Don’t worry-most labors are quite straightforward, but just occasionally there may be a complication that needs a special approach. With good prenatal care, any potential difficulties are usually spotted well in advance and avoided. Now and then, though, the first stage is underway before a problem becomes apparent.
Backache Labor
Occasionally, a woman may feel the discomfort of uterine contractions mainly as low back pain. This is usually due to stretching of the cervix as it dilates. It may also happen if your baby lies in the posterior position with the back of his head up against your spine (this is not abnormal-one in 10 babies lies this way). In this position, your baby’s neck may not be properly flexed and a larger proportion of the head than normal presents, which may mean that labor takes longer. Usually, your baby will rotate the 180 degrees into the anterior position and labor will go ahead smoothly. If, as sometimes happens, the baby fails to turn, there’s still no cause for alarm, although your doctor may deliver him using forceps or, more rarely, vacuum extraction. This kind of labor may start slowly and take a while, so it can be tiring. There are various ways in which you and your birth assistant can relieve your backache.
Counterpressure This is the most effective way of relieving a backache. But if you find being touched by someone else irritating-for example, during transition-you can apply counterpressure with your own knuckles by placing a hand underneath each buttock.
Change in position When you’re lying flat on your back, your baby is pressing down hardest on your spine and its nerves. Try to stay upright and walk around as much as you can. You can also relieve the pressure of your baby on your spine by sitting tailor-style, leaning forward, or rocking your pelvis. If you feel more comfortable lying down, lie on the side that your baby is turning toward (your midwife will be able to tell you which side that is).
Application of heat A heating pad or hot-water bottle placed against your lower back may help between contractions. A hot shower, directed onto your back, may also give some relief.
Prolonged Labor
Labor is said to be prolonged when contractions fail to bring about the expected delivery. This may be ‘because the cervix hasn’t dilated, or the baby hasn’t descended through the birth canal. Doctors and midwives keep a very careful eye on the length of each stage of labor. If labor appears to be going more slowly than normal, your attendants may suspect obstruction and make an early decision to intervene-with a forceps delivery or vacuum extraction, if suitable, or a cesarean section.
No woman is allowed to go on with a difficult birth for much over the accepted times because this may lead to maternal exhaustion and fetal distress.
It’s usually easier to detect obstruction in a mother who has had several children. But your midwife will be monitoring your general condition throughout labor, and she’ll be alerted to possible obstruction if your condition appears to get worse and you look tired and anxious.
If your labor is very long and you’re going without food and rest, you might become too tired or upset to push enough. Your midwife won’t let this happen.
Failure to dilate When contractions are weak and infrequent and your cervix is dilating slowly, the uterus may be failing to coordinate muscular activity. One way in which your midwife will be able to see exactly how your labor is progressing is by plotting a partogram. If failure of the uterus to contract efficiently is the only reason for the lack of progress, your attendants may suggest speeding up dilatation. The membranes may be artificially ruptured and then Pitocin may be administered intravenously with a drip or with a pump. The dosage will be carefully increased until strong contractions are coming regularly about every three minutes. Your midwife and doctor will keep a close watch throughout to make sure there are no unexpected increases in the strength or frequency of your contractions.
Failure to descend I’ve mentioned breech and posterior presentation as causes of obstruction. One other reason for an obstructed labor is disproportion. This means that the size of your baby’s head and the size of your pelvis don’t match-for example, if your pelvis is too small relative to your baby’s head. It’s easy to understand how your baby might fail to descend in such circumstances.
If you’re a first-time mother and your baby is still high and non engaged during the last few weeks of your pregnancy, your doctor may suspect disproportion. This will also be taken into account if your baby’s head remains high during labor despite strong contractions.
If the disproportion is quite slight, your doctor may let you try having a normal labor (bear in mind that it’s your uterus on trial, not you), provided there are no other irregularities, and the baby’s head is felt to be descending. Once the baby’s head enters the pelvic cavity, there can usually be a vaginal delivery. If the disproportion is major, which is rare, you’ll need a cesarean section.
Don’t worry-most of the abnormalities that cause obstruction and prolonged labor will be picked up during your pregnancy so that early treatment is possible, and a plan of action can be laid out by the doctors and midwives before labor begins.
Premature Labor
A premature labor is one that starts at less than 37 weeks of gestation. The cause is a mystery in about 40 percent of cases, but it’s known to happen in the following circumstances: premature rupture of the membranes; multiple pregnancy; preeclampsia; cervical incompetence; and uterine abnormalities. Overwork, stress, and some maternal diseases, such as anemia or malnutrition, may also have an effect.
Knowing whether you’ve actually gone into premature labor is almost as difficult for your doctors as it is for you. The diagnosis is not easy, and criteria differ at different clinics-showing that often it’s quite arbitrary. As a general rule, a premature labor begins without any warning; the first sign may be rupture of the membranes, the beginning of uterine contractions, or some vaginal bleeding. There’s no stopping labor if your membranes have ruptured and labor has begun, but you or your doctor can take certain precautions while the membranes are intact or before labor really gets going.
What you can do If your membranes have ruptured but labor hasn’t started, go straight to the hospital. The risk of infection is great, and both you and your pre term baby will be vulnerable. The doctors will monitor you closely for signs of infection, such as a fever, and will give you antibiotics. Labor is unlikely to be suppressed once the membranes have ruptured spontaneously. Nonetheless, if labor doesn’t start spontaneously, it won’t usually be induced until after 34 weeks unless there are signs of infection.
What the hospital will do If labor starts between 24 and 34 weeks, the aim is to delay your labor with ritodrine or magnesium sulfate to allow time to mature the baby’s lungs with steroids. A preterm baby has an increased risk of developing respiratory distress syndrome, and the shorter the gestation period, the greater the risk.
Being in hospital also allows your doctor to check for evidence of infection in cases of premature rupture of the membranes, and to monitor your baby’s condition. It also means that your premature baby can be taken to intensive care immediately after delivery and cared for.
If your local hospital does not have a neonatal intensive care unit that can handle very premature babies, you may need to be moved to another hospital that has these facilities. This may be farther away, making it harder for your partner, friends, and family to visit you, but be comforted by the thought that the NICU will be able to give your tiny baby the best possible start in life after the birth.
Drug treatments All of the drugs used cause some side effects, and for that reason they’re only suitable in certain cases of premature labor. The main criteria for drug treatment are that you are healthy and have no heart disease, diabetes, high blood pressure, or an abnormally placed placenta. Another, of course, is that your baby is alive, with no evidence of a congenital defect.
If you are very anxious, a mild sedative may be given to help to calm you, but morphine and Demerol should not be given during labor unless your pain is extremely severe. These drugs may make your uterine muscles more irritable rather than calming them down, and they may also have a sedating effect on your premature baby.
Managing labor Once the membranes have ruptured, labor will go on as normal. As a general rule, a premature labor tends to be shorter and easier than full-term, mainly because the baby’s head is smaller and softer. However, an episiotomy is usually given to protect the baby’s head from pressure changes within the birth canal.
You may prefer to have an epidural anesthetic instead of analgesic drugs, which can depress your baby’s respiratory system. Doctors will take special care to avoid hypoxia (lack of oxygen to the tissues) throughout labor and delivery. Cesarean delivery is used to deliver some premature babies, particularly if there is fetal distress.
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