Obstructed labour – an obstetric emergency

Posted: 28/02/2025

Obstructed labour occurs when the baby is unable to pass through the mother’s pelvis during delivery, despite strong uterine contractions. It is an obstetric emergency and can lead to potentially life-threatening complications for mother and baby without appropriate intervention. 

This article will look at the causes of obstructed labour, how it is assessed and managed, potential complications, and when it might lead to a claim.

What are the causes of obstructed labour?

Common causes of obstructed labour are:

• a mismatch between the size of the baby and the mother’s pelvis;
• malpresentation (ie the baby’s position in the womb) – for example, where the shoulder is in transfer lie, presenting at the cervix;
• fetal abnormalities – such as hydrocephalus, a build-up of fluid in the brain which causes enlargement of the fetal head;
• pelvic abnormalities – for example a contracted (ie clinically small) pelvis, or one which has bony obstructions;
• abnormal growths – maternal soft tissue tumours such as fibroids.

How is obstructed labour assessed?

The following are clinical signs indicating that labour has become obstructed:

• prolonged labour with minimal cervical change;
• strong, frequent contractions with no descent of the baby;
• severe pain or pressure in the lower back, pelvis or abdomen;
• fetal distress indicated by abnormal heart rate patterns;
• excessive bleeding or blood-stained liquor (amniotic fluid);
• dehydration and decreased urine output;
• Bandl’s ring – a visible or palpable depression between the upper and lower halves of the uterus;
• abnormal uterine shape – where the uterus is continuously hard and moulded around the fetus.

How should obstructed labour be managed?

Managing obstructed labour may involve the following:

• close monitoring of the mother’s progress and fetal wellbeing;
• identifying the cause of the obstruction;
• taking necessary interventions such as repositioning techniques (if obstructed labour is caused by transverse lie);
• assisted vaginal delivery (using forceps or vacuum extraction);
• caesarean section where a vaginal delivery is not possible.

NICE (National Institute of Clinical Excellence) guidelines recommend a repeat examination where there is suspected delay in labour after two hours.

What complications can occur if obstructed labour is not appropriately managed?

Complications for the mother can include:

• uterine rupture;
• postpartum haemorrhage;
• uterine infection;
• sepsis;
• bladder and rectal injuries;
• obstetric fistula – where an opening forms in the vaginal wall connecting to the bladder or rectum;
• hysterectomy.

Complications for the baby can include:

• asphyxia (lack of oxygen) leading to stillbirth, brain damage, or neonatal death;
• neonatal sepsis;
• convulsions (fits).

When might obstructed labour lead to a claim?

The key to managing obstructed labour is close monitoring of mother and baby and acting without delay. Negligence may occur in the following circumstances:

• there is an inadequate assessment of risk factors for obstructed labour;
• there is a failure to identify obstructed labour as a result of inadequate monitoring and assessment;
• there is a delay in using interventions for assisted delivery – for example vacuum extraction or forceps delivery;
• there is a delay in performing a caesarean section where vaginal delivery is not possible.

If you have suffered an injury from obstructed labour which you think may have been avoidable, you may be able to make a claim for compensation. Our specialist birth injury team can offer an informal discussion on what your options are. Please call us on 0800 328 9545, email clinnegspecialist@penningtonslaw.com, or complete our online assessment form.

Previous articles in this series:

• Jaundice in newborn babies – what is it and why might it lead to a claim?
• Vitamin K deficiency bleeding (VKDB): a preventable disorder
• Large for gestational age: what expectant mothers should know
• Monitoring during labour - how will you baby be monitored and why?
• Understanding necrotising enterocolitis (NEC)

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