Labor and delivery in cases of suspected fetal anomalies at Genesis Dnepr, Dnipro. Alternative: Childbirth when fetal developmental anomalies are suspected at Genesis Dnepr, Dnipro.

What are deliveries for suspected fetal anomalies: this is an approach to managing childbirth with increased attention to the fetus’s condition and readiness to perform additional diagnostics and provide neonatal care if necessary.

This approach may be relevant when there are concerning results from prenatal screening, ultrasound, or genetic testing. It is important to discuss in advance with your doctor and obstetrician the monitoring plan, place of delivery, possible modes of delivery and available pain-relief options, as well as the availability of a neonatal team. The decision on the delivery format is made based on the clinical picture, examination results, and the resources of the maternity hospital. During labor the plan may change in the interest of the mother’s and baby’s safety, so flexibility and clear communication with the team remain a priority.

## What this birth format means

This birth format implies increased attention to the fetus’s condition and readiness to make operative decisions.

Childbirth when fetal developmental anomalies are suspected involves close monitoring, additional tests, and, if necessary, the involvement of a neonatal team.

The choice of this format is based on examination results, the mother’s condition, and the capabilities of the maternity hospital.

• Increased fetal monitoring and readiness for additional diagnostics.
• Availability of a neonatal team and the possibility of surgical intervention if needed.
• Discussion of the birth plan, place of delivery, and pain relief options in advance.
• Difference from routine births — increased readiness to change the plan for safety.
• Limitations depend on examination results, the course of labor, and the mother’s condition.
• Partner presence and minimal-intervention approaches are discussed individually and may not always be possible.

Before labor, discuss all questions with your doctor and midwife to understand possible scenarios.

During labor, the team may adjust the plan in the interests of the mother’s and baby’s safety.

Who this type of delivery plan may be appropriate for

This approach may be considered when there are suspicions of fetal anomalies or when closer monitoring is required. It is not suitable for everyone — the decision is made based on examinations, the mother’s condition, and the hospital’s capabilities. It is important to discuss possible scenarios, partner participation, and pain management in advance. The birth plan may change depending on the progress of labor and monitoring results.

• Pregnant people with suspicious results from prenatal screening or ultrasound.
• Women who want to discuss a detailed delivery plan with their physician and midwife in advance.
• Patients for whom the presence of a partner or loved one during labor is important.
• Pregnant people planning to discuss pain-relief options and consult an anesthesiologist ahead of time.
• Women who want to understand who will manage the delivery and how care will be organized.
• Patients with previous birth experiences that should be taken into account in planning.
• Pregnant people who need a calm, clear, and pre-agreed plan of action.

Discuss these points with the maternity team before labor to have a clear idea of possible scenarios. The final decision will depend on examinations and the course of labor.

When this mode of delivery may be restricted or changed

Sometimes the chosen mode of delivery must be restricted or changed in the interests of the mother’s and baby’s safety. This is normal medical practice: the team assesses the situation and makes decisions based on current information. Below are common reasons why the mode may be adjusted.

• Obstetric complications requiring expedited intervention or monitoring.
• Signs of fetal distress on monitoring that require an immediate response.
• The need for an urgent operation (cesarean section) due to the course of labor.
• Contraindications to a specific type of pain relief (analgesia) discussed in advance.
• Infectious or organizational restrictions preventing the partner’s presence.
• Severe maternal condition in which the priority is urgent stabilization.
• Limitations in hospital resources at a given time (for example, the availability of a neonatal team).

If the plan changes, the team will explain the reason beforehand and offer a safe alternative for you and your baby.

Who and how the decision about the mode of delivery is made

The decision about the mode of delivery is made jointly and is based on clinical data, the maternity hospital’s resources, and your preferences. During labour when fetal anomalies are suspected, it is especially important to consider examination results alongside the patient’s wishes. You state your preferences, and the medical team evaluates laboratory tests, ultrasound, and the current condition of the mother and fetus. The birth plan may change during labour if required for safety.

• Patient’s wishes: mode of delivery, presence of a partner, and preferences regarding interventions.
• Assessment of the pregnancy: results of laboratory tests, ultrasound, and prenatal screening.
• Clinical condition at the time of labour: the mother’s condition and fetal monitoring findings.
• Team decision: the obstetrician and midwife discuss the optimal plan with the patient.
• Involvement of an anesthesiologist to discuss pain relief options and contraindications.
• Involvement of a neonatologist if there is risk to the baby or a need for specialized care.

The decision is made openly and takes your preferences into account, but is primarily guided by safety. If the situation changes, the team will explain the reasons and offer available alternatives.

What to discuss with your doctor before childbirth

Before childbirth, it's helpful to have a list of questions to discuss key points and expectations at your appointment.

If there is a suspicion of fetal abnormalities, some details are especially important to talk through in advance.

