Your due date has arrived and excitement is mounting up! We all know that giving birth rarely happens like it does on movies: Your water breaks; you gasp and exclaim, “He’s coming!” Then, a few seconds later, you cradle your chubby newborn as your handsome husband looks on. Nevertheless, we hope your experience isn’t going to be traumatic either: A swarm of doctors sprinting into the delivery rooms, shouting, “Get her ready for emergency C-sect! And the NICU team! Baby is in foetal distress!”. More than likely, labour and delivery will be somewhere between the two scenarios. However, problems may sometimes develop suddenly and unexpectedly and it is good to be informed. Serious problems are relatively rare, and most can be anticipated and treated effectively by your doctor.
Here are a few of the most common labour complications and how your doctor will manage them.
According to Dr Ann Tan, OBGYN at Women Fertility & Fetal Centre in Mount Elizabeth Medical Centre, during the labour, when there is low volume of amniotic fluid or when the umbilical cord is being compressed repeatedly during the process of labour, the foetal heart rate will slow due to the decrease in oxygen that the baby is receiving. This can be observed by abnormal heart rate patterns detected on the CTG (cardiotocography) which is used to monitor foetal well-being during labour. These declarations are common when the baby is coming down through the pelvis and out of the mother’s body. However, if these declarations occur over a prolonged period and the delivery is not imminent, this heart beat irregularities could be detrimental to the baby’s well-being and delivery would commonly need to be expedited.
Abnormal Foetal Lie in Labour
Occasionally, even though the baby’s head appears to be at the lower abdominal region in the late stage of the pregnancy, at the time of labour, the baby could still have turned especially if the baby’s head is “unengaged”, Dr Tan describes.
Cephalopelvic Disproportion (CPD)
This is the result of the foetal head being too big to pass through the mother’s birth canal, Dr Ng states. This may then result in prolong labour, foetal distress and failure to progress in which the cervix fails to dilate any further despite optimal uterine contractions.
According to Dr Ng, this can also occur when the baby’s head safely passes out through the vagina but one of the shoulders is stuck behind the pubic bone of the mother. This is more likely to happen if the baby’s weight is above average.
During the progress of labour, regular vagibal examination helps determine how a woman’s labour is progressing by assessing the cervical dilation. During active labour, the cervix should dilate 1 cm per hour and the uterine contractions should be optimally at approximately one every two to three minutes in frequency. The baby’s head should be felt to drop deeper into the pelvis and this is described as the station of the foetal head.
3rd / 4th Degree Vaginal Tear
A 3rd degree tear is from the vaginal down to the anal sphincter and a 4th degree tear extends from the vagina all the way into the anus or rectum, Dr Ng explains. They occur as a result of traumatic tears following difficult vaginal births. The risk is higher in primips (first time delivery), instrumental vaginal assisted deliveries, birth of above average size babies and shoulder dystocia. Besides discomfort, women may develop faecal incontinence and this is usually temporary until healing is complete.
Post-partum Haemorrhage (PPH)
Post-partum haemorrhage is excessive loss of blood of more than 500 ml after delivery. Up to 5 per cent of women will experience PPH, Dr Tan states. There is primary or Immediate PPH which occurs at the time of the birth or within 24 hours. Secondary or delayed PPH is bleeding that occurs after the first 24 hours or up to six weeks of post-delivery.
For the majority of women, the placenta spontaneously expels itself within 30 minutes. If the whole placenta or parts of it fail to do so, this is called retained placenta which can lead to life threatening haemorrhage (PPH) and infections. Once recognised, a manual removal of the placenta (MRP manoeuvre) can be performed in the labour ward or in operating theatre with antibiotic cover, Dr Ng explains.