The Big Day! Delivery Option

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The big day is arriving!

Most babies arrive between the 38th and 42nd week of pregnancy. Remember that the last date is just an estimate, not a guaranteed time for your baby’s arrival. Various symptoms and discomforts may indicate that your body is preparing for labour.
While a smooth, natural birth with predictable stages is ideal, preparing for different possible outcomes and delivery methods is essential.

Childbirth Delivery Methods

Vaginal Delivery - Natural Birth

Obstetricians generally believe that the female body is designed to expand enough to deliver a baby of average size safely. This process is often referred to as Natural Delivery, as it’s the body’s inherent way of bringing new life into the world. Most women give birth naturally between 38 and 41 weeks of pregnancy. Vaginal delivery is typically preferred due to the following benefits:
  • Shorter hospital stay
  • Lower risk of infections
  • Faster recovery time
  • Babies born vaginally are less likely to experience respiratory issues
Your obstetrician will guide you through what to do when labour starts. Signs of labour include regular contractions, leaking or a sudden release of amniotic fluid, and bloody discharge. If you notice these signs, it’s time to head to the hospital.

Signs and Symptoms of Labor

Here are some signs and symptoms that labour may be beginning:
You may feel cramps similar to menstrual cramps or experience contractions. It’s also possible to have nausea, diarrhoea, or indigestion during this time. Some people experience lower back pain or a dull ache in their lower back.
Additionally, you might feel pressure or discomfort in your pelvic area, thighs, or groin. Changes in vaginal discharge are common as well, which could be thin, watery, or even pinkish, brownish, or contain traces of blood. Some people may also pass a mucus plug. A trickle or gush of fluid from your vagina may suggest your water has broken, signalling that the membrane surrounding your baby has ruptured and the amniotic fluid is leaking.
If you think labour has started, contacting your healthcare provider is essential. Reach out to us at 9159580000 or visit the hospital immediately if you experience bleeding with cramps, watery discharge, or contractions that occur 10 minutes apart or less. You will be admitted and assessed to determine your stage of labour.

Stages Of Labour

The first stage of labor is the longest phase and can last up to 15-20 hours for first-time mothers. For women who have previously given birth, this stage may progress more quickly. During this time, the cervix begins to dilate and thin out due to regular contractions, which can cause some discomfort or pain.
To help the process, you may be encouraged to move around or walk during breaks between contractions. The cervix will open to 10 centimeters (approximately 3.9 inches), at which point your baby will be ready to pass through the birth canal.
Pain management during labor is a personal decision. While some women choose to go without medication, others may opt for relief.
It’s important to discuss pain relief options with your doctor during prenatal visits, but you can also decide during labor if you want to use pain management, even if you hadn’t initially planned to. Some common forms of pain relief include epidural anesthesia, cervical anesthesia, nitrous oxide, pelvic anesthesia, and other medications. Having a partner, loved one, or a labor coach present can also provide emotional support and help keep you calm.
The second stage of labor, known as the expulsion phase, starts when the baby begins to descend through the birth canal. This phase continues until your baby is born, and it usually lasts less than a few hours, although it can be longer for first-time mothers.
During this stage, you may feel pressure in the pelvic area and a strong urge to push. Your healthcare provider will guide you on when to push and when to rest. In some cases, a small incision called an episiotomy may be made between the vaginal opening and the anus to help ease the baby’s passage or prevent tearing.
Once your baby is born, you’ll hear their first cries. The umbilical cord will be clamped and cut, and any mucus or fluids will be cleared from your baby’s airways. After a brief examination, your baby may be placed on your chest for skin-to-skin contact.
The final stage of labor, known as the afterbirth, typically happens within minutes to an hour after delivery. During this stage, the placenta is expelled from your body. Your healthcare provider will check for any tears in the vaginal area and apply stitches if necessary. You will then be cleaned and taken to the recovery room. Meanwhile, your baby will be examined in the nursery and receive necessary treatments. You’ll be reunited with your baby as soon as possible.
Following a typical vaginal delivery, you’ll stay in the birthing room with your baby for around two hours. During this time, you may have a meal or a shower before being transferred to the postnatal ward. You and your baby will usually spend one or two days in the hospital before being discharged with detailed care instructions for when you return home.
What should I expect physically in the first 24 hours after birth?
The way you feel during the first 24 hours after birth can vary greatly. You might experience a mix of joy, fatigue, and emotional highs or lows—all completely normal after such a significant life event. One of the physical changes you’ll notice is vaginal bleeding, known as ‘lochia.’ Initially, this bleeding is similar to a heavy menstrual flow, and you may also pass some small blood clots. However, if you pass large clots, such as ones the size of a coin, inform your midwife. You may continue to experience vaginal bleeding for 4 to 6 weeks after delivery.
Some women also experience after-birth pains as the uterus contracts to its original size. These pains can range from mild to moderate and may feel like labor pains or period cramps. For those who have given birth before, the discomfort might be more intense. Using a warm pack on your back or stomach can offer some relief, and you can always ask your healthcare provider for pain management options.
Swelling of the perineum is another common experience within the first 24 hours. To manage this, you can follow the RICE method:
  • Rest: Lying down can help minimize swelling and discomfort.
  • Ice: Apply an ice pack for around 20 minutes every 2 to 4 hours to minimize the swelling.
  • Compression: Wear snug-fitting underwear and use 2 to 3 maternity pads for added support.
  • Exercise: Begin gentle pelvic floor exercises when you feel comfortable, ideally within a few days of birth.
If you have perineal pain or stitches, don’t hesitate to ask your midwife for pain relief. Stitches will typically dissolve in 1 to 2 weeks. Keep the area clean by washing it gently in the shower, then pat it dry. To avoid constipation, drink more water, eat fibre-rich foods, and request laxatives. Your healthcare provider will also keep an eye on your perineum to check for any issues like excessive bruising or trauma before you leave the hospital.
In terms of breastfeeding, your breasts will start producing colostrum, the nutrient-rich first milk, which is ideal for your baby’s tiny stomach—about the size of a marble.