These questions will help you and the medical team understand possible scenarios and prepare for different options.

• Which mode of delivery do you consider preferable, and under what conditions can it be discussed?
• Can a partner or close person be present, and what restrictions apply?
• What pain relief options are available, and are there any contraindications?
• What was the course of previous deliveries — vaginal, cesarean, any complications?
• Which chronic conditions or medications should be taken into account when planning?
• Which ultrasound, screening, and test results should I bring to the appointment?
• What is the preliminary plan of action if the condition of the fetus or mother worsens?
• When should I go to the hospital if labor begins or if worrying symptoms appear?
• What documents and contacts should I have when being admitted?
• What should I pack for the maternity hospital, and what can I expect regarding postpartum stay conditions?

Write down the doctor's answers and ask follow-up questions if anything remains unclear. This will help you feel more confident when planning your delivery.

How preparation for this type of delivery is carried out

Preparation for delivery when fetal anomalies are suspected involves planning monitoring and arranging care before birth. The process aims to clarify findings, discuss options, and coordinate the roles of the care team and the maternity hospital. It is important to understand that preparation facilitates coordination, but the final decision may change during labor.

• Consultation with the physician and obstetrician to discuss an individualized birth plan.
• Review of the maternity record and prenatal test results before hospitalization.
• Performing examinations appropriate for the gestational age to clarify the current condition.
• Discussion of pain relief options and, if necessary, consultation with an anesthesiologist.
• Familiarization with organizational documents and the conditions of stay at the maternity hospital.
• Preparing the partner: their role, restrictions, and rules for presence during delivery.
• Packing essential items for the hospital and a short list of required documents.
• Agreeing on an action plan in case the situation changes and providing emergency contact numbers.

Discuss the prepared points with the team in advance to reduce uncertainty at the time of delivery. The team will explain possible changes to the plan and offer safe alternatives if needed.

How labor proceeds in this scenario

Below is a typical sequence of events for labor when fetal anomalies are suspected, explained in simple steps. This approach involves closer monitoring of the fetus and readiness of the team for different actions. The order may change depending on the mother's condition and monitoring results. It is important that the team discusses the plan in advance and stays flexible during labor.

1. Admission to the clinic and brief registration; discussion of current complaints and signs of labor activity.
2. Initial examination: the doctor and midwife assess the mother's condition and basic information about the fetus.
3. Review of the maternity record and current ultrasound or prenatal screening results.
4. Continuous or intermittent monitoring of contractions and fetal heart activity.
5. Regular examinations and discussion of labor progress with the doctor and midwife; adjustment of the plan as needed.
6. Discussion of pain relief and involvement of an anesthesiologist if indicated or by agreement.
7. Pushing stage (second stage of labor) with team support: instructions, help with positioning, and monitoring of condition.
8. Birth of the baby with participation of the obstetric team and, if necessary, the neonatal team.
9. First examination of the newborn; provision of initial care or additional support if indicated.
10. The first hours after birth — observation of the mother and baby, discussion of the further plan and possible examinations.

The team will explain each action as needed and offer alternatives if the situation changes. The main priority is the safety of the mother and baby, so the plan may be adjusted in the interest of health.

Pain relief during labor when fetal anomalies are suspected

The issue of pain relief is discussed in advance and coordinated with the anesthesiologist during delivery planning. The clinic offers standard methods, and the choice depends on the mother's condition, the course of labor, and any contraindications. The decision is made jointly with you and the medical team, and can be adjusted during labor if necessary. It is important to understand that a completely predictable response to analgesia cannot be guaranteed.

• Preliminary discussion of pain relief options at the antenatal visit.
• Anesthesiologist consultation to assess indications and possible contraindications.
• Available methods: epidural anesthesia, spinal anesthesia, and systemic analgesia.
• Individual selection of the method taking into account the mother's condition and the progress of labor.
• Shared decision-making between the team and the patient, considering the anesthesiologist’s opinion.
• Possibility to adjust the pain relief plan during labor if needed.
• Contraindications to specific methods are discussed in advance and taken into account when choosing.
• Limitation of expectations: complete elimination of pain cannot be guaranteed.

Discuss your preferences and concerns with the anesthesiologist before delivery to have a clear plan.

In an emergency, priority remains the safety of the mother and the baby.

Monitoring and safety during labor

During labor, when fetal anomalies are suspected, primary attention is paid to regular monitoring of the mother and the baby. Monitoring is a standard, planned part of labor management, not a sign of an inevitable problem. The team tries to agree on a plan in advance and to respond quickly to changes if necessary. The priority is the safety of the mother and baby, so tactics may be adjusted during labor.

