Interventions during labour#
Pain relief#
Pain relief options include:
Gas and air (Entonox) - breathe in through mask/mouthpiece just as a contraction begins
Pethidine injections - injected to thigh or buttock, last 2-4 hours, not recommended if close to pushing (second stage)
Epidural - type of local anaesthetic given through a drip, will then need to monitor contractions and baby’s heart rate continuously
Remifentanil - into vein on arm, lasts a few minutes, control with push of button, will need to monitor oxygen levels
Anecdotally, Steve Thornton says this is not used on their unit
Water birth - being in water can help contractions seem less painful
TENS machine (transcutaneous electrical nerve stimulation) - most effective during early stages when you may have lower back pain
Speeding up labour#
If labour is slower than expected, which can happen if contractions are not coming often enough, aren’t strong enough, or baby is in an awkward position, then a doctor/midwife may consider ways to speed up labour:
Breaking your waters, also known as artificial rupture of the membranes (ARM) - midwife/doctor makes a small break in the membrane that contains the fluid around the baby, which will often lead to contractions being stronger and more regular.
Oxytocin drip, also known as syntocinon - if breaking waters doesn’t work, then doctor/midwife may suggest this to make contractions stronger, it’s given through a drop into a vein (usually wrist or arm).
Delivery of the baby#
Episiotomy#
Episiotomy - small cut made to perineum (area between vagina and anus), which may be suggested to avoid tear or speed up delivery, local anaesthetic injection given to numb area before making cut, then episiotomy or any large tears are stitched up after the baby is born.
Assisted delivery#
Assisted delivery (assisted birth, or instrumental delivery) - forceps or ventouse suction cups used to help deliver the baby. A local anaesthetic is given to numb the perineum if have not already had an epidural. It is likely that an episiotomy will be needed.
Ventouse (vacuum cup) - a ventouse is attached to the babys head by suction, and the obstetrician/midwife pulls gently during a contraction
Forceps - the forceps are smooth metal instruments (similar to spoons/tongs) that are positioned around the babies head, which the obstetrician pulls gently during a contraction. Some forceps are specifically designed to turn the baby to the right position for birth.
An assisted delivery is used in about 1 in 8 births, and may be needed if:
you have been advised not to try to push out your baby because of an underlying health condition (such as having very high blood pressure)
there are concerns about your baby’s heart rate
your baby is in an awkward position
your baby is getting tired and there are concerns that they may be in distress
you’re having a vaginal delivery of a premature baby – forceps can help protect your baby’s head from your perineum
you require an epidural for pain relief during labour
Caesarean section (C-section)#
In the UK, around 1 in 4 pregnancies are a caesarean birth. They can be planned (elective) or emergency. They are carried out by an obstetrician. They involve a cut about 10-20cm long being made across someone’s lower tummy/womb. It is usually done under spinal or epidural anaesthetic, and typically takes 40 to 50 minutes. Elective caesareans are usually done from the 39th week of pregnancy.
Caesareans may be done if:
your baby is in the breech position (feet first) and your doctor or midwife has been unable to turn them by applying gentle pressure to your tummy, or you’d prefer they did not try this
you have a low-lying placenta (placenta praevia)
you have pregnancy-related high blood pressure (pre-eclampsia)
you have certain infections, such as a first genital herpes infection occurring late in pregnancy or untreated HIV
your baby is not getting enough oxygen and nutrients – sometimes this may mean the baby needs to be delivered immediately
your labour is not progressing or there’s excessive vaginal bleeding
Delivery of the placenta#
There are two ways to manage the third stage of labour (delivery of the placenta):
Active - using treatment to make it faster
Physiological - no treatment, stage happens naturally
Active treatment involves giving an injection of oxytocin to the thight to make the womb contract. Once the placenta has comes away from the womb, the midwige will pull the cord to remove it from the vagina (usually within 30 minutes of the baby being born).
Active management speeds up delivery of the placenta and lowers the risk of postpartum haemorrhage (heavy leeding after birth), but increases change of being/feeling sick and can make afterpains (contraction-like pains after birth) worse.