The Five Most Dangerous Labor Complications
A childbirth complication refers to any abnormal obstetrical condition or adverse event occurring during pregnancy, labor, or delivery that can adversely impact a mother or baby. Obstetric complications are ultimately what cause all birth injuries. There are a number of well-known childbirth complications that occur in a certain percentage of all pregnancies with varying rates of occurrence. Some of these complications are relatively benign while others can be dangerous and even life-threatening.
The list below identifies the most dangerous childbirth complications. These are the complications that are the most difficult for doctors to manage and which have the greatest potential to cause catastrophic birth injuries or death. Remember that though it is important to know the warning signs, these events are rare.(1) Uterine Rupture
Uterine rupture is at the top of our list because it is arguably the most dangerous of all obstetric complications for both baby and mother. Uterine rupture is a rare event in which the wall or lining of the mother's uterus tears open. The rupture of the uterine wall occurs suddenly and usually without any prior warning. In severe cases, the rupture tears open a hole in the wall of the uterus, allowing the amniotic fluid and even the baby to come out of the womb.
The reason uterine rupture is so dangerous is that as soon as a rupture occurs, the baby is under immediate threat of oxygen deprivation, which causes major brain damage or death very quickly. The minute the uterus ruptures, the baby is in danger. Depending on the severity of the rupture, the baby must be delivered via emergency C-section within 10-30 minutes to avoid a devastating brain injury or death.
Even under the best circumstances, when the rupture is diagnosed immediately and doctors are ready for the emergency C-section, 10-30 minutes is often not enough time. But very few uterine ruptures occur under the optimum circumstances. Although most ruptures occur in the hospital during labor, they are not always diagnosed immediately. This is why uterine rupture is such an extremely dangerous event.(2) Shoulder Dystocia
Shoulder dystocia is an emergency event that can suddenly occur during vaginal delivery in which the baby's shoulder becomes stuck while entering the birth canal, usually on the mother's pelvis bone. The occurrence of shoulder dystocia during childbirth presents an urgent danger to the well-being of the baby. When the baby becomes stuck in the birth canal from should dystocia, oxygen deprivation creates a risk of brain injury or even death if the situation is not quickly overcome.
Shoulder dystocia requires doctors to act quickly to dislodge the baby to avoid a hypoxic injury. There are a number of maneuvers that are usually employed to free the stuck shoulder. What makes shoulder dystocia particularly dangerous for the baby, however, is that it tends to be a double-edged sword. The response to shoulder dystocia is often just as hazardous for the baby as the condition itself. In their rush to free the baby's shoulder, doctors and nurses in the delivery room often use too much lateral traction, or force. They pull, push, and twist too hard and too fast and end up causing physical injury to the baby.
When shoulder dystocia is not managed quickly enough the resulting oxygen deprivation can cause brain injuries and disabilities such as cerebral palsy. Excessive force in response to shoulder dystocia can cause fractured collar bones or damage to the brachial plexus nerves at the base of the neck. This type of nerve damage is the cause of a specific birth injury called Erb's palsy.(3) Umbilical Cord Prolapse
Another dangerous emergency complication during labor and delivery is prolapse of the umbilical cord. The umbilical cord is the critical lifeline connecting baby and mother. In a normal childbirth, the baby goes through the birth canal first and is followed by the umbilical cord and placenta. Prolapse occurs when the vital umbilical cord drops down into the cervical opening first and ends up in front of the baby as it enters the birth canal.
This is very dangerous because as the baby's head pushes down, it will compress the cord against the pelvis or birth canal walls. This pinching or compression of the cord can restrict or even completely cut off the baby's oxygen supply from the mother. The cord gets more and more compressed as the mother's labor contractions continue pushing the baby down.
Compression of a prolapsed umbilical cord mandates the immediate delivery of the baby to avoid birth asphyxia. One reason umbilical cord prolapse is so dangerous is that it is one of the few events that can completely cut off oxygen to the baby as opposed to simply restricting or decreasing it. This is why the perinatal mortality rate for cord prolapse can be as high as 50%. Fortunately, UCP is a very rare occurrence reported in less than half of a percent of all deliveries. This low occurrence rate is why it only ranks 3rd on our list.(4) Chorioamnionitis
Chorioamnionitis is a complication during pregnancy in which a maternal bacterial infection infiltrates the amniotic fluid and/or fetal membranes. The infection usually originates in the mother's vaginal area and spreads upwards into the womb. Although maternal infections during pregnancy are fairly common, chorioamnionitis is a unique type of maternal infection which is not common (only found in 2% of pregnancies) and is considerably more dangerous.
Chorioamnionitis puts the fetus in significant danger. The reason chorioamnionitis is so hazardous is because the infection in the fetal membranes can directly disrupt the supply of oxygen and nutrients from mother to baby. New research has shown that this type of intraamniotic infection can cause prenatal oxygen deprivation or disruption and cause brain injuries. Chorioamnionitis is now recognized as a significant cause of cerebral palsy. Another potential danger of this type of infection is that it may cause premature labor and delivery which greatly increases the risks of major birth injuries.(5) Fetal Macrosomia
Fetal macrosomia is the scientific term for a baby that is too big for safe vaginal delivery. Clinical definitions of fetal macrosomia differ, but any baby in excess of 9 lbs. at full term is considered macrosomic. By itself, fetal macrosomia is actually not an adverse health condition. There is nothing inherently unhealthy about a large baby. Undiagnosed fetal macrosomia is the potentially dangerous complication.
Vaginal delivery is not safe for macrosomic babies because they are too big and are very likely to get stuck in the birth canal. When a baby becomes stuck in the birth canal during delivery, they are at risk of oxygen deprivation, which can result in major brain injuries.Supporting Medical Literature
“Epidemiology of Clinical Risks in Pregnancy and Childbirth” in Birth Settings in America: Outcomes, Quality, Access, and Choice by the National Academy of Sciences, February 2020.
This book chapter discusses the maternal and fetal factors that increase the risk of pregnancy complications in the United States. Hypertension, gestational diabetes, breech presentation, multiples, and previous cesarean birth are among the key clinical risk factors discussed by the authors.
Maternal Mortality: A US Public Health Crisis by J. Phillip Gingey, American Journal of Public Health, March 2020.
In this article, the author discusses the causes of maternal mortality in the US. Uterine rupture, infection, and heart disease, she says, are the most commonly listed causes of maternal death on death certificates. According to the author, preventable mortality is linked to issues with access to care, poverty, race, and a health system that is sometimes ill-equipped to diagnose and deal with these emergencies.