Dystocia is defined as an abnormal difficult labor and delivery. Several factors cause dystocia like abnormally irregular uterine contractions, abnormal fetal presentation and cephalopelvic disproportion.

Dystocia management ranges from the use of Oxytocin to improve uterine activity or assisted delivery like forceps or a c-section to ensure safe passage for the infant.

A specific case of dystocia is shoulder dystocia, which happens during delivery when the anterior shoulder of the infant cannot pass the symphysis pubis and cannot be delivered after expulsion of the head.

It is difficult to diagnose shoulder dystocia that is why the problem will surface only during the actual birth of the infant. And in this case, it is an obstetrical emergency situation that needs immediate management or fetal death can occur within 5 minutes if the infant is not delivered immediately.

There are obstetrical maneuvers done by experienced obstetrician to facilitate the immediate delivery including:

1. McRoberts maneuver involves hyperflexing the woman’s legs to widen the pelvic opening and flatten the lumbar spine. If this is not effective, pressure is applied on the lower abdomen and the head of the infant is gently pulled.
2. Rubin I (suprapubic pressure) and Rubin II (posterior pressure) maneuver on the anterior shoulder, which will place the fetus in an oblique position somewhat towards the vagina.
3. Woods’ screw maneuver, the opposite of Rubin maneuver which will turn the anterior shoulder to the posterior and vice versa.
4. Jacquemier’s maneuver (also called Barnum’s maneuver), or delivery of the posterior shoulder first by identifying in the birth canal and be gently pulled.
5. Gaskin maneuver, named after Certified Professional Midwife, Ina May Gaskin, mother is placed in all fours position with the back arched, widening the pelvic outlet for infant delivery.
6. Zavanelli’s maneuver, involves pushing the fetal head back followed by Cesarean section
7. Clavicular fracture, to reduce the diameter of the infant’s shoulder girdle to allow passage through the birth canal.
8. Maternal symphysiotomy, this is done by opening the birth canal through creating a large incision in the connective tissue between the two pubic bones facilitating the passage of the shoulders.
9. Hysterectomy facilitates vaginal delivery of the impacted shoulder.

More drastic maneuvers include:
The major concern with shoulder dystocia is the devastating risk it poses both to the mother and the infant whether the maneuver is performed or not.

But with the experience of a skilled and properly trained obstetrician and aid from health providers both mother and child will be saved from fatal injuries.

Parents strive to connect with their unborn child and also try to do the best they can for a health development while still in the womb as well as at the time of birth. The home birth could be a wonderful and intimate option.

Couples recognize that pregnancy can be a time to build on a relationship, to help create a healthy, stable and loving setting for a child to be born into and also prefer to eschew the option of a sterile hospital birth in favor of a home birth.

Experts agree that babies fare best when parents make the effort to strengthen their relationship during the time when they prepare for the arrival of the newborn.

Planning for a home birth can be significant in that it creates the opportunity for a couple to work together as a team towards a mutually important goal.

Good communication is fostered and health outlets for stress will enhance that process.

Parents describe the decision of a home birth as “the beginning of (our) parenting” and can set a template for future parenting. A home birth may mean going against the norm, but who knows it could just be the right choice for you?

A new test has been developed in Sweden, which may help predict whether a woman will need a C section or not. This offers hope for all those women, who labor hard and long in the hope of a natural or vaginal delivery, and then be subjected to a C section in the end.

In many cases, women hold out for as long as possible in the hope that a vaginal delivery may be possible, so they undergo a long and grueling labor. However, in the end, an urgent or emergency Cesarean section is performed to protect the life and health of both mother and baby.

This is like having the world of both worlds; the pain of labor involved in a natural delivery as well as the post operative recovery pain and risks involved in a C section.

In the test, which is available in many European hospitals, the lactic acid level in the amniotic fluid is measured. When high levels of this acid are found to be present in the amniotic fluid, it decreases the chances of the mother delivering the baby vaginally.

It was seen that the muscles of the uterus, like other muscles, when they work hard, produce lactic acid. However, when the lactic acid reaches a certain level, it starts to inhibit contractions, and a C section may then become necessary.

According to the American College of Obstetricians and Gynecologists, infection is one of the common complications that occur due to Cesarean section deliveries, in an estimated 10 to 40% cases. This risk is less than 3% for natural deliveries and there is now an attempt to redress this imbalance.

Whereas antibiotics are usually given to the mother soon after the delivery, it is now advised by a new obstetric guideline in US that the antibiotics be administered before the C section surgery.

The administration of the antibiotics is usually done after the delivery in order that any brewing infection in the newborn baby could be spotted and not masked by the antibiotics administered to the mother, which may pass over into the baby’s blood stream.

However, now it is understood that antibiotics can be administered to the mother about an hour before the C section, quite safely, without any risk to the baby.

