Childbirth complications
Childbirth complications refer to the various challenges that can arise during labor and delivery, affecting either the mother or the baby. While about 5 to 10 percent of pregnancies may be classified as high-risk through medical monitoring, a significant number of complications—up to 60 percent—can occur unexpectedly in pregnancies with no prior issues. These complications can be categorized into two main types: those affecting the mother during labor and those affecting the baby.
Common maternal complications include the need for cesarean sections, which can be planned or emergency-based, often due to conditions like placenta previa or placental separation, posing risks of severe bleeding. Complications for the baby may include premature labor, which can lead to various health issues, and the baby being in a breech position, which complicates delivery. Conditions like cephalopelvic disproportion may also necessitate a cesarean delivery. Understanding these complications is critical for ensuring safe childbirth experiences, underscoring the importance of prenatal care and monitoring.
On this Page
Childbirth complications
ANATOMY OR SYSTEM AFFECTED: Reproductive system, uterus
DEFINITION: The difficulties that can occur during childbirth, either for the mother or for the baby
With medical monitoring and diagnostic tests, about 5 to 10 percent of pregnant women can be diagnosed as having high-risk pregnancies, and appropriate precautions and preparations for possible complications can be made prior to labor. Yet up to 60 percent of complications of labor, childbirth, and the postpartum period (immediately after birth) occur in women with no prior indications of possible complications. Difficulties in childbirth can be placed into two general categories—problems with labor and problems with the child—and encompass a wide range of causes and possible treatments.
Complications of labor. Cesarean birth (also called cesarean section, C-section, or a section) is the surgical removal of the baby from the mother. An increasing number of infants are delivered by cesarean birth. In this procedure, one incision is made through the mother’s and a second through her uterus. The baby is physically removed from the mother’s uterus, and the incisions are closed. This type of surgery is very safe but carries with it the general risks of any major surgery and requires approximately five days of hospitalization. In some cases, diagnosed preexisting conditions suggest that a cesarean birth is necessary and can be planned; in the majority of cases, unexpected difficulties during labor dictate that an emergency be performed.
Some conditions leave no question about the necessity of a cesarean section. These absolute indications include a variety of physical abnormalities. Placenta previa is a condition in which the has implanted in the lower part of the instead of in the normal upper portion, thereby totally or partially blocking the cervix. The baby would not be able to pass down the birth canal without dislodging or tearing the placenta, thereby interrupting the baby’s blood and oxygen supply. Placenta previa is frequently the cause of painless bleeding after the twentieth week of pregnancy, and it can be definitively diagnosed by ultrasound. Sometimes a low-lying placenta will migrate to a higher uterine position, but this condition requires careful monitoring. Bed rest may be ordered, and a cesarean section may be performed before the onset of labor.
Placental separation, also known as placenta abruptio, is the result of the placenta partially or completely separating from the uterus prior to birth. This condition results in painful bleeding, with either mild or extreme blood loss depending on the severity of the separation. If severe, up to four pints of blood may be lost, increasing risks related to maternal hemorrhage, including disseminated intravascular (DIC). Transfusions may be ordered, along with emergency cesarean section.
Occasionally, as the baby begins traveling down the birth canal, the umbilical cord slips and lies ahead of the baby. This condition, called prolapsed cord, is very serious because the pressure of the baby against the cord during a vaginal delivery would compress the cord to the extent that the baby’s blood and oxygen supply would be cut off. This condition necessitates an emergency cesarean section.
Some conditions that occur during labor are judged for their potential for causing harm to either the mother or the baby. The physician’s decision to proceed with vaginal delivery will be based on the severity of the and consideration of the best option for the mother and baby. A few of the more common indicators for possible cesarean section which occur during labor include a fetal head size that is too large for the mother’s birth canal; fetal distress, evidenced by insufficient oxygen supply reaching the baby; rupturing of the membranes without labor commencing or prolonged labor after membranes burst (usually twenty-four hours); and inelasticity of the pelvis in first-time mothers over forty years of age.
Other maternal conditions are diagnosed prior to the onset of labor, and the physician or midwife may or may not recommend a cesarean birth based on the severity of the complication. These include postmaturity, in which the onset of labor is at least two weeks overdue and degeneration of the placenta may compromise the health of the baby; maternal diseases, such as and eclampsia, in which the stress of labor would be highly risky to the mother; and previous cesarean section.
Complications with the baby. Premature labor can occur between twenty and thirty-six weeks gestation, and a infant is considered to be any infant born before thirty-seven weeks of gestational age. Certain maternal illnesses or abnormalities of the placenta can lead to premature birth , but in 60 percent of the cases there is no identifiable cause. If labor begins six weeks or more before the due date, the best chance of infant survival occurs when the baby is delivered and cared for at a hospital with a perinatal center and specialized for premature infants. The survival rate of premature infants increases with age, weight, and body system maturity.
In about 4 percent of births, the baby is in the breech position—buttocks first or other body part preceding the head—rather than in the normal head-down position. Delivery in this position is complicated because the will not dilate properly and the head may not be able to pass through the cervix. Other complications of are prolapse or compression of the umbilical cord and to the baby if delivered vaginally. Manual techniques may be used to rotate the baby into the correct position. Vaginal delivery may be attempted, frequently aided by gentle forceps removal of the baby. Breech babies are frequently born by cesarean section.
Cephalopelvic disproportion is a condition in which the baby’s head is larger than the pelvic opening of the mother. This can be determined only after labor has begun, because the mother’s muscles and joints expand to accommodate the baby’s head. If at some point during labor it is determined that the baby will not fit through the mother’s pelvic opening, a cesarean section will be performed.
Bibliography:
Campos, Bonnie C., and Jennifer Brown. Protect Your Pregnancy. New York: McGraw, 2004.
Carlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn. The New Harvard Guide to Women’s Health. Cambridge, Mass.: Harvard UP, 2004.
Gonik, Bernard, and Renee A. Bobrowski. Medical Complications in Labor and Delivery. Cambridge, Mass.: Blackwell, 1996.
Hotchner, Tracie. Pregnancy and Childbirth. Rev. ed. New York: Quill, 2003.
MedlinePlus. "Childbirth Problems." MedlinePlus, May 6, 2013.
Mishell, Daniel R., et al. Management of Common Problems in Obstetrics and Gynecology. 4th ed. Hoboken, N.J.: Wiley, 2010.
Moore, Keith L., and T. V. N. Persaud. The Developing Human. 8th ed. Philadelphia: Saunders, 2008.
Rabin, Roni Caryn. "Complications After Delivery: What Women Need to Know." The New York Times, 28 May 2023, www.nytimes.com/2023/05/28/health/maternal-complications-symptoms.html. Accessed 28 Mar. 2024.
Sears, William, and Martha Sears. The Birth Book: Everything You Need to Know to Have a Safe and Satisfying Birth. Boston: Little, 1994.
Stoppard, Miriam. Conception, Pregnancy, and Birth. Rev. ed. New York: DK, 2005.
Worku, Bekelu, Teka, et al. Complication Experience During Pregnancy and Place of Delivery Among Pregnant Women: A Cross-Sectional Study. BMC Pregnancy Childbirth, vol. 23, no. 161, 11 Mar. 2023, doi.org/10.1186/s12884-023-05390-2. Accessed 28 Mar. 2024.