Information for the public
Published September 2007

Care of women and their babies during labour

This is an extract from a NICE publication. The complete publication is available at http://publications.nice.org.uk/ifp55

Complications

While most women have a normal labour, some develop complications. The most common ones are listed below.

If you are giving birth outside hospital, you may have to be moved to an obstetric unit during labour if you develop any of these complications.

Complication

What should happen

Your waters have broken but labour has not started.

  • You should contact your midwife to let them know what has happened. Most women (60%) go into labour within 24 hours.

  • Your membranes breaking increases your baby's risk of serious infection from 0.5 to 1%. Therefore, you will be advised to take your temperature every 4 hours while you are awake and to tell your midwife if you develop a temperature. You should report immediately any change in the colour or smell of your vaginal discharge or any decrease or change in your baby's movements. You can have a shower or a bath but should be advised against sexual intercourse because of the increased risk of infection.

  • If you have not gone into labour on your own within 24 hours, the risk of infection increases. You should be offered drugs to start your labour artificially (this is called 'induced labour').

  • You should only receive antibiotics if either you or your baby shows signs of infection and no further tests should be done on your baby unless they are showing signs of being unwell. If you do have signs of infection, you will be given a course of antibiotics.

  • NICE recommends that women who have not gone into labour within 24 hours of their waters breaking give birth in hospital where there is access to neonatal services. You should also stay in hospital for at least 12 hours following birth so your baby can be monitored.

  • Following the birth there is still a risk of infection for your baby (for up to 5 days but particularly in the first 12 hours). Contact your midwife, hospital or GP immediately if you are worried.

Your labour is not progressing as quickly as would be expected. This is called a 'delay' and could happen in any stage of labour.

  • If your waters have not yet broken, your midwife or obstetrician will break them (sometimes called artificial rupture of the membranes), which will make your labour shorter and may make your contractions stronger.

  • If you are giving birth for the first time and your labour becomes delayed in the first stage, you may also be offered a drip with oxytocin, which is a drug that makes your contractions stronger. You should also be offered an epidural and your baby will need to be monitored continuously (see below).

Electronic fetal monitoring.

Why would electronic fetal monitoring be needed?

  • Your midwife will offer to monitor your baby's heartbeat continuously (called 'electronic fetal monitoring'). Sensors will be placed on your abdomen and/or on your baby's scalp. These are attached to a machine which records your baby's heartbeat during labour. You will not be able to move around.

  • Your baby's heartbeat will be monitored continuously if abnormal changes are heard during intermittent auscultation, if your baby is found to have passed meconium, if you start bleeding in labour, if you develop a temperature or your blood pressure goes up, if you need oxytocin to stimulate contractions or if you want your baby to be monitored all the time.

Your baby's heart rate is causing concern.

  • Your obstetrician may recommend taking a blood test from your baby's scalp (called 'fetal blood sampling'). This involves taking one or two drops of blood from your baby's scalp and testing how much oxygen is in it.

You are ready to have your baby (second stage) but your labour is delayed, your baby develops problems or you become exhausted.

  • You may be referred to someone, usually an obstetrician, who will consider using forceps or other instruments to assist with the birth of your baby. You should have effective pain relief during the procedure and you may need an episiotomy (see below).

You need an episiotomy.

  • An episiotomy is a surgical cut from your vagina at an angle into your perineum that makes the opening to your vagina bigger. This may need to be done if your baby is born using forceps or if your baby needs to be born quickly. You will be offered effective pain relief during the procedure.

You have a serious perineal tear.

  • Severe perineal tears affect the muscle or even the inside of the anus. If you have a serious tear, you will need to have it repaired by an operation shortly after your baby's birth.

Your placenta is not delivered within 30 minutes or part of it stays inside your uterus.

  • You may be offered an injection of oxytocin into the cord. Your obstetrician might recommend removing the placenta under anaesthetic.

You have heavy blood loss after giving birth.

  • Heavy blood loss is called a 'postpartum haemorrhage' and you may start to feel faint. Although it is an emergency and can be frightening, healthcare professionals are well trained to deal with it. You will be given oxytocin or ergometrine to help your uterus contract to stop the bleeding. You may also be given other drugs or a blood transfusion.