Your guide to assisted delivery

Assisted delivery

If you have a large baby or your baby shows signs of distress, help can be given to ease your baby out safely.

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For a variety of reasons, your baby may need assistance when being delivered. Often the mother has been pushing for a long time and baby is making slow progress down the birth canal. If you have a large baby or your baby shows signs of distress, help can be given to ease your baby out safely.

Ventouse delivery

A ventouse extraction is when the obstetrician uses suction to guide the baby out. A device that looks a bit like a bath plug is placed on the baby’s head, and the baby is gently suctioned out as you push. Your baby may have a little swelling on her head for about 24 hours after the birth, but this will soon go back to normal.

Forceps delivery

Forceps are usually used if the baby needs to come out quickly. Forceps look a bit like metal salad tongs and your obstetrician will fit them carefully around your baby’s head and gently guide her out whilst you push. Some forceps can be used to turn your baby around if she is in an awkward position. Sometimes a baby born with the help of forceps can have two red marks on either side of his head, but this will disappear within the first week. An episiotomy is normally used with a forceps delivery.

Episiotomy

Although once widely practised in childbirth, there is much debate about whether having an episiotomy helps or not. Some people believe letting your skin tear naturally in childbirth is better for you then a surgical cut made by the midwife.

An episiotomy is a procedure where an incision is made in the perineum, (the stretch of skin in between your vagina and anus) to enlarge the vaginal opening for the baby’s head to emerge.  While routine episiotomies are no longer standard, there are reasons you may have to have one. If you have a large or breech baby, a forceps or ventouse delivery or your baby gets stuck in the birth canal an episiotomy may be suggested.
The perineal area will be numbed, and the cut can be made in two ways; a midline cut which is a straight down cut towards the rectum, or a mediolateral cut which is angled to one side, away from the rectum.  Even though the midline cut is easier to repair, and causes the mother less discomfort, doctors favour the mediolateral cut because it is less likely to cause damage close to the rectum.

How can I reduce my chances of an episiotomy?

Many women swear by perineal massage, for six to eight weeks before your due date, so that your perineum is used to being stretched before labour, reducing the need for an episiotomy.
Start thinking about massaging your perineum everyday for six to eight weeks before your due date. Your perineum is located just below your vagina and just above your rectum and is a stretchy piece of skin. Make sure your hands are clean and any jagged nails are cut beforehand. Apply olive oil or sweet almond oil to the base of your vagina and move your finger slightly inside. Move your fingers up the inside walls of the vagina in a U shape, and repeat the procedure every day.

It may also be possible to reduce the chances of an episiotomy by labouring in an up right position. Standing or squatting are good positions to try. A warm compress applied to the perineal area can also help.

Lots of women worry about episiotomy cuts, and how much they will hurt. They can be painful, especially a few days after delivery, but they also heal very quickly. Your midwife will only perform an episiotomy if she thinks you need one, for example your baby might become distressed and needs to be born quickly. Placing an ice pack on the swollen area, or having a warm lavender bath can help with the discomfort.

Perineal tears

Your perineum is the area between your vagina and anus and although it does not always happen, it is common for this area to tear slightly during the birth of your baby. There are different degrees of tears and whilst it can be common with your first vaginal delivery, their are steps you can take to help prevent it from happening. (See perineal massage below).

There are four degrees of perineal tears:

First degree – is when there are minor tears to the area around the entrance to the vagina. These will heal well and most will not need stitches.

Second degree – This is when the tear goes through the skin and the perineal muscles underneath.  The anal sphincter muscles remain intact. Second-degree tears will need several stitches through the muscle and tissue in the perineal area. You may feel a bit of discomfort with a second-degree tear.

Third degree tear – This is where the anal sphincter muscles are torn, but the lining inside the rectum remains intact. These tears require careful stitches to repair.

Fourth degree tear – this type of tear is not common and occurs in one per cent of births. The anal sphincter is torn and the anal mucosa is opened. You will need careful, skilled stitching to repair a fourth degree tear.  You are more likely to experience a fourth degree tear if you have a ventouse or forceps delivery.

Sometimes your midwife will suggest you have an episiotomy which is when you are cut, instead of tearing to make more room for your baby to be born. Some people favour a natural tear because it is just that: natural. Midwives tend to only perform episiotomies if they are really needed, for example, the baby seems to be stuck in the birth canal, or you have been pushing for over and hour and your baby needs to be born. With both a natural tear and an episiotomy you will be stitched up and will heal very quickly. Research shows that three months after birth, the pelvic floor muscles of women who had episiotomies, tore naturally or didn't tear at all were all virtually the same.

Who is more likely to tear?

Whilst minor tearing is fairly common, third and fourth degree tears are not. You are more at risk from this type of tear if:

  • You have had an assisted delivery, so forceps or a ventouse were used to help get your baby out.
  • Your baby is bigger than normal.
  • Your baby is breech and is being delivered vaginally
  • You have had an episiotomy. An episiotomy is used instead of tearing and is supposed to prevent tears, but sometimes, women can tear beyong the episiotomy cut.

If I do tear - what will the treatment be?

Some tears will require stitches depending on the severity of the tear. You will be given a local anesthetic which will numb the area that needs to be stitched. Having stitches shouldn't take long and afterwards it might give you some relief to apply a cold ice pack to the area or even have some additional medication. It might sting when you urinate for a while afterwards but this will soon pass. You are advised to abstain from sex until you get the go ahead from your GP at your six week check up.

 

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