How will your birth affect your baby?

Sometimes an intervention is the best way to get the smooth and pain-free labour we all hope for, but are drugs and surgery OK for your baby? Here’s what you need to know

While it’s great to make an informed choice about what you do and don’t want to have at the birth of your baby, sometimes too much information can be a bad thing. ‘I’m meant to be writing my birth plan,’ says Katie Lowdon, 31, whose first baby is due in five weeks.

‘I don’t want to rule anything out unnecessarily, but I don’t want to put my baby in any danger, either. I keep being told different things, or I do an internet search and find yet another terrifying study. How am I supposed to make up my mind?’

Here are some of the most common types of intervention you may be considering – and the possible effects they may have on your baby. And while everyone has their own reasons for wanting to avoid some interventions, it’s good to know that if you do find yourself pleading for help to get you through on the day, the risks to your baby really are very low.

Plus remember, intervention is used to get your baby out safely – your health and that of your baby is the most important thing to consider. 
 
Gas and air

Gas and air, or entonox as it’s properly known, is a mixture of oxygen and nitrous oxide that you breathe in to ease the pain of labour. It gets the all-clear from pretty much everyone.

‘As far as we know it doesn’t have any lasting effects because it goes through the mother’s lungs very quickly,’ says midwife Sue Macdonald, of the Royal College of Midwives.

Pethidine

Pethidine is a drug many women decide to avoid. It stays in the mother’s system a lot longer than gas and air, and crosses the placenta to the baby. This can mean some babies are slow to start breathing after they are born as Pethidine can have a depressive effect on a baby’s respiratory system – but this is most likely to happen if you’re given Pethidine in the hour before you actually give birth.

And if it does occur, your baby can be injected with a drug that reverses the effects – although the worst case scenario sees some babies drowsy for a few days after that.

Epidural

Epidurals stir up a huge amount of controversy, so it’s hardly surprising that if you look hard enough, you can find studies that suggest babies born after an epidural are drowsier to start with and then prone to all sorts of problems. Before you get worried though, it’s best to put these statements in a bit of context.

Today’s epidurals are a lot more sophisticated than previously and don’t ‘cosh’ you in the same way. Mr Patrick O’Brien, consultant obstetrician at University College Hospital in London, says, ‘If you put all the studies together, epidural doesn’t have a negative effect.

Occasionally, a top-up epidural can drop the mother’s blood pressure briefly, which can make the baby a bit unhappy for a few minutes, but that doesn’t last very long and it’s likely to be over well before birth. Other than that, epidural is perfectly safe for the baby.’

But what about the theories that an epidural can kick off the whole ‘spiral of intervention’ – like the need for forceps, ventouse or episiotomy? ‘The most recent take on epidurals is that it doesn’t increase the risk of Caesarean,’ says Patrick O’Brien.

‘What an epidural does do is make it a bit more difficult to push, so the statistics are that the risk of instrumental delivery (using ventouse or forceps) goes from seven to 12 per cent.

But there’s still an 88 per cent chance you’ll have the baby normally.’ He says it’s also important to remember that most of those studies were also done on the old-style epidural – these days many places are using a mobile epidural, which doesn’t interfere with your ability to push nearly as much.

And midwives today know a lot more about how to get your delivery working with – rather than against – an epidural, so will wait until the contractions have moved the baby down to the pelvic floor before telling you to push.  
 
Forceps

It’s common consensus that forceps can bruise the baby’s head – very occasionally they can also bruise the nerves in the face, or even cause a small fracture. Babies can also get a cephalhaematoma, or scalp blister, which clears up after a few days. Very rarely, there’s a permanent mark.

It’s hardly surprising that, as midwife Sue Macdonald puts it, ‘Babies born after forceps can get very shaky and jittery, because they’ve got a bit of a headache.’ Because of this, many hospitals prefer to use ventouse instead.

Ventouse

Babies who’ve been ‘hoovered out’ often have cone-shaped heads for a couple of days. Sometimes a haematoma, or blood blister, can develop on top of the head – and this can be quite serious because it’s accumulating over a third of the blood in their bodies. ‘The overall effect of ventouse can make the baby jaundiced after the birth, and can cause some pain,’ says Sue Macdonald.

‘Generally, though, ventouse is carried out by skilled midwives and doctors, and the equipment is much more sophisticated than it used to be’. And before you rule out an instrumental delivery completely, Patrick O’Brien points out,

’There are certain situations where it’s safer than a Caesarean, say if you’ve been pushing for an hour and the head is deeply engaged. It’s reasonable to say that if you have a choice, ventouse is preferable over forceps.’  

Caesarean section

Having a Caesarean is sometimes wrongly treated as a ‘failure’ – but birth isn’t a competition. And some babies born after a Caesarean do have serious complications – but the section itself is very rarely to blame.

It is a fact that Caesareans are linked to potentially serious breathing difficulties – one study suggests that babies delivered in this way are four times more likely to experience this. But this statistic applies only to Caesareans that are planned – that is, those where the mum doesn’t go into labour at all.

Labour helps get the lungs working, the contractions squeeze them into action, and the whole ‘stress’ of labour seems to develop them as well. And among planned Caesareans, the risk goes down dramatically, the closer to 40 weeks’ gestation you get.

According to NHS clinical guidelines, the likelihood drops from four per cent at 38 weeks to under two per cent at 39 weeks, and at 40 weeks the likelihood is even less.

No-one wants to be that one person in 50 but, as Sue Macdonald says, ‘If you’re having a Caesarean there’s usually a reason. And if the baby is having breathing difficulties, they’re in the right place for it to be dealt with.’

Read all about it

If you’re writing your birth plan and want more information, good books to check out are, The Great Ormond Street New Baby and Child Care Book (Vermilion, £15.99) by Tessa Hilton, Maire Messenger and Philip Graham; or Mums on Pregnancy: Trade Secrets from the Real Experts (Cassell Illustrated, £9.99) by Rachel Foster, Carrie Longton and Justine Roberts.