Archive for the ‘Baby’ Category
Difficult Labors
Normally the baby is born with the head down, facing backwards, so the widest part of the baby’s head passes through the widest part of the pelvis. The baby’s head pressing down on the cervix helps it dilate, and the baby rotates as it is born, helping the body slip out behind the head.
Some babies, however, are born in a different position. This normally causes problems in labor. A posterior presentation means that the baby faces forward; its spine can press against the mother’s as it moves down, causing her pain and slowing labor. And because the widest part of the baby’s head is passing through the narrowest part of the pelvis, the baby can get stuck here more easily, again prolonging labor and sometimes requiring the use of forceps.
A breech birth occurs when the baby does not turn, so that the head is not born first; breech babies are normally born buttocks-first, occasionally feet-first. About four births in a hundred are breech. Most breech births are straightforward, though you are most likely to need intervention, especially in a first birth. Many women are advised to have an epidural; usually the baby’s head is delivered with forceps to protect it, and you are likely to have an episiotomy to help the baby’s head out. If you wind up needing an emergency Cesarean, the epidural will already be set up.
Medical Intervention
Over the past decade or two, hospitals have increasingly used a variety of techniques that have revolutionized the process of childbirth. Most of these are intended to save lives, and frequently they do. However, many interventions have become routine in some hospitals, thus interfering with the birth process for many mothers who are not at risk. Hospitals are now more likely to discuss any possible intervention with you. You should make your views clear, although obviously everyone involved should accept that intervention may be necessary in case of an emergency.
Episiotomy
An episiotomy is a small incision made in the perineum, the skin between the vagina and the anus, to enlarge the vaginal opening and help the delivery of the baby’s head. The cut is made with scissors under a local anesthetic when the baby’s head comes into view. Done properly, the perineum will have stretched very thin and the cut can be made with a minimum of damage and bleeding. An episiotomy should not be necessary in a normal delivery, and you can ask not to have one if you prefer.
However, there is some controversy over whether it is better to have a small episiotomy or risk tearing the perineum when the baby’s head is born. Some feel that a small tear is better and heals more rapidly, while others believe it is easier to sew up a clean cut. You should not be in great pain when the stitches are put in; if you are, ask to have more local anesthetic.
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Prenatal Depression
A great deal has been written about postnatal depression, but very little about prenatal depression, although it is certainly common for women to be depressed in some stages of pregnancy. Many women feel overwhelmingly tired. Social engagements, work, housework and relationships all suffer if other people do not understand:
"I used to go to bed whenever I could. The house got really, really messy because I couldn’t face cleaning it. I couldn’t be bothered to cook nice meals and I didn’t have the energy to go to parties or to movies with friends. My husband used to groan because every night about nine o’clock I’d just say, I’m exhausted, I’m going to bed now.’ A lot of the time I was too tired for sex as well."
Depression is perhaps particularly common in a second pregnancy, especially when the woman has a toddler or young child to care for. No one makes quite the same fuss over you after the first pregnancy, and it is harder to get the extra rest you need. Working women may find the second pregnancy particularly tiring and feel that they are not being efficient at their work, which can contribute to feelings of depression.
Older women in pregnancy, particularly, may worry about the health of their baby and about the birth itself-whether they will have complications and whether there will be anything wrong with the baby. Their attitude may depend to some degree on the attitude of the health professionals who care for them in pregnancy:
"I found out I was pregnant by accident in my early forties, too late to have an abortion or even the tests my provider was very nervous about it and my husband worried and thought something would be wrong. The scans indicated a different due date and showed the baby was small-it was a scary time.
"I worried about the birth because of my age, but the genetic counselor was fantastic. He said, ‘You’re a healthy woman-you should have a super-easy birth’ – he was very reassuring."
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