A lot of the posts on this site are fun, funny or outrageous, but sometimes you have to be serious. Pregnancy can come with a lot of complications all on its own, but having additional conditions during this delicate time of life can make for even more serious complications.
Unlike some people, I’m relatively laid back about my birth plan. As long as I have the epidural in a timely manner and don’t get sent home, I’m cool. Others, however, have more particular plans and ideas of how their labor should progress. I’m not saying the others are wrong; I’m just more type B. Some conditions that arise during pregnancy are fairly easily manageable, but some will actually affect your birth plan.
Many moms-to-be have had a birth plan in their minds for years before even trying to get pregnant. So it can be quite devastating when something, usually beyond mom's control, interferes with that plan. However, even with mom's first pre-natal check up, it's made pretty clear that a birth plan needs to flexible and allow for some last minute changes.
Sometimes, it's made evident throughout the pregnancy if something will have to be modified in the birth plan. From the relatively manageable positive Group B Strep result to placental abruption and hemorrhage, these are conditions that could affect your delivery.
12 "The Swab"
Group B Streptococcus is a relatively common bacteria found in the genitourinary tract of many women. It doesn’t mean that you’re unclean as there are hundreds of different types of bacteria found in a healthy vagina - in fact, if there aren’t enough bacteria it will open up the space needed for yeast to thrive and we all know (well, most of us know) how much a yeast infection sucks! (Aside: this is why yeast infections often occur after antibiotic use.)
During your third trimester your doctor will test you for Group B Strep. If you’ve been pregnant before, you know about “The Swab.” If this is your first pregnancy, don’t worry. You’ll find out. A positive result isn’t a huge deal, but it will make some aspects of labor different for you than for a woman with a negative result. The major difference is that your doctor will treat you with IV antibiotics during labor. Penicillin is the most common antibiotic used and will protect the baby from an infection with Group B Strep.
Another difference is that if your water breaks, your doctor may want you to come right in to the hospital as opposed to laboring at home so you can receive the antibiotics sooner. Once your water breaks, the baby is more open to infection. Group B Strep can cause meningitis in newborns which is mortally serious, causing at best a NICU stay and at worst-death.
11 Infected Amniotic Sac
Chorioamnionitis, or an infection of the chorion and amnion, the inner and outer membranes that make up the amniotic sac, can cause anything from premature labor to sepsis of the newborn and/or mother. It is caused by bacteria from the vagina entering the uterus. The risk of infection increases with each vaginal exam during the final month of pregnancy, including during labor.
The main initial sign is a mother presenting with a fever of over 100.4 degrees Fahrenheit. The healthcare staff must rule out other types of infection, but will treat with antibiotics. Other signs that chorioamnionitis might be an issue include fetal tachycardia (over 160 beats per minute), maternal tachycardia (over 100 beats per minute), uterine tenderness and a foul smelling odor of the amniotic fluid.
Due to fetal distress, an emergency Cesarean is a possibility. After birth the newborn will be treated with antibiotics, possibly placed in the NICU and watched for several days for signs of infection. Blood cultures will be drawn periodically to rule out sepsis. The mother will continue a course of antibiotics as well. Chorioamnionitis can be serious, but, as was the case with my sister’s son’s birth, the prognosis is good and no one will have lasting difficulties.
10 Recipe For Disaster
From peeing in a cup to check for protein to getting your arm squished while they check your blood pressure at Every. Single. Appointment. – you should be well versed in the screening tests for preeclampsia by your ninth month of pregnancy. Preeclampsia is a potentially serious and life threatening condition that occurs in about 5% of pregnancies in the United States. The complication causes high blood pressure due to vessel restriction and organ damage due to reduced blood flow. This can cause tiny vessels to leak, resulting in swelling. When this happens in the kidneys it causes small amounts of protein from the blood to leak into the urine, becoming detectable by urinalysis. It can cause serious problems for you as well as your baby.
The effects that preeclampsia have on your baby come from too little blood reaching the uterus due to the vessel restriction. This can cause poor growth, too little amniotic fluid and placental abruption. If the condition is severe, the mother is sometimes forced to deliver early to save both her and her baby’s life which means the infant will be forced to deal with issues related to prematurity. Preeclampsia can be very serious which makes the screening for it during routine OB visits all the more important. So roll up those sleeves and grab a cup!
