In labor storm, hyperactive labor presents itself, corresponding to contractions that are too strong or too short in succession. This phenomenon can cause uterine rupture and put the fetus at risk. If incisional delivery is not induced, administration of emergency medications is required to reduce contractions.
What is a labor storm?
A labor storm is a hyperactive contraction. In this case, contractions occur either with an amplitude of more than 50 mmHg or with normal amplitude at only short intervals. In this case, this means more than 5 contractions in a ten-minute period. Basal tone is within the normal range in both occurrences. The labor storm is a complication associated with risks. For example, rupture of the uterus may occur during the apparition. Also, an undersupply of oxygen to the unborn child may occur. Therefore, obstetricians must respond to a labor storm with high responsiveness. Possible causes of the phenomenon include incorrect doses of certain medications. Incorrect position or shape of the embryo should also be considered as causes of a labor storm.
Causes
If there is a mismatch between the unborn baby and the mother’s pelvis, then this can cause a labor storm. This statement is especially true for a macrosomic fetus that has relatively high birth weight. However, even a fetus of normal weight and average size can cause the labor storm in an enormously petite woman with a narrow pelvis. Just as often, abnormal posture or position of the unborn child is the cause of a labor storm. Cervical dystocia is also sometimes a possible cause. Sometimes the labor storm is caused by too high a dose of oxytocin. This substance is also produced in the organism. Therefore, if the endogenous oxytocin level is too high, it can also cause a labor storm. The endogenous oxytocin level increases especially in multiple pregnancies, because the uterus is greatly dilated. Likewise, amniotomies sometimes result in abnormally high oxytocin levels.
Symptoms, complaints, and signs
The expectant mother experiences contractions in labor that are either too rapid in sequence or abnormally strong. She usually also complains of severe pain. When the ligamentous furrow in the uterus rises and reaches the umbilicus during the labor storm, there is usually mainly tenderness in the lower segment of the uterus. If this occurs, uterine rupture may be imminent. Persistent pain during the labor pause likewise refers to uterine rupture. Rupture of the uterus is not the only danger, however. The unborn child may also be at risk during a labor storm. During this phenomenon, the intrauterine pressure increases. This can threaten the oxygen supply to the fetus. The fetal heart rate must therefore be permanently monitored by obstetricians through cardiotocography. If the heart rate shows pathologic values, a microblood test is usually initiated.
Diagnosis and course of the disease
Usually, palpation of the uterus is sufficient to raise the initial suspicion of labor. The pregnant woman’s uterus is abnormally hard and immobile. The tocogram secures the diagnosis by showing too frequent or too strong contractions. At times, continuous contraction is also evident from the tokogram. Palpation of the cervix can rule out positional abnormalities as a cause of labor. Cardiotocography of the unborn child and microblood examination are important additional tests to ensure the integrity of the fetus. In modern times, the course of a labor storm is generally favorable and is sometimes determined by the responsiveness and experience of the midwives and the attending physician.
Complications
A labor storm does not usually result in major complications. However, there may be pain and other accompanying symptoms. The expectant mother usually feels severe discomfort, associated with sweating and cardiovascular discomfort. The typical pressure pain can cause the patient to cramp up and no longer be able to adequately support labor. Furthermore, there is a risk that the Bandl groove in the uterus will rise. If this happens, uterine rupture can occur, which is associated with life-threatening complications.A complete uterine rupture is also conceivable. The child is also at risk during a labor storm. If the intrauterine pressure rises too much, this can affect the child’s oxygen supply. A lack of air supply can lead to physical and mental sequelae. In the most severe cases, the child dies as a result of a labor storm. When treating a labor storm, the risks come from the medications prescribed. Most often, Partusisten is administered, which can lead to circulatory problems. If an incisional delivery must be performed, this is always associated with risks. For example, the caesarean section may cause injuries to the vessels and muscles or to the child. After a procedure, scars are often left behind, which are occasionally accompanied by wound healing problems and scar pain.
