Problems in labour

Giving birth is a natural event, and the vast majority of women have trouble-free labours. In fact three-quarters of all women produce their babies through normal deliveries. The problems which can occur for the remaining quarter are largely guarded against by good antenatal care and by continued monitoring during labour itself.

What can go wrong during labour

A babv’s four-inch journey through its mother’s pelvis is potentially the most dangerous trip he will ever make. The mother, too, may be put at risk during labour so a careful watch must be kept at all times. When problems occur during labour they often do so very quickly and unexpectedly, and need prompt attention if thev’re not to become grave hazards.

Foetal distress

Sometimes strong contractions to the uterus may squeeze the arteries taking blood to the placenta (the organ supplying the unborn baby with oxygen and nourishment). When this happens the unborn baby’s vital oxygen supply is diminished, and it responds by first increasing its heart rate, then dropping it to a lower level. If the heart beats too fast or if the rate drops too low, then this means that the baby is being stressed by lack of oxygen and the heart can’t cope. Foetal distress, as this is called, happens in between five and 10 per cent of labours.

The midwife can check the heart rate by listening in with a special stethoscope, but many hospitals now use electrocardiography to continuously monitor the baby’s heart. A tiny electrode is safely attached to the baby’s scalp and electrical impulses from its heart are picked up, analyzed and displayed on a dial as well as on a paper trace. To check for diminished oxygen levels a bead of the baby’s scalp blood can be taken quickly and jxexamined. [ treatmenty If there is concern for his safety, rapid action must be taken. A Caesarean section will be performed if the cervix is not fully opened, or a forceps delivery carried out if the cervix is open, and the baby’s head can be drawn through the vagina.

Maternal distress

A choice of pain relief is available fairly readily, and most women manage to get through labour with no real problems. But if, for example, the baby’s head is slightly too big for the mother’s pelvis, or if contractions are not coordinated, she may become distressed. She’ll be exhausted and thoroughly fed up with labour.

Depending on how far the labour has advanced, the obstetrician may decide on a Caesarean section or a forceps delivery, so avoiding any further strain or exhaustion in the mother.

Malpresentation

The space in the mother’s pelvis through which a baby makes his journey is not a perfect cylinder. The baby has to negotiate the space rather like an armchair being taken through a doorway that’s a shade too narrow – the manoeuvring must be just right.

For normal delivery, the baby should lie with his head down and his chin tucked against the chest This ensures that the narrowest part of the baby s head arrives first, forging an easy route for the rest of the head and body.

If the baby is in the wrong position, the top of his head or his face may be the first to appear, and the head sometimes gets jammed into the pelvis.

The mother may be able to continue unaided, but some help from the obstetrician is usually needed especially if the baby’s face is presented first. With mal-presentation, labour is more difficult and so it takes longer.