Childbirth is the process of giving birth to a baby. It includes labor and delivery. Usually everything goes well, but problems can happen. They may cause a risk to the mother, baby, or both. Some of the more common childbirth problems include

• Preterm (premature) labor, when your labor starts before 37 completed weeks of pregnancy
• Premature rupture of membranes (PROM), when your water breaks too early. If labor does not start soon afterwards, this can raise the risk of infection.
• Problems with the placenta, such as the placenta covering the cervix, separating from the uterus before birth, or being attached too firmly to the uterus
• Labor that does not progress, meaning that labor is stalled. This can happen when
  • Your contractions weaken
  • Your cervix does not dilate (open) enough or is taking too long to dilate
  • The baby is not in the right position
  • The baby is too big or your pelvis is too small for the baby to move through the birth canal
• Abnormal heart rate of the baby. Often, an abnormal heart rate is not a problem. But if the heart rate gets very fast or very slow, it can be a sign that your baby is not getting enough oxygen or that there are other problems.
• Problems with the umbilical cord, such as the cord getting caught on the baby's arm, leg, or neck. It's also a problem if cord comes out before the baby does.
• Problems with the position of the baby, such as breech, in which the baby is going to come out feet first
• Shoulder dystocia, when the baby's head comes out, but the shoulder gets stuck
• Perinatal asphyxia, which happens when the baby does not get enough oxygen in the uterus, during labor or delivery, or just after birth
• Perineal tears, tearing of your vagina and the surrounding tissues
• Excessive bleeding, which can happen when the delivery causes tears to the uterus or if you are not able to deliver the placenta after you give birth to the baby
• Post-term pregnancy, when your pregnancy lasts more than 42 weeks

If you have problems in childbirth, your health care provider may need to give you medicines to induce or speed up labor, use tools to help guide the baby out of the birth canal, or deliver the baby by Cesarean section.

Fetal membranes, premature rupture - spontaneous tearing of the membranes surrounding the fetus any time before the onset of obstetric labor. Preterm prom is membrane rupture before 37 weeks of gestation.

This condition occurs when the placenta covers part of the opening of the cervix inside the uterus. It can cause painless bleeding during the second and third trimesters. The health care provider may recommend bed rest. Hospitalization may be required if bleeding is heavy or if it continues. Placental problems may affect how the baby is delivered.

A Cesarean section (C-section) is surgery to deliver a baby. The baby is taken out through your abdomen (belly). In the United States, almost one in three babies are born this way. Some C-sections are planned. Others are emergency C-sections, which are done when unexpected problems happen during delivery.

When is a Cesarean section (C-section) needed?

You may need a C-section because:

• You have health problems, including infection
• You are carrying more than one baby
• Your baby is too big
• Your baby is in the wrong position
• Your baby's health is in danger
• Labor is not moving along as it should
• There are problems with your placenta (the organ that brings oxygen and nutrients to your baby)

Not everyone who has had a C-section before will need another one next time. You may be able to have a vaginal birth after Cesarean (VBAC). Talk to your health care provider about what is right for you.

The baby is in the wrong position. Most often when this occurs, the baby is breech, or in a breech presentation, meaning that the baby is coming out feet first instead of head first. The baby may also be in a transverse (sideways) or oblique (diagonal) position.

Preterm labor is labor that starts before 37 completed weeks of pregnancy. It can lead to premature birth. Premature babies may face serious health risks.

Symptoms of preterm labor include

• Contractions every 10 minutes or more often
• Leaking fluid or bleeding from the vagina
• Feeling of pressure in the pelvis
• Low, dull backache
• Cramps that feel like menstrual cramps
• Abdominal cramps with or without diarrhea

If you think you might be having preterm labor, contact your health care provider.

Each pregnancy and delivery is different, and problems may arise.

If complications occur, providers may assist by monitoring the situation closely and intervening, as necessary.

Some of the more common complications are:

• Labor that does not progress. Sometimes contractions weaken, the cervix does not dilate enough or in a timely manner, or the infant's descent in the birth canal does not proceed smoothly. If labor is not progressing, a health care provider may give the woman medications to increase contractions and speed up labor, or the woman may need a cesarean delivery.
• Perineal tears. A woman's vagina and the surrounding tissues are likely to tear during the delivery process. Sometimes these tears heal on their own. If a tear is more serious or the woman has had an episiotomy (a surgical cut between the vagina and anus), her provider will help repair the tear using stitches.
• Problems with the umbilical cord. The umbilical cord may get caught on an arm or leg as the infant travels through the birth canal. Typically, a provider intervenes if the cord becomes wrapped around the infant's neck, is compressed, or comes out before the infant.
• Abnormal heart rate of the baby. Many times, an abnormal heart rate during labor does not mean that there is a problem. A health care provider will likely ask the woman to switch positions to help the infant get more blood flow. In certain instances, such as when test results show a larger problem, delivery might have to happen right away. In this situation, the woman is more likely to need an emergency cesarean delivery, or the health care provider may need to do an episiotomy to widen the vaginal opening for delivery.
• Water breaking early. Labor usually starts on its own within 24 hours of the woman's water breaking. If not, and if the pregnancy is at or near term, the provider will likely induce labor. If a pregnant woman's water breaks before 34 weeks of pregnancy, the woman will be monitored in the hospital. Infection can become a major concern if the woman's water breaks early and labor does not begin on its own.
• Perinatal asphyxia. This condition occurs when the fetus does not get enough oxygen in the uterus or the infant does not get enough oxygen during labor or delivery or just after birth.
• Shoulder dystocia. In this situation, the infant's head has come out of the vagina, but one of the shoulders becomes stuck.
• Excessive bleeding. If delivery results in tears to the uterus, or if the uterus does not contract to deliver the placenta, heavy bleeding can result. Worldwide, such bleeding is a leading cause of maternal death.

