5 Most Common Labor Complications
The problems that arise during labor often sound scarier than they actually are. Here's the real deal on the top five.
Of the 4.2 million deliveries that took place in the United States in 2008, 94 percent involved a "complication," according to a U.S. government report. Yikes, right?
Not really, says Marjorie Greenfield, M.D., a professor of OB-GYN at Case Western Reserve University School of Medicine in Cleveland.
"Most 'complications' are irrelevant," she says. "They have no impact on the health of the mother or the baby." Here's a look at the five most common potentially sticky scenarios.
1. Umbilical cord issues
What it means: The umbilical cord is looped around the baby's neck or otherwise entangled, possibly causing compression.
Frequency: 23 percent
What usually happens: A normal birth. If the cord isn't being compressed, there's no problem, Greenfield says. "Often the cord is wrapped around the baby's body or arm and the doctor doesn't even mention it because it didn't cause any problems." If the cord is being squeezed enough to decrease blood flow to the fetus, the heart rate will dip briefly. "We see this during contractions and it's normal," Greenfield says.
Can you prevent it? No
2. Perineal lacerations
What it means: A tear in the perineum, the area between the vagina and anus.
Frequency: First degree: 16 percent; second degree: 17 percent; third or fourth degree: 2.5 percent. It's more common with a first baby.
What usually happens: A first-degree tear is a minor one that usually requires few or no stitches and causes minimal pain. A second-degree tear involves the muscles underneath and requires stitches, which dissolve during the healing process. Third- and fourth-degree tears extend to the anal sphincter and are, fortunately, rare.
Can you prevent it? Possibly. Perineal massage during the last month of pregnancy has been found to reduce the chances of perineal trauma during birth (that includes having an episiotomy), stitches from a tear or episiotomy and pain afterward, according to a review of research by The Cochrane Library. Having an overly large baby increases risk.
RELATED: Types of Perineal Tears
3. Abnormal fetal heart rate or rhythm
What it means: The fetal heart rate goes outside the "normal" range of 110 to 160 beats per minute or the rhythm is unusual.
Frequency: 15 percent
What usually happens: Continuous electronic fetal monitoring is nearly universal in U.S. hospitals even though it's not recommended for low-risk women and hasn't been shown to improve birth outcomes.
"Sometimes the monitoring is very reassuring, and other times it's clear the baby is not getting adequate oxygenation and we need to do a Cesarean section," says Greenfield. "But often we're somewhere in the middle." Your doctor or midwife will consider several factors, including the length and pattern of the abnormality and how close you are to delivery before deciding whether to let labor continue or perform a C-section.
Can you prevent it? Maybe. Greenfield says lying on your back during labor increases the chances of abnormal fetal heart rate tracings. For low-risk women, she adds, intermittent rather than continuous monitoring may be preferable because of fewer false alarms and subsequent C-sections.
4. Amniotic cavity issues
What it means: Too much or too little amniotic fluid or rupturing of the membranes that hold the amniotic fluid (aka your "water breaks") before labor at or beyond 37 weeks.
Frequency: 12 percent
What usually happens: Excessive fluid is common and rarely causes problems during labor, says Greenfield. But once your water breaks, there's less of a cushion for the umbilical cord, which can allow it to become compressed. If this is suspected, your doctor or midwife may insert water into the amniotic cavity. If your water breaks before you start having contractions, they'll likely begin within 24 hours. Most care providers will want to induce labor right away, however, to decrease the chance of infection reaching the baby.
Can you prevent it? No
5. Failure to progress
What it means: Labor stalls.
Frequency: 8 percent
Can you prevent it? Maybe. To reduce your risk of a "failed" labor, you can:
- Stay home until your contractions are three minutes apart, if your doctor or midwife says it's OK.
- Gain no more than the recommended amount of weight.
- Hire a doula. Having a professional birth assistant results in faster labors and fewer Cesareans, research shows.
- Change positions. "Reclining is the worst position for labor," says Greenfield. Sit, lie on your side, stand up or get on your hands and knees. Though you can't predict what will happen during labor, the best way to be prepared for a potentially difficult delivery, Greenfield advises, is to do your homework and select a care provider and a hospital or birth center that share your philosophies and will respect your wishes when possible.
Pregnancy Conditions That Aren't Really Complications
While documented as complications in the federal government's report, these common prenatal conditions are either benign, not true complications or easily corrected, according to Childbirth Connection, a New York City-based nonprofit group aimed at improving maternity care: previous C-section
- Advanced maternal age (35 years or older)
- Prolonged pregnancy (past 40 weeks)
- Genitourinary infections