Going with the flow

The old adage about baby ‘popping out’ can often be wide of the mark. No matter what you think you’ll do during labour, or what your birth plan says, it’s very important to remember that, when it comes to labour, things often don’t go according to plan.

Going with the flow

It’s realistic to make plans for your baby’s delivery and it’s certainly a good idea to write a birth plan. The important thing to remember when it comes to labour, however, is that you have to be prepared to cope with the unexpected.

Breech babies

As your pregnancy progresses, and space in the uterus becomes limited, your baby will settle into its birth position. In 97 per cent of cases, this position will be head first, but in the rest the baby will be ‘the wrong way round’ ie, feet and bottom first.

There is a possibility that your baby will turn by itself before the birth, but, as the pregnancy progresses, this becomes less likely due to the limited space. Your baby can also be helped to turn by using external manipulation on the mother’s abdomen to convert a breech to a cephalic (ie, head first). This is successful in around 35 to 86 per cent of pregnancies. Often, however, a baby will turn and then move back into the breech position.

If your baby is lying in a breech position, it does not mean that you are definitely going to have a Caesarean section. Provided there are no complications, a vaginal birth is a perfectly normal way of delivering a breech baby. Your doctor will try to turn the baby around – using a scan to see what’s going on – by putting his hands on your bump and trying to gently push the baby into the right position. If this doesn’t work, however, it’s still possible to have a normal delivery with the baby in a breech position, but the doctor will advise what’s best depending on circumstances. The first stage of labour is very similar to what it would be like if the baby was lying the other way round. In the second stage, the midwife will usually inform the obstetrician and a paediatrician may also be present to check that all is well.

Assisted deliveries

Sometimes, no matter how hard you try, it’s just not possible for you to push your baby out by yourself. This can prove very upsetting for some women, but remember, that, as labour goes on, you’ll become increasingly tired and be glad of some assistance. At the end of the day, some babies just need some extra help to be born, so don’t look at it as giving up on giving birth and just consider it a helping hand!

Midwives and doctors will watch for the following signs before going down the assisted delivery route.

• Foetal distress – this is a sign that baby is getting tired and would rather be born
• Position of baby’s head. Baby’s head may not be in the best position for birth, particularly if it is lying in the occipito-posterior position. This means that the back of the baby’s head is at the mother’s back instead of her front. Although contractions will usually help the baby to rotate in labour, sometimes this doesn’t happen and assistance is required
• Mother is becoming very tired, particularly if the labour has been long
• If the mother has high blood pressure or a heart condition and it’s not advisable for her to push

If any of these signs are observed, the midwife or doctor has a couple of tools to help gently pull the baby out. The decision to help you have your baby using forceps or ventouse will generally include you, but the decision on which to use – forceps or ventouse – is usually that of the doctor alone.

Forceps are like large hollow spoons, which are specially made to cradle the baby’s head. They are inserted into the vagina one at either side of baby’s head using plenty of lubricating cream. Once they are inserted, the midwife will tell you to push when you have a contraction. At the same time, the doctor will pull on the forceps and help you to push your baby’s head down the birth canal. It may take a few pushes for baby’s head to emerge. Once this has happened, the doctor will take the forceps off and, with the next contraction, the midwife will tell you to push again so that baby can be born.

With forceps, your baby may have a mark on his cheek, but this will disappear within a day or two.

The ventouse is a suction cup, which is attached to your baby’s head before birth. It usually takes a little longer to apply than forceps because the suction has to be built up. Once the ventouse extractor is in place, the procedure is the same as for forceps.

With a ventouse delivery, the baby may have some swelling and bruising where the cup was applied, but, as with the forceps delivery, these marks will disappear within a few days.

Episiotomy

An episiotomy is a small cut, which is made under local anaesthetic in the perineum – the area between the vagina and the anus. It’s made to prevent the skin tearing, which is much worse than a controlled cut. With care and attention to basic hygiene, the cut will heal quite quickly and leave no lasting effects.

Induction

Induction of labour is the term used for starting labour artificially and usually happens if there is a risk to the mother’s health, such as high blood pressure, or to the baby’s health, if for example it isn’t growing normally.

A prolonged pregnancy – longer than 42 weeks – can lead to placental insufficiency. This means that the placenta is not doing its job of nurturing the foetus so well. In this instance, induction may also be recommended by the midwife or obstetrician.

Two of the most common forms of induction are:
Syntocinon: When you are in labour, your body produces the hormone, oxytocin, which stimulates your uterus into contracting. Syntocinon is an artificial form of oxytocin, which is given in an intravenous infusion and measured by a pump.

Prostaglandin E2: This comes in pessary, tablet or gel form and is used to ripen the cervix, giving nature a push in the right direction.

Caesarean section

A Caesarean section occurs when a baby is delivered by cutting through the mother’s abdomen and into the womb. The baby is then lifted out. In the past, a Caesarean or C-section was only used when there was a real medical need, but in the last few years, there has been a dramatic increase in the number of women, who choose to have C-sections.

There are two types of Caesarean:

Elective – that is, planned in advance. This may be recommended if the midwife and doctor believe a normal birth would be dangerous for either the mother or the baby.

Emergency – this is where the mother gets into some real difficulty and a normal birth cannot take place.

Caesareans are always performed under anaesthetic. Where possible, an epidural will be used. This is a special anaesthetic, which completely numbs the nerves between the birth canal and the brain, allowing the mother to stay fully awake without pain.