Having an Assisted Birth
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Most women having a normal pregnancy and who are in good health are likely to plan for a natural birth either at home, in hospital or at a birth centre.
Some mothers-to-be, however, know in advance that their birth might be a bit more complicated. For example, the baby could be in the breech position (bottom or feet first). Other mothers will find that complications or challenges during the labour result in a change of birth plan.
What is an assisted birth?
When medical intervention is needed, this is known as an assisted birth. During an assisted birth, the doctors and midwives step in to help to ensure a safe and healthy delivery for both mum and baby.
In the UK, around one in eight babies need some sort of help to be delivered, so there is a chance your baby may need help. During your pregnancy, it's a good idea to research and read up on the different methods that are used. That way it won't be a shock if events don't go smoothly and you will have a better understanding of what needs to happen and why.
During an assisted birth, instruments (either a ventouse cup or forceps) are attached to the baby's head so he or she can be safely pulled out.
You may need intervention during the second, or 'pushing', stage of labour for the following reasons: the baby gets part of the way through the birth canal but then gets stuck and can't get further down; your contractions have slowed down and labour isn't progressing quickly enough; the medical team think your baby should be born quickly because he's showing signs of distress. If you have become very tired and are finding it difficult to continue pushing, the midwives and doctors may also decide to step in.
How is it decided that you need an assisted birth?
If it's thought that you need an assisted birth, the doctor will conduct an internal exam and feel your bump to ensure that the baby is in a good position for the procedure and to decide whether to use forceps or ventouse. If there is any concern that the assisted delivery might be tricky, you may be moved to an operating theatre in case a caesarean needs to carried out quickly.
While all this is going on, you may frightened, so remember to keep doing your breathing and relaxation exercises and remember too that you are in safe and skilled hands. Don't be alarmed by the increased number of medical staff that may appear, as this is normal.
How is an assisted birth carried out?
Before the procedure is carried out, you will be given pain relief, either in the form of a local injection in the vagina, an epidural or a spinal anaesthetic (which works faster than an epidural).
Forceps are often described as looking like salad servers or sugar-tongs. If you have a forceps birth, the doctor will carry out an episiotomy, or cut, to enlarge the vaginal opening and allow the instruments to be put around the sides of the baby's head. If your eyes have started to water just reading this, remember you will have had pain relief and it won't hurt, though you may still feel what's going on, depending on the type of pain relief given.
When you have a contraction you will be asked to push and the doctor will pull gently to help ease the baby down the birth canal. If, however, the baby doesn't move with each pull or, after three attempts the baby has not been born, the doctor will usually decide you need a caesarean.
Following a forceps birth there may be a mark, or even bruising, on either side of the baby's head, but it will quickly fade.
A ventouse birth is considered to be less painful than forceps for mum, during and after the delivery. There's also a smaller risk of your perineum tearing and an episiotomy is less likely. Because the ventouse is attached onto the top of the baby's head, instead of going around it like the forceps, less space is required.
The cup stays in place using suction (it may be noisy while a hand or foot pump is used to suck the air out of the cup). As you push with the next contraction the doctor will pull the ventouse to try and pull the baby out. If this method isn't effective, then the doctor will stop using the ventouse. The doctor may decide to try forceps or you may be recommended to have a caesarean. The ventouse cup can lead to swelling to the baby's head, but this will disappear in a few days.
What happens to the baby, and you, after an assisted birth?
For your baby, an assisted birth can make him more likely to get jaundice and an assisted birth also increases the risk of vitamin K deficiency bleeding, so ensure he gets his vitamin K dose. You may be concerned that a forceps or ventouse delivery could lead to serious injury to your child, but this is very rare.
Your own recovery is likely to be longer than if you had no intervention. You may need stitches and will probably feel sore, delicate and bruised. Take regular pain relief, drink plenty of fluids and have lots of fibre in your diet to make passing urine and moving your bowels easier.
It can be difficult looking after a newborn when you yourself are in some pain or discomfort, so once you get home, accept all the offers of help you can to make the first few days as easy as possible.
If you are anxious about a future birth, remember that 80% of women who need an assisted birth go on to have a straightforward delivery the next time.