Labour & birth Pregnancy 7 complications you could have in labour We take a look at some of difficulties that can arise during labour, and what you can do to stay cool and in control 1 of Ad break Problem 1: Slow to dilateWhy this happens: Everybody’s labour is different, and sometimes, often for no particular reason, it can be very, very slow. Anxiety, the baby’s position, or weak contractions can all contribute to the pace of your labour. Try this: Remember that contractions build up in strength over time – it can take the cervix quite a while to open up the first 5 cm before picking up the pace on the way to full dilation. To speed things up, try moving around. Change positions a lot, but stay upright. Have a wee, because a full bladder can slow things down. Ask your partner for a back or foot massage to relax you, and if you are hungry have a small snack to give you more energy. Or this: If you are in the second part of your labour and your cervix isn’t dilating at a rate of around half a cm an hour, your midwife may decide to speed things up. This is called ‘augmentation’, and could start with her breaking your waters. If this doesn’t work, the obstetrician may suggest a hormone drip. The drip contains an artificial hormone, which mimics oxytocin and should make your contractions strong enough to get things moving. Outcome: Long labours are exhausting – but rest assured, your baby will come out eventually! The good news is that second labours are generally shorter than first ones, so you probably won’t have to wait this long again! Problem 2: Too tired to pushWhy this happens: A long labour can be challenging and exhausting, so not surprisingly, your energy reserves may have dwindled considerably by the time you actually need to push. Try this: “Keeping well hydrated and as mobile as possible helps to keep things moving,” says Gail Johnson of the Royal College of Midwives. And remember, it really won’t be long now – just think of meeting your gorgeous baby at the end of it all! Or this: If you’re really running out of strength, you might need some extra help either in the form of a ventouse – an instrument that uses suction to attach a cup to the baby’s head – or forceps, which look like large salad servers and are curved to fit round your little one’s head. With each contraction, the doctor or specialist midwife will pull gently on the instrument to help deliver your baby. “Which method we use depends on what position the baby is in, and how far down the birth canal the baby is,” says Gail. Outcome: Ventouse or forceps can leave a few marks on your precious new arrival, but don’t worry, they will soon disappear. If you’ve had an episiotomy (a surgical cut to carefully enlarge the vaginal opening, which is normal practice for a forceps delivery) you will feel a bit battered and bruised, but painkillers will help and your stitches will heal within a few weeks. “The good news is that with both methods, you are still delivering your baby, as you still have to do a bit of pushing,” says Gail. “You will still feel part of the birthing process.” Problem 3: Can’t cope with the painWhy this happens: You were doing ok but now a combination of tiredness and never-ending contractions are taking their toll. Anxiety and fear tend to block the effect of the body’s natural pain-relieving endorphins. It’s quite normal to say ‘I can’t do this any more.’ Try this: Talk to your midwife, as not knowing what is happening can make your perception of pain greater. How far does she think you have to go? What are your pain relief options at this stage? Understanding your situation and knowing you have complete support from your partner and birth attendant may be enough to help you go that extra mile. Or this: If your labour has a way to go, you might consider asking for an epidural, which is an injection that blocks nerve impulses from your womb so that you don’t feel pain. An anaesthetist injects a hollow needle into your back and passes a tube inside, through which anaesthetic passes. You’ll also need a drip for fluids. It usually takes about 20 minutes to work and can be topped up with more, or less drug as needed. Outcome: It’s hard to prepare for the pain of labour when you’ve never experienced it before, or know how you are going to cope with it. Do remember that no one labour is the same, so give yourself and your baby a pat on the back for coming through – whichever way you did it. Problem 4: Baby in an awkward positionWhy this happens: Your baby may be lying with her back towards yours, in the posterior position, which happens in about 10%of labours. Babies like to face the placenta, and if yours is in the front wall of the womb, this may be why. A baby lying in the breech position, meanwhile, means she is facing the wrong way for delivery – feet or bottom first. Around 15% of babies lie this way during pregnancy and most of them turn round just before or during labour, but about 3% don’t. Try this: If your baby is in a posterior position try and take her weight off your back by kneeling on all fours with pillows under your hands and knees. Standing up, leaning forward and rotating your hips might also encourage her to rotate. In 60% of cases posterior babies do rotate spontaneously during labour. Or this: If your breech baby doesn’t turn spontaneously during labour, your