Assistance in Labour - Knowledge Area

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GIVING BIRTH - ASSISTANCE IN LABOUR

All sorts of things can happen when you are giving birth to a baby and no two labours are the same.

Here are some of the procedures that you may have to assist you during labour. For more detailed information, please talk to your midwife or GP.

For detailed information about Caesareans, please click here and for information about Pain Relief, click here.

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Induced Labour

What does it mean?

Starting off labour artificially, usually using hormones to make the womb contract.

Why might I be induced?

There are various reasons, these are some of the main ones:

Overdue - Being 10-14 days past an accurate due date (this is the most common reason). The placenta works less effieciently after 42 wks and the baby's skull may become too hard to be able to mould during it's passage down the birth canal.
Pre-eclampsia - pregnancy related high blood pressure and protein in urine which can cause serious problems to both the mother & baby.
Rhesus incompatibility - if your blood type is Rhesus negative & the father's is Rhesus positive there is a chance that the baby will be Rhesus positive which is incompatible to your blood type. Doesn't occur in first pregnancies but there may be complications with later pregnancies.
Waters breaking early & the baby is at risk of infection
If you have diabetes

What happens?

There are various medical options, but it's worth trying some natural ways (unless your induction is due to a medical emergency) to get things going first.

Naturally inducing labour

None of these are strongly medically proven but there is some anecdotal evidence (although if you are already overdue, it's difficult to know if your contractions started naturally or because of the remedy) and it's important to check with your midwife first.

Homeopathic remedies - Pulsatilla and Caulophyllum are 2 remedies commonly used to bring on labour, but contact a registered homeopath first, via the Society of Homeopaths.
Herbal remedies - these are much stronger than homeopathic remedies and should always be used under professional guidance. Contact the National Institute of Medical Herbalists.
Acupuncture - (fine needles inserted into specific points on the body) - shown to be safe for mother and baby and may be effective. Find a qualified practitioner via the British Acupuncture Council.
Raspberry Leaf Tea - this is often cited as a way of inducing labour but there is no proof. However, it has been shown to speed up the 2nd stage of labour and can be safely sipped during labour. Tablets also available.
Spicy food - if you're overdue you are guaranteed to be advised by at least one person to have spicy food. Not a good idea if you find very hot food intolerable and you may just get heartburn. It is possible it stimulates the gut and bowel and this in turn stimulates the uterus to contract but it nothing else, it takes your mind off things for a while!
Sex - another thing that, if it doesn't work, will have distracted you for a while! May help to stimulate the uterus, may trigger the release of oxytocin (hormone that starts contractions) and sperm can help soften the neck of the womb. Not safe, though, if your waters have already broken, if your placenta is low lying or if you have had vaginal bleeding during pregnancy. At this late stage, you may find it uncomfortable, or at least awkward.
Nipple stimulation - it is thought that oxytocin (the hormone causing contractions) is released when breasts are stimulated. Can produce very strong contractions, so be careful, but tests show it can work. Massage the whole areola (dark area around the nipple), not just the nipple, for 15 mins every hour for several hours (probably best to stay at home!).
Go for a Walk - a gentle walk can get things going, with gravity helping and the baby's head pushing down can stimulate release of oxytocin. Don't overdo it though - you'll be in labour at some time soon and you don't want to be tired already. A bumpy car journey could do the same without you getting tired (not too bumpy though!).
Get ready - some people say that being physically and emotionally ready for the birth (ie, bags packed, friends on standby etc) can help to start labour and not being ready could be a psychological barrier.

Medically Induced Labour

You should be able to fully discuss any of these options with your doctor or midwife prior to them being carried out, and they will explain whether there are any risks to you or your baby.

Membrane Sweeping - increases chances of labour starting naturally within 48 hours. The midwife or doctor places a finger just inside your cervix and makes a circular "sweeping" movement to separate the membranes from the cervix. Can cause discomfort or bleeding but will not cause harm to your baby or increase the risk of infection. Can be carried out at home, as an outpatient or in hospital.
Artificial Rupture of Membranes (ARM) or Amniotomy - if your waters have not broken the midwife or doctor may make a small hole in your membrane to release (or break) the waters. Done during an internal examination through the vagina using a small instrument like a fine crochet hook. Causes no harm to the baby but can be uncomfortable.
Prostaglandins - hormone-like drugs that encourage the cervix to soften and shorten, allowing contractions to start. Administered as pessary or gel inserted into the vagina and then you should lie down for 30 mins. Carried out in hospital and doses given every 6-8 hours if required. The baby's heartbeat should be monitored beforehand and then during contractions until it is known that everything is ok. Should be no more painful than a naturally started labour.
Syntocinon/Oxytocin - syntocinon is the synthetic form of the hormone oxytocin which stimulates contractions. Administered via an intravenous drip - once contractions begin the rate of the drip is adjusted so that contractions occur regularly until the baby is born. You are more likely to have an epidural to help cope with the pain as contractions stimulated by syntocinon can be very strong, and your baby should be continuously monitored.

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Speeding up Labour

Why might my labour need to be speeded up?

Giving birth does not have a set time and will be different for everyone. However, if your labour is taking very long and you and the baby are getting exhausted it is worth trying to speed up labour, also known as augmentation. Discuss any procedure with your midwife first.

Depending on your situation, it is worth trying some natural methods first to help open your cervix, before the medical procedures.

