Childbirth is a natural process in every pregnant woman, even if there is no problem a priori, complications may occur during childbirth. The labor process has three phases: dilatation and effacement of the cervix, descent of the fetal cylinder and birth of the newborn and delivery. Medical supervision avoids problems through instrumental assistance (forceps, Thierry’s spatulas or vacuum cups), or by performing a cesarean section. Completely dispensing with medical assistance can turn natural childbirth into a situation of real risk.
One of the complications is the risk of loss of fetal well-being. The main objective of intrapartum monitoring is to lower fetal and maternal morbidity and mortality rates. Through intrapartum fetal monitoring we are able to detect fetuses at risk in order to implement measures to try to improve perinatal outcome. It is accepted that during labor the fetus is at risk of hypoxic damage, this damage is reflected by the fetal heart rate, so intrapartum monitoring of the fetal heart rate is recommended in all pregnant women.
Non-progression of labor is another possible complication. Prolonged labor is defined as labor lasting more than 20 hours in multiparous women and 14 hours in primiparous women. There may be stagnation of labor in those cases in which the fetus adopts a bad position. The possible solution will be evaluated in each case, performing a cesarean section as a last measure.
Normoinsert placental abruption (NIPD) and early postpartum hemorrhage are other risks in labor. NIPD occurs when the placenta separates from the placenta previa, from its decidual insertion, in a gestation of more than 20 weeks and before the third stage of labor. Retroplacental hematoma caused by placental abruption leads to separation of the placenta and, therefore, impairment of feto-maternal exchange, resulting in fetal distress or fetal death. The blood loss in a vaginal delivery is approximately 500cc. and in cesarean section conditions approximately 1,000cc. A higher blood loss would cause early postpartum hemorrhage. This could be due to different situations such as decreased uterine tone (uterine atony), retained tissue -retention of placental products or clots-, birth trauma -tearing in the birth canal due to precipitous or instrumental delivery- and cesarean tear due to malposition or fetal wedging. Coagulation alterations, uterine rupture and uterine inversion are also situations that could cause early postpartum hemorrhage.
All pregnant women have a venous stasis due to their pregnant status, which predisposes them to thrombotic processes, so any woman with suspected deep vein thrombosis should undergo a Doppler ultrasound of the lower limbs and be treated with low molecular weight Heparin. Another important and serious complication, fortunately exceptional, is Pulmonary Thromboembolism, which presents with increased respiration (Tachypnea) and hypoxia. In the presence of this suspicion we will request Angio-CT or Perfusion-Ventilation Gammagraphy. An exceptional complication, but no less serious, is Amniotic Fluid Embolism, which occurs in an incidence of one in every 80,000 deliveries, is a catastrophic event with high mortality for the mother.
Medical surveillance and assistance does not in itself presuppose the deviation of a natural childbirth, but the correction of any complication in its early stages, avoiding a progression towards a worsening situation.