The Not-Normal Delivery by the Pregnant Woman
There are about five percent cases in which the delivery is not normal due to various reasons. Some prominent reasons are being described below.
(A) Breech Presentation
The baby’s normal position should be ‘head-down’ in the uterus. However, if it is in the ‘upright’ position with its buttocks lowermost the position is known as ‘Breech Presentation’.
Now owing to various researchers in this field and the availability of the latest facilities breech deliveries are no longer considered complicated ones, although such deliveries are certainly more difficult than the normal ones. It would be advisable to have the baby delivered in a hospital if it is in such a ‘breech’ position. In a breech delivery, as the head of the baby would be the last to emerge, if there are any factors that interfere with the supply of oxygen to the baby, its survival may be endangered. If the baby happens to have a head larger than normal, or if it is facing the wrong way, the delivery is likely to be more difficult. In all such cases, any undue haste in delivering the baby would be likely to cause harm to the baby.
(B) Cephalic Delivery
These are the deliveries in which the head of the baby emerges very slowly from the uterus. As the baby descends, the shape of its head keeps changing because of various pressures on the as yet soft bones of the skull in its passage through the pelvis. The changes in shape help it to slide outwards more easily. Such deliveries tend to progress slowly, and labour may last for several hours.
If the two babies simultaneously develop in the womb, they are said to be ‘twins’. However, there are two types of ‘twins’: the identical twins and fraternal twins. Identical twins are those that develop from the same fertilized ovum, which has divided into two in every phase of development. They are not only similar but replicas of one another: hence the term, identical twins. Fraternal twins develop from separate ova which have been independently fertilized, and so generally their similarities are dissimilarities are no less or greater than those of any brothers or sisters.
The necessity of this surgical procedure arises when the head of the baby is larger than the maximum dilatation possible for the muscles of the vagina so that delivery gets obstructed. The procedure consists in making an incision in the perineum between the vaginal opening and the anus, generally towards one side, either left or right. The intention is to widen the passage and thus facilitate delivery of the baby. Of course, if an episiotomy is decided upon a local anesthetic is administered first, before proceeding with the incision.
(E) Delivery Through Suction (Vacuum) Extraction
This is the method employed to expedite the second stage of delivery. At the end of the first stage, a small metal cap is applied to the head of the baby. A special device is used to create a partial vacuum in the cup so that the cup is firmly attached to the head by the resulting suction. Now pulling on the cup, the baby is gradually eased out. One disadvantage of this method is that there develops a slight swelling on the head of the bay where the cup has been attached, and the swelling takes some time to subside.
The advantage is that even when the cervix has not been fully dilated, the baby can be delivered with comparative ease, without too much distress either to the mother or to the baby. No forceps are needed in this method.
(F) Forceps Delivery
When due to weakness the mother cannot push with sufficient force, this method is employed for extraction of the bay, though great care is required to be exercised, to guard against the possibility of harming the baby. Epidural anesthesia may or may not have been administered before forceps delivery is undertaken.
(G) Caesarian Delivery
Called so because Julius Caesar was the first to be born this way, there was a time when Caesarian delivery was considered to be a highly risky procedure. The chances of the mother surviving such as delivery were rated very low indeed. But to-day Caesarian delivery has come to be looked upon as quite an ordinary variation of the process of delivery. There is a very little risk either for the mother or for the baby in a Caesarian delivery today. The method consists in making an incision in the lower abdomen, and another one in the uterus to open it up, and gently lifting the baby out of the uterus.
Reasons for a Caesarian Delivery
Given below are the reasons which necessitate Caesarian delivery :
- A cervical tumour : This may impede the process of delivery, making a Caesarian section necessary.
- An Excessively Large Head of the Baby: In case the head of the baby has become enlarged because of the presence of excessive fluids in the skull, the fluids may have to be let out by puncturing the scalp, or alternatively, delivery has to be affected by Caesarian section.
- Owing to Protrusion of Baby’s Arm: As shown in the figure below, the arm of the baby may sometimes protrude through the cervix along with the head. In such a condition, Caesarian delivery becomes inevitable.
- Baby Lying in the Womb in Transverse Position: The baby’s lying in the womb in transverse (head and feet horizontal) position and not in the normal head-down position develops this complication, necessitating Caesarian section. If the baby cannot be manipulated into the normal position, there is no go but to resort to this kind of operation.
Besides the above mentioned reasons, if the pelvic bones of the mother are too narrow, or her general condition of health is unfavourable to a normal vaginal delivery, or if she has high B. P., or she has previously had a Caesarian delivery, or if the baby is getting asphyxiated in the womb for same reason, Caesarian delivery must be resorted to for there is no other alternative save bring out the child through surgical operation.
(H) Rupture of the Uterus
If a previous baby has been delivered by caesarian section for any reason such as narrow pelvis or passage, or if there has been excessive use of a drug like Pitocin, there is a likelihood of rupture of the uterus during labour contractions. Such as condition arises more frequently in cases of women of advanced age, or woman who have had numerous deliveries, or, as mentioned above, in cases of women who have had Caesarian deliveries.
Test Tube Babies
Although the delivery, in this case, is no different than the normal-depending upon the health of the woman, this sub-title is included in this chapter because of its novelty. The ‘Test Tube Baby’ is the latest development in medical sciences. It has opened up possibilities of conception to a number of women who ordinarily would not have been able to achieve motherhood. The method is a boon to women whose fallopian tubes are not functioning.
In the cases where the fallopian tubes are defective but the uterus is normal and the sperm count of the husband is satisfactory the procedure is adopted.
In this procedure a special device, the ‘Laparoscopy’ is used to extract the ovum from the ovary of the woman. This is then placed in a test tube, and allowed to be fertilized by the husband’s sperm. The fertilized ovum is allowed to develop in the test tube up to a certain stage and then implanted in the uterus of the woman.
In other words, the processes normally taking place in the Fallopian tubes of a woman have carried out artificially in a test tube. That is why the process is referred to as ‘the test tube fertilization,’ and the baby is called a test tube baby, though most of its development takes place in the uterus. Highly satisfactory results have been obtained in a number of cases. Now the first Indian test-tube baby is already ten years old and pretty healthy wise.