What Are Common Labor and Delivery Complications?
A pregnancy that has gone smoothly can still have problems when it's time to deliver the baby. Your doctor and hospital are prepared to handle them. Here are some of the most common concerns:
Preterm labor and premature delivery
One of the greatest dangers babies face is being born too early, before their body is mature enough to survive outside the womb. The lungs, for example, may not be able to breathe air, or the baby's body may not generate enough heat to keep warm.
A full-term pregnancy lasts about 40 weeks. Having labor contractions before 37 weeks of pregnancy is called preterm labor. Also, a baby born before 37 weeks is considered a premature baby who is at risk of complications of prematurity, such as immature lungs, respiratory distress, and digestive problems.
Drugs and other treatments can be used to stop preterm labor. If these treatments fail, intensive care can keep many premature babies alive.
The symptoms of preterm labor and birth include:
- Contractions before 37 weeks of pregnancy, with a tightening and hardening of the uterine muscle, 10 minutes apart or less (these may be painless)
- Cramps similar to menstrual cramps (not to be mistaken with Braxton Hicks contractions, which typically are not at regular intervals and do not open the cervix)
- Low backache
- A feeling of pelvic pressure
- Abdominal cramps, gas, or diarrhea; in combination with contractions, may signal preterm labor
- Vaginal spotting or bleeding
- A change in quality or quantity of vaginal discharge, especially any gush or leak of fluid
Call you doctor if you notice or feel any of those symptoms.
Protracted labor refers to cervical dilation that is abnormally slow or to abnormally slow fetal descent. This means the labor does not progress as fast as it should.
This could happen with a big baby, a baby in a breech position (buttocks down), or other abnormal presentation, or with a uterus that does not contract strongly enough. Often, there is no specific cause for protracted labor.
Both the mother and the baby are at risk for several complications, including infections, if the amniotic sac has been ruptured for a long time and the birth doesn't follow.
If labor goes on too long, the doctor may give IV fluids to prevent you from getting dehydrated. If the uterus does not contract enough, they may give you oxytocin, a drug that promotes stronger contractions. And if the cervix stops dilating despite strong contractions of the uterus, a C-section may be necessary.
"Presentation" refers to the part of the baby that will appear first from the birth canal. In the weeks before your due date, the fetus usually drops lower in the uterus. Ideally, for labor, the baby is positioned head-down, facing the mother's back, with its chin tucked to its chest and the back of the head ready to enter the pelvis. That way, the smallest part of the baby's head leads the way through the cervix and into the birth canal. This normal presentation is called vertex (head down) occiput anterior.
Because the head is the largest and least flexible part of the baby, it's best for the head to lead the way into the birth canal. That way, there's little risk that the baby's body will make it through the birth canal, but the head will get caught.
Some babies present with their buttocks or feet pointed down toward the birth canal. This is called a breech presentation. Breech presentations are often seen during an ultrasound exam far before the due date, but most babies will turn to the normal head-down presentation as they get closer to the due date.
Types of breech presentation include:
- Frank breech. In a frank breech, the baby's buttocks lead the way into the pelvis; the hips are flexed, the knees extended.
- Complete breech. In a complete breech, both knees and hips are flexed, and the baby's buttocks or feet may enter the birth canal first.
- Incomplete breech. In an incomplete or footling breech, one or both feet lead the way.
Transverse lie is another type of presentation problem. A few babies lie horizontally in the uterus, called a transverse lie, which usually means the baby's shoulder will lead the way into the birth canal rather than the head.
In cephalopelvic disproportion, the baby's head is too large to fit through the mother's pelvis, either because of the size or because of the baby's poor positioning. Sometimes the baby is not facing the mother's back, but instead is turned toward their abdomen (occiput or cephalic posterior). This increases the chance of a lengthy, painful, childbirth, often called "back labor," or tearing of the birth canal.
In malpresentation, the baby is not "presenting" or positioned in the normal way. In malpresentation of the head, the baby's head is positioned wrong, with the forehead, top of the head, or face entering the birth canal, instead of the back of its head. Sometimes a placenta previa (when the placenta blocks the cervix) may cause an abnormal presentation. But many times the cause is not known.
Abnormal presentations increase a woman's risk for uterine or birth canal injuries and abnormal labor. Breech babies are at an increased risk of injury and a prolapsed umbilical cord, which cuts off the baby's blood supply. A transverse lie is the most serious abnormal presentation, and it can lead to injury of the uterus, as well as injury to the fetus.
Toward the end of your third trimester, your doctor will check the baby's presentation and position by feeling your belly or with ultrasound. If the fetus remains in breech presentation several weeks before the due date, your doctor may attempt to "turn" the baby into the correct position in a procedure called an "external version."
One way to try to turn the baby after 36 weeks is an external cephalic version, which involves a doctor manually rotating the baby by placing their hands on the mother's belly and turning the baby. These manipulations work about 50% to 60% of the time and are usually more successful on women who have given birth previously, because their uteruses stretch more easily. The procedure typically takes place in the hospital, in case an emergency C-section becomes necessary. To make the procedure easier to perform, safer for the baby, and more tolerable for the mother-to-be, doctors sometimes give a uterine muscle relaxant and then use an ultrasound and electronic fetal monitor as guides.
If the first attempt is unsuccessful, turning the baby may be tried again with an epidural pain medication to help relax the uterine muscles. Since not all doctors have been trained to do versions, you may be referred to another obstetrician.
