Whether you are pregnant with your first, second or even third child, all mothers face anxious moments as they get closer to the delivery date. Pregnancy is common to all women; however, each woman reacts differently to labour. Although most labours can get by with few glitches, there are some complications that may occur during labour.

Foetal distress

Foetal distress means a baby is not coping well when in the womb. When you go into labour, contractions momentarily reduce blood flow (and oxygen as well) to the baby, and when the uterus relaxes, blood flow increases again.

In most babies, this is not a problem; however for some, contractions may distress the baby. The risk is higher if:

• Your baby is smaller than average;
• Your baby is overdue;
• Contractions that are too fast, ie, too close together.

Health conditions in the mother, such as diabetes or kidney disease, may cause foetal distress too. Babies who are unwell, such as those with an inherited disorder, abnormality, or infection, or show an unfavourable reaction to a drug given to the mother, may also show some distress.

Abnormal position of foetus

The most common and ideal position is when a baby is facing the mother’s back, with his face and body angled to one side, the neck bent forward and is presented head first. There are a few other positions, which are abnormal and may pose a more difficult labour and delivery.

• Breech position: This is when the buttocks are presented first, instead of the head. When the buttocks are delivered first, this may cause the head to get stuck inside, leading to complications such as nerve damage. Furthermore, the umbilical cord is compressed between the head and birth canal, and very little oxygen reaches the baby. Lack of oxygen can cause brain damage.
• Other positions: Sometimes, the baby rests in a way where the neck is arched and the face or brow is thus presented first. A baby who lies horizontally across the birth canal and presents his shoulder first is known as transverse lie. Shoulder dystocia on the other hand, occurs when the baby’s shoulder is lodged against the mother’s pubic bone, after delivery of the head.

In pregnancies where the baby is in the breech position, the doctor may try to turn the foetus in the 37th or 38th week, so that it presents head first. If however, the baby is in breech position when labour starts, caesarean delivery is usually preferred. Normal delivery with breech position may cause injuries to the baby, or in some cases, babies may even die.

For babies with shoulder dystocia, doctors try to free the arm, which may sometimes result in damage to the nerves, or may break the arm or collarbone. An incision to widen the opening of the vagina (episiotomy) may be done to help with the delivery.

In case of foetal distress, or when there is prolonged labour, the doctor may assist your delivery with a vacuum extractor, forceps, or may even carry out an emergency caesarean operation if necessary.

What causes these complications?

Some health conditions in the mother may result in these complications; one of them is if she is suffering from diabetes. Being pregnant when you have diabetes is not something uncommon anymore; however, it is very important to control your blood sugar levels. Poor blood sugar control may lead to larger babies, which will pose a problem during delivery. Larger babies are at a higher risk of being in breech position and have a higher risk of getting injured during labour.

Poor nutrition, on the other hand, may result in babies that are smaller, which may also increase the risk of reduced liquor volume (low amniotic fluid), foetal distress, or abnormal lie positions.

Shoulder dystocia is usually more common in larger babies. It is also more common in women who are obese, have diabetes, or have had a previous baby with shoulder dystocia.

Don’t take chances

A pregnancy that has progressed smoothly may still give way to complications during labour. It is important to reduce any risk that may lead to higher chances of complications in delivery. Look after your health, keep up a healthy regime that includes both diet and exercise, and keep any health conditions, eg diabetes, in check.

Don’t take any chances when it comes to the health and development of your little one!

Don’t Wait Too Long

• Women are most fertile between the ages of 20 to 24
  
  
• It is best to have your baby before the age of 30
  
  
• Having a baby after the age of 35 increases the risk of health problems eg pre-eclampsia (high blood pressure during pregnancy), gestational diabetes (which occurs only during pregnancy) and placenta previa (a condition where the placenta is attached too low to the uterine wall, placing both mother and baby at higher risk of serious bleeding)
  
  
• Babies born to mothers over age 35 have a higher risk of Down syndrome and other chromosomal abnormalities
  
  
• It is still possible to have a normal, healthy child if you are over age 35 but you will need a higher level of medical care

Achieve Healthy Body Weight

• It is important to have a healthy body weight (BMI 18.5 to 24.9) before getting pregnant.
  

• If you are currently underweight (BMI below 18.5), you risk giving birth to a baby who has low birth weight and high chances of facing health complications during labour, delivery and after being born
  
  
• If you are overweight (BMI more than 24.9) and obese (BMI of 30 or more) when you conceive, you are more likely to develop a number of diseases during pregnancy including high blood pressure and diabetes
  
  
• High blood pressure during pregnancy is linked to foetal growth restriction resulting in underweight babies
  
  
• Diabetes during pregnancy could cause baby to be born larger than normal, with increased risk of abnormalities of the spinal cord and heart  Start practising healthy eating habits and lead an active lifestyle to achieve healthy body weight.

• Eat a wide variety of food eg different types of carbohydrate foods (eg rice, noodles, bread), all kinds of vegetables (leafy vegetables, colourful vegetables, root vegetables), different types of protein-rich foods (eg eggs, meat, fish, poultry), milk and dairy products.
• Eat foods that are nutritious, particularly those that are rich in iron and folic acid, as these micronutrients will help put you and baby in better stead.

• Folic acid plays a role in making new blood cells. The lack of folic acid in your body can lead to neural tube defects (eg spina bifida and anencephaly) in your baby. This micronutrient can be found in green leafy vegetables, dark yellow fruits and vegetables, liver, legumes, nuts and processed food (eg breakfast cereals) that are fortified with the vitamin.

