Blood transfusions are required in a very small percentage of births. Women do lose some blood during a routine labor and delivery. But it's not a lot — generally not enough to warrant a blood transfusion.
Women at high risk of needing a blood transfusion are those who have a known blood-clotting disease, have had bleeding problems with past births or have placenta previa. Placenta previa is a condition in which the placenta is near or blocks the opening of the cervix. Sometimes, a blood transfusion is necessary if you have a Caesarean birth. Certainly, the small percentage of women who experience major blood loss (hemorrhage) during or after labor and delivery may need a transfusion.
If you're worried about the possibility of needing blood during delivery, discuss your questions and fears with your health care provider. Be assured, though, that the risk of contracting a disease from a transfusion in the United States today is very low.
walk or change positions to assist in labor. You'll likely be given fluids intravenously, to keep you hydrated, if you're having a long labor.
However, if you've been in active labor and you haven't made any progress for several hours, your health care provider may start oxytocin and rupture your membranes — if your water hasn't broken already — in an attempt to move things along. These steps may be enough to restart labor and allow you to deliver naturally.
Your health care provider may consider the possibility that your baby's head is too large to pass through your pelvis. That may mean that you need a Caesarean birth.
Your health care provider may consider a Caesarean birth if you haven't made good progress after pushing for two to three hours or longer. However, if you're able to continue and the baby isn't showing signs of distress, you may be allowed to push for a longer time. Sometimes, near the end of your labor, the baby's head can be eased out with the gentle use of forceps or a vacuum extractor. You may be asked to try a semisitting, squatting or kneeling position, which can help to push the baby out.
Complications with the baby
Your labor and delivery may become complicated if your baby is in an abnormal position within your uterus — making vaginal delivery difficult or, sometimes, impossible.
At around the 32nd to 34th week of pregnancy, most babies settle into a head-down position for descent into the birth canal. As your due date nears, your health care provider may determine the position of your baby simply by feeling your abdomen for external clues as to the baby's placement, by doing a vaginal exam or, sometimes, by using ultrasound. Occasionally, an ultrasound is done while you're in labor to determine the baby's presentation.
If your baby isn't in position for an easy exit through your pelvis during labor, problems can develop. Several positions can cause problems.
Signs and symptoms
Your pelvis is widest from side to side at the top (inlet). The baby's head is widest front to back. Ideally, the baby's head should turn to one side once engaged at the top of the pelvis. The chin is then forced down to the chest so that the more narrow back of the head leads the way. After descending to the midpelvis, the baby needs to turn either facedown or faceup to align with the lower pelvis. Most babies turn facedown, but when a baby is facing up, progress in labor can be slowed. Health care providers call this the occiput posterior position. Intense back labor and prolonged labor may accompany this position.
Occiput posterior position
Most babies will turn on their own, if there's enough room. Sometimes, changing positions can help rotate the baby. Your health care provider might have you get on your hands and knees with your buttocks in the air. This position can cause your uterus to drop forward and the baby to rotate.
If this doesn't work, your health care provider might try to rotate the baby manually. By reaching through your vagina and using his or her hand as a wedge, he or she can encourage the baby's head to turn facedown. If this technique isn't successful, your health care team can monitor your labor to determine whether your baby is likely to fit through your pelvis faceup or whether a Caesarean birth would be safer. Most babies can be born faceup, but it may take a bit longer.
Signs and symptoms
Your baby's head is at an awkward angle
When a baby's head enters the pelvis, ideally the chin should be pressed down onto the chest. If the chin isn't down, a larger diameter of the head has to fit through the pelvis. However, a baby can enter the birth canal presenting with the top of the head, the forehead or even the face — none of which are preferred positions for descent.
If your baby's head moves through your pelvis at an awkward angle, it can affect the location and intensity of your discomfort and the length of your labor.
Your doctor may have to consider a Caesarean birth if your baby isn't making progress down the birth canal or shows signs he or she isn't tolerating labor.
Signs and symptoms
Your baby's head is too big to fit through your pelvis
When a baby's head is too big to fit through the pelvis, the problem is called cephalopelvic disproportion. The problem may be that the baby's head is
Occiput posterior position too big, or the mother's pelvis is too small. Or it may be more that the baby's head isn't properly aligned and the smallest width isn't leading the way. No matter what's causing the problem, labor can't progress beyond a certain point, and the cervix won't continue to dilate. The result is prolonged labor.
You may expect your health care provider to have an idea ahead of time whether your baby will fit through your pelvis. With an ultrasound exam, your baby's size can be estimated. But it's nearly impossible to predict the course a labor will take. The forces of labor can temporarily mold a baby's head, even when poorly positioned, to fit through the pelvis, and loosened ligaments allow the bones of the pelvis to move. Because of these variables, the best way for your health care provider to find out whether your baby's head is a match to the roominess of your pelvis is to monitor your labor as it progresses. If necessary, the baby can be delivered by Caesarean birth.
Signs and symptoms
Your baby is breech
A baby is in the breech presentation when the buttocks or one or both feet enter the pelvis first.
