What are the signs of fetal distress?
Breathing problems
When a baby does not start to breathe at birth, even though no problems were detected before delivery, the baby will require resuscitation. This is why a skilled obstetric team is a necessity for any birthing environment or complicated vaginal delivery.
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Abnormal position and presentation of the fetus or stuck in the birth canal
Position refers to whether the fetus is facing rearward (toward the woman's back, or face down) or forward (face up). Presentation refers to the part of the fetus's body that leads the way out through the birth canal. The most common and safest combination is head first and facing down, with the face and body angled toward the right or left and with the neck bent forward, chin tucked in, and arms folded across the chest. If the fetus is in a different position or presentation, labor may be more difficult and delivery through the vagina may not be possible.
Multiple births
The number of twin, triplet, and other multiple births has been increasing over the past 20 years. During pregnancy, the number of fetuses can be confirmed by ultrasonography. Carrying more than one fetus overstretches the uterus. An overstretched uterus tends to start contracting before the pregnancy reaches full term causing babies to be born prematurely and to have a low birth weight.
In some cases, the overstretched uterus does not contract well after delivery, causing the mother to bleed after delivery. Because the fetuses can be in various positions and presentations, vaginal delivery can be complicated. Also, the contraction of the uterus after delivery of the first baby may shear away the placenta of the remaining baby or babies. As a result, the baby or babies that follow the first may have more problems during delivery and later.
For these stressful reasons, doctors may decide in advance how to deliver twins - vaginally or by cesarean section. Occasionally, the first twin is delivered vaginally, but a cesarean section is considered safer for the second twin. For triplets and other multiple births, doctors usually perform a cesarean section.
Shoulder dystocia occurs when one shoulder of the fetus lodges against the woman's pubic bone and the baby becomes caught in the birth canal. The head comes out, but it is pulled back tightly against the vaginal opening. The baby cannot breathe because the chest is compressed by the birth canal. As a result, oxygen levels in the baby's blood decrease. This complication is more common with large fetuses, particularly when labor has been difficult or when forceps or a vacuum extractor has been used because the fetus's head has not fully descended in the pelvis.
When this complication occurs, the doctor quickly tries various techniques to free the shoulder so that the baby can be delivered vaginally. In extreme circumstances, if the techniques are unsuccessful, the baby may be pushed back into the vagina and delivered by cesarean section.
Prolapsed umbilical cord
The umbilical cord precedes the baby through the vagina in about 1 of 1,000 deliveries. When the umbilical cord prolapses, it may constrict so that the fetus' blood supply is cut off. This complication may be overt or not. Prolapse is overt when the membranes have ruptured and the umbilical cord protrudes into or out of the vagina before the baby emerges. Overt prolapse usually occurs when a baby emerges buttocks first (breech presentation). But it can occur when the baby emerges head first, particularly if the membranes rupture prematurely or the fetus has not descended into the woman's pelvis. If the fetus has not descended, the rush of fluid as the membranes rupture can carry the cord out ahead of the fetus. If the cord prolapses, immediate delivery, almost always by cesarean section, is necessary to prevent the blood supply to the fetus from being cut off. Until surgery begins, a nurse or doctor holds the fetus’ body away from the cord so that the blood supply through the prolapsed cord is not cut off.
When the prolapsed is not overt or obvious, the opposite is considered occult. Membranes are intact and the cord is in front of the fetus or trapped in front of the fetus' shoulder. Usually, an occult prolapse can be identified by an abnormal pattern in the fetus heart rate. Changing the woman's position or raising the fetus head to relieve pressure on the cord usually corrects the problem. Occasionally, a cesarean section is necessary.
Nuchal cord
The umbilical cord is wrapped around the fetus' neck in about 25 percent of deliveries. Normally, the baby is not harmed. Before birth, a nuchal cord can sometimes be detected by ultrasonography, but no action is required. Doctors routinely check for it as they deliver the baby. If they feel it, they can slip the cord over the baby's head.
Placental abruption
If the placenta separates from the inner wall of the uterus before delivery, it's known as placental abruption. Placenta abruption is a rare but serious complication requiring immediate medical attention. The uterus bleeds from the site where the placenta was attached. The blood typically passes through the cervix and out the vagina. Sometimes, the blood remains trapped behind the placenta. Left untreated, placental abruption puts both mother and baby in danger.
Meconium
Meconium staining of amniotic fluid is seen frequently as the fetus matures and by itself is not an indicator of fetal distress. A slight degree of meconium without fetal heart rate abnormalities is a warning of the need for vigilance. Thick meconium suggests passage of meconium in reduced amniotic fluid and may indicate the need for expedited delivery and meconium management of the neonatal upper airway at birth to prevent Meconium Aspiration Syndrome (MAS). In breech presentation, meconium is passed in labor because of compression of the fetal abdomen during delivery. This is not a sign of distress unless it occurs in early labor.
Fetal macrosomia
Fetal macrosomia (excessive birth rate / 8 pounds 14 oz) and complications associated with macrosomia risk of cesarean delivery, postpartum hemorrhage, vaginal lacerations, urinary tract infection, shoulder dystocia, fracture of the clavicle, and brachial plexus injury.
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C-Sections
A C-section is the surgical delivery of a baby that involves making incisions in the mother's abdominal wall and uterus. Generally considered safe, C-sections do have more risks than vaginal births. There's far less chance of infection and severe bleeding with a vaginal delivery than with a C-section. Plus, you can come home sooner and recover quicker after a vaginal delivery. C-sections are worth avoiding, if possible. However, these common surgical deliveries can help women with high-risk pregnancies avoid dangerous delivery-room complications and can save the life of the mother and/or baby in emergency situations.
