Baby, why the trouble?

BIRTHING TROUBLE

Despite steadfast advancements in medicine, millions of women continue to experience  complications during labour.  Dr Leelavati Devadas explains why this may be the case

For a couple awaiting the birth of their child, pregnancy is a long, long journey. Like any other journey, hurdles galore are encountered en route, inordinate delays for reasons unexplained are possible and unexpected complications can crop up  without warning. These not only endanger the two precious lives at hand but also bring on inexpressible misery to the entire family.

In spite of this pessimistic statement, it’s really fortunate that more than 90 per cent of deliveries end successfully. As for  the rest, the process of labour turns into an ordeal that can be painful for the mother and child.

Why should this be? Can we not save the millions of women dying in labour every minute? Can we not pull them out of this safely? Are we not capable of preventing the umpteen problems encountered on the way?

First, let’s identify the problems. The three ‘P’s have to be tackled. They are:
nThe passenger —The foetus in the womb.
nThe  passages —  The maternal pelvis, its muscles, and other closely-associated tissues .
nThe power — Mainly the uterine contractions.
The passenger
The foetus, especially its head, may be too big for the maternal pelvis. The normal position of the foetus is head-down. If the buttocks are down, or if it is lying across in the uterus, one can expect complications.

It can be smooth-sailing for the foetus  if it is at an attitude of flexion. In case this is disturbed, and any part of  it is extended, trouble will surely arise. Labour will be prolonged, causing distress to the mother and child (to the doctor in charge too).
Rarely, tumours in the foetus obstruct  normal descent. In normal labour, the foetus doesn’t come down as in a pipe. In fact, it has to undergo various movements on the way. If, for some reason, this natural mechanism fails, one should expect an abnormal labour.

The passage

Even when the foetus is of normal size, if any part of the mother’s pelvis is smaller than usual, labour cannot progress satisfactorily. The maternal  pelvis has a specific curve and shape, which facilitate the normal progress of the foetus. But if these are  disturbed at any level, there will be difficulty in descent. Tumours of the maternal pelvis or of its muscles and other tissues will be obvious deterrents to normal delivery.

The placenta is almost always situated in the upper segment of the uterus but, at times, it gets attached to the lower segment, either partially or in toto. If this takes place, it acts as an obstruction for the easy emergence of the foetus. Other complications also are to be expected.

In normal labour, the mouth of the uterus i.e — the cervix, should dilate satisfactorily and in time. It must fully dilate by the end of the first stage of labour, merging itself with the lower uterine segment. Now and then, if and when this does not happen, and the cervix remains either closed or partially open, it becomes difficult for the emergence of the foetus.

Among the many causes  for this problem is the fragile mental attitude of the woman in labour. Her fears (tocophobia) her anxiety, her mental tension, can affect the outcome of labour.

The power

It is a known fact that the uterine contractions are the main source of giving the necessary thrust to the unborn baby’s body. The uterus should contract  regularly and effectively and the interval between two contractions must gradually get shortened. The powers should neither be too weak nor too strong.

For the ideal progress of labour, when the upper uterine segment contracts, the lower segment should relax, facilitating the smooth descent of the foetus. When this polarity is not there, labour comes to a standstill.

There is another unique characteristic of the uterine muscle fibre which is not exhibited by any other muscle in the body — the uterine muscle fibre, when relaxing after a contraction, gets shortened. Thanks to this wonderful design, the upper segment of the uterus gets smaller after a contraction and the foetus, which has now come down, cannot go back to its former place during a relaxation. There will not be sufficient space for it. It has to descend and come out.

But abnormalities can spoil the show. The uterine contractions may be incoordinate or they may be either too strong or too weak too. In such cases,the ‘bag of waters’ ruptures prematurely, paving the way for infections to set in.

Out of the several factors responsible for causing difficulties in labour, some are predictable and some are not. Some are treatable with medicines and some may need surgery.

Keeping this in mind, it should be an axiom that all deliveries must be handled in a well-equipped, sufficiently-staffed  hospital. If home delivery is unavoidable, a vehicle should be kept ready to transport the woman in labour to the nearest hospital  in the shortest of time, in case of any complications.