Delivery

What are possible labor complications?

Although serious complications are rare during labor, some problems can develop during this time. Some of the more common complications include:

• fetal meconium

  When the amniotic sac membrane ruptures, the normal color of the amniotic fluid is clear and cloudy. However, if the amniotic fluid is greenish in color, it may indicate fetal meconium, which is normally passed as the baby's first stool, after delivery. Meconium (stool) in the amniotic fluid may indicate fetal distress. A woman should consult her physician or certified nurse midwife immediately.

• abnormal fetal heart rate

  The fetal heart rate during labor is a good indicator of how the fetus is handling the contractions of labor. If a fetus appears to be in distress, immediate action can be taken, such as giving the mother oxygen, increasing fluids, and turning the mother on her left side.

• abnormal position of the fetus during birth

  The normal position for the fetus during birth is head-down, facing the mother's back. However, sometimes a fetus is not in the right position, making delivery more difficult through the birth canal. There are several abnormal positions for a fetus:

  • positioned head-down but facing the mother’s front
  • positioned with the brow down in the mother’s pelvis
  • positioned breech (where the buttocks or feet are down first in the mother’s pelvis)
  • positioned with one shoulder in the mother’s pelvis

Depending on the position, a physician or certified nurse midwife may try to deliver the fetus as it presents itself, attempt to turn the fetus before delivery, or perform a cesarean delivery.

Delivery of the baby:

Delivery is the moment when the fetus, followed by the placenta, exits the mother’s body. In preparation of the delivery, a woman may be moved into a birthing room or delivery room, or she may remain in the same room for both labor and delivery. Fathers or partners are encouraged to be actively involved in the process of childbirth by helping with relaxation techniques and breathing exercises.

Positions for delivery may vary from squatting, sitting, to semi-sitting positions (between lying down and sitting up). With semi-sitting positions, gravity can help the mother in pushing the baby through the birth canal. The type of position for delivery depends on the preference of both the mother and the physician.

During the delivery process, the medical personnel will continue to monitor the mother's vital signs (i.e., blood pressure and pulse) and the fetal heart rate. The physician or certified nurse midwife will examine the vagina to determine the position of the fetus' head and will continue to support and guide the mother in her pushing efforts.

Delivery can either be accomplished vaginally or by cesarean section (also called c- section).

What is a vaginal delivery?

During a vaginal delivery, the physician or certified nurse midwife will assist the fetus’ head and chin out of the vagina when it becomes visible. Once the head is out of the vagina, the physician usually rotates the fetus to the side and eases his/her shoulders out, followed by the rest of the body.

What is a cesarean section (c-section)?

If a woman is unable to deliver the fetus vaginally, the fetus is delivered surgically, by performing a cesarean section. Cesarean sections are usually performed in an operating room or a designated delivery room. Some cesarean sections are planned and scheduled accordingly, while others may be performed as a result of complications that occur during labor.

Once the anesthesia has taken effect, an abdominal incision is made, the amniotic sac is opened, and the baby is removed. The woman may feel some pressure and/or a pulling sensation.

Following the delivery of the baby, the physician will stitch the abdominal incision and the mother is given oxytocin (either by an injection into the muscles or intravenously) to contract the uterus, thereby preventing bleeding from occurring.

Conditions for a cesarean section:

There are several conditions which may necessitate performing a cesarean section. These include, but are not limited to, the following:

• previous cesarean section
• infection in the mother
• chronic health conditions of the mother (i.e., heart disease or diabetes)
• fetal distress
• abnormal delivery presentation (i.e., breech, shoulder, brow)
• a labor that fails to progress or does not progress normally
• placental complications (i.e., placenta previa, in which the placenta blocks the cervix and presents the risk of becoming detached prematurely from the fetus)

What is the Apgar score?

The Apgar test is a scoring system designed by Dr. Virginia Apgar, an anesthesiologist, to evaluate the condition of the newborn at one minute and five minutes after birth. The physician or certified nurse midwife and nurses will evaluate the following signs and assign a point value:

A score of 7-10 is considered normal. A score of 4-6 may indicate that the baby needs some resuscitation measures (oxygen) and careful monitoring. A score of 3 or below indicates that the baby requires immediate resuscitation and lifesaving techniques.

Immediate care for the newborn:

When a baby first enters the world, there are several immediate steps taken to ensure that he/she is healthy, including:

• Mucus is cleared from the mouth, nose, and throat.
• The umbilical cord is cut and clamped shut near the navel.
• The baby’s weight and height are measured.
• The baby is cleaned, dried, and dressed.
• A physical examination is done.
• Silver nitrate solution drops (or a similar drug) are put in the eyes to protect them from infection.
• A vitamin K injection is given to help prevent bleeding.

Childbirth Services at OHSU

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