Most often, the labor and birth process is uncomplicated. However, there are times in which complications arise that may require immediate attention. Complications can occur during any part of the labor process.
Common complications of labor include:1-3
- Failure to progress
- Fetal distress
- Perinatal asphyxia
- Shoulder dystocia
- Excessive bleeding
- Placenta previa
- Cephalopelvic disproportion (CPD)
- Uterine rupture
- Rapid labor.
In this Medical News Today Knowledge Center article, we examine each of the above 10 complications of labor, including some information on how they can be caused, treated or prevented.
1. Failure to progress
Labor may be described as prolonged or having failed to progress when it lasts for an abnormally long period of time. For first time mothers, failure to progress is described as labor lasting over 20 hours, whereas in mothers who have previously given birth, it is described as labor lasting more than 14 hours.4
Labor typically lasts for 6-18 hours. In some cases, however, it can last for over 20 hours.
Prolonged labor can occur in any phase of labor; however, it is most concerning during the active phase.4
Causes of prolonged labor include:1,4
- Slow cervical dilation
- Slow effacement
- A large baby
- A small birth canal or pelvis
- Delivery of multiple babies
- Emotional factors, such as worry, stress and fear.
Pain medications can also be a contributing factor by slowing or weakening uterine contractions.4
In cases of labors that fail to progress, women may be given labor-inducing medications or require a cesarean section (C-section).1
Depending on the stage of labor, it may be recommended that a woman tries relaxation techniques, walking, sleeping, bathing or positional changes, such as side lying, standing or squatting.4
2. Fetal distress
Fetal distress, now referred to as non-reassuring fetal status, is a term that is used to describe when a fetus does not appear to be doing well.
Causes of fetal distress include:5,6
- The baby not receiving enough oxygen
- Low levels of amniotic fluid (oligohydramnios)
- Pregnancy-induced hypertension (PIH)
- Post-date pregnancies of 42 or more weeks gestation
- Intrauterine growth retardation (IUGR)
- Meconium-stained amniotic fluid.
During episodes of non-reassuring fetal status, it may be recommended that women change position, increase their hydration, maintain oxygenation, undergo amnioinfusion (the instillation of fluid into the amniotic cavity) or tocolysis (temporary stoppage of contractions) and receive intravenous hypertonic dextrose.5
To confirm the presence of fetal distress, a fetal blood acid base study may be performed; at times, delivery via C-section may be warranted.5
3. Perinatal asphyxia
Perinatal asphyxia (birth asphyxia) is a condition which can occur before, during or immediately following birth and is caused from inadequate oxygenation.1,7
This condition can result in blood abnormalities in the baby including hypoxemia (low oxygen levels) and acidosis (excessive acid in the blood).7
Babies who are not yet born may show symptoms of perinatal asphyxia by way of a low heart rate and lower than normal pH levels; babies affected by the condition at birth may present signs such as poor skin color, low heart rate, weak muscle tone, gasping, weak breathing or meconium-stained amniotic fluid.7
Treatment of perinatal asphyxia can include maternal oxygenation, C-section, mechanical breathing or medication.7
4. Shoulder dystocia
Shoulder dystocia is an unpredictable condition in which the baby’s head is delivered vaginally, only for their shoulders to remain stuck within the mother.8
In the presence of shoulder dystocia, health care providers may employ several maneuvers to release the shoulders:8
- Pressure to the abdomen
- Manually turning the baby’s shoulders
- Performing an episiotomy to make room for the shoulders
- Pressing the mother’s thighs against her belly.
Complications from shoulder dystocia are typically treatable and temporary. However, there are cases of significant injury. Risks to the infant include nerve injury to the shoulder, arms and hand that typically resolve within 6-12 months, and decreased brain oxygenation which can lead to brain damage and death.8
Maternal complications include uterine, vaginal, cervical or rectal tearing and heavy postpartum bleeding.8
5. Excessive bleeding
An estimated 4% of women will experience postpartum hemorrhage – the excessive loss of blood within 24 hours of delivery
On average, women lose 500 ml during the vaginal delivery of a single baby. During a C-section for a single baby, the average amount of blood lost is 1,000 ml.9
Approximately 4% of women will experience postpartum hemorrhage – excessive bleeding following the delivery of a baby.9
The most common cause of postpartum hemorrhage is uterine atony, in which the uterine contractions are too weak to provide adequate compression to the blood vessels at the site of where the now-expelled placenta was attached to the uterus.9
Maternal blood pressure, shock and death can result from postpartum hemorrhage.9
Certain medical conditions can increase a woman’s risk for developing postpartum hemorrhage:9
- Placental abruption
- Placenta previa
- Uterine overdistention
- Multiple gestation pregnancy
- Pregnancy-induced hypertension
- Several prior births
- Prolonged labor
- Labor-inducing medications or medications to stop labor
- Forceps or vacuum-assisted delivery
- Use of general anesthesia.