There is a very small risk that the maneuver could cause the baby's umbilical cord to become entangled or the placenta to separate from the uterus. There's also a chance (about 4%) that the baby might flip back into a breech position before delivery, so some doctors induce labor immediately. The closer you are to your due date, the lower the risk of reverting back to a breech position. But the bigger the baby, the harder it is to turn.
The procedure can be uncomfortable for the mother, but if successful, may avoid a C-section, which is more likely if the baby can't be moved into the proper position.
Premature rupture of membranes (PROM)
Normally, the membranes surrounding the baby in the uterus break and release amniotic fluid (known as the "water breaking") either right before or during labor. Premature rupture of membranes means that these membranes have ruptured too early in pregnancy, meaning prior to the onset of labor. This exposes the baby to a high risk of infection.
If the baby is mature enough to be born, your doctor will induce labor or do a C-section if necessary. If the baby isn't mature enough, you may be given antibiotics to prevent infection as well as other medications to try to prevent or slow preterm PROM.
Umbilical cord prolapse
The umbilical cord is your baby's lifeline. You pass oxygen and other nutrients from your body to your baby through the umbilical cord and placenta.
Sometimes, before or during labor, the umbilical cord can slip through the cervix after your water breaks, preceding the baby into the birth canal. The cord may even protrude from the vagina -- a dangerous situation because the blood flow through the umbilical cord can become blocked or stopped. You may feel the cord in the birth canal if it prolapses, and may see the cord if it protrudes from your vagina.
Umbilical cord prolapse happens more often when a baby is small, preterm, in breech presentation, or if its head hasn't entered the mother's pelvis yet. Cord prolapse can also occur if the amniotic sac breaks before the baby has moved into position in the pelvis. Umbilical cord prolapse is an emergency. If you aren't at the hospital when it happens, call an ambulance to take you there. Until help arrives, get on your hands and knees, with your chest on the floor and your buttocks raised. In this position, gravity will help keep the baby from pressing against the cord and cutting off their blood and oxygen supply. Once you get to the hospital, a C-section will be performed.
Umbilical cord compression
Because the fetus moves and kicks inside the uterus, the umbilical cord can wrap and unwrap itself around the baby many times throughout pregnancy. While there are "cord accidents" in which the cord gets twisted around and blocks blood supply to the baby, this is extremely rare and can't be prevented.
Sometimes the umbilical cord gets stretched and compressed during labor, leading to a brief decrease in blood flow to the fetus. This can cause sudden, short drops in fetal heart rate, called variable decelerations, which are usually picked up by monitors during labor. Cord compression happens in about one in 10 deliveries. In most cases, these heart rate changes are of no major concern, and the birth proceeds normally. But a C-section may be necessary if the baby's heart rate worsens or the baby shows other signs of distress.
Umbilical cord compression can occur if the cord becomes wrapped around the baby's neck or a limb or gets pressed between the baby's head and the mother's pelvic bone. You may be given oxygen to increase the oxygen available to your baby. Your doctor may hurry along the delivery by using forceps or vacuum assistance, or, in some cases, delivering the baby by C-section.
Amniotic fluid embolism
This is one of the most serious complications of labor and delivery. Very rarely, a small amount of amniotic fluid -- the fluid that surrounds the fetus in the uterus -- enters the mother's bloodstream, usually during a particularly difficult labor or a C-section. The fluid travels to the woman's lungs and may cause the arteries in the lungs to constrict. For the mother, this constriction can result in a rapid heart rate, irregular heart rhythm, collapse, shock, or even cardiac arrest and death. Widespread blood clotting is a common complication, requiring emergency care.
Preeclampsia is a complication of pregnancy involving high blood pressure that develops after 20 weeks of pregnancy or shortly after delivery. Preeclampsia may lead to premature detachment of the placenta from the uterus, maternal seizure, or stroke.
Uterine bleeding (Postpartum hemorrhage)
After a baby is delivered, excessive bleeding from the uterus, cervix, or vagina, called postpartum hemorrhage, can be a major concern. Excessive bleeding may result when the contractions of the uterus after delivery are impaired, and the blood vessels that opened when the placenta detached from the wall of the uterus continue to bleed. It can also result from other causes such as cervical or vaginal lacerations.
Post-term pregnancy and post-maturity
In most pregnancies that go a little beyond 41 to 42 weeks, called late-term pregnancy, there are usually no problems. But problems may develop if the placenta can no longer provide enough nourishment to maintain a healthy environment for the baby. The risks can become significant in post-term pregnancies, those that go to 42 weeks or more.
How Do I Prevent Problems With Labor and Delivery?
The most important thing you can do to try to have a healthy baby is getting early and adequate prenatal care. The best prenatal care begins even before you are pregnant, so you can be in the best of health before pregnancy.
To help prevent complications, if you smoke, quit. Smoking can trigger preterm labor. Researchers have found a link between gum disease and preterm birth, so brush and floss your teeth daily. It may also be helpful to reduce your stress level by setting aside quiet time every day and asking for help when you need it.
Your doctor will check you for risk factors for preterm labor and premature delivery, and discuss any precautions you should take. Measuring the length of the cervix using a transvaginal ultrasound probe can help predict a woman's risk of delivering prematurely. This procedure is usually done in a doctor's office between 20 and 28 weeks of pregnancy for women who may be at risk.
Fetal fibronectin testing
Fetal fibronectin testing can also be used as a possible predictor of preterm labor for women who may be at risk. This test is done like a Pap smear, and test results are used to predict your risk of preterm labor. The fetal fibronectin test can't tell for sure if you're in preterm labor, but it can tell you if you're not. A woman at risk for premature delivery can be forewarned about what to do if preterm labor symptoms occur, and can undergo further screening tests.