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Dystocia or Difficult Birth

What is a difficult birth?

Dystocia or “difficult birth” is a term used to describe labor that is unusually difficult and progresses unusually slowly.
Dystocia can be caused by one or more of the following four factors:

• Power abnormalities: Inadequate uterine muscle contraction (uterine dysfunction) or inadequate voluntary abdominal muscle contraction during the second stage of labor
• Fetal presentation and position abnormalities : When a delay of more than 60 seconds occurs for the shoulders to deliver after the fetal head (shoulder dystocia), when the fetal buttocks are in the presenting position (breech or frank breech), when the fetus is positioned perpendicular to the mother’s long axis (transverse lie), when the fetus descends into the birth canal with its head up instead of the normal position looking down at the ground (persistent occiput posterior position)
• Maternal pelvic abnormalities : Abnormally narrow pelvis (pelvic stenosis)
• Deformed birth canal

Inadequate pelvic stenosis and uterine contractions are interrelated and are the two most common causes of dystocia. In general, uterine dysfunction always occurs when there is an imbalance between the presenting part and the birth canal. The most common cause of performing a C-section is dystocia.

(Reviewed by: Information Committee of the Korean Society of Obstetrics and Gynecology)

How to Deal with Dystocia

When labor progresses slowly

Medical professionals can check how labor is progressing by doing a physical exam to see how dilated your uterus is and how far down the baby has descended. If your uterus is slow to open or your contractions are slow or stop, your labor is not progressing as expected.
At this time, it is good to relax and put your mind at ease as anxiety can stall labor. In such case, ask what you, your partners, and your assisting staff can do to help labor progress again.

The hospital may make suggestions such as:

• Changing to a comfortable position
• Walking around: Moving around helps the baby move lower and stimulates labor.

If progress continues to be slow, oxytocin may be used to stimulate uterine contractions to help labor progress more effectively. If you are tired or have uncontrollable pain, ask about other pain relief options.

When the baby is in an abnormal position

Most babies are born headfirst, but some are in positions that complicate labor and delivery.

Occipital region

The baby's face should be facing the mother's anus, but this refers to the baby being positioned in the pelvis with the face facing upwards. Labor may be longer and back pain may become more severe. Most babies turn to the right side during labor, but some do not. If the baby does not turn, the doctor may try to turn the baby's head or use suction to deliver the baby, but if this is difficult, a C-section may be necessary.

Unsettling fetal condition

During labor, the fetus is monitored using an electronic fetal heart rate monitor (EFM). If the fetal heartbeat is abnormal or the amniotic fluid is darkly colored with meconium, fetal condition will be closely observed. Meconium staining in the amniotic fluid itself may look normal, but careful observation is necessary when the meconium is dark or is accompanied by fetal heart rate abnormalities. If fetal distress is suspected, a vacuum-assisted delivery or C-section may be necessary to expedite the delivery.

Postpartum hemorrhage (more severe or excessive than normal bleeding)

Some bleeding after giving birth is normal and will decrease on its own as the uterus contracts. However, some women experience more bleeding than normal, which is called postpartum hemorrhage.
Postpartum hemorrhage is blood loss exceeding 500 ml after the complete expulsion of placenta. The most common cause is uterine atony, which occurs when the uterus does not contract properly. In addition, injuries to the birth canal and retained placenta are also common causes of postpartum bleeding. After the baby is born, a uterotonic agent is injected to contract the uterus, reducing the risk of excessive bleeding. After giving birth, you need to examine your uterus frequently to check whether it is firm and contracted.
Postpartum hemorrhage can cause various complications or even lead to maternal death. If postpartum hemorrhage occurs, you may need to be hospitalized longer after giving birth.

When the placenta remains in the uterus

Sometimes, the placenta does not come out even after the baby is born, in which case the doctor may remove the placenta. However, if placenta accreta is severe and the placenta grows deeply into the uterine muscle layer, the removal of the placenta is impossible. If severe bleeding occurs, a hysterectomy may be necessary. When bleeding is not severe, and the remaining placental tissue is small, you may take your time and wait for the placental tissue to be expelled on its own.