Intervention during labour

Even the most detailed birth plan can’t guarantee that things will go exactly as you’d hoped. So, just in case, it pays to be prepared and know about the common problems that can arise during labour, and the type of intervention they’re likely to require.

INDUCTION involves bringing labour on artificially and is used when delivery is a safer option than continuing with the pregnancy, as long as there’s no reason to perform a Caesarean. ‘Reasons for induction include pre-eclampsia, which can only be cured by delivery,’ says Jackie Ross, obstetrician at London’s King’s College Hospital, ‘or being overdue, as delivery after 42 weeks is associated with more problems in labour.’

How does it work?

‘There are three possible options,’ explains Jackie. ‘A drug called prostaglandin can be inserted into the vagina [in pessary form] every six hours to stimulate your cervix opening; your waters can be broken; and, finally, a Syntocinon drip can be used - this imitates oxytocin, the hormone produced in labour to stimulate contractions.

Labour may start with just the prostaglandin, or require all three steps – or, as induction doesn’t always work, a Caesarean may ultimately be necessary.’

It happened to me…

‘I was two weeks over my due date before I was induced,’ says Maxine Timbs, 32, from Tunbridge Wells, mum to Jamieson, 3, and Graciela, 14 months. ‘Having now experienced ‘normal’ labour, I’d say the induction was more painful, because my body didn’t have time to build up the endorphins that help you to cope with the pain - but at the same time, it was a relief; I was desperate to get Jamie out!’

What’s the alternative?

If you’ve been booked in for an induction for medical reasons e.g. you have gestational diabetes, there usually isn’t an alternative. But if it’s just due to you going over your due dates, you’ll usually be given a couple of days to decide what you want to do and may first be offered a ‘sweep’ by your midwife, which involves inserting her finger into your vagina and ‘sweeping’ it around your cervix to separate it from the membranes surrounding your baby, which releases natural prostaglandin hormones to help start labour naturally.

AUGMENTATION is used to speed up a labour that has already started but is progressing more slowly than expected, and to help reduce the physical stress that a long labour may cause to both you and your baby.

How does it work?

‘The first step is to break the waters,’ explains Jackie. The midwife or doctor uses a plastic stick to pop a small hole in the membranes that surround the baby. This releases the amniotic fluid and stimulates your natural prostaglandins to increase contractions. If the labour is still progressing slowly, you’ll be given Syntocinon via a drip. 

It happened to me…

Francie O’Neill, 31, from Macclesfield, mum to Jasmine, 8 months says, ‘The worst thing about being on the drip was that it involves continuous monitoring of the baby’s heartbeat, so it reduced my mobility. But after a 36 hour labour I was pretty exhausted by that point!’

What’s the alternative?

Stay at home for as long as possible before heading for hospital, since a change of scene is often associated with labour slowing down. Staying upright and as mobile as possible can also help to keep your contractions strong and regular.

FORCEPS look similar to salad servers, and are used in the second stage of labour when the baby has descended but can’t quite get out, either because of his position, maternal exhaustion or weak contractions.

How does it work?

‘The forceps are placed on either side of the baby’s head and used to help turn it to a more favourable position,’ says Mervi Jokinen, Practice and Standards Development Adviser at the Royal College of Midwives. ‘This needs to happen with a contraction – the mother pushes, the doctor pulls – so if the contractions are weak, Syntocinon can be used to help create a really strong push.’

Be aware, too, that an episiotomy [deliberately cutting the skin between your vagina and anus] is often necessary to create enough room to insert the forceps.

It happened to me…

‘It wasn’t at all scary when it happened to me because my team of doctors and midwives were very clear in explaining exactly what was going to happen and why,’ says Imogen Perry, 38, from London, mum to Calypso, 7 months. ‘And there was only a tiny bit of bruising to Callie’s head.’

What’s the alternative?

There’s ventouse (see below) – which tends to be used more frequently than the forceps, as it’s softer on the baby and the walls of your vagina. However, the forceps offer the doctor a better ‘grip’ and more control, so if your baby needs to be born urgently, these will probably be the instrument of choice.

VENTOUSE is a small, soft silicon suction cup that attaches to your baby’s head. As with the forceps, it’s used if you’re exhausted or your baby’s in an awkward position.

How does it work?

‘The ventouse is attached to a machine, which controls the amount of vacuum suction, and there’s a choice of different sized cups according to the size of the baby’s head,’ says Mervi.

‘It can take a few minutes for the suction to build up; your baby’s head will then be eased out while you push.’

It happened to me…

‘I’d been pushing for hours but Max’s head kept slipping back,’ says Kate Davey, 27, from Sheffield, mum to Max, 14 months. ‘It was such a relief to have him out. I kept pushing so I felt like I was helping, but this time he actually came out!’

What’s the alternative?

A change of position can be useful for getting the baby into a good exit position and keeping things moving, but, says Mervi, ‘This will have been tried before resorting to the ventouse or forceps.’

An emergency caesarean

This will be advised when the obstetrician believes that a vaginal birth will be too risky for the mother, baby, or both, such as if the baby is showing signs of distress before the cervix has fully opened e.g. if your baby’s passing meconium or his heart suddenly drops and stays low, or if your blood pressure raises suddenly.

How does it work?

‘You’ll be wheeled into the operating theatre, usually with your birth partner,’ says Jackie. ‘In most situations there’ll be enough time for an epidural to be administered so that you can be awake to see and hear your baby being born, but if a very rapid delivery is needed, a general anaesthetic may be used.’

A horizontal cut is made at the bottom of your abdomen, through to your uterus, and the baby is delivered through the incision. Unless you’ve had a general anaesthetic, you’ll be able to hold your baby almost immediately, including while you’re being stitched up.

It happened to me…

‘After 18 hours of labour, my baby’s heart rate had dropped so alarmingly that the procedure itself was not one-tenth as terrifying as the thought that he was in trouble,’ says Caroline Hodges, 36, from  Bristol, mum to Zack, 2, ‘I was just glad to be having him delivered safely. Having said that, the following weeks were a bit tough – I was achey and my recovery was quite slow, so my mum came to stay and help out.’

What’s the alternative?

Since the decision to perform an emergency Caesarean will be made in response to situations that arise in labour, there won’t be much you can do to avoid it. Although it’s unlikely you’ll need one, it doesn’t hurt for you and your partner to be prepared and know as much about the procedure as possible beforehand, so that you feel more informed and in control if the situation arises.

Remember that the decision won’t be taken lightly – it will only ever be made with yours and your baby’s safety in mind so at no point must you feel like you’ve ‘failed.’ What matters after any delivery is a healthy mum and baby.