In general, the more immature the unborn baby, the greater the risks from labour and delivery. Roughly speaking, if premature
labour can be held off until the 34th week of pregnancy or later, delivery will proceed in a similar fashion as a normal delivery.
The delivery may need to take place in a hospital equiped with an NICU, where specialists will be on hand to monitor the labour
and delivery, as well as the baby after he is born. During labour and delivery, the baby’s heart rate and the contractions
of the uterus will be monitored.
The first stage of labour lasts from the time when contractions start until the time that the cervix is fully open or dilated.
Contractions act to dilate the cervix wide enough to let the baby through. The contractions become stronger, longer, more
frequent, and better coordinated. Then, for the next few hours, the contractions are strong and regular, occurring every two
to three minutes. The baby’s head descends more and more into the pelvis. The cervix widens to 10 cm, which is the diameter
of the baby’s head at its narrowest angle of presentation. If a labour is premature, given the smaller size of the baby, the
cervix may only be dilated to 6 cm before the baby begins to emerge.
The second stage of labour is when the baby is actually delivered. In stage two, there are strong and regular contractions,
occurring every one to three minutes. Each contraction helps to move the baby’s head farther down into the pelvis, along the
birth canal. The baby’s head emerges at the end of stage two. The doctor or midwife gently guides the baby’s head through
the birth canal, followed by one shoulder and then the other. The rest of the body follows easily. The baby may need assistance
once she is born; she may also need to be put on a ventilator to help her breathe.
The third stage of labour is the delivery of the placenta. The placenta usually comes out with a few painless contractions.
In this stage, the blood vessels that were supplying the baby in the womb rapidly close down, and the womb becomes small and
compact.
Delivery of twins and multiple babies
Twins and multiple babies are associated with a higher risk of childbirth complications, as well as premature birth. About
half of all twins deliver at 36 weeks or less. Half of triplets deliver before 32 weeks.
Many mothers of twins and multiple babies go into premature labour spontaneously. Others may need to have premature labour
induced because of fetal growth restriction or high blood pressure in the mother. Placental abruption, where the placenta
pulls away from the walls of the uterus may necessitate premature delivery.
When a woman carrying a multiple pregnancy goes into premature labour in ideal conditions, a number of precautions should
be taken.
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The labour should be carried out at a hospital under the care of an
obstetrician.
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A trained obstetric attendant should remain with the mother throughout labour.
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The babies should be monitored throughout labour.
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An
anaesthesiologist should be immediately available in case a
caesarean section is needed.
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Each baby requires its own healthcare provider who is skilled in the resuscitation and care of newborn infants.
The first twin bears the brunt of dilating the cervix and birth canal. If the twin is in the normal head-down position, there
is usually no problem with its delivery. If, on the other hand, the first twin is breech, there may be major problems with
vaginal delivery, and a caesarean section may be required.
The second twin usually comes out within 15 minutes after the first. If the first twin was born vaginally and the second twin
is positioned head-down, it can usually be born vaginally. Sometimes the doctor may need to turn the baby within the womb,
to make its position more favourable for birth. A caesarean section may be required in some cases.
In very rare cases where the first twin was born prematurely, contractions can stop altogether and the second twin may be
born days or weeks later.
In the case of triplets, the first baby to be born usually comes out vaginally, without complications. The next two babies,
however, may need complex obstetrical manoeuvres or caesarean section to be delivered safely. Many obstetricians recommend
caesarean section for delivery of all triplets. When the mother is carrying four or more babies, a caesarean section is recommended.
