Although labour and birth are natural processes, there are times when you and your baby may need a helping hand. By registered midwife Andrea Klinkenberg
An intervention occurs when it becomes clear that you will be unable to give birth without some kind of assistance or your baby is in distress and needs to be born more quickly.
There are a number of interventions that can be considered to help make labour or your baby’s birth easier, or to ensure a better outcome for both of you. We look at the most common ones.
If labour is taking a long time to get started, or your membranes have ruptured naturally without you being in labour, your obstetrician or midwife may discuss the option of inducing labour with you. This is usually done using prostaglandins, which have a hormonal effect and help to soften and ripen the cervix, and bring on contractions to start labour. Prostaglandins come in gel form, which is inserted through the vagina using a thin plastic tube and deposited right next to the cervix. This is not a painful procedure.
Breaking of waters
Your baby is protected by a sac of water in your womb called the amniotic sac. If labour is not progressing very well, your obstetrician or midwife may consider breaking this sac open to speed up labour. Once your waters are broken, your contractions will become more intense and gravity will help your baby move further down into your pelvis. Your midwife or obstetrician will break your waters by inserting a small plastic hook through the cervix and scratching at the membranes until they break. The procedure is considered to be more uncomfortable than painful.
Augmentation of labour is usually done using oxytocin in order to encourage your cervix to dilate quicker. Oxytocin is a hormone that is given intravenously through a drip in your arm and works by increasing labour contractions, which in turn helps your cervix to dilate. It can also be used to induce labour. Using oxytocin means that you will need to have continuous foetal monitoring to ensure that your contractions are not too severe and that your baby does not become too tired.
Episiotomies are not common these days, but they are used during delivery if there is not enough space for your baby’s head to emerge, or if you have been pushing for a long time and your healthcare providers are concerned about the wellbeing of your baby. Remember that being born is difficult for your baby too, and it’s not unheard of for a baby to get tired from all the contractions and pushing.
An episiotomy is a simple procedure. Initially, you will be given an injection of local anaesthetic to the area and your obstetrician or midwife will then make a small, diagonal cut at the bottom of the vagina, directed downwards. After you have delivered, the area will be numbed again and they will stitch it up using dissolvable stitches. You may have some swelling and tenderness over the area for a few days afterwards, and you will be given instructions on how to care for the area. Your stitches should heal within a month after delivery.
A vacuum delivery is used when you are having difficulty pushing, for example, after an epidural, or if you have been pushing for a long time and your baby is becoming distressed. A vacuum delivery is performed by attaching a vacuum cup onto the head of the baby. Using suction, your obstetrician then pulls the head with the vacuum instrument attached while you have a contraction and push, making pushing easier. This may cause some swelling on your baby’s head after delivery, which will soon resolve on its own.
Forceps are not routinely used for a vaginal delivery these days as most obstetricians prefer the vacuum method. A forceps delivery is used for the same reason as a vacuum delivery, and is done by placing two smooth metal instruments on either side of your baby’s face. Your obstetrician then pulls the forceps while you’re having a contraction and pushing to make delivery of your baby easier. It can occasionally leave marks on your baby’s face, but these will soon heal on their own.
A C-section is a procedure that should be done for specific, medical reasons. Most commonly, this could be due to foetal distress or prolonged labour. It’s performed in an operating theatre where a surgeon cuts through the layers of your abdomen until he gets to the womb to surgically deliver your baby. While it carries the same risks as any surgery, it has saved the lives of both moms and babies when used appropriately.
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