Possible complications during childbirth

Abreech birth is a possible complication where the baby is positioned head-up in the uterus. This affects approximately 3–4% of pregnancies (1) and is only considered from 36 weeks onwards, as it becomes more difficult for the baby to turn and position correctly at this stage. Several factors, such as multiple pregnancy, a contracted pelvis, placenta praevia, a uterine abnormality, or a short umbilical cord, can increase the risk of this presentation (2).

A breech presentation can disrupt a mother's birth plan. However, both planned caesarean section and vaginal birth are two options considered and possible in the case of a breech presentation. They simply need to meet eligibility criteria to ensure they are carried out safely. In the same way, a breech presentation does not necessarily mean a induction of labour. 

According to the Haute Autorité de Santé, a breech presentation is not in itself an indication for a planned caesarean section (3). In France, a trial of vaginal birth is offered to 1 in 3 women with a foetus in breech presentation at term, with a success rate of 70% (4). It is common to offer the mother an external cephalic version to help the baby turn (by placing hands on the mother's abdomen, the baby's bottom is lifted and pressure is applied to the head to encourage movement), with variable success rates but allowing a caesarean to be avoided in 35 to 86% of cases (5). 

Methods such asnatural birth on all fours or acupuncture may be considered. Whilst the all-fours position reduces obstetric manoeuvres, foetal trauma and labour duration (by 45 minutes), moxibustion (a traditional Chinese acupuncture method) (12) and acupuncture (13) may encourage cephalic version of the breech presentation, where the baby repositions head-down and bottom-up. To find out more, see our article on acupuncture during pregnancy.

Traumatic injuries to the baby during a breech birth are rare (< 1%). There is a slightly increased risk of umbilical cord prolapse of 1.3% in the case of a breech presentation (8). However, this risk remains low.

The umbilical cord prolapse occurs when the umbilical cord slips in front of the baby following rupture of the membranes. It can then pass through the open cervix. Although rare (0.4% of deliveries) (9), this complication can have serious consequences for the baby due to compression of the cord, which reduces blood flow, heart rate, and therefore oxygen supply (10). This may result in lower Apgar scores at birth (reflecting the baby's circulatory, respiratory, and neurological status), indicating neonatal distress. Finally, higher rates of perinatal mortality (6.4 times higher) have been observed in newborns who experienced cord prolapse compared to those who did not (11).

Several risk factors are associated with this complication. These include obstetric factors (12) such as abnormal foetal presentation, polyhydramnios (excess amniotic fluid), umbilical cord knots, induction of labour, or breech presentation (13). In addition, medical interventions during labour and delivery may be associated with a risk of cord prolapse (14). This is the case with artificial rupture of membranes, attempts to rotate the foetal head, or external cephalic version (15).

Managing delivery in a patient with umbilical cord prolapse requires swift and effective action. It is crucial to relieve the pressure on the cord in order to restore adequate blood flow to the baby. This can be achieved by placing the patient in specific positions, such as the Trendelenburg position (head down, hips up), to help decompress the cord (16). Furthermore, rapid delivery (< 30 minutes) is necessary to minimise risks to the baby (17). In most cases, this involves an emergency caesarean section, although a vaginal delivery may be considered if the baby is closely monitored and labour is progressing quickly (18).

The meconium is the newborn's first bowel movement. It forms in the foetal intestines between 11 and 14 weeks of pregnancy (19) and is generally passed within 24 to 48 hours after the birth of a healthy newborn. Its passage indicates the integrity and permeability of the newborn's intestines (20). However, it may sometimes not be passed, which can be a sign of a condition or intestinal obstruction (21), or it may be passed in utero.

Meconium may be present in the amniotic fluid, with an incidence of 12 to 16% of deliveries (22); its incidence increases beyond 37 weeks of pregnancy. Its presence is both a sign of normal gastrointestinal maturation and may also indicate a hypoxic event (lack of oxygen), making it a warning sign of foetal compromise (22). Factors such as prolonged rupture of membranes, complications such as placental insufficiency or umbilical cord compression, can lead to its passage in utero (23). 

