Childbirth Complications (cont.)
Failure to progress refers to labor that does not move as fast as it should. This could happen with a big baby, a baby that does not present normally or with a uterus that does not contract appropriately. But more often than not, no specific cause for "failure to progress" 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 section may be indicated.
Sometimes a placenta previa may cause an abnormal presentation. But many times the cause is not known. Towards 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.
One option typically offered to women after 36 weeks is an "external cephalic version," which involves manually rotating the baby in cog-like fashion inside the uterus. These manipulations work about 50% to 60% of the time. They're usually more successful on women who have given birth previously because their uteruses stretch more easily.
"Versions" typically take place in the hospital, just 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 administer a uterine muscle relaxant, then use an ultrasound machine and electronic fetal monitor as guides. The procedure typically doesn't involve anesthesia, but sometimes an epidural can help with the version. 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 cord to become entangled or the placenta to separate from the uterus. There's also a chance that the baby might flip back into a breech position before delivery, so some doctors induce labor immediately. The risk of reverting to breech is lower closer to term, but the bigger the baby, the harder it is to turn.
The procedure can be uncomfortable, but avoids a cesarean section, which is most likely if the baby can't be moved into the proper position.
Umbilical cord prolapse happens more often when a fetus is small, preterm, in breech (frank, complete or incomplete/footling) presentation, or if its head hasn't entered the mother's pelvis yet ("floating presenting part"). This prolapse can occur, too, if the amniotic sac breaks before the fetus has moved into place in the pelvis.
Umbilical cord prolapse is an emergency. If you are not 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 cesarean delivery will probably be performed unless a vaginal birth is already progressing naturally.
Umbilical Cord Compression
Umbilical cord compression can occur if the cord becomes wrapped around the baby's neck or if it is positioned between the baby's head and the mother's pelvic bone. You may be given oxygen to increase the amount 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 cesarean section.
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