Giving birth prematurely
Any baby born before term—37 weeks—is considered premature, with several vital organs that may not be fully developed. About 10 percent of all births in the U.S. are premature, and many face serious health problems. That’s why doctors try every means they can to keep the baby in the uterus as long as possible, if only for a few days.
A “preemie” is marked by low birth weight, small size, a weak cry, poor sucking instinct and troubled breathing. Modern hospital technology helps babies born as early as 24 weeks old to survive, and the longer they develop in the womb, the fewer their complications seem to be.
Neonatal caregivers overcome breathing difficulties, for instance, by providing oxygen through a ventilator and an array of drugs to improve oxygen intake and carbon dioxide elimination. A feeding tube provides nourishment, allowing the infant to grow stronger. Fortunately, most preemie problems resolve over the course of several weeks or months, allowing baby to finally go home.
A woman’s risk factors for premature labor include age under 18; high blood pressure; poor medical care during pregnancy; poor nutrition; and alcohol, tobacco or drug abuse. To avoid premature labor, doctors emphasize good prenatal care above all. If early labor comes anyway, drugs called tocolytics are often used to stop contractions, buying valuable time for the baby to remain in the womb.
Giving birth is intense enough without problems. Yet even mothers who’ve breezed through a full 38- to 41-week term can suddenly develop complications during childbirth.
Fortunately, innovations such as fetal monitoring along with high-tech training allow doctors to routinely overcome many delivery-room complications. Here’s what doctors and nurses watch for:
“Breech” position. Ideally, baby lies upside-down in the womb facing mom’s spine. In breech, baby is right-side up facing forward and the legs or bottom point down. Some babies sit cross-legged or lie horizontally in the womb. If doctors cannot manipulate the baby for vaginal delivery, they’ll perform a cesarean (surgical) birth.
Placenta problems. During pregnancy, the placenta attaches to the uterine wall, providing baby with nutrients through the umbilical cord. But in rare cases it can abruptly dislodge, cutting off oxygen to the baby and causing hemorrhaging in the mother. A vaginal delivery is sometimes possible; more often a cesarean delivery is performed. Vaginal bleeding and abdominal pain before labor occurs are warning signs.
Tangled cord. Baby’s umbilical cord sometimes pushes through the cervix before he or she does; it kinks and cuts off blood and oxygen. Other times the cord wraps around baby’s neck or gets pinched between baby’s head and mom’s pelvic bone. At that point, doctors may opt for a cesarean delivery or a vacuum extraction (attaching a suction cup to the crown of baby’s head to ease him or her down the birth canal) or forceps extraction (inserting a tool that resembles salad tongs into the vagina to cup baby’s cheeks and ease him or her out as mom pushes).
Exhaustion. An extremely difficult delivery drains the mother’s ability to push and sets the stage for postpartum complications. Once delivery stalls, many doctors use forceps or perform a cesarean birth.
Hemorrhage. Severe bleeding can occur if tissues are torn either by the baby or by forceps or vacuum extraction. Incomplete separation of the placenta from the uterine wall also causes bleeding.
Hematoma. Large bruises inside the birth canal must be drained through the vagina to reduce swelling and pain. Surgeons also use laparotomy to drain internal abdominal bruising. Doctors prescribe antibiotics to prevent infection.
Although complications during childbirth can be sudden and unnerving, they are uncommon. And thanks to advances in healthcare, your hospital is one of the best places in the world to be should problems arise. But the odds are you’ll have nothing more than a routine, uneventful and miraculous delivery of a beautiful baby and nothing too complicated to handle.