Complications and Emergencies in Labour and Birth

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1. Fetal Heart Rate Changes

  • During active labour and pushing, the fetal heart rate is monitored very closely. This careful monitoring allows providers to make the best care plans for you and your baby. Monitoring can be done with intermittent auscultation or with continuous monitoring.
  • Intermittent auscultation is listening to the fetal heart rate every 15 minutes in active labour and then every 5 minutes during pushing. If any concerns arise or for other indications your provider may use continuous monitoring.
  • Continuous monitoring involves using two monitoring disks attached to the abdomen with belts. The ultrasound disk monitors the fetal heart rate, while the tocodynamometer (toco) disk uses pressure changes to detect contractions. With all of this data, providers are able to determine if a baby’s heart rate pattern is normal or abnormal.
  • An abnormal heart rate does not always indicate a problem but does mean steps need to be taken to determine why the fetal heart rate is abnormal and attempt to improve it.
  • Sometimes babies with abnormal heart rates will need to be delivered quickly usually by forceps, vacuum, or c-section. If concerns about the fetal heart rate arise during an out-of-hospital birth, this would be an indication to transfer into the hospital.

2. Meconium Stained Amniotic Fluid

  • Meconium is the substance contained in a newborn’s first few bowel movements. Sometimes babies release meconium while still inside the uterus.
  • This meconium mixes with the amniotic fluid, turning the amniotic fluid a green/brown colour.
  • Some babies release meconium because they are well overdue, others because they are in distress. Depending on the amount of meconium released into the amniotic fluid, some babies can have difficulty breathing after birth.
  • Meconium stained amniotic fluid, as recommended by best practice guidelines, is an indication for a hospital birth, with continuous monitoring and the pediatric team present at birth.

3. Umbilical Cord Prolapse

  • Umbilical Cord Prolapse is an obstetric emergency, in which the baby’s umbilical cord slips past the presenting part of the baby, through the cervix and into/out of the vagina. Cord prolapse is an emergency because during this event the amount of oxygen the baby is receiving is greatly reduced. Malpresentation of the baby (not head down) or too much amniotic fluid can increase the risk of cord prolapse. Cord prolapse usually means an immediate c-section to deliver the baby as quickly as possible.

4. Antepartum Hemorrhage (APH)

  • A small amount of bleeding in labour is expected due to cervical changes. When the amount of bleeding becomes too much it is called an antepartum hemorrhage. Antepartum Hemorrhage is an emergency, especially if the source of bleeding is unknown.
    If the amount of bleeding is too much, it can affect the amount of oxygen the baby is receiving and subsequently impact the baby’s heart rate. APH is also a concern for clients, who are at risk of complications from massive blood loss.
  • Depending on the amount of bleeding, a c-section is generally performed as soon as possible to deliver the baby and stop the bleeding. Once the baby is born steps can be taken to help the baby’s oxygen levels and to reduce the client’s blood loss.

5. Shoulder Dystocia

  • Shoulder dystocia is a rare obstetric emergency when after the baby’s head is out, the bony part of the baby’s shoulders is stuck on the bony part of the client’s pelvis. This impaction makes it very difficult for the client to push out the baby until the impaction is reduced (unstuck). All midwives and OBs are trained in maneuvers to dislodge shoulder dystocia, delivering the baby as quickly as possible once the shoulder dystocia is identified.
  • While it is impossible to identify who is going to have shoulder dystocia, some risk factors increase the chance of occurrence. Risk factors include: a client previously having had shoulder dystocia, a baby’s estimated size greater than 4500g, a client with gestational diabetes, and a client with BMI greater than 30kg/m2 (RCOG 2012).
  • Because shoulder dystocia is rare (0.58%-0.70% of all vaginal births), only a few clients with risk factors will have shoulder dystocia (RCOG 2012). Alternatively, occasionally clients who have no risk factors will also have shoulder dystocia.

6. Postpartum Hemorrhage (PPH)

  • PPH is the loss of over 500mls of blood after vaginal birth and over 1000mls after a c-section. The most common cause of PPH is the uterus not contracting down controlling bleeding after the birth of the baby. PPH is generally managed with the administration of a series of medications. If concerns about excess bleeding occur during an out-of-hospital birth, and it is determined by your midwife they can not be managed out of the hospital, this would be an indication to transfer into the hospital for treatment and/or monitoring.
For more information regarding any of the aforementioned events, please see the additional resources below. Please feel free to ask your midwife any questions or concerns you may have regarding these events.