9 Insulin Dependent
The plague that is gestational diabetes, a condition many women have to deal with during pregnancy, can be more than just a nuisance. I mean, between checking your sugar up to four times a day, taking medication, possibly giving yourself insulin shots, not to mention missing out on all that cake at your own baby shower, could it suck any more? The answer is, yes. If undetected or untreated, gestational diabetes can be more than a pain in the butt.
When you’re pregnant some women’s bodies become more resistant to insulin, causing blood sugar levels to rise. High levels of glucose in your blood are harmful to you as well as your baby. Untreated gestational diabetes can cause your baby to be larger than what would be considered normal (macrosomia). This can cause problems such as getting stuck in the birth canal, which can injure nerves in the neck and shoulders or necessitate a C-section. You have a higher risk for high blood pressure and preeclampsia as well as preterm labor. The baby has a higher risk of obesity as an adult and you and your child have a higher risk of developing type 2 diabetes. In short, gestational diabetes is a serious condition affecting 5-10% of all pregnancies. It’s manageable, but you must be willing to do the work!
8 Neonatal Herpes
If you are one of the one out of five people in the United States that has herpes simplex virus 2, you might be wondering how your infection could affect your pregnancy and labor. Neonatal herpes is a serious condition which can lead to damage to the central nervous system, mental retardation or even death. A woman who acquires herpes late in her pregnancy has the highest risk of passing herpes to her newborn because she has not had time to develop antibodies to the herpes virus that would normally offer some measure of protection to the baby.
Despite the seriousness of neonatal herpes, it is actually quite rare. Twenty-five to thirty percent of all pregnant women carry genital herpes, but only 0.1% of babies are born with the infection each year. There are a few things you must consider if you are dealing with genital herpes and pregnancy. For example, as labor commences you must be aware of whether or not you have an active infection. Have your doctor look with a strong light for signs of sores or outbreak.
If you have an active infection it is safer for the baby to be delivered via cesarean. Also, don’t allow your doctor to break your water early as the amniotic sac may offer some measure of protection to your baby. Ask your doctor to refrain from using the vacuum, forceps or a fetal scalp heart monitor unless absolutely necessary as use of any of these things can cause breaks in the scalp and allow the virus ingress. For several weeks after the baby is born, watch him for signs of infection (rash, fever, loss of appetite) and contact your pediatrician if you notice any of those things.
7 Baby Isn't Getting Enough Blood
We all know how important the umbilical cord is to your baby. It delivers vital nutrients and oxygen to your growing baby. Occasionally, there are problems that occur with the umbilical cord including umbilical cord prolapse. Umbilical cord prolapse occurs when a portion of the cord exits the cervix ahead of the baby. The weight of the baby during delivery can then compress the cord and cut off the baby’s blood supply, causing decreased blood pressure and heart rate and possibly stillbirth.
There are a few causes of umbilical cord prolapse including premature delivery, delivery of more than one baby (twins, triplets, etc), an excess of amniotic fluid, breech delivery or an unusually long umbilical cord. During delivery the doctor will be monitoring the baby’s heart rate and in cases of bradycardia (less than 120 beats per minute), prolapsed cord might be suspected. The doctor can do a pelvic exam and may be able to shift the baby, but usually the baby will have to be delivered via cesarean.
6 Baby Deprived Of Oxygen
Placental abruption is a rare but serious complication that can arise during pregnancy. During a placental abruption, the placenta prematurely peels away from the uterus, either completely or partially. When this happens, the baby will be deprived of nutrients and oxygen. It can also cause hemorrhage in the mother. If left undetected or untreated, it can cause peril to both baby and mother.
Placental abruption generally occurs during the last trimester of pregnancy and is characterized by vaginal bleeding, uterine tenderness, abdominal pain, back pain and rapid contractions. The cause is often unknown, but occasionally follows a trauma such as a car accident or fall. Risk factors for placental abruption include previous placental abruption, trauma, substance abuse, high blood pressure, advanced maternal age, multiple pregnancies and blood clotting disorders. Basically, it’s very serious and if you have any of the symptoms you should seek emergency help immediately. Depending on the baby’s gestational age, placental abruption might indicate a need for immediate premature delivery or hospitalization and close observation of both baby and mother.
