Complications of Childbirth

Babies Wait for No One

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New life. It's a beautiful and wonderful event to behold.

It's also messy, loud and chaotic. Even though it's almost always remembered fondly, there are a few things that can go wrong. 

When babies are delivered as scheduled in the hospital, there are contingencies for the worst case scenarios. The doctor knows most of what to expect. Moms who've had prenatal care have given their docs the chance to rule out all the potential hazards. Things that can go wrong are identified and plans are made to address them. No matter what happens, it's all covered.

But what happens when you're not in the hospital? What happens when the baby doesn't get the memo and all the best laid plans are erased by the ice storm or power failure? Maybe there was construction on the freeway and the transportation authority failed to check your due date and schedule accordingly.

Babies happen. And, they happen on their schedule without thought to the months of preparation you've put in. Indeed, sometimes they come in groups or when you're not expecting them at all.

Delivering a baby outside the hospital without any medical help is not something I would ever recommend. However, it could happen. I don't care how well you packed the baby-bug-out-bag or how pink you painted the nursery. When the bambino decides he's had it with the accommodations, he's headed for a change of scenery. Like it or not, you might want to know what to do, just in case.

The following complications are some of the things that can go wrong when trying to deliver a baby. Some of these you might already know is a possibility with your baby-to-be. Others always come as a complete surprise. All of them are potentially serious to either mom or baby--or both.

Really Big Baby

Woman giving birth with knees up
Ron Chapple/Photodisc/Gettiy Images

Babies with giant noggins or really broad shoulders can have a hard time getting through the birth canal. It's called distocia (obstructed birth) and it is pretty common. You shouldn't be trying to deliver a baby if the only training you have is what you're currently reading on the internet, so right now would be the right time to call 911, even though you aren't sure yet that the baby will get stuck.

The best option to help a moose of a baby get through his journey is to have mom pull her knees as close to her chest as possible and put a little pressure on her lower belly, just above the pubic bone (see picture). In cases of shoulder distocia, the head will be delivered but that's where baby stops. Sometimes while mom is pushing, the clavicle (collar bone) will snap. Don't worry, that just means the shoulder will collapse and baby will come right out. For a baby, a broken collar bone is not such a big deal.

Whether it's head or shoulders causing the problem, mom needs to stay in this position and you need to continue the gentle, but firm, pressure until the baby comes out or the ambulance gets there.

Nuchal Cord

For 40 weeks, give or take, your soon-to-be newborn is floating around in a soft tank of amniotic fluid attached to mom with something akin to a combination industrial cable and triple lumen firehose. The umbilical cord is long enough to allow baby lots of wiggle room, all the better to kick mom in the gut or punch her in the bladder.

All that flailing around can sometimes result in the umbilical cord getting all wrapped up. It can be looped around a leg or an arm. Sometimes baby grabs it and gives a good yank. It becomes a serious problem if he tries to escape with it wrapped around his neck.

The condition is called a nuchal cord (nuchal means neck). The bad news is that it's very dangerous, even life threatening. The good news is that it's easy to fix.

How to Deliver a Nuchal Cord

  1. STOP! As soon as you see the baby's head coming out of the vagina, look for the cord around the neck. If you see it, instruct mom not to push. It's easier said than done, as any woman who's delivered vaginally will tell you.
  2. Slip your fingers under the cord and loosen it. You can be pretty vigorous here. The cord is really strong and right now, baby is not yet breathing on his own. His chest is still in the birth canal, so he can't take a breath if he wanted to.
  3. If you get the cord loose enough, slip it over the baby's head. Sometimes there is more than one loop around the neck. That's okay. If you're able to get one loop over the head, the other will be even easier. Once the cord is over the head and the neck is bare, you're clear for takeoff.
  4. If you can't get the cord loose, don't panic. You'll need a couple of shoestrings (or just a couple of strings). Tie two strings around the cord really tight. It should look like you're pinching the cord completely. Tie the strings an inch or two apart.
  5. Cut the cord between the strings. Use a pair of scissors if you can, in order to protect baby. You don't want to cut her neck. If you have something like bandage scissors or trauma shears, use those. They're perfect for this. Obstetrical kits (emergency childbirth kits) will often have a sterile scalpel with which to cut the cord. They also have clamps, so you don't have to use string. The scalpel is fine when the cord isn't touching baby's neck. In this situation, however, scissors are better. And, sterility isn't that big of an issue, in case you haven't noticed where we're working here.
  6. Once the cord is cut, you should be able to remove it from the baby's neck. One last thing: If the cord is wrapped around the neck more than once, make sure you tied both strings on the same loop of cord, otherwise you might not actually be cutting between them.