obstetrician may try and turn her by hand, using a technique called external cephalic version (ECV). You’ll be given a drug beforehand to encourage your womb muscles to relax. Outcome: A posterior baby who does not rotate may result in a long labour, so your baby might have to be delivered with the help of forceps. Breech babies are often delivered by caesarean, although there us a growing school of thought that a vaginal birth is just as safe so long as the midwife or doctor on hand has the skill to facilitate it. Continue slideshow > Problem 5: Baby in distressWhy this happens: Just like you, your baby can become exhausted by labour. Signs of distress include meconium (baby poo – a dark green substance) in your waters, changes in your little one’s heart rate and excessive movement. Try this: If the midwife or doctor suspects your baby is not coping well they will do a test to check how quickly she needs to come out. Inserting a small tube into your vagina, they’ll take a pinprick sample from your baby’s head. “Babies aren’t at all distressed by it,” says Gail. Or this: A baby in distress needs a speedy delivery. You may need an assisted birth, or a caesarean. If this is the case, you’ll probably have a regional anaesthetic and a catheter inserted to empty your bladder, but don’t panic – the whole operation can take as little as 5 minutes from start to finish. “If your baby is healthy, she’ll go straight to you to be held, just like if you had given birth vaginally,” says Gail. Outcome: If you've had a c-section, you need to take your recovery seriously - after all you've just had a major operation. "But emotional recovery is just as important," says Gail Johnson. "Do spend time talking to your midwife (and partner) about what went on, why it happened and how you feel about it." Problem 6: Quick labourWhy this happens: This sounds marvellous but if it’s too fast and furious it can be overwhelming. Quick labours can happen naturally or may be the result of an induction, when you are given a synthetic hormone to get things going. Try this: Most inductions are planned in advance, so ideally you will have had the opportunity to prepare mentally for a potentially quick birth and to consider pain relief options. Your obstetrician may decide on membrane-sweeping first – where your midwife places a finger just inside your cervix and makes a circular movement – to increase the chances of labour starting naturally. Or this: One of the challenges of a fast, painful labour is getting the right pain relief to work for you in time – before you deliver! An epidural offers the most pain relief but it takes time to set up, and if you are in a lot of pain, it may be hard to lie still for it to be administered. “Take strength from your partner and midwife, try to be calm and stay as relaxed as you can,” says Gail, “and look at it from a positive view – at least it’s unlikely to go on for very long.” Outcome: Not surprisingly, a fast labour can leave you feeling knocked for six. “The whole thing can be a bit of a shock,” says Gail, “but you and your baby will recover well and quickly.” Problem 7: Post-partum haemorrhaging (PPH)Why this happens: Once the placenta has been delivered, the uterus should contract strongly to shut off all the blood vessels where the placenta was attached, but bleeding can happen when this doesn’t occur. It’s more likely to happen after a very short or a very long labour, a c-section or an assisted delivery. Try this: If your womb is too soft, your midwife can ‘rub up’ a contraction (massage the top of the womb to stimulate it), or she may give you an injection of synthetic oxytocin to speed things up. She may also check for any unusual tears. “Sometimes it can happen simply because the bladder is full,” says Gail, “and emptying it is all we need to do.” Or this: If the bleeding is very severe, a blood transfusion may be needed. To ensure you receive the right blood, the doctor will make careful identification checks before any transfusion. They will ask you to state your full name and date of birth and check the details on your wristband to ensure that you receive the right blood. Outcome: In the UK, most women who lose a half to one litre of blood recover well. “The physiology of pregnancy and birth means that women can cope with a certain amount of blood loss,” says Gail. “You’ll be encouraged to get adequate rest, eat well and if necessary, you’ll be prescribed iron supplements. Over the coming weeks your body will make new red blood cells to replace the ones it lost.” Mum's storySarah-Jane Humphries, 35, lives with her partner Carl and daughter Maisie, 5 months. "I was two weeks overdue, so I was booked in to have an induction. They gave me the cream and wham - overwhelming contractions started almost immediately. There were no gaps between them and they were massively painful, fast and furious. I remember thinking 'I can't do this, it hurts too much.' "I tried gas and air, TENS, pethidine - anything to help with the pain. Then I had an epidural and it felt better, but when the time came to push I was exhausted, and my baby was becoming distressed. They then tried a ventouse, and that didn't work, but I finally managed to push Maisie out with the help of forceps - and seeing her maded everything worthwhile!" 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