Possible complications in childbirth

Historically, childbirth has been a major cause of premature female death; however, with advances in medical care and technology, complications are now very rare and the vast majority of births go very smoothly without any complications or problems. Although serious complications are now rare, childbirth does still present risks to both the health of the mother and the unborn baby and occasionally problems do arise. Throughout labour, both the mother and baby will be monitored closely to ensure the labour is progressing well; if a problem is detected during foetal monitoring (this involves monitoring the progress and health of the baby) it can then be resolved as quickly as possible.

Some of the more common examples of complications during childbirth are outlined below:

Premature Labour

The term premature labour is used to describe labour which comes on before the mother has reached 37 weeks of pregnancy; it can be a very serious complication, especially if the labour starts a long time before this date (generally, survival rates are higher during the latter stages of pregnancy and rates are very low in babies that are born before 30 weeks).

The ideal number for giving birth is 40 weeks of pregnancy; however, some babies do come one or two weeks before. If your baby does come early it can often be daunting as you are so unprepared for this development, but there will be help available from the hospital and medical staff.

The further along you are in pregnancy the better the chance of a healthy born baby. This is because the organs need time to mature and lungs of your baby prepared for breathing independently. Many babies who are born too early, at around 28 weeks, may survive but be left with a disability. Babies who are born before 24 weeks have less chance of survival due to the development of the organs. It is a very upsetting time for parents but there is always help and support available if you need it.

Causes of Premature Labour

In some cases there is no real explanation for delivering prematurely; however, there are many factors that contribute to the onset of premature labour. These factors include the following circumstances:

  • Mother of multiples such as twins or triplets may have more chance of delivering prematurely
  • If you have had a previous premature baby
  • An underage pregnancy could result in premature birth due to little or no support
  • A mother’s social circumstances such as age and job can contribute to premature birth
  • Smoking
  • Drugs
  • Being underweight
  • Bacterial Infection in your vagina
  • An abnormality of uterus
  • Waters breaking early
  • Cervical weakness

All these factors can contribute to having a premature birth. It is therefore important to look after your body to reduce the risk of having a premature labour.

It is important to act quickly if you experience any of the early signs of premature labour; in some cases, treatment can be provided and this can reduce the risk of the baby being born prematurely. Common symptoms to look out for include:

  • Bleeding from the vagina (especially bright red blood)
  • Contractions, which usually come regularly and can come up to five times an hour
  • A sudden surge of clear fluid from the vagina
  • Pain during urination
  • Persistent, dull aching in the lower back

If you do notice any of these symptoms, you should contact your doctor immediately.

What Should I do if I go into Premature Labour?

If you suspect that you may be going into premature labour and you are less than 37 weeks pregnant you should ring your midwife or hospital immediately. If you start feeling contractions or your waters have broken you should go straight to the hospital and bring your medical pregnancy folder.

You will then be assessed by the doctor to establish whether you are going into labour. Even if you start feeling contractions before 37 weeks you should still go to the hospital as it is better to be safer than sorry.

What will happen at the hospital if I am giving birth prematurely?

If the labour has started early some mothers may find that the labour stops on its own. However, if the labour is already underway there is little that can be done to stop it.

Fetal fibronectin is the procedure where your waters will be tested to check for protein and this can give you an indication whether your baby is coming soon. Your baby’s heartbeat will be monitored and pain relief options may be discussed. Many midwives advise against taking pethidine due to its affects on your baby’s breathing. The most common form of pain relief in a premature labour is an epidural.

If you are less than 34 weeks you may be given steroid injections which help to delay the birth for a short time. Your baby is more likely to be in a better condition if he or she is born at 34 weeks in comparison to premature babies born under this gestational time period. In some cases a Caesarean section may be needed if you have heavy bleeding or other complications.

What happens after my baby is born?

If your baby is born after 34 weeks he may not need any additional treatment. Your baby may look small but he should be able to go with you to the postnatal ward. If you have had your baby before 34 weeks your baby may need more specialised care and attention.

Premature babies are more likely to experience difficulty in terms breathing, feeding and are more prone to infection. Your baby may be taken straight to the neonatal unit (NICU) and it may be a very upsetting experience for you. If your baby is born before 28 weeks then the hospital may need to give it specialised care until the baby is healthy enough to go into the outside world with you.

Where can I find Support for Premature babies?

Your hospital will be able to provide you with support and help if you deliver your baby prematurely. It is often a difficult time and you may need the help of family and friends to get you through this tough time. It is important to remember that the specialised care your baby is receiving is working to improve the health of your baby. Many charities support premature births in terms of assistance for mothers and families of premature babies.

