If your labour does not start, the doctor will want to keep a careful check on your baby’s health. This is often referred to as ‘monitoring’. If there is any evidence that your baby is not doing well, or if you are overdue by a week or two, the doctor will suggest that labour is induced (see below).
Induction
Sometimes labour must be started artificially. This is called induction. Labour may be induced if there is any sort of risk to the mother’s or baby’s health – for example, if the mother has high blood pressure or if the baby is failing to grow and thrive. Induction is always planned in advance, so you will be able to talk over the advantages and disadvantages with your doctor and midwife and find out why it is thought suitable in your particular case.
Contractions can be started by inserting a pessary or gel into the vagina, or by a hormone drip in the arm. Sometimes both are used. Induction of labour may take a while, particularly if the neck of the womb (cervix) needs to be softened with pessaries or gels. Once labour starts it should proceed normally.
Forceps delivery or vacuum extraction
If the baby needs to be helped out of the vagina – perhaps because the contractions aren’t strong enough, because the baby has got into an awkward position or is becoming distressed, or because you have become too exhausted – then forceps or vacuum extraction (sometimes called Ventouse) will be used.
A local anaesthetic will usually be given to numb the birth canal, if you haven’t already had an epidural or spinal anaesthetic.
Forceps are placed round the baby’s head by an obstetrician and with gentle firm pulling the baby can be born. With vacuum delivery, a shallow rubber or metal cap is fitted to the baby’s head by suction. You can help by pushing when the obstetrician asks you to. Sometimes you will find red marks on your baby’s head where the forceps have been or a swelling from the vacuum. They will soon fade.
An episiotomy is nearly always needed for a forceps delivery.Your partner or companion should be able to stay with you if you wish.
Caesarean section
There are situations where the safest option for either you or your baby, or both, is to have a Caesarean section. As a Caesarean section involves major surgery, it will only be performed where there is a real clinical need for this type of delivery. The baby is delivered by cutting through the abdomen and then into the womb. The cut is usually done crossways and low down, just below the bikini line. It is usually hidden when your pubic hair grows back again.
A Caesarean section may be ‘elective’ (that is, planned in advance) or ‘emergency’. An elective Caesarean may be recommended if labour is judged to be dangerous for you or the baby. An emergency Caesarean may be necessary if complications develop and delivery needs to be quick. This may be before or during labour. Sometimes the cervix does not dilate fully during labour and an emergency Caesarean will be suggested but, providing you and the baby are well, there is no need to proceed with great haste.
Whenever a Caesarean is suggested, your doctor should explain why it is necessary and any possible side-effects. Do not hesitate to ask questions.
Where possible, the operation is performed under epidural anaesthesia or the similar spinal anaesthetic. A general anaesthetic is sometimes used, particularly when the baby needs to be delivered very quickly or if there are technical problems, but this increases the risks for you and the baby. This is why epidural and spinal anaesthetics are recommended.
If you have an epidural, you will be awake throughout the operation but you won’t feel pain, just some tugging and pulling and wetness when the waters break. A screen will be put across your chest so that you cannot see what is being done. The doctors will talk to you and let you know what is happening.
The operation takes about 30 to 40 minutes. One advantage of an epidural or spinal anaesthetic is that you are awake at the moment of delivery and you can see and hold your baby immediately. Most hospitals are willing to let your partner be present at a Caesarean under epidural or spinal so that they can give you lots of support and welcome the baby at birth. Please ask.
After a Caesarean you will be uncomfortable for a few days, as you would expect to be after any major surgery. It will be difficult to sit up or stand up straight and it will hurt to laugh. You will have to stay in hospital a bit longer, about five to seven days, but this will depend on your condition. You will also have to take it easy once you are home and you will need help. You shouldn’t lift anything heavy or drive a car for six weeks. Your doctor or midwife will advise you on how much you can do.
Postnatal exercises are especially important after a Caesarean to get your muscles working again, but take things at a gentle pace. The midwife or hospital physiotherapist will tell you when you should begin them. You can also contact the Caesarean Support Network for information and support.
Next Time
Once a Caesarean always a Caesarean? If you have your first baby by Caesarean section, this does not necessarily mean that any future baby will be delivered in this way.
Vaginal birth after a previous Caesarean can and does happen. This will depend on your own particular circumstances. You can discuss your hopes and plans for any other deliveries with your doctor or midwife.
Hepatitis B
Some people carry the virus in their blood without actually having the disease itself. If a pregnant mother has hepatitis B, or catches it during pregnancy, she can pass it on to her child. The child may not be ill but has a high chance of becoming a carrier and developing liver disease later in life. Babies born to infected mothers should receive a course of vaccine to prevent them from getting hepatitis B and becoming a carrier. The first dose is given within 24 hours of birth, and two more doses are given at one and two months with a booster dose at twelve months old.
Breech birth
A breech birth is when a baby is born bottom first. Your obstetrician and midwife will discuss with you the best and safest way for your breech baby to be born. They may arrange an ultrasound scan to assess how big your baby is. They may advise a Caesarean section, or they may encourage vaginal delivery depending upon your individual circumstances. Ultimately, the decision is yours.
A vaginal breech delivery is a little more complicated, than the usual ‘head first’ delivery. An epidural is usually recommended and forceps are often used to deliver the baby’s head. In some units you will be offered the option of an external cephalic version (ECV). The baby is turned into the usual head down position (cephalic) by pressing on the woman’s tummy.
Twins
If you are expecting twins, labour may start early because the womb becomes very stretched with two babies. More people will usually be present at the birth – for example, a midwife, an obstetrician, and usually two paediatricians, one for each baby.
The process of labour is the same but the babies will be closely monitored, usually by using an electronic monitor.You will be given a drip in case it is needed later and an epidural will often be recommended. Once the first baby has been born, the midwife or doctor will check the position of the second by feeling your abdomen and doing a vaginal examination. If the second baby is in a good position to be born, the waters surrounding the baby will be broken and the second baby should be born very soon after the first because the cervix is already fully dilated. If contractions stop after the first birth, hormones will be added to the drip to restart them.
If you’re expecting twins or more babies, you might like to contact the Twins and Multiple Births Association (TAMBA) for advice and support.
Information provided by Health Promotion England
