Monitoring labour
Complications during labour
Maternal complications
A high maternal temperature: This is common and happens in around 10 in 100 women.
This requires investigations such as blood tests and swabs and antibiotics and fluids may be needed. We may suggest additional tests and may recommend urgent birth to protect both mother and baby.
Raised Blood pressure: Whilst this can happen any time in pregnancy, sometimes it happens in labour. We may want to take bloods and a urine sample and give some medications to reduce blood pressure.
Uterine hyperstimulation: is where the uterus (womb) gets too many contractions in a short space of time, this can be uncomfortable but can also cause the fetus to not get enough oxygen. This can sometimes happen if we have tried to help her labour progress using a medication called oxytocin (a medication that helps your womb contract). If this is the case, we can stop the medication and if necessary, give a drug to relax the uterus.
Bleeding before or during labour (Antepartum Haemorrhage): This is not normal and if this happens, we will recommend continuous fetal monitoring. Most serious is if your placenta is separating from the uterus before your baby is born, if this is the case, we will recommend an urgent caesarean birth or an urgent instrumental birth.
Baby-related complications
There can be some events in labour that are complications for your baby these are:
Baby doing a poo: This is your baby’s first poo (meconium) and normally it happens after your baby is born but sometimes it happens before they are born. This can be normal (e.g. baby is post-dates (41+ weeks), or it can be a sign of distress during labour. We are concerned about this not only because it is a sign of possible distress, but also because if a baby breathes in this meconium, they can become unwell. For this reason, your midwife or doctor may want to transfer you to a consultant-led unit if you are not already at one. This enables continuous monitoring and the availability of doctors that specialise in looking after newborn babies if required.
Fetal distress: This is when we suspect that the baby may not be getting enough oxygen. This can be for unknown reasons but also because your uterus is tightening too frequently without getting enough rest between contractions. This can mean your baby does not get enough oxygen. This can also be because your baby has an infection.
Cord Prolapse: This is where the umbilical cord comes out of the womb before baby is born. This complication is severe but uncommon. It happens in 0.1-0.6 in 100 births. If this happens you will most likely be moved immediately to a surgical theatre for a caesarean birth unless an instrumental vaginal birth would be quicker or transferred urgently into a consultant-led unit if you are not there already.
Shoulder dystocia: This is where baby’s shoulder gets stuck after their head has come out. This happens in 0.58-0.70 in 100 vaginal births.
This can result in a brain injury to baby as they cannot get enough oxygen or an injury (brachial plexus injury) which impacts their shoulder and arm. Shoulder dystocia causes a brachial plexus injury in 0.043 per 100 live births in the UK and 10 in 100 of those that end up with this injury will have permanent neurological problems.
Chorioamnionitis: is an infection which affects your uterus and the baby. This will require antibiotics.
Neonatal infection: If your waters have broken before labour starts your baby has 1 in 100 risk of neonatal infection compared to 0.5 in 100 if your waters were still intact.
Maternal complications references:
Intrapartum care. NICE guidelines Published September 29, 2023. Accessed October 18, 2023. https://www.nice.org.uk/guidance/ng235/chapter/Recommendations#planning-place-of-birth
Chandraharan E, Krishna A. Diagnosis and management of postpartum haemorrhage. BMJ. 2017;358:j3875. doi:10.1136/bmj.j3875
Intrapartum care for women with existing medical conditions or obstetric complications and their babies. Evidence reviews for pyrexia. NICE. Published online 2019.
Calman KC, Royston G. Personal paper: Risk language and dialects. British Medical Journal 1997;315:939–42.
Baby complications references:
Intrapartum care. NICE guidelines Published September 29, 2023. Accessed October 18, 2023. https://www.nice.org.uk/guidance/ng235/chapter/Recommendations#planning-place-of-birth
Crofts J, Draycott TJ et al, on behalf of the Royal College of Obstetricians and Gynaecologists. Shoulder Dystocia. BJOG 2012
Chebsey CS, Fox R, et al on behalf of the Royal College of Obstetricians and Gynaecologists. Umbilical Cord Prolapse. BJOG 2014
