How Are Labor and Delivery Complications Diagnosed and Treated?
Preterm Labor and Premature Delivery
Drugs and other treatments can be used to stop premature labor (labor before 37 completed weeks of gestation). If these treatments fail, intensive care can keep many premature babies alive.
Prolonged Labor (Failure to Progress)
Prolonged labor, also called failure to progress, refers to labor that does not progress as fast as it should. This could happen with a big baby, a baby in a breech position (buttocks down), or other abnormal presentation, or with a uterus that does not contract strongly enough. Often, there is no specific cause for prolonged labor.
If labor goes on too long, the doctor may give IV fluids to prevent you from getting dehydrated. If the uterus does not contract enough, he or she may give you oxytocin, a drug that promotes stronger contractions. And if the cervix stops dilating despite strong contractions of the uterus, a C-section may be necessary.
Toward the end of your third trimester, your doctor will check the baby's presentation and position by feeling your belly or with ultrasound. If the fetus remains in breech presentation several weeks before the due date, your doctor may attempt to "turn" the baby into the correct position in a procedure called an "external version."
One way to try to turn the baby after 36 weeks is an external cephalic version, which involves a doctor manually rotating the baby by placing his hands on the mother's belly and turning the baby. These manipulations work about 50% to 60% of the time and are usually more successful on women who have given birth previously, because their uteruses stretch more easily. The procedure typically takes place in the hospital, in case an emergency C-section becomes necessary. To make the procedure easier to perform, safer for the baby, and more tolerable for the mother-to-be, doctors sometimes give a uterine muscle relaxant and then use an ultrasound and electronic fetal monitor as guides.
If the first attempt is unsuccessful, turning the baby may be tried again with an epidural pain medication to help relax the uterine muscles. Since not all doctors have been trained to do versions, you may be referred to another obstetrician.
There is a very small risk that the maneuver could cause the baby's umbilical cord to become entangled or the placenta to separate from the uterus. There's also a chance (about 4%) that the baby might flip back into a breech position before delivery, so some doctors induce labor immediately. The closer you are to your due date, the lower the risk of reverting back to a breech position. But the bigger the baby, the harder it is to turn.
The procedure can be uncomfortable for the mother, but if successful, may avoid a C-section, which is more likely if the baby can't be moved into the proper position.
Premature Rupture of Membranes (PROM)
If the baby is mature enough to be born, your doctor will induce labor or do a C-section if necessary. If the baby isn't mature enough, you may be given antibiotics to prevent infection as well as other medications to try to prevent or slow preterm labor.
Umbilical Cord Prolapse
Umbilical cord prolapse happens more often when a baby is small, preterm, in breech presentation, or if its head hasn't entered the mother's pelvis yet. Cord prolapse can also occur if the amniotic sac breaks before the baby has moved into position in the pelvis.
Umbilical cord prolapse is an emergency. If you aren't at the hospital when it happens, call an ambulance to take you there. Until help arrives, get on your hands and knees, with your chest on the floor and your buttocks raised. In this position, gravity will help keep the baby from pressing against the cord and cutting off his or her blood and oxygen supply. Once you get to the hospital, a C-section will be performed.
Umbilical Cord Compression
Umbilical cord compression can occur if the cord becomes wrapped around the baby's neck or a limb or gets pressed between the baby's head and the mother's pelvic bone. You may be given oxygen to increase the oxygen available to your baby. Your doctor may hurry along the delivery by using forceps or vacuum assistance, or, in some cases, delivering the baby by C-section.