Breech presentation poses potential problems for the baby during birth, and those problems can, in turn, create complications for you. A prolapsed umbilical cord is serious and more common in breech births. In addition, it's impossible to be certain whether the baby's head will fit through the pelvis. The head is the largest and least compressible part of the baby to travel through the birth canal, and it may become trapped even though the body was born easily.
Your health care provider may try to turn the baby into the proper position, usually a few weeks before your due date. This technique is called an external version. If the baby isn't too far down in the pelvis, your health care provider might be able to move the baby into a head-down position simply by pushing on the baby through your abdomen.
If the external version doesn't work, your health care provider will likely discuss with you the option of a Caesarean birth. Although most babies born breech are fine, current evidence indicates that a Caesarean birth is safer for almost all babies in breech presentation.
Signs and symptoms
Your baby lies sideways
A baby that's lying crosswise (horizontally) in the uterus is in the position called transverse lie.
Just as in breech presentation, an external version may be successful. All babies who remain in this position are delivered by Caesarean birth, and even laboring with a baby in this presentation may be harmful.
Signs and symptoms
If the umbilical cord slips out through the opening of the cervix, blood flow to the baby may be slowed or stopped. Cord prolapse is most likely to occur with a small or premature baby, with a baby in a breech position or when the amniotic sac breaks before the baby is down far enough in the pelvis.
If the cord slips out after you're fully dilated and ready to push, a vaginal delivery may still be possible. Otherwise, a Caesarean birth is usually the best option.
Signs and symptoms
If the umbilical cord becomes squeezed between any part of the baby and the mother's pelvis, or if there's a decreased amount of amniotic fluid, the umbilical cord can become pinched (compressed). Blood flow to the baby is slowed or stopped during a contraction. This problem usually develops when the baby is well down the birth canal, close to the time of birth. If cord compression is prolonged or severe, the baby may show signs of decreased oxygen supply.
To minimize the problem, you may be asked to labor in various positions, to take weight off the cord. You may be given oxygen to increase the amount the baby gets. It may be necessary for your health care provider to get the baby out with forceps or a vacuum extractor or, if the baby is too high, a Caesarean birth.
A fetus is considered to be intolerant of labor if he or she persistently demonstrates signs that suggest decreased oxygen supply. These signs are usually detected by studying the fetal heart rate on an electronic monitor. Decreased oxygen delivery to the baby usually occurs when blood flow from the placenta to the baby is reduced, meaning that he or she isn't receiving enough oxygen from the mother. This may mean that the baby will need to be delivered quickly.
Potential causes for this problem include compression of the umbilical cord, decreased blood flow to the uterus from the mother and a placenta that's not functioning correctly.
During labor, your baby's heartbeat may be monitored regularly. If your baby's heart beats persistently very quickly or very slowly, it can mean that he or she isn't receiving ample oxygen. By using a fetal monitor, your health care provider can pick up heartbeat irregularities that may indicate concern. Two methods of fetal monitoring are:
In external monitoring, two wide belts are placed around your abdomen. One is put high on your uterus to measure and record the length and frequency of your contractions. The other is secured across your lower abdomen to record the baby's heart rate. The two belts are connected to a monitor that displays and prints both readings at the same time so that their interactions can be observed.
Internal monitoring can be done only after your water has broken or has been broken for you. Once your amniotic sac has ruptured, your health care provider can actually reach inside your vagina and dilated cervix to touch the baby. To monitor the baby's heart rate, your doctor attaches a tiny wire to the baby's scalp. To measure the strength of contractions, the doctor inserts a narrow, pressure-sensitive, fluid-filled tube between the wall of your uterus and the baby. The tube responds to the pressure of each contraction. As in external monitoring, these devices are connected to a monitor that displays and records the readings, as well as amplifies the sound of your baby's heartbeat.
Other tests may be needed to indicate how well your baby is tolerating labor. These may include:
Ordinarily, when a baby's scalp is stimulated by the health care provider's touch, the baby will move around, and his or her heart rate will go up. A baby who doesn't have an increase in heart rate may not be getting enough oxygen.
A more precise test of the well-being of your baby can be done by checking the pH (acid-based balance) in a sample of the baby's blood. If the pH is low, it confirms the baby isn't getting adequate oxygen. In the test, a tube is inserted through the vagina and dilated cervix and pressed against the baby's head. Using a tiny blade on a long handle, the health care provider gently nicks the baby's scalp to obtain a drop of blood, which is sent to a lab and analyzed.
A baby whose pH is very low must be delivered quickly and treated, if necessary. However, most babies whose fetal-monitoring findings cause concern are normal, and many abnormal heart rates return to normal with minor intervention.
There are ways to help a baby get more oxygen. Your health care provider may give you medication during labor to slow your contractions, which increases blood flow to the fetus. If your blood pressure is low, you may be given a medication to increase it. You may also be given oxygen, if necessary.
Very rarely, a severe lack of oxygen to a baby can result in brain damage. In extreme situations, oxygen deprivation can be fatal. Your health care provider is trained to identify the signs of these problems and to minimize the risk of any complications developing.
The majority of cases of nervous system (neurologic) damage occur before labor begins. Current high rates of Caesarean birth haven't decreased the risk of these problems. In most cases, labor should be allowed to continue, even when there are signs the baby is responding to temporary stress.
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