Delivery may also require a provider's special attention when the pregnancy lasts more than 42 weeks, when the woman had a C-section in a previous pregnancy, or when she is older than a certain age.

The amount of pain felt during labor and delivery is different for every woman. The level of pain depends on many factors, including the size and position of the baby, the woman's level of comfort with the process, and the strength of her contractions.

There are two general ways to relieve pain during labor and delivery: using medications and using "natural" methods (no medications). Some women choose one way or another, while other women rely on a combination of the two.

A woman should discuss the many aspects of labor with her health care provider well before labor begins to ensure that she understands all of the options, risks, and benefits of pain relief during labor and delivery before making a decision. It might also be helpful to put all the decisions in writing to clarify things for all those who might be involved with delivering the baby.

Pain-Relieving Medications

Pain-relief drugs fall into two categories: analgesics (pronounced an-uhl-JEE-ziks) and anesthetics (pronounced an-uhs-THET-iks).

Each category has different forms of medications. Some of these medications carry risks. It is important for women to discuss medications with their health care provider before going into labor to ensure that they are making informed decisions about pain relief.

Analgesics

Analgesics relieve pain without causing total loss of feeling or muscle movement. These drugs do not always stop pain completely, but they reduce it.

• Systemic analgesics affect the whole nervous system rather than a single area. They ease pain but do not cause the patient to go to sleep. Systemic analgesics are often used in early labor. They are not given right before delivery, because they may slow the baby's breathing and reflexes. They are given in three ways:
  • Injected into a muscle or vein
  • Administered through a small tube placed in a vein. The woman can often control the amount of analgesic flowing through the tube.
  • Inhaled or breathed in with a mixture of oxygen. The woman holds a mask to her face, so she decides how much or how little analgesic she receives for pain relief.
• Regional analgesics relieve pain in one region of the body. In the United States, regional analgesia is the most common way to relieve pain during labor. Several types of regional analgesia can be given during labor:
  • Epidural analgesia, also called an epidural block or an epidural, causes loss of feeling in the lower body while the patient stays awake. The drug starts working about 10 minutes to 20 minutes after it is given. A health care provider injects the drug near the spinal cord. A small tube (catheter) is placed through the needle. The needle is then withdrawn, but the tube stays in place. Small amounts of the drug can then be given through the catheter throughout labor without the need for another injection.
  • A spinal block is an injection of a much smaller amount of the drug into the sac of spinal fluid around the spine. The drug starts working right away, but it lasts for only 1 to 2 hours. Usually, a spinal block is given only once during labor, to help with pain during delivery.
  • A combined spinal-epidural block, also called a "walking epidural," gives the benefits of an epidural block and a spinal block. The spinal part relieves pain immediately. The epidural part allows drugs to be given throughout labor. Some women may be able to walk around after a combined spinal-epidural block.

Anesthetics

Anesthetics block all feeling, including pain.

• General anesthesia causes the patient to go to sleep. The patient does not feel pain while asleep.
• Local anesthesia removes all feeling, including pain, from a small part of the body while the patient stays awake. It does not lessen the pain of contractions. Health care providers often use it when performing an episiotomy (pronounced uh-pee-zee-OT-uh-mee), a surgical cut made in the region between the vagina and anus to widen the vaginal opening for delivery or when repairing vaginal tears that happen during birth.

Natural Pain-Relief Methods (Also Called Natural Childbirth)

Women who choose natural childbirth rely on a number of ways to ease pain without taking medication. These include:

• The company of others who offer reassurance, advice, or other help throughout labor, also known as continuous labor support
• Relaxation techniques, such as deep breathing, music therapy, or biofeedback
• A soothing atmosphere
• Moving and changing positions frequently
• Using a birthing ball
• Massage
• Yoga
• Taking a bath or shower
• Hypnosis
• Using soothing scents (aromatherapy)
• Acupuncture or acupressure
• Applying small doses of electrical stimulation to nerve fibers to activate the body's own pain-relieving substances (called transcutaneous electrical nerve stimulation, or TENS)
• Injecting sterile water into the lower back, which can relieve the intense discomfort and pain in the lower back known as back labor

If a pregnant woman is showing signs of preterm labor, her doctor will often try treatments to stop labor and prolong the pregnancy until the fetus is more fully developed. Treatments include therapies to try to stop labor (tocolytics) and medications administered before birth to improve outcomes for the infant if born preterm (antenatal steroids to improve the respiratory outcomes and neuroprotective medications such as magnesium sulfate).

Medications to Delay Labor

Drugs called tocolytics (pronounced toh-coh-LIT-iks) can be given to many women with symptoms of preterm labor. These drugs can slow or stop contractions of the uterus and may prevent labor for 2 to 7 days. One common treatment for delaying labor is magnesium sulfate (pronounced mag-NEEZ-ee-um SUL-fate), given to the pregnant woman intravenously through a needle inserted in an arm vein.

Medications to Speed Development of the Fetus

Tocolytics may provide the extra time for treatment with corticosteroids (pronounced kohr-tuh-koh-STER-oids) to speed up development of the fetus's lungs and some other organs or for the pregnant woman to get to a hospital that offers specialized care for preterm infants. Corticosteroids can be particularly effective if the pregnancy is between 24 and 34 weeks (between 5½ and 7¾ months) and the woman's health care provider suspects that the birth may occur within the next week. Intravenously delivered magnesium sulfate may also reduce the risk of cerebral palsy if the child is born early.