A large number of women are usually thrilled when they realize they are carrying the miracle of life. Feeling that baby move, the bump expand, and seeing the baby on an ultrasound are just pure joy. Women can push through nausea, fatigue, aches, and other unpleasant symptoms with the thought of giving birth in mind.
When there are no signs of complications, such women look forward to the due date when she can expel the baby and have her bundle of joy.
The day of delivery not only brings that thought to a reality, but just as all pregnancies do not go as smooth as we expect them to, the same way not all deliveries go the way we think they would go. Labor and delivery are totally different from what is displayed on TV shows where the water breaks then the whole exclamation of “the baby's coming” with the cool look remaining on the face of the actress and all that.
This could happen for some women, but definitely not most. Carrying a child in the body alone carries a lot of risks; add that to the risk of delivery and one would realize that the whole idea of pregnancy is risky.
Death could occur at any time, from during the pregnancy to labor and postpartum. The occurrence of death at any time is usually a devastating experience to the family involved. Sadly, it can never be ruled out, but adequate medical care during pregnancy, labor and after reduces the possibility of its occurrence. Still, thousands of women and babies die every year both in developed and undeveloped countries.
We will be looking at various factors that can lead to the death of the mother and/or baby during labor. These factors could come from issues before pregnancy, during pregnancy, or situations that come up as a result of complications during labor.
15 Preterm Labor
This is one of the greatest dangers a baby could face because this would mean that all vital organs will not be matured enough to handle the world outside the uterus. A normal pregnancy lasts around 40 weeks, but if the woman starts experiencing contractions that lead to delivery before the 37th week, it becomes premature or preterm labor.
This happens when either what is known as Preterm Premature Rupture of Membranes, which is when the water breaks far too early, or if the cervix expands/opens without contractions weeks before delivery is due.
The risk of this occurring is increased in smokers, those that are overweight or underweight during pregnancy, lack of adequate or any prenatal care, intake of alcohol during pregnancy, health conditions such as preeclampsia, high blood pressure, a baby with certain defects, a pregnancy achieved through in-vitro fertilization, multiple pregnancy, lack of adequate spacing between the previous baby and the current pregnancy, as well as family history with preterm labor.
It could be fatal to the baby mostly if it occurs too early, such babies can develop breathing problems, brain hemorrhage, and nervous system disorders, as well as other organs like the digestive tract being affected. Such babies have a strong tendency to have infections. The death of the baby during or a few hours shortly after labor is mostly present to there being no adequate medical facility to handle premature babies.
14 Placenta Previa
This is a high cause of death during labor. Placenta previa occurs when the placenta attaches itself to the lower area of uterus. There is also the case of placenta accreta; a condition that emerges due to a presence of placenta previa.
The possibility that this will happen is increased if cesarean sections have been carried out in the past; the more CS, the higher the risk. It can also occur if the age of the mother is advanced and if the mother is a smoker or takes hard drugs. Previous induced abortions can also lead to this condition.
The occurrence of this can lead to death, mostly if there are attempts to extract the placenta manually as this would lead to massive hemorrhage that most times would require hysterectomy. Hysterectomy can only follow in severe cases if the physician is wise enough to handle it. In some cases, women die due to the loss of blood before any attempts at removing the uterus is made.
13 Intrauterine Asphyxia
Labor increases restricted flow of oxygen to the fetus; uterine contractions during labor lead to a lower blood flow from the placenta to the child. This leads to hypoxemia (low oxygen level in the fetus) and hypercapnia (high carbon dioxide in the fetus).
Although fetuses possess adaptive measures to this such as reducing oxygen consumption, decrease in heart rate, as well as switching to more anaerobic form of cellular activity, the duration of the asphyxia, as well as intensity of uterine contractions can harm the fetus fatally.
To prevent this from happening, the baby’s heart rate is usually monitored in standard hospitals. In the case of an emergency, a cesarean section is carried out. But due to the expectation of reduced fetal heart rate during labor, it may go unnoticed.
Also in cases where there is a lack of adequate medical facilities that can detect and monitor the heart rate of fetus, this would go unnoticed, and when it is not responded to quickly, it will result in death of the fetus.
12 Placental Abruption
This occurs when a part of the placenta detaches itself from the uterus prematurely. In the placenta, there are millions of blood vessels to create a channel through which the fetus gains nutrient and oxygen from the mother. With the separation of the placenta, the blood vessels are broken and they will result in bleeding, the larger the area that is separated, the more hemorrhage it would cause.
The cause of this is not exactly known but it occurs in about 1 percent of 100 births.
Though the main cause is not known, speculations have been made that in the case of accident that caused trauma to the uterus, such could lead to abruption. The risk is also increased with multiple pregnancies, high blood pressure, and sickle cell anemia. Apart from the severe hemorrhage that would ensue, it can also lead to shock and brain damage.
