When nature needs a hand

An assisted vaginal birth is where a doctor or midwife uses specially designed instruments to help deliver the baby during the last part of labour.

Why might I need help with the birth of my baby? There are several reasons. The main reasons are:

• your baby is not moving out of the birth canal as would normally be expected
• there are concerns about your baby’s wellbeing during birth
• you are unable to, or have been advised not to, push during birth

The purpose of an assisted vaginal birth is to mimic a normal (spontaneous) birth with minimum risk to you and your baby. To do this, an obstetrician or midwife uses instruments (ventouse or forceps) to help your baby to be born.

A caesarean section, or C-section, is an operation to deliver your baby through a cut made in your tummy and womb.

The cut is usually made across your tummy, just below your bikini line. A caesarean is a major operation that carries a number of risks, so it’s usually only done if it’s the safest option for you and your baby.

A caesarean may be recommended as a planned (elective) procedure or done in an emergency if it’s thought a vaginal birth is too risky.

An induced labour is one that’s started artificially. Every year, 1 in 5 labours are induced in the UK. Sometimes labour can be induced if your baby is overdue or there’s any risk to you or your baby’s health. This risk could be if you have a health condition such as high blood pressure, for example, or your baby is not growing.

Induction will usually be planned in advance. You’ll be able to discuss the advantages and disadvantages with your doctor and midwife, and find out why they think your labour should be induced.

It’s your choice whether to have your labour induced or not.

If your pregnancy lasts longer than 42 weeks and you decide not to have your labour induced, you should be offered increased monitoring to check your baby’s wellbeing.

Your midwife will monitor you and your baby during labour to make sure you’re both coping well.

This will include using a small handheld device to listen to your baby’s heart every 15 minutes. You’ll be free to move around as much as you want.

Your midwife may suggest electronic monitoring if there are any concerns about you or your baby, or if you choose to have an epidural.

Electronic monitoring involves strapping 2 pads to your bump. One pad is used to monitor your contractions and the other is used to monitor your baby’s heartbeat. These pads are attached to a monitor that shows your baby’s heartbeat and your contractions.

Sometimes a clip called a fetal heart monitor can be attached to the baby’s head instead. This can give a more accurate measurement of your baby’s heartbeat.

You can ask to be monitored electronically even if there are no concerns. Having electronic monitoring can sometimes restrict how much you can move around.

Sometimes a doctor or midwife may need to make a cut in the area between the vagina and anus (perineum) during childbirth. This is called an episiotomy.

An episiotomy makes the opening of the vagina a bit wider, allowing the baby to come through it more easily.

Sometimes a woman’s perineum may tear as their baby comes out. In some births, an episiotomy can help to prevent a severe tear or speed up delivery if the baby needs to be born quickly.

If your doctor or midwife feels you need an episiotomy when you’re in labour, they will discuss this with you. In England, episiotomies are not done routinely.

Up to 9 in 10 first-time mothers who have a vaginal birth will have some sort of tear, graze or episiotomy.

The National Institute for Health and Care Excellence recommends that an episiotomy might be done if:

• the baby is in distress and needs to be born quickly, or
• there is a need for forceps or vacuum (ventouse), or
• there is a risk of a tear to the anus

Around 1 in 7 deliveries in England involves an episiotomy.

If you have a tear or an episiotomy, you’ll probably need stitches to repair it. Dissolvable stitches are used, so you will not need to return to hospital to have them removed.

Massaging the perineum in the last few weeks of pregnancy can reduce the chances of having an episiotomy and perineal trauma during birth.

The type and frequency of massage varies across research studies. Most involve inserting 1 or 2 fingers into the vagina and applying downward or sweeping pressure towards the perineum.

The most benefit was in women who repeated this every day.

Babies often twist and turn during pregnancy, but most will have moved into the head-down (also known as head-first) position by the time labour begins. However, that does not always happen, and a baby may be:

• bottom first or feet first (breech position)
• lying sideways (transverse position)