Childbirth Complications Childbirth Complications Save This Article For Later Share this: Font size: AAA WebMD

Feature 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. 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 position the fetus takes as your body prepares for delivery, and 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 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

the less room there is to maneuver. the umbilical cord can get wrapped and unwrapped around the baby many times throughout the pregnancy. Sometimes the umbilical cord gets stretched and compressed during labor. which usually means the shoulder will lead the way into the birth canal rather than the head. A few babies lie horizontally (called transverse lie) in the uterus. Your doctor will determine the presentation and position of the fetus with a physical examination. When a baby is in the breech position before the last six weeks to eight weeks of pregnancy. While there are "cord accidents" in which the cord gets twisted around and harms the baby. Transverse lie is the most serious abnormal presentation. called variable decelerations. and it can lead to injury of the uterus (ruptured uterus) as well as fetal injury. Sometimes before or during labor. Call an ambulance to get you to the hospital. the umbilical cord can slip through the cervix. through the placenta and the umbilical cord. However. short drops in the fetal heart rate. the odds are still good that the baby will flip. the bigger the baby gets and the closer you get to the due date. Breech babies are at risk of injury and a prolapsed umbilical cord. This is an emergency situation. and over 90% of babies who are breech after 37 weeks will most likely stay that way. Doctors estimate that about 90% of fetuses who are in a breech presentation before 28 weeks will have turned by 37 weeks. preceding the baby into the birth canal. leading to a brief decrease in the flow of blood within it. Sometimes a sonogram helps in determining the fetus' position. This can cause sudden. This is dangerous because the umbilical cord can get blocked and stop blood flow through the cord. Abnormal presentations increase a woman's risk for injuries to the uterus or birth canal. You will probably feel the cord in the birth canal and may see it if it protrudes from your vagina. Umbilical Cord Compression Because the fetus moves a lot inside the uterus. It may even protrude from the vagina. one or both feet lead the way. Oxygen and other nutrients are passed from your system to your baby. which are usually . and for abnormal labor. Childbirth Complications Childbirth Complications (continued) Save This Article For Later Share this: Font size: AAA Umbilical Cord Prolapse The umbilical cord is your baby's lifeline.breech. this is extremely rare and usually can't be prevented.

One option typically offered to women after 36 weeks is an "external cephalic version. a cesarean section may be indicated. But a cesarean section may be necessary if the heart rate worsens or the fetus shows other signs of distress. these changes are of no major concern and most babies quickly pass through this stage and the birth proceeds normally. If the uterus does not contract enough. "Versions" typically take place in the hospital. And if the cervix stops dilating despite strong contractions of the uterus.. If the fetus remains in breech presentation several weeks before the due date. Cord compression happens in about one in 10 deliveries. your doctor will check the presentation and position of your fetus by feeling your abdomen. But many times the cause is not known. a baby that does not present normally or with a uterus that does not contract appropriately. They're usually more successful on women who have given birth previously because their uteruses stretch more easily. doctors sometimes administer a uterine muscle relaxant. he or she may give you oxytocin. your doctor may attempt to turn the baby into the correct position. In most cases.picked up by monitors during labor. This could happen with a big baby. a medicine that promotes stronger contractions. These manipulations work about 50% to 60% of the time.. Childbirth Complications Childbirth Complications (continued) Save This Article For Later Share this: Font size: AAA Abnormal Presentation continued. just in case an emergency cesarean delivery becomes necessary. no specific cause for "failure to progress" is found. To make the procedure easier to perform. Causes and Treatments Failure to Progress (Prolonged Labor) Failure to progress refers to labor that does not move as fast as it should. your doctor may give you intravenous fluids to help prevent you from getting dehydrated. If labor goes on too long. But more often than not. Abnormal Presentation Sometimes a placenta previa may cause an abnormal presentation. such as decrease of fetal blood pH or passing of the baby's first stool (meconium). safer for the baby and more tolerable for the mother-to-be. Towards the end of your third trimester." which involves manually rotating the baby in cog-like fashion inside the uterus. then use an ultrasound machine .

