Abnormalities of Labor

As complicated as labor is, there are a number of situations that can arise that would present a danger to the mother, the baby, or both. The baby and the umbilical cord must be correcting positioned in the birth canal throughout the process for a healthy delivery. While a condition as mild as slow labor can be easily corrected with medicine, several other complications are more severe. The remedy for many of these complications is birth by cesarean section.

Labor is defined as the process by which the uterus rhythmically contracts and expels the baby and placenta. Labor is a progressive process that generally does not stop until the baby and placenta have been delivered.

For a woman pregnant with her first child, the average length of time from the beginning of labor to the delivery of the baby is about 14 hours; for a woman with at least one previous delivery, it is about 8 hours.

During a woman's labor, the doctor examines the cervix periodically (about every two hours) to determine how far it has dilated (widened). Before labor begins, the cervix is closed. When the cervix is fully dilated, it has reached 10 centimeters in diameter (there are 2.54 centimeters per inch). At this point, the baby's head has enough room to move into the vagina and be delivered.

The nurse or doctor also checks the baby's heartbeat during labor. Sometimes a special stethoscope called a fetoscope may be used. More commonly today, hospitals use an electronic fetal monitor. With this device, a special microphone is placed on the mother's abdomen above the uterus and secured with a strap. This microphone is connected to the fetal monitor, which amplifies the sound of the heartbeat and records the heart rate on a moving strip of paper. The baby's heart rate during labor is normally in the range of 110 to 160 beats per minute.

Another function of the fetal monitor is to record the mother's labor contractions. A special pressure-sensing device is secured to the abdomen with a strap and then connected to the monitor. Each time a labor contraction occurs, it shows up on the monitor paper as a short wave. By watching the monitor, the nurses and the doctor can tell how frequently the mother is having contractions.

Slow Labor

Some women may experience abnormally slow labor, which is usually caused by mild or infrequent contractions. The doctor can detect this by looking at the fetal monitor and noting that the cervix is dilating slowly. The usual treatment of slow labor is to give the drug oxytocin (Pitocin) intravenously. Oxytocin speeds up labor contractions and causes them to become stronger.

Failure to Progress

In some cases, the mother may have been in labor for many hours without giving birth. The doctor's examination usually shows that either the cervix has stopped dilating or the baby is still high up in the mother's pelvis. In medical terms, this problem is called failure to progress.

Failure to progress is usually caused by one of two problems: either the baby is too large to fit through the mother's pelvic bones or the mother's pelvic bones are too small to allow the delivery of even a normal-size baby.

Since in many cases of failure to progress the baby cannot fit through the pelvis, cesarean section is necessary to ensure a safe delivery.

Prolapse of the Umbilical Cord

The umbilical cord is the attachment between the fetus and the placenta. It literally forms the lifeline of the fetus through which it obtains oxygen and nutrients from the mother. During labor, a portion of the umbilical cord may prolapse (fall down) into the vagina before the baby is delivered.

If this occurs, the umbilical cord may become compressed between the fetal head and the walls of the mother's pelvis, thereby cutting off the blood supply to the fetus. Unless a vaginal delivery is expected to occur immediately, cesarean section must be performed to save the baby's life.

Abnormalities of the Fetal Heart Rate

During labor, the fetal heart rate is normally steady. In some situations, however, there may be a decrease, or deceleration, of the heart rate during uterine contractions. Compression of the fetal head against the wall of the mother's pelvis may give a particular pattern of deceleration that is quite normal, especially during the latter parts of labor.

Serious causes of fetal heart rate deceleration include problems with the placenta and a compressed or pinched-off umbilical cord. Since these decelerations may mean that the fetus is not getting enough oxygen, immediate delivery of the baby -- usually by means of cesarean section -- is necessary.

The range of complications that can have severe repurcussions on a mother and baby may seem like they make pregnancy a scary time. But most pregnancies are normal and healthy, and hospitals are well equipped to handle most adverse situations. Knowing what to do in the unlikely event something does go wrong will help you delivery a strong, healthy baby.

Hemorrhage

Excessive bleeding or hemorrhage is a serious complication of labor and is usually caused by either placenta previa or placental abruption. Immediate cesarean section is usually necessary to save the life of both the mother and baby.

It is not healthy or helpful to dwell on what can go wrong during a pregnancy. However, a little knowledge about pregnancy complications can show you that they are rare, often corrected, and an aspect of pregnancy that all parent have to confront.

ABOUT THE AUTHOR

Dr. Elizabeth Eden, M.D. is a practicing obstetrician with her own private practice in New York City. She serves as an attending physician at the Tisch Hospital of the New York University Medical Center, as well as a Clinical Assistant Professor at the New York University School of Medicine.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.