Forceps Delivery

Forceps delivery is one of the assisted births where doctors use large, spoon-like instruments, called forceps, to gently grasp the baby’s head and guide it out of the birth canal. This method is less commonly used today, as a Cesarean section is often preferred in complicated deliveries.

Who is a Candidate for Forceps Delivery?

Forceps delivery may be considered in the second stage of delivery when the cervix is fully dilated, the baby has moved into the birth canal, and labour is progressing slowly. This method may also be used if the baby becomes stuck during the birthing process or if the mother is unable to push the baby out.
When and Why is Forceps Delivery Recommended?
Several situations might call for the use of forceps during delivery, such as:
  • Prolonged labour: If labour stalls despite the mother pushing for an extended period, forceps may assist in delivering the baby.
  • Abnormal fetal heart rate: If the baby’s heart rate becomes irregular, forceps delivery may be needed to complete the birth quickly.
  • Maternal health concerns: If the mother has medical conditions like high blood pressure or heart disease, doctors may opt to shorten labour by using forceps.
  • Exhaustion: If the mother is too tired to continue pushing, forceps can help complete the delivery safely.

Advantages of Forceps Delivery

There are notable benefits to using forceps in certain situations, including:
  • It serves as a potential alternative to a C-section, avoiding major surgery.
  • It carries relatively low risk compared to surgical options.
  • It helps realign the baby’s head for smoother delivery.
  • It can expedite the delivery process, allowing for a quicker birth.

Potential Risks of Forceps Delivery

Though forceps delivery is generally safe, there are some risks, both for the mother and the baby.
Risks for the Mother:
  • Tears or injuries to the vagina, rectum, or urethra
  • Excessive bleeding
  • Temporary urinary incontinence
  • Pain in the perineal area
  • Pelvic organ prolapse, caused by weakening of pelvic muscles
  • In rare cases, uterine rupture

Risks for the Baby:

  • Facial palsy
  • Minor facial bruises or injuries
  • Skull fractures or internal bleeding
  • Weakness in facial muscles

Conclusion

Forceps delivery is an option during the second stage of labour, typically used when labour is prolonged or when the baby is in distress. If you have concerns about assisted delivery methods, In that case, it’s essential to communicate your choices with your doctor and create a detailed birth plan to minimize the likelihood of unexpected interventions like forceps use.

Vacuum Extraction Delivery

Vacuum extraction is one of the types of assisted delivery used to help the baby through the birth canal when labour stalls in the second stage. This procedure involves applying suction and traction to the baby’s head using a vacuum device, aiding in the delivery process while the mother continues to push. However, it is only advised in specific situations.

What is Vacuum Extraction Delivery?

During the second stage of labour, where the mother is actively pushing, labour can sometimes slow down or come to a halt. Despite efforts, the baby may not progress through the birth canal, and this phase can last for hours.
To ensure the safety of both mother and baby, the healthcare team continuously monitors the baby’s heart rate and the mother’s vital signs, looking for any signs of distress. When prolonged labour presents health risks, the medical team may explore ways to assist in the delivery.
Vacuum extraction is one such method. If certain criteria are met—like the baby being in the correct position and low enough in the birth canal—a vacuum extractor is used to help guide the baby out. The device consists of a suction cup connected to a mechanical or electric pump, which applies gentle traction to the baby’s head, assisting in the delivery while the mother continues to push. While it may not always be the solution needed, it can be effective in certain situations.

