Complications in Pregnancy and Delivery, a Nurses Perspective

The Privilege to Participate in the Birth of a Child

While working in a place usually filled with wonder and joy there are times things do go very wrong in the Labor and Delivery Unit of the hospital. I had the awesome opportunity to observe the miracle of birth but with that came the pain of things going terribly wrong as we live in a fallen world and not every birth is perfect. It is a joy and privilege to participate in such a special time of a family's life. I will share some of the emergencies I saw along the way.

Source

Pregnancy

A healthy Pregnancy increases chances of a healthy baby.
A healthy Pregnancy increases chances of a healthy baby. | Source

In the Labor and Delivery Unit and Mother/Baby Unit

I was a labor and delivery nurse for many years and later worked with new moms in the mother/baby unit. During that time I was able to see all kinds of deliveries and new moms and infants. My experiences were usually very happy and gratifying although we did have some emergency and tragic situations.

It is the joyous moments I saw the most and choose to remember but some of the sad ones are difficult to put behind you.

I will never forget the day a young mom was up walking the halls. She was suffering from preeclampsia, a condition causing hypertension and often leading to increased intracranial pressure. Suddenly she collapsed. Not from exhaustion but from a major seizure. This happens when the condition changes from preeclampsia to eclampsia. She died only moments later. How difficult it must have been for that young father to take home his infant and not his wife. It wasn't supposed to happen this way but sometimes it does as nature takes its course.

Another mother was delivering her third infant in our low risk unit when something went terribly wrong. The baby was very large and her labor was slow to progress. A common practice today is to use a pitocin drip. A very safe way to speed up labor but the mom and baby need to be monitored constantly. After several hours she did deliver a beautiful baby girl. Normally the uterus contracts after delivery, once to deliver the placenta and then again to keep the uterus from bleeding where the placenta was attached. Usually the physician will order medication to be added to her IV to help the uterus to clamp down. Gentle massage also helps as does breast feeding, another one of nature's miracles. For an unknown reason this mom would not stop bleeding. You may have heard the term "bleeding out" on medical shows. They are talking about something similar. The blood volume is being depleted so fast that the body can't keep up. At this time IV fluid is increased and blood is given.

In the worst case scenario the doctor will have to go back and do emergency surgery to find the source of the bleeding. The mom is packed with gauze and the mother is taken to surgery. This mom had to be transferred to another hospital with more advanced equipment. Usually an emergency hysterectomy is performed. This particular woman's blood volume dropped to fatal levels and she later sadly died from hemorrhage.

Another cause of a high risk pregnancy that often leads to a C-section is when an infant is presenting in a breech position or feet first. The problem in allowing a mother to deliver a baby in this presentation vaginally is that it is possible the infant's head is too large to pass through the birth canal.

Often when monitoring labor either the nurse or doctor will notice the infant having late decelerations,( baby's heart rate not recovering as quickly as it should), bradycardia, (too slow a heart rate or tachycardia, ( too fast of the baby's heart rate). At this time the mother is often given oxygen and turned on her left side to take pressure off the baby. Sometimes the mom is put in trendelenburg position ( head of the bed is lowered ) to take pressure off a possible prolapsed cord. The moms uterus might be stimulated and the baby's head might be massaged vaginally. Pitocin might be immediately started and mom may be given a bolus of lactated ringers. The mother and baby are then monitored for several minutes and decision will be made whether to do and emergency C-section

A stillbirth maybe one of the hardest things to assist with.Depending on how far the pregnancy has progressed the mother may still have to go through labor and delivery as if her child was alive.. She may even have an episiotomy. Sometimes an infant is alive but too young to survive If the parents do not want the infant with them an RN must stay at his bedside until he breathes his last breath. I did experience this several times and I remember a quiet and almost holiness to the delivery room as I stood by praying and watching the tiny infant struggling to breath.

If the mother is not far along and the baby dies she will probably have a D&C.