Additional medical conditions increasing the risk of postpartum hemorrhage include cervical, vaginal or uterine blood vessel tears, hematoma of the vulva, vagina or pelvis, blood clotting disorders, placenta accreta, increta or percreta and uterine rupture.9
Treatment for postpartum hemorrhage includes the use of medication, uterine massage, removal of retained placenta, uterine packing, tying off bleeding blood vessels and surgery – a laparotomy or hysterectomy.9
Certain baby positions can make vaginal delivery more difficult, including breech and horizontal positions.
Not all babies will be in the best position for vaginal delivery. Although facing downward (occiput anterior) is the most common fetal birth position, babies can be in other positions. At times, these positions can raise certain challenges.10
Other positions that babies may find themselves in include:10
- Facing upward: (occiput posterior)
- Breech: buttocks first (frank breech) or feet first (complete breech)
- Lying sideways: lying horizontally across the uterus as opposed to vertically.
Depending on the position of the baby and situation, health care providers may decide upon manual position changes, the use of forceps, episiotomy or C-section to deliver the baby.2,10
7. Placenta previa
When the placenta covers the opening of the cervix, this is referred to as placenta previa. In cases if placenta previa, a C-section is typically performed to deliver the baby.2,11
Risk factors for developing placenta previa include:11
- Prior uterine surgeries
- Prior deliveries or placenta previa
- Multiple gestation pregnancy
- Age 35 or older
- Cocaine use.
The main symptom of placenta previa is bleeding during the second half of pregnancy, ranging from light to heavy. Bleeding during pregnancy can lead to severe bleeding during labor and preterm birth. If placenta previa bleeding is light, rest is typically recommended. Severe bleeding may be treated by supervised rest in hospital, blood transfusion or C-section – particularly if the bleeding does not stop.11
8. Cephalopelvic disproportion
When a baby’s head is too large in relation to the maternal pelvis and unable to fit through it, a diagnosis of cephalopelvic disproportion (CPD) is made.
According to the American College of Nurse Midwives, cephalopelvic disproportion occurs in 1 in 250 pregnancies.12
Causes of CPD may include:12
- Presence of a large baby
- Abnormal fetal positions
- Small or abnormally-shaped maternal pelvis.
Most often, babies with cephalopelvic disproportion are delivered via C-section.12
9. Uterine rupture
If a woman has previously had a Cesarean section delivery, the scar can potentially tear open during subsequent pregnancies.
If someone has previously had a baby delivered by C-section, there is a chance that the scar could tear open during future labor. Although infrequent, this can be dangerous to an unborn baby, putting them at risk of oxygen deprivation.13
If a C-section scar begins to tear during labor, another C-section will be required to deliver the baby.
Due to the potential risk, it is recommended that women trying for a vaginal birth who have previously had a C-section delivery should aim to have their baby delivered at a health care facility with access to an operating theater and blood transfusion service.
The most common sign of uterine rupture is the baby having an abnormal heart rate. Other indicators include vaginal bleeding, irregular contractions and lasting pain between contractions. Ultrasound scanning can also be used to determine the thickness of the C-section scar.
Uterine rupture is estimated to affect 2 out of every 1,000 babies delivered via vaginal birth after a C-section.13
10. Rapid labor
Together, the three stages of labor typically last for 6-18 hours. However, some instances of labor can last for 3-5 hours. Such instances are referred to as rapid labor or precipitous labor.14
The chances of rapid labor are increased by:14
- A smaller than average baby
- A uterus that contracts efficiently and strongly
- A compliant birth canal
- A history of rapid labor.
Rapid labor can be preceded by a sudden series of quick, intense contractions that leave little time in between for rest, to the extent that they feel as though they are one continuous contraction.
Rapid labor can be problematic for the mother as it can leave them feeling out of control and not leave them with enough time to get to a health care facility. The condition can also increase the risk of tearing and laceration to the cervix and vagina, hemorrhage and postpartum shock.
For the baby, rapid labor can lead to the aspiration of amniotic fluid and increase the risk of infection due to the possibility of being born in an unsterile location.
In the event of the onset of rapid labor, a doctor or midwife should be contacted, and the use of breathing techniques and calming thoughts can help people to feel slightly more in control of their situation. Remaining in a sterile place and lying down on either the back or side can also help.14