5 Second Trimester Loss
An incompetent, or weakened, cervix is the cause of 25% of second trimester losses. As the baby gets heavier, a woman with an incompetent cervix generally won’t be able to carry a baby to term without medical intervention. Unfortunately, an incompetent cervix is usually not diagnosed until after a late term loss has occurred. Fortunately, it is relatively rare, occurring in only 1-2% of pregnancies.
In the case of an incompetent cervix, your doctor can perform what is called a cerclage. A cerclage is small suture in the cervix to actually sew the cervix closed. The instances where a cerclage cannot be performed are increased irritation of the cervix, dilation of four or more centimeters, and rupture of the membranes. In short, incompetent cervix is a rare occurrence but it can be serious and is often missed until the worst has already happened.
4 HELLP Syndrome
HELLP syndrome is considered to be a more serious variant of preeclampsia. HELLP stands for Hemolysis of red blood cells, Elevated Liver enzymes, and Low Platelet count. It can be difficult to diagnose because occasionally high blood pressure and urine protein aren’t present. Its symptoms can mirror anything from gastroenteritis, flu, acute hepatitis or gall bladder disease. The mortality rate of HELLP has been reported as high as 25% worldwide which is why it is important for pregnant women to be aware of the symptoms.
Symptoms of HELLP include headache, nausea and vomiting after eating, abdominal or chest tenderness and right upper side pain, bleeding, changes in vision or swelling. Often the mother will need blood transfusions of red cells or platelets, but the most definitive treatment of HELLP is delivery of the baby.
3 Other Placental Problems
There are other issues with the placenta that can cause problems with the delivery of your baby. Placenta Previa is characterized by a low lying placenta that is covering, either partially or completely, the internal os (opening) of the cervix, which is problematic because it is blocking the baby’s exit. It may be diagnosed on the twenty week ultrasound, but often the placenta will “migrate” later in the second or third trimester. Often a cesarean is required.
Placenta accreta is a condition where the placenta is attached deeper into the uterine wall than is considered normal. The condition can lead to retained placenta which requires surgical intervention.
It is thought that the rise of these placental abnormalities can be attributed to the higher rate of cesareans performed today. Risk of placental abnormality increases with each C-section a woman has, in addition to advanced maternal age. The incidence of placenta accreta is approximately 1/2,500 deliveries and placenta previa is 1/200 births with 1/1,000 being major or complete covering of the os. These conditions, though serious, are relatively rare.
2 Excessive Bleeding And Tearing
There is no scarier word to a woman in labor than “hemorrhage.” It’s likely not appreciated by the doctors and nurses caring for a woman in labor either. Hemorrhage during labor can be caused by multiple things, some of which we’ve already discussed. Placenta previa and accreta as well as placental abruption can cause hemorrhage. Also, tearing of the cervix or rupture of the uterus can cause hemorrhage. Though hemophilia in women is rare, being a carrier of the hemophilia gene can cause some degree of clotting insufficiency and thus heavier bleeding than considered normal.
Treatment of hemorrhage during labor ranges from medication to manual contraction of the uterus by your doctor to possible surgical intervention. You will be monitored throughout to make sure that your blood pressure and pulse stay stable. In extreme cases, a hysterectomy may be performed but that is incredibly rare.
1 Iron Deficiency
If you are one of the 15-25% of women (myself included) who suffer from iron deficiency anemia while pregnant, don't fret. You're in good company! Along with folate deficiency anemia and B12 deficiency anemia, iron deficiency anemia is one of the most common anemias that are seen during pregnancy. The exact cause of anemia is too few red blood cells to carry oxygen to the body's tissues, and women experience anemia during pregnancy as a result of a greater expansion of plasma volume compared to the smaller increase in red cell volume. Iron, B12 and folate are vital to red blood cell function.
Symptoms of anemia include fatigue, weakness, dizziness, irregular heart beat, chest pain, paleness, cold extremities and trouble concentrating. As anemia can be serious during labor, it is important to recognize these symptoms and bring it up with your healthcare provider so you can begin treatment as soon as possible. Anemia during pregnancy is associated with preterm labor, low birth weight and maternal mortality during labor. Treatment of anemia during pregnancy can be as simple as taking vitamin supplements or increasing the amount of these vital nutrients in your diet. In some severe cases, however, the woman may have to be treated with blood transfusions. Diagnostic laboratory testing can help your caretaker decide which treatment will work best!
Sources: Baby Center, Parents, Mayo Clinic, American Pregnancy