Complications of Childbirth

Editor’s note: This article first appeared in Midwifery Today, Issue 128, Winter 2018.
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Complications of childbirth are frightening for moms-to-be—yet they exist. Luckily, in our present day and age, there are effective treatments for most. Learning to deal with complications—to bring moms and babies through safely—is an important part of a midwife’s learning.

Basically, human birth tends toward the normal. This can cause a misperception for childbirth attendants. For instance, you may have attended 50 births and all were normal. Fifty healthy mothers and babies. There is a human tendency to feel that your presence and your manner of helping brought about 50 normal births. Don’t be fooled. Again, most births are normal. But complications of childbearing can and will occur. Be prepared.

After developing a trusting relationship with the mothers who come to you, discuss potential problems. It is helpful to mention that there are treatments for each complication and, for most, they are highly effective. High blood pressure, prolonged labor, breech position, other unusual positions and presentations, fetal distress, prolonged second stage, shoulder dystocia, hypoxia in baby and resuscitation, hemorrhage … these are among the problems to review.

Discuss them briefly and answer all questions. Tell how you would help her in each case and what your usual approach might be. Stick to the basics. Offer more detail as appropriate. Reaffirm that birth is a natural process and that you want her to understand how one might deal with various problems. Ask for her input and preferences.

Be honest about hospital transport if a home- or birth center birth is planned. Our hospitals are not perfect and some are better than others, but they provide lifesaving services when problems occur. Let her know your thinking and practices.

I would rather midwife home or birth center clients who see hospital transport as a sensible decision in certain circumstances, not as a tragedy or personal failure.

Sometimes a discussion of complications will affect choices for practitioner and/or place of delivery.

Once I met with a woman and her partner in the early second trimester. They were new to the town where I lived and practiced. They questioned me about whether I would ever transport a woman in labor to the hospital and, if so, why. I briefly reviewed what I saw as critical reasons for hospital transport and reasons for which transport might be a wise choice, but not always necessary.

“I would never go to the hospital for any reason.  If I had to go to the hospital to save my life I would choose to just die instead,” the father spoke very firmly.

I thought about this a minute, looking toward the woman to see how she was reacting. She remained silent, looking at the floor.

As the father looked at me challengingly, I said, “Well, I cannot agree with that.  If I am your midwife and there is a hemorrhage I can’t get under control, I am not willing to let a woman die if she could be saved in the hospital. Luckily there are many midwives in this area who you can meet with for further discussion.”

We talked a little more and I suggested that the two of them discuss this and make some mutual decisions. I gave them midwife contact numbers, offered to help them in any way I could, and they left.

Several weeks later I saw the mother while out shopping. She was about 28 weeks. I greeted her and asked how she was doing and which local midwife they had chosen to help them with their birth.

“Well,” she replied, “I’m fine. But we aren’t having our baby here.” With a pause, she looked at me steadily and then continued. “I’m going home to Wisconsin. My parents and the rest of my family are there and will give me the help I need. My partner and I aren’t together anymore.”

We talked about her baby and her family a little. I was happy to see her and felt she was making a good decision. I was curious and would have liked to hear more, but there in the grocery store was not the time or place. I asked her if she wanted to have a visit before she left, but she was leaving in a couple of days. She reassured me that she and the baby were, and would be, fine.

I never saw this woman again, but I have thought of her many times.  Perhaps our discussion made her realize that she didn’t want to be with a man who would not support her in a potential hospital transport that might be life-saving for her or her baby, or both.

I have been told that “if you think something will happen, it will” and that you should not talk about complications of pregnancy. I do not believe this is the case. I had a long career as an out-of-hospital birth midwife and discussed complications and problems openly with my clients, while maintaining a transport rate of about 6%. I treated most hemorrhages without injections or IV and never had a mother refuse those treatments if she needed them.

Open discussion helps a pregnant mom sleep better. Reviewing complications and their treatment defuses the anxiety around possible problems and leads to a healthier and more relaxed pregnancy and childbirth.

About Author: Marion Toepke McLean

Marion Toepke McLean, CNM, attended her first birth as primary midwife in August 1971. She received her nursing degree from Pacific Lutheran University in 1966 and her midwifery and family nurse practitioner degree from Frontier Nursing Service in 1974. From 1976 through 2001 she did home, clinic and hospital births, while also working as a family nurse practitioner. In 1980 she taught a year-long program for local midwives, returning to Frontier Nursing Service to teach during the summer. She had a homebirth practice until 1985, when she went to work at the Nurse-Midwifery Birthing Service, a freestanding birth center. In June 2000 she completed a BA in International Studies at the University of Oregon, with concentrated studies on Mexico. Since 2002 she has worked in a reproductive health clinic and attended an occasional homebirth. She lives in Eugene, Oregon, and is a contributing editor to Midwifery Today.

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