When you need a bit of help

When it comes to delivering your baby, things don’t always go according to your birth plan. Sometimes medical intervention is necessary in order to ease baby’s entry into the world, explains Penny Voigt.

In its simplest terms, an intervention means your midwife or doctor intervenes in the birth process to assist in delivering your baby. There are a number of ways this could happen: An assisted delivery by forceps or ventouse suction, an episiotomy, induced labour, or a Cesarean section. Whatever the method, an intervention occurs when you are unable to give birth without assistance or your baby is in distress. As an expectant mum, it’s important you have a clear understanding about the risks and benefits of each of these interventions, so you can make an informed decisions about what’s right for you and your baby.

Induced labour

If there are health reasons that pose a risk to either you or your baby, or you are overdue and past 41 weeks of pregnancy, your doctor may recommend bringing your labour on arti cially instead of waiting for it to begin naturally. An induced labour is the process of starting your labour using drugs or other methods. An induction can be a lengthy process, lasting anywhere from 2 to 3 days up to delivering your baby within 24 hours of induction.

Before being induced, your doctor or midwife will perform an internal examination to assess your cervix. Inserting a nger through the cervix to separate the membranes from the uterus without breaking them is called a stretch and sweep; it’s a gentle way of helping to start labour before an induction is performed. If the stretch and sweep does not start your labour, there are a number of other ways your doctor or midwife could induce your labour:

  • Prostaglandin gel is a hormone gel that is placed in your vagina to help soften and open your cervix. It’s a slow- working gel and you may need more than one dose in order to start your labour.
  • A balloon catheter is a small plastic tube with an unin ated balloon at the end. The catheter is inserted into your cervix and the balloon is in ated, putting pressure on the cervix and stimulating the release of prostaglandins which cause your cervix to dilate in preparation for delivery of your baby.
  • An amniotomy or rupturing of membranes involves arti cially breaking your waters to start your labour. Your doctor may insert a thin, plastic, hooked instrument through the cervix to break your amniotic sac. This form of induction can only be done if your cervix has begun dilating and baby’s head is low.
  • Syntocinon Once labour has begun, if your contractions are too weak or irregular, you may be given syntocinon, a hormone that mimics your own natural hormone oxytocin. Syntocinon is given intravenously in small amounts until your contractions become strong and regular.

Having an induction may mean you are unable to walk around freely or use a birthing pool.

Caesarean section

A caesarean section is a surgical procedure that allows a baby to be delivered via a surgical incision in the mother’s abdominal wall. A caesarean is either planned, called an elective Caesarean, or unplanned, otherwise known as an emergency Caesarean.

An emergency Caesarean is performed when baby or mother are in distress and a quick delivery is vital.

There are a number of other reasons why an unplanned Caesarean section may be necessary.

  • Labour is not progressing or moving forwards to make a vaginal birth possible.
  • Baby’s head has not descended once the cervix has fully dilated.
  • An induction has failed to bring labour.
  • Placenta praevia, where the placenta is situated in the lower part of the uterus or is covering the cervix.

In the case of multiple pregnancies babies in the breech position, or an overly large baby, an elective Caesarean may be recommended by your doctor or midwife.

A caesarean section will be undertaken with an epidural or spinal block, so the lower half of your body is numb while you remain awake. While you are totally conscious during the procedure, you will have little involvement in the delivery of baby.

Whether it’s a scheduled Caesarean or an emergency decision, typically the procedure is straightforward and relatively quick, usually no more than 10 minutes followed by another 30 minutes of stitching you back up.

During the procedure a short screen will be placed over your abdomen which will block your view of the actual surgery. Once your lower half is totally numb, the doctor will make a small incision in your lower abdomen, just above your pubic hair line, and another incision in the lower part of your uterus.

The amniotic fluid is suctioned out and your baby is brought into the world — you’ll probably feel a bit of tugging as baby is pulled out. Excess mucous in baby’s respiratory tract will need to be suctioned out before you hear his first cry.

Once the umbilical cord has been cut, the surgeon will remove your placenta and do a quick routine check of your reproductive organs. Then you are stitched up and ready to meet the newest little person in your life.

Until the effects of your epidural or spinal block wear off, you’ll be unable to move around, so use this time to regain your energy. Once you are able to get out of bed, try walking around as moving will help speed up your recovery time.

Assisted Delivery

If there are concerns about your baby’s heart rate, your baby is in a di cult position, or you’re too exhausted to help push your baby out, your doctor may assist the delivery of your baby using forceps or a ventouse.

Surgical forceps have been used for hundreds of years as an effective and reliable means of assisting delivery. Not dissimilar in appearance to large spoons or tongs, forceps are designed to fit around the sides of your baby’s head; as you push with each contraction, your doctor will gently pull on the forceps to help guide your baby out of the birth canal.

While forceps work well even if your contractions are weak or you’re finding it hard to push, you are more likely to have vaginal or perineal damage with this type of assisted birth, and will likely need an episiotomy. Forceps can also leave small marks on your baby’s face, but these will disappear shortly after birth.

A ventouse is a plastic or metal cup attached by a tube to a suction device. The suction cup is attached to the top of your baby’s head and, during a contraction with the help of your pushing, baby is gently pulled through the birth canal.

The ventouse is generally the preferred choice in assisted delivery, as it carries less risk of complications. With a ventouse-assisted birth, you are less likely to experience vaginal tearing or require an episiotomy, but baby may experience a small swelling on the head or have bruising which should disappear quite quickly.

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