Complications of Labor and Birth

Today, we are joined by Dr. Jennifer Mccoy, a Maternal Fetal Medicine specialist, to answer our questions about complications of labor and birth. 

We answer the following question: 

1. How common are complications in labor and birth?
   • While most people have safe, normal labor, sometimes, even pregnant people who are at the lowest risk can have problems or complications during labor and birth. Some of these cannot be predicted until they arrive and are in labor.
2. What types of complications could occur during labor?
   • The pregnant person 

     • Sometimes, during pregnancy or in labor, the pregnant person can develop high blood pressures even if they have never had high blood pressures in the past. This is very unpredictable, and is not caused by anything anyone does. However, we know that it can come on very suddenly. While we don’t really know why this happens, we know it is due to the placenta and the pregnancy itself because the only way to help cure it is to give birth.

       Having new high blood pressures in pregnancy is called preeclampsia. Preeclampsia has many different forms, from a more mild form called gestational hypertension, to the most severe form called eclampsia.

       In the more severe forms of preeclampsia, the disease can cause damage to the pregnant person’s kidneys, liver, lungs, and even brain. It is very, very dangerous, and in its most severe form can cause seizures, stroke, and even death. Some symptoms to watch out for are headaches that don’t go away even with medicine like Tylenol, severe pain on the upper right part of the belly, and spots in their vision that don’t go away.

       Because preeclampsia can cause people to be very sick, we have to watch them very closely. The only way to resolve it is to give birth, and that is why if pregnant people are diagnosed with it, they need to have a conversation with their doctor about how best to manage it, and also when to give birth so that there is a balance between the risk of that person becoming very sick vs. the risk of baby being born too early.

     • If it is diagnosed before that person goes into labor, it really depends on how severe the preeclampsia is. Some people who have more mild forms may be able to go home as long as they can come in for bloodwork and ultrasounds regularly. We also request that they come in on a regular basis for monitoring of the baby. However, with more severe forms, people need to stay in the hospital for very close monitoring. They also need to receive a medicine called magnesium to decrease their risk of having a seizure. In the most severe forms, we may need to very quickly deliver the baby to make sure that the pregnant person does not get sicker.
   • The baby 

     • For baby, the things that we worry about include how the baby is doing during labor -- meaning is baby getting enough oxygen and nutrients--and an abnormal labor course - meaning the cervix is not dilating or the baby is not coming down through the birth canal when the pregnant person is pushing.

     • When that baby is inside the womb, they get all of their oxygen and nutrients through the placenta. So, there is a little bit of a filter. It’s not really like if the pregnant person eats an apple, the baby also eats part of the apple. Instead, mom’s body will process the apple and give the nutrients to the baby through the placenta through blood flow. So that even when mom is not eating, the placenta is always giving baby oxygen and nutrients through the baby’s umbilical cord.

     • During contractions, there is decreased blood flow to the uterus. Most of the time, the baby and the placenta have enough reserve that this doesn’t bother the baby. However, if the placenta is not working well, or during a contraction the umbilical cord gets pushed on, then you can imagine that the baby is not going to get enough oxygen.

     • We can tell by the way the baby’s heart rate is on the baby’s heart rate monitor. A happy, healthy baby’s heart rate monitor pattern looks like a squiggly line. Sometimes, the heart rate will go up a little and then come back down to normal. If the placenta is not working, or if the baby is laying on the cord, the heart rate monitor will show baby’s heart rate dropping to an abnormal point before coming back up. Your doctor, midwife, or nurse can interpret the monitor, and they may try different treatments, like fluid, or stopping your contractions for a while to give the baby a break. They may also ask you to change your position a few times to see if there is a position that gets the baby off of the umbilical cord.

     • Just like us, if the baby doesn’t get enough oxygen for a long time, the baby can get brain damage or even pass away on the in