There are several factors that can put a pregnancy at increased risk for labor and birth complications. These risk factors include a premature birthing history, a multiple gestation pregnancy, a significantly young or old mother, or drug use during pregnancy. Here we will talk about the different types of complications that can occur, their risk factors, and how to best handle these complications.

Abnormal Labor Duration

Prolonged Labor

A prolonged labor is when labor is taking more than 20 hours. Prolonged labor can be due to several reasons, including the mother having a small pelvis, the baby being overly large, the mother’s cervix dilating very slowly, and stress on the mother. This issue is most concerning once the active stages of labor have been reached. There are several strategies to move a prolonged labor along, including labor inducers, relaxation methods, and the use of a c-section.

Rapid labor

Also known as a precipitous labor, rapid labor is when all stages of labor are undergone and finished within 3 to 5 hours. Several factors may be indicative of a rapid labor, including the baby being small, uterine contractions being very efficient, the mother having rapid labor previously, and the birth being exceptionally strong. A rapid labor has several risks associated with it. For instance, there is an increase in the possibility of tearing and laceration of the vagina and cervix during labor. As a result, there can be excess hemorrhaging from the vagina and cervix. This hemorrhaging can result in the mother going into shock. Further, because rapid labor happens so fast, another complication is that the mother may not make it to the hospital in time to give birth and may instead have her baby in an unclean environment, which can increase the risk of infection for the baby. The baby may also undergo aspiration of amniotic fluid, which can put the baby in respiratory distress and be life-threatening.

Preterm Labor

A preterm labor is when labor occurs between week 20 and week 37 of pregnancy. There are several indications of preterm labor, including a multiple gestation pregnancy, a short cervix, a history of preterm labor, and drug use during pregnancy. A preterm labor can pose several risks to both mother and baby. These risks include a premature birth of a baby resulting in low birth weight, respiratory issues, immature organs, and vision issues. A premature birth also puts the baby at a higher risk of having cerebral palsy, learning disorders, and behavioral issues. In the worst cases, a premature death can mean the death of a baby. To avoid preterm labor, it is important that the mother regularly visits their doctor, does not use drugs, and gives ample time between pregnancies. There are also several ways to stop preterm labor from occurring, including medication and manually closing the cervical opening so nothing can pass through; however, these methods may or may not work.

There are several fetal positions that are considered abnormal and deemed a complication during labor and birth. These positions include fetal dystocia, breech, occiput posterior, shoulder dystocia, umbilical cord prolapse, and fetal distress. Fetal dystocia is when the fetus is smaller or larger than normal or in an abnormal position. This can lead to the umbilical cord being compressed. Breech position encapsulates complete, incomplete, frank, or footling breech. A complete breech is when the baby’s feet are closest to the birth canal and the knees are bent. An incomplete breech is when one of the baby’s knees is bent and close to the birth canal. A frank breech is when the baby’s legs are folded up near their face, and their bottom is nearest the birth canal. A footling breech is when the baby’s feet are closest to the birth canal and delivered first. Occiput posterior positioning is the most common abnormal fetal positioning and is when the occipital bone of the fetus is touching the mother’s sacrum.

Shoulder dystocia is when the head of the baby has exited the birth canal, but the shoulders get stuck. In this case, an episiotomy is an option to get the baby free. This positioning can result in injury such as fracture, brachial plexus, or brain injury to the baby if forced through. Another abnormal position is umbilical cord prolapse, which is when the umbilical cord comes through the birth canal before the fetus. Umbilical cord prolapse is a dangerous position, and a little under 10 percent of cases lead to fetal death. Lastly, fetal distress is when there is an irregular heartbeat coming from the baby. This is common in pregnancies at or past 42 weeks.

Preeclampsia

Preeclampsia is a special name for a case where a mother has high blood pressure during pregnancy. For women with initially normal blood pressure, preeclampsia usually presents around 20 weeks or more into the pregnancy. It is important for a mother and her doctor to keep on the lookout for signs of preeclampsia, including high blood pressure, excess protein in the urine, and edema in the legs. Preeclampsia is a pregnancy risk for both mother and baby, so if it does occur, it is important that the mother get oral or intravenous medication to stabilize the baby for birth. Often, a mother will need to consider the risk versus the reward of delivering early or going to term.

Miscarriage

A miscarriage is when a woman’s pregnancy terminates before 20 weeks. Miscarriages are the most common way to lose a pregnancy, with 10 to 20 percent of pregnancies resulting in miscarriage. Miscarriage usually occurs due to poor or irregular development of the fetus or due to the age and health of the mother. High fetal cortisol levels can also increase the chances of a miscarriage occurring. Although there are medications to lessen complications of a miscarriage, there are no known ways to stop a miscarriage once it has been initiated. There are several ways to indicate that a miscarriage may be imminent, including the passage of fluid, blood, or tissue out of the vagina, abdominal pain, or lower back pain. Miscarriages are one of the most physically and emotionally distressing processes for a mother to endure.

Still Birth

A still birth is when there is fetal death inside the mother following 20 weeks of pregnancy. Usually, a still birth happens some time before labor, but sometimes it can occur during labor. Although still births are not quite as common as miscarriages, they do occur in approximately 1 out of 175 labors.^[1] Several factors that can increase the chance of a still birth pregnancy are obesity, high blood pressure, diabetes, and drug use. However, still births can also occur in women without any of these risk factors. Once a still birth is found, it is critical it is removed to prevent any further complication or infection. There are several ways to remove the fetus, depending on how far along the pregnancy is. Some removal methods include cervical dilation and evacuation, induction of labor, and c-section.

Excessive Hemorrhaging

Hemorrhaging can be a major issue related to labor and birth since a mother can have complications, including shock if they lose too much blood. During a normal vaginal birth, the mother typically loses around 500 mL of blood. During a c-section birth, a mother usually loses around 1000 mL of blood. Any more blood loss than this is considered excessive hemorrhaging. Most of this bleeding occurs after the placenta has been delivered. Certain situations put a mother at higher risk for excessive hemorrhage, including placental abruption, prolonged labor, assisted delivery, infection, blood clotting disorders, and obesity.

Vaginal and Anal Tearing

Labor and birth can result in vaginal or anal tearing. The risk of tearing is increased in situations such as rapid labor or an abnormally large baby. There are also several different degrees of tearing. A first-degree tear is when the skin between the vagina and rectum tears. A second-degree tear is when there is a tearing of the perineal muscles. A third-degree is when there is a tearing of the perineal muscles and anal sphincter. Finally, a fourth-degree tear is when there is a tearing of the mucous membrane lining the rectum. Tearing can cause several issues for the mother, including fecal incontinence and dyspareunia.