The procedure typically doesn't involve anesthesia. delivering the baby by cesarean section. if the amniotic sac breaks before the fetus has moved into place in the pelvis. but the bigger the baby. The procedure can be uncomfortable.and electronic fetal monitor as guides. Umbilical cord prolapse is an emergency. which is most likely if the baby can't be moved into the proper position. If you are not at the hospital when it happens. too. Umbilical Cord Compression Umbilical cord compression can occur if the cord becomes wrapped around the baby's neck or if it is positioned between the baby's head and the mother's pelvic bone. In this position. get on your hands and knees with your chest on the floor and your buttocks raised. call an ambulance to take you there. but sometimes an epidural can help with the version. in breech (frank. so some doctors induce labor immediately. you may be referred to another obstetrician in your area. The risk of reverting to breech is lower closer to term. Until help arrives. a cesarean delivery will probably be performed unless a vaginal birth is already progressing naturally. complete or incomplete/footling) presentation. There's also a chance that the baby might flip back into a breech position before delivery. There is a very small risk that the maneuver could cause the baby's cord to become entangled or the placenta to separate from the uterus. gravity will help keep the baby from pressing against the cord and cutting off his or her blood and oxygen supply. Once you get to the hospital. Umbilical Cord Umbilical cord prolapse happens more often when a fetus is small. Since not all doctors have been trained to do versions. or if its head hasn't entered the mother's pelvis yet ("floating presenting part"). preterm. but avoids a cesarean section. or in some cases. This prolapse can occur. You may be given oxygen to increase the amount available to your baby. Your doctor may hurry along the delivery by using forceps or vacuum assistance. . the harder it is to turn.

This allows the baby to easily travel down the birth canal. All of the necessary nutrients and oxygen are supplied through the cord and the placenta so it is critical that nothing happen to disrupt this flow. the use of a vacuum assist. intervention will be needed to ensure the baby is safely delivered. In some cases. below are the most common types of birth complications. facing the mother’s back. such as in the breech position. and may even be seen outside of the vagina. this is referred to as an abnormal presentation. especially those who are having their first baby. and it is important to understand that as long as you have proper medical care. you and your baby will be just fine. Presentation that is Abnormal: Any time the baby is not positioned properly. forceps. a c-section may be needed if the cervix ceases to dilate completely. as this . To help you prepare for what could occur. These complications can happen for a number of reasons. This becomes quite serious because it can cut off the blood supply to the baby. Prolapsed Umbilical Cord: The baby depends completely on the umbilical cord for survival. To help the process along. oxytocin may be administered to promote contractions that are more productive. the baby can be manipulated and turned to correct the positioning. In some cases. No time should be wasted when this occurs. That being said. or a c-section may be needed for complete safety. This places the baby and the mother at risk for serious issues such as infections. it is still possible that you may encounter one of several different types of birth complications. with the back of the head against the pelvis and the chin tucked down into the chest. and in other cases. Breech babies are often found well before the due date. Labour that is Prolonged or Fails to Progress: For some women. If the baby is not in this position for any reason. The ideal position for the baby to be delivered is head down.ommon Birth Complications Even if your pregnancy was smooth sailing all the way. labour can last far too long. there are times either before or during labor that part of the umbilical cord can slide through the opening of the cervix. and can be dealt with before complications arise.

The consequences of birth . Fauzia Akhter. a csection will be needed immediately. United Nations Children's Fund. Mahbub Elahi | Copyright • Permalink INTRODUCTION Giving birth should be a time for celebration. if the fetal heart rate does not recover properly. Musharrat. unless a vaginal delivery is well underway. Beyond these maternal deaths are numerous episodes of acute maternal complication: by some estimates. and birth can proceed without further concern. be sure to discuss them in advance with your doctor or midwife. Bangladesh. however. Compression of the Umbilical Cord: Because babies tend to move a great deal in the womb. Anisuddin. While the above mentioned complications may make you feel a bit anxious about delivery. you must remember they are not the norm. Marge. In most cases. Dasgupta. Jahan.(Report) Journal of Health Population and Nutrition June 1. these issues cause no major problems. Chowdhury. the cord gets wrapped and unwrapped around the body of the baby several times. For the most part. for an estimated 358. Profile of maternal and foetal complications during labour and delivery among women giving birth in hospitals in Matlab and Chandpur. Ronsmans. Ahmed.000 women worldwide. Jannatul. Koblinsky. and the majority of births go off without a hitch. Ferdous. 9-10% of pregnant women or about 14 million women per year suffer from acute maternal complications (2. there are times when the cord gets compressed or stretched. or there are other signs of the baby being in distress. they are quite rare. Carine. leading to fetal heart rate decreases. During labor. Even though situations where the cord gets wrapped around the baby and causes harm do happen. and United Nations Population Fund (approximately 15% of expected births suffering from obstetric complications) is more than double this figure: approximately 20 million women suffer from an obstetric complication. Sushil Kanta. a c-section will be needed to safely deliver the baby. pregnancy and childbirth end in death and mourning ( a medical emergency. If you have any specific concerns.3).2). 2012 | Huda. However. Estimate of the World Health Organization (WHO). which can decrease the blood flow for a short time.

