Prenatal Complication and Induced Deliveries

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Premature labour : If premature labour is inevitable, then a caesarean section may be performed. This is because the soft head of the baby has to be protected from the trauma of delivery and the risk of brain damage.

Cord prolapse : If the umbilical cord descends before the baby when the membranes rupture, the risk to the baby is considerable because the pressure of the head can pinch the cord against the pelvis and cut off the blood supply to the baby. It is a clear indication for a section.

Foetal 'distress' : The baby becomes distressed if it does not get enough oxygen. It may be due to the cord being tight or the effect of pressure on the baby, particularly if it is not in a favourable position. Distress may be shown by an alteration in the baby's heartbeat. If it seems that the baby is in increasing distress, a section is the only answer.

Failure to progress : If you have been in labour for sometime and your cervix has ceased to dilate any further; it may lead to a section. But if you and the baby are not distressed, then be patient, longer labours are not unnatural.

Obstructed labour : This can be a cause of failure to progress. It includes babies whose presenting part is the shoulder or various parts of the face. If the position remains unchanged throughout the labour, then the baby has to be delivered by a caesarean section.

Failed induction : No induction should be performed without a pressing medical cause such as rising blood pressure which cannot be controlled. In circumstances of urgency, a failed induction must lead to a section. If, however; it has been done for less convincing reasons and it fails, then perhaps it should be accepted that the woman is not yet ready to have her baby. If the membranes have been ruptured artificially, the foetus will be at risk of infection.

Failed forceps : If the baby is stuck in the second stage and squatting and forceps have failed to deliver it, or if the baby is in such a position that forceps would be dangerous, then an operation is essential.

Caesarean Section : If the baby cannot be born through the birth passage, then the mother may need a caesarean operation. Delivery by a caesarean section involves an incision being made on the abdominal wall and uterus and the baby being removed while the mother, is under general or epidural anaesthesia. The mother stays in the hospital for about two weeks. If one baby is born by a caesarean operation, then the mother must have her future deliveries in the hospital; in case of a caesarean birth again. If the mother tries to have the baby at home; the uterus may rupture or tear open inside, which will be fatal for both mother and child.

Possible indications for a Caesarean Section : There are reasons for which one might have an elective caesarean (that is not done as an emergency).

Placenta praevi : When the placenta is sighted low down in the uterus. If it is completely blocking the cervix, there is no alternative to caesarean section. If there is bleeding during pregnancy, you can have the position of the placenta determined by ultrasound and a decision can be made on the basis of this result.

Placental abruption: The placenta may come away from the wall of the uterus prematurely causing pain and bleeding. Except in minor degrees, this is an indication for operating immediately.

High blood pressure : It may be necessary to extract the baby by section, if the blood pressure cannot be controlled. This is because the risk of depriving the baby of oxygen during induced labour is high.

Previous caesarean section : As mentioned earlier, if you have had two or more caesarean deliveries, you are unlikely to be given the contracted pelvis: It may he necessary if your pelvis has been damaged by an injury.

Small pelvis : Mothers with small pelvis may need a caesarean section. Though this is not necessarily an indication as it is not possible to predict accurately before labour whether a baby will be able to fit through a pelvis

Herpes : Active sores are a serious indication for a caesarean operation as the baby may contract herpes during birth.

Transverse lie: If the baby lies across the uterus, instead of vertically, a caesarean section is needed.

Breech position : This is the most disputed indication. There is an increased risk associated with breech births because the baby's head can be subject to sudden pressure when it comes rapidly through the pelvis and such pressure can damage the membranes of the brain. Some consultants will deliver breech babies only by a caesarean operation. Placental insufficiency: If the baby does not seem to be growing because the placenta is not working well, it may be necessary to deliver the baby rapidly without putting any further strain on the placenta.

When do you need stitches (Episiotomy)?

Episiotomy is a cut made by the midwife or doctor into your perineum in order to enlarge the outlet for your baby. If the birth is quick, or the baby is large, then the skin around the vagina may tear. Sometimes, the baby needs to be born quickly, so the midwife or doctor makes a small cut in the mother's perineum to make it easier for the baby to come out. As with a tear, the cut is sewn up a few minutes after the birth. The doctor will inject the mother so that she feetis no pain while the tear is sewn up with a special thread. The thread melts and drops out after a few days. The area may be very sore, which can be helped by sitting on a soft cushion.

Remember to keep the stitches as clean and dry as possible.
Use a handful of salt in the bath as an antiseptic.
Sit in a tub of hot and cold water alternatively.
Although the stitches are meant to be absorbed; your midwife may be able to help by snipping some after a few days.

Forceps : Forceps are used to hasten delivery in cases of foetal distress and to help the baby out, if the mother is unable to push it out herself. The mother may have a small pelvis, or the birth may go on so long that the baby gets tired. Forceps may also be needed to protect the head of a premature baby or to turn the baby's head; if it is stuck in the pelvis. This does not hurt the baby, though the baby's head may look odd for a day or two.

What to do if the midwife doesn't get there in time?

If labour happens very quickly, before the midwife arrives, make sure you have someone with you to help. Here is what your helper can do to ensure a smooth delivery:

Keep calm.
Except for one or two helpers, ask everyone to leave the room.
Keep the room well-aired and well-lit.
Place a sheet of plastic or rubber underneath the mother- to-be.
Wash the area around her vagina with boiled water and clean rags.
Wipe away faeces, if any, with dean rags.
Those present in the room should have clean hands and nails.
Ask the mother to stop pushing as soon as you see the baby's head.
When the baby's head is out, feel with a finger around the baby's neck for the umbilical cord. If it is wrapped around the neck, hook a finger under the cord and lift it over the head and conduct delivery with proper guard.
After the baby is brought out, nark the augur score, clean the airways, cut the cord aseptically, clean the baby and wrap him/her with a clean sheath and then place him/her to the mothers lap for nursing.

Submitted By:
DR. MASWOODUR RAHMAN PRINCE

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