Complications at delivery
If, as sometimes happens, labour and delivery don't go quite as smoothly as expected, your obstetrician may need to give you some help to complete a vaginal delivery. Forceps can be used to protect your baby's head or, along with vacuum extraction, may be used to speed your baby's progress through the birth canal.
Use of vacuum extraction in delivery
© Jupiter
The vacuum extractor, or ventouse, is a gentler alternative to forceps, and is widely used throughout Europe. It's made up of a metal plate or cone-shaped cup of synthetic material. This plate or cup is placed over the baby's scalp. An attached pump is then used to create a vacuum that makes the plate or cup hold fast to the baby's head. This instrument then becomes a “handle”, which the obstetrician can use to rotate the baby's head and apply traction.
Multiple deliveries
If you're having twins, their delivery will always be treated as though you're having two single babies: if one has a vaginal delivery it doesn't always follow that the other will. Your doctor and midwives will probably suggest you have the babies in hospital in case they aren't presenting properly. If all goes well, twins usually present head down, the second one arriving half an hour or so after the first. Twin labours can be long, so an epidural anaesthetic might help. Also the second baby may have to be turned - this is done by rupturing the second baby's membrane and moving him by hand and again an epidural is recommended.
Twin deliveries are much safer than they used to be because the exact position of the second baby, and his condition, can be determined by ultrasound and fetal monitors. If you're carrying three or more babies, you'll have a Caesarean section for their safety.
Breech delivery
Four out of every 100 babies are born in the breech position so this isn't that unusual. A breech baby is usually born buttocks first, followed by his legs and body. Recent studies have suggested that it is safer for all full-term breech babies to be born by Caesarean section. But in some circumstances - for example, if you are already progressing well in labour - your doctors may encourage you to have a vaginal delivery. Before your baby's head can be delivered, you'll almost certainly need an episiotomy. The head is the widest part and your baby's rump will not necessarily have stretched your birth canal enough for his head to pass through it. Once your baby's body is born, his weight will start to pull his head down to your vagina. His body will then be lifted upwards and slightly backwards by the midwife, and one push is usually enough to deliver him. Forceps may be used to protect your baby's head.
It's now fairly common practice to have an epidural if you're having a breech birth. This is to prevent you pushing against an incompletely dilated cervix, but it also means that if you do need a Caesarean section, it can be done quickly and simply without further anaesthesia.
Forceps delivery
Forceps look like large sugar tongs and are designed to fit snugly over the sides of a baby's head, covering the ears.
The decision to use forceps is a medical judgment on the part of your attendants. Forceps are applied only when the first stage is complete, the cervix is fully dilated, and the head is in the birth canal.
Why forceps are used
Forceps are applied when your baby's head has descended into your pelvis, but fails to descend further; when a baby presents in a posterior position; in a breech delivery (see main text); when the uterus fails to maintain contractions; or when you lack the strength to push. Occasionally, forceps may be used for a quick delivery early in the second stage if your baby shows signs of lacking oxygen, even if the birth is not imminent.
How it's done
If you're going to have a forceps delivery, your legs will be put up in stirrups. Usually you will have had a spinal anaesthetic. Then the forceps will be inserted into your vagina one at a time. A few gentle pulls on the forceps, 30-40 seconds at a time, will bring your baby's head down on to your perineum. You should feel no pain. At this point you'll have an episiotomy. Once your baby's head has been delivered, the forceps are removed and the rest of his body will be delivered as normal.
Vacuum extractor
- It can be applied to the lowest part of the baby's head.
- It doesn't affect the shape of a baby's head. It does, however, leave a bruise, but this will fade within a week or two of the birth.
- An episiotomy isn't always necessary when a ventouse is used for delivery.
Posted 16.11.2010
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