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| Advice
for mothers |
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| Common
complications in labour...
Assisted delivery
A forceps or ventouse delivery sounds daunting, but if you
need help you'll be very glad of either. They can turn a baby's
head so that it fits under the pubic arch; or prevent it sliding
back after a contraction so that the baby makes progress with
each push. They can control the speed of the delivery so it's
neither too fast nor too slow when a baby is premature or
breech (born bottom first) .
Your legs are supported in stirrups, short poles attached
to the end of the bed, with webbing slings for your feet.
Your legs will be lifted both together to avoid straining
your pelvic ligaments. Unless you already have an epidural
in place you may have a spinal block inserted lower down your
back for the delivery, or possibly a pudendal block (local
anaesthetic injected into the vagina).
An episiotomy (a cut to enlarge the birth outlet) may be performed
to give extra room, but it isn’t always necessary. The
doctor waits for a contraction, asks you to push and helps
by applying pressure as though slowly withdrawing a cork from
a bottle. When the contraction ends everyone waits for the
next one.
Your pushing helps your baby to be born.
Overall, about 17 per cent of women have an assisted delivery,
but the rates vary between hospitals. Over half of women having
their first baby and a third of women with children have forceps
or ventouse after an epidural.
Breech
baby
A breech baby lies with her bottom down. Her legs are usually
straight up (frank breech) or bent at the knee (full breech).
About 20% of babies are lying breech at 28 weeks; only 4% remain
in this position.
Compared with younger women, more than twice as many first babies
born to women over 35 are breech, and women with large families
(who tend to be older) are more likely to have a breech baby.
It's not known whether a caesarean birth is safer for the baby
than a vaginal delivery. There's no standard way of deciding
which women would benefit from having one. It might be recommended
if your baby is large or in an awkward position that could slow
up the delivery, or if your doctor has little experience of
delivering breech babies.
Some doctors estimate the baby's size by scan, although this
isn't very accurate. Others use X-ray pelvimetry or a CT scan
(which uses a smaller dose of radiation) to check the size of
your pelvis. Before exposing yourself to either of these you
may want to discuss with your doctor how the information would
affect the management of your delivery. Sometimes it makes no
difference.
Caesarean
Birth
Any woman might need a caesarean for a complication
that arises before or during labour. There could be a problem
involving the baby's placenta, his cord descending first or
something that affects his oxygen supply so that he becomes
distressed.
There could be a problem with your pelvis, say after a car or
riding accident, or with the effectiveness of your contractions
during labour. You might have heart or kidney disease, pre-eclampsia,
diabetes, HIV or an active herpes infection, low-lying fibroids
or previous surgery to repair your vagina.
Some indications are sufficient on their own, while others are
used in combination. Some caesareans are imperative for the
safety or health of mother or baby. Others are a matter of judgment,
including those performed for the mother's choice. Your doctor
should explain why it's suggested in your circumstances - there
may be room for discussion.
A caesarean section isn't a second-rate sort of birth, and many
women are happy to have one. It isn't always an easy option,
however.
Recommended books:
- Caesarean
Birth: Your Questions Answered national Childbirth Trust.
from NCT Maternity Sales, (0141 636 0600) £3.50 +
50 p postage
- The
Caesarean Experience by Sarah Clement, Pandora 1995 £7.99
Episiotomy
An episiotomy is a cut made in the entrance to the birth
canal to prevent a serious tear, or to speed the delivery if
you or your baby are becoming distressed. Round-ended scissors
are used to make a small incision angled away from the muscles
around the back passage. Occasionally it's on the midline of
the perineum, the tissue between the vagina and anus.
A small episiotomy might be performed at the height of a contraction
when the tissue is stretched and numb, so you feel nothing.
Otherwise, local anaesthetic is injected into the tissue around
the vagina. If you have an assisted delivery the pain relief
for this is adequate. Although it sounds awful you don't even
notice an episiotomy at the time.
You're more likely to have an episiotomy if you deliver your
baby lying on your back (even propped up on pillows); or if
you have an epidural or an assisted delivery. As more women
choose their own position for pushing and midwives rediscover
their skills, episiotomies are becoming less common.
However hard everyone tries to avoid it, a tear can occur if
the baby is large or in an awkward position, if the delivery
is fast and the midwife is unable to control the baby's head,
or if you're in a position that increases pressure on the perineum,
such as lying on your back. |
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Pre-conception |
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Pregnancy |
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Labour & birth |
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