Problems with the umbilical cord

Many parents worry when they hear that their baby’s umbilical cord is wrapped around its neck but this is actually far more common than most people think. It is estimated that around one third of babies are born with their cord around their neck. The problem arises during pregnancy as a result of the baby moving around.

In most cases where the cord is wrapped around the baby’s neck it can be easily lifted over the baby’s head; this will be done by the midwife or doctor immediately after the baby’s head becomes visible. In more complex cases, where the cord is wrapped more tightly or is wrapped multiple times, it may take longer to unravel the cord and the midwife will usually tell the mother to stop pushing until the cord has been sorted out; sometimes, if the cord cannot be untangled quickly enough, it will be cut; if this is the case, the midwife will encourage you to push so that the baby is born quickly (this is important because they are no longer getting the nutrients from the mother via the cord).

There are usually no long-term effects of being born with the cord around the neck.

Foetal distress

There are several possible reasons why the baby may become distressed during labour; these include:

  • A lack of oxygen: this is the most common cause of foetal distress; it usually occurs as a result of the contraction of the uterus cutting the supply of oxygen to the placenta.
  • Meconium (this is the baby’s stool, which may become lodged in the amniotic fluid and may subsequently cause problems)
  • Problems with the umbilical cord
  • Adverse reactions to medication
  • Long labour
  • Foetal abnormalities
  • The general stress of labour
  • Infection

Usually, foetal distress is identified by changes in the baby’s heart rate, which is monitored throughout labour. In some cases where the baby is distressed, doctors may advise a caesarean birth as this will mean the baby is delivered quickly.

Problems with the placenta

In many cases, problems with the placenta are detected before labour starts. Possible complications associated with the placenta include placenta previa and placental abruption. Problems with the placenta can cause problems with the oxygen supply to the baby and the baby may consequently become distressed; in many cases where the baby needs to be delivered quickly, the doctor will recommend a caesarean section.

  • Placenta previa

This is a condition which occurs when the placenta is blocking the cervix; there are three types of previa including complete, partial and marginal previa. Placenta previa occurs in around 0.5 percent of pregnancies. In many cases, the condition is diagnosed during the latter stages of pregnancy and is usually characterised by painless vaginal bleeding. Once diagnosed, mothers with placenta previa will be advised to rest and they may be given shots of steroid; this will help the baby’s lungs to mature more quickly and will be beneficial if the baby is born premature.

Placenta previa can be extremely dangerous at full-term; it can cause haemorrhaging, congenital health conditions and can potentially prove fatal. If the previa is still present at full-term, the mother may be advised to have a caesarean section.

Risk factors for placenta previa include:

  • Multiple births
  • History of placenta previa: you are more likely to have placenta previa if you had it in previous pregnancies
  • Age: older women are more likely to suffer from placenta previa
  • Using cocaine
  • Smoking
  • If you have had a caesarean section in the past
  • Placental abruption

This is a very serious condition, which occurs when part, or all, of the placenta comes away from the wall of the uterus before the baby is born. The condition can cause the oxygen supply of the baby to become disrupted and may contribute to haemorrhaging, which can be very serious. Placental abruption also increases the risk of premature labour.

Signs to look out for include:

  • Tenderness in the uterus
  • Back ache
  • Vaginal bleeding (this may be light or heavy)
  • Abdominal pain
  • Cramps

You should contact your doctor immediately if you experience any of these signs or symptoms.

If the abruption occurs near the due date, the baby will be delivered immediately by caesarean section; however, if the abruption is minor and there is still a way to go with the pregnancy, the mother may be given medication to delay labour and steroids to help the baby’s lungs to mature more quickly.

Risk factors for placental abruption include:

  • History of placental abruption in previous pregnancies
  • Age: the risks are slightly higher in older women
  • Smoking and using cocaine
  • Blood clotting disorders
  • Having twins or triplets
  • Trauma or an accident
  • Hypertension or preeclampsia

Postpartum haemorrhage

This is a relatively rare problem, occurring in just 5 percent of labours. Postpartum haemorrhage is a loss of more than 500ml of blood during the postpartum period; caesarean births often have a greater blood loss of around 800-1000 ml.

Possible causes and risk factors for postpartum haemorrhage include:

  • Having a larger than average baby
  • Having more than one baby
  • Having a long labour
  • Taking magnesium sulphate medication
  • Placenta previa
  • Uterine atony (this occurs when the uterus is not contracting forcefully enough to stop the bleeding at the placenta)
  • Blood clotting disorders
  • Uterine rupture
  • Cervical laceration or tear

In order to manage haemorrhages, doctors and midwives will be on hand after the birth; in some cases, they may give medication, oxygen or uterine massage to stem the bleeding. In some rare cases, surgery may be recommended.

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