Complications in Labor and Delivery

Complications happen in practically all births (though fairly rare) and vary from minor to deadly serious. They can occur to any mother, with any practitioner and in any hospital or birth center. No one can predict them accurately.
Of course, a risk of having serious complications is lower in a mother, who is healthy and was well-cared during pregnancy, then in a mother, who had little prenatal care, who has a history of chronic disease or a had some pregnancy complications. During your pregnancy be sure to discuss your risk factor with your doctor or midwife.
Here is the list of possible complications:

1. Preterm labor

This is labor that starts before the 37th pregnancy week. For many moms it can happen very early, sometimes even only past 20 weeks. The earlier the labor starts, the greater is the risk for the baby. Ask your practitioner about the signs of premature labor and for instructions on what you should do if these signs appear. About 10% of women experience preterm labor. It is not desirable, as the risk to your baby increases, even if it is born only few weeks earlier.

2. Placenta Issues

Most of the placenta problems are known before the birth. Nevertheless, they can occur once the labor is started. The most widespread issues with placenta are:
- Placental abruption/abruption  (when it tears away from the uterine wall too early);
- Placenta previa (when placenta covers all or part of the cervix);
- When placenta grows through the lining of your uterus.
All of these issues are more common after uterine surgery (like a C-section). These problems can cause maternal or fetal hemorrhage that leads to the loss of blood or death for mother or baby.

3. Bleeding Issues

Afterbirth excessive bleeding is also known as postpartum hemorrhage. This is more common with a C-section, but it can also occur after a vaginal birth. The following factors make this issue be more likely:

- Twins or multiple births;
- Grand multips (at least 5 previous births);
- Labor induction;
- Pulling on the placenta
Be sure to ask your doctor or midwife how they handle the postpartum bleeding. As a rule, most of them start with uterine massage, then use medications and finally perform an operation to remove the placenta, the uterine lining and, worst case scenario, the uterus.

4. Fetal Distress

This problem can be caused by using medications in labor, cord issues, induction or infection. That is why fetal monitoring is done in labor. Some variables in the baby’s heart rate could be the sign of meconium (baby’s first defecation). However, neither of these are absolute indicators, therefore other tests are done, including the use of internal fetal monitoring and fetal scalp pH sampling. If the birth is not imminent, forceps, vacuum extractor or C- section can be used to accomplish the birth more quickly.

Perineal Massage
When we think about the threat of episiotomy in labor, we rarely think of anything to prevent it, counting on the doctor or midwife as they know what to do best. In fact, there are things we can do by ourselves.
The area of skin between your vagina and rectum is called ‘perineum’. Prenatal perineal massage has been shown to be effective in preventing the need for episiotomy. It also help to decrease the amount of tearing women have in labor. This technique is used to stretch and prepare the perineum skin for birth. This method is particularly effective in women over the age of 20 as well as in women expecting their first baby.
Perineal massage will not only help to stretch and prepare your tissue for birth, but it will also allow you to learn how to control these muscles and feel the sensations of birth. This knowledge can help you relax this area in labor as well as during other types of vaginal exam.
Instructions:
1. Find a comfortable place where you can sit and be alone (or with your honey uninterrupted);
2. Using mirror, find your perineum and see what it looks like;
3. You can take a warm bath or use warm compresses on the perineum for about 10 minutes;
4. Wash your hands. If the massage will be done by your partner, ask him to wash his hands;
5. Lubricate your thumbs and the perineum with pure vegetable oil or vitamin E oil. There are also some oils (with or without herbal preparations in them) designed particularly for this use;
6. After all necessary preparations get comfortable and relax. Then gently place your thumbs about an inch inside the vagina, press downward and pull towards the sides. You should feel a light stretching, tingling or sometimes light burning, but you should not feel immense pain. Hold this stretch for about two minutes or until the area becomes slightly numb.
7. If you've had a previous episiotomy or tear, pay special attention to the scar tissue. It will not stretch as readily, so that you may need to do some extra work.
8. Massage back and forth over the vaginal tissues bottom area, rubbing the lubricant in.
9. Pull the thumbs out slightly imagining how it would pull as your baby's head comes out.
10. If the whole procedure is done by your partner, he can use his thumbs or index fingers. The main direction for partners: be sensitive to her body and her feedback on the amount of pressure to use.
CAUTION: Avoid the urinary opening! Otherwise it can cause urinary tract infections (at the top of the vaginal opening). Also do not massage the perineum if you have active herpes lesions as this can cause the lesions to spread.
The most suitable time to begin massage sessions is around the 34th week of your pregnancy. If you are further along and haven't started yet, you can start at any moment. This massage can be done as often as once a day.
Remember that massage alone will not protect your perineum. It is only one part of the grand scheme. Choosing a more upright birth position (e.g. kneeling, squatting, and sitting) will allow the perineum to distribute the pressure equally. A side lying position will also help to prevent enormous amounts of strain on the perineum.
What makes a tear or episiotomy almost impossible to avoid is lying flat on your back. It creates the most stress on the perineum, so be sure to consult your practitioner and try to avoid this position.

