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In truth, 94 percent of labour and deliveries suffer some kind of complication. Most are as simple as a laceration to the perineum which is stitched by the gynaecologist with no future problems. Another simple complication is the OP presentation in which the foetus descends the birth canal with the face facing up, called “sunny side up”. Other problems are more dangerous and the health of the foetus and the mother.
A total of 23 percent of deliveries are complicated by umbilical cord issue. The umbilical cord is caught around the baby’ head, goes in front of the foetal head or the cord is ruptured before delivery. If the cord is intact and isn’t compressing the blood flow to the foetus, there is usually a normal delivery out of it. If there is a cord prolapse or a ruptured cord, this is an obstetric emergency requiring imminent delivery by vaginal or caesarean means. There can be foetal distress and long term complications for the infant.
Perineal lacerations are more likely to happen in first baby deliveries. There are several degrees of lacerations from a mild first degree to a more serious 4th degree. The rate of these includes:
While a first degree only involves vaginal tissue, a fourth degree goes through the rectal wall and requires significant stitches. A complication can be problem with stooling. A woman can get a rectocele if the fourth degree is not repaired correctly. Perineal massage can go a long way to preventing a fourth degree tear. This is done during the last month of pregnancy and during the second stage of labour in order to lubricate the passage and stretch out the perineum.
An abnormal foetal heart rate or abnormal rhythm can happen during labour. Having a foetal heart rate outside of the normal range of 110 to 160 beats per minute or having a foetal heart arrhythmia can do some damage to the oxygenation of the fetus and are signs of foetal distress. The incidence of this in a normal delivery is 15 percent. It is picked up on foetal monitoring. If the heart rate is too high, it can mean foetal infection or foetal distress. Most foetal distress shows up as a low heart rate. The treatment for abnormal heart rates includes having an emergency delivery, whether it be vaginal or caesarean section. The foetal outcome can range from a normal infant to an infant with cerebral palsy. Another aspect of treatment is giving maternal oxygen during the delivery. The longer the foetus goes with low pulse, the greater the risk of foetal abnormality.
Breakage of water and having too much or too little amniotic fluid happens in 12 percent of cases. There can also be a rupture of membranes prematurely with a loss of amniotic fluid in a foetus that could use the fluid for comfort. Excess fluid is not usually a problem but rupture of membranes with too little fluid can cause foetal distress at any gestational age. Infection is considerably likely if the water is broken longer than 24 hours. It is for this reason that delivery is recommended prior to the 24 hour mark.
Failure to progress in labour happens when labour stalls out. It happens 8 percent of the time and is the most common reason to have a caesarean section. Pitocin is used to strengthen the contractions but it is not always successful. Complications include infection from prolonged rupture of membranes. Changing position fan improve the speed of labour. The worst part of labour is lying recumbent. Instead, lying on the hands and knees or standing up are preferable and will speed labour.
Uterine rupture can happen in labour and delivery, especially when there has been a previous caesarean section. This can cause foetal distress, blood loss and parental loss of blood pressure and is considered an obstetrical emergency. A caesarean section is warranted on an emergency basis because it will not be possible to have a swift vaginal delivery.
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