Common Labor Complications

Labor complications encompass a range of challenges that can arise during childbirth, impacting the health and safety of both the mother and the baby. These complications include issues like Failure to progress, fetal distress, Perinatal asphyxia, Shoulder dystocia, Excessive bleeding, Malposition, Placenta previa, Cephalopelvic disproportion, Uterine rupture, and Rapid labor.

While not all births involve complications, healthcare providers are trained to identify and manage these challenges promptly to ensure the best possible outcomes for both the mother and the newborn. Regular prenatal care and open communication between expectant mothers and healthcare professionals are crucial in addressing and mitigating potential complications.

Failure to progress

Prolonged labor, labor that does not progress, or failure to progress, is when labor takes longer than expected.

The American Pregnancy Association defines prolonged labor as more than 20 hours if it is a first labor. For those who have previously given birth, failure to progress is when labor lasts more than 14 hours.

Prolonged labor is classified into two types: prolonged latent phase (early stage) and prolonged active phase (later stage). Prolonged labor may be tiring if it occurs in the early or latent stage but usually does not lead to complications.

However, if it occurs in the active phase, medical evaluation and intervention may be required. The causes of prolonged labor are:

A large baby
Slow cervical dilations
Slow effacement
Delivery of multiple babies
Emotional factors such as worry, stress and fear
A small birth canal or pelvis
Pain relievers can also help by reducing or weakening uterine contractions.

Fetal distress

Fetal distress describes a condition in which the fetus shows signs of distress late in pregnancy or delivery. Most healthcare providers have replaced the term fetal distress with non-reassuring fetal status (NRFS). There are many reasons why a fetus may show signs of distress, such as labor, reactions to medications, or problems with the umbilical cord or placenta. Fetal distress can be dangerous and cause complications for both the mother and the fetus. As part of your pregnancy care, your obstetrician will look for signs of distress.

The most common symptoms of fetal discomfort are:

Changes in the heart rate of the fetus (below or higher than normal).
The fetus moves less for a long time.
Low amniotic fluid.

Perinatal asphyxia

Birth suffocation is a condition in which the baby does not receive enough oxygen before, during or directly after birth. In severe cases, it can cause serious complications and even threaten life. Immediate treatment is necessary to ensure that the baby receives enough oxygen.

Other names for birth asphyxia include perinatal asphyxia and newborn asphyxia. Insufficient oxygenation to the body can cause a decrease in oxygen levels or the accumulation of excess acid in the baby’s blood.

These effects can be life-threatening and require immediate treatment. In mild or moderate cases, babies may recover completely. However, in severe cases, birth asphyxia can cause permanent brain and organ damage or be fatal.

Shoulder dystocia

Shoulder dystocia is a condition that occurs when one or both of the baby’s shoulders get stuck during vaginal delivery. There are no symptoms and no way to prevent this disease. Reasons may include having a large baby, having a small pelvis, or being in the wrong position. Severe complications may occur, including neurological damage to the child.

Excessive bleeding

On average, women lose 500 milliliters (ml) of blood during vaginal delivery of a singleton. During cesarean delivery for a singleton, the average amount of blood lost is 1000 ml. This can occur within 24 hours of delivery or up to 12 weeks later, if there is secondary bleeding.

Bleeding happens after the placenta is expelled because the uterine contractions are too weak to put enough pressure on the blood vessels where the placenta is attached to the uterus. Low blood pressure, organ failure, shock and death can result. Certain medical conditions and treatments can increase the risk of postpartum hemorrhage:

Placental abruption
Excessive dilatation of the uterus
Multiple pregnancy
Blood pressure caused by pregnancy
Several previous births
Prolonged labor
Use of forceps or vacuum-assisted delivery
Using general anesthesia or drugs to induce or stop labor
Infection
Obesity

Malposition

Malposition of the baby during childbirth refers to a situation where the baby is not in the optimal head-down position for delivery. The ideal presentation for birth is with the baby’s head facing downward, allowing for a smoother passage through the birth canal. Malposition can include situations where the baby is breech (feet or buttocks first), transverse (sideways), or in other positions that are not head-down.

Malposition can lead to prolonged labor, increased difficulty in the descent through the birth canal, and a higher likelihood of interventions such as assisted delivery or cesarean section. Healthcare providers monitor fetal position during pregnancy, and if malposition is detected, they may attempt techniques to encourage the baby to move into a more favorable position. In some cases, manual maneuvers or external cephalic version may be considered to turn the baby.

