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Labor and delivery complications: What can go wrong

Childbirth is one of life's most exciting milestones. Of course, it's also a major medical event. Even with normal pregnancies, complications can arise at any time during labor and delivery, requiring swift intervention to protect both mother and baby.

Obstetrics has one of the highest rates of malpractice among all medical specialties. With two lives at stake, mistakes can have devastating consequences.

What, exactly, can go wrong?

Shoulder dystocia

During vaginal deliveries, the widest part of the baby's body - the shoulders - sometimes get stuck behind the mother's pubic bone. Providers can perform certain maneuvers to help free the baby. Depending on the severity of the situation, these measures may range from repositioning to performing an episiotomy to attempting an emergency C-section.

If not properly managed, shoulder dystocia can result in serious harm to the baby, including brachial plexus injuries (damage to the nerves of the neck and shoulder), brain damage due to insufficient oxygen and, in severe cases, even death.

Fetal monitoring

Fetal monitoring is essential for making sure your baby is tolerating labor. Most hospitals use electronic monitoring equipment to track the baby's heart rate. Although intermittent monitoring may be appropriate in some circumstances, certain factors call for continuous monitoring - for example, an attempt at vaginal birth after Cesarean or the use of oxytocin to induce or augment labor.

Even with adequate fetal monitoring, providers sometimes fail to promptly identify problems with the baby's heart rate. Lapses in communication or delays in responding to troublesome readings can put the baby's life at risk.

Vaginal birth after Cesarean (VBAC)

If you had a previous delivery via Cesarean section, attempting a vaginal delivery for a subsequent birth can be risky. Your prenatal care provider (whether an OB, midwife or family practice doctor) should inform you of these risks in light of your particular circumstances.

If you decide to proceed with a trial of labor after Cesarean (TOLAC), the situation should be handled with care. Your provider as well as the hospital and staff should have procedures in place to reduce the risk of uterine rupture and other potentially life-threatening complications. For example:

  • Your baby should be continually monitored for signs of distress.
  • Risky medications such as prostaglandins and oxytocin should be administered with caution (if at all).
  • A team should be on standby to perform an emergency C-section if necessary.

Assisted deliveries

Assisted delivery (or operative vaginal delivery) may become necessary if you can't get the baby out on your own - for example, due to prolonged labor or fetal distress. The doctor may use a forceps or vacuum extractor to deliver the baby quickly. These maneuvers require a high degree of technical skill. Mistakes in performing assisted deliveries (or unnecessarily performing them) can leave the baby with serious birth injuries.

How to protect yourself and your baby

While you certainly shouldn't spend your entire pregnancy dwelling on worries about childbirth, it's important to be aware of what can go wrong. Getting quality prenatal care throughout your pregnancy goes a long way toward reducing your risk of complications. Carefully weigh your options when choosing your provider and hospital. Finally, don't be afraid to ask questions, speak up when something doesn't seem right and take an active role in your well-being (and that of your baby).

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