Complicated delivery does not have to be the reason for Caesarean section

Article

08. 02. 2018

Ideally a baby is delivered naturally during uncomplicated delivery. However, some situations can disrupt a smooth course of vaginal delivery.

Delivery can be complicated by the fetus as well as the mother in labour or by the combination of the two.

What can complicate delivery?

Obstetricians consider distress of a child due to lack of oxygen the most serious complication - e.g. as the consequence of umbilical cord wrapped around the baby's limb or neck, umbilical cord knots, etc. Delivery must be quickly completed in such cases to prevent irreversible damage to the child's brain due to the lack of oxygen. "Of course, the child has certain reserves but it is not able to tolerate it for a longer period. Due to this reason it is necessary to know that children of a normal size have a better ability of tolerance than smaller children. Smaller children then have a higher probability that during vaginal delivery - because they do not have the reserves - they will not be able to manage the strain," states doc. MUDr. Ladislav Krofta, CSc., the top specialist of Canadian Medical Care and also the doctor of the Institute for Care of Mother and Child in Prague - Podolí.

Owing to possible fetal hypoxia it is necessary to manage umbilical cord prolapse as soon as possible as it can occur together with the rupture of membranes or placenta abruption (bleeding in the woman resulting from the blood flowing not into placenta but out of it). With the given complications pregnancy must be mostly terminated by acute Caesarean section.

There are other complications which can occur when the fetus is going through the birth canal: there might be certain head or limbs traumas or shoulder dystocia - the shoulders get lodged in the pelvis and baby cannot be delivered. One of the consequences can be brachial plexus or collarbone trauma (fracture), in some cases these traumas can be irreversible. Therefore doctors try to pre-select the children in whom the mentioned complications could occur - these are mostly children big in stature.

The principal complication on the mother's side is mainly bad uterine contractions during labour - the woman has weak contractions which do not lead to the opening of the birth canal. In some cases it is therefore necessary to terminate vaginal delivery as fast as possible.

Also labour mechanism disorders can form an obstacle during a smooth course of delivery. "During delivery the fetus performs rather complicated complex of motions which is susceptible to some error. Only a slight deviation from a correct direction or a poorly angled head lead to the delivery stop. The delivery does not proceed. The first or second stage of labour can last too long which limits the ability of uterus to push the fetus out and the woman is exhausted," states MUDr. Krofta. In such a situation, according his words, it is necessary to start with a drug therapy or to complete delivery per vaginam by some extraction technique or Caesarean section.

If the woman is not able to push the baby out, a vacuum-extractor ("vex") - a vacuum bell which is applied to the head and the baby is pulled out - or other instruments belonging to forceps category are used. "Certain conditions to complete vaginal delivery by instruments must be met. If they are not met, the mother and fetus are at risk of injury and in such cases Caesarean section is performed," explains MUDr. Krofta.

What are the most frequent complications in women during delivery?

In connection with the third labour stage the risk condition in the woman in labour can result from the uterus not going into spasm and the woman loses a lot of blood in a short period of time. Such a situation is managed by medications which support uterine contractility. Bleeding after delivery can occur quite unexpectedly, e.g. after a long delivery owing to a uterus congenital developmental disorder or in women who have given birth to more children.

Different traumas are part of postnatal complications – uterus can be damaged, partially torn or torn, or torn away – and also conditions linked to insufficient placental abruption, or placenta remains in uterus in one piece. In such cases bleeding can occur in the woman which can endanger her life.

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