Marcile Marker'Petrilli POP, LM, MM, CPM


The 5 Most Common Questions I get about Labor Complications

The problems that arise during labor often sound scarier than they actually are. Lets talk here about realities.

Of the 4.2 million deliveries that took place in the United States, 94 percent involved a "complication," according to a recent U.S. government report. Yikes, right? Most 'complications' are irrelevant. They have no impact on the health of the mother or the baby. Here's a look at the five most common concerns of pregnant patients.

{1} What About Umbilical cord issues

When the umbilical cord is looped around the baby's neck or otherwise entangled, possibly causing compression.

Frequency 23 percent

What usually happens? A normal birth. If the cord isn't being compressed, there's no problem. Often the cord is wrapped around the baby's body or arm and I usually don't even mention it because it didn't cause any problems. If the cord is being squeezed enough to decrease blood flow to the fetus, the heart rate will dip briefly. I see this during contractions and it's normal.

Can it be prevented ?

A. No

{2} Perineal lacerations

This is when a tear in the perineum happens, the area between the vagina and anus.

Frequency First degree: 16 percent;

second degree: 17 percent;

third or fourth degree: 2.5 percent.

These are the national stats. In real practice my percentages are lower, this is the case with most home birth midwives. It is because we allow women to birth in the best position dictated by her body and her baby at the time of birth.

A first-degree tear is a minor one that usually requires few or no stitches and causes minimal pain. A second-degree tear involves the muscles underneath and requires stitches, which dissolve during the healing process.

Third- and fourth-degree tears extend to the anal sphincter and are, fortunately, rare.

Can you prevent it? Possibly. Perineal massage during the last month of pregnancy has been found to reduce the chances of perineal trauma during birth (that includes having an episiotomy), stitches from a tear or episiotomy and pain afterward, according to a review of research by The Cochrane Library. Having an overly large baby increases risk. However I have seen over 10 Lbs babies birthed without even a 1st degree tear.

{3} Abnormal fetal heart rate or rhythm

This is when the fetal heart rate goes outside the "normal" range of 110 to 160 beats per minute or the rhythm is unusual.

It happens in about 15 percent of labors

What usually happens Continuous electronic fetal monitoring is nearly universal in U.S. hospitals even though it's not recommended for low-risk women and hasn't been shown to improve birth outcomes. . As the midwife I consider several factors, including the length and pattern of the abnormality and how close you are to delivery before deciding whether to let labor continue or transport to the hospital for evaluation by a doctor.

Can you prevent it? Maybe. We know lying on your back during labor increases the chances of abnormal fetal heart rate tracings. For low-risk women, intermittent rather than continuous monitoring is preferable because of fewer false alarms and subsequent C-sections.

{4} Amniotic cavity issues

This means too much or too little amniotic fluid or rupturing of the membranes that hold the amniotic fluid (aka your "water breaks") before labor at or beyond 37 weeks.

It happens about 12 percent of pregnancies/labors

What usually happens is excessive fluid is common and rarely causes problems during labor. But once your water breaks, there's less of a cushion for the umbilical cord, which can allow it to become compressed. If this is suspected, I monitor the baby much more frequently and/or send the momma in for evaluation. If your water breaks before you start having contractions, they'll likely begin within 24 hours.

Can you prevent it? No

{5} Failure to progress

When Labor stalls.

Frequency 8 percent

What usually happens failure to progress is the most common reason for a C-section in the hospital setting.

In the home birth situation it is prevented by

  • The midwife doesn't come to your home until your contractions are three minutes apart.

  • Weight gain is monitored closely by your midwife as well as your nutrition ensuring you and your baby are both healthy at birth

  • Using a professional midwife results in faster labors and fewer Cesareans, research shows.

  • Change positions. Reclining is the worst position for labor, lie on your side, stand up or get on your hands and knees. Though you can't predict what will happen during labor, the best way to be prepared for a potentially difficult delivery, is to do your homework and select a care provider and a childbirth class that share your philosophies and will respect your wishes when possible.

Pregnancy 'Complications' That Aren't

While documented as complications in the federal government's recent report, these common prenatal conditions are either benign, not true complications or easily corrected,

  • advanced maternal age (35 years or older)

  • prolonged pregnancy (past 40 weeks)

  • genitourinary infections

  • anemia

  • and some sources say previous C-section

I hope I have been able to answer some of your questions here. Please contact Marcile for more information.

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