Labor and delivery is one of those things that every pregnant women stresses over, especially during their first pregnancy. With so many different options, so many variations on what can happen, and so many unsolicited opinions coming your way, it's easy to feel overwhelmed and anxious for what's to come. Women trying to avoid C-sections are probably prone to wondering what happens if you fail to progress during labor or what happens if your baby gets stuck during delivery? There's often no way to predict these things, and we have to trust our healthcare providers to do what's best when the time comes.
According to Dr. Boyd Cooper, MD and OB-GYN for over 50 years, the two general causes for babies getting stuck are either the baby is an abnormal position, or the baby's head is too large. Regardless, there are two typical options. "Forceps, a tool used to pry the baby out," Boyd tells Romper, "could be used to grasp the baby's head through the vagina and pull the baby out. That said, it takes a very skilled doctor to use forceps properly and safely." But, forceps are not being used as much as they once were — C-sections for problem deliveries are much more common.
"If a baby gets stuck in delivery, I would venture to say the most reasonable modern option will be the C-section," Boyd continues, "and there is nothing to be worried about, as it is a very safe and standard procedure."
Since labor and delivery has three distinct phases, it is possible that your baby could get "stuck" at any one, notes Linda Rice, CNM, Harvard Vanguard Medical Associates in Massachusetts. During the first stage of active labor, Rice tells Romper, women are considered stuck if they are not dilating, or dilating very slowly. During the second stage, it is if the baby stops progressing through the birth canal.
The most common causes of both are that the contractions are not strong enough. Getting up and moving, or changing positions may help strengthen contractions, Rice notes, "but if the contractions seem adequate, there are several reasons why the baby may not be fitting." The most common is that the baby’s head is turned in a way that makes it harder to fit, either looking up or tilted to the side. While pushing, using a squatting position sometimes helps to maximize the diameter of the pelvis, and encourage baby to fit through. "But, in some cases, the baby may just be too big, and the mother may need a C-section," Rice tells Romper.
"Many babies will not descend into the birth canal and despite hours of pushing, still the baby’s head will be found to not be fully in the pelvis," adds Dr. Sasha Davidson, MD, OB-GYN, Maternal Fetal Medicine Specialist and high risk pregnancy expert. This is a situation that requires delivery by C-section. "At other times, babies do descend into the birth canal, however due to the distribution of fat (in the arms and trunk), the body of the baby can get stuck even after the head comes out," Davidson tells Romper. This is a true emergency and is referred to as "shoulder dystocia." The delivering doctor or midwife then has to perform certain maneuvers to release the arm that is stuck.
The most common cause of shoulder dystocia is cephalopelvic disproportion (CPD), adds Dr. Jamil Abdur-Rahman, MD, OB-GYN and clinical instructor at Rosalind Franklin University's Chicago Medical School. "CPD basically means that the baby is too big to negotiate the pelvis," Abdur-Rahman tells Romper. "When we examine laboring patient's pelvis to see how dilated the cervix is, we also assess where in the pelvis the baby's head is — the location of the baby's head in the pelvis is referred to as baby's 'station.'"
If the baby's station is not changing form check to check, it might be that either the baby is too big, or the pelvis is too small. Either way, CPD usually results in a C-section. "Rarely is CPD so profound that a baby will not eventually squeeze through if given enough time. However, allowing that puts baby at great risk because they can get stuck," notes Abdur-Rahman.
There are certain maneuvers performed to release a baby that is stuck. "Some of these maneuvers include McRobert’s maneuver, which requires flexing of the mom’s legs to rotate the pubic bone, and therefore releasing the stuck arm/shoulder," says Davidson. These maneuvers are usually successful in releasing the arm and allowing delivery of the baby, but could carry some risk. There is also a high risk of fracturing the baby's clavicle, fracturing the mother's pubic bone, or even tearing nerves in the baby's body, says Abdur-Rahman.
"This is why a C-section is the best option to delivery a baby that has not descended into the birth canal," Davidson says. "Obstetricians are highly trained on how to manage these high risk situations."
If you're worried about your baby being on the bigger side and possibly getting stuck, or if you carry any of the risk factors for larger babies (additional weight gain, gestational diabetes, and obesity are a few), be sure to talk to your doctor about best possible labor and delivery scenarios and options. It's often hard for us to let go of the birth plan we had in mind. But when it comes to the health and safety of you and your baby, sometimes practicing a little caution can provide you with the best outcome.
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