Birth

Most "complications" can usually be dealt with successfully by the obstetrician and the hospital staff. The baby may, for example, come out bottom first in what is called a breech presentation. Sometimes one foot is first to appear, and sometimes the umbilical cord comes out alongside the head. The doctor must manage these variations and often actually turn the baby before birth with great skill to avoid any further complications.

Babies, for the most part, deliver themselves. It is when complications develop that the training and expertise of the health-care provider are needed. The fetal heartbeat is monitored during labor, and when there is cause for concern, a cesarean delivery may need to be performed.

A cesarean birth is one in which the baby is delivered through a surgical incision made into the woman's abdomen and uterus. Although it is generally considered a safe operation for both mother and baby, it is still major surgery. Babies delivered by cesarean do not have molded heads and look better in general than babies born vaginally. A cesarean delivery might be performed for reasons such as difficult and perhaps dangerous labor, fetal distress, breech presentation, and previous cesareans. These reasons explain some 50 percent of all cesareans being performed. As a rule, a cesarean delivery is planned ahead of time and performed before labor has a chance to begin. Today it can be performed even after the uterine contractions have started if the child cannot be delivered otherwise.

Another means of helping nature during birth is through a tonglike instrument, known as forceps. These concave, elongated tools are inserted as two separate units into the vagina. Each is placed on the baby's head. When the handles are joined, the baby be rotated and pulled.

A forceps delivery may be required if the mother's contractions slow down or stop. Today, hormones are usually given to make the contractions continue. But danger signs from either fetus or expectant mother could call for delivery with forceps.

The use of forceps either in the first stage of delivery or early second stage can cause brain damage to the child. At these stages it is important to place the forceps accurately on the child's head. It is also necessary to use considerable force to pull the baby's head out. This is called high forceps delivery and is almost never used today because of the danger involved. Low forceps delivery, that is, the use of forceps in the actual delivery stage, is rarely damaging to the child and is still commonly used in many hospitals.