Ask an OB: Red Flags

"Ask an OB" is a weekly series with Dr. Maude "Molly" Guerin, MC, FACOG. If you have a question for her, please share it with us here.

What signs should midwives be looking for in labor that signal the mother and/or baby need additional help? It seem that other birth attendants (like dads!) would also like to know these signs and help look out for them. -- Lansing area family 

“Needing additional help” falls in to four categories:
1) Baby not tolerating labor
2) Mom exhausted/too painful to continue without medication
3) Labor not progressing as it should, especially if membranes are ruptured
4) Mom's status is concerning  

1.) Baby not tolerating labor
To know this you have to listen to the baby’s heartbeat FREQUENTLY. American College of Obstetrics and Gynecology recommends listening before, during, and after a contraction every 15 minutes in active labor, and every 5 minutes during pushing (which will be almost every push most likely).  Adhering to this standard will find most cases of severe fetal compromise. Subtle, earlier changes that are marked by loss of “variability” without changes in the “rate” of the baby’s heart will not be picked up by this method.   
You can read this article for details. 

2) Mom exhausted/too painful to continue without medication

3) Labor not progressing as it should, especially if membranes are rupture
In a “normal” labor, first-time moms will progress about a centimeter an hour during the “active phase” between 4 and 10 cm. The “latent phase”, from 0 to 4 cm can take a lon ger time, up to 24 or even 48 hours. Pushing can take up to 2 hours and be considered normal.  So anything outside this time frame (24 hrs latent phase, 6 hrs active phase, and 2 hrs pushing phase) should be cause for concern. Previous vaginal delivery shortens all these numbers dramatically! Pushing more than 1 hour would be abnormal in someone with a previous vaginal delivery. Many many women will not fit this time frame and be perfectly fine, and we do NOT put women on a timetable in labor! But an alert accoucheur will prick up her ears when these thresholds are crossed and begin to discuss the situation, try to figure out why (baby too big? Labor poor quality? Baby in unusual position?), have Plan B in mind, and do the simple things that can help (hydrate, position change etc). As time goes by and no progress is made, despite best efforts, transfer is a good idea. Frequently pain relief, rest, and augmentation to make contractions better will result in a vaginal delivery. 

4) Mom’s status concerning 
Fever, high pulse rate, excessive pain, high blood pressure, severe headache, blurred
vision can be signs of preeclampsia or infection. Transfer is mandatory if these are suspected. 

You can read more about Dr. Maude "Molly" Guerin, MD, FACOG, right here.