How to Avoid Germs in Labor
It is not a surprise to most people that hospitals are not sterile and even some germs can be found there. For some families this is a reason to have their babies in birth centers or to have home births. However, the majority of women still chose hospitals to give birth in. In this case it is important for these moms to avoid catching a nosocomial infection (i.e. one that is actually from hospital germs).
Everyday people enter the hospital and bring their own personal germs there. Different viruses and bacteria are brought in hospital even by the staff and, of course, by the visitors - who are all healthy people at first sight. So imagine what a cesspool of germs a hospital can turn into.
Here is the list of procedures to be done in order to prevent germ spread:
Hospital Policy
Hospitals work very hard to ensure that germs and infections cannot pass from patient to patient within their precincts. You will probably find that the labor and birth unit and the postpartum unit are not mixed in with other patients who have communicable diseases. This obviously provides some protection.
Hand Washing
The hospital staff is specifically trained how to prevent the spread of germs from one patient to another. Hand washing is an obligatory part of germ control. Moreover, it helps to prevent germ spread not only in hospitals, but absolutely everywhere.
Sterile Medical Equipment
Medical equipment can be of two types: it is either disposable (used only one time) or sterilized after every use. Items like needles, exam gloves and IV kits are disposable. Larger pieces of equipment are usually placed in a medical grade sterilizer, according to the hospital's protocols for sterilization.
Try to Avoid Skin Breaks from Needles or Surgery
Being healthy is a great benefit in the fight against infections and can support your immune system in the hospital. Well-nourished, well-rested, healthy individuals are less susceptible to infections, though it is not always possible to be well-rested at the end of your pregnancy. Hopefully when you enter the hospital you are healthy.
Avoiding unnecessary procedures can also help prevent the spread of germs. This means that the fewer holes poked in your skin you have, either by IV injection or surgical incisions, the less likely you are to get an infection. Remember that thinking about the type of labor you will have – a medicated or a natural one.
Avoid Premature Birth
If you have premature birth, your baby, as a preemie, will be immunocompromised. It means he will have a weakened immune system which is not capable of protecting him from infections. This makes him more likely to become ill, even from a virus or bacteria that would not infect someone else.
Keep Your Baby with You
Keeping your baby with you at all times is a step in the right direction. It will reduce the exposure your baby can have to other workers and babies in the central nursery. It also allows you to help protect your baby's immune system by providing better and timely breastfeeding.
Remember that being mindful of the sterilization protocols and ensuring that everyone wash their hands and use only new or sterilized equipment can help in preventing germ spread. You can also ask your doula to do it for you as you are totally concentrated on labor.

Breech Babies: What to do if Your Baby is Breech?

The word ‘breech’ is used to speak about the babies who is not in a head down position before labor. in other words, breech babies are those who are bottom down. At 37 weeks gestation about 3-4% are usually breech.
You are more likely to have a breech baby if:
- You’ve had several babies before;
- You have excessive amount of amniotic fluid (polyhydramnios);
- Your placenta is low lying;
- You have placenta previa;
- Your baby has some anomalies;
- Your uterus has growths or anomalies.
Babies usually begin to turn head down between weeks 28 and 32, and continue to turn on their own even during labor. There are also special methods to increase the chances of your baby turning to right position.

Non-medical Methods

1. Tilt Positions
It is probably the most famous method for changing your baby’s position. It’s quite easy to do and doesn’t need any extra equipment.  Just lie on the coach with your feet up and your head down. The principle is the following:  your baby's head, the heaviest part of its body, will disengage from the pelvis and baby will turn head down. It's generally recommended to do this about 20 minutes a day until baby turns. Some women report to have dizziness doing this exercise. Always discuss this or any other method with your doctor or midwife.
2. Light or Music
Use light or music directly at your pubic bone. It will encourage the baby to come towards the light or sound. Many women report success with this method. Moreover, this technique has no side effects. You can also ask your honey to talk towards your pubic bone, again to encourage baby to move towards the sound. You can do this as often as you like until baby turns head down.
3. Water
Diving into a pool or simply being in a pool is claimed to encourage baby to turn head down. Again, it is safe and no real problems from using this technique have been noted.
4. Acupuncture
This has been used together with moxibustion for turning breech babies into the right position. The biggest difficulty here is to find a real specialist who practice this technique and can make the baby to turn.
5. Chiropractic Techniques
Chiropractors may be able to help turn the baby using some special techniques. You can ask your practitioner for more information about Webster Technique.

Medical Methods

1. Homeopathy
For centuries different homeopathics (generally pusatilla) have been used in assistance in turning a breech baby. However, you have to discuss the use of homeopathics with your practitioner.
2. External Cephalic Version (ECV).
As a rule, external cephalic version is done around 37 weeks. You need to have adequate amounts of amniotic fluid to cushion the baby in order to do this procedure. It is performed in a hospital with fetal monitoring, ultrasound, and many times IV medications to relax the uterus. It is not recommended to perform the ECV prior to 37 weeks as there is a risk of premature labor. Another great risk of the ECV is separation of the placenta which occurs mostly due to the guidance of the ultrasound. There can be also potential complications with cord involvement. Recent studies show that epidural anesthesia may actually increase the success rates of external version.
What does it mean if you've tried all of these methods and your baby is still breech?
In fact, there is a lot of misinformation regarding the birth mode for breech babies. Many people will tell you that the only safe method of delivery in case of breech baby is an elective cesarean. Do not believe it! Many problems that were once thought to be caused by the vaginal breech birth where actually caused by something prior to the birth. Almost 50 of all breech babies are currently being born vaginally, though this statistic varies drastically from practice to practice. Before considering a vaginal birth for a breech baby, many criteria have to be met (though even the experts disagree on what they should all be). All in all, your chances of delivering a healthy breech baby vaginally increase with the following:
- Baby is frank breech (feet straight up);
- You've already given birth vaginally prior to this birth;
- The baby is not excessively large;
- You have no uterine or pelvic anomalies.
However, for some breech babies it is generally better to be born by cesarean. Only your practitioner can help you determine whether a cesarean is better for your baby. If yes, this wouldn’t mean that all of your subsequent babies would be breech or necessarily be born via C-section.