American Medical Association Family Medical Guide - American Medical Association [302]
Prolapsed umbilical cord
A prolapsed umbilical cord is an umbilical cord that has moved into the vagina before the baby’s head. A prolapsed cord can become compressed or squeezed and cut off the baby’s supply of blood and oxygen. An emergency cesarean delivery is usually necessary.
Excessive Bleeding After Delivery
Postpartum hemorrhage is excessive loss of blood from the uterus or vagina after delivery. Bleeding often occurs when the uterine contractions are not strong enough to enable the uterus to shrink back to its original shape and compress the blood vessels in the uterus. (The contractions limit bleeding caused by the separation of the placenta from the uterus.) The muscles of the uterus may be weakened by an unusually long labor or stretched excessively by multiple fetuses or by multiple previous deliveries. Bleeding also can result when fragments of the placenta remain inside the uterus and prevent it from contracting sufficiently after childbirth. Excessive bleeding can also occur if the vagina was torn during delivery.
Bleeding from the uterus can be controlled with medications that stimulate the uterus to contract. If fragments of placenta remain inside the uterus, they will be removed. If the bleeding has resulted from torn vaginal tissues, the tear will be closed with stitches after the area has been numbed with a local anesthetic. Bleeding that is life-threatening may require surgical removal of the uterus (hysterectomy; see page 870).
Retained Placenta
The placenta usually separates easily from the wall of the uterus after delivery. The doctor may assist the separation of the placenta by pressing on the woman’s abdomen (which helps the uterus contract) while at the same time pulling gently on the umbilical cord. Massaging the abdomen not only helps the uterus contract but also helps stop bleeding. Occasionally the placenta becomes trapped inside the uterus if it doesn’t separate completely from the uterine wall. A retained placenta is a placenta that hasn’t been expelled within 30 minutes of delivery.
A retained placenta is removed by the doctor. After giving you an anesthetic, the doctor will reach inside your uterus with his or her hand and remove the placenta. You will then be given medication to help your uterus contract and prevent excessive bleeding.
Delivering the placenta
The uterus continues to contract after delivery until the placenta (afterbirth) is delivered, completing the third and final stage of labor. To help expel the placenta, the doctor massages the woman’s abdomen and, while the uterine contractions push the placenta out, the doctor gently pulls on the umbilical cord (which is attached to the placenta).
Adjusting After Pregnancy and Childbirth
Although the dramatic physical changes you experienced over the 9 months of your pregnancy occurred gradually and slowly, they reverse themselves relatively quickly after delivery. Your body will undergo other changes during this transition time as you get to know your newborn and take on the challenges and joys of parenting. Be flexible and enjoy this special time with your baby. Always call your doctor or pediatrician about any problems that arise.
Common Problems
After delivery, your body will be readjusting from the demands placed on it during pregnancy and childbirth. You will probably experience one or more of the following common problems or discomforts in the weeks after delivery.
Uterine Contractions
After the delivery and over a period of about 6 weeks, you will have mild contractions of your uterus that will help it return to its normal size. Breastfeeding helps to stimulate these contractions. If the contractions are painful, your doctor can prescribe a pain reliever.
Vaginal Discharge
For the first few days after delivery, most women have a vaginal discharge that consists