PREGNANCY
Labour and Childbirth Complications
Complications that could arise In Pregnancy & Birth
No matter how healthy or prepared you are for childbirth, there is always a chance of unexpected complications. Learn more about problems that can occur in labour or childbirth and how they could affect mum and baby.
Problems during labour or childbirth can arise through complications such as the timing of labour (whether labour occurs earlier or later than normal), problems in the foetus or newborn or problems in the mother.
Most problems are obvious before labour begins. Such problems include:
Premature rupture of the membranes (the mother's water breaks too soon)
Postterm pregnancy and postmaturity (a pregnancy continues longer than normal, sometimes causing problems with the baby)
Abnormal position and presentation of the foetus (the foetus is in the wrong position for the safest delivery)
Multiple births (such as twins or triplets)
Some complications that women develop during pregnancy can cause problems during labour or delivery. For example, preeclampsia (high blood pressure with protein in the urine) may lead to premature detachment of the placenta from the uterus (placental abruption) and problems in the newborn
Some problems develop or become obvious during labour or delivery. Such problems include:
Amniotic fluid embolism (the fluid that surrounds the foetus in the uterus enters the woman’s bloodstream, sometimes causing a life-threatening reaction in the woman)
Shoulder dystocia (the foetus's shoulder lodges against the woman's pubic bone, and the baby is caught in the birth canal)
Labour that starts too early (preterm labour) or too late (postterm pregnancy)
Prolonged Labour (Labor that progresses too slowly)
Prolapsed umbilical cord (the umbilical cord comes out of the birth canal before the baby)
Nuchal cord (the umbilical cord is wrapped around the baby's neck)
A foetus that is too large to pass through the birth canal (pelvis and vagina)—called fetopelvic or cephalopelvic disproportion
When complications develop, alternatives to spontaneous labour and vaginal delivery may be needed. They include:
Artificial starting of labour (induction of labour)
Forceps or a vacuum extractor (called operative vaginal delivery) to deliver the baby
Caesarean delivery
Some problems occur immediately after delivery of the foetus, around the time the placenta is delivered. They include:
Excessive uterine bleeding at delivery
A uterus that is turned inside out (inverted uterus)
Uterine rupture
Fetal distress, respiratory distress in the newborn, and uterine rupture are uncommon complications of labour.
No more than 10% of women deliver on their specified due date (usually estimated to be about 40 weeks of pregnancy). About 50% of women deliver within 1 week (before or after), and almost 90% deliver within 2 weeks of the due date
Too early (preterm): Before the 37th week of pregnancy
Late (postterm): After the 42nd week of pregnancy
In such cases, the health or life of the foetus may be endangered. Labour may be early or late because the woman or foetus has a medical problem or the foetus is in an abnormal position.
Determining the length of pregnancy can be difficult because the precise date of conception often cannot be determined. Early in pregnancy, an ultrasound examination, which is safe and painless, can help determine the length of pregnancy. In mid to late pregnancy, ultrasound examinations are less reliable in determining the length of pregnancy.
Amniotic fluid embolism is a rare but serious condition that occurs when amniotic fluid — the fluid that surrounds a baby in the uterus during pregnancy — or fetal material, such as fetal cells, enters the mother's bloodstream.
Amniotic fluid embolism is most likely to occur during delivery or in the immediate postpartum period.Amniotic fluid embolism is difficult to diagnose. If your doctor suspects you might have one, you'll need immediate treatment to prevent potentially life-threatening complications.
Shoulder dystocia occurs unexpectedly during childbirth, when the baby’s head has been born but the shoulders become stuck behind the mother’s pelvic bone, preventing the birth of the baby’s body. It can occur during a normal (spontaneous) birth or an instrumental (ventouse or forceps) birth, and is considered an emergency. The baby’s shoulder needs to be released quickly so that the baby’s body can be born and he or she can start breathing. Obstetricians and midwives are trained in certain manoeuvres that may help release the shoulders and in most cases the baby will be delivered promptly and safely.
It is estimated to affect about 1 in 150 (0.7%) births.
About 10% of women with shoulder dystocia are affected by heavy bleeding (postpartum haemorrhage) and vaginal tears can occur (see below).
About 10% of babies who have shoulder dystocia have a brachial plexus injury. This is where the nerves in the neck become damaged, which may cause loss of movement (paralysis) to the baby's arm. The most common type of brachial plexus injury is called Erb's palsy. In most cases it is temporary and movement returns within hours or days but a small number of babies (about 1%) will experience permanent damage.
Sometimes shoulder dystocia can cause other injuries including fractures of the baby’s arm or shoulder. In the majority of cases, these heal extremely well. In some situations, even with receiving the best care, a baby can suffer brain damage if he or she did not get enough oxygen, however this is very rare.
