Medical Procedures during Birth

The type of pain you experience during contractions can vary.  No two contractions will feel the same and its important to be prepared for the fact that you may need a little help to go through labour.  There are different types of painkiller from those that take the edge off to those that take away sensation altogether. Labour isn’t a test about who is the strongest.  Labour is about delivering a baby and you having the strength to do that.

If you are experiencing pain then a useful tip is to wait fifteen minutes before asking to see if you can adapt to the pain.  The more natural your labour, the more endorphins you release and the higher your pain threshold will be.

Ask your medical provider about the types of pain medication that is available to you and then outline your choices in your birth plan

Foetal Monitoring

Foetal heart monitoring is when the baby heart is monitored to check that the baby is not getting into distress.  

External

Two belts are secured around your abdomen both with a sensor.  One will measure the baby heartbeat and the other will monitor contractions.  You do not have to laying down flat on your back for this to work effectively.  

A midwife may also listen to your belly through a doppler or fetoscope.  This can be used in the shower.

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Internal

A baby may also be need to listened to with internal foetal monitoring if there is the need to get a more accurate assessment of how they are coping with labour.  A small electrode is attached to the baby head with a very thin piece of wire.  It is attached through your vagina, after your waters have broken and your cervix is open.  You won’t be able to move around much whilst this is being done and there may be a small scratch or bruise on the baby head.

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Vacuum extraction (Ventouse)

A vacuum extraction can happen when the baby is getting into trouble.  It may be that you are too tired to push or to help get the baby head into a better position.  It can cause temporary bruising or swelling to the baby head which disappears in a few days.

Forceps

These are metal devices which are gently applied to your baby head to help them move down the birth canal.  Again they can be used to speed up delivery and help change your baby’s position.  Whilst they can help avoid a caesarean birth they are linked to a higher episiotomy rate and the there is an increased risk of vaginal and cervical bruising.  These can also cause marks or bruises to be left on the baby’s head.

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Entonox or Gas and Air

Entonox or Gas and Air as its most commonly called is a colourless, odourless gas that has a calming effect which takes the edge off labour pains.  It is also called Laughing Gas.

It is available in most birthing centres and is fed direct into your room either by a central system or through a canister.  About 80% of women use Gas and Air as a pain relief through labour.  If you are in early labour then its probably best to hold off from using any form of analgesia until the later stages as your body will have got used to it and may need stronger medications to get help you cope.

How to use Gas and Air 

  • Put the mouthpiece between your lips and teeth or bring the mask to your face so that the seal is over your nose and mouth. If you are offered a mask and prefer an air piece then the hospital should be able to change it for you. (These are single use items so will be clean – if you have any doubts about the cleanliness of the tubes then you can ask for them to be changed too)
  • Breathe deeply and evenly into the mouthpiece or mask. You don’t need to move it away from your face when you exhale as it has a two way valve so the carbon dioxide is taken away.
  • Continue to breathe deeply and evenly until you feel light headed then take the mouthpiece away from your face.
  • You will feel fine again within a few seconds.
  • It takes at least 30 seconds of breathing for the gas to build up in your blood stream and you to feel any benefits.
  • Start using the Gas and Air the moment you feel a contraction beginning.  If you wait until the contraction is hurting to start breathing then it will begin to work BETWEEN the contractions so won’t be as effective and you won’t get a break. 

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Advantages of Gas and Air

  • Flexible and fast working
  • Easy to use
  • You control how and when you use it
  • It doesn’t interfere with your labour
  • It doesn’t stay in your system so once you’ve stopped breathing it in its leaves your lungs and any side effects stop
  • It takes the edge off contractions
  • Its safe for you and the baby
  • Any additional oxygen you breathe in will be beneficial for you and the baby
  • You can use it in conjunction with other forms of pain relief

Disadvantages of Gas and Air

  • It is only a mild painkiller
  • It can make you drowsy, light headed or sick
  • It can give you a tingling, pins and needle like sensation, temporary cramps or spasms in your wrist and ankle joints
  • It can dry out your mouth if used for a long time so make sure you have lip salve or ice flakes to help you feel less dry
  • Holding the mask can stop you moving around 
  • It can take a while to get the timing right so that its effective at the peak of your contractions
  • If used with pethidine it can make you drowsy

Pethidine and Diamorphine

Pethidine is a synthetic form of morphine and is a painkiller and relaxant.  Diamorphine is derived from morphine, is a stronger pain killer and has a longer length of action time than pethidine. 

