Usually, labor and delivery occur without any problems. Serious problems are relatively rare, and most can be anticipated and treated effectively. However, problems sometimes develop suddenly and unexpectedly. Regular visits to a doctor or certified nurse midwife during pregnancy make anticipation of problems possible and improve the chances of having a healthy baby and safe delivery.
Problems may involve
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The timing of labor—whether labor occurs earlier or later than normal
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Problems in the fetus or newborn
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Problems in the mother
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A problem with the placenta called placenta accreta
Placenta accreta may be discovered during pregnancy or only after delivery.
Most problems are obvious before labor begins. Such problems include
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Prelabor (premature) rupture of the membranes (the mother's water breaks too soon)
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Postterm pregnancy and postmaturity (a pregnancy continues longer than normal, sometimes causing problems with the baby)
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Abnormal position and presentation of the fetus (the fetus is in the wrong position for the safest delivery)
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Multiple births (such as twins or triplets)
Some problems (complications) that women develop during pregnancy can cause problems during labor or delivery. For example, preeclampsia (high blood pressure with protein in the urine) may lead to premature detachment of the placenta from the uterus (placental abruption) and problems in the newborn.
Some problems develop or become obvious during labor or delivery. Such problems include
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Amniotic fluid embolism (the fluid that surrounds the fetus in the uterus enters the woman’s bloodstream, sometimes causing a life-threatening reaction in the woman)
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Shoulder dystocia (the fetus's shoulder lodges against the woman's pubic bone, and the baby is caught in the birth canal)
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Labor that starts too early (preterm labor)
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Prolapsed umbilical cord (the umbilical cord comes out of the birth canal before the baby)
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Nuchal cord (the umbilical cord is wrapped around the baby's neck)
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A fetus that is too large to pass through the birth canal (pelvis and vagina)—called fetopelvic disproportion
When complications develop, alternatives to spontaneous labor and vaginal delivery may be needed. They include
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Artificial starting of labor (induction of labor)
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Forceps or a vacuum extractor (called operative vaginal delivery) to deliver the baby
Some problems occur immediately after delivery of the fetus, around the time the placenta is delivered. They include
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A uterus that is turned inside out (inverted uterus)
Timing of Labor and Delivery
No more than 10% of women deliver on their specified due date (usually estimated to be about 40 weeks of pregnancy). About 50% of women deliver within 1 week (before or after), and almost 90% deliver within 2 weeks of the due date.
Labor may start
In such cases, the health or life of the fetus may be endangered.
Labor may be early or late because the woman or fetus has a medical problem or the fetus is in an abnormal position.
Determining the length of pregnancy can be difficult because the precise date of conception often cannot be determined. Early in pregnancy, an ultrasound examination, which is safe and painless, can help determine the length of pregnancy. In mid to late pregnancy, ultrasound examinations are less reliable in determining the length of pregnancy.
