Understanding Labor and Delivery Complications - Diagnosis and Treatment

Preterm Laborand Premature Delivery

Whenever possible, drugs and other measures can be used to prevent or stop premature labor before it results in birth. If these measures fail, neonatal 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, no specific cause for prolonged labor is found.

If labor goes on too long, your doctor may give you intravenous fluids to help prevent you from getting dehydrated. If the uterus does not contract enough, he or she may give you oxytocin, a medicine that promotes stronger contractions. And if the cervix stops dilating despite strong contractions of the uterus, a cesarean delivery may be necessary.

Abnormal Presentation

Toward the end of your third trimester, your doctor will check the presentation and position of your fetus by feeling your abdomen. 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 a "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 inside the uterus. 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 cesarean delivery 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 in your area.

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 risk of reverting to a breech position is lower, the closer you are to term. 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 cesarean delivery, which is more likely if the baby can't be moved into the proper position.