Complications at Delivery

I've talked about the way delivery usually goes on the previous pages. Occasionally, though, there may be complications, and some special procedures may be needed. Something unforeseen may happen once labor has started, meaning that forceps or a vacuum extractor have to be used. Other special deliveries, such as multiple and breech births, are usually diagnosed well in advance.

Assisted Delivery

If, as sometimes happens, labor and delivery don't go quite as smoothly as expected, your obstetrician may need some help to complete a vaginal delivery. Forceps can be used to protect your baby's head, or, along with vacuum extraction, may be used to speed your baby's progress through the birth canal.

Vacuum extraction - The vacuum extractor is a gentler alternative to forceps and is widely used. It's a cone-shaped cup of synthetic material that is placed over the baby's scalp. An attached pump is then used to create a vacuum that makes the cup hold fast to the baby's head. This instrument then becomes a "handle" that the obstetrician can use to rotate the baby's head and apply traction. Although the vacuum extractor leaves a bruise on the baby's head, it has many advantages.

Multiple Deliveries

If you're having twins, their delivery will always be treated as though you're having two single babies: if one has a vaginal delivery, it doesn't always follow that the other will. The risks of vaginal birth go up with the number of fetuses. As a result, women carrying more than two babies often have a cesarean delivery. Your doctor will probably suggest you have the babies in the hospital in case they aren't presenting properly. If all goes well, twins usually present head-down, the second one arriving eight to ten minutes after the first. Twin labors can be long, so an epidural anesthetic might help. Also, the second baby may have to be turned-this is done by rupturing the second baby's membrane and moving him by hand.

Twin deliveries are much safer than they used to be because the exact position of the second baby, and its condition, can be determined by ultrasound and fetal monitors. If you're carrying three or more babies, it's more likely that you'll have a cesarean section.

Breech Birth

One out of twenty-five babies is born in the breech position, so this isn't all that unusual. However, most breech babies are delivered by cesarean section, especially babies lying sideways in the uterus rather than head-down. In these cases a cesarean birth is the only choice for delivery. Breech doesn't always mean a cesarean section, though, and if your attendants decide it's safe for your breech baby to be delivered normally, he'll usually be born buttocks first, followed by his legs and body.

Before your baby's head can be delivered, you'll almost certainly have to have an episiotomy. The head is the widest part and your baby's rump will not have stretched your birth canal enough for his head to pass through it unpressurized.

Once your baby's body is born, his weight will pull his head down to the vagina. His body is then lifted upwards and slightly backwards by the doctor, and one push is usually enough to deliver him. Forceps may be used to protect the baby's head. It's now fairly common practice to have an epidural if you're having a breech birth, which means that if you do need a cesarean section it can be done quickly and simply without further anaesthesia.