Complications of Labor and Birth

Today, we are joined by Dr. Jennifer Mccoy, a Maternal Fetal Medicine specialist, to answer our questions about complications of labor and birth. 

We answer the following question: 

1. How common are complications in labor and birth?
   • While most people have safe, normal labor, sometimes, even pregnant people who are at the lowest risk can have problems or complications during labor and birth. Some of these cannot be predicted until they arrive and are in labor.
2. What types of complications could occur during labor?
   • The pregnant person 

     • Sometimes, during pregnancy or in labor, the pregnant person can develop high blood pressures even if they have never had high blood pressures in the past. This is very unpredictable, and is not caused by anything anyone does. However, we know that it can come on very suddenly. While we don’t really know why this happens, we know it is due to the placenta and the pregnancy itself because the only way to help cure it is to give birth.

       Having new high blood pressures in pregnancy is called preeclampsia. Preeclampsia has many different forms, from a more mild form called gestational hypertension, to the most severe form called eclampsia.

       In the more severe forms of preeclampsia, the disease can cause damage to the pregnant person’s kidneys, liver, lungs, and even brain. It is very, very dangerous, and in its most severe form can cause seizures, stroke, and even death. Some symptoms to watch out for are headaches that don’t go away even with medicine like Tylenol, severe pain on the upper right part of the belly, and spots in their vision that don’t go away.

       Because preeclampsia can cause people to be very sick, we have to watch them very closely. The only way to resolve it is to give birth, and that is why if pregnant people are diagnosed with it, they need to have a conversation with their doctor about how best to manage it, and also when to give birth so that there is a balance between the risk of that person becoming very sick vs. the risk of baby being born too early.

     • If it is diagnosed before that person goes into labor, it really depends on how severe the preeclampsia is. Some people who have more mild forms may be able to go home as long as they can come in for bloodwork and ultrasounds regularly. We also request that they come in on a regular basis for monitoring of the baby. However, with more severe forms, people need to stay in the hospital for very close monitoring. They also need to receive a medicine called magnesium to decrease their risk of having a seizure. In the most severe forms, we may need to very quickly deliver the baby to make sure that the pregnant person does not get sicker.
   • The baby 

     • For baby, the things that we worry about include how the baby is doing during labor -- meaning is baby getting enough oxygen and nutrients--and an abnormal labor course - meaning the cervix is not dilating or the baby is not coming down through the birth canal when the pregnant person is pushing.

     • When that baby is inside the womb, they get all of their oxygen and nutrients through the placenta. So, there is a little bit of a filter. It’s not really like if the pregnant person eats an apple, the baby also eats part of the apple. Instead, mom’s body will process the apple and give the nutrients to the baby through the placenta through blood flow. So that even when mom is not eating, the placenta is always giving baby oxygen and nutrients through the baby’s umbilical cord.

     • During contractions, there is decreased blood flow to the uterus. Most of the time, the baby and the placenta have enough reserve that this doesn’t bother the baby. However, if the placenta is not working well, or during a contraction the umbilical cord gets pushed on, then you can imagine that the baby is not going to get enough oxygen.

     • We can tell by the way the baby’s heart rate is on the baby’s heart rate monitor. A happy, healthy baby’s heart rate monitor pattern looks like a squiggly line. Sometimes, the heart rate will go up a little and then come back down to normal. If the placenta is not working, or if the baby is laying on the cord, the heart rate monitor will show baby’s heart rate dropping to an abnormal point before coming back up. Your doctor, midwife, or nurse can interpret the monitor, and they may try different treatments, like fluid, or stopping your contractions for a while to give the baby a break. They may also ask you to change your position a few times to see if there is a position that gets the baby off of the umbilical cord.

     • Just like us, if the baby doesn’t get enough oxygen for a long time, the baby can get brain damage or even pass away on the inside. That is the scariest thing that we always try to make sure doesn’t happen.
     • If we think that something bad is going to happen, this is usually a reason for an emergency C-section. Because baby is in a bad environment where they are not getting enough oxygen, we feel that it may be best to have the baby come out and breathe on their own to get oxygen. I know that many people don’t want to have a C-section, but usually, if we explain to them that it is in the best interest of their baby, they understand.
3. What complications could occur during a delivery?