Why is Vacuum Extraction Used During Delivery?

Vacuum extraction, also known as “ventouse,” is one method used to help in delivering a baby when natural progression isn’t happening. Other alternatives include forceps delivery or, in some cases, a cesarean section, though surgery is usually considered a last option. Vacuum extraction and forceps delivery both aim to avoid the need for surgery by providing extra assistance during labour.
The decision between vacuum extraction and forceps delivery often depends on the healthcare provider’s experience and training. Both methods come with risks, but they are recommended when the risks of prolonged labour outweigh those of assisted delivery. This could be due to the mother’s exhaustion or concerns about the baby’s well-being due to the extended labour.

How Common is Vacuum-Assisted Delivery?

Vacuum-assisted deliveries account for approximately 2.5% of vaginal births in the U.S. Over time, the rates of vacuum extraction as well as forceps delivery have declined, while cesarean sections have become more common. Assisted vaginal deliveries are only used under specific circumstances, and if those conditions aren’t met, a cesarean section may be recommended instead.

Procedure Details

When is vacuum
extraction delivery
necessary?

Vacuum extraction may be considered when:
  • Labor has slowed or stalled during the second stage.
  • The baby’s heart rate is deemed concerning.
  • The mother is too fatigued or has a health condition that prevents further pushing.

What does it mean
when a fetal heart rate
is "non-reassuring"?

An abnormal fetal heart rate can indicate that the baby is not receiving adequate oxygen during labor.
While it’s common for oxygen levels to fluctuate briefly during delivery, prolonged periods of reduced oxygen can be hazardous. A fetal heart rate may be considered non-reassuring if:
  • It is unusually high or low.
  • It shows a pattern of sudden drops.
  • It takes too long to return to a normal rate following contractions.

What alternatives can be tried before vacuum extraction?

If there are signs of fetal distress, the medical team may attempt the following before opting for vacuum extraction:
  • Administering oxygen to the mother.
  • Providing intravenous fluids.
  • Adjusting the mother’s position to encourage progress.
If these steps do not improve the baby’s condition or labor progress, vacuum extraction may be recommended.

When is vacuum extraction not advisable?

Vacuum extraction may not be suitable in certain situations, such as when:
  • The baby is born prematurely.
  • The baby hasn’t descended far enough into the birth canal.
  • The baby’s head may be too large to pass through the birth canal.
  • The baby is not headfirst.
  • The baby requires repositioning.
  • The baby has a bleeding disorder.

How is vacuum extraction performed?

Before the procedure, the healthcare provider will explain the potential risks and benefits and request the mother’s consent. Pain relief will be provided if it hasn’t already been administered. In some cases, an episiotomy (a small incision between the vaginal opening and anus) may be needed to widen the birth canal.
The medical team may also break the amniotic sac and empty the bladder. The vacuum cup (ventouse) is then carefully placed on the baby’s head, avoiding the mother’s vaginal tissues. During contractions, the provider will use suction from the vacuum to assist with delivery, adding force to the mother’s pushing.
The healthcare provider will manage the vacuum pressure carefully to avoid scalp injuries to the baby. If the suction is too strong, it can damage the baby’s scalp, while insufficient suction can cause the vacuum cup to detach. The provider will simultaneously guide the baby’s head through the birth canal while using the vacuum. If the vacuum cup detaches multiple times or if the baby’s scalp shows any signs of bruising, the vacuum procedure will be discontinued. If successful, the vacuum is removed once the baby’s head emerges, and the rest of the delivery proceeds manually.

When should vacuum extraction be stopped?

The attempt will be discontinued if:
  • It has been ongoing for 20 minutes without progress.
  • The vacuum cup repeatedly detaches from the baby’s head.
  • There is evidence of scalp injury.

What happens after the procedure?

Once the baby is delivered, both mother and baby will be checked for any signs of injury related to the procedure. Any tears or episiotomies will be repaired. The baby will be monitored for any potential complications, some of which might take a few hours to become apparent. If no issues arise within the first 10 hours, the mother and baby will typically be allowed to go home.
If the vacuum extraction does not succeed, a cesarean section may be recommended by the healthcare team.

