By Henry Lerner - thewinnower, CC BY 4.0, Wikimedia
At the onset of labour, she was taken to the home of the traditional birth attendant who tried to conduct the delivery. After several hours of failed attempts to conduct the delivery, the woman's husband took her from there to a prayer house where she was prayed for. After several hours of labour in the prayer house, she was then rushed to the teaching hospital.
When we examined the woman, the fetal parts were already palpable on her abdomen which is a sign of uterine rupture. The Fetal heart rate was also absent which pointed to the fact that the fetus was already dead in the womb. She was later resuscitated and taken to the theatre for urgent intervention. But then, the baby was no more alive even before they arrived at our facility.
As a complication of the obstructed labour, the woman had an abnormal communication between the bladder and the vagina, what we refer to as vesico vaginal fistula (VVF). This is a very pathetic story but similar things happen very often, especially in low-income societies and developing countries where women don't have free access to obstetrics care.
By Suzanne M. Day, Public Domain, Wikimedia
Now let's look at what is Obstructed Labour and the Causes.
According to WHO:
Obstructed labour means that despite strong contractions of the uterus, the fetus cannot descend through the pelvis because there is an insurmountable barrier preventing its descent? Obstruction usually occurs at the pelvic brim, but occasionally it may occur in the cavity or at the outlet of the pelvis.
The commonest cause of obstructed labour is Cephalopelvic disproportion (CPD). Normally during delivery, the fetal head passes through the maternal pelvis. However, when there is a mismatch between the fetal head and the maternal pelvis such that the baby's head cannot navigate through the mother's pelvis, we refer to it as cephalopelvic disproportion and it is a leading cause of obstructed labour. The mismatch between the fetal head and the maternal pelvis can occur when the maternal pelvis is too small (contracted pelvis) or the baby's head is too big (fetal macrosomia).
By David Roseborough from Los Angeles, United States - CC BY 2.0, Wikimedia
Another cause of obstructed labour is malpresentation. Normally during delivery, the baby comes out with the head (cephalic presentation), particularly the occiput. But when the baby comes with any other part of the body like the face, brow, etc, it is called malpresentation.
Other causes of obstructed labour are traverse lie (when the baby presents in a traverse plane instead of the normal longitudinal plane during delivery), uterine fibroids, septate uterus, and other uterine abnormalities.
How can obstructed labour be prevented?
Obstructed labour is a leading cause of death and other complications amongst pregnant women and has many serious maternal and fetal unpleasant outcomes like Uterine rupture, Vesico Vaginal fistula, Intrauterine fetal death, birth injuries, excessive bleeding following delivery (postpartum hemorrhage), depression, nerve injuries, etc.
By Meutia Chaerani - Indradi Soemardjan - Own work Indrani, CC BY 2.5, Wikimedia
Therefore, prevention remains the key to detecting and treating obstructed labour before it happens.
The most important objective tool to detect obstructed labour is the Partograph.
WHO recommends that ALL health care workers use the partograph for ALL births.
The Partograph is a graphical representation of all the events of labour. It allows labour attendants to monitor the progress of labour to take action immediately there is a problem.
Another very key method of prevention of obstructed labour is proper antenatal care. Every pregnant woman should register and attend all her antenatal visits faithfully. It will help the physician to identify early signs of obstructed labour and address them before labour. During the antenatal visits, the doctor will confirm the fetal lie and presentation to ensure that they are all normal. And if there is any abnormality, proper arrangements are made ahead of the commencement of labour to avoid the incidence of obstructed labour. Women who are at increased risk of obstructed labour are also identified and referred for expert management.
By Tom Adriaenssen, CC BY-SA 2.0, Wikimedia
In conclusion, Obstructed labour is a preventable condition and all hands must be on deck to ensure that it is prevented. The complications and attendant sequelae of obstructed labour are so grievous that no woman should be allowed to pass through it. Information is key, and we should all be informed about it and help our women to have a safer and more successful delivery. The government should also ensure free and available antenatal services for our women.
Pregnancy is not a disease and no woman should die of it!
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