Written by:

Dr Tom Pettinger

MBChB, MRCOG

Dr. Pettinger is a specialist registrar in obstetrics and gynaecology, working in hospitals throughout West Yorkshire. He is currently completing advanced training in benign gynaecological surgery and obstetrics, and is particularly interested in improving communication in maternity care.

Complications in labour

In this article:

  • Going into labour early
  • Waters breaking early
  • Breech babies and other positions
  • Bleeding before delivery
  • Back labour
  • Assisted delivery
  • Fetal distress
  • Meconium
  • Tearing and episiotomies
  • Scars on the uterus
  • Main points
  • References

Complications in labour

Even women who have experienced a problem-free pregnancy can unfortunately encounter complications during labour and delivery. Sometimes all that is required is extra monitoring for you and your baby, but in other situations, some kind of intervention is recommended. This page outlines some of the issues that can occur during birth and what will be recommended by your maternity team. The complications covered here can slow labour down or make it more difficult; other complications are emergencies and your maternity team will act quickly to keep you and your baby safe. You can learn about potential emergency situations during labour here.

Going into labour early

Although it’s useful to establish your baby’s due date, in reality, very few babies arrive on the day of their expected delivery date. This is an average, with most women going into labour at some point between two weeks before and two weeks after this date. However, around 6% of women with a single pregnancy (and approximately half of all women with twins) will end up having their babies significantly before this.1 This is called preterm labour, and refers to babies born before 37 weeks.

The type of treatment your doctors will suggest in the case of preterm labour will depend on the suspected reason behind it and the gestational age of your baby. It might seem like the best option would be to keep your baby in your womb for as long as possible, but sometimes your baby would be safer being born early than remaining inside if, for example, there are clear signs of infection or problems with the placenta. Whatever the cause, if you think you might be going into labour before 37 weeks, you should contact your hospital straight away.

Waters breaking early

If you feel a sudden gush of fluid coming from your vagina during pregnancy, it could be your waters breaking. This amniotic fluid (or “liquor”) surrounds your baby in a clean protective bubble. It is produced by your baby’s kidneys, passes out through the bladder and is swallowed again. The fluid is held within a double-walled sac, often referred to as “the membranes”, and if this sac breaks it is called a “rupture of membranes”.

Most women’s waters break around the time of birth, either during labour or just before. Sometimes they don’t break at all and the baby is born within them. Some women’s waters break too early (premature rupture of membranes), and if this happens to you, you need to be seen by an obstetric doctor.

Breech babies and other positions

As you approach your due date, your midwife will feel your belly to confirm that your baby is in a head-down (cephalic) position. If not, you will be asked to attend hospital to check the position with a scan. However, occasionally women go into labour without realising that their baby is not in a head-down position.

If your midwife suspects your baby may not be head down at any point during labour, they’ll ask a doctor to check the position with a scan. If baby is coming bottom first (breech), the options for delivery will be discussed with you (see our page on breech babies), which include having a caesarean, trying to turn the baby or delivering the baby vaginally in a breech position. If your baby is neither head nor bottom down (transverse, oblique or unstable lie), similar options may be offered, but it is quite likely you will be recommended to have a caesarean.

Bleeding before delivery

While a small amount of blood loss is expected during a vaginal delivery, it isn’t normal to lose fresh red blood before your baby is born. Many women will pass some thick discharge or mucous streaked with blood in the run-up to labour (a “bloody show”), but anything more than this should be mentioned to your midwife, and if you are not in hospital already, you should contact them to be checked over straight away. Losing blood at any stage of pregnancy or labour before your baby is born is called “antepartum haemorrhage”. Before labour, your doctor will recommend a speculum examination, to see where the blood is coming from, and a period of heartbeat monitoring for your baby. During labour, if your baby’s heartbeat isn’t being continuously monitored, this will usually be recommended. Often no cause is found and no further problems arise, but there are some serious causes which need urgent medical attention and treatment.

Back labour

A baby’s head must make a number of turns as it enters, passes through and leaves your pelvis. Most often, this results in the baby looking downwards, lying with its back closest to your belly so that at delivery it is directly facing your bottom. This position makes the width of the baby’s head as small as possible, meaning labour and delivery can progress well. If your baby enters or travels through the birth canal in a different position, it can slow labour down or halt it altogether. This is particularly obvious if your baby is facing upwards, with its back lying closest to your own back.

Assisted delivery

Around 1 in 10 women in the UK are helped to deliver their baby by a doctor using forceps or a suction cup.2 There are three main situations in which this is recommended: Your baby may be stressed by the final moments of labour, your labour may have stopped progressing on its own, or you may have a medical reason why prolonged pushing is not recommended. The reasons for an assisted (instrumental) delivery and exactly what happens are explained here.

Fetal distress

During a contraction, your baby will inevitably be squeezed by the womb. This squeezing reduces blood flow to the womb temporarily, and can also press on the baby’s umbilical cord, briefly reducing the oxygen supply. Often the heart rate will dip down during contractions; this can be thought of as the baby holding its breath and is an expected and natural part of labour. While most babies are well prepared for this challenge, others will get tired. This could be because the baby’s reserves are already low due to a growth problem or prematurity, or because labour was a lot longer or more intense than expected.

