Intervention procedures during labour

The fact is that your body was designed to be able to carry and give birth to a baby. But that’s not to say that you might not need a helping hand when it comes to the crunch of labour. Here's some information about some of the intervention procedures that are sometimes used during labour

Many of us know at least one woman who claims to have eased her baby out while doing the Killer Sudoku, but for every woman in the UK who gives birth without any form of intervention, there’s another who needs some help. According to BirthChoiceUK, 10.8% of babies are born with the help of the forceps or ventouse.

This can come as a shock if you’re unprepared, as Anne, 32, mum to Solomon, five months, found. “I had big plans for a totally natural birth,’’ she says, “but ended up having almost every form of assistance. It was very distressing - although you just don’t care once you’re holding your baby. The means by which they got here becomes totally irrelevant.”

“The best way to avoid intervention is by being prepared for labour,” says Janet Balaskas, founder of the Active Birth Centre. “The more you practice breathing techniques and remain mobile, the better able you’ll be to cope with the pain of labour.

Watching your posture in your last trimester is also valuable as this will encourage the baby into the optimal fetal position (where the baby’s back is to your front) which lessens the likelihood of needing the forceps or ventouse.” Here are some of the reasons you may need an assisted delivery and what may happen.

Augmentation

If labour has started, but then stopped or slowed down, or if you’re having contractions but your cervix is not opening up, your midwife may suggest augmenting, or accelerating, your labour. Although every labour is different, adequate progress is generally considered to be 1cm of dilation per hour for a first-time mum.

What does it involve?

Artificial rupture of membranes – having your waters broken – is one option. Otherwise Syntocinon, a drug which imitates the action of oxytocin, the hormone produced in labour to stimulate contractions, is administered via a drip.

What does it really feel like?

Women whose labours are augmented often experience sharper and more relentless pain; this is probably because your labour advances quickly, without giving your body a chance to build up endorphins in the way it does during a labour that progresses naturally.

“It’s more painful than normal labour,” agrees Sasha, 31, mum to Grace, two, and Millie, six months. “But it’s also more bearable, because you know you’re actually getting somewhere and that it will be over more quickly.”

How can I avoid it?

Stay at home for as long as you possibly can; a change of environment in labour is associated with contractions stopping or slowing down. Stay upright and mobile to simulate your contractions, and keep sipping water, as dehydration can also slow labour.

“Above all, keep breathing”, says Francine Allen, of The Royal College of Midwives. “Anxiety and fear can hinder your labour, so you need to feel as relaxed and as confident as possible.

Visualisations of relaxing images can really help” Don’t forget, you can refuse augmentation – and any other treatment – and just let nature do it’s thing, however long it takes, provided your baby is ok, of course.

Episiotomy

The mere mention of this procedure has many mums-to-be crossing their legs, but routine episiotomies are not performed today, as it’s now believed to be better to allow you to tear naturally.

Reasons for needing one include avoiding a large or jagged tear if your baby has a large head, or, if you need a forceps or ventouse to help ease your baby out, to allow a little extra room to manoeuvre.

If your baby’s heartbeat is giving cause for concern in the last minutes of labour, an episiotomy might also be performed to allow him to born as quickly as possible.

What does it involve?

There’s no nice way of putting it: quite simply, an episiotomy is a cut in the perineum, the area between the vagina and the anus, using special scissors, to increase the vaginal opening and make it easier for your baby to come out.

What does it really feel like?

You’re unlikely to feel a thing: most episiotomies are performed in the last minutes of labour, by which time the perineum is so stretched that you’ll hardly register the cut. If there’s time, you might have a local anaesthetic, which will also be used afterwards when you’re being stitched up.

“The procedure itself isn’t painful at all,” says Joanna, 27, mum to Maxwell, three, and Simona, six months. “It’s in the following weeks that you’ll feel uncomfortable.” Her advice? “Arnica is fantastic, as is sitting in a warm bath with a few drops of lavender oil and tea tree.

Those doughnut-shaped cushions are great, too, as they help take pressure off your bits.” The first few times that you go to the loo can be a bit scary, so drink lots of water and eat fibre-rich foods to avoid straining.

How can I avoid it?

Talk to your midwife or write a birth plan that makes it clear that you want to give the area time to stretch naturally. Perineal massage, using Vitamin E or pure vegetable oil, is also considered to reduce the likelihood of tearing or needing an episiotomy; start doing this about 5-6 weeks before you’re due.

Since you’re more likely to have a forceps delivery – and therefore an episiotomy – with an epidural, you might also want to consider other forms of pain relief.

Ventouse/ Forceps

An instrumental delivery might be needed to get the baby out if things have stalled or slowed during the second stage of labour, particularly if you are tired and unable to push any longer, or if your baby is showing signs of distress.

It may also be that your baby is an awkward position for exit. Of the two, most doctors prefer to use the ventouse, as this is considered to cause less damage to the walls of the vagina.

What does it involve?

Forceps look a bit like metal salad servers; they’re placed on either side of your baby’s head (an episiotomy is usually necessary to create room to insert them).

Episiotomies are less likely with a ventouse, which is effectively a suction cup placed on top of the baby’s head to ease him out, while you continue to push. It can take a few minutes to build up the necessary suction, so if your baby needs to be born urgently, it’s more likely that the forceps will be used.

What does it really feel like?

“Pure relief!” says Sophie, 36, mum to Jago, three months. “I had been pushing for so long, but Jago’s head just kept slipping back in. By the time they got the ventouse, I wouldn’t have cared if it was a kitchen plunger – I just wanted his head out!”

Most mums and babies will feel a bit sore after an instrumental delivery, and your baby may have bruising to the face or scalp and/or a bit of a ‘cone-head’ for a few days.

How can I avoid it?

You’re more likely to need forceps if you’ve had an epidural, so opt for other methods of pain relief, if possible.

Caesarean

Some Caesareans are planned, but in other instances, an emergency caesarean might be necessary due to circumstances that arise once labour has commenced: the placenta separating from the wall of the uterus, putting the mother at risk of haemorrhage, for example, or your baby’s heartbeat indicating that he is getting distressed. 

What does it involve?

An incision is made in your stomach and uterus so that your baby can be delivered through your abdomen: it’s a major procedure and you’ll either be given a local anaesthetic (epidural or a spinal) or, in some cases, a general.

Before the operation, you’ll be attached to a drip, to ensure that you have enough fluids throughout the operation and a catheter will be inserted to empty your bladder. 

What does it really feel like?

“Surreal,” says Rachel, 33, mum to Josh, four. “I could feel rummaging and tugging, but there was no pain at all – it felt as if someone was doing the washing up in my stomach.”

In the weeks following the delivery, you’ll probably feel some discomfort and will be instructed to take it easy: accept all offers of help and keep up with your pain medication, if it has been prescribed.

How can I avoid it?

Because emergency Caesareans are performed in response to situations that arise during labour, there’s little more you can do than to look after yourself throughout your pregnancy to ensure that you and your baby are in the best possible health at delivery time.

Being obese is linked to a much greater likelihood of needing an emergency Caesarean, according to a study by University College London Obstetrics & Gynaecology dept., so achieving a healthy weight before you fall pregnant is advisable.