Labour Emergencies

The biggest factor and cause of labour emergencies is fetal distress. If doctors or midwives detect an abnormality in the baby’s heart rate, such as a noticeable increase or decrease in beats per minute, they may decide that the baby is not coping well with the labour. t.

Fetal distress can be caused by problems related to the mother’s condition during labour, including:

• Change to blood pressure
• Excessive contractions
• Bleeding
• Maternal infection
• Raised temperature
• Prolapsed cord
• Placental abruption

In the first instance, the medical team will try to normalise the mother’s and the baby’s condition by giving extra fluids and encourage the mother to turn on her side. If there is no improvement in the baby’s condition, then the labour will be assessed for emergency caesarean. If it is too late for surgery and the mother is fully dilated, the birth may be assisted with forceps or ventouse to deliver the baby more quickly.

Blood pressure management

Throughout labour mothers can expect to have regular blood pressure checks and fetal heart rate monitoring. Certain activities during labour can cause a dip in blood pressure, such as long periods lying down or reduced mobility from the effects of an epidural.

A sudden rise in blood pressure may occur due to the development of pre-eclampsia. A very high reading will necessitate management by drugs to control blood pressure and to ensure that during the pushing stage of labour blood pressure levels are kept within reasonable limits.

Slow progression of labour

During the established first stage of labour a woman will generally expect to progress and dilate at 1cm per hour. Sometimes this can take longer during a mother’s first labour.

Other reasons for slow progress may be the position of the baby or that contractions are not strong and regular.

The labour ward team may feel it necessary to speed up the labour either by rupturing the membranes (breaking the waters) or stimulating the release of natural hormones to correct the problem (usually via a pessary or gel inserted into the vagina). If this does not improve the progress, medical staff will administer oxytocin via an intravenous drip to help better establish the strength and frequency of contractions.

Position of Baby

Sometimes, labour may be slow because either the size of the baby is too big for the pelvis or the baby is not in an ideal position. If either of these are identified alongside fetal distress it is likely that an emergency caesarean will be required.

An emergency may also arise if shoulder dystocia is discovered. This is where the baby is prevented from travelling down the birth canal because its shoulders have got stuck. This is not common but medical intervention may be required to deliver the baby before its oxygen supply is affected.

If a baby’s shoulders are stuck medical staff may try to use manipulation to safely deliver it, however there are risks associated with this.

If a baby is identified as being in the breech position during labour it is likely that a caesarean will be carried out to reduce risks of complications.

Blood loss

It is perfectly normal to have some blood loss during labour. However, if the blood loss goes above 500ml in the first 24 hrs following birth it will be classified as post-partum haemorrhage. If this is the case, immediate medical attention is required. Typically, this occurs when the uterus does not contract after delivery. Mothers will be advised to have a routine injection of Syntocinon (oxytocinon) at birth and this should reduce the risk of bleeding.

Excessive bleeding may also occur following vaginal and/or perineum tears, and episiotomy (a cut made to facilitate birth). Another cause may be that the placenta does not fully detach and deliver properly after labour. If this happens, emergency treatment will be given, which may include an injection to contract the uterus, and the administering of intravenous fluid. Episiotomy wounds and tears may be repaired with sutures if blood loss is prolonged.

If you have lost more than a litre of blood you may be offered a blood transfusion and treatment for clotting problems.

You’re in safe hands

Being in hospital or a maternity unit is the safest environment if there is a medical emergency. Staff will be fully trained in life-saving techniques and will have all the equipment on-hand to provide the care required.

If you are giving birth at home, your midwife will be trained in emergency techniques and will summon any necessary help. You may need to be transferred to hospital in certain situations.

Read Dr Tom Pettinger’s articles on complications in labour and emergencies in labour.