Pregnancy Week by Week

Unusual Labours

There are times when everything does not go quite according to plan with a birth. Some babies appear before time and rapidly, while others take a lot longer than average. One thing is certain: everyone's experience of labour and childbirth will inevitably be slightly different and therefore your labour is unlikely to match your expectations in every respect.

Sudden and fast birth

Many couples worry that the labour will progress so quickly that their baby is unexpectedly born at home or on the way to the hospital. This is called precipitate labour. It is unusual for this to happen, particularly with a first baby, and is more common in women who have already had a child. There are rarely any problems if a baby is born quickly. Problems are far more likely to occur in a labour where there is very slow progress. If you fee! that your labour is progressing very quickly, you can always call your midwife to attend you at home or telephone for an ambulance rather than risk a car journey to the hospital. Women who have had a previous precipitate labour may prefer to go into hospital and be induced in a subsequent pregnancy, or have a planned home birth, rather than risk a journey in labour.

Premature babies can be born very quickly as the cervix does not have to be 10 cm dilated. If you show any signs of labour before 37 weeks of pregnancy it is very important to go straight to the maternity hospital, using an ambulance if the contractions are strong.

What to do in an emergency

Your partner will probably be reassured if he knows what to do in the event of a sudden birth - even if it never happens:

If you feel the urge to push, get down on all fours, with your bottom in the air, and try to 'pant' through the contractions. This can help to delay the delivery. s Have some clean towels ready to dry and wrap your baby and to put underneath you.
If there is time, your partner should wash his hands.
If your baby's head is visible, your partner should encourage you to pant and 'breathe' your baby out rather than push.
Putting his hand on your baby's head will help to 'control' the speed of the birth.
When your baby's head is out, stay calm and do not try to pull out the rest of her body. The body will be born with the next contraction.

Your partner should carefully run a finger around your baby's neck and, if he can feel a cord, try to gently loop it over the baby's head.

Support your baby's head as her body is born to prevent her falling onto the floor.
Dry your baby with a towel to stimulate her if she initially appears to be a bit floppy. oWrap her up and cuddle her, keeping the cord attached.
Do not try to cut or pull on the cord.
Put your baby to the breast to feed as soon as you wish. This will help the uterus to contract.
If you feel the urge to push out the placenta after a contraction, do so, but otherwise leave it alone. If the placenta is expelled, still do not attempt to cut the cord. 'Your partner should keep both of you warm. Hopefully, help should soon be at hand.

Prolonged labour

Although an average first labour lasts about 10-12 hours, some labours are obviously much shorter while others are much longer. If you have had no problems during your pregnancy, the best thing you can do to keep your labour progressing is to stay at home for as long as possible. Many women find their labour slows down when they get to hospital. There are a number of possible reasons for a prolonged labour and it is more common for first-time mothers than for women who have had a baby before.

Tension

There is a cycle of events that midwives recognize all too readily, which is why you need encouragement during your labour to keep moving around for as long as possible.

Your muscles tense whenever you feel anxious. The uterus is a muscle so tension can affect the contractions and slow them down.
Rather than staying upright and moving about when you get to hospital, you may lie down on the bed. This can also slow down the progress of labour.
If you are tense, you might find it difficult to deal with the contractions and ask for pain relief at an early stage of your labour. If you are given an injection of pethidine or an epidural this will confine you to the bed, in which case the contractions can slow down.

Position of your baby's head

Your baby's position also determines the progress of your labour. In order for your baby's head to fit through your pelvis, she needs to have her chin tucked onto her chest. In some cases, the baby's chin is higher than this so that she has what is referred to as a 'deflexed head'. If the contractions are effective, your baby will tuck her chin down, but waiting for this can prolong labour.

Size of your baby's head

Labour will also be prolonged if your baby's head is large in proportion to your pelvis. This is very rare. In this case, you may show signs such as a rise in temperature and pulse rate. A vaginal examination may show swelling on your baby's head. If these signs accompany slow progress, it may indicate that the head might not fit through the pelvis.