Risks / Benefits

Advantages of Vacuum Extraction

When the circumstances are ideal, vacuum extraction can help deliver a baby from an oxygen-deprived environment without requiring surgery. This method is often quicker than surgery, which can be critical.

Potential Risks or Complications of Vacuum Extraction Delivery

The risks for the mother during vacuum-assisted delivery are generally comparable to those encountered in any childbirth. These risks may include:
  • Vaginal tears
  • Postpartum bleeding
  • Difficulty urinating or temporary incontinence
For the baby, several short-term side effects may occur due to vacuum extraction, including:
  • Caput Succedaneum: Also known as scalp oedema, this swelling can create a temporary cone-headed appearance, which usually resolves within a few days.
  • Bruising and Jaundice: The vacuum extractor can cause scalp bruising, which may lead to jaundice—a temporary yellowing of the skin caused by an increase in bilirubin from the breakdown of red blood cells. Jaundice generally clears up within a few weeks.
  • Cephalohematoma is the pooling of blood between the scalp and skull, resulting from damaged blood vessels. It does not affect the brain and is considered a minor injury that typically resolves within a week or two.
Serious complications for the baby are rare but may include:
  • Skull Fracture: Newborn skulls are soft and can be injured more easily. While most fractures are small and heal on their own without long-term effects, more severe fractures can lead to brain bleeding. In some cases, surgery may be needed.
  • Intracranial Haemorrhage: This is bleeding within or around the brain. While brain bleeds are uncommon, they can be serious. Possible effects include apnea and seizures, and in rare cases, the pressure from the bleeding can lead to brain damage.
  • Subgaleal Haemorrhage: This occurs when blood accumulates between the skull and scalp due to ruptured veins in the baby’s head. This condition can result in hemorrhagic shock or death if not identified and treated promptly. Subgaleal haemorrhage typically develops over several days following delivery and occurs in approximately 0.6% of vacuum-assisted deliveries.

Recovery and Outlook

How long does it take to recover from a vacuum-assisted delivery?

If your vacuum-assisted delivery went smoothly without serious complications, you can generally expect to recover within about six weeks. During this time, you might need to use pads to manage normal vaginal bleeding. Pain can usually be regulated with over-the-counter medications while you heal, and any stitches from the delivery should dissolve on their own.
Your baby may experience some common short-term effects from the vacuum delivery, such as bruising, jaundice, or scalp swelling. These issues typically get cured within a few weeks. It’s important to handle your baby’s head with care during this time and to attend any scheduled follow-up appointments to ensure proper recovery.
While many expectant mothers aim for a straightforward vaginal birth, the delivery process can sometimes present unexpected challenges. Vacuum extraction is one of the tools available to assist in delivering your baby when needed. Discussing potential interventions like vacuum extraction with your healthcare provider beforehand can help you understand the options, including their risks and benefits, and plan accordingly for your childbirth experience.

Caesarean Section
Or C-Section

A cesarean section (C-section) may either be planned ahead of time or become necessary during labor. This surgical method involves performing an incision in the abdomen to deliver the baby.

Planned Cesarean
Sections:

Certain conditions may lead to a planned C-section, including:
  • Carrying multiple babies (e.g., twins)
  • A very large baby
  • Prior surgery, such as a previous C-section
  • The baby being in a breech (feet-first) or transverse (sideways) position
  • Specific maternal health issues, such as high blood pressure, kidney disease, diabetes, active herpes, preeclampsia, or eclampsia
Similarly, conditions affecting the baby, such as a fetal abnormality, a head too large for the vaginal canal, or a difficult fetal position, might also necessitate a C-section. Additionally, complications like placenta previa (where the placenta blocks the cervical opening) or placental abruption (where the placenta removes off from the uterine wall) may require a C-section. Your healthcare provider will tell the reasons for a C-section based on your unique situation and preferences.

Emergency Cesarean Sections:

Sometimes a C-section cannot be planned in advance and may be required if the mother or baby shows symptoms of distress during labor. This could happen if labor is prolonged, with the cervix failing to dilate after 16 to 18 hours, or if the umbilical cord is compressed, potentially cutting off the baby’s oxygen supply.

What to Expect During a Cesarean Birth:

The procedure typically lasts about 30 to 40 minutes, with the baby usually being delivered within the first 10 minutes. You may be in the operating room for an hour or more.
During the operation, the doctors will update you on the progress. You will generally receive an epidural or spinal anesthesia, which numbs the lower part, allowing you to stay awake. In emergencies, general anesthesia may be used, meaning you will be asleep throughout the procedure.
A catheter is inserted inside your bladder to collect urine, as you will be unable to get up to use the bathroom. IV lines is placed in your arm to administer fluids and medications. The obstetrician will clean your abdomen and make an incision near the pubic hairline, cutting through the layers of fat, muscle, and uterus to deliver the baby. If a quick delivery is needed, the incision may be extended from below the belly button to above the pubic bone.

