, in which the c-section incision re-opens during delivery. Today doctors are screening women more carefully before recommending VBACs. So while fewer are being performed, they are much safer and more successful. In fact, the success rate is between 60 and 80 percent. About two-thirds of women who’ve had c-sections are good candidates for VBAC, but only your doctor can determine for sure if you’re one of them.
If you had a c-section because your cervix did not dilate adequately or the baby’s head did not descend, or both, your chance of a successful VBAC is somewhat lower.• How healthy you and your baby are: If your baby’s health is unstable or if there are complications, such as your child being in a breech position, you can’t have a VBAC. Your health is also considered, because conditions such as diabetes and high blood pressure can make VBAC riskier. If problems arise during labor, a c-section can still be performed quickly and safely. In fact, ACOG (American College of Obstetricians and Gynecologists) guidelines state that a physician capable of performing a c-section should be present during every VBAC delivery. For this reason, home births aren’t recommended for moms-to-be attempting a VBAC.
The latest guidelines say that VBAC is a safe option for women who have had only one cesarean. Even though some women with multiple c-sections may want to try VBAC, it’s difficult to find a doctor to do it.Before you decide if a VBAC is right for you, it’s important to be aware of the risks involved. Having a VBAC increases your risk of complications like uterine rupture, endometritis (a temporary inflammation or irritation of the uterine lining), and a variety of newborn injuries caused by the uterine rupture.
The good news is that these complications are relatively rare. In fact, one of the largest studies ever done on VBAC found that the risk of developing a serious complication during a VBAC is about 1 in 2,000. –Stacey Stapleton