When this happens and it is not managed adequately during labor, it could lead to loss of the life of the mother and child. The mother due to loss of blood and the infant from lack of oxygen and nutrients.
11 Other Placental Conditions
Having discussed placenta previa and accreta, it is also important to talk about placenta increta and placenta percreta. These two are classified in the same class as placenta accreta but differs due to the depth of attachment. Placenta increta occurs when the placenta attaches itself deeply into the wall of the uterus, i.e. into the muscle wall of the uterus than what is present in the placenta accreta.
Placenta percreta can be described as the worst among the three. Here, not only does the placenta attach itself to the wall of the uterus, it also grows through it to nearby organs surrounding the uterus. It is extremely dangerous.
These issues can be managed with timely adequate medical attention, the most common result of these is hemorrhage. It should also be noted for physicians that have not dealt with such issues before to not continuously try to detach the placenta manually. The most popular sign of this is bleeding in the third trimester.
In some cases, a hysterectomy is performed immediately after delivery. If this condition is not adequately managed during delivery, the woman could die.
10 Uterine Rupture
Though a rare condition, it is a very serious one. It is a life-threatening complication to both the mother and/or child. It is mostly due to a previous cesarean operation and other uterine scars, as well as excessive pushing during labor. Other causes are some medications like Pitocin when not properly administered.
A woman with weak uterine muscles also has high chances of experiencing this during labor. The major symptoms are extremely sharper pains than those associated with usual labor contractions, slowing down of contractions, recession of the baby's head back up the birth canal and also the movement of the head of the fetus out of the uterus to be on the pubic bone.
It could lead to fetal distress and hemorrhage and if not properly managed and quickly responded to, the placenta, as well as the child can be pushed out of the uterus into the abdominal cavity. This would result in severe hemorrhage, neurological disorders for the baby and in severe cases, death for both mother and child.
This is a unique pregnancy disorder and is diagnosed when the mother has continuous high blood pressure and a condition known as proteinuria, which is the presence of protein in the urine. It is responsible for the death of over 70,000 mothers yearly worldwide. Its presence is usually silent because the symptoms tend to look like normal pregnancy symptoms like weight gain and nausea.
The risk of its occurrence is increased with the presence of diabetes, sickle cell anemia, obesity and family/personal history of preeclampsia.
It is so serious that if it does not cause death in severe cases, it could lead to one or more of the following: stroke, kidney and liver damage, fluid in the lungs and seizures. It is also a cause of premature birth. When preeclampsia becomes extremely severe, it leads to eclampsia, which causes coma and brain damage as well as the death of mother and/or baby.
Most babies who survive this are prone to blindness, epilepsy, learning disabilities and other serious life problems.
8 Cardiovascular Disease And Cardiac Arrest
A lot of changes happen to the cardiovascular system during pregnancy and these changes expose women to cardiovascular diseases and cardiac arrest. This is one of the most common causes of maternal death. During pregnancy, the heart rate and blood volume is increased while vascular resistance is decreased, this increases the possibility of cardiac arrest and possible death to both the mother and/or infant.
It can be due to blood infection, heart failure, hemorrhage, preeclampsia and embolism of the amniotic fluid.
This can lead to preterm birth and death of the mother. When it leads to cardiovascular disease on the mother, it increases the chances of transmission of congenital heart disease to the child. The possibility is increased when an underlying health problem is present but not properly managed during pregnancy. For healthy women, there is a risk of heart problems, but for those women who are already suffering from such before pregnancy, the possibility of death is heightened.
7 Umbilical Cord Problems
There are various problems that could ensue if something goes wrong with the umbilical cord during labor. The umbilical cord is the lifeline through which oxygen and food are transferred to the fetus. There are various issues that can lead to the death of the infant due to the umbilical cord, they include umbilical cord prolapse, nuchal cord, cord structure and umbilical cord knots.
Umbilical cord prolapse occurs when the cord drops out from the birth canal before the baby comes out. If not immediately taken care of, the baby would be deprived of oxygen which will lead to long-term respiratory and brain disorders or even death.
A nuchal cord is an umbilical cord coiled around the neck of the fetus, if not noticed and managed properly, it will lead to heart abnormalities on the part of the child and even death. Cord stricture is one of the most common causes of fetal death. It is related more to death during pregnancy than labor.
6 Obstructed Labor
This is a condition where the baby cannot exit the pelvis due to blockage even though the uterus is having normal contractions. This would lead to lack of adequate oxygen on the part of the infant and subsequent loss of life. It can be due to a contracted pelvis, hydrocephaly, wrong positioning of the baby and incompatibility in the size of the baby in relation to the size of the pelvis of the mother.
