When Complications Arise

Your Role When Things Get Complicated

The Priority That Overrides Everything

A healthy birthing person and a healthy baby override every preference in the birth plan. When a complication arises, the question is: will this intervention improve the odds of a healthy outcome? If yes, the birth plan adjusts. If unclear, use BRAIN to ask.

High Blood Pressure and Preeclampsia

Preeclampsia involves high blood pressure combined with protein in the urine and potential organ effects. Signs to watch for and report immediately: sudden puffiness in hands or face, persistent severe headache, visual changes (spots or flashing lights), pain under the right ribs. If you see these, tell the nurse right now.

Placenta Previa

The placenta is covering the cervix. Causes painless bright-red vaginal bleeding. Requires cesarean, vaginal birth is not possible. If this is diagnosed during pregnancy, the birth plan includes a scheduled cesarean before labor begins.

Placental Abruption

The placenta begins separating from the uterine wall. Signs: severe continuous abdominal pain, a uterus that stays hard and does not soften between contractions, vaginal bleeding. This is an acute emergency. Follow the care team immediately.

Postpartum Hemorrhage

Excessive bleeding after birth (more than 2 cups for vaginal birth). Most common cause: the uterus not contracting firmly after delivery. Routine Pitocin injection immediately after birth is now standard and has greatly reduced this risk.

Umbilical Cord Prolapse

The cord slips out ahead of the baby after membranes rupture. Signs: a loop of cord visible or felt at the vaginal opening. This is an emergency, call for help immediately. The laboring person should get into hands-and-knees with hips elevated. Do not push.

Shoulder Dystocia

The baby's head delivers but the shoulders become stuck behind the pubic bone. The caregiver will direct urgent position changes. The Gaskin Maneuver, getting the laboring person onto hands-and-knees, often releases the shoulder. Follow the caregiver's instructions immediately and without delay.

When a Complication Arises Mid-Labor

Slow the room down, even briefly. Use BRAIN (Benefits, Risks, Alternatives, Intuition, Nothing/Not yet). Make sure your partner is the one consenting, not just nodding in shock. And when it truly is emergent, trust the team.