• Continuous observation of the mother by the physician and midwife throughout the process.
• Assessment of the fetal heart rate on admission and dynamically as indicated.
• Use of cardiotocography (CTG) when necessary for more precise fetal monitoring.
• Monitoring the progress of labor and regular cervical examinations and assessments of the mother’s condition.
• Informing the patient about the current situation and discussing possible steps.
• The team’s readiness to change tactics and, if necessary, to call a neonatologist.
• Considering safety priorities in any decisions regarding delivery.

If it becomes necessary to change the plan, the team will explain the reasons and offer a safe alternative. Monitoring helps to make timely decisions in the best interests of the mother and the baby.

What happens if labor doesn’t go according to plan

A birth plan is a guide, not a strict instruction; the team is ready to change tactics for safety. During labor, including if there is a suspicion of fetal abnormalities, changes are made based on monitoring and clinical assessment. This is a normal part of labor management: decisions are made quickly and with an explanation of the situation. Below are common ways the plan may change and what that means for you.

• Having a partner present: you may be asked to have your partner step out if medically necessary.
• Vaginal birth: labor may need to be augmented or a cesarean section may be required.
• Epidural anesthesia: it may be contraindicated or technically unavailable at the time of labor.
• Upright labor positions: switching to another position may be necessary if circumstances change.
• Minimal-intervention plan: it may change if there are signs of risk to the baby.
• Rapid change of tactics: the team will act to ensure the safety of mother and baby.
• Involvement of specialists: an anesthesiologist and a neonatologist will be brought in if needed.
• Information and alternative options: the team will explain the reasons and offer the available choices.

Changing the plan is a professional response to the current situation, not a failure. The team will try to keep you informed and offer the safest available course of action.

Possible risks and limitations when choosing the mode of delivery

When delivering in cases of suspected fetal anomalies, it is important to keep in mind that every mode of delivery has its limitations. Decisions about management are based on the mother's condition, the results of examinations, and the capabilities of the maternity hospital. Understanding these limitations helps set more realistic expectations for the plan and to discuss alternatives in advance.

• Limitations of the chosen mode of delivery depend on the condition of the mother and fetus and on the resources of the maternity unit.
• Risks are determined by the course of the pregnancy, the findings of examinations, and the progress of labor.
• The need for operative or pharmacological interventions may arise during the process.
• The doctor and midwife will explain in advance the situations in which the birth plan may change.
• Do not rely solely on other people's experiences — every pregnancy is unique.
• Safety is the priority — medical decisions are made in the best interests of the mother and baby.

Discuss possible limitations and scenarios in advance with your doctor and midwife. If the plan changes, the team will explain the reasons and offer safe alternatives.

What happens immediately after childbirth

The first hours after birth are a time for initial examination, first contact, and monitoring the condition of the mother and baby. During delivery, including when fetal anomalies are suspected, the team follows a planned protocol: they perform required examinations and assist with the first latch. All measures are aimed at safety and comfort; the sequence may vary depending on the situation.

• Skin-to-skin contact and the first placement of the baby on the breast when possible.
• Performing CTG (cardiotocography) and a mandatory newborn examination by a neonatologist.
• Assessment of the mother’s condition by the physician and midwife, monitoring bleeding and wellbeing.
• Assistance with the first latch and feeding consultation if needed.
• Observation of mother and baby during the first hours with regular checks.
• Transfer to a ward if the mother and baby are stable.
• Transfer of the newborn to the neonatal unit if additional care is required.

The team will explain all procedures performed and answer your questions in the first hours after birth. If additional help is needed, you will be informed in advance about the next steps.

The role of the physician and the team in childbirth

Labor is managed by a team of specialists, each performing a specific function to ensure the safety of the mother and baby. When fetal malformations are suspected, coordination among specialists is especially important for a rapid response to changes. Your preferences are taken into account, but clinical assessment remains decisive in decision-making.

• Obstetrician‑gynecologist — assessment of condition, clinical decision‑making, and coordination of labor management.
• Midwife — continuous monitoring, support of the mother, and assistance during the second (pushing) stage.
• Anesthesiologist — assessment of indications for pain relief, consultation, and administration of anesthesia if needed.
• Neonatologist — reception and initial examination of the newborn, and organization of additional care if indicated.
• Surgical/operating room team — readiness for planned or emergency surgery and rapid organization of intervention.
• Monitoring of labor progress and fetal heart activity for timely adjustment of tactics.
• Informing the patient about labor progress and discussing available options.

Decisions are made jointly by the team and you, with safety remaining the priority. If the situation changes, the team will explain the reasons and offer available alternatives.

How this format benefits the patient

This format gives the patient the opportunity to agree in advance on the details of labor management and to reduce uncertainty. It is especially relevant when congenital fetal anomalies are suspected and team coordination is important. It is important to remember that the final decision depends on the condition of the mother and fetus and may change as labor progresses.

