With United States home births as an estimate, neonatal complications are common, with cord wrapped around the head 12-37% of the time (nuchal cord), insufficient oxygenation (birth asphyxia) 9% of the time, pulselessness 6% of the time, and breech presentation 3% of the time Breech presentation Frank Breech Presentation (buttocks first) is the most common type of breech presentation Normally, the head is the first part of the body to present out of the birth canal. However, other parts such as the buttocks or feet can present first, which is referred to as breech presentation. Risk for breech presentation may increase with multiple pregnancies (more than one baby), when there is too little or too much fluid in the uterus, or if the uterus is abnormally shaped. Babies in breech presentation can be delivered vaginally depending on the experience of the provider and if the fetus meets specific low risk criteria, however C-section is recommended if available. Ideally, vaginal breech delivery should not be performed without the availability of nearby<unk>  C-section capabilities and extensive efforts should be made to bring a woman in labor with breech presentation to a hospital. There are many variations of breech presentations and multiple ways the baby can get stuck during delivery. If a breech delivery is occurring, the provider will guide the hips out by giving light, downward traction holding the pelvis until the scapula is present. Then at the level of the armpits, each shoulder is delivered by rotating the baby as required, then subsequently rotating 180 degrees to deliver the other shoulder. The head is delivered with careful attention to the baby's arms. The arms will be delivered downwards through the vulva and may have to be gently held downwards by the provider's fingers. Pre-term labor Incidence of preterm delivery is approximately 12%, and preterm births are a significant contributing cause of unplanned<unk>  delivery. Pre-term labor is defined as occurring before 37 weeks, and risks for pre-term labor include pregnancy with multiple fetuses, prior history of premature labor, structural abnormalities of the cervix or uterus, urinary tract, vaginal, or sexually transmitted infections, high blood pressure, drug use, diabetes, blood disorders, or pregnancy occurring less than 6 months after a prior pregnancy. The same principles of term<unk>  delivery apply to<unk>  delivery for a preterm fetus, though the baby will be at higher risk of other problems such as low birth weight, trouble breathing, and infections. The newborn will need additional medical care and monitoring after delivery and should be taken to a hospital providing neonatal care, which may include antibiotics and breathing treatments. Shoulder dystocia In shoulder dystocia, the shoulder is trapped after the head is delivered, preventing delivery of the rest of the baby. The major risk factor (other than prior history of shoulder dystocia) is the baby being too large (macrosomia), which can result from the mother being obese or gaining too much weight, diabetes, and the pregnancy lasting too long (post-term pregnancy). Shoulder dystocia can lead to further fetal complications such as nerve compression and injury at the shoulder (brachial plexus), fracture of the collarbone, and low oxygen for the fetus (whether due to compression of the umbilical cord or due to inability of the baby to breathe). Shoulder dystocia is often signaled by retreat of the head between contractions when it has already been delivered ("turtle sign"). Treatment includes the McRoberts maneuver, where the mother flexes her thighs up to her stomach with her knees wide apart as pressure is applied on her lower abdomen, and Wood's screw maneuver, where the deliverer inserts a hand into the vagina to rotate the fetus. If all maneuvers fail, then C-section would be indicated. Prolapsed cord Umbilical cord prolapse A prolapsed cord refers to an umbilical cord that is delivered from the uterus while the baby is still in the uterus and is life-threatening to the baby. Cord prolapse creates a risk of decreased blood flow (and oxygen flow) to the baby as delivery will cause cord compression. However, if the cord delivers before the baby, the cord should not be placed back into the uterus through the cervix since this increases risk of infection. Emergent obstetric care for C-section would be indicated, and in the meantime, one should elevate the foot of the bed if possible to attempt to keep the baby above the level of the cord. If no specialized care is available, one may attempt to reduce pressure of the cord manually and continue delivery, but this is often difficult to do. Nuchal cord After the baby crowns, the umbilical cord may be found to be wrapped around the neck or body of the baby, which is known as nuchal cord. This is common, occurring in up to 37% of term pregnancies, and most do not cause any long-term problems. This wrapped cord should be slipped over the head so it is not pulled during delivery. If the wrap is not removed, it can choke the baby or can cause the placenta to detach suddenly which can cause severe maternal bleeding and loss of blood and oxygen to the baby. The cord may also be wrapped around a limb in breech presentation, and should similarly be reduced in these cases. Resuscitation If the baby is not doing well on its own, further care may be necessary. Resuscitation typically starts with warming, drying, and stimulating the newborn. If breathing difficulty is noted, the airway is opened and cleared with suction and oxygen is monitored; if necessary, one may consider using a positive airway pressure ventilator (which gives oxygen while keeping the airway open) or intubation. If the heart rate is below 60 beats per minute, CPR is started at 3:1 compression to ventilation ratio, with compressions given at the lower breastbone. If this fails to revive the newborn, epinephrine will be given. Resuscitation is not indicated for newborns below 22 weeks of gestation and weighing below 400 grams. Resuscitation may also be discontinued if the baby's heart does not start after 10–15 minutes of full resuscitation (including breathing treatments, medications, and CPR).
Emergency childbirth
Labor induction
Vaginal delivery
Natural childbirth
Trial of labour
Caesarean section
Post-abortion care
Precipitate delivery