When should you see a doctor?
In all cases, a labor storm is a reason to go immediately to a hospital with a maternity ward or to be taken there by emergency transport. The labor storm is not only sometimes very painful and may need to be stopped or regulated with medication. It is also a sign of the onset of labor and possible complications. Among other things, the labor storm carries the risk of uterine rupture and is a sign of a more complicated birth. There can be various reasons for this, most of which are mechanically caused by the fetus. These include very large and incorrectly positioned children in the uterus. Due to the fact that a labor storm involves strong contractions of the uterus, there is also a risk for the child inside. For example, oxygen deprivation may occur as a result of bruising or strangulation in the baby. The labor storm should therefore be categorized as a circumstance requiring acute treatment. As soon as the contractions are felt to be unusually violent or even the pauses between them are felt to be painful, a doctor should therefore be consulted urgently. More than five contractions within ten minutes are considered signs of a labor storm.
Treatment and therapy
During a labor storm, the expectant mother is primarily instructed to breathe calmly so that the oxygen supply to the fetus does not deteriorate further. Relaxation techniques are used. A warm bath can also initiate relaxation. In an emergency, antispasmodic medications are also given. The expectant mother moves to a knee-elbow position to reduce pressure on the cervix. Stimulation of the cervix reduced in this way brings about a decrease in contractions. If an abnormal position of the fetus causes the labor storm, a vaginal birth is not feasible. In this case, obstetricians will induce an incisional delivery. If the labor storm has another cause and a vaginal birth is feasible, the obstetrician gives the expectant mother a spinal anesthetic if there is any doubt. This peridural anesthesia reduces labor pain. Partusist is usually administered as an emergency medication to keep the uterus from contracting violently. In this way, the oxygen supply to the fetus is restored. The mother’s heart rate increases significantly as a side effect of the drug, but usually returns to normal after the drug has worn off. Administration of the drug is mandatory to avoid further endangering the unborn child and to advance the birth.
Prevention
The labor storm can only be prevented to a certain extent, for example, by preferring an incisional delivery from the outset if there is a mismatch between the unborn child and the mother’s pelvis.
Aftercare
After a labor storm birth, healing in the postpartum period is the top priority. Mother and baby need to recover from the dramatic events in the delivery room. Close medical checkups after birth guarantee that the uterus recedes well and that no damage is left to the female body as a result of the labor storm. Good medical aftercare is the best measure to prevent permanent physical damage. If the attending physicians were unable to determine the causes of the labor storm during the birth, then the gynecologist should clarify this point retrospectively. Psychological reappraisal of the birth is also imperative. For the health of the psyche, it is necessary that the affected woman accepts and embraces the dramatic birth process. In addition to consulting the gynecologist in charge, a visit to a psychologist may also be necessary.Especially for subsequent pregnancies, it is helpful if neither physical nor psychological consequences remain after birth with a labor storm. Only in this way is a relaxed new pregnancy possible. Intensive preparation for the following birth and avoidance of the causes of the labor storm enable a birth without complications. The pregnant woman can calmly face a new pregnancy and the birth.
This is what you can do yourself
In case of acute labor storm, the affected woman must be treated by a doctor as soon as possible. Otherwise, the hyperactive labor can become life-threatening for mother and child. Self-help measures alone do not usually relieve the symptoms. However, there are some methods that can help the affected woman cope better with the situation. First, the patient should try to remain as calm as possible. This usually also has a positive effect on the fetus. During a labor storm, calm and steady breathing is particularly helpful. The woman concerned can use certain breathing techniques. The use of certain relaxation techniques such as yoga, autogenic training or meditation is also helpful. Adopting the so-called knee-elbow position also has a soothing effect. Alternatively, the woman can assume the position of the bridge. This reduces the pressure on the cervix, which will decrease contractions. In addition, a warm bath can have a relaxing effect, allowing the patient to rest. Basically, the affected woman should move as little as possible until the labor storm loses intensity.