CHILDBIRTH, COMPLICATIONS OF
C
PAIN RELIEF IN LABOUR AND DELIVERY
Method
Why given
Possible effects on baby
Narcotic
analgesics
Routine pain relief during
labour
Baby may be less responsive at birth,
and may have respiratory problems,
but these effects are reversible
Epidural
Routine pain relief during
labour, delivery of twins,
breech delivery, and
caesarean section
Effects are uncommon unless
mother's blood pressure falls
Nitrous oxide
Pain relief during labour and
delivery; used for short
periods only
None
Pudendal block
Forceps delivery
None
Local anaesthetic
into perineum
Forceps delivery or
episiotomy
None
General
anaesthesia
Caesarean section
Baby may show reduced
responsiveness at birth
Braxton Hicks’ contractions
may be m is-
taken for the onset of labour. However,
when the contractions become pro-
gressively more painful and occur more
regularly
and with
shorter intervals
between, labour has probably started.
At the onset of labour, the
cervix
(the
neck of the uterus) becomes thinned
and softened and then begins to dilate
w ith
each
contraction.
During
this
time, there may be a “show’’, w hich is
when the mucous plug that blocks the
cervical
canal
during
pregnancy
is
expelled as a bloody discharge. “Break-
ing
of the
waters’’,
w hich
is
the
rupture of the
amniotic sac
(the fluid-
filled membranous bag that protects
the fetus in the uterus), may occur
either as a slow trickle of fluid from the
vagina or as a sudden gush.
STAGES OF LABOUR
Childbirth occurs in three stages (see
illustrated box on p
.163
for details).
The first stage of childbirth covers
the period lasting from the onset of
labour to the point when the woman’s
cervix is fully dilated, w hich is when
the
opening
has widened
to
about
10
cm in diameter. The duration of this
stage varies from woman to woman
and from birth to birth.
The second stage of labour lasts from
full dilation of the cervix until the
delivery of the baby. In this stage, the
mother feels the urge to push with
each strong contraction. As the baby’s
head descends into the mother’s
vagina,
the baby rotates to face the mother’s
back. Once the baby’s head is delivered,
the rest of the body follows with the
next contractions. After delivery, the
umbilical cord,
w hich connects the baby
to the
placenta,
is clamped and cut.
In the third stage of labour, the deliv-
ery
of the placenta
(the afterbirth)
takes place. This event happens w ithin
about ten minutes of the baby’s birth.
PAIN RELIEF
Pain relief is available during norm al
labour and delivery. There are various
forms, including opioid
analgesic drugs
,
epidural anaesthesia,
and
pudendal block.
(See
also
childbirth, complications of;
childbirth, natural.)
childbirth, complications of
Problems that occur during
labour
and
delivery. Complications may affect the
mother, the baby, or both. Some are
potentially
life-threatening,
especially
to the baby if they im pair the baby’s
oxygen supply (see
fetal distress).
MATERNAL PROBLEMS
If contractions begin, or if the mem-
branes rupture, before the
3
7
th week
of pregnancy, premature labour may
occur, with the delivery of a small,
immature baby (see
prematurity).
Premature rupture of the
amniotic sac
(the fluid-filled, membranous bag that
protects the fetus in the uterus) can
lead to infection in the
uterus,
requir-
ing prompt delivery of the baby and
treatment with
antibiotic drugs.
Slow progress in the first stage of a
normal labour may be due to inade-
quate contractions of the uterus. It is
usually treated with intravenous infu-
sions
of
synthetic
oxytocin
.
If
the
mother cannot push strongly enough,
or if the contractions are ineffective in
the second stage of labour, the baby
may be delivered by
forceps delivery
,
vac-
uum extraction
,
or
caesarean section
.
Rarely,
eclampsia
(convulsions associ-
ated with raised blood pressure) may
develop during labour. This disorder
requires treatment with
anticonvulsant
drugs
and oxygen, and a caesarean sec-
tion w ill be necessary.
Bleeding before labour
(
antepartum
haemorrhage
) or during labour may be
caused by premature, partial separation
of the
placenta
from the w all of the
uterus. Less commonly, it may result
from a condition called
placenta praevia,
in w hich the placenta lies over the
opening of the
cervix
.
Blood loss after
the delivery
(
postpartum haemorrhage
)
is
usually due to failure of the uterus to
contract after delivery, or to retention
of part of the placenta.
FETAL PROBLEMS
If the baby lies in the breech position
(see
breech delivery
) ,
or in any other
malpresentation
(not lying in the normal
head-down position in
the uterus),
caesarean section may be necessary.
Multiple pregnancies (see
pregnancy,
multiple
)
carry an increased risk
of
problems during delivery due to the
difficulty of predicting the position of
the second or subsequent babies. It is
also more likely that babies in multiple
pregnancies w ill be born prematurely.
FETAL-MATERNAL PROBLEMS
If the mother’s pelvis is too small in
proportion to the head of her baby (a
condition known as cephalopelvic dis-
proportion), the baby may have to be
delivered by caesarean section.
childbirth, natural
The use of relaxation and other tech-
niques to help
cope with pain and
minim ize the use of drugs and medical
intervention during
childbirth
.
child development
The acquisition of physical, mental,
and social skills in children. Although
there is wide variation in individual
rates of progress, most children devel-
op certain skills w ithin predictable age
ranges (see the illustrated boxes oppo-
site and overleaf).
164
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