Obstetric complications

Originally published in The Ottawa Citizen August 7, 2001

Some women can sail through pregnancy with nary a problem while others can have a difficult time. The basis for treating these conditions rests entirely upon individual circumstances. If these problems interfere with ones ability to function consult with your doctor. Ask about the available treatment options. It is important to have options and to be comfortable with the decision one makes when opting for a particular treatment.

Heartburn is a common problem occurring any time during pregnancy. It is caused by fetal growth. The enlarging uterus exerts pressure on the stomach forcing acid into the esophagus potentially causing ulcers within it. It tends to be more painful at night when acid production is greatest.

When the pain becomes more than just an irritant, there are several solutions. Frequent small meals can help absorb some of the acid. An antacid like TUMS can alleviate minor heartburn. It also provides much needed calcium. In moderate to severe cases, Zantac (Ranitidine) is used. Both medications are safe to use during pregnancy.

Nausea and vomiting tends to be most severe in the first 12 weeks of pregnancy. It can markedly reduce one’s food and water intake. In severe cases, the patient is hospitalized because of weight loss and dehydration. The only SOGC (Society of Obstetricians and Gynecologists of Canada) approved medication for the treatment of nausea in pregnancy is Diclectin.

The effect of one’s work environment at home or office should not be understated. Many pregnant women intend to work for as long as possible. However for some their physical stamina wanes. Back and hip pain makes it difficult to sit or stand for extended periods of time. Fatigue catches up to them earlier in the day. Left unchecked these problems can lead to exhaustion and for some, depression. I strongly suggest that patients pay close attention to what their body tells them. It is important to maximize one’s emotional and physical strength for delivery and the post-partum period.

When, where and how deliveries occur is another area of interest for many. One commonly hears that subsequent deliveries are always faster than the first. Not necessarily. Complications can slow labour. These include big shoulders, a large or poorly positioned head and ineffective contractions.

Complications can be unexpected. Last month, Ms. P. had a perfect delivery. However her placenta, usually delivered within five to 30 minutes after the baby, became stuck within the uterus. It prevented the uterus from contracting. Within 30 minutes about a litre of blood was lost. An adult has a blood volume of about 5 litres. Medication and manual removal of the placenta controlled the bleeding. Appropriate pain relief was used before its removal. Had she been at home, she may have bled to death before being able to reach the hospital.

Last month I attended another “normal” labour and delivery. Once the baby was delivered, he would not breathe. There were no warning signs that this would happen. He did not respond to normal stimulation. He was floppy and blue. You have four minutes before he suffers brain damage.

The neonatal team arrives within 30 seconds. They insert a tube into his airway to suction out secretions and to help him breathe. Silence envelops the room as time slows down. Everyone waits for the child to cry. The parent’s faces are frozen in fear. Within two minutes the baby starts to whimper, then cry. His skin turns pink and he moves his arms. A collective sigh, the mother and father cry. If he was born at home, he would have died.

I relate these events to you not to be a scaremonger. Labour and delivery can be unpredictable. We have one of the lowest infant and maternal mortality rates in the world. Modern obstetrical care has led parents to expect normal outcomes as a matter of fact. This is a fantastic turnaround in expectations. Seventy-five to 100 years ago, one hoped that some of their babies survived childbirth. Mr. B., a volunteer fireman and the father of Ms. P. commenting on her delivery stated, “Well, I would sooner fight a fire with a fire truck than use a bucket.” Indeed. The availability of rapid obstetric and neonatal backup that a hospital can offer is invaluable.

Home births carry an increased risk of morbidity and mortality if complications arise. Granted most home births are uncomplicated and indeed it is a more intimate and comfortable place to give birth. The degree of acceptable risk is an individual choice. But it is impossible to predict which of these normal deliveries will go wrong. Most times, you beat the odds practicing low-risk obstetrics. But the potential risk to the health of the mother and child is not to be gambled. The birth of one’s child is indeed a joyous occasion. One to two days in hospital to maximize the health and safety of the mother and child is a small inconvenience for the next 18 years raising a healthy child.

© Dr. Barry Dworkin 2001

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