• A clear birth plan discussed in advance with the medical team.
• The opportunity to discuss your wishes and concerns with the doctor beforehand.
• Less uncertainty thanks to pre-agreed scenarios and contact information.
• The ability to choose and arrange for the presence of a specific physician during delivery.
• Availability of analgesia options and consultation with an anesthesiologist if needed.
• Continuous monitoring of the mother and baby at all stages of labor.
• The team is ready to promptly adjust tactics if the situation changes.
• Access to facilities and support during the first hours after birth.

These benefits help you prepare better and reduce anxiety before childbirth. If the plan changes, the priority remains the safety of the mother and baby.

How the pre-delivery consultation is conducted

At a pre-delivery consultation when fetal anomalies are suspected, the team discusses the current situation and management options in detail. This is a structured meeting to review documents, assess risks, and agree on a preliminary plan. The consultation may require more than one visit if additional tests or further discussion of options are needed. It is important to come prepared and with a list of questions.

• History taking: pregnancy history, previous deliveries, and chronic illnesses.
• Review of the maternity record and previous follow-up notes.
• Assessment of ultrasound results, screenings, and other available examinations.
• Discussion of your preferences for the mode of delivery and partner involvement.
• Explanation of possible limitations, scenarios, and circumstances in which the plan may be changed.
• Joint assessment and recommendation of a safe option by the doctor and the midwife.
• Clarification of signs of labor and recommendations on when to go to the clinic.

Write down the main conclusions of the consultation and a list of questions for the next visit. The plan can be adjusted as new information becomes available or the condition changes.

Please note that online consultations are available for patients from other cities. We often receive requests from Zaporizhzhia, Pavlohrad, Kamenskoye (Dniprodzerzhinsk), Novomoskovsk (Samar), Kryvyi Rih, Nikopol, Marganets, Sinelnikovo, Pokrov, Zhovti Vody, and other cities.

Preparing for admission for childbirth

A small practical tip: what people usually pack and which documents to bring when being admitted. If fetal anomalies are suspected, it is important to have the maternity record and up-to-date test results on hand. Discuss with your doctor the list of medications you are taking and any details before hospitalization.

• - Documents: passport, identification and hospital admission papers.
• - Maternity record (exchange card) with the obstetrician‑gynecologist’s notes.
• - Results of recent ultrasound scans, prenatal screenings and current test results.
• - A list of regularly taken medications and a note to discuss them with your doctor.
• - A set of necessary items for the mother and personal hygiene products.
• - Basic baby items and documents for the newborn.
• - Items for the partner if their presence is planned, and arrange these in advance.
• - Contact numbers for your doctors, your birth plan, and instructions for warning signs.

Before admission, check the reception’s list and clarify any questions with your doctor. This will help start monitoring more quickly and reduce uncertainty on arrival.

Conditions of the Genesis Dnepr Maternity Department

The maternity department is organized to ensure monitoring and a rapid team response during childbirth. In cases of suspected fetal anomalies, a combination of monitoring, specialist availability, and organized care conditions is important. Expect planned coordination between the obstetrician, anesthesiologist, and neonatologist depending on the situation. Specific conditions are best clarified during a pre-delivery consultation.

• Delivery rooms equipped for labor with monitoring capabilities.
• Postpartum rooms and an option for rooming-in (mother and baby staying together).
• CTG (cardiotocography) monitoring and neonatal examination by a neonatologist during delivery.
• Availability of an anesthesiologist for consultation and pain relief if needed.
• Option for partner-supported births, subject to medical and organizational limitations.
• Support from a midwife and physician during the pushing phase and delivery.
• Ability to quickly arrange additional assistance or transfer if indicated.

Please clarify at your consultation which of these conditions apply in your case and what limitations may exist. The priority is the safety of the mother and baby, so the plan may be adjusted.

When to seek urgent medical care

If a fetal abnormality is suspected, it is especially important not to delay seeking help when warning symptoms occur. If you notice any of the following — contact the maternity hospital or go to the emergency department. In an emergency it is better to get a professional assessment than to wait for a scheduled appointment.

• Vaginal bleeding or heavy vaginal discharge.
• Your waters have broken or you have a sudden leakage/gush of fluid.
• Regular contractions that are increasing in frequency and intensity.
• Severe, unbearable abdominal or pelvic pain.
• Reduced or absent fetal movements.
• A sudden large increase in blood pressure or a feeling of pressure in the head.
• Severe headache, especially with visual disturbances or nausea.
• Marked weakness, fainting, or difficulty breathing.
• Fever and signs of infection.
• Any sudden or unexpected change in how you feel.

If in doubt — call the maternity hospital or go for an assessment without delay. In the emergency department you will be examined, your condition assessed, and advised on next steps.

Frequently Asked Questions