Types of Delivery

Most babies arrive within a week or two of the estimated delivery date without medical intervention. However, specialist assistance is needed for various reasons in a substantial proportion of births.

Labour may be late in starting and doctors may consider that it is advisable to start contractions artificially by inducing labour. You may be too exhausted to push or your baby is becoming distressed, you may be offered an assisted birth, e.g. forceps or Vacuum extraction to help the birth.

The different delivery types are shown below:

Induction
Caesarean Section
Episiotomy
Forceps
Ventouse – Vacuum Extraction

Induction

The length of pregnancy is 40 weeks from the first day of your last menstrual period. However, you are not regarded as being overdue until after week 42. If the pregnancy lasts longer than 42 weeks, the placenta may not be able to function efficiently, so the doctor may decide to start labour by ‘Induction’.

The main reason for inducing a baby is that the baby is overdue. Other reasons for inducing labour are

  • Pre-eclampsia
  • Multiple-births
  • Labour is progressing too slowly
  • Waters break early leaving the baby exposed to infection
  • Gestational diabetes – baby is growing too large
  • Placenta is detached from the wall of your uterus

Labour can be induced by rupturing the membrane surrounding the baby (breaking you waters).This can be done during an internal pelvic examination, and usually leads to contractions starting within 12 hours. Or the cervix maybe softened by gel or pessaries containing prostaglandins (a hormone-type substance), which are inserted into the vagina.

Another method involves injecting small amounts of the hormone, oxytocin (Syntocinon) very slowly into an arm vein.

Induction may make labour faster and more painful, so ask for the pain relief you need. It’s also more likely to mean further intervention such as a forceps delivery, so it’s important that you understand why it’s being suggested, and that it really is the best option for you and your baby in the circumstances.

Caesarean Section

A caesarean section may be performed to deliver your baby if a normal delivery is considered impossible or too dangerous.

The Operation

The operation does not take very long (45-60 minutes), but the baby is delivered within the first 5-10 minutes. Small horizontal incisions are made in the mother’s abdomen and the baby is removed.

Following delivery of the baby, the placenta is removed and the incision is closed carefully in layers of tissue. If the operation can be planned in advance, it may be possible to arrange for epidural anaesthesia, so that the mother remains awake throughout, but will be shielded by screening curtains from the operation. Where caesarean section is carried out as an emergency procedure, a general anaesthetic is necessary unless the mother is already having epidural anaesthesia.

A ‘planned’ caesarean means you know in advance that your baby will be delivered this way, and can prepare yourself.

The main reason for acaesarean section is that you or your baby are at risk. These situations include

  • Foetal distress
  • Labour is taking a long time
  • Pre-eclampsia
  • Cord Prolapse

There are many more reasons for a caesarean section aswell as those listed above

Episiotomy

This is an incision made through the perineum and the vaginal wall. It is done if the vaginal opening isn’t stretching enough to let the baby emerge and it is likely to tear. A tear can be ragged and more difficult to repair than a short, straight cut of an episiotomy. A local anaesthetic is given to numb the area, unless the woman has had an epidural. The doctor will stitch the episiotomy and any tears in the cervix or vagina after delivery.

An episiotomy may be required if:

  • Birth is imminent and your perineum hasn’t had time to stretch slowly.
  • Your baby’s head is too large for your vaginal opening.
  • You cannot control your pushing and push gradually and slowly.
  • Your baby is in distress
  • You may require a forceps or vacuum delivery
  • Your baby is in breech presentation and there is a complication during delivery.

Forceps

Forceps are like metal tongs with two large spoon shaped edges that fit around the baby’s head. They are inserted into the vagina to grip the baby’s head and speed up delivery. This technique may be used if the baby’s heartbeat slows down during a slow delivery of the head, or to ensure its safe delivery during a breech birth.

Forceps can reduce the need for caesarean section. It requires an episiotomy.

Forceps are used when the mother is unable to push because she has had an epidural injection or because labour is not progressing well or if the baby is in distress.

Forceps deliveries are becoming less common, as many doctors prefer the alternative technique of vacuum extraction which works in a similar way. Where delivery is delayed and the baby’s head remains high up in the pelvic cavity, Caesarean section is likely to be considered a safer option.

Forceps can bruise your baby’s head, and his/her head may appear elongated or an odd shape, but any bruising or swelling will usually subside within a few days and will have disappeared within a couple of weeks.

Ventouse – Vacuum Extraction

Vacuum extraction (ventouse) is a gentler alternative to forceps. It consists of a metal plate or cone-shaped cup of synthetic material. The suction cup is placed over the top of your baby’s head and using an attached pump a vacuum is created. This instrument then becomes a handle which the doctor can use to rotate the head and pull while you push.

Ventouse can bruise your baby’s head, and his head may appear elongated or an odd shape, but any bruising or swelling will usually subside within a few days and will have disappeared within a couple of weeks. After the birth, the doctor or midwife will carefully stitch the episiotomy or any tear.