Even if you’re healthy and well prepared for labour and giving birth, there’s always a chance of unexpected difficulties.

Slow progress of labour

Your doctor or midwife can tell how labour is progressing by checking how much the cervix has opened and how far the baby has dropped. If your cervix is opening slowly, or the contractions have slowed down or stopped, your midwife or doctor may say that your labour isn’t progressing. It’s good if you can relax and stay calm – anxiety can slow things down more. Ask what you and your support person can do to get things going.

The midwife or doctor may suggest some of the following:

• change to a position you’re comfortable in
• walk around – movement can help the baby to move further down, and encourage contractions
• a warm shower or bath
• a back rub
• have a nap to regain your energy
• have something to eat or drink.

If progress continues to be slow your midwife or doctor may suggest inserting an intravenous drip with Syntocinon to make your contractions more effective. If you’re tired or uncomfortable, you may want to ask about options for pain relief.

When the baby is in an unusual position

Most babies are born headfirst, but some are in positions that may complicate labour and the birth.

Posterior position

This means the baby’s head enters the pelvis facing your front instead of your back. This can mean a longer labour with more backache. Most babies will turn around during labour, but some don’t. If a baby doesn’t turn, you may be able to push it out yourself or the doctor may need to turn the baby’s head and/or help it out with either forceps or a vacuum pump. You can help by getting down on your hands and knees and rotating or rocking your pelvis - this may also help ease the backache.

Breech birth

This is when a baby presents bottom or feet first. In Australia about 3-4% of babies are in the breech position by the time labour starts. Sometimes a procedure called ‘external cephalic version’ will be discussed – this is where a doctor gently turns the baby in late pregnancy by placing their hands on your abdomen and gently coaxing the baby around so it can be born headfirst. This turning is done at around 36 weeks, using ultrasound to help see the baby, cord and placenta.

The baby and the mother are monitored during the procedure to make sure everything is ok. There’s a small risk that turning the baby may tangle the cord or separate the placenta from the uterus. This is why the procedure is done in hospital, in case an emergency caesarean is needed.

Your midwife or doctor will discuss with you the best way of managing a breech labour and birth. If the baby is still in the breech position at the end of pregnancy, a caesarean may be recommended.

Multiple pregnancy

When there is more than one baby, labour may be preterm. When the last baby has been born, the placenta (or placentas) is expelled in the usual way. If the babies are premature, they are likely to need extra care at birth and for a few days or weeks afterwards.

At term, you may be induced if your babies are in the correct position. Often the obstetrician will suggest that you have an epidural. This is because after the first twin is born the second twin can get in an unusual position and the obstetrician may need to manoeuvre the second twin into position for birth.

Read more on having a multiple birth.

Concern about the baby’s condition

Sometimes there may be concerns that the baby is distressed during labour. Signs include:

• a faster, slower or unusual pattern to the baby’s heartbeat
• a bowel movement by the baby (seen as a greenish-black fluid called 'meconium' in the fluid around the baby).

If a baby is not coping well, its heart rate will usually be monitored. If necessary, the baby will be delivered as soon as possible with vacuum or forceps (or perhaps by caesarean).

Postpartum haemorrhage

Postpartum haemorrhage (PPH) is a complication that can occur after a baby is born. PPH is uncommon. Losing some blood during childbirth is considered normal. PPH is excessive bleeding from the vagina after the birth.

To help prevent PPH, you will be offered an injection of Syntocinon as your baby is being born, which stimulates contractions and helps to push the placenta out.

Your midwife will check your uterus regularly after the birth to make sure that it is firm and contracting. Postpartum haemorrhage can cause a number of complications and may mean a longer stay in hospital.

Learn more about postpartum haemorrhage here.

Retained placenta

Occasionally the placenta doesn’t come away after the baby is born, so the doctor needs to remove it promptly. This is usually done with an epidural or a general anaesthetic in theatre.

Learn more about a retained placenta here.