Labor Challenge

Birth Emergencies

Certain situations endanger the life of the baby or the mother. Although these emergencies are very rare, it is important that informed parents understand what these terms mean so they can respond quickly.

Why are birth emergencies a challenge?

Birth emergencies are frightening experiences. When the baby's life is in danger, the mother may "shut out" what is happening around her and only focus on her fear. Her companions may need to help move her mother to action or help her respond to questions or directions from caregivers.

It is important to remember that many women who experience birth emergencies have good outcomes because of the interventions available today. When an emergency is recognized, it should be handled accordingly.

Recognizing Emergencies

Placental Abruption - An abruption occurs when the placenta begins to pull away from the wall of the uterus. It is very rare, although it can happen at any time in pregnancy, not just during labor. The mother may or may not notice bleeding depending on which part of the placenta is pulling away. The mother may feel a non-ending contraction or have an overwhelming sense of doom. Abruption should be considered when the mother has abdominal pain, even if there is no bleeding since the bleeding may be trapped behind the placenta. Often when the bleeding is trapped a widening of the abdomen can be seen as the area behind the placenta fills with blood.

A mild abruption during pregnancy may resolve itself, but abruption can also be very dangerous to the mother and baby. As the placenta pulls off the wall of the uterus, it becomes more difficult for the placenta to provide the needed oxygen to the baby. The mother risks problems with hemorrhage because of the bleeding. It is important to get help immediately, however even with help over 30% of the babies who have an abruption are not able to be saved. More than half of those deaths are before the mother is able to reach help. Another significant cause of death for babies with an abruption are the related factors to pre-term delivery.

Umbilical Cord Prolapse - A prolapse cord can occur with a baby who is still high in the pelvis if the bag of water breaks with a gush. As the water passes under the baby and out the vagina, the cord may be pulled down with it. This is more common in breech babies than in vertex, but is very rare overall. The mother may feel something sticking in her vagina, or may feel a glob of mucus stuck to her leg that will not wipe away. If the baby engages into the pelvis, the cord can become compressed preventing the baby from getting oxygen.

The mother should move quickly into a knee-chest position to use gravity to help the baby stay out of the pelvis. Attempts to put the cord back into the uterus are generally unsuccessful due to the difficulty in reaching around the baby's head. Instead, the cord should be wrapped in a warm, moist towel in a loose way. In most cases, a cesarean surgery will allow the baby to be born healthy.

prolapsed cord
A prolapsed cord leaves the uterus before the baby.

Potential Solutions

Help the mother understand what is happening, and why it is important to respond quickly.

Assist the mother in getting help by calling for an ambulance if at home or getting a nurse if in the hospital.

Do not leave the mother alone.

Things to discuss with your caregiver:

Knowing what to do in an emergency is part of your birth planning. Your caregiver can help you determine what the best approach to getting help will be depending on the services around the area you live.

In the event of an emergency, you may want to go to the closest hospital regardless of where you had planned to have your baby or even if your caregiver does not have privileges at that hospital.

It is rare that babies die in developed countries, but it does happen. Although you do not want to dwell on the possibility, it can be helpful to understand what options are available to help you through your grieving. Hospitals generally allow family visits, photographs and time alone with the baby.

References:

Enkin, Keirse, Nilson, Crowther, Duley, Hodnett and Hofmeyr. A guide to effective care in pregnancy and childbirth Third Edition. 2000. Oxford: Oxford University Press.
Dr. Gregory J. White. Emergency Childbirth: A Manual. 1998. Napsac International.