What Is Abnormal Labor?
Abnormal labor is also called dysfunctional labor or dystocia, is a medical referring to difficult childbirth or labor. Doctors disagree on the characteristics of dystocia, so there is no proper definition for abnormal labor. Other terms used for abnormal labor include difficult labor, failure to progress, prolonged labor, obstructed labor, and cephalopelvic disproportion (CPD).
What Happens During Abnormal Labor?
There are many variations in the diagnostic criteria for abnormal labor. However, abnormal labor is an umbrella term that can consist of a number of circumstances during childbirth. Broadly, abnormal labor results in difficult, obstructed, or lengthy labor. Abnormal labor can occur in both the first stage of labor (latent and active phases) and during the second stage of labor. The conditions following fall under the term abnormal labor:
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The abnormally delayed descent of the baby during the second stage of labor.
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Abnormal delay in the dilation of the cervix during the active phase of labor.
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Shoulder dystocia (when the shoulders of the fetus get logged even after the head has been delivered).
What Are the Causes of Abnormal Labor?
The following are the causes of abnormal labor:
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Uterine Factors - Normal contractions begin at the fundus and gradually move down to the pelvis. But labor will be prolonged and difficult if the uterine contractions are short or infrequent or the activity is uncoordinated. Women who become pregnant for the first time may be more at risk of uterine dystocia because they have a high degree of uterine incoordination, making their labor longer.
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Fetal Factors - The position of the fetus (for example, transverse or breech), macrosomia (when a baby's birth weight is more than 4.5 kg), and shoulder dystocia are the factors that contribute to abnormal labor.
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Pelvic Passage Factors - A pelvis with a round brim is favorable in labor. But not all women have a round brim; some women may have an oval and long brim. If the fetal head has not been occupied in the pelvis by 37 weeks of pregnancy, it can be due to the small pelvis in women who are having their first pregnancy. Other factors that can cause trouble for the baby to pass through the pelvis are scoliosis (a medical condition that causes the spine to curve to the side, usually in an "S" or "C" shape), rickets (a rare disease that affects bone development in children, causing the bones to become weak and brittle), and kyphosis (a medical condition that causes an excessive curvature of the spine, leading to a hunchback appearance). Shoulder dystocia can occur due to a small or abnormal pelvic inlet.
What Are the Types of Abnormal Labor?
The following are different types of abnormal labor that can occur during any stage of labor:
1) Cephalopelvic Disproportionation - Even after giving Oxytocin, still, the labor is slow or stalled; it can happen because of the large size of the baby's head that can not fit through the mother's pelvis. This condition is commonly called cephalopelvic disproportion (CPD). A doctor cannot correct CPD with Oxytocin, so vaginal delivery will not be possible. As a result, cesarean delivery is done in this condition.
2) Precipitous Labor - Typically, the labor lasts about six to 18 hours. But precipitous labor progresses quickly and lasts for only three to five hours, which is referred to as rapid labor. It can occur for several reasons:
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When the baby is smaller than average.
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Previous history of precipitous labor.
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If the birth canal is flexible enough to leave the baby out of the womb.
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When the uterus contracts very strongly.
Precipitous labor can cause several risks for the mother, like heavy bleeding, cervical or vaginal tearing, and shock following birth. In this labor, the baby may be more susceptible to infection if they are born in an unsterile environment.
3) Uterine Hypercontractility - When the labor stops or halts in between the labor due to failure of uterine contraction, it is called uterine hypercontractility. Medications that are used to lessen the frequency or intensity of the contractions may sometimes cause it. This is most common in first-time mothers. Doctors treat this condition using Oxytocin to augment labor. However, the condition of both the mother and the baby is monitored before delivering Oxytocin.
4) Uterine Rupture - This is a rare condition. It is a tear in the uterus wall, usually at the site of a previous incision. It is most often in women who have had uterine surgery or had a cesarean delivery done before. An emergency cesarean delivery is required to prevent serious problems. Heavy bleeding in the mother and brain damage in the baby is the potential damage caused by uterine rupture. In some cases, a hysterectomy (removal of the uterus) is required to stop the mother’s bleeding.
5) Shoulder Dystocia - Shoulder dystocia occurs when the head of the baby is delivered, but the shoulders are stuck inside the mother's body. It is not possible to prevent or predict it because it cannot be discovered until labor has begun.
This can cause injuries in the mother, including tearing of the vagina, rectum, or cervix and excessive bleeding. And the baby might experience a lack of oxygen to the brain and nerve damage. Doctors are usually able to take the baby out by applying pressure on the lower belly of the mother or by turning the baby’s shoulder.
6) Macrosomia - When a baby is much larger than average, it is called macrosomia. This condition can cause problems during delivery that can result in injury, which leads to an increased risk for health problems after the baby's birth. The mother may experience increased bleeding and tearing of the vagina or rectum.
7) Umbilical Cord Prolapse - When the umbilical cord slips out of the cervix and vagina before the baby is called umbilical cord prolapse. This happens during labor as a result of premature rupture membrane. It can lead to increased pressure on the umbilical cord or umbilical cord compression.
The babies may experience mild umbilical cord compressions that are often harmless. But in some cases, these compressions can become more severe than lasting for a long time. Such compressions result in decreased oxygen supply to the baby, which lowers their blood pressure and heartbeat. To prevent these problems, the baby is moved away from the umbilical cord, or the baby is delivered immediately by cesarean delivery.
Conclusion:
Abnormal labor is quite common, but in most cases, it does not cause any complications. However, in some cases, severe complications can occur that affect both the mother and the baby. This can occur due to uterine factors, fetal factors, or pelvic passage factors. Whatever the cause, prompt action can reduce the complications.
