What could go wrong in the labour ward?

We have heard people sweep floors with their hands, throw off one cloth at a time or those that under go C-sections. Most people I’ve heard sharing these stories have walked out of the labour ward with their babies as if all was well. Some, even those who lose the child had no knowledge of what went wrong.

Dr Mike Kagawa, a gynaecologist with Mulago Hospital, says so many things can go wrong during labour and in the worst case scenario, there are there possibilities. “We might lose the baby or the mother or both,” he says. “Labour is a dynamic process and when a mother comes in, she and the baby are both monitored,” he explains.

The mother
The doctors monitor the nature of the contractions. The normal contractions are supposed to increase steadily, neither too much nor too low, consistently. “Contractions are related to the dilated cervix (goes until 10cm) and the descent of the baby, and if none or just one or two is happening, then there is a problem.” The mother, he explains, is checked to ensure that she is neither hungry nor dehydrated and her body temperature is normal at 37 degrees celcius. “The temperature can however go low especially when the mother loses a lot of blood.” Excessive bleeding is commonly associated with the placenta being in the wrong place.

“It is supposed to come distal to the baby and after the legs,” Dr Kagawa emphasises. In other cases, the placenta might detach before the baby is born, this too causes profuse bleeding. Tears and or other local causes in the birth canal might also contribute to this so doctors look out for all these. On the other hand, when the mother is dehydrated, this means that the baby is not getting enough oxygen. Hunger and dehydration put the child in distress, a condition called foetal-distress. “The baby could die in the womb when distressed; it is like being suffocated in a room.” He maintains that there could be just a little as opposed to a lot of bleeding.

The blood pressure might also rise in labour but even if it does, it has to stay within the normal ranges (100-120/60-80mmHg). Monitoring of mother and child is done concurrently and for the baby, it is necessary to see that it is alive all through the process. “The baby’s heart beat is constantly checked using a fetoscope placed on the mother’s tummy intermittently,” Dr Kagawa notes. The rate normally ranges from 120 to 160 beats per minute. It might be too fast or too slow and if so, the doctor has to find out. When the baby is distressed, the heart rate is affected. The water around the baby has to be clear and its amount is also checked. Babies in distress, the doctor explains, pass stool which alters the clarity of the water. If this is so, the water passed out by the mother is green.

The doctor says it is otherwise normal for babies to take in water and problems only arise if they take in that contaminated by stool. The descent of the baby through the birth canal is also assessed and here, either the mother’s abdomen or the canal is checked to monitor movement because first, it is important to find out if the baby is moving at all. “Through the canal, we can see if the membrane/bag is still there, and if the cervix is opening,” Dr Kagawa says, adding, “We feel for the cord within the membrane. Normally, it should not be there.”

Then the doctors feel for the baby’s body structure if and when the waters break. The baby normally descends back of the head first. If the positioning of the baby is altered, problems are bound to arise as the doctor further explains. “During birth, the baby’s head is squeezed between the mother’s bones which shape and mold it in order to pass through the canal,” he says. “The shaping should be acceptable and within normal limits.”

Problems with this are caused by the mother’s bones being too narrow or when the baby comes out with the wrong part. It is imperative therefore that the doctor finds out the cause of whatever is going wrong. “We normally say the sun should set twice when a mother’s still in labour,” Dr Kagawa concludes.