000 women die each year due to pregnancy-related complications (7). deaths. social or other barriers to obtaining care and. The area has been under surveillance since 1966 for vital events (births. The aim of the present study was to document the types and severity of acute maternal and foetal complications among women admitted to different hospitals around the time of childbirth and post-partum. using a pregnancy-detection strip. The major sources of income are fishing and farming. therefore. along . even if the woman suffered from a life-threatening complication (12. including death and disabilities. Other CHRWs provided services from fixed-site clinics bi-weekly. MATERIALS AND METHODS Study area We conducted the study in the icddr. the population in the study area was approximately 113. Women with disabilities may also face cultural. Reliable ascertainment of maternal complication requires observation by a trained service provider. marriages.000 women suffer from injuries or disabilities caused by these complications during pregnancy and childbirth (8).000-21.b service area in Matlab. At the time of this study. Measuring acute maternal complication is difficult. the capital of Bangladesh. become silent sufferers (9-11). The reliability of reported complications based on a woman's recall is poor. migration) by the village-based Community Health Research Workers (CHRWs). these may render women outcast from their family and society.660 (16). and about two-thirds of women have received institutional education (16).13). and this is typically facility-based. an estimated 11. few studies have been able to measure the incidence of acute maternal complications at the population level (14. In Bangladesh. Although most of these injuries or disabilities are not lifethreatening. the CHRWs visited each household bi-monthly to collect data on the reproductive health status of women and determined pregnancy. In 2007.15). particularly in populations where not all women give birth in a hospital.and acute maternal complications. and a further 320. a rural area located about 55 km southeast of Dhaka. make up the largest burden of disease affecting women in developing countries (4-6). For this reason. The number and percentage of women in Bangladesh who suffer from acute maternal complications or medium or long-term disabilities are not yet known.

4]) for eclampsia. These CHRWs also disseminated information to groups of pregnant women about home-based lifesaving skills for newborns.b offers free transportation to all the patients referred but management of patients in hospitals in Chandpur is not part of the responsibility of icddr.b where the staff members provide all components of basic emergency obstetric care (EmOC).b. Complicated cases not manageable at the Matlab Hospital are referred to the public and private hospitals in Chandpur district town where services can be reached in about 40 minutes by motorized transport and in about one hour by three-wheelers from Matlab.000 persons.sub. Study population We targeted all pregnant women in the icddr. icddr. and removal of retained products. the first dose of antibiotic for infection.b service area has four subcentre clinics run by nurse-midwives and paramedical staff and a hospital in Matlab town with a 30-bed maternity unit run by doctors and nurses (16). and sedatives for eclampsia. such as prolonged labour. who gave birth during 2007-2008.b service area in Matlab. and two public and 26 private hospitals in Chandpur district. . one public hospital in Matlab. including manual removal of the placenta. The icddr. MgS[O. they refer women with complications to the Matlab Hospital of icddr.4]. oxytocin for AMTSL.sub. including care for normal labour and delivery. and oxytocin only for active management of third stage of labour (AMTSL). Definition of maternal complications Information on maternal complications was collected for all women who were admitted during labour or up to 42 days postpartum to any of the following hospitals: the Matlab Hospital of icddr. Each subcentre clinic serves about 20. excessive bleeding. and birth asphyxia (17-19). They provide limited obstetric services 24 hours. assisted delivery. When necessary. the first dose of magnesium sulphate (MgS[O. including management of the newborns during normal delivery and for maternal and neonatal complications.b.with counselling pregnant women to seek antenatal care and attend hospital for safe delivery.

and vaginal delivery without any maternal complication. including the admission registers and individual patient-records. giving precedence to haemorrhage. including the place of birth. The definition of severe maternal complication was adapted from the definitions of near-miss and lifesaving surgery proposed in the literature (20). E. using the women's unique identifiers. infection. Some women had given birth by CS without a reported maternal complication.(Report) Journal of Health Population and Nutrition December 1. N. Arifeen. these were included in a category of CS without any maternal complication.. using three groups: severe maternal complication. we added a category of foetal complication. A physician searched the hospital-records for any Matlab woman admitted during labour or postpartum to the Matlab Hospital. regardless of whether or not women had a maternal complication (Table 1).We aimed at classifying women by the severity of maternal complications. Moran. Admissions were classified by maternal or foetal … Delivery practices of traditional birth attendants in Dhaka Slums. Women with maternal complications were classified by primary diagnosis only. H. Baqui. anaemia. and dystocia sequentially. Admissions to more than one hospital were noted. less-severe maternal complication. (21). A. Indications for CS were classified using the classification proposed by Stanton et al.. S. or any of the public or private hospitals in Matlab or Chandpur. They collected information within one or two week(s) of a pregnancy outcome on all pregnant women during 20072008. A. and the name and location of the hospital if any admission took place during delivery or immediately postpartum. 2007 | Fronczak. |Copyright • Permalink ABSTRACT . E.. C. Bangladesh. Lastly. They also noted whether the child was born alive and survived or not until the first week of life. the CHRWs generated a list of pregnant women. Data-collection As part of the regular responsibilities. hypertensive disorders of pregnancy. L. Caulfield..

