Problems of labor and childbirth

Even if you're doing everything right as you go through labor and childbirth, complications can occur. If something does go wrong, trust your health care provider to do the best for both you and your baby. If you aren't comfortable before birth with the care you're receiving, that's the time to make a change. It's important to trust your health care team when problems arise in labor because treatment usually must begin quickly. That's not the time to doubt your provider's skill.

If things start to go wrong, it's easy to feel out of control. Often, it's best to be as flexible as you can. Your health care provider can explain concerns and discuss possible outcomes and new courses of action. Together, you can make a decision about what the next step should be.

Labor that fails to start

Sometimes, labor won't start on its own. If this happens to you, your health care provider may decide to start (induce) your labor by artificial means, through medical intervention.

Signs and symptoms

Your health care provider may induce labor for a variety of reasons. He or she may recommend labor induction if your baby is ready to be born but contractions haven't started yet or if there's concern for the health of you or your baby. Some situations in which you may be induced include:

• Your baby is overdue. You're beyond 42 weeks, or in some cases 41 weeks, pregnant.

• Your water has broken (membranes have ruptured), but your labor hasn't started.

• There's an infection in your uterus.

• Your health care provider is concerned that your baby is no longer thriving because your baby's growth has slowed or stopped, the baby isn't active enough, there's a decreased amount of amniotic fluid, or your placenta is no longer nourishing the baby.

• You have high blood pressure resulting from your pregnancy (preeclampsia).

• You have diabetes or complications of lung disease, kidney disease or other pre-existing medical conditions that may put you or your baby at risk.

• The placenta has started to separate from the wall of your uterus.

• You have rhesus (Rh) factor complications, which means that your blood and that of your child may not be compatible.

You may be induced for other reasons, such as if you live a long way from the hospital or if you had a rapid delivery the last time you had a child.

If you were planning on a natural delivery but your health care provider wants to induce labor, try to view it as a positive. Making an appointment to have your baby can be much more convenient than waiting for nature to take its course. Induction may allow you to be more prepared, mentally and physically, when you go to the hospital.

Treatment

Your health care provider can induce labor in several ways. But before labor can be induced, your cervix must be softening (ripening) and opening (dilating). If it isn't doing so naturally, your health care provider can give you certain medications — known as cervical-ripening medications — to get things started.

Synthetic forms of prostaglandins, the natural chemicals that trigger contractions in your uterus, can be used to soften and dilate your cervix. Misoprostol (Cytotec) is one such drug. Dinoprostone (Cervidil, Prepidil) is another. These medications often work to begin labor as well, and they may reduce the need for other labor-inducing agents, such as oxytocin. In addition, they tend to decrease the time between induction and delivery.

All medications that induce labor carry one major risk: They might cause exaggerated contractions that may affect your baby's oxygen supply. Because of this risk, your health care provider may monitor your baby's heart rate while any of these agents are being administered. That way the dose can be adjusted in response to any unwanted effects.

In addition to prostaglandin preparations, other means can be used to soften and dilate the cervix. One way is to place into the uterus by way of the cervix a small catheter with a water-filled balloon. The uterus is irritated by the balloon and expels it through the cervix, softening and opening it somewhat. Another technique is to place into the cervix small cylinders of dried leaves of the laminaria plant. The cylinders draw in water and get thicker, thereby slightly dilating the cervix.

If you need to have your cervix ripened, you may go to the hospital the night before your labor is induced to give the medication time to work.

To induce labor, your health care provider may use one or both of these techniques:

Artificial breaking of your water

When your water breaks, the amniotic sac that envelops your baby is ruptured and the fluid begins to flow out. Normally, this signals that the baby isn't too far behind. One of the results of this rupture is an increased production of prostaglandins in your body, leading to increased uterine contractions.

One way of inducing or accelerating labor is to artificially rupture the amniotic sac. To do this, your health care provider inserts a long, thin plastic hook into the cervix and creates a small tear in the membranes. This procedure will feel just like a vaginal exam, and you'll probably sense the warm fluid coming out. It isn't harmful or painful to you or your baby.

Having your health care provider break your water can shorten the duration of your labor. It also gives your health care provider a look at your amniotic fluid, which can be examined for the baby's first bowel movement (meconium). Feces from the baby in the amniotic fluid stains the fluid a greenish-brown and demands that a few precautions be taken. If meconium is found, your labor will likely be monitored a bit more closely.

Administration of oxytocin

Oxytocin is a hormone that your body produces at low levels throughout pregnancy. These levels rise in active labor. Your health care provider may use a synthetic version of oxytocin (Pitocin) to induce labor. Usually, oxytocin is administered after your cervix is dilated somewhat and thinned (effaced).

Oxytocin is administered intravenously. An intravenous (IV) catheter is inserted into a vein in your arm or on the back of your hand. Connected to your IV is a pump that delivers small, regulated doses of oxytocin into your bloodstream. These doses may be adjusted throughout your induction, in case your contractions become too strong or not frequent enough. Contractions usually begin after 30 minutes if you're at or close to full-term, and they are generally more regular and more frequent than are those of a naturally occurring labor.

Oxytocin is one of the most commonly used drugs in the United States. It can initiate labor that may not have started otherwise, and it can also speed things up if contractions stall in the middle of labor and progress isn't being made. Uterine contractions and your baby's heart rate are monitored closely to reduce the risk of complications.

If labor induction is successful, you'll begin to experience signs of active, progressive labor, such as longer-lasting contractions that are stronger and more frequent, dilation of your cervix and rupture of your amniotic sac — if it hasn't broken or been broken already.

Induction of labor should be done only for good reasons. If the health of you or your baby is in question and an induction is unsuccessful, your doctor may decide to take further intervention, such as a Caesarean delivery.

Labor that fails to progress

If your labor isn't progressing, a condition called dystocia, it's usually due to a problem with one or more components of the birth process. Progress in labor is measured by how well your cervix opens (dilates) and the descent of your baby through the pelvis. Good progress is the progressive dilation of your cervix and descent of your baby. This progress requires the following:

• Strong contractions

• A baby that can fit through the mother's pelvis and is in the correct position for descent

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