Childbirth, complications

Childbirth, complications

Childbirth, complications of: Childbirth used to be a very dangerous process, resulting
in the deaths of many mothers and babies. Thanks to modern medicine, it is now
remarkably safe. The rate of death for newborn babies is quite low, and for mothers even
lower. Nevertheless, certain conditions, known as complications, may occur before,
during, or immediately after birth. These require special medical attention to prevent
death or lasting harm.

Premature delivery One of the greatest dangers a baby can encounter is to be born too
early, before the body systems are mature enough to ensure survival. The lungs, for
example, may not be able to breathe air, the body may not generate enough heat to keep
warm, and the digestive system may not be able to transform food into nourishment.
Whenever possible, drugs and other measures prevent or stop premature labor before it
results in birth. If these fail, intensive care can keep many premature babies alive.
As a fetus approaches birth, it should move into position with its head down. Just
before birth, the fetus turns and faces the mother's back, but if there is premature
rupture of the membranes, the birth process begins before the fetus has reached the
correct position.

Premature rupture of membranes (PROM) Normally the membranes surrounding the baby in the
uterus break and release amniotic fluid (known as the "water breaking") either during
labor or right before it. Sometimes, however, the membranes rupture prematurely, and
labor does not immediately follow. Without the protection of the membrane sac, the baby
runs a high risk of infection.
If the baby is mature enough to be born, the usual remedy is either chemically induced
labor or surgical delivery (cesarean section). If the baby is still immature, antibiotics
and other means are used to prevent infection and hold off labor.

Abnormal presentation Most babies, by the time they are ready to be born, are positioned
head down in the uterus and facing the mother's back. This is the safest and easiest
presentation for birth. Other positions, such as a breech presentation, with the head up
and the legs or buttocks down, cause difficulties with delivery and may require a
cesarean section.

Cephalopelvic (sef-uh-loh-PEL-vik) disproportion The largest part of a baby is the head.
Sometimes the head (cephalos in Greek) is too big to pass through the ring of the mother's
pelvic bones. If the disproportion is severe enough, a cesarean delivery may be necessary.

Umbilical cord compression or prolapse Until a baby is born and breathing air, the hollow
umbilical cord between the placenta and the baby's navel is a vital lifeline for the
delivery of oxygen. Without a steady supply of oxygen, the baby will suffer dangerous
asphyxia. Before or during labor circulation through the cord may become reduced or cut
off. The cord may be compressed if it gets tightly wrapped around the baby's body. Or
it may slip forward (prolapse) into the birth canal during labor and then get trapped
between the baby and the canal. The cord can sometimes be freed during ordinary delivery,
but an emergency cesarean may be necessary.

Asphyxia (as-FIK-see-uh) Before birth the oxygen a baby needs must be supplied by the
mother, carried in blood that is transferred through the placenta and the umbilical cord.
At birth this source is cut off, and oxygen must be absorbed from the baby's own lungs.
In either case, if the oxygen supply is interrupted, the baby quickly suffers oxygen
deprivation, or asphyxia, which may cause death or permanent damage. For example,
asphyxia is thought to trigger bleeding into the brain, which in turn is believed to be
a major cause of cerebral palsy, epilepsy, and hydrocephalus. Before birth asphyxia may
result from several conditions, ranging from preeclampsia see ( Pregnancy and disease)
to prolonged labor. The main solution is to deliver the baby as soon as possible, by
cesarean section if necessary.
If a newborn baby does not breathe properly, resuscitation measures are used to prevent
asphyxia (below).

Birth injuries A baby's passage through the birth canal is often a tight squeeze, and
injuries are not uncommon. Most of them, such as bruises and swellings on the head, are
minor and soon disappear. Others, such as a broken collarbone or damaged nerves in the
neck, may require treatment with a supporting splint or even surgery.

Breathing difficulties For any of several reasons a newborn may have trouble breathing
properly and may risk asphyxia. The baby might have wet lung syndrome, for example: The
lungs fail to become entirely free of the fluid that filled them before birth and as a
result cannot absorb enough oxygen. Or the lung surfaces may be clogged with meconium
(mee-KOH-nee-um), a waste material released prematurely from the baby's bowel. Or the
normal flow of nervous impulses that control breathing may be impaired, causing
temporary apnea (ap-NEE-uh), or "nonbreathing."
A variety of resuscitation measures are used to stimulate breathing and to ensure a
supply of oxygen to the lungs. These range from simply massageing the chest to
administering stimulative drugs and providing oxygen through a mechanical respirator.