demonstrated that approximately 75% of women reported at least one postpartum morbidity (2. Other factors .3). (b) conditions which develop during pregnancy. Community studies. although women living in urban slum areas of Dhaka reside in close proximity to facilities with skilled care. birthing practices. Bangladesh. 489 home-based birth attendants. Dais with more experience were more likely to use potentially-harmful birthing practices which increased the risk of postpartum morbidity among women with births at home. Postpartum morbidity did not differ by birthlocation.506 women. and audits in 20 facilities where the women from this study gave birth. Postpartum morbidity can be attributed to (a) maternal heath status prior to pregnancy. Bangladesh. while two studies in urban slum areas of Dhaka. Prospective studies. birthing practices. Key words: Birth practices. A national survey showed that 24% of women reported at least one complication during the postpartum period (1). Traditional birth attendants. and some birthing practices. delivery-related complications.This paper describes associations among delivery-location. delivery-location. delivery-related complications. birth practices. Associations among maternal characteristics. Self-reported postpartum morbidity was associated with maternal characteristics. Maternal health. Bangladesh INTRODUCTION Postpartum morbidity is common among women in Bangladesh. training of birth attendants. 70% of women in urban areas give birth at home with non-medically trained providers (5) which is likely to be even higher in urban slums. Delivery. data on deliverylocation. In Bangladesh. The World Health Organization (WHO) currently recommends that all births are assisted by a skilled attendant to address unacceptably high levels of maternal mortality and morbidity (4). and (c) complications or conditions which occur as a result of childbirth. and postpartum morbidity were collected through interviews with 1. and early postpartum morbidity were specifically explored. training of birth attendants. During November 1993-May 1995. Safe motherhood programmes must develop effective strategies to discourage potentially-harmful home-based delivery practices demonstrated to contribute to morbidity. Postpartum morbidity. and early postpartum morbidity in women in slum areas of Dhaka.

trained data collectors interviewed pregnant women in their homes in these households (n=1. access to care. lack of hand-washing by the birth attendant. the associations among place of delivery. childbirth practices. and self-reported postpartum morbidities was collected. and methods to hasten delivery of the infant or to expel the placenta (1216). Specifically. Harmful practices for childbirth include: giving birth on a dirty surface.506 women living in urban Dhaka (2). the types of delivery-care providers used by these women. a high incidence of self-reported delivery-related complications was documented among 1. trained female physicians interviewed and examined women. stool. prior history of pregnancy. and low education (6-11). their training and experience.9-11). At 14-22 days postpartum. or other objects. and socioeconomic factors. and traditional methods commonly used to stop bleeding. Other delivery practices. frequent vaginal examinations. internal version to re-position malpositioned infants. place of delivery.that influence postpartum morbidity include maternal traits. Information collected previously at 72 hours and 14-22 days postpartum was used for categorizing self-reports of delivery-related complications and subsequent postpartum morbidity using . the capital of Bangladesh.506) at seven months gestation and at 72 hours and seven days postpartum. such as primiparity. Slum clusters were chosen using a multistage probability-sampling methodology. Previously. training and experience of home-delivery providers. In this paper. childbirth experience. The level of training of birth attendants and the management of complications by both home and facility-based attendants can contribute to postpartum morbidity (7. guarding the perineum with the foot. are considered unsafe if used by untrained persons (12-16). and postpartum morbidity were explored. and short stature. knee. such as using oxytocic drugs to augment labour. Women who completed at least seven months of pregnancy and who planned to give birth in Dhaka were eligible for the study. and reported birthing practices are described. MATERIALS AND METHODS This community-based prospective study was conducted in 424 clusters of 25-50 households in five selected low-income upazilas (administrative areas) of Dhaka city. information on economic status. and manually removing the placenta. such as poverty. In these interviews. self-reported complications. During November 1993-May 1995. grand-multiparity. such as pressure on the abdomen with hand.

and information on emergency transfers to a health facility. any interventions or practices that occurred during the delivery. and clinical records of complications and morbidity. The nutritional status was assessed by calculating body mass index (BMI=weight (kg) / height [(m).5 … . The interview at 72 hours postpartum began with open-ended questions to elicit a narrative description of the woman's delivery experience from the onset of labour pains until delivery. supplies. specific management of the retained placenta. including equipment.sup. Undernutrition was defined as BMI <18. Here. this morbidity information is linked to the labour and delivery experience reported by the mother at 72 hours postpartum. Structured questions were then asked about the home-based birth attendant. Data were also collected from 20 facilities where the study women delivered. materials used during delivery.operational definitions (2). Home-based birth attendants identified by study women were interviewed regarding formal training and experience in conducting deliveries.2]) from measures taken at seven days postpartum.

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