Ways to Reduce the Risk of Preterm Labor

Another sign of a problem is preterm labor which can be stopped at home. Some helpful tips to prevent this include but are not inclusive of

  • Do no't overdo
  • Drink plenty of water to stay hydrated.
  • Try to eat a healthy diet and include fiber.
  • Ask your doctor about adding things like Benefiber or dulcolax to your diet to prevent
  • constipation. Even magnesium can help if allowed by your physician.
  • Keep you stress level down
  • You can usually keep up your regular exercise routine that you were doing prior to pregnancy
  • A nice short walk in your last few weeks is great.
  • Don't get overheated.
  • Be sure to be taking your prenatal vitamin with extra folic acid for the baby's health.
  • Don't eat too late at night.If you are having trouble sleeping. This can cause indigestion with the infant pushing on your organs.
  • Try to slow down your routine if you are feeling overwhelmed
  • If you are having trouble sleeping try turning off all your electrical devices like iphone and television and maybe take a warm bath or shower.
  • Eat a light high protein snack like cheese and crackers with milk or a small bowl of cereal before bed.Dark Chocolate Almond milk has the benefit of added calcium if the caffeine from the chocolate does not bother you.
  • Read for a few minutes to help you get sleepy.



Signs of preterm labor

Signs of preterm labor can include

  • bloody show a clear bloody stained discharge usually seen a week to two before delivery.
  • Cramping more than (Braxton Hicks' (normal pre labor contractions that prepare the cervix for delivery)are often seen at end of 3rd trimester and usually normal unless they do not stop with rest or last for extended periods and you can't talk during them,These contractions usually start around the 6th week of pregnancy although are not felt that early. They prepare the uterus and cervix for labor.
  • Rupture of your membranes or your water beaks
  • Low back pain that does not let up
  • The baby slows down movement considerably
  • Braxton hicks contractions will often stop if you change your activity. Walk if your were laying down. Lay down and rest if you were up and active. If they become harder and closer together call your doctor or midwife.

Breech Presentation

Stages of Pregnacy

Development of a Normal Infant

Click thumbnail to view full-size
 16 weeks gestation.This little one can blink and even has fingerprints. Mom may be feeling her baby's movement.This is the baby at 4 weeks gestationEight weeks gestation. You can clearly see the fetus,umbilical cord and placenta20 weeks gestation.The baby is now about 6 inches long and can yawn, suck her thumb and show facial expressions24 weeks gestation 4D ultrasound Mom can feel hiccups and the infant may be able to sense being upside down28 weeks This little one might weigh 2lbs 6oz and can survive if born now36 weeks Now at about 18.5 inches and 6 lbs the baby is developing her brain rapidly. Head is usually down now and the infant is considered term at 37 weeksBirth Now at 40 weeks this infant is full term. If mom goes to 42 weeks labor will be induced.
 16 weeks gestation.This little one can blink and even has fingerprints. Mom may be feeling her baby's movement.
16 weeks gestation.This little one can blink and even has fingerprints. Mom may be feeling her baby's movement. | Source
This is the baby at 4 weeks gestation
This is the baby at 4 weeks gestation | Source
Eight weeks gestation. You can clearly see the fetus,umbilical cord and placenta
Eight weeks gestation. You can clearly see the fetus,umbilical cord and placenta | Source
20 weeks gestation.The baby is now about 6 inches long and can yawn, suck her thumb and show facial expressions
20 weeks gestation.The baby is now about 6 inches long and can yawn, suck her thumb and show facial expressions | Source
24 weeks gestation 4D ultrasound Mom can feel hiccups and the infant may be able to sense being upside down
24 weeks gestation 4D ultrasound Mom can feel hiccups and the infant may be able to sense being upside down | Source
28 weeks This little one might weigh 2lbs 6oz and can survive if born now
28 weeks This little one might weigh 2lbs 6oz and can survive if born now | Source
36 weeks Now at about 18.5 inches and 6 lbs the baby is developing her brain rapidly. Head is usually down now and the infant is considered term at 37 weeks
36 weeks Now at about 18.5 inches and 6 lbs the baby is developing her brain rapidly. Head is usually down now and the infant is considered term at 37 weeks | Source
Birth Now at 40 weeks this infant is full term. If mom goes to 42 weeks labor will be induced.
Birth Now at 40 weeks this infant is full term. If mom goes to 42 weeks labor will be induced. | Source

Chance for low birth weight Infant

Source

Preventing Problems

Women need to go into a pregnancy knowing they are caring for two lives. It is important to start early prenatal visits and keep up with your appointments

  • Taking 400 micrograms of folic acid is very helpful for the infant
  • You need to be up to date on your immunizations
  • Maintain a good diet and try not to skip meals
  • Drink plenty of fluids and try to drink only one cup of coffee a day. Coffee can speed up the baby's heart rate.

