BY Tina Perridge
The process of creating, growing and giving birth to a new human being is a minor miracle for everyone involved.
There are many ways of giving birth, some are chosen and some choose us. What is critical is that each woman feels she has played an active part in this process and that her views have been heard and respected. Then she will feel positive about her experience and will not suffer feelings of failure, disappointment or guilt.
So what are the options?
STRAIGHTFORWARD BIRTH
There is a lot of talk about “normal birth” suggesting that other ways are abnormal? I prefer to think about straightforward birth where the labour starts spontaneously at around term (37-42 weeks) and progresses without the need for intervention to an unassisted vaginal birth. A woman who experiences this is fortunate and will likely emerge feeling positive, however even after such a birth, some women may feel traumatized if their caregiver is unkind or not supportive. Recent evidence suggests that only 22-30% of births meet this criteria.
INDUCTION OF LABOUR
Along the way there are a number of diversions that may occur leading to a birth that is not quite so straightforward. However generally there is still a degree of choice available. The most common is of course induction of labour. The 2016-2017 Maternity Statistics indicate that some 30% of women will experience some form of IOL. Consequently it is important that you understand the process and understand that in many cases there is a choice and you need to inform yourself so that you know what to ask. IOL can lead to further interventions such as the need for an epidural, continuous fetal monitoring as well as an instrumental birth (forceps and ventouse) probably requiring an episiotomy.
IOL is usually commenced with a prostaglandin gel or pessary, this is to soften the cervix and ensure it is ready for the waters to be broken and the artificial hormone drip to be started. Sometimes the pessary can initiate labour on it’s own and the woman may go on to have a non complicated birth. Otherwise the waters will be broken and the hormone drip will be started to increase and maintain strong productive contractions. The combination of these contractions and the woman’s inability to move as freely as she would like will often lead to her requesting an epidural.
NICE Guidelines now state clearly that use of an epidural may lead to a longer second stage and an increased likelihood of forceps or a ventouse. The reasons for this are linked to poor mobility with an epidural as well as the difficulty the woman might have in experiencing the necessary urge to push her baby out. If the second stage goes on too long, both the mum and the baby may get tired and an instrumental option (ventouse or forceps) may be offered. The ventouse can be done if the baby is low enough in the birth canal for the cap to be fitted easily and the combined efforts of the woman and the doctor using the ventouse will usually ensure that the baby is born. S/he may have a somewhat bruised and slightly misshapen head but that should resolve very quickly over the first day or two. Forceps are more likely to be used if the baby is still a little high in the birth canal and will usually be used in theatre, just in case there is a need to proceed to a caesarean section. An episiotomy is usually done too. Again the baby may be bruised and so will the woman. Recovery is generally uncomplicated but many women may feel somewhat traumatized by this process and will benefit from good support and a debrief.
So it is easy to see how a simple decision to accept IOL can lead to a very different experience to the one you envisaged. The association for Improvement in Maternity Services and the NCT will provide you with good quality information on IOL to help you make an informed choice.
Sometimes what starts as a planned vaginal birth ends as a caesarean section. Equally some births are planned as a caesarean section from the start.
The emergency C section rate in the UK is 15%, while some 13% are planned C sections, giving a total of 28% of all births. The reasons for this are varied. The woman may have a medical or obstetric condition that suggests a c section is preferable. It may be an issue with the baby. Perhaps a previous birth incident or experience indicates that a c section is a good choice. Many of these issues will be individual to the woman and her baby.