We all know giving birth isn't going to be like it is on TV dramas: Your water breaks; you gasp, exclaim, "She's coming!" Then, lipstick refreshed, you cradle your newborn as your handsome husband looks on.
Alternatively, we hope it isn't going to be fodder for reality TV: A swarm of doctors sprints into the delivery room, shouting, "Get the NICU team, STAT! We've got a quadruple nuchal and need a cold-knife section!" More than likely, it'll be somewhere between the two. However your labor story unfolds, being educated helps. Below are six possible scenarios of labors with complications, complete with doctors' lingo and happy endings.
Complication: Nuchal Cord
What it means: The umbilical cord is wrapped around baby's neck. Two times around is a "double nuchal."
Frequency: It happens in approximately 25 percent of births.
Likely remedies:"A nuchal cord doesn't necessarily mean baby is in danger," says Nanci Levine, M.D., an OB-GYN at Montefiore Medical Center in Westchester, N.Y. "Even if it sometimes causes baby's heart rate to go down [known as 'variable deceleration in the heart rate tracing'], a nuchal cord doesn't have to be serious. But if you have a contraction and baby's heart rate doesn't go back up, the cord may be too tight, and that could mean baby is having problems."
For New York City-based Catherine Hooper, 34, mother of 21-month-old Sophie, it wasn't until late in labor that there was a problem. "As baby was coming down the birth canal, her heartbeat slowed from a quick bubump, bubump, bubump to almost nothing," she recalls. Assuming the problem was a nuchal cord, Hooper's doctor applied upward pressure to baby's head to give the cord some slack, and her heartbeat immediately came back. "After I pushed her out," says Hooper, "the doctor quickly unwrapped the cord, and she was fine."
"If the variable deceleration in the heart rate tracing goes on for quite a while, we will want the mother to deliver fairly soon," says Leslie Goldstone-Orly, M.D., an OB-GYN at Bridgeport Hospital at Yale-New Haven in Bridgeport, Conn. If the mother is unable to push baby out, forceps or a vacuum extractor (a soft suction cup placed on baby's head) may be used to assist baby down the canal. "If baby is too high or the mother is not adequately dilated, a C-section might be necessary," Goldstone-Orly says.
Complication: Cephalopelvic Disproportion (CPD)
What it means: Baby's head is too big to pass through the mother's pelvis, resulting in "failure to progress."
Frequency: Unknown. The condition is hard to quantify because you're never sure if it's a true CPD or simply a failure to progress—i.e., the mother stops dilating, or baby is not moving down due to undetermined causes.
Likely remedies: Failure to progress is the single most common cause for a c-section, though you may be given the drug Pitocin to induce contractions first, says Levine. There's no accurate way to predict CPD prior to labor. "You can measure the mom's pelvis by feeling it, but that is unreliable," says Goldstone-Orly. However, exercising during pregnancy and keeping your weight gain within recommended limits can diminish your chances of developing gestational diabetes, thus reducing the risk of a large baby, she adds.
Complication: Meconium Aspiration
What it means: Meconium (a black, tarry substance in baby's intestines) is present in amniotic fluid baby has inhaled. This can cause breathing complications.
Frequency: More common in babies a week or more overdue, meconium is passed in 10 percent of labors. Of these, between 1 percent and 6 percent of babies become ill from it.
Likely remedies: If meconium is spotted, your doctor or midwife will clear it from the baby's nose and mouth at birth. If baby has inhaled it, she'll go to intensive care for observation. "Most babies do fine and just need a little breathing support," says Goldstone-Orly.
Complication: Placenta Previa
What it means: The placenta is covering the cervix.
Frequency: Placenta previa is found early in pregnancy about 75 percent of the time. Usually, by the end of pregnancy, the placenta has pulled away and it's not a problem.
Likely remedies: If the placenta is covering the cervix at 36 weeks, a c-section will likely be scheduled, Goldstone-Orly says. "If the mother is bleeding vaginally, however, she should have a c-section immediately because there can be significant blood loss," she adds.
Complication: Breech Baby
What it means: The baby is positioned in the uterus head up, bottom down, sideways or feet first. It's also known as "malpresentation."
Frequency: Rare (4 percent).
Likely remedies: Some doctors and midwives say elevating your hips above your heart by getting on all fours, then lowering yourself onto your forearms, encourages baby to turn. At 37 to 38 weeks, some doctors try an external version—turning the baby manually by applying pressure to the mother's abdomen. If that doesn't work or baby flips back, the doctor can try again or schedule a c-section. Very few OBs will attempt a vaginal delivery for fear baby's head will get stuck in the birth canal.
Complication: Fetal Distress
What it means:"'Fetal distress' is an older, vague term that OBs don't generally use anymore," says Levine. "If you do hear it, ask for specifics." The term often has to do with the fetal heart rate; it's assumed the fetus is in some kind of peril when the heart rate is slow, for example, or doesn't return to normal following a contraction.
Frequency: "True fetal distress implies urgency—as in 'I'm really worried about this baby right now'—and that doesn't happen very often," Levine says.
Likely remedies: If the woman's cervix is fully dilated and baby's head is low, your practitioner might use forceps or a vacuum extractor to deliver baby quickly. Otherwise, it's a c-section.
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