Your baby's position

If your baby is in an occiput posterior position (see page 218), this can cause a prolonged labour. This is quite common. With regular contractions, most of these babies eventually turn round, but labour can be long and, at times, there may seem to be very little progress. Because of the baby's position, you will probably feel much of the pain in your back, which can be distressing if there is a strong urge to push before the cervix is fully dilated.This is because the back of the baby's head is pressing on your back passage. A good position to adopt for this type of labour is on all fours, which takes the pressure off your back and allows your birth partner to massage you or put hot towels on the base of your back.

Slow dilation

If progress is slow, the doctor may suggest an oxytocin drip to produce stronger and more regular contractions. It is also important to consider an effective form of pain relief, such as an epidural, as you may already be distressed and tired from a long labour.

If the cervix still does not dilate, despite the drip, a caesarean section will be necessary to deliver the baby. This may be a relief if you have genuinely had aprolonged labour or failure to dilate, even if this is not how you originally planned to give birth.

Some women have a rare condition called cervical dystocia, which-affects the structure of the cervix. Some women are born with this, while others develop it as a result of scarring from infection and surgery. Despite strong uterine contractions, the cervix remains firm and does not dilate.

Induced labour

Despite the best of intentions and well-scripted birth plans, some women need help getting into or speeding up labour and it is best to be aware of this, just in case it happens to you. Throughout your pregnancy, a lot of emphasis is placed on your due date, so you may be surprised to see that date come and go with no sign of labour. Women should be offered an induction 7-14 days over their due date, as the placenta can start to deteriorate.

Initially, this usually takes the form of a 'stretch and sweep', where the midwife gently inserts her gloved finger into your cervix and sweeps it around the bag of membranes. This can be done in your home or at the clinic. It can be a little uncomfortable, but it works in many cases.

Reasons for inducing labour

There are various reasons for inducing labour, the most important being concerns about the welfare of the baby or mother. For example, labour may be induced if your blood pressure rises, or if you develop pre-eclampsia, although the initial approach is usually to try and lower your blood pressure by rest or medication.

However, there may be signs that high blood pressure is affecting the function of the placenta, which is your baby's source of food and oxygen and can affect his growth. Some babies are small for their age and the midwife might feel that their growth is tailing off, which again can be a sign of placental dysfunction. In both these cases, it may be necessary to induce labour. Some women, for example those with gestational diabetes, have labour induced because their baby is getting very large.

Most women go into labour within 24 hours of their waters breaking. If this fails to happen within a day or two, there is a risk of the baby getting an infection, in which case the contractions may need a 'kick start'.

How labour is induced

The initial approach in inducing labour, particularly in the case of a first baby, is to insert a pessary or gel of prostaglandin (hormone) into your vagina. This softens the cervix and can start the contractions. However, this process usually needs to be repeated, and it may be a couple of days before the contractions begin. Once the cervix has started to dilate, the midwife can break your waters with an instrument that looks rather like a crochet hook. This will be a little uncomfortable but it should not hurt.

However, if you still show no signs of going into labour, then you may need an intravenous drip of oxytocin, a powerful hormone that makes the uterus contract. This requires close monitoring of both you and your baby because, in some cases, your body is not ready to go into labour and there is a danger of the uterus being overstimulated and your baby becoming distressed.

Being induced before your due date may increase the risk of a caesarean section, particularly with a first baby, so the decision should not be taken lightly.

Speeding up labour with drugs

The majority of women go into labour spontaneously, but some women need help in speeding up their labour because the contractions can 'go off. This happens particularly in cases where the mother has had an epidural, has been unable to stay upright, or if she has been in labour for a long time and the uterus is becoming tired. An intravenous drip of oxytocin should get the uterus contracting effectively, but both mother and baby need to be monitored closely (see above). The dosage of the drug is gradually increased until the contractions are approximately every 3-4 minutes.