Post-Operation:

After the baby is delivered, the placenta is removed and the incision is closed with stitches or staples. You may feel some tugging and pulling if you are awake, but not pain. A screen is usually positioned across your chest so you cannot see the procedure. If you are awake, you can typically hold your baby immediately after birth and begin skin-to-skin contact and breastfeeding. The baby may need some initial care to clear fluids or address any immediate concerns.

Room and Personnel:

During the C-section, your partner or support person can usually be with you. The room will include various medical staff:
  • Obstetrician: Performs the surgery and delivers the baby
  • Anaesthetist: Administers anesthesia
  • Scrub nurse: Assists the obstetrician by passing instruments
  • Scout nurse: Supports the scrub nurse
  • Anaesthetic nurse: Assists the anaesthetist
  • Paediatrician: Cares for the baby post-birth
  • Midwife: Looks after the baby until you are moved to the ward
  • Theatre technician: Manages the operating theatre and helps you on and off the table

Pain Relief Options:

Several types of anesthesia may be used:
  • Epidural: Involves a local anesthetic and a catheter inserted near the spinal cord, allowing for ongoing medication as needed.
  • Spinal Block: Delivers a single dose of anesthetic into the spinal fluid for rapid numbing, but cannot be topped up.
  • General Anesthetic: Used if other forms of anesthesia are not suitable or in urgent situations. This will put you to sleep during the procedure.
    • a spinal block or epidural anaesthetic doesn’t work
    • there isn’t time for a spinal block or epidural anaesthetic to be used
    • there are concerns for your health or your baby’s health
    • you request a general anaesthetic

Risks and Complications:

As major surgery, a C-section carries risks, though complications are rare. These include:
  • Blood loss
  • Infection at the wound site
  • Blood clots
  • Potential damage to nearby organs
  • Risks associated with anesthesia
Complications are more likely if you are overweight or have had previous C-sections. Babies born via C-section may have temporary breathing difficulties, but these are usually managed by the medical team. There is a very small chance of a baby being cut during the operation, typically a minor injury that heals on its own.

Recovery Expectations:

Recovery from a C-section is generally slower compared to vaginal birth. You might experience pain for a few days, managed with medication. A typical hospital stay is three to five days, with guidance from your obstetrician and midwife on your recovery process.

Vaginal Birth After Cesarean (VBAC)

VBAC refers to performing a vaginal birth after a previous C-section. This can be a safe option for those wanting to avoid another C-section. Discuss this option with your healthcare provider early in your pregnancy.

Success Rates for VBAC

The likelihood of a successful VBAC varies, with success rates between 30% and 50%. Factors that increase the possibilities of success include:
  • Previous vaginal birth or successful VBAC
  • Low transverse incision during the previous C-section
  • Natural onset of labor
  • Low-risk pregnancy
  • Previous C-section due to the baby’s position
  • Normal weight
VBAC may not be recommended in certain cases, such as:
  • Complicated previous C-section or classical uterine incision
  • Placenta previa
  • Previous uterine rupture
  • More than three prior C-sections
  • Baby’s transverse position

Benefits of VBAC:

  • Lower risk of complications like infections or blood clots
  • Shorter recovery and hospital stay
  • Reduced risk of complications in future pregnancies
  • Less abdominal pain post-birth
  • Enhanced ability to care for your baby and other children
  • Lower risk of respiratory issues in the baby
  • Potentially better breastfeeding outcomes

Risks of VBAC:

The main risk is uterine rupture, occurring in about 5 to 7 per 1,000 VBACs. This risk underscores the need for hospital delivery and close monitoring. In rare cases, a hysterectomy may be necessary due to severe bleeding. There is also a possibility of needing an emergency C-section, which can increase the risk of bleeding and infection.
Your healthcare professionals will check you and your baby closely during labor and will discuss pain management options, including epidurals and other methods. If complications arise, your team will inform you and guide you through the necessary steps. Understanding the possibility of needing a C-section during a VBAC can help in making informed decisions during labor.
Nandhini – Pearl Hospital, a leading Muti speciality hospital in Velachery, Chennai, has been dedicated to women’s wellness for over 35 years, offering comprehensive gynaecological, fertility, cancer care, and specialty care treatments for women. Our team of expert obstetricians has safely delivered over 50,000 babies.
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