Name: Jessa B.

Alojado

Unconventional Delivery and Emergencies:

“Birth Injuries From Delayed C-Section”

Cesarean delivery (c-section) is a common surgical procedure in which a baby is

delivered by surgically opening the mother's abdomen and uterus. In the U.S., almost 1
out of every 3 babies are delivered via c-section. C-sections are often necessary when
normal vaginal delivery presents unnecessary risks to the mother or baby. Over half of
all c-section deliveries are scheduled in advance in response to risk factors that develop
as the pregnancy progresses. For example, if the baby is abnormally large or in an
abnormal position doctors will normally schedule a preemptive c-section to avoid harm
to the baby. In other cases, however, a c-section is an emergency procedure performed
in response to situations that arise during vaginal delivery. When complications arise
during delivery and the baby is under duress, a prompt emergency c-section is often the
only way to avoid injury to the baby.

For mothers who want to have normal delivery, one way to reduce the likelihood
of having a c-section is if they have a low-risk pregnancy. Many women cannot pick and
choose what hospital they want to deliver. Other measures they can take includes
asking their doctor about his or her practices. Midwives, too, are useful to some women
during the labor and delivery process. Inducing labor early and unnecessarily increases
the risk of complications and therefore of needing a c-section. Other women ask if they
can elect to have a c-section even if not medically necessary. A small percentage of
cesarean deliveries are performed on the mother’s request. It is well within your rights to
request a c-section, but your doctor will not necessarily approve your request.

Reasons for Scheduled C-Sections

Most cesarean deliveries (C-sections) are scheduled in advance as a preemptive
measure in situations where attempting a vaginal delivery may be too risky. Below are
some of the most common reasons why doctors may opt for a scheduled c-section:

 Fetal Macrosomia: Fetal macrosomia is the medical term for babies that are
abnormally large prior to birth. Babies are defined as "macrosomic" whenever
their gestational or birth weight excess 8 pounds 13 ounces (4,000 grams). Fetal
macrosomia is diagnosed in approximately 9-10% of all pregnancies. Male
babies are 3 times more likely to be macrosomic. Fetal macrosomia can make
normal vaginal delivery very dangerous and create a significant risk of birth
injuries. The reason for this is somewhat obvious: it is much more difficult for an
abnormally large baby to pass through the birth canal. When fetal macrosomia is
accurately diagnosed in advance, a preemptive c-section is always warranted.
Monitoring fetal growth and diagnosing macrosomia is a key part of good
prenatal care. Unfortunately, fetal macrosomia is notoriously difficult to identify
during pregnancy mainly because there is no actually weigh the baby inside the
mother. The 2 primary indicators of macrosomia are:
o Large Fundal Height: fundal height is a measurement of the distance
between the mother's pubic bone and the top of the uterus. A larger than
average fundal height is often a sign of macrosomia.
o Amniotic Fluid Levels: Excessive amounts of amniotic fluid (an
uncommon condition called polyhydramnios) is also a key indicator of fetal
macrosomia.
 Abnormal Fetal Presentation: In a normal vaginal delivery, the baby is
supposed to come out head-first and face-up. This is called the vertex
position and most babies rotate into this position near the end of pregnancy (after
week 33). Abnormal presentation (malpresentation) refers to any case where the
 baby does not rotate into the normal vertex position prior to delivery. The most
common types of abnormal presentation are breech & transverse.
o Breech Presentation: breech presentation is when the baby is positioned
to come through the birth canal backward - with their butt or feet first
instead of the head. Breech position occurs in a 3-4% of all childbirths and
is much more common with premature births.
o Transverse Presentation: transverse presentation occurs when the baby
is positioned sideways, across the mother's stomach, instead of head first.
Abnormal presentations, such as breech and transverse, will make normal
vaginal delivery very risky. When the baby is not in the normal position
their passage through the birth canal will be much more difficult and
potentially complicated. When abnormal presentations are identified in
advance, a scheduled c-section is usually the best course of action to
avoid potential birth injuries.

 Placenta Previa: The placenta is a sack usually located at the top of the uterus
which supplies the baby with nutrients during pregnancy. Placenta previa is a
condition that occurs when the placenta is lying too low in the uterus, near or
covering the cervix. Placenta previa is not common and occurs in just 1 out of
every 200 pregnancies. When placenta previa is present towards the end of
pregnancy, a scheduled c-section delivery will almost always be required to avoid
dangerous complications.
 Birth Canal Obstruction: A scheduled c-section may be necessary if the mother
has some sort of mechanical issue, such as a uterine fibroid, obstructing the birth
canal. A uterine fibroid is a noncancerous tumor that grows in the muscles tissue
or walls of the uterus and can obstruct the birth canal. Fibroids are diagnosed in
almost 10% of pregnancies and are more common in older mothers.