According to this new guideline issued by the American College of Obstetricians and Gynecologists elective C sections should have the antibiotics one hour before surgery, emergency C sections should have the antibiotics as soon as possible. Women who are already on antibiotics for some other reason are exempt.

If it is your first pregnancy you may be wondering what to prepare and what things to bring to the hospital on the day of delivery. But, before you think of the things to bring you should get yourself ready. Here are a few things to remember:

1. Keep in mind the date given to you by your Obstetrician, you should be prepared two weeks before and two weeks after your expected date of delivery. So on these dates you should focus more on getting enough rest and sleep to prepare you for the big day.
2. You should have the energy to push and you should have mustered the breathing techniques you will use during labor and delivery. Practice deep breathing exercises that are used during labor and shallow breathing with pursed lips when you are just about to deliver.
3. When contractions begin to get regular and intense, have a quick shower and then have yourself brought to the hospital immediately.
4. It is also a must to make arrangements what number to call, who to call and who should bring you to the hospital.
5. Have the things ready in one bag so you will just snatch it and you are off to go.
6. Although you will feel a mix of emotions on the day itself, try to relax it will help a lot.

Then have a checklist of all the things to bring that you should have ready inside one bag. The list should include the following:

1. Have at least 3 or 4 sets of baby clothes to be used during hospital stay, several diapers, mittens, bibs and baby wraps.
2. Have at least 3 set of clothes for you, if you are going to breastfeed find clothes with front openings. Keep several sets of underwear including panties, maternity napkins, maternity bra and your girdle. The girdle will serve as support to lessen the pain when moving around.
3. Extra bottles and nipples for feeding, you may want to include a breast pump.
4. All your prenatal record and laboratory tests.
5. Alcohol and betadine solution in case it would be needed plus extra analgesics and antipyretics.
6. Your toiletries and other personal belongings.
7. And of course your credit card and have extra cash ready as well.

Doing an early preparation will save you time and lessen your anxiety so you can better focus on your delivery and think of happy thoughts in your upcoming new responsibility of raising your child.

Cesarean section or c-section is a surgical procedure done to deliver your infant instead of the normal vaginal delivery. A general indication for it is when the life of the mother or the baby is in danger.

As a person outside of the medical field you are bound to the management of the Obstetrician, but that does not have to be, a little knowledge will help you understand your condition.

There are two conditions where a c-section is called for; one is planned when the medical condition calls for it or the other may just happen while you are already on the delivery table.

The following conditions may require a planned c-section, the reason being that the condition cannot be altered and doing otherwise will endanger you or your child:

1. Cephalopelvic disproportion (CPD) is a condition when the head of your baby is determined to be too large than your pelvic bones making it impossible to pass through for a vaginal delivery.
2. Placenta previa is a condition where your placenta that gives oxygen and nutrition to your baby is lying near the cervix partially or totally covering it, therefore blocking the passageway for a vaginal delivery.
3. A previous cesarean birth is another indication taking into consideration the type of incision previously done and the space between pregnancies. This is not however definitive because there are women who can deliver via normal birth even after a c-section, however, your obstetrician will be in the best position to decide on this.
4. Multiple pregnancies are another indication taking into consideration the position of the babies inside. If, however, the position of the babies will allow a vaginal birth then it is not a contraindication for vaginal birth.
5. Transverse lie means the baby is lying horizontal or sideways making it impossible for a vaginal delivery.
6. Breech presentation is when the baby is positioned where the feet or bottom is to be delivered first making it difficult for a normal vaginal delivery.

An unplanned c-section on the other hand may be scheduled under the following conditions:

1. When the cervix fails to open fully halting the labor process to progress.
2. When the umbilical cord becomes compressed because it is coiled around the baby’s neck depleting oxygen supply to the baby.
3. When the umbilical cord comes out of the cervix before the baby is out compressing it so that oxygen supply is blocked.
4. Abruptio placenta is a condition when the placenta suddenly separates from the uterus before the delivery of the baby completely halting the oxygen supply.
5. Fetal distress is a condition when the baby becomes stressed which can be measured as an increase or decrease in the heartbeat which can lead to more serious problems both for the mother and baby.
Understand these conditions and be better informed of your pregnancy.

It has become common practice for doctors to perform a C section automatically after a woman has had one Caesarean section delivery, even though it is possible to safely give birth even after a prior C section. Doctors are refusing to even try and deliver vaginally and this is largely due to medical risks and lawsuits, according to experts.

Now guidelines have been issued to try to reduce repeat C sections, so that women can more easily find hospitals and doctors who are pro VBACs (Vaginal birth after Caesarean).

It is thought that the earlier guidelines (which the new ones will replace) were actually responsible for the high prevalence of C sections today.

