Things can go wrong in childbirth, but the more you know about complications in advance, the easier it is to deal with them should they arise.

Emergency Birth

In cases in which the fetus begins to show signs of distress (rapid acceleration or sudden slowdown of fetal heart rate) or you experience a life-threatening condition such as hemorrhage, you will be rushed to the OR for an emergency cesarean. In most cases, because time is of the essence, you will be given a general anesthetic.

Women who attempt a vaginal birth after a cesarean (VBAC) can be at risk for uterine rupture or a separation of their previous C-section scar. If this occurs, an emergency C-section would be performed. It should be noted, however, that the success rate of VBAC is very good — between 60 and 80 percent of individuals who are considered candidates for the procedure come through it with flying colors. (Return to Chapter 11 for more on VBAC.)

Delivery Complications

A child with a head too large for passage through the pelvis (called cephalopelvic disproportion), a labor that fails to progress past 6 or 7 centimeters despite best efforts, or fetal distress caused by a compressed umbilical cord are all possible complications that could cause an unplanned cesarean section.

In cases in which your baby needs a little extra help getting out of the birth canal, the use of forceps may be required. This tong-like device is used to reach into the birth canal, gently grasp the baby's head, and pull him out. Forceps are also used to reposition a baby who is intent on arriving in a poor position. The terms mid- and low-forceps delivery indicate where the doctor inserts the instrument into the birth canal. When forceps are used at all, the low position is the more likely one.

Sometimes forceps are used simply to lift the baby up and out right there at your perineum, which use is called outlet forceps. Babies delivered via forceps do wear signs of these instruments as bruises or red marks on either side of their heads for a few days, and there is a very slim risk of brain injury.

If your provider is concerned that using forceps will injure your perineal tissues, he may choose vacuum extraction instead. Suctioned onto the baby's head, the cup is attached to a chain or handle that the doctor pulls on while you keep on pushing. The cup will simply fall off the baby's head if too much pressure builds up. However, babies who arrive via vacuum extraction can have a bruised, swollen look to the top of their heads.

Other maternal complications can occur following a successful delivery. Postpartum hemorrhage and a related dive in blood pressure can occur when the uterus fails to contract again after both baby and placenta have been delivered. Compression and massage of the uterus and/or drug therapy might be used to stop the bleeding. In cases in which a tear of the cervix has occurred, this will be sutured. If these measures still don't stop the bleeding, surgery may be required.