Labour: When extra help is needed to deliver your baby

Sometimes during labour and birth things don’t go according to plan and you will be offered medical intervention. Your consent will be required before any treatment is given.

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 will only be offered if it is thought to be necessary for the wellbeing of either you and/or your baby. Any treatment will be explained so that you will make an informed choice about whether to have it or not.

Breaking the waters (amniotomy)

It may be necessary to have your waters broken during labour. 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.  This is usually because:

• Contractions are not as strong as they should be
• Labour is taking longer than expected
• There are concerns about baby
• Your baby needs to be monitored differently
• Need to be induced

Once the waters have been broken labour often continue its course. If this doesn’t happen additional care and intervention may be necessary which includes:

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 you and your baby can be monitored continuously.

Fetal monitoring

During labour your baby’s heartbeat will be monitored to make sure that he is not distressed, it may be necessary to monitor your baby’s heartbeat with a monitor. A fetal blood sample may also be taken.

Continuous monitoring

If your baby’s heartbeat needs to be monitored more closely you will be offered electronic fetal monitoring (EFM), also known as CTG. This means you are attached to an EFM which will be used throughout labour. Your baby’s heartbeat is recorded continuously so that your midwife or doctor can see how well your baby is coping.

Fetal Scalp Electrode

Sometimes a fetal scalp electrode, or ‘clip’ is attached to your baby’s head which then picks up the heartbeat directly.

Assisted delivery

This is when instruments are used to assist the baby's birth. 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 may have a bruise on its head, but this will disappear soon after delivery. You may need a local anaesthetic and an episiotomy (a cut to the vaginal opening) with this type of birth.

Forceps 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 forceps delivery is most commonly used for babies whose heads are in an awkward position or to protect the heads of preterm babies. You will need an episiotomy and offered appropriate pain relief.

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 or midwife 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.

Most Caesareans are performed using a spinal block or epidural which means you will be awake during the operation.

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 complications such as pre-eclampsia, a low-lying placenta or if the baby is too big or too small or is lying 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).