VBACs are safe to perform so long as the previous C section cut was low and horizontal, which is how most C sections are performed today. 60 to 80% of those women who try to deliver vaginally after a C section succeed in doing so.

The new guidelines state that a VBAC is reasonable even when there is the history of two previous C sections and those who are carrying twins. The guidelines also state that the risk of rupture (the main cause for concern in VBACs) is very low, even in the case of repeat C sections.

Among the many natural ways to induce labor, there is the time honored way of doing so by using castor oil. Castor oil has long been used as a means to ease the symptoms of constipation and to facilitate bowel movement, and it is also used as a means of inducing labor.

Many medical practitioners as well as mothers swear by the efficacy of castor oil as a means of inducing labor. It is thought that castor oil stimulates the bowels and as the same time also irritates the uterus; thereby causing contractions and setting off labor.

When the bowels are stimulated to empty, the uterus is also similarly stimulated, it is believed.

Others however will testify to the fact that they took castor oil, and even suffered some of the side effects but that it had no effect on their pregnancy and that labor was not in fact induced for them.

Castor oil, which is a vegetable oil or juice derived from the castor bean, is known to have an unpleasant taste and smell, and may be unpalatable for many women.

However, their formulations are available without any flavor and odorless. You can also have castor oil mixed up in scrambled eggs, in orange juice or in a smoothie.

If you are looking to induce labor using castor oil, it is important to keep the following in mind:

• It is never a good idea to induce labor before the due date unless there is a medical reason to do so.
• The dosage to the castor oil for induction of labor should be appropriate to your requirement and it should not be taken without the guidance and advice of your doctor or midwife.
• There are several side effects that could occur due to castor oil intake: diarrhea is a direct consequence of the stimulation of the smooth muscle of the abdomen, which may also however cause nausea, vomiting and ultimately could lead to dehydration. Dehydration could be dangerous.
• It may not work for everyone. Whereas some women will experience a distinctive stirring in the abdomen shortly after their castor oil dose, other women will experience nothing or may require an additional dose.
• Some experts have also suggested that castor oil is associated with meconium and fetal distress and should therefore be avoided, though many do argue that there is no connection between castor oil and the baby passing meconium.

According to a recent study published by the American Journal of Obstetrics & Gynecology (AJOG), the issue of planned home births and their association with neonatal mortality was examined.

It was found by the researchers that about 1 in 200 babies in the United States are delivered at home; 75% of those deliveries are planned as home births. Home births are associated with less medical intervention; however this is also seen to greatly increase rate of neonatal death.

Home births were seen to triple the chances of neonatal mortality. It was found that the major cause for these new born infants dying in home births was respiratory distress and failed resuscitation.

Home births are associated with less medical intervention such as epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and cesarean deliveries.

Also women may have fewer infections, vaginal lacerations, retained placentas and hemorrhages.

However, the risks of a home birth for the baby are seen to rise in the case of home deliveries, and this, according to the researchers is what needs to be highlighted for the attention of public health officials at state and national levels.

Throughout your pregnancy, you have probably experienced some aches and pains. More than likely you have even felt some contractions in your abdomen as your uterus periodically spasms or contracts in a way that mimics mild labor pains.

These early contractions (known as the Braxton Hicks contractions) are not to be confused with real labor pains however. So how do you avoid confusing these practice contractions with the real thing? Here is how you can identify the signs of real labor pain:

Learn to indentify the practice contractions or false labor: Braxton Hicks contractions begin as early as 6 weeks gestation, but you may not actually feel them until the second or third trimester.

These pains are characterized by infrequency, random and can happen at irregular intervals.

The cramping or pain is only mild in this case because the uterus is just practicing for the real thing.

These contractions are the tightening of the uterine muscles for an hour or two and could be part of the process of the thinning or effacement of the cervix.

It should be remembered that many women do not experience Braxton Hicks contractions at all; not having them is as normal as having them.

Real labor may be accompanied by certain other signs and symptoms: Real labor will happen later in the pregnancy and unless yours is a preterm delivery, it will happen after the completion of the 37th week of your pregnancy. In the event it will be accompanied by other signs of going into labor such as:

• The head of the baby will have settled into the birthing canal, a stage also known as lightening.
• Your water may break. The mucus plug that seals the mouth of the uterus and amniotic sac is dislodged and the amniotic fluid escapes in a gush or in a trickle, indicating that the baby is now on his way.
• You may have a “show” or a slightly bloody discharge as the mucus plug is dislodged.
• Lower back pain will also indicate that it is labor and not practice contractions.

The contractions will start in real earnest: When real labor begins, the contractions will be strong and more painful. They will be frequent and evenly spaced, with predictable durations and periods between them.

Timing the contractions will give you an idea that this is indeed real labor pain and that you need to call your doctor or midwife!