Naturally speeding up labour

Keep upright and don't stay lying down
Regularly change your position and try going for a wander around
Empty your bladder as a full bladder can slow down labour
Try to stay relaxed - this can make labour more enjoyable and therefore easier to cope with
Ask your birth companion or the midwife to give you a back massage
Keep up your energy levels - make sure you are eating and drinking sensibly
Rock your hips and lean forwards during contractions to help your womb push the baby firmly down into the cervix

Medically speeding up labour

These 2 procedures are also listed above for inducing labour and should be carefully discussed with your midwife or doctor:

Artificial Rupture of Membranes (ARM) or Amniotomy
Syntocinon/Oxytocin

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Episiotomy

What is it?

An episiotomy is a deliberate cut in the perineum, an area of skin and muscle between the vagina and the back passage/anus.

A local anaesthetic will be administered or if you already have an epidural this may be topped up. After birth the cut is stitched, usually with dissolvable stitches, and should heal within 3 to 4 weeks.

Why might I need one?

During birth, the baby's head stretches the opening of the vagina and can cause it to tear. It is important that the tear goes in the right direction and although previously 90% of women giving birth naturally had an episiotomy, it is less likely now unless the baby is in distress or if the mother is at risk of severe tearing. An episiotomy can help avoid serious and uncontrolled tearing.

Other reasons for needing one include:

a very large baby (whose head is hard to push out)
an awkwardly positioned baby
a previous birth tear that has been repaired, but which may split again
previous pelvic floor surgery
unusually short perineum, the area of skin between the vagina and anus
during a forceps or ventouse delivery

Can it be avoided?

Discuss your options with your midwife during antenatal care and during labour, such as position and what she can do to help. Using a Birthing Massage Oil can help.

Can there be complications?

The most common complications following an episiotomy can include:

Pain - an episiotomy can add to the bruising of your vaginal area and perineum. You can take mild painkillers (on the advice of your midwife or health visitor) and cold or warmth may help to ease the pain.
Constipation - if the tear has spread to the anus you could become constipated, or you may be concerned about going to the toilet because of the stitches (tearing whilst using the toilet is unlikely). Hold some clean toilet paper or a sanitary towel over the stitched area when you need to do a poo, which can also help to keep the area clean.
Incontinence - this can occasionally occur but should disappare once the bruising and swelling has gone down. If not, you may be referred to a specialist.
Getting comfortable - you may find it difficult finding a comfortable position ot sit down. Try sitting on a cushion or rubber ring, and sit down carefully.
Bonding - the pain & discomfort you may feel due to the episiotomy can sometimes interfere with bonding with your new baby, so do be aware of this and discuss any emotional problems with a health professional

Recovery

Your midwife will discuss the best way towards quick healing following an episiotomy, such as which activities should be avoided, but here are some hints:

Keep the area clean, and when going to the toilet, wipe carefully from front to back
Ice packs, warm baths and herbal remedies (calendula cream or arnica) can be helpful
Take painkillers such as paracetamol or ibuprofen, but check with your midwife, GP or health visitor first
Do pelvic floor exercises regularly following the birth as these can help the muscles heal more quickly

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Forceps & Ventouse Assistance

What are they?

Both are instruments that attach to the baby's head to help with pulling it out during delivery. If your midwife or doctor feels that either of these might be necessary they will discuss your options with you first.

Forceps - a bit like large salad tongs made from stainless steel with curved ends to grip the baby's head.

Ventouse - or vacuum extractor. A silicon or metal cup on a small vacuum pump which is attached to the baby's head. The type of cup used may depend on the baby's position.

Why might they be used?

If your baby has become distressed during the second stage of labour (the pushing bit)
If you are very tired and cannot push any more
If the baby is not making progress through the pelvis
If you have a condition such as heart disease which prevents you from pushing for too long
If you are having twins and need help with the second one
If the baby is breeched - ie, bottom first instead of head first. About 1 in 20 breech babies are born using forceps.

What happens?

If you require assistance using instruments such as these it is likely that a paediatrician (baby doctor) is in attendance.

You will need to lie down on a bed and put your legs in "stirrups", or supports to keep them in the correct position. The end of the bed is removed so the doctor or specially trained midwife has easier access.

A catheter will be inserted to empty your bladder and your legs will be covered in sterile sheets.

The doctor or midwife will most likely perform an episiotomy (see above) but this is less likely with ventouse.

For a forceps delivery, the doctor or midwife will place them through the vagina to reach and grip the babies head, and once in place the doctor will pull while you have a contraction to move the baby down the birth canal to be born.

For a ventouse delivery, the doctor or midwife will place the ventouse cup on the baby's head, through the vagina, and suck the air out using a vacuum pump (this can be noisy). Once the cup is securely in place you will push with your next contraction and the doctor will pull the baby at the same time. Sometimes the cup may need to be replaced and the procedure repeated.

How might this affect the baby?

Following a forceps delivery the baby may be slightly bruised or scratched but this will clear up in a few days. More rarely, the facial nerve may be damaged causing a palsy so the baby's mouth droops at one corner but this is also usually temporary.

Following a ventouse delivery, the baby may have a cone-shaped head but just for a couple of days. A blood blister may form where the ventouse cup was attached but this usually goes within a week.

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Personal Experiences

If you have experienced anything that we have covered here we would really like to hear from you.

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