Extra Help | Emma's Diary India

Pregnancy By Weeks

When extra help is needed

Extra Help
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Sometimes medical intervention is needed to help bring your baby into the world.

Sometimes, during labour and birth, things don’t go according to plan and in these cases medical intervention may be needed.

If you want a natural birth having to accept medical help during labour can be disappointing. However, the important thing to remember is that medical intervention is only offered if it is believed to be necessary for the wellbeing of either you and/or your baby. 

Induction

Sometimes labour has to be started artificially. This is often because the baby is late – more than 41 weeks – the waters have broken and labour hasn’t begun, or there is a risk to the health of either the baby or the mother.

Why labour may be started artificially: 

  • Your pregnancy is between 41-42 weeks
  • Your waters have broken but labour hasn’t begun within 24-48 hours. The longer the time between your waters breaking and the start of labour the greater the risk of infection
  • Health related problems such as diabetes, high blood pressure or pre-eclampsia. These can put both you and your baby at risk.

Induction is always planned in advance so your maternity unit's induction policy will be explained to you and you will have the chance to discuss the reasons for it and the methods that will be used. Once everything has been explained, it’s then your choice whether you go ahead with the induction. 

Membrane sweep

Unless your waters have broken you should be offered a membrane sweep before any other induction procedures are used. This will usually take place during an internal examination at an antenatal clinic. 

A circular, sweeping movement with a gloved finger is used to separate the membranes of the amniotic sac from your cervix. Although a membrane sweep doesn’t hurt, you may experience some discomfort and slight bleeding afterwards. 

If labour doesn’t start within 48 hours you may be offered other methods of induction. These will take place in a hospital maternity unit.

Prostaglandins

These are hormones that encourage the cervix to soften and ripen and contractions to start. A pessary or gel containing prostaglandins is inserted into the vagina. 

If a standard pessary or gel is used you will be assessed again after six hours, if you are given a slow release pessary it can take up to 24 hours to work.

Breaking the waters (amniotomy)

The membranes of the amniotic sac are ruptured with a small instrument which is inserted through the vagina and cervix. This procedure can be uncomfortable. 

Once the waters have been broken labour often occurs naturally.

Syntocinon

This is an artificial form of the labour hormone oxytocin, which stimulates the uterus to contract. It is given through a drip once your waters have broken and you’ll be on the labour ward so that your baby can be monitored continuously.

If induction doesn’t work you may be offered another dose of prostaglandins or, in some cases, a Caesarean section may be suggested.

Foetal monitoring

During labour your baby’s heartbeat will be monitored to make sure that he is not distressed - a foetal blood sample may also be taken.

Intermittent monitoring

If you are healthy and have had a trouble-free pregnancy your baby will be monitored every 15 minutes once you are in established labour, increasing to once every 5 minutes as labour progresses.

An ear trumpet known as a ‘Pinard stethoscope’ or a ‘Doppler’ or ‘Sonicaid’, which is a hand-held ultrasound machine, is used. The advantage of this type of monitoring is that you are free to move around.

Continuous monitoring

If your baby’s heartbeat needs to be monitored more closely you will be offered an electronic foetal monitor (EFM). This means you are attached to an EFM for 20 to 30 minutes at a time, or it may be used all through labour.

Your baby’s heartbeat is recorded continuously so that your doctor or nurse can see how well he is coping.

Foetal scalp electrode

Sometimes a finger is used to attach a foetal scalp electrode, or ‘clip’ to your baby’s head which then picks up the heartbeat directly. This electrode is attached to the monitor by a wire, which passes from the baby’s head down your vagina.

Assisted delivery

This is when instruments are used to assist the baby out. This may be because of difficulties during the second stage of labour such as the baby becoming distressed or not being in the right position for delivery or if the labour has been long, you may be exhausted and have problems pushing the baby out.

Ventouse – vacuum extraction

The ventouse has a suction cup that is attached to the baby’s head and is held in place by a vacuum created by a pump.

It has a handle, which is used to ease the baby down the birth canal as you push. A baby delivered by ventouse will have a ‘cone-shaped’ head, but this will disappear soon after delivery. You may not need an episiotomy or a local anaesthetic with ventouse.

Forcep delivery

This instrument looks a bit like metal salad servers, which fit around the baby’s head so that the baby can be helped out as you push.

A forcep delivery is most commonly used for babies whose heads are in an awkward position or to protect the heads of premature babies. You may need an episiotomy and an epidural or a local anaesthetic will be given to numb the area.

Caesarean section

This is an operation where an obstetrician makes a cut through the abdomen and uterus so that the baby can be lifted out.

It is a major surgical procedure that usually takes 40-50 minutes and has a recovery time of up to six weeks. Your doctor will explain why a Caesarean is needed and what will happen during the operation.

They should also explain the risks if you do not have the operation. Your consent is required before a Caesarean can be carried out.

Most Caesareans are performed using a spinal block or epidural. You will be awake during the operation and may feel a gush of fluid and pressing on your abdomen as the baby is born.

Your partner can usually stay with you for the birth. Sometimes a general anaesthetic has to be given so you are asleep during the birth. In this case the baby will usually be handed to your partner soon after delivery.

Elective or planned caesarean

This is planned in advance because of medical complications such as pre-eclampsia, or if the baby is too large, too small, or in the wrong position.

Emergency caesarean

This is performed where there is a risk to either you or your baby. A problem may develop during labour, such as the baby becoming distressed and not getting enough oxygen, or your labour stalls or is very slow.

Sometimes a life-threatening emergency occurs which means your baby needs to be born as quickly as possible.

If you are planning to have more children, it is possible to have a vaginal birth after having a Caesarean (VBAC).

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