Labour and childbirth are meant to be a natural processes, ideally without any issues. However, in some cases, certain complications may arise during a part of the labour process, requiring immediate action.
The following are some of the complications that can arise, their treatments and how they can be prevented.
It is normal for a woman to lose 500 millilitres of blood during vaginal birth or 1000 ml during caesarean delivery. A woman is considered to have excessive bleeding if, within 24 hours:
- She loses more than 2 pints of blood, and
- Has symptoms of significant blood loss, such as rapid heart rate, fatigue, weakness and dizziness.
This complication can result in hypotension (low blood pressure), shock, organ failure or even death if not dealt with. Prolonged labour, obesity and infection are some of the factors that can increase a woman’s risk of developing postpartum haemorrhage which is the other term for excessive bleeding at birth.
Postpartum haemorrhage treatment aims at stopping the bleeding through:
- Removal of the retained placenta
- Use of medication to help the uterus contract
- Massage of the uterus
- Tying bleeding blood vessels
- Blood transfusion
- Surgery to find the cause of bleeding (laparotomy) or to remove the uterus (hysterectomy)
- Uterine packing.
To prevent this complication from occurring, a doctor should take the necessary steps to prevent or prepare for postpartum haemorrhage. This can be done by determining whether a woman has any conditions that increase the risk of excessive bleeding and whether she has an unusual blood type and ensuring her blood type is available.
Once she has delivered the placenta, she should be monitored for at least 1 hour to ensure the uterus has contracted. Bleeding should also be assessed before she is allowed to go home.
Also known as ‘Failure to Progress’, this complication occurs when labour lasts longer than expected- over 20 hours if it is a woman’s first delivery and more than 14 hours for women who have given birth before. When failure to progress happens during the latent or early stage, it does not lead to complications even though the woman gets tired. However, if it happens in the active stage, medical intervention may be required. Some of the causes of prolonged labour are slow effacement, a large baby, delivering multiple babies, slow cervical dilation and having a small birth canal.
Stress and fear can also put a woman at the risk of experiencing this complication. When this happens, a woman is advised to get sleep, run a warm bath or take a walk, but in the late stages, labour-inducing medications may be given and if progress is not made, caesarean delivery is recommended.
This complication occurs when a baby is not able to initiate and sustain breathing before, during or immediately after delivery due to an inadequate supply of oxygen. It can cause high carbon dioxide levels, too much acid in the blood or hypoxemia (low oxygen levels). It can also bring about organ malfunction and cardiovascular problems. Some of the indications of the complication before birth are low pH and heart rate levels that indicate high acidity. Indications at birth include:
- Weak muscle tone
- Weak breathing
- Poor skin colour
- Low heart rate
Perinatal asphyxia is treated by providing oxygen to the mother or performing CS (caesarean delivery). Once the baby is born, they may be put under mechanical breathing or medication to help with the breathing. If the complication is being caused by meconium aspiration, fluid needs to be removed to enable the child to breath normally.
In cases where the child has not been breathing for a long period of time, brain damage can occur, or acid can build up in the blood and that is treated through hyperbaric oxygen therapy.
Commonly referred to as ‘Non-reassuring foetal status’, foetal distress is a term used to describe the situation when a foetus is not in a good state due to inadequate oxygen. This can occur when the pregnancy lasts longer than usual (post maturity) or due to other labour or pregnancy complications.
Causes of this complication include:
- Maternal anaemia
- Meconium-stained amniotic fluid
- Insufficient oxygen levels
- Pregnancy induced hypertension in the mother
- Intrauterine growth retardation (IUGR)
Irregular heartbeat in a baby, low amniotic fluid levels and muscle tone and movement problems can be linked to non-reassuring foetal status in a baby.
How to deal with non-reassuring foetal status:
- Maintain oxygenation for the mother
- Relieve pressure in the amniotic cavity
- Increase maternal hydration
- Intravenous hypertonic dextrose
- Temporary stoppage of contractions that can delay preterm labour
This is when the head of the baby is delivered vaginally but the shoulders remain inside the mother. Though it is not common, most of these cases are among women who are giving birth for the first time. To deal with it, the mother’s position can be changed, or the baby’s shoulders can be turned. An episiotomy (which is basically the surgical widening of the vagina to make room for the baby’s shoulders) can also be carried out. If non-reassuring foetal heart rate is still present, that could indicate the following problems:
- Foetal fracture
- Hypoxic-ischemic brain injury or low oxygen supply to the brain which can cause brain damage
- Foetal brachial plexus injury which is a nerve injury that could affect the arms, shoulders and hands
This happens when the placenta covers the cervix opening and is a complication that usually requires the use of a caesarean delivery. Even though this complication is rare, certain women are more likely to experience it than others. These include, women who:
- Have had previous deliveries
- Have had fibroids
- Have had the complication before
- Are over 35 years of age
- Have a multiple gestation pregnancy
Apart from bleeding without pain in the third trimester, other indications of this complication include:
- Baby being in the breech position
- Early contractions,
- Having a large uterus size for the stage of pregnancy
Treatment usually involves:
- Blood transfusion
- Immediate caesarean delivery
- Bed rest or supervised hospital rest if the case is severe
There are several other complications that can affect a mother and her baby during birth. The ones discussed in this article are just a few examples. However, every birth process is different and therefore, women should have regular check-ups during pregnancy to help prevent complications that can actually be anticipated and stopped.
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