Source NHS Cambridge University Hospitals
Preterm labour occurs when regular contractions result in the opening of your cervix after week 20 and before week 37 of pregnancy.
Preterm labour can result in premature birth. The earlier premature birth happens, the greater the health risks for your baby. Many premature babies (preemies) need special care in the neonatal intensive care unit. Preemies can also have long-term mental and physical disabilities.
The specific cause of preterm labor often isn't clear. Certain risk factors might increase the risk, but preterm labor can also occur in pregnant women with no known risk factors.
Sometimes, labor stalls or occurs much too slowly. Prolonged labor may also be referred to as "failure to progress."
Prolonged labor can be determined by labor stage and whether the cervix has thinned and opened appropriately during labour. If your baby is not born after approximately 20 hours of regular contractions, you are likely to be in prolonged labor. Some health experts may say it occurs after 18 to 24 hours.
If you are carrying twins or more, prolonged labor is labour that lasts more than 16 hours.
Your doctor may refer to slow labor as "prolonged latent labour."
Prolonged labour may happen if:
The baby is very big and cannot move through the birth canal
The baby is in an abnormal position. Normally, the baby is head-down facing your back
The birth canal is too small for the baby to move through
Your contractions are very weak
The medical team will check:
How often you have contractions.
The strength of your contractions.
The following tests may be done:
Intrauterine Pressure Catheter Placement (IUPC) - a tiny straw monitor is placed into the womb beside the baby that not only lets your doctor know when a contraction is occurring, but how strong the contractions are. If your doctor does not feel like the contractions are strong enough, at this point is when they may consider adding pitcoin.
Continuous electronic fetal monitoring (EFM) to measure the baby's heart rate.
How Is Prolonged Labor Treated?
If your labor is going slowly, you may be advised to just rest for a little while. Sometimes medicine is given to ease your labor pains and help you relax. You may feel like changing your body position to become more comfortable.
Additional treatment depends on why your labor is going slowly.
What Happens if Labor Goes Too Slowly?
Most women dream of a fast labor and swift delivery. But if your labor seems to be going very slowly, take comfort in knowing that your doctor, nurse, or midwife will closely monitor you and your baby for any problems during this time.
Umbilical cord prolapse is a complication that occurs prior to or during delivery of the baby. In a prolapse, the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. The cord can then become trapped against the baby's body during delivery. Umbilical cord prolapse occurs in approximately one in every 300 births. An umbilical cord prolapse presents a great danger to the foetus. During the delivery, the foetus can put stress on the cord. This can result in a loss of oxygen to the foetus, and may even result in a stillbirth.
What causes an umbilical cord prolapse?
The most common cause of an umbilical cord prolapse is a premature rupture of the membranes that contain the amniotic fluid. Other causes include:
Premature delivery of the baby
Delivering more than one baby per pregnancy (twins, triplets, etc.)
Excessive amniotic fluid
Breech delivery (the baby comes through the birth canal feet first)
An umbilical cord that is longer than usual
Nuchal cord is the term used by medical professionals when your baby has their umbilical cord wrapped around their neck. This can occur during pregnancy, labor, or birth.
The umbilical cord is your baby’s life source. It gives them all the blood, oxygen, and nutrients that they need. Any problem with your baby’s umbilical cord can be very worrying, but the majority of nuchal cords aren’t dangerous in any way.
A nuchal cord is also extremely common, with around 1 in 3 babies being born perfectly healthily with the cord wrapped around their neck.
What causes a nuchal cord?
If you’re pregnant, you’ll know better than anyone how much babies move around in there! Baby acrobatics are a definite factor as to why they might end up with a nuchal cord, but there are a few other causes to be aware of, too.
Healthy cords are protected by a gelatinous, soft filling called Wharton’s jelly. The jelly is there to keep the cord knot-free so that your baby will be safe no matter how much they wriggle and flip themselves around. Some cords have insufficient Wharton’s jelly. That makes a nuchal cord more likely.
You may also be more likely to get a nuchal cord if:
you’re having twins or multiples
you have excessive amniotic fluid
the cord is especially long
the structure of the cord is poor
There’s no way to avoid a nuchal cord and they’re never caused by anything the mother has done.
Nuchal cords are hardly ever dangerous. If you do have one present, you probably won’t even hear it mentioned during your baby’s birth unless a complication arises. Babies can get the cord wrapped around their necks multiple times and still be completely fine.
Around 1 in 2,000 birthsTrusted Source will have a true knot in the cord, in which case there are some associated risks. Even in these cases, it’s rare for the cord to tighten enough to become dangerous. A nuchal cord that cuts off blood flow is life-threatening to the baby, however.
