Pregnancy and Childbirth Complications

Even though pregnancy and childbirth are now safer than it has ever been, complications can and do happen. 

Premature Rupture of Membranes

This is when the membranes rupture/waters break more than 1 hour before contractions/tightenings start.  If a woman is Group B streptococcus (GBS) negative we can wait up to 24 hours for her to go into labour and if not we will start an Oxytocin infusion to induce labour.  If she is GBS positive we start antibiotics immediately and induce the labour as soon as possible because of the risk of the baby contracting GBS (which can happen despite the antibiotics.)

Slow Progress in the First Stage of Labour

We will assess women to monitor their progress in labour by examining the dilation of the cervix and plotting it against a graph.  Examinations are only done when needed and maybe as infrequent as every four hours.  If a woman is not progressing there are things we can do to prevent a long drawn out labour.

In the early stages of labour, walking helps to establish labour.

We can improve hydration if a woman is dehydrated by starting intravenous fluids. Pain that is out of control can slow labour, improved pain management (see pain relief in labour), will often help.

Sometimes labour may progress slowly because of irregular, infrequent or weak contractions/uterine tightenings.  This can be managed by rupturing the membranes if it is still intact and/or starting an Oxytocin infusion.

If none of our treatments work and progress of labour stops, a caesarean section is indicated.

Slow Progress in the Second Stage of Labour

A prolonged second stage of labour may lead to distress in the baby or damage to the pelvic floor with an increase in the risk of urinary incontinence and possibly pelvic floor prolapse. There are several reasons for this eg weak contractions.   A “posterior” or “face to pubis” presentation where the baby is looking down instead of up. A big baby or a tight fit through the pelvis, exhaustion of the mother. Often these babies will deliver spontaneously but we may have to cut an episiotomy, do an instrumental delivery or even a caesarean section if the head is too high.

Fetal Distress

Fetal distress means the baby is not receiving enough oxygen through the placenta.  This is usually picked up during birth/labour when there is a drop in the baby’s heart rate, also called decelerations.  An abnormally fast heart rate can also mean fetal distress.  Fetal distress means that the baby has to be delivered urgently, usually by either an instrumental delivery or a caesarean section.

Instrumental Deliveries

There are two types of instruments, vacuums (also called ventouse) and forceps.  It is used when the head is low in the pelvis to assist the delivery of the baby.  The reasons it is used is where there is a prolonged second stage (see above) fetal distress or for medical conditions in the mother where exhaustion must be avoided.

Vaginal Tears and Episiotomy

Vaginal tears are relatively common in childbirth. It is graded as a first degree when it involves only the skin or mucus membrane.  A second degree when it involves the skin and muscles of the pelvic floor.  A third-degree when it involves the skin, pelvic floor muscles and the anal sphincter muscle.  A fourth degree is like a third-degree but extends into the rectum.  A first-degree tear only requires suturing if it is bleeding excessively but all the others need suturing to ensure it heals properly.

An episiotomy is a surgical incision into the vagina and pelvic floor muscles. It is made into a safe area and angled away from the anal sphincter muscle.

It is not done for all women, only where there is a good reason.  It will speed up the delivery where there is fetal distress. It is also done when it is clear that there will be a significant tear if it is not done.  It is also done for all forceps and some vacuum deliveries.

Caesarean Section

Sometimes a caesarean section has to be done where there are complications in childbirth.  It is called a non-elective caesarean section.

Post-Partum Haemorrhage(PPH)

A certain amount of bleeding is normal after birth but if there is excessive blood loss it is called a PPH.  The most common cause for this is a loss in the tone of the uterine muscle.  We recommend that all women are given medications to help with the release of the placenta and tighten the uterine muscle(also called contraction) to help prevent a PPH. If that does not work, the uterus is not contracting and the woman is bleeding, the uterus is rubbed vigorously to help stimulate a contraction,  more medications are given, a catheter is inserted to empty the bladder.  If that does not work we can insert a balloon into the uterus and sometimes we have to go to the operating theatre if the bleeding is severe.

A retained placenta or placental fragments can also cause a PHH and may have to be removed in the operating theatre.

Tears to the vagina, cervix or uterus can also cause PPH and has to be repaired as soon as possible, sometimes in the operating theatre.

In severe cases, we may have to administer blood transfusions and clotting factors or even do a hysterectomy.

Fever in Labour

Low-grade fever can be caused by dehydration.  It can also mean infection in the mother, uterus or even baby.  A woman with significant fever in labour  is usually started on wide spectrum antibiotics

Breech Presentation

Most babies are head down by the 36th week of pregnancy. Sometimes, the baby may be buttocks or feet first, it is called breech presentation.

When a baby is a breech your doctor may be able to turn, called an external cephalic version (ECV).  If there are reasons why it cannot be done, the ECV is unsuccessful or a woman goes into labour with a breech baby,  she will need a caesarean section due to the increased risks of injury to the mother and baby.

Umbilical Cord Prolapse

This is a rare complication where the umbilical cord slips through the cervix and into the vagina and may even protrude from the vagina.  It can only happen after the membranes have ruptured(waters have broken).  It is an emergency as the blood flow to the baby through the umbilical cord may get obstructed and the baby has to be delivered urgently.

Amniotic Fluid Embolism

Another very rare complication which occurs when the amniotic fluid that is around the baby gains entry into the blood circulation. It can lead to a sudden and severe drop in blood pressure3 and severe blood clotting issues. Women usually need to be admitted to an intensive care unit for treatment.