Recognizing signs that signal medical intervention during labor

Signs that signal a need for medical intervention during labor—and how doulas respond

Birth is a natural process, but it also comes with moments that demand quick, thoughtful medical care. For anyone supporting a birthing person, recognizing when intervention might be needed is a key safety skill. Here’s a clear, down-to-earth look at three major red flags: abnormal fetal heart rate, prolonged labor, and excessive bleeding. When any of these show up, the medical team steps in to protect both baby and parent. As a doula, your calm presence and clear communication can make all the difference.

Let me set the scene: you’re in the labor room, contractions are steady, and the room hums with focus. Then a pattern shifts. The heart rate of the baby becomes unsettled, or contractions stall, or the room suddenly feels colder with the sign of heavy bleeding. In those moments, the question isn’t whether something might be happening—it’s how quickly you respond, how you support the person giving birth, and how you coordinate with the medical team.

The big three signal flags

• Abnormal fetal heart rate

• Prolonged labor

• Excessive bleeding

Think of these as the tripwires that tell the care team to assess more closely and possibly take action. They’re not a predictor of doom; they’re important alerts that help keep everyone safe.

Abnormal fetal heart rate: listening to the baby’s pace

What it means

The baby’s heart rate is a live read on how the baby is doing during labor. Normal ranges exist, and patterns can shift because of the baby’s needs, the uterus’s rhythm, or how labor is progressing. When the heart rate becomes abnormal—either too high (tachycardia) or too low (bradycardia) or shows unusual fluctuations—that’s a signal to pause and check what’s happening.

What happens next

The care team will assess the situation, which may involve checking the baby’s position, the mother’s fluid status, and how labor is progressing. They might adjust the environment (change positions, improve oxygen delivery to the birthing person, ensure the person is staying hydrated) or they may decide on further monitoring or interventions. The key is timely action to protect the baby while staying with the birthing person as a steady presence.

What a doula can do

• Stay with the birthing person, providing reassurance and grounding.

• Communicate clearly with the team and the person in labor, translating medical notes into plain language.

• Help with repositioning or comfort measures that can positively influence blood flow and oxygen delivery.

• Support informed decisions by calmly summarizing options and helping the birthing person ask the right questions.

Prolonged labor: when progress stalls

What it means

Labor is usually measured by how quickly the cervix dilates and how effectively contractions move labor forward. If progress slows or stalls for several hours, the team considers factors like the baby’s well-being, the mother’s energy, and the risk of infection. Prolonged labor isn’t a failure; it’s a signal that a shift in plan might be wise.

What happens next

Approaches vary. Some cases benefit from interventions to help labor progress (for example, methods to stimulate contractions) or a temporary pause to reassess the situation. In other cases, the team may discuss moving toward delivery by cesarean or assisted vaginal birth if needed. The goal is to minimize risk while supporting a safe, healthy birth outcome.

What a doula can do

• Maintain a calm, supportive presence to conserve the person’s energy.

• Track the timeline and communicate changes to the birthing person and the team.

• Encourage rest, hydration, and gentle comfort measures—because fatigue can make decisions harder.

• Help the birthing person voice preferences and questions to the care team, ensuring their voice remains central.

Excessive bleeding: a serious warning

What it means

Bleeding after birth or heavy bleeding during labor can be a sign of a hemorrhage, a condition that requires urgent medical attention. Even if bleeding seems gradual at first, rapid escalation can occur, and time matters. Pale skin, dizziness, a fast pulse, or a drop in blood pressure are signals that the body is under stress. Bleeding is not something to “ride out”; it’s a situation that calls for immediate medical assessment and often swift action.

What happens next

The medical team will assess the source and severity of the bleeding and may implement measures to stabilize the birthing person and protect the baby. They might administer medications to help the uterus contract, provide IV fluids, or perform procedures as needed. The doula’s role is to ensure seamless communication, keep the birthing person informed, and help them stay as comfortable and as connected to their birth plan as possible.

How to respond when one of these signs appears

• Stay calm and confident. Your steady presence helps reduce fear and keeps everyone focused on safety.

• Notify the right people promptly. If you’re in a hospital or birth center, alert the nurse or midwife immediately and then inform the supporting partner or family.

• Preserve comfort and dignity. Use gentle positioning, soothing touch (if welcome), and clear explanations to the birthing person.

• Document key details. Note the time, what you observed, and any actions taken. This can be helpful for the team and for the birthing person’s memory afterward.

• Respect the person’s choices. Even in urgent moments, consent and clear communication matter. Help them ask questions like, “What does this pattern mean for us right now?” or “What should we expect next?”

Why these signs matter for doulas

Doulas aren’t diagnosticians or clinicians, but we are first responders to a kind of crisis—calm crisis, if possible. Recognizing these signals allows us to:

• Translate medical information into understandable language for the birthing person and their support circle.

• Stabilize the emotional environment so decision-making stays thoughtful and not overwhelmed.

• Keep the lines of communication open between the birthing person and the medical team, ensuring everyone knows what to expect.

• Help the birth team coordinate rapid, coherent care that respects the birthing person’s values and birth plan.

A practical mindset for safety and care

Preparation helps reduce stress when minutes count. Here are a few practical ideas to carry into any birth setting:

• Know the facility’s usual protocols for fetal monitoring, labor augmentation, and hemorrhage management. Ask about what triggers escalations and who should be alerted.

• Have a simple, clear birth plan that outlines preferences but also acknowledges the need for flexibility if safety requires a change in plan.

• Practice communication scripts. Phrases like “I hear that the baby’s heart rate is showing a pattern that needs attention. Could you explain what this means for us right now?” can be incredibly powerful.

• Build a quick reference with emergency contact numbers and key medical history (allergies, current medications, prior birth experiences). This helps the team respond faster if something changes.

• Stay present with sensory cues. A cool cloth on the forehead, a soothing voice, and steady breathing can help the birthing person feel safer—because safety isn’t just medical; it’s emotional too.

A note on the bigger picture

Birth is a team sport. The signs we’ve covered are part of a larger conversation about safety, consent, and empowerment. A skilled doula helps ensure that when the medical team steps in, they’re stepping in with respect, clear communication, and a plan that aligns with the birthing person’s values. It’s not about resisting medical care; it’s about making care timely, precise, and person-centered.

A quick takeaway

During labor, three patterns merit attention: abnormal fetal heart rate, prolonged labor, and heavy bleeding. When any of these emerge, swift, compassionate action from the care team is essential. Doulas support by staying calm, communicating clearly, and helping keep the birthing person engaged and informed. In the end, it’s about safety, presence, and the shared goal of a healthy outcome for both baby and parent.

If you’re exploring birth work more deeply, you’ll find that these practical cues sit at the heart of safe, supportive care. It’s a lot to hold, but with the right team and a steady approach, you help create a birth experience that’s as safe as it is empowering. And that, more than anything, makes all the difference.