Childbirth

Normal childbirth also known as a normal vaginal delivery has 3 stages – put simply they are;
the opening of the cervix, the birth of the baby and then the delivery of the placenta. When contractions are coming every 5 minutes or you need something for pain, we advise you to go to the Hospital. If your waters break i.e. there is fluid loss, the best action is to contact the Hospital to arrange for a review. First labours (or the first stage of labour) last for 8 to 16 hours and subsequent labours last 4 to 8 hours. Once full dilatation is reached, the mother pushes with contractions (this is known as the second stage of labour). After the childbirth is the delivery of the Placenta.

During the labour we will regularly check your pulse, temperature, blood pressure and contractions as well as the baby’s heart rate. At birth we check the baby’s heart rate, tone, colour, breathing and reflexes are assessed (this is referred to as an Apgar Score).

A Caesarean section is an operation involving delivering the baby through a bikini line incision in the lower abdomen. An anaesthetist performs a spinal or epidural block which allows the mother to be awake while the baby is being born. We do Caesarean sections for a variety of reasons. Some of these include if you’ve had a previous Caesarean section, breech presentation, abnormal fetal heart rates, obstructed labours (where the baby is just too big for the pelvis), placenta previa and active genital herpes. Some women elect to have a Caesarean section because they have worries about a vaginal birth and multiple pregnancies sometimes require a Caesarean section. A Paediatrician is usually present at the delivery for caesarean sections.

When it comes to pain relief during childbirth there are many things that we can do to make you feel more comfortable in terms of techniques and medications.

One of the most important things that can help you to cope with pain during childbirth is having a good support person with you, whether that’s your spouse, partner, family or a friend. Often patients use massage, breathing techniques taught in antenatal classes, relaxation, mindfulness, yoga and hypnosis to help cope with the pain. There is evidence that acupuncture can help too during childbirth and using heat packs and finding the most suitable position is advised.

There are a number of conventional medications we can use to relieve pain too. Nitrous oxide is a commonly used gas which is administered by mask and helps to take the edge off the pain. Pain relief such as Pethidine or Morphine are injected into the muscles in the thigh to provide pain relief but have been known to cause some nausea, drowsiness or vomiting. Epidural or spinal anaesthesia is a technique of killing pain in the abdomen but allowing you to be fully conscious. It involves inserting a drip into your arm and a catheter into your bladder (because your bladder is numbed from the local anaesthesia).

It is often hard to tell what sort of pain relief you are going to require during childbirth, so having an open mind about all of your options is important.

An induction of labour means to start labour by using artificial means. We usually induce labour for medical reasons. At some time during the pregnancy, the decision needs to be made whether the baby is better off delivered or staying inside the uterus. Conditions such as high blood pressure or diabetes may be reasons for inducing the labour or if the pregnancy goes well past the due date and the placental function deteriorates, I would offer you an induction. Sometimes I am asked to perform inductions because people live a long distance from the hospital, or because their husbands may work in other countries and are in town for only a short period of time. These are called social inductions.

For an induction, we start labour by using hormones such as Prostaglandins. These allow the cervix to thin and to dilate, ready for birth. Sometimes a Foley catheter (which is a small water filled balloon) can be inserted into the cervix and traction applied to help dilate the cervix. Once the cervix is dilated enough, I then advise rupturing the amniotic sac; this is done using a small device (it looks like a little crochet hook) which makes a very small hole in the amniotic sac. If this fails to produce labour, our next step is to try to produce contractions using Oxytocin. This is a hormone, very like the hormone which your pituitary gland produces to make the uterus contract.

Although generally very successful, inductions, like all medical interventions, are not without their risks. Sometimes the uterus can contract too frequently and too strongly causing hyperstimulation or a rupture of the uterus. In other instances, the baby may become distressed and if this happens there is a high risk of Caesarean section. These problems are not usual but it’s important to be aware of the potential risks involved.

Pre-term labour is a labour that begins before 37 weeks and occurs in about 1 in 10 births. Babies that are born pre-term can suffer from a number of problems. Some of these include; a slower growth rate than full-term babies and vision, hearing, breathing and liver system problems may develop too..

There are a few features which will make a pre-term labour more likely. These include having had a previous pre-term birth, multiple pregnancy (twins and triplets). Having had surgery to your cervix for an abnormal smear, smoking, cocaine use, low placentas or placental separation, infection during pregnancy and an abnormal baby are risk factors for pre-term labour. Polyhydramnios (an increase in the amount of amniotic fluid around the baby) is another risk factor.

You may detect early labour if you become aware of an increase in low abdominal or pelvic discomfort, backache and contractions which may be either painful or painless. Another indicator can be a sudden gush of fluid meaning that your membranes have probably ruptured. Pre-term labour can be predicted by ultrasound as we can see a shortening of the cervix. Along with this, we can detect a substance called fetal fibronectin in the upper vagina which is a protein present in pregnancies which are more likely to deliver preterm. If you feel tightness in your abdomen coming more than every 8 minutes, I advise you to contact me for a review in hospital. In some cases if you have had a previous pre-term delivery, giving you Progesterone may reduce your risk of having another pre-term birth. If you are less than 34 weeks pregnant, it may be wise to stop the labour using drugs called Tocolytics. Nifedipine is one of these. We often give steroids such as Betamethasone or Dexamethasone to help mature babies’ lungs. Sometimes the baby may need to be delivered early because of particular problems with the pregnancy which may include fetal distress, fetal growth problems, bleeding during pregnancy, high blood pressure or infection.

Most patients who had a previous Caesarean Section are suitable to have a vaginal birth for their next pregnancy. Every case is a bit different and there are pros and cons both for repeat Caesarean Section and Vaginal Birth after Caesarean Section. VBAC generally has a lower risk of complications for the mother such as bleeding or infection and less pain after delivery, a quicker recovery and a shorter time in hospital. There are also risks with VBAC which I can take you through in your consultation.

How soon after a Caesarean Section should women consider having a VBAC?

Current advice suggests waiting 18 months before falling pregnant again. Pregnancies that occur less than 18 months after a Caesarean Section have a high risk of a uterine rupture and less likely success in women undergoing a VBAC. If you are over 35, because of the increased risk of fertility issues and other complications, a shorter wait period might be considered but we can discuss this at your visit.

Occasionally, a vacuum extractor or forceps might be needed to assist in delivery of your baby. This occurs at full dilatation and for the following reasons:

• Despite the mother pushing, the baby’s head is not progressively descending.
• The babies heart pattern shows distress.
• The mother is exhausted.
• The baby’s head needs to rotate.
• Some maternal medical conditions eg. hypertension.
• To control the head in breech deliveries.

There are definite risks to both the mother and baby associated with an instrumental delivery, which I can take you through in your consultation.