As midwives, our role extends beyond providing support and care during a healthy pregnancy and birth. While many births progress smoothly, complications can arise unexpectedly, and it’s essential to be prepared to manage these situations effectively. Handling birth complications requires a combination of clinical knowledge, quick decision-making, and emotional resilience. This guide offers practical advice and resources to help midwives navigate birth complications with confidence and skill. In this post, we will explore common birth complications, how to recognize them, and the steps midwives can take to ensure the safety and well-being of both mother and baby.
1. Understanding Common Birth Complications
Midwives need to be prepared to identify and respond to complications that may arise during pregnancy, labor, or delivery. Some of the most common complications include:
a. Hemorrhage (Postpartum Hemorrhage)
One of the most critical complications that midwives must be prepared for is postpartum hemorrhage (PPH), which is excessive bleeding after childbirth. PPH can occur within the first 24 hours after delivery, but it may also present later.
- Signs to Watch For: Sudden, heavy bleeding, clots larger than a fist, and a drop in blood pressure.
- How to Manage:
- Initial Steps: Apply fundal massage, ensure the bladder is empty, and help the uterus contract.
- Medical Interventions: If the bleeding persists, medications such as oxytocin, misoprostol, or methylergonovine may be used to promote uterine contractions. Manual removal of retained placenta may also be necessary.
- Prepare for Transport: If bleeding cannot be controlled, transfer to a hospital setting for further intervention, including surgery or blood transfusion.
b. Shoulder Dystocia
Shoulder dystocia occurs when the baby’s shoulders become stuck during delivery, preventing the baby from being born. It is an emergency situation that requires immediate action to prevent injury to both mother and baby.
- Signs to Watch For: Difficulty delivering the shoulders despite the head emerging, or the “turtle sign” where the baby’s head emerges and then retracts back toward the perineum.
- How to Manage:
- McRoberts Maneuver: Instruct the mother to flex her knees toward her chest to open the pelvic outlet.
- Suprapubic Pressure: Apply gentle pressure above the pubic bone to help release the shoulder.
- Delivery of the Posterior Arm: If necessary, try to deliver the baby’s arm to make space for the shoulders to pass.
- Prepare for Transport: If the baby does not emerge quickly, immediate transport to a hospital is required for advanced interventions, such as the Zavanelli maneuver or symphysiotomy.
c. Breech Birth
Breech presentation refers to a baby being positioned feet or buttocks-first instead of head-first. While breech births are considered high-risk, they can be managed with the right skills and protocols.
- Signs to Watch For: The baby’s feet or bottom is palpable during abdominal palpation or confirmed via ultrasound.
- How to Manage:
- External Cephalic Version (ECV): If the baby is still in a breech position at 36-37 weeks, a version procedure may be performed to turn the baby head-down. If successful, vaginal delivery may be planned.
- Vaginal Breech Delivery: In some cases, vaginal breech delivery is possible. A skilled midwife should be present to manage the birth safely.
- Transport to Hospital: If a breech birth is anticipated and the midwife is not experienced in breech delivery, transfer to a hospital with a skilled obstetrics team is the safest option.
d. Prolapsed Umbilical Cord
When the umbilical cord slips ahead of the baby during labor, it can be compressed, cutting off the baby’s oxygen supply. This is a medical emergency that requires prompt action.
- Signs to Watch For: Visible or palpable cord with or without decelerations in the fetal heart rate.
- How to Manage:
- Relieve Cord Compression: Gently push the baby’s head off the cord to relieve pressure and encourage oxygen flow.
- Positioning: Have the mother assume a knee-chest position or Trendelenburg position to relieve pressure on the cord.
- Immediate Transport: Transfer to the hospital immediately for an emergency delivery, which may involve cesarean section.
e. Eclampsia and Severe Pre-eclampsia
Pre-eclampsia is a pregnancy complication characterized by high blood pressure, while eclampsia involves seizures caused by high blood pressure.
- Signs to Watch For: Elevated blood pressure, protein in the urine, severe headaches, vision changes, swelling, and seizures.
- How to Manage:
- Prevent Seizures: Magnesium sulfate is the medication of choice for preventing and treating eclamptic seizures.
- Monitor Blood Pressure: Keep a close watch on blood pressure and monitor for signs of worsening pre-eclampsia.
- Prepare for Transport: If pre-eclampsia or eclampsia is suspected or confirmed, transfer to a hospital for further management, including medication and possible early delivery.
2. Training and Preparedness
Handling birth complications requires more than theoretical knowledge; it’s about developing the skills to act swiftly and confidently in an emergency. Continuing education and hands-on training are essential components for managing birth complications effectively.
a. Ongoing Education
Midwives should engage in regular continuing education to stay up-to-date with the latest guidelines and practices for handling complications. This may include workshops, certification courses, or attending conferences focused on obstetric emergencies.
- Example: The American College of Nurse Midwives (ACNM) offers courses and webinars on handling birth complications, including topics like hemorrhage, shoulder dystocia, and eclampsia.
b. Simulation and Drills
Participating in simulation-based training can help midwives gain practical experience in managing emergencies. Many hospitals and midwifery schools offer simulation drills where midwives can practice handling various complications in a controlled, low-risk environment.
- Example: Some midwifery programs offer Advanced Life Support in Obstetrics (ALSO) courses, which simulate real-life emergency scenarios, allowing midwives to practice decision-making and skills in a hands-on way.
3. Effective Communication and Support
Birth complications can be stressful, and maintaining clear, calm communication with the birthing team, the family, and the mother is essential. This is especially true during emergencies when quick decisions are necessary.
- With the Birthing Team: Midwives should have a collaborative relationship with obstetricians, nurses, and other healthcare providers. Knowing when to call for backup or transfer to a hospital is critical for managing complications effectively.
- With the Family: It’s equally important to communicate with the birthing family. Reassuring the mother, explaining what is happening, and involving her in decision-making, when possible, can reduce anxiety and provide emotional support.
4. Documentation and Legal Considerations
Documenting all steps taken during a birth, especially when complications arise, is essential for legal and medical purposes. Clear, accurate records of assessments, interventions, and outcomes are vital in case of any review or legal inquiry.
- Example: Always document your assessment of the situation, the interventions performed, medications administered, and the time of each event. Keep detailed records of communication with the family and healthcare team, as well as any transfers made.
5. Preparation and Readiness
The key to handling birth complications effectively is preparation. As a midwife, always ensure that you have the necessary tools and supplies on hand to manage emergencies. Regularly check your emergency kit, ensure your equipment is functioning correctly, and familiarize yourself with the hospital transfer protocol.
6. Conclusion: Managing Birth Complications with Confidence
Handling birth complications can be one of the most challenging yet rewarding aspects of being a midwife. It requires a combination of knowledge, experience, and the ability to stay calm under pressure. Through continued education, hands-on practice, and a strong support system, midwives can develop the skills necessary to manage even the most complex situations.
By being proactive, well-prepared, and staying up-to-date with the latest research and guidelines, midwives can ensure the safety and well-being of both mother and baby during emergencies, making a meaningful difference in maternal and infant health outcomes.
Key Takeaways:
- Know the common birth complications and their signs.
- Practice emergency drills and simulations to build skills.
- Engage in ongoing education to stay updated on best practices.
- Maintain effective communication with the birth team and family.
- Document all interventions and communicate clearly with legal and medical teams.
With these tools and strategies, midwives can handle birth complications with confidence and provide the best possible care to their patients.