• Regular physical activity helps you maintain healthy body weight while improving your strength, level of fitness and flexibility
  
  
• Don’t wait until you are pregnant to start getting active. Staying fit now will help keep up your energy levels and reduce your physical discomfort (eg from backaches) when you are pregnant.

Making sensible preparations, understanding what will (or could) take place in the course of labour and delivery, and getting to trust your medical team will help you stay calm and focussed on giving birth to baby.

Pre-admission
Round about the time of your final ante-natal visit, you and your husband may need to fill in pre-admission forms for the delivery, pay a deposit and book a room, depending on your hospital’s procedures.You may also receive a briefing regarding your stay.

Admission
You should get admitted as soon as labour starts. The usual signs include spotting of blood, bursting of the water bags, or sudden contractions. Upon admission, you will be taken to the labour room. Here, your pulse, blood pressure and temperature will be monitored regularly. An Electronic Foetal Monitoring machine (EFA), otherwise known as CTG (cardiotocograph), will be strapped to your abdomen. It has two straps – one to record the strength and frequency of your contractions, and the other to record your baby’s heartbeat pattern.

Labour & Birth
Once you are in labour, your cervix will begin to work and stretch until it is fully dilated, reaching about ten centimetres in diameter, to allow baby to come through. This process, which may take anything from several hours to a few days, entails three stages.

The first stage consists of two phases. In the early or latent phase (when cervical dilatation is at less than 4 cm), contractions tend to occur as far apart as every 20 minutes. At the beginning of each contraction, breathe in and out deeply and slowly. This will help you stay calm.

In the active phase (cervical dilatation 4 to 10 cm), contractions start coming more frequently (every 2 to 5 minutes) with each lasting from 40 to 60 seconds. Try breathing more rapidly now. Each time you inhale, count “one two” before exhaling. Count “onetwo” again before taking another breath. Keep this up for as long as you need. Your doctor will be checking on the dilatation of your cervix and will tell you when you are actually ready to give birth. Even before that moment arrives, you might feel the urge to push. Resist it and start huffing and puffing (puff out your cheeks when exhaling) until the urge to push subsides. If it helps, lie on our side or sit up slight with several pillows under your back to improve baby’s blood and oxygen supply through the placenta.

Second stage. When your doctor teels you to start pushing, concentrate on inhaling deeply and then push for five to six seconds or longer at a time. When baby’s head eventually emerges, it will take a few more pushes before the rest of his body comes out! Your doctor will cut the umbilical cord and after a brief, initial inspection, baby will be wiped and handed to you to hold for a while. Baby will thereafter be weighed, measured and given Vitamin K and Hepatitis B vaccination jabs before leaving the delivery room.

Third stage. Your whole ordeal will be over when the placenta detaches from your uterus.You will feel exhausted and soon be sent to your room where you and your family can indulge in your new arrival. Now will be a good time to breastfeed baby as it is one of the best ways for the two of your to bond.

Pain Relief
There are several methods of pain relief in labour. Epidural is by far the most effective in most cases. It is highly recommended in instances where the mother suffers from certain medical conditions, for example high blood pressure and most types of heart diseases. Other methods of pain relief include inhalation of Entonox and injection of sedatives such as Pethidine. Knowing your own pain threshold and weighing it against the potential efficacy and side effects of these methods well beforehand is very helpful. This helps you choose a pain relief method before the onset of labour.

Assisted Births
Most women go through a normal delivery. Sometimes, however, baby’s position in the uterus or mom’s state of health may call for an assisted vaginal birth or caesarean section. The procedures are explained here.

Assisted Vaginal Births

• Episiotomy. This is where an incision is made into the perineum, towards the right side and away from the anus, to enlarge the vaginal opening. This facilitates the birth and helps prevent damaging lacerations in the area.
  
  
• Forceps delivery. The doctor may use a pair of metal blades attached to handles to cradle baby’s head so that he can be pulled out. A light abrasion to baby’s skin might occur but it will heal over time.
  
  
• Vacuum Extraction. This is where a soft cone-shaped suction cup (made of rubber, metal or plastic) is put on baby’s head, thereby allowing the doctor to gently ease him out. A little swelling on baby’s scalp may result but it usually disappears in one to two days. Forceps and vacuum extraction are commonly used when the second stage of labour is prolonged or when baby gets distressed (indicated by abnormal heart rate pattern). The doctor will decide on which method to use, based on obstetric judgment of the situation and a variety of medical factors.

Caesarean birth
Caesarean birth may be necessary in certain situations. These include when baby is in a breech or other abnormal position, baby is potentially too big for mom’s pelvic size, labour is progressing poorly, baby fails to descend during labour, or if baby is distressed.

Caesarean section may also be required in some cases of multiple pregnancies (twins, triplets, etc) or when mom had had two or more previous Caesarean births. The doctor will administer an epidural, spinal or general anaesthetic depending on medical advisability as well as mom’s preference. After that, an incision will be made on the abdominal wall and into the uterus.

In almost all cases, a low transverse incision on the uterus is preferred, as there is less bleeding and it forms a strong scar to withstand future labour. Do expect a lengthy recovery and healing period compared with a normal vaginal delivery.

Until the moment arrives
Labour and birth are inevitable when baby is ready to pop into the world. In the meantime, make your pregnancy as relaxing and comfortable as you can. Clarify any doubts with your doctor. Speak to friends about their birth experiences but always remember that impressions and perceptions differ from one mom to another. Delegate chores or errands to family and friends. Rest and continue to eat well to conserve your energy for your coming delivery day. Treat yourself to warm baths, soothing massage and step into your walking shoes for some light exercise. Congratulations on your coming baby and enjoy him to the fullest!