Associated with cardiac and respiratory disorders in the newborn (62%) (24), the presence of meconium in the amniotic fluid carries a risk twice as high of caesarean delivery (23). Meconium-stained amniotic fluid is also associated with an increased incidence of admissions to neonatal intensive care units (23), particularly in the case of thick meconium (25).

Meconium aspiration syndrome occurs when meconium, found below the vocal cords, is inhaled by the foetus during gasping or by the newborn during the first breaths. This phenomenon occurs in approximately 10% of meconium cases in utero (19) and causes serious respiratory complications. It is a rare complication, but is associated with a risk of neonatal mortality (2%).

Any injury to the perineum during childbirth is defined as a perineal injury. It may occur spontaneously during vaginal birth and affect the perineum, vulva, vagina and/or cervix, or it may result from an episiotomy (26). 

In France, between 19% and 65% of women who give birth vaginally experience a perineal tear (27,28). Caused in particular during the deflection of the foetal head, they are classified by degree ranging from first degree, for the least severe tear, to fourth degree, for the most serious. The most severe tears are those affecting the anal area — these are obstetric anal sphincter injuries (OASI). Such tears occur in 4 to 6.6% of vaginal deliveries, according to World Health Organization data (29), with 6% for instrumental deliveries and 5.7% for spontaneous vaginal births. In France, their prevalence is estimated at 0.5% following spontaneous delivery and 2.2% following instrumental delivery, affecting approximately 5,000 women per year (30). 

Many risk factors have been identified in the occurrence of severe tears, in particular: primiparity, instrumental delivery, macrosomic foetuses (birth weight> 4 kg), posterior presentation, "cannonball" deliveries with a rapid and sudden expulsive phase. Episiotomy, the deliberate incision of the perineum, is also identified as a risk factor when it is midline. The incision is then made vertically, from the vagina towards the rectum. However, mediolateral episiotomies, where the incision is made diagonally from the vagina towards the rectum, can also become a risk factor if performed incorrectly.

Women who give birth in a semi-sitting position or who squat during the pushing phase are at greater risk of sustaining perineal injuries. It is also reported that prolonged labour significantly increases the risk of perineal injuries (31). 

The most common consequences of perineal injuries are pain and the risk of urinary and anal incontinence, sexual dysfunction, and infection (32).

Antenatal perineal massage, carried out from the 34th week of pregnancy, is a technique that helps increase the muscular elasticity of the perineum and promote blood flow. It helps to reduce the occurrence of perineal trauma and the incidence of tear degrees. This allows for a reduction in muscular resistance and therefore prepares the muscles for their structural modification during childbirth, and may reduce pelvic floor damage (33).

Collagen plays an essential role in the healing process after childbirth. It is considered the best postpartum food supplement for wound healing. It supports the regeneration and repair of damaged tissues, thereby contributing to faster and more effective healing of tears and episiotomies. It is also important to note that collagen reserves in the body decline with age, which can slow the healing process. As a result, collagen supplementation may be beneficial, particularly for older women, to optimise healing after childbirth and support a faster and more complete recovery. 

Although childbirth may be accompanied by various perineal complications in the medium and long term, it is worth remembering that these situations are rare and that the vast majority of births proceed without any major issue. Each of these complications requires specific and tailored management to ensure the wellbeing of both mother and baby. 

Some solutions include medical interventions such as caesarean section in cases of cord prolapse, preventive techniques such as antenatal perineal massage for tears, and close monitoring for meconium in the amniotic fluid. Mamas, stay informed and supported throughout your perinatal journey. Medical teams are there to support and care for you when needed. There is no need to be afraid throughout pregnancy, nor to seek out the best pregnancy food supplement to avoid complications — there is no miracle cure, and it is important to bear in mind that these events are rare. The best approach remains good support for proper management.