We all know that giving birth isn't going to be like it is on TV dramas: Your water breaks; you gasp, exclaim, "She's coming!" Then, lipstick refreshed, you cradle your newborn as your handsome husband looks on. Alternatively, we hope it isn't going to be fodder for reality TV: A swarm of doctors sprints into the delivery room, shouting, "Get the NICU team, STAT! We've got a quadruple nuchal and need a cold-knife section!" More than likely, it will be somewhere between the two. However your labor story unfolds, being educated helps. Below are six possible scenarios of labors with complications, complete with doctors' lingo and happy endings.
COMPLICATION: Nuchal Cord
WHAT IT MEANS: The umbilical cord is wrapped around the baby's neck. Two times around is a "double nuchal."
FREQUENCY: Approximately 25 percent of births.
LIKELY REMEDIES: "A nuchal cord doesn't necessarily mean the baby is in danger," says Nanci Levine, M.D., an OB-GYN at Montefiore Medical Center in Westchester, N.Y. "Even if it sometimes causes the baby's heart rate to go down [known as 'variable deceleration in the heart rate tracing'], a nuchal cord doesn't have to be serious. But if you have a contraction and the baby's heart rate doesn't go back up, the cord may be too tight, and that could mean the baby is having problems."
For New York City-based Catherine Hooper, 34, mother of 21-month-old Sophie, it wasn't until late in labor that there was a problem. "As the baby was coming down the birth canal, her heartbeat slowed from a quick bubump, bubump, bubump to almost nothing," she recalls. Assuming the problem was a nuchal cord, Hooper's doctor applied upward pressure to the baby's head to give the cord some slack, and the baby's heartbeat immediately came back. "After I pushed her out," says Hooper, "the doctor quickly unwrapped the cord, and she was fine."
"If the variable deceleration in the heart rate tracing goes on for quite a while, we will want the mother to deliver fairly soon," says Leslie Goldstone-Orly, M.D., an OB-GYN at Bridgeport Hospital at Yale-New Haven in Bridgeport, Conn. If the mother is unable to push the baby out, forceps or a vacuum extractor (a soft suction cup placed on the baby's head) may be used to assist the baby down the canal. "If the baby is too high or the mother is not adequately dilated, a C-section might be necessary," Goldstone-Orly says.
COMPLICATION: Cephalopelvic Disproportion (CPD)
WHAT IT MEANS: The baby's head is too big to pass through the mother's pelvis, resulting in "failure to progress."
FREQUENCY: Unknown. The condition is hard to quantify because you're never sure if it's a true CPD or simply a failure to progress--i.e., the mother stops dilating, or the baby is not moving down due to undetermined causes.
LIKELY REMEDIES: Failure to progress is the single most common cause for a C-section, though you may be given the drug Pitocin to induce contractions first, says Levine. There's no accurate way to predict CPD prior to labor. "You can measure the mom's pelvis by feeling it, but that is unreliable," says Goldstone-Orly. However, exercising during pregnancy and keeping your weight gain within recommended limits can diminish your chances of developing gestational diabetes, thus reducing the risk of a large baby, she adds.