Choosing where to give birth

Are you at increased risk of complications during labour and birth?

3 min read

We explain how medical conditions or problems in a previous pregnancy could mean you’re at increased risk of complications when giving birth.

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You might be classified as being at increased risk of complications during labour for a number of reasons. This will impact your approach to labour and birth, from what types of pain relief you can have to where you plan to give birth.

Conditions in your current pregnancy

If any of the following apply to you, you might be at increased risk of complications.

  • Your baby is breech (head not facing downwards) close to your due date.
  • You’re carrying twins or other multiple pregnancy.
  • You have anaemia (low levels of haemoglobin).
  • You’re dependent on alcohol or other drugs.
  • You have a body mass index (BMI) of more than 35.
  • You have problems with your placenta or amniotic fluid, such as a persistent low-lying placenta, bleeding if the placenta has separated prematurely, or a lot of amniotic fluid.
  • You have a condition associated with your pregnancy such as gestational diabetes or pre-eclampsia/high blood pressure.
  • Your waters have broken prematurely.
  • There are known problems with your baby in this pregnancy, such as being small or having an abnormal heart beat.

Your midwife or doctor might want to have an individual assessment with you to determine if you’re at increased risk of complications if any of the following apply.

  • You’re aged over 35.
  • You have had four or more previous children.
  • Your BMI is 30-35.
  • You’ve had some unexplained bleeding during pregnancy (after 24 weeks).
  • You’re receiving psychiatric care.
  • Your blood pressure has been higher than normal (140 systolic – top number- or 90 diastolic – bottom number) on two occasions.

Complications with a previous birth

You may be at increased risk of complications if any of the following happened with a previous birth:

  • You’ve had a previous caesarean birth
  • You suffered from severe pre-eclampsia or eclampsia
  • You had a serious postpartum haemorrhage (bleeding after the birth) which required extra treatment
  • You had a retained placenta which required removing under anaesthetic
  • A previous baby had a serious adverse outcome.

In addition, your health professional may want to make individual assessment of any risk to you if any of the following happened at a previous birth:

  • A previous baby weighed over 4.5kg at birth
  • You developed pre-eclampsia around the time of the birth in a previous pregnancy
  • You had extensive trauma to your perineum or birth canal.

Pre-existing medical conditions

You may be at increased risk of complications if you have any of the following:

  • heart disease
  • high blood pressure
  • diabetes
  • blood disorders such as sickle cell disease, thalassaemia, clotting problems
  • respiratory problems such as cystic fibrosis or severe asthma
  • overactive thyroid
  • current infection such as HIV, tuberculosis, toxoplasmosis
  • history of blood clots (thromboembolism)
  • liver or kidney disease
  • autoimmune problems such as lupus.

In addition, your health professional may want to make individual assessment of any risk to you if you have any of the following conditions:

  • mild anaemia
  • previous fractured pelvis or spinal abnormalities
  • crohn’s disease or ulcerative colitis
  • sickle cell trait or thalassaemia trait.

For a full list of risk factors see the NICE Intrapartum Care Guidelines. These guidelines recommend that women who are at a higher risk of developing complications during birth should be advised to give birth in a labour ward (obstetric unit).

For more information about maternity care for specific conditions see the Royal College of Obstetricians and Gynaecologists (RCOG) Patient Information Leaflets.

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