Cephalopelvic disproportion (CPD) occurs when a baby’s head or body is too large to fit through the mother’s pelvis. It is believed that true CPD is rare, but many cases of “failure to progress” during labor are given a diagnosis of CPD. When an accurate diagnosis of CPD has been made, the safest type of delivery for mother and baby is a caesarean.
Possible causes of cephalopelvic disproportion (CPD) include:
Large baby due to: Hereditary factors, Diabetes, Postmaturity (still pregnant after due date has passed), Multiparity (not the first pregnancy)
Abnormal fetal positions
Small pelvis
Abnormally shaped pelvis
Postpartum haemorrhage is a complication where you bleed heavily from the vagina after the baby’s birth.There are two types of PPH, depending on when the bleeding takes place:
primary or immediate – bleeding that occurs within 24 hours of the baby’s birth
secondary or delayed – bleeding that occurs after the first 24 hours and up to six weeks after the birth
It is normal to bleed after you have had a baby. The bleeding mainly comes from the area in your womb (uterus) where the placenta was attached, but it can also come from any cuts and tears caused during the birth. Bleeding is usually heaviest just after birth and gradually becomes less over the next few hours. The bleeding will continue to reduce over the next few days. This bleeding is called the lochia and should stop by the time your baby is four to six weeks old, but more often by two weeks.
A primary PPH is when you lose more than 500ml (a pint) of blood and affects about 5 in 100 women. Severe haemorrhage (more than two litres or four pints) is much rarer, affecting about 6 in 1000 women. If you lose a lot of blood, you are likely to feel dizzy, light-headed, faint or nauseous. You may be given oxygen and a drip for extra intravenous fluids. Drugs will be used to help stop bleeding and you may be given a blood transfusion and fluids to help your blood clot. With fluids and blood, you should start to feel much better. You will be very closely monitored and may need a longer stay in hospital.
A secondary PPH affects less than 2 in 100 women. It is usually associated with an infection and you may need antibiotics. You should contact your community midwife or GP if your bleeding is getting heavier after you have gone home, or the loss becomes offensive.
Most women, up to 9 out of 10 (90%), tear to some extent during childbirth, it is common and nothing to worry about. Most tears occur in the perineal area, the area between the vaginal opening and the anus (back passage).
They may be:
first degree tears - small, skin-deep tears which usually heal naturally
second degree tears – deeper tears affecting the muscle of the perineum as well as the skin. These sometimes require stitches.
Of those women that tear, 9 out of 100 (9%) have a more extensive one. This may be:
a third degree tear – involves the vaginal wall, perineum and the anal sphincter (the muscle that controls the back passage)
a fourth degree tear – also involves the lining of the back passage
Sometimes during the process of giving birth, a doctor or midwife may be required to make a cut in a woman’s perineum to make more space for the baby. This is called an episiotomy. Although an episiotomy makes more space for the baby to be born it does not prevent a third or fourth degree tear.
If you have a severe tear you will be given an appointment in our specialist clinic where there is access to a consultant obstetrician and urogynaecologist, as well as a specialist midwife and specialist physiotherapist. Both third and fourth degree tears can lead to a decrease in bladder and/or bowel control and it is important to have an expert evaluation to identify or prevent problems.
Some women develop an infection in their stitches following a perineal tear. It is important that you know how to care for your tear. Your midwife will be able to advise you on this. You should also contact your midwife or GP if you have any of the following symptoms:
increased pain
redness or increased swelling around the perineal area
an offensive smelling discharge
feeling unwell or feverish
In the majority of women the placenta will separate and deliver within 30 minutes to 1 hour. In all small number of women (about 2%) this does not occur despite the use of drugs to encourage separation.
If your placenta does not deliver and you are not bleeding heavily we will try a few simple measures such as emptying your bladder and feeding your baby but if these do not work it may be best to go to the operating theatre. With appropriate pain relief the doctor will then deliver your placenta, carry out any necessary stitching and give antibiotics to prevent infection. This will have no longer term effects on you.
Following the delivery of the placenta it is checked by the midwife to make sure it appears to be complete. Despite this it is possible for small pieces of placental tissue to be left in the womb. This can occur whether the placenta separates naturally or artificially. If we think the placenta is complete and you are not bleeding heavily it is not standard practise to perform any further investigations to make sure the womb is empty.
In the majority of cases any small pieces of retained of placental tissue will either be passed spontaneously or be reabsorbed. However a small number of women may develop infection or continued bleeding. If after you go home you feel that your bleeding is becoming heavier or you experience any of the following; fever, shivering, abdominal pain and/or vaginal discharge that looks or smells unpleasant, you should contact your GP. They may prescribe antibiotics if they are concerned you have an infection.
If you have very heavy bleeding or you continue to have problems despite having had antibiotics you will need to be reviewed at the Rosie to decide whether you need any further investigations or treatment.
Source NHS Cambridge University Hospitals.
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