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What Are the Various Labor & Delivery Complications?

A pregnancy that has progressed without any apparent hitch can still give way to complications during delivery. Here are some of the most common concerns.

Premature Delivery
One of the greatest dangers a baby can encounter is to be born too early, before the body systems are mature enough to ensure survival. The lungs, for example, may not be able to breathe air or the baby's body may not generate enough heat to keep warm.

Failure to Progress (Prolonged Labor)
A small percentage of women, mostly first-time mothers, may experience a labor that lasts too long. In this situation, both the mother and the baby are at risk for several complications including infections.

Abnormal Presentation
Presentation refers to the the part of the fetus that will appear first from the birth canal. It could be either vertex (head down) or breech (buttocks down). In the weeks before your due date, the fetus usually drops lower in the uterus. Ideally for labor, the baby is positioned head-down, facing the mother's back, with its chin tucked to its chest and the back of the head ready to enter the pelvis. That way, the smallest possible part of the baby's head leads the way through the cervix and into the birth canal.

Because the head is the largest and least flexible part of the baby, it's best for it to lead the way into the birth canal. That way there's little risk the body will make it through but the baby's head will get hung up. In cephalopelvic disproportion, the baby's head is often too large to fit through the mother's pelvis, either because of their relative sizes or because of poor positioning of the fetus.

Sometimes the baby is not facing the mother's back, but instead is turned toward her abdomen (occiput or cephalic posterior). This increases the chance of painful "back labor," a lengthy childbirth, or tearing of the birth canal. In malpresentation the baby is not “presenting” or positioned in the pelvis in the normal manner. In malpresentation of the head, the baby's head is positioned wrong, with the forehead, top of the head or face entering the birth canal, instead of the back of its head.

Some fetuses present with their buttocks or feet pointed down toward the birth canal (a frank, complete, or incomplete/footling breech presentation). Breech presentations are normally seen far before the due date, but most babies will turn to the normal vertex (head-down) presentation as they get closer to the due date. In a frank breech, the baby's buttocks lead the way into the pelvis; the hips are flexed, the knee extended. In a complete breech, both knees and hips are flexed and the buttocks or feet may enter the birth canal first. In a footling or incomplete breech, one or both feet lead the way. A few babies lie horizontally (called transverse lie) in the uterus, which usually means the shoulder will lead the way into the birth canal rather than the head.

Abnormal presentations increase a woman's risk for injuries to the uterus or birth canal, and for abnormal labor. Breech babies are at risk of injury and a prolapsed umbilical cord cutting off its blood supply (see below). Transverse lie is the most serious abnormal presentation, and it can lead to injury of the uterus (ruptured uterus) as well as fetal injury.

Your doctor will determine the presentation and position of the fetus with a physical examination. Sometimes a sonogram helps in determining the fetus' position. When a baby is in the breech position before the last six weeks to eight weeks of pregnancy, the odds are still good that the baby will flip. However, the bigger the baby gets and the closer you get to the due date, the less room there is to maneuver. Doctors estimate that about 90% of fetuses who are in a breech presentation before 28 weeks will have turned by 37 weeks, and over 90% of babies who are breech after 37 weeks will most likely stay that way.

Premature Rupture of Membranes (PROM)
Normally the membranes surrounding the baby (the bag of waters) in the uterus break and release amniotic fluid (known as the "water breaking") either during labor or right before it. Sometimes, however, these membranes rupture too early and labor doesn't ensue. This exposes the baby to a high risk of infection.

Umbilical Cord Prolapse
The umbilical cord is your baby's lifeline. Oxygen and other nutrients are passed from your system to your baby, through the placenta and the umbilical cord. Sometimes before or during labor, the umbilical cord can slip through the cervix, preceding the baby into the birth canal. It may even protrude from the vagina. This is dangerous because the umbilical cord can get blocked and stop blood flow through the cord. You will probably feel the cord in the birth canal and may see it if it protrudes from your vagina. This is an emergency situation. Call an ambulance to get you to the hospital.

Umbilical Cord Compression
Because the fetus moves a lot inside the uterus, the umbilical cord can get wrapped and unwrapped around the baby many times throughout the pregnancy. While there are "cord accidents" in which the cord gets twisted around and harms the baby, this is extremely rare and usually can't be prevented.

Sometimes the umbilical cord gets stretched and compressed during labor, leading to a brief decrease in the flow of blood within it. This can cause sudden, short drops in the fetal heart rate, called variable decelerations, which are usually picked up by monitors during labor. Cord compression happens in about one in 10 deliveries. In most cases, these changes are of no major concern and most babies quickly pass through this stage and the birth proceeds normally. But a cesarean section may be necessary if the heart rate worsens or the fetus shows other signs of distress, such as decrease of fetal blood pH or passing of the baby's first stool (meconium).