Reasons for Emergency C-Sections

In many cases, a cesarean delivery is performed as an emergency procedure during an
attempted vaginal delivery. Emergency c-sections are typically ordered in response to
complications or signs of fetal distress during labor and delivery. The most common
reasons for an emergency c-section are:

 Fetal Distress: During labor and delivery, doctors and nurses constantly monitor
the vital sign of the baby, specifically the baby's heart rate, using fetal monitoring
strips. Fetal monitoring devices are used to give doctors and hospital staff early
warning signs that a baby is under physical duress during labor and delivery.
Doctors and nurses must continuously monitor and interpret the fetal monitoring
devices for signs of potential dangers to the baby. When indicators of fetal
distress occur, the OB/GYN and hospital must immediately respond with an
emergency c-section to avoid potential birth injuries.
 Umbilical Cord Problems: Any sort of complications or problems with the
umbilical cord during childbirth can be very dangerous to the baby because the
umbilical cord is literally the baby's lifeline. Compression of the umbilical cord
during labor and delivery can restrict the flow of oxygen and nutrients to the
baby's brain and result in permanent brain damage. A compressed umbilical cord
is usually cause for an immediate emergency c-section. The longer the umbilical
cord remains compressed, the greater the danger to the baby. Umbilical cord
prolapse is another complication that can require an emergency c-section.
Normally the cord is supposed to come out after the baby. Prolapse of the
umbilical cord occurs when the cord drops down the cervix into the birth canal
 before the baby. This is dangerous because the cord can become stuck,
entangled or compressed as the baby comes down afterward.
 Rupture of Membranes: Membrane ruptures are serious complications that can
occur during labor and delivery (or later stage of pregnancy). A uterine rupture is
a rare event that occurs when the uterus actually tears open and the baby comes
out into the abdomen. Uterine rupture occurs in only 1% of all pregnancies, and it
almost always occurs in women with scars from prior c-sections. This is the
primary reason why vaginal delivery after a prior c-section is considered high
risk. Another type of membrane rupture is placental abruption. Placental
abruption takes place when the placenta actually tears away from the inner wall
of the uterus prior to delivery. Placental abruption can happen very suddenly,
often without warning. When placental abruption occurs it can be very dangerous
for the baby because the detached placenta will often block the flow of oxygen to
the baby. An emergency c-section must be performed immediately in response to
placental abruption.
 Placental Insufficiency:  Another reason an immediate Caesarean section
might be required to protect the fetus is placental insufficiency. This is the
inability of the placenta to deliver oxygen and nutrients to the baby.   

Birth Injuries Caused by C-Section Delays

It is a well-recognized fact that a significant percentage of birth injuries are caused by
medical errors and mistakes during labor and delivery. There are various types of
medical negligence or error that commonly result in birth injuries. However, delay in
performing a c-section is by far the leading cause of malpractice-related birth injuries.
Failure to schedule a c-section or negligent delay in performing an emergency c-section
is strongly linked as the cause of many brain injuries.

Reference: https://www.birthinjuryhelpcenter.org/c-section-birth-injury.html#:
 Reaction paper on Unconventional Delivery and Emergencies:
“Birth Injuries From Delayed C-Section”

During labor, feeling pain is a part of it. There are mothers or first time mothers
that want to feel the pain because it gives them the feeling of fulfillment or satisfaction of
being a mother. This is why they opt for normal vaginal deliveries. However, there are
also women who prefers to do other methods aside from the conventional way of
delivery such as c-section.

C-section is indicated for various complications and problems during labor. But
now, there are cases that mothers can have a choice regarding their way of delivery.
From my own perspective, mothers may have the benefit when they feel they
have choices in how their birth is managed, but they should also be educated and
informed about other possibilities of choosing unconventional way when there is a
normal way of delivery with less problems and complications. C-sections are serious
abdominal surgeries that should not be taken lightly. Cesarean sections leave scars and
may result in longer healing times and higher medical bills for new mothers.
Complications after childbirth can be increased by surgery, especially in older or
overweight women. Furthermore, there is an increased risk of serious complications in
subsequent pregnancies after a woman has had a c-section. When a women gets
pregnant again and the case necessitates additional c-sections, then there is more risks
for both the mother and the baby. Cesarean deliveries, on the other hand, are useful
when necessary. They can prevent situations that would kill or disable a baby. C-
sections is a method that is used to reduce the risks associated with high-risk
pregnancies. Moreover, there are delimmas regarding the patient’s right and the health
care provider’s decision. It is well within the woman’s rights to request a c-section, but
the doctor will not necessarily approve their request. The doctor may have the
upperhand in knowing what is best for the patient but when patient’s are so persistent,
health care providers can’t do anything but to follow proper procedures of getting the
necessary consents and waivers.

As a student nurse, I have learned that delivering a child via vaginal birth is the
safest way to deliver the baby. But I am not also against with having C-section when it is
necessary. There are several reasons why mothers have C-section such as having
breech presentation, fetal distress during labor, umbilical cord prolapse and coiling, and
many other problems. In the past, mothers and babies die because there are no
alternative methods that health care providers can provide. But in todays modern times,
there are now other alternative that can be used to save both the life of the mother and
the baby. In conclusion, whether it is conventional or unconventional method of delivery,
the life of both the mother and the baby should always be prioritized.