Assisted Delivery

Though childbirth is one of the most natural and uncomplicated process, it most often requires medical assistance. When normal labour is in progress, and conditions arise that seen to hinder delivery, various assisted delivery procedures can be used to deliver the baby.

The following medical procedures could be used to assist delivery if and when

  • The baby is in distress – especially during the second (pushing) stage of labour
  • The expectant mother is too tired and cannot push anymore
  • The baby is not making any progress through the pelvis
  • The mother has a medical condition (for e.g, heart disease) and cannot push anymore
  • There are twins or breach babies

Fetal Monitoring

When a difficulty in labour is suspected, fetal monitoring is usually performed to watch the baby’s heart rate for indicators of stress during labour and birth. There are various types of fetal monitoring through the fetoscope, Doppler and telemetry monitoring. But the most common method is electronic fetal monitoring that can be done externally or internally.

External Fetal Monitoring

An ultrasound device is placed on your abdomen to record information about baby’s heart rate, and the frequency and duration of your contractions.

Internal Fetal Monitoring

This method involves the use of two electrodes to record baby’s heart rate. While the membranes must be ruptured before the electrodes can be attached to the baby’s scalp, this is also the most accurate way of fetal monitoring.

Induced Labour

When labour needs to be started, due to a ruptured membrane or other complications, labour is usually induced with Pitocin, a synthetic form of the drug Oxytocin.

Amniotomy

An amniotomy is the artificial rupture of the amniotic membranes or sac, that contains the fluid surrounding the baby. It is usually done before or during labour to induce or augment labour or to check for other complications. Your Doctor might use an ‘amniohook’ to rupture the sac. Once this procedure is done, delivery should take place within 24 hours to prevent infection.

Episiotomy

An episiotomy is a surgical cut in the perineum, the muscular area between the vagina and the back passage. A local anaesthetic is usually given before the episiotomy is carried out. Having an episiotomy is no longer a routine part of labour. Your Doctor might suggest one if your baby is becoming distressed and needs to be born quickly, or if she thinks that you may tear very badly unless the opening from the vagina is carefully enlarged.

Recent studies have revealed that an episotomy usually results in pain, incontinence and poor healing, with very few benefits for either mothers or babies. So doctors today offer episiotomy only to women who will clearly benefit from the procedure.

Forceps Delivery

‘Forceps’ are twin steel blades that the doctor inserts into the vagina and around the baby’s head during a forceps delivery. You’ll have to put your legs in stirrups or supports at the side of the bed and the end of the bed will be removed. A catheter will be put into your bladder to empty it. Your doctor will need to make a cut (episiotomy) through the back of your vagina to enlarge the opening so that the forceps can be put round your baby’s head. Once the forceps are in place, the doctor will pull while you push during a contraction to help your baby move down through the birth canal and be born.

A Paediatrician is usually present for any birth that requires instruments. Most forceps births are straightforward, although you may experience some soreness and bruising afterwards – due to the stitches placed after the episiotomy. There is a small risk of permanent damage to your bladder or back passage. Injury during delivery can also result in bowel incontinence or the need to move your bowels urgently.

Ventouse (Vacuum Extraction)

A vacuum extraction is an alternative to forceps delivery, and your doctor will decide which is more appropriate for your circumstances. During this procedure, the doctor uses an instrument called a vacuum extractor, which has a suction cup that is placed on the baby’s head. A vacuum is created using a pump, and the baby is pulled down the birth canal with the instrument and with the help of the mother’s contractions.

The ventouse is considered less painful for the mother both during and after the birth. There is a lesser risk of bowel or bladder function being damaged than with forceps, and an episiotomy might not be necessary. Babies sometimes have cone-shaped heads for a couple of days when they’ve been born with ventouse. A blood blister may form on top of the baby’s head, but this usually disappears in a week.

 

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