Complicated induced labor, cesarean section, twin births.

• What is induced labor?

This term is used to describe a method of artificially inducing labor. The fact is that sometimes labor needs to start, but it does not start on its own. This may be necessary: if the pregnancy lasts longer than 41 weeks; in cases where there is a Rh conflict between the mother and the fetus; if the amniotic sac ruptures prematurely; if the fetus is too heavy and may become even heavier; in cases of certain chronic diseases in the expectant mother (diabetes, hypertension).

If this method is used for strict indications, it does not pose any danger. To implement it, the following conditions must be met: the presenting part must be the head of the fetus, and the cervix must be prepared for labor (softened and its os slightly open).

Induced labor is performed in a maternity hospital, under the supervision of an experienced obstetrician-gynecologist. Such labor is performed with the help of oxytocin drugs (oxytocin is a hormone that causes contractions naturally). Before deciding on this method of delivery, you need to carefully weigh all the chances of success, because if the contractions are ineffective and labor "does not go", it will have to be completed by a cesarean section.

Contraindications to induced labor are: breech presentation of the fetus; transverse or oblique position of the fetus; previous cesarean section.

If everything goes well, then labor begins and ends just like normal labor.

• Why do they do a cesarean section?

This operation is performed in cases where a woman cannot give birth herself or there is an urgent need to extract the baby.

The main indications for a caesarean section are: acute hypoxia (oxygen starvation) of the fetus; placenta previa (the placenta covers the exit from the uterus, and even if only its edge is adjacent to the exit, there is a high probability of life-threatening bleeding for the woman); the onset of placental abruption (when bleeding has already begun); the threat of uterine rupture during labor; severe gestosis (preeclampsia or eclampsia); high myopia (there is a threat of retinal detachment and blindness); an obvious discrepancy between the size of the fetus's head and the size of the mother's birth canal. In addition to these indications, there are some others that may appear in each specific case. It is not always possible to determine before labor whether there will be a need for a caesarean section. But if you are offered this operation, agree. This means that the doctor doubts that everything will be fine with you and the baby during natural childbirth.

A cesarean section can be performed either under general anesthesia or with epidural anesthesia. Sometimes these methods are combined. Each of these methods has its pros and cons.

General anesthesia involves injecting drugs into a woman's vein that turn off consciousness and motor activity (even breathing is turned off), as well as painkillers. Thus, the woman is in a coma during the operation. Naturally, after the effect of the injected drugs wears off, consciousness and motor activity will be restored. But the fact is that some of these drugs can get to the fetus. This is not too dangerous for it, but, nevertheless, in the first minutes after extraction, it can sleep under their influence. And so that the child does not suffocate, artificial respiration is performed at this time. Another negative aspect of a cesarean section is that the child is born not through the natural birth canal, but through an incision in the uterus. The fact is that during birth, the child, passing through the birth canal, is compressed from all sides by its walls. At the same time, the chest is compressed and the remains of amniotic fluid are squeezed out of the lungs (the child makes breathing movements in utero). In addition, compression of the lungs helps to activate the first breath. In a cesarean section, such a mechanism is absent. In addition, there is also an "immaterial" component - the child feels the mother's condition and mood, and the fact that she is unconscious during the operation does not add "optimism" to him.

Epidural anesthesia is performed by introducing local anesthetic drugs such as lidocaine into the epidural space. These drugs block the transmission of pain impulses from the surgical area without turning off consciousness. With epidural anesthesia, the woman is conscious during the operation, but does not feel pain. Only a feeling of stretching remains (when the fetus is extracted). Thus, with epidural anesthesia, the psychological contact between mother and child is not disrupted and the woman is shown the extracted baby, just as is done during childbirth.

The negative aspects of epidural anesthesia are that the drugs injected into the epidural space reduce blood pressure and worsen possible compression of the uterus by a large vein (the inferior vena cava) that carries blood to the heart. This can cause a sharp drop in blood pressure - collapse, which is accompanied by nausea, vomiting, loss of consciousness and fetal hypoxia. However, an experienced anesthesiologist (and inexperienced ones, as a rule, do not know how to perform epidural anesthesia) can always foresee and prevent these negative aspects.

• What is the difficulty of giving birth to twins?

Firstly, these births usually occur before the fortieth week. Consequently, the babies are born with varying degrees of prematurity. In addition, both (or more) fetuses receive somewhat less nutrition, and even if the birth occurs on time, the babies are most often born immature, which can create difficulties in the process of their adaptation. We will discuss this in more detail when we talk about premature babies.

Secondly, twins are usually in different presentations in the uterus: one in the head, and the other in the breech. Naturally, this can create certain difficulties during the birth of the one who is born breech. In addition, they can "catch" each other with their arms or legs, or the umbilical cord of one can wrap around the other, which makes birth impossible (not to mention conjoined "Siamese twins").

Therefore, the doctor must determine the position of both fetuses and decide whether to deliver the baby normally or perform a cesarean section. If the babies are lying transversely, if the baby born first is in a breech presentation, then it is better to end the birth with an operation. If the first fetus is head first, then there are usually no obstacles for the second fetus, since the first has already "paved the way" for its successor. If, after the birth of the first child, the doctor determines that the second is lying crooked, then, inserting his hand into the uterus, he turns it so that the baby is born buttocks or legs first. This, of course, is not very good, but it is better than urgently operating on the woman to extract the second fetus, although this does happen.

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