Pethidine usually lasts for two – three hours and is given by injection in the thigh or buttock.  It can also be given intravenously.  It can make you sleepy or dizzy.  It can also cross into the placenta which can impact the baby’s breathing.  It can make the baby sleepy which does impact the start to the breastfeeding journey. 

Useful information

  • You don’t want to be under the effects of either pethidine or diamorphine when you start to push so make sure that a vaginal exam to see how far along you are has been carried out before administration.
  • It can take about 20 minutes for them both to work
  • Ask for a small dose to see how you react – it can be topped up
  • It is very common for babies to be sleepy after birth if you have received this drug so make sure you have lots of skin to skin contact until they are ready to feed which could take a few hours

Meptid

Meptid basically acts in the same way as pethidine (and has the same side effects) but does not cross into the placenta to impact the baby’s breathing as much. It is considered more expensive so not every hospital carries it.

  • You don’t want to be under the effects of meptid when you start to push so make sure that a vaginal exam has been carried out before administration to check how dilated you are.
  • It is not available everywhere so ask your healthcare provider if it is available
  • It can take about 15 minutes for them both to work
  • It is very common for babies to be sleepy after birth if you have received this drug so make sure you have lots of skin to skin contact until they are ready to feed

Epidural

An epidural is an injection into the epidural space around the spinal cord.  It can  only be given by an anaesthetist and usually takes around 10-20 minutes. You lay on your side or curl over the edge of the bed to get into position.  Your back is wiped with an antiseptic solution and you are given a small local anaesthetic.  You may feel a little pressure or a momentary shooting pain (most women don’t feel anything) as a fine needle is placed in the area of the nerves and then a painkiller injected through a catheter which is left in place so it can be topped up as needed during your labour. Sometimes the tube is attached to a small pump  which allows the mother to control how much is released, other times it is primed to automatically release every few minutes.  As you will not be able to feel anything a catheter will be inserted into your bladder to collect urine (it will be removed when you are able to go to the bathroom)

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During the second stage of labour, the mother can sit  up and receive another top up.  This allows the medical staff to deliver the baby painlessly if assistance is required.  You should be pain free but have some sensation of pressure, especially as the baby is born.

Some hospitals are now giving the option of a walking epidural.  This is where you are given a lower dose of anaesthesia which means that you are still able to walk around and change positions.  This has the added benefit of meaning that you can push more effectively.

Advantages of epidural

  • Efficient pain relief
  • You can be awake and alert
  • Controls blood pressure (tends to lower it)
  • Can give the mother a break in a long labour
  • Can help the mother regain her strength 
  • Help restore your confidence – you are calm and in control
  • Only a small amount enters your bloodstream which makes it safer for the baby
  • It can be given when you ask for one – there is no need to wait until a certain stage of labour (although if your labour is progressing quickly there may not be time for one)
  • If possible than the epidural can be stopped so you can feel when to push your baby out

Disadvantages of epidural

  • Can sometimes not work and only partially stop the pain
  • Can make mother shivery
  • The epidural requires a drip in the arm as blood pressure can drop which can have implications for the baby.  The drip is a precaution just in case your blood volumes needs a boost
  • Mothers have to be fully monitored and stay in bed
  • Epidurals can lengthen the second stage of labour
  • Your birth becomes completely medicalised
  • Ventouse or forceps delivery are more common
  • Some women do get headaches

Spinal block

Usually given at the end of labour just before a caesarean section, forceps or ventouse delivery.   You have to lie on your side or curl over the bed in order to get in the right position to have the injection.  It is a single injection into the spine and works very quickly.  It cannot be topped up and does have side effects such as shivering, headache, itchiness or nausea.

Episiotomy

This is where the perineum (the muscle between the vagina and anus) is cut.  This is done to enlarge the opening that the baby will come from. It was felt that an episiotomy would be preferable to a tear however medical professionals are starting to feel that that may not be the case. With an episiotomy there is an increase risk of infection and recovery time can be longer so its worth asking if your doctor does one as a matter of course and any steps you can take to avoid one.  Reasons for an episiotomy are:-

  • you are likely to experience extensive vaginal tearing during delivery
  • your baby is in an abnormal position
  • your baby is larger than normal
  • your baby needs to be delivered early

You can help avoid the risk of an episiotomy by

  • massaging your perineum with olive or coconut oil in the weeks leading up to birth
  • by being prepared for birth with pelvic floor exercises