In low-risk labours, your midwife will listen to your baby’s heart regularly after a contraction to make sure they’re coping well. In higher risk labours, such as for medical problems or concerns about the baby, the heart rate will be continuously monitored on a CTG machine. These are very sensitive, and while a normal heart rate pattern is very reassuring, an abnormal pattern does not mean your baby is low on oxygen. Many changes to the heart pattern can be explained by other factors, and doctors and midwives are regularly trained to understand what they mean. If there is significant concern about a baby’s wellbeing, further quick tests can be performed. If these tests also give abnormal results, or there are sudden unexpected changes in the heart rate, your doctor may recommend a rapid delivery by either caesarean section or forceps.

Meconium

This is your baby’s first poo, which is a greenish black colour. It isn’t clear whether a baby who has passed meconium (pooed while still in the womb) has done so due to a moment of distress, or whether it is a natural occurrence. The longer your pregnancy, the more likely it is that your baby has passed meconium, with 15-20% of term pregnancies affected.3

Just seeing meconium is not a big worry in itself; your midwife or doctor will look at the whole picture with regard to how well you and your baby are during labour. However, if you were not yet having your baby’s heart continuously monitored, this will be recommended. If your waters break before the start of labour and meconium is seen, the doctors are likely to recommend starting a drip to bring on contractions immediately.

Tearing and episiotomies

Many different factors influence whether or not you will have a vaginal tear during the birth of your baby. The size of your baby, your previous deliveries and your ethnicity all affect the risk. Tears range in severity from small tears that have no lasting impact, to severe tears from which it can take a long time to recover. There is more detailed information on perineal tears here, as well as the role of episiotomy (having the midwife or doctor make a cut at the opening of the vagina during delivery). The majority of tears either require no stitches or can be repaired under local anaesthetic, but some need to be repaired in an operating theatre.

Scars on the uterus

A few complications of labour only affect women who have had surgery on their womb in the past. In the majority of cases this will be due to a previous caesarean, but for others it could be because of other operations such as the removal of fibroids (myomectomy).

If you plan to have a vaginal delivery after caesarean (VBAC), you should have discussed the risks and benefits with a doctor during pregnancy. This will have included the small possibility of the scar starting to come apart during labour. If this happens it is usually picked up promptly and an emergency caesarean can be performed, but rarely it can be a sudden and catastrophic event. If you have had other operations on your womb, the surgeon who performed the operation should have discussed with you the options for delivering any children you may have in the future. Your obstetrician may contact them before making a recommendation.

Main points

  • Many women experience complications during labour, even if they’ve had a problem-free pregnancy.
  • Some complications can slow labour down, while others are an emergency and require your medical team to act quickly.
  • Going into labour early (preterm labour) is a common complication. The treatment your doctors suggest to you will be dependent on the cause of your preterm labour as well as the gestational age of your baby.
  • Your waters may also break early (premature rupture of membranes), and you will need to be seen by an obstetrician.
  • Just before birth, your baby may be in the bottom-first position (known as breech position) as opposed to the normal head-down (cephalic) position. They may also be in the transverse, oblique, or unstable lying positions. Your maternity team may attempt to turn the child, of they may also suggest a caesarean as the best option.
  • Most women will pass thick discharge mixed with blood before going into labour, and a small amount of blood is usually lost during a vaginal delivery. However, losing fresh red blood before birth is known as antepartum haemorrhage. Your doctor will examine you to determine the cause. You may need urgent treatment.
  • If your baby’s back is lying closest to your own back, this can make labour more painful. Some women will require a doctor to help turn their baby while others may require a caesarean.
  • If your baby is stressed by the final moments of labour, your labour has stopped progressing on its own, or there is a medical reason why prolonged pushing is not recommended, an assisted delivery may be recommended.
  • Your baby is squeezed by the womb during contractions, which may briefly reduce their oxygen supply. Some babies may become tired during labour, and their heart rate may drop. In higher risk labours, your baby’s heart rate will be monitored on a CTG machine. Sudden changes in heart rate may mean the need for a rapid delivery.
  • Your baby may pass their first poo (meconium) while still in the womb. This is usually not a worry.
  • Perineal tears are also common. Treatment will depend on the severity of the tear. An obstetrician may also need to make a small cut in the area to ease delivery of the baby, which is a procedure known as an episiotomy.
  • If you’ve had surgery on the womb in the past, then complications may arise from this.
  • If you plan to have a vaginal delivery after caesarean (VBAC), you should discuss the risks and benefits with a doctor during pregnancy.

References

  1. National Office of Statistics: Preterm Birth in England and Wales 2005.
  2. Operative Vaginal Delivery (Green-top Guideline No. 26). Royal College of Obstetricians and Gynaecologists 2011.
  3. Best Practice in Labour and Delivery. Cambridge University Press 2010