Breech Delivery

"Let's make like a baby and head out."

Babies are supposed to come out head first. Anything else is not ideal. The head of the baby is typically bigger than the rest of the baby, which sort of opens up the path and lets everything else follow. On the second page, we talked about what happens when the baby's head isn't the largest part of her body.

Sometimes, the head doesn't come out first. When any other part of the baby's body other than the crown of the head is coming out of the vagina first, it's called a breech presentation. Because the baby's head didn't properly prepare the birth canal, breech births can be very difficult and might require medical intervention to deliver.

If you see anything other than the crown of the head coming out, call 911 immediately!

A breech presentation can include any other part of the baby coming out first: hand, foot, ear, knee, elbow, hip, etc. Only two options can be delivered. I call them the "Two and Two" and they are:

  1. Two butt cheeks (best case scenario for a breech delivery)
  2. Two feet

The good news is that round little baby butt cheeks are shaped enough like the crown of the head to open the birth canal. A breech delivery butt first is pretty likely to succeed (you should still have the ambulance on the way).

The problem with breech delivery always comes from the baby's head. Its bigger size means it has the potential to get stuck in the birth canal after the rest of the baby has been born. Unfortunately, by the time you realize the head is stuck, the chest is out...and the baby is trying to breathe. A baby coming out feet first doesn't force the canal open, leaving the potential for the head not to deliver successfully.

What if the Head Doesn't Deliver?

If the baby is coming out breech and the head doesn't deliver, you will have to put your fingers on either side of the baby's mouth and nose to pull them away from the wall of the birth canal. The baby will try to breathe as soon as his chest is free. As soon as he takes his first breath, his body will turn off the flow from the umbilical cord. At that point, he's on his own.

If you're doing this, he's not coming out without medical help. Once you're protecting his ability to breathe, you are saving his life. The ambulance crew will direct you on what to do when they get there.

As for the ambulance crew, if you didn't call 911 yet, do it now!

Not Two Butt Cheeks or Two Feet

One foot won't come out and neither will one butt cheek. If you don't see both cheeks or both feet, the baby is turned sideways in the birth canal and the chance of a successful delivery is pretty much nil.

If anything other than "Two and Two" is trying to come out, call 911 immediately. There's no way the baby is going to deliver that way.

While the ambulance is on the way, have mom roll over and get on her knees with her head down. This is the same position that we'll use for prolapsed cord. Gravity will help keep the baby from being compressed by the contractions.

Prolapsed Cord

The worst case scenario of childbirth is when the umbilical cord comes out before the baby. It's called prolapsed cord and if left untreated, it is deadly for the baby.

The umbilical cord is the baby's life support. Without it, she won't be able to survive the birth. If the cord is coming out ahead of the baby, it means it is being pushed by her head. Unfortunately, there's not enough room for her head and the cord, too.

An umbilical cord looks a little like a thick purple telephone cord--the squiggly kind that goes from the handset to the base. If you look for crowning (the crown of the baby's head protruding from the vagina) and see the purple cord instead, act fast:

  1. One person call 911 while the other one moves on to the next step. Do not wait! If it's just mom and you, have her call while you move on to step 2.
  2. Have mom roll over on her knees with her head and shoulders all the way to whatever she's laying on (floor, bed, couch, etc.). She should look like she's listening to the ground with her butt in the air. Gravity will help keep the baby from moving further down the birth canal just like the position used for an undeliverable breech presentation.
  3. Grab the cord gently and feel for a pulse (a throbbing sensation). If the pulse is present, it will be obvious; continue to hold the cord gently to monitor the pulse.
  4. If the cord does not have a pulse--If you don't feel it, or think you don't feel it, then it's not there--you'll have to create space between the wall of the birth canal and the baby's head. Slide your fingers on either side of the cord (the cord is a loop, so slide both ends of the loop together in order to work with one hand). With one hand, force the baby's head off the loop of cord. Try not to push right in the center of the baby's head. You're trying to keep the baby off the wall of the birth canal, not push her back into the womb. Feel the cord with your other hand. Continue to separate the canal wall and the baby's head until you feel a pulse in the cord. Remember, if you aren't absolutely positive you feel a pulse, then you don't.
  5. As soon as you feel a pulse in the cord--STOP! Don't move. You're going to stay right there until the ambulance arrives. If the pulse goes away, adjust the baby's position until it returns.

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