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Understanding Labor and Delivery Complications -- the Basics

What Are Common Labor and Delivery Complications? continued...

In cephalopelvic disproportion, the baby's head is too large to fit through the mother's pelvis, either because of the size or because of the baby's poor positioning. Sometimes the baby is not facing the mother's back, but instead is turned toward her abdomen (occiput or cephalic posterior). This increases the chance of a lengthy, painful, childbirth, often called  "back labor," or tearing of the birth canal. 

In malpresentation, the baby is not "presenting" or positioned in the normal way. In malpresentation of the head, the baby's head is positioned wrong, with the forehead, top of the head, or face entering the birth canal, instead of the back of its head. Sometimes a placenta previa (when the placenta blocks the cervix) may cause an abnormal presentation. But many times the cause is not known.

Abnormal presentations increase a woman's risk for uterine or birth canal injuries and abnormal labor. Breech babies are at an increased risk of injury and a prolapsed umbilical cord, which cuts off the baby's blood supply. A transverse lie is the most serious abnormal presentation, and it can lead to injury of the uterus, as well as injury to the fetus.

Your doctor will determine the presentation and position of the fetus with a physical exam. Sometimes a sonogram helps in determining the position of the fetus. When a baby is in the breech position before the last six to eight weeks of pregnancy, the odds are still good that the baby will change position before birth. But the bigger the baby gets, and the closer you get to your due date, the less room there is in the uterus for the baby to turn. Doctors estimate that about 90% of fetuses who are in a breech presentation before 28 weeks will have turned by 37 weeks, while over 90% of babies who are breech after 37 weeks will most likely stay that way.

Premature Rupture of Membranes (PROM)

Normally, the membranes surrounding the baby in the uterus break and release amniotic fluid (known as the "water breaking") either right before or during labor. Premature rupture of membranes means that these membranes have ruptured too early in pregnancy. This exposes the baby to a high risk of infection.

Umbilical Cord Prolapse

The umbilical cord is your baby's lifeline. You pass oxygen and other nutrients from your body to your baby through the umbilical cord and placenta.

Sometimes, before or during labor, the umbilical cord can slip through the cervix after your water breaks, preceding the baby into the birth canal. The cord may even protrude from the vagina -- a dangerous situation because the blood flow through the umbilical cord can become blocked or stopped. You may feel the cord in the birth canal if it prolapses, and may see the cord if it protrudes from your vagina. This is an emergency: Call an ambulance and get to the hospital right away.

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