We all know that giving birth rarely happens like it does on TV shows: Your water breaks; you gasp, exclaim, "She's coming!" Then, lipstick refreshed, you cradle your newborn as your handsome husband looks on. Alternatively, we hope your experience isn't going to be fodder for dramatic TV: A swarm of doctors sprints into the delivery room, shouting, "Get the NICU team, STAT! We've got a quadruple nuchal and need a cold-knife section!"
More than likely, it will be somewhere between the two. However your labor story unfolds, being educated helps. Below are six possible scenarios of labors with complications, complete with doctors' lingo and happy endings.
What it means: " 'Fetal distress' is an older, vague term that OBs don't generally use anymore," says Nanci Levine, M.D., an OB-GYN at Montefiore Medical Center in Westchester, N.Y. "If you do hear it, ask for specifics." The term often has to do with the fetal heart rate; it's assumed the baby is in some kind of peril when the heart rate is slow, for example, or doesn't return to normal following a contraction.
Frequency: "True fetal distress implies urgency— 'I'm really worried about this baby right now'—and that doesn't happen very often," Levine says.
Likely remedies: If your cervix is fully dilated and the baby's head is low, your doctor or midwife may use forceps or a vacuum extractor (a soft suction cup placed on the baby's head) to deliver the baby quickly. Otherwise, it's a Cesarean section for you.
What it means: The baby is positioned in the uterus head up, bottom down; sideways; or feet first. It's also known as "malpresentation."
Frequency: Rare (4 percent)
Likely remedies: Some doctors and midwives say getting on all fours to elevate your hips above your heart, then lowering yourself onto your forearms, encourages the baby to turn. At 37 weeks to 38 weeks, some doctors try external version—turning the baby manually by applying pressure to the mother's abdomen. If that doesn't work or the baby flips back, the doctor can try again or schedule a C-section. Very few OBs will attempt a vaginal delivery for fear that the baby's head will get stuck in the birth canal.
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What it means: The placenta is covering the cervix.
Frequency: Placenta previa is found early in pregnancy about 75 percent of the time. Usually, by the end of pregnancy, the placenta will correct itself.
Likely remedies: If the placenta is covering the cervix at 36 weeks, a C-section will likely be scheduled, says Leslie Goldstone-Orly, M.D., an OB- GYN at Bridgeport Hospital at Yale-New Haven in Bridgeport, Conn. "If the mother is bleeding vaginally, however, she should have a C-section immediately because there can be significant blood loss," she adds.
What it means: Meconium (a black, tarry substance in the baby's intestines) is present in amniotic fluid the baby has inhaled. This can cause breathing complications.
Frequency: More common in babies a week or more overdue, meconium is passed in 10 percent of labors. Of these, between 1 percent and 6 percent of babies become ill from it.
Likely remedies: If meconium is spotted, your doctor or midwife will clear it from the baby's nose and mouth at birth. If the baby has inhaled it, she'll go to intensive care. "Most babies do fine and just need a little breathing support," says Goldstone-Orly.
What it means: The umbilical cord is wrapped around the baby's neck.
Frequency: Approximately 25 percent of births
Likely remedies: "A nuchal cord doesn't necessarily mean the baby is in danger," says Levine. "Even if it sometimes causes the baby's heart rate to go down, a nuchal cord doesn't have to be serious. But if you have a contraction and the baby's heart rate doesn't go back up afterward, the cord may be too tight, and that could mean the baby is having problems." If you're unable to push the baby out, forceps or a vacuum extractor may be used to assist the baby down the canal. "If the baby is too high or the mother is not adequately dilated, a C-section might be necessary," Goldstone-Orly says.
What it means: The baby's head is too big to pass through the mother's pelvis, resulting in "failure to progress."
Frequency: Unknown. The condition is hard to quantify because it's impossible to be sure if it's a true CPD or simply a failure to progress—i.e., the mother's cervix stops dilating, or the baby is not moving down due to undetermined causes.
Likely remedies: Failure to progress is the single most common cause for a C-section, though you may be given the drug Pitocin to induce contractions first. Unfortunately, there's no accurate way to predict CPD before labor. "You can measure the mom's pelvis by feeling it, but that is unreliable," says Goldstone-Orly. However, exercising during pregnancy and keeping your weight gain within recommended limits can diminish your chances of developing gestational diabetes, thus reducing the risk of having a too-large baby, Goldstone-Orly adds.