Drinking alcohol can be very dangerous for your baby as is smoking. Alcohol can lead to Fetal Alcohol Syndrome with birth defects. especially brain and changes in the shape of cranial bones.

  • Ask your doctor about any medications you might be on
  • Get plenty of rest and some exercise as your body allows
  • A daily nap can be helpful

Don't change your cat litter box. Don't be obsessive and get rid of your cat but be cautious with feces to prevent toxoplasmosis

This is a very exciting time. Take lots of pictures, maybe journal and enjoy!!!!

Age in Relation to having Down's Syndrome Infant

Different Kinds of High Risk Pregnancy


There are many forms of high risk pregnancy along with many causes:

  • Gestational Diabetes This is often caught early when mom is growing faster than expected or a urine test reveals sugar . Hypertension is another sign and she might be feeling extra thirsty. having frequent urination, nausea, fatigue, blurred vision and even weight loss even though she is eating enough. Good prenatal care. diet and sometimes medication may need to be given. The baby is often very large and a c-section may be necessary.
  • mothers with little or no prenatal care
  • multiple births
  • very young mothers
  • older mothers
  • HIV or AIDS We now have preventive drugs to stop the baby from getting HIV from the mother
  • mothers with sexually transmitted disease
  • High blood pressure is often from preeclampsia sometimes seen in young mothers or with mothers carrying twins. Protein will be found in her urine. This can lead to death of the mother, baby or both. Eclampsia is more dangerous and presents with seizures and coma. Preeclampsia is treatable and with corrective diet and bed rest the pregnancy can progress normally. It is a possible sign that the placenta is beginning to separate from the uterus. If not liver enzymes can rise to dangerous levels and cause damage to the mother's kidney, liver and brain. If the condition can't be slowed delivery will be induced or a c-section will be performed.
  • Over weight or underweight moms
  • Pre-term labor. This is often classified as labor prior to 37 weeks and the infant can often live out side the woman's body with a very controlled environment. In my early days as and RN the doctor used IV alcohol to stop labor. One afternoon a young mother of twins, with a bit too much alcohol lost her lunch all over me.
  • Today we know better and have some great medications to stop labor.such as magnesium sulfate or calcium channel blockers. The baby is often given steroids to make sure his lungs are developed and prevent respiratory distress syndrome. Mom is often put on limited or strict bed rest.
  • Pre-existing medical conditions or a history of previous difficult pregnancies

Helpful Websites

Some helpful website

BabyCenter.com

How to Get Pregnant Quickly

Early signs of pregnancy

http://www.cdc.gov/ncbddd/pregnancy_gateway/default.htm


watch your babies development

Having a healthy Baby

References

National Institute of Child Health & Human Development

Pubmed Health

Ezine Mag

medicinenet.com

webmd

babycenter.com

More by this Author


Comments 7 comments

nancynurse profile image

nancynurse 22 months ago from Southeast USA Author

Thank you so much . I hope and pray all goes well for you and your sweet baby.


nancynurse profile image

nancynurse 2 years ago from Southeast USA Author

I am so sorry for your friend's loss. You are right. It does happen. Cesarean sections are up to an alarming rate with the use of pitocin and other drugs to induce labor for convenience.


Brite-Ideas profile image

Brite-Ideas 2 years ago from Toronto, Canada

Very informative, especially to read about the things that we rarely hear about or see. Mind you someone we know just experienced a full term stillbirth and the sadness is gut-wrenching. It was and still is something I can't put into words, so so so hard. I've been fortunate to have 4 healthy sons and fairly easy births (my 4th was a bit scarier, but it turned out fine)


nancynurse profile image

nancynurse 3 years ago from Southeast USA Author

I am so glad it helped . I hope your pregnancy went well.


nancynurse profile image

nancynurse 4 years ago from Southeast USA Author

Thank you so glad it helped you.


nancynurse profile image

nancynurse 4 years ago from Southeast USA Author

I am so glad you found it helpful. I hope you have a safe and happy delivery and wonderful life with your new little one.


Lindajr06 profile image

Lindajr06 4 years ago from St. Louis, Missouri

Thank you for publishing this hub. As a mom who is currently having a high risk pregnancy, I found it very informative.

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