This leads to asphyxia in the infant because there are continuous contractions that result in reduced flow of blood from the placenta. At the end, the mother--if she does not die in the course of labor--ends up giving birth to an injured and deformed dead child. When noticed in time, cesarean section is usually the solution, but if it is not perceived by the physician, both mother and child could lose their life.
5 Intrauterine Growth Restriction
This is a condition where the fetus does not grow to its normal determined genetically standard size. It could be caused by chronic hypertension, uncontrolled diabetes, autoimmune disease, as well as uterine malformations in the mother. It can also be caused by placenta previa and other placental abnormalities and the possibility is increased in double pregnancies when the fetuses share one placenta.
The presence of this condition increases the possibility of death and if this does not occur, internal hemorrhage and respiratory problems can be present in the infant.
Fetuses that have this condition are usually less able to handle the stress of labor occurring to the uterus and themselves than fetuses that are normal in size. It is the second leading cause of death in infants during labor and those that survive would have to live with weak muscle tone and poor circulation. A good number of them die a few weeks after birth.
4 Pregnancy Related Sepsis
It is referred to as blood poisoning and can lead to cancer, stroke, and loss of life. Though stated to be worse in developing countries, the presence of sepsis in pregnancy cannot be denied in developed countries; it is responsible for more than 7 percent of maternal deaths in the United States and is one of the leading causes of maternal death in the UK.
It is not only caused as a result of pregnancy-related infection; it can also be caused by underlying health problems such as pneumonia. They could occur if there is obstructed labor, ruptured membrane, cesarean operation, and infections.
When the bacteria has spread around the blood stream, it leads to septic shock that can affect the uterine wall or baby. It can cause terrible damage to vital organs and if it has been present for too long before delivery, would lead to loss of life. Due to its ability to cause spontaneous abortions and preterm birth, the baby is at risk during delivery mostly if the child is not yet properly developed.
3 Embolism (Amniotic Fluid And Pulmonary)
These are two separate conditions that are life threatening. Pulmonary embolism is caused when there is a sudden blockage of a blood vessel in the lungs by a large blood clot. This blood clot is usually formed in the leg (deep vein thrombosis) and travels to the lungs to block an artery leading to obstruction of blood flow to the lungs.
The possibility that this will happen is increased when the woman has cancer, is overweight or has heart disease.
The risk is higher during pregnancy and in cases of late pregnancies even worse. It is one of the most common causes of maternal death in the world. This is furthered worsened when there is an amniotic fluid embolism. AFE occurs when the amniotic fluid, fetal skin and/or other cells travels into the bloodstream of the woman and triggers an allergic reaction.
It can trigger and quicken the process of pulmonary embolism in some cases. AFE can lead to the sudden collapse of women during labor and most often than not results in death.
2 HELLP Syndrome
This can be as a result of preeclampsia, but can also occur on its own. It is a series of various issues to form a syndrome, they are hemolysis (which is the breakdown of red blood cells), elevated liver enzymes and low platelets count. The symptoms range from severe headaches to nausea, to abdominal pain to pain when breathing, etc.
In most cases, it occurs within 48 hours before and after delivery or more; the more the length of time between when it began and delivery, the worse it would get.
If it goes undiagnosed before labor, it would lead to placental abruption, lung failure on the part of the mother and the infant, hemorrhage, acute renal failure and fluid on the lungs. The mortality rate during labor is higher in infants with up to a 60 percent possibility while mothers have a 1.1 percent.
The risk is higher in diabetic patients, Caucasian women, women over the age of 30, obese women and those who are suffering from malnutrition. Once a woman has HELLP syndrome, her chances of having it in her next pregnancy increases and with lack of adequate care, chances of survival are drastically reduced.
1 Obstetrical Hemorrhage
This is heavy bleeding during labor or postpartum, it also refers to heaving bleeding during pregnancy. Most cases occur after delivery. It can be caused by various reasons like retaining of placenta, placenta abruption, coagulopathy (impairment in the ability of blood to clot), previa accreta, laceration, and rupture.
During labor, hemorrhage can occur. As previously mentioned, it can be due to placenta previa, placenta accreta, percreta and increta, and uterine rupture. There is also the issue of vasa previa, which is very rare in terms of occurrence. It is a complication wherein blood vessels of the fetus cross, or are too close to the interior narrowing of the uterus.
These blood vessels would rupture when the supporting membranes around it rupture because they are fragile due to not being supported by the umbilical cord or placenta. This condition occurs more in in-vitro fertilization pregnancies. This is a very serious condition for the baby and if the bleeding is not traced to the fetus on time, fetal death is bound to occur.