Section 22. Women's Health Issues

Chapter 261. Complications of Labor and Delivery

Topics: Introduction | Problems With the Timing of Labor | Problems Affecting the Fetus or Newborn | Problems Affecting the Woman | Procedures Used During Labor

Procedures Used During Labor

Induction of labor is the artificial starting of labor. Usually, labor is induced by giving the woman oxytocin, a hormone that makes the uterus contract more frequently and more forcefully. The oxytocin given is identical to the oxytocin produced by the pituitary gland. It is given intravenously with an infusion pump, so that the amount of drug given can be controlled precisely. Sometimes prostaglandins, which help the cervix dilate, are also given to help start labor. Throughout induction and labor, the fetus's heart rate is monitored electronically. At first, a monitor is placed on the woman's abdomen. After the membranes are ruptured, an internal monitor may be inserted through the vagina and attached to the fetus's scalp. If induction is unsuccessful, the baby is delivered by cesarean section.

Augmentation of labor is the artificial hastening of labor that is proceeding ineffectively or too slowly. Oxytocin is used to augment labor. Labor is augmented when a woman has contractions that are not effectively moving the fetus through the birth canal.

Slowing of labor is the artificial delaying of labor that is proceeding too forcefully. Very rarely, a woman has contractions that are too strong, too close together, or both. If contractions are caused by the use of oxytocin, the drug is discontinued immediately. The woman may be repositioned and given analgesics. If the contractions occur spontaneously, a drug that can slow labor (such as terbutaline or ritodrine) may be given to stop or slow the contractions.

Forceps are metal surgical instruments, similar to tongs, with rounded edges that fit around the fetus's head. Forceps are occasionally used in a normal labor to ease delivery. Forceps may be required when the fetus is in distress or abnormally positioned, when the woman is having difficulty pushing, or when labor is prolonged. (Sometimes doctors perform a cesarean section instead.) If forceps delivery is tried and is unsuccessful, a cesarean section is performed. Rarely, using forceps bruises the baby's face or tears the woman's vagina.

See the figure Using Forceps or a Vacuum Extractor.

A vacuum extractor can be used instead of forceps to help with delivery. A vacuum extractor consists of a small cup made of a rubberlike material that is connected to a vacuum. It is inserted into the vagina and uses suction to attach to the fetus's head. Rarely, a vacuum extractor bruises the baby's scalp.

Cesarean section is surgical delivery of a baby by incision through a woman's abdomen and uterus. Doctors perform this procedure when they think it is safer than vaginal delivery for the woman, the baby, or both. In the United States, about one fourth of deliveries are cesarean sections. An obstetrician, an anesthesiologist, nurses, and sometimes a pediatrician are involved in this surgical procedure. Use of anesthetics, intravenous drugs, antibiotics, and blood transfusions helps make a cesarean section safe. Having the woman walk around soon after surgery reduces the risk of pulmonary embolism, in which blood clots that form in the legs or pelvis travel to the lungs and block arteries there. Compared with a vaginal delivery, delivery by cesarean section results in more overall pain afterward, a longer hospital stay, and a longer recovery time.

For a cesarean section, an incision is made in the upper or lower part of the uterus. A lower incision is more common. The lower part of the uterus has fewer blood vessels, so that less blood is usually lost. Also, the healed scar is stronger, so that it is less likely to open in subsequent deliveries. A lower incision may be horizontal or vertical. Usually, an upper incision is used when the placenta covering the cervix (a complication called placenta previa), when the fetus lies horizontally across the birth canal, or when the fetus is very premature.

The choice of having a vaginal delivery or a repeat cesarean section is usually offered to women who have had a lower incision. Vaginal delivery is successful in about three fourths of these women. However, such women should plan to have their baby in facilities equipped to rapidly perform a cesarean section, because there is a very small chance that the incision from the previous cesarean section will open during labor.