Placenta previa

The placenta is an organ that develops in the uterus during pregnancy. In most pregnancies, the placenta attaches to the top or side of the uterus. In placenta previa, the placenta attaches to the lower part of the uterus. The placenta may partially or completely cover the cervix. Placenta previa can cause heavy bleeding in the mother before, during or after delivery.

Changes in the uterus and placenta during pregnancy may lead to self-correction of this problem. If not, the baby will be born by caesarean section.

Cephalopelvic disproportion

Cephalopelvic incompatibility is a rare obstetric complication. This happens when the baby’s head does not fit through the opening of the mother’s pelvis. This is more likely for babies who are large or out of position when they enter the birth canal. Hip shape can also be a factor.

Uterine rupture

If a person has previously had a cesarean delivery, there is a small chance that the scar will open during a future delivery. If this happens, the baby may be at risk of oxygen deprivation and a cesarean delivery may be necessary. The mother may be at risk of excessive bleeding. Apart from a previous cesarean delivery, other possible risk factors include:

Induction of labor
Baby size
Mother’s age is 35 years or more
Using tools in natural childbirth

Rapid labor

Rapid labor, also known as precipitous labor, is a condition where the entire process of childbirth occurs much more quickly than the average duration. While the duration of normal labor can vary, rapid labor is typically characterized by an unusually short labor period, often lasting less than three hours from the onset of contractions to the birth of the baby. Rapid labor can pose challenges and risks for both the mother and the baby.

For the mother, rapid labor may result in intense and overwhelming contractions, potentially causing increased pain, exhaustion, and emotional stress. There is also an increased risk of tearing or lacerations in the birth canal.

For the baby, rapid labor may lead to a swift descent through the birth canal, which can be associated with issues such as fetal distress, difficulty adjusting to the sudden change in pressure, and an increased risk of injury during delivery.

Healthcare providers need to be alerted promptly if a woman is experiencing rapid labor to ensure a safe delivery. Despite the potential challenges, rapid labor is not inherently harmful, but medical professionals need to be prepared to provide timely and appropriate care. It’s important for pregnant individuals to communicate closely with their healthcare team and be aware of signs of labor to receive the necessary support and interventions in the event of rapid labor.

The bottom line

Common labor complications encompass a range of challenges during childbirth. While not all births involve complications, healthcare providers closely monitor pregnancies to identify and address potential issues promptly. Timely intervention and effective communication between expectant mothers and healthcare professionals are crucial for ensuring the safety and well-being of both the mother and the baby. Regular prenatal care plays a vital role in the early detection and management of complications, contributing to healthier outcomes for mothers and newborns.

Dr. Naim is a leader in obstetrics care in the Los Angeles area. He provides full prenatal care and pregnancy care to help ensure the optimal health of mothers and their babies. Dr. Naim will be with you until the end of the journey, which will be the birth of your baby.

Additional questions

How is cephalopelvic disproportion diagnosed?

Cephalopelvic disproportion (CPD) is diagnosed through a combination of clinical assessments and medical imaging. Healthcare providers perform a pelvic exam to assess the size and shape of the mother’s pelvis, determine the baby’s position, and monitor the progress of labor. While X-rays were historically used for pelvimetry, concerns about radiation exposure have led to a decline in its use. Ultrasound may provide information on the baby’s size and position. CPD is a relatively rare cause of labor complications, and the diagnosis is made based on a comprehensive evaluation of various factors. In some cases, a trial of labor may be attempted before considering interventions such as a cesarean section. Each case is unique, and decisions are made based on the overall assessment of individual circumstances.

What percentage of pregnancies are high-risk?

For the vast majority of women, pregnancy follows a normal course. However, some women face medical problems related to their health or the health of their baby. These women experience what is called a high-risk pregnancy. High-risk complications occur in only 6-8% of all pregnancies.

Are childbirth complications hereditary?

When it comes to pregnancy, premature birth, postpartum depression, preeclampsia, gestational diabetes, and miscarriage can run in families. However, not every complication that occurs during pregnancy is hereditary.

What happens when there is less amniotic fluid?

This liquid opens the air sacs in the lungs and helps them grow. The baby’s lungs grow a lot in the middle of the second trimester. If the amniotic fluid is too low during this period, the fetus may not produce enough lung tissue. This can cause breathing problems during delivery.