   • It is very common for have some tearing of the skin or muscle of the vagina and the area called the perineum, which is the place between the vagina and the anus. This is caused by the baby’s head or even arms or hands when the baby comes through the birth canal.

   • Most of the time, the midwife or doctor can repair these tears quickly, meaning in about fifteen to thirty minutes, after birth. If you have an epidural, you will already have numbing medicine to help you with the discomforts of the repair. If you don’t, your doctor or midwife can inject lidocaine, which is a numbing medication, into the area that they have to repair.

     We grade the tearing from one to four. One is when there is a small tear in just the skin. Two is when there is some tearing of the muscle, and three and four means that there is some tearing into the anus, which is rare. If you have a grade 3 or 4 tear, your doctor may talk to you and move you to the operating room for repair because there is usually better lighting, and our anesthesia providers can give you more medication to make you comfortable. Usually, these tears take a  few weeks to fully heal, and it is why we ask that you don’t put anything in the vagina for a full six weeks after delivery. It can be uncomfortable before then, and, it can also cause the stitches that we put there to open or become loose. After a few weeks, when the area has healed, the stitches dissolve.

4. What complications can occur after the baby is born?

   • It is normal to bleed after having a baby. In fact, pregnant people’s bodies account for that by increasing the total amount of blood that is in the body during their pregnancy. This is to help with the amount that is lost after delivery. However, in a small percentage of cases, they may have too much bleeding. We always take precautions against too much bleeding, to keep people from losing too much blood

   • Even before you start your labor course, your doctors will have talked to you about some things that we can do. One of those things is that they will ask if you would accept a blood transfusion if you have too much bleeding such that it could threaten your wellbeing or even your life. It is very important that if you have religious or cultural reasons for NOT accepting blood transfusions that you tell your provider immediately so that they can make a plan with you about what to do in the event of an emergency.

   • The most likely time for people to have too much bleeding is immediately after the baby and the placenta come out. This is why your provider will give you pitocin immediately after you give birth so that your uterus can contract down and cut off any bleeding. Your provider will also push on your belly to help massage your uterus so that it contracts down. This part is usually not very comfortable, but we ask that you bear with us because it is to make sure that you aren’t bleeding too much.

   • However, sometimes, if the bleeding is caused by there being a piece of the placenta or afterbirth that gets stuck inside, then we may need to remove that piece of placenta, which involves either being in the delivery room or in the operating room. Very rarely do we have to do other procedures, like a hysterectomy, to get the bleeding to stop. While that sounds very scary, I want to emphasize again that that is very, very rare.

   • Sometimes, people can get an infection during labor. This is usually caused by being in labor or having the water broken for a long time. While the inside of the uterus is sterile, meaning this is no bacteria, the vagina is not. That is why if a person is in labor for a very long time, there is a higher chance that bacteria from the vagina can travel up and infect the uterus and the entire pregnancy. We would be able to tell because the person can get a fever or their belly can become very sensitive to touch. We can also tell sometimes by the baby’s heart rate monitor. When the pregnant person gets a fever, the baby’s heart rate tends to increase as well.

   • The best way to treat it is to remove the cause. Since the source of infection is the pregnancy, it is best to deliver your baby as soon as you can. You can still have a vaginal delivery, but an infection may be the reason your doctor or midwife suggests some medication to increase your contractions to speed up labor. It is also important for the baby, because by being in the infected womb, the baby can also get an infection and will need treatment after birth.

   • The other way of treating an infection is with antibiotics, and so if you show any signs of infection, your doctor or midwife will also start antibiotics to help treat the infection. But like I said before, the best treatment is to get rid of the cause of infection. So even though we give antibiotics, we still need to get baby delivered!

   • Some really bad things can happen if we don’t treat the infection or get baby delivered. The infection could spread from the uterus to other parts of the body, and they can get very, very sick. They need to go to the intensive care unit and need to be on life support because the infection can cause other important organs like the kidneys to shut down. They could even lose their uterus if that happens. This is why if you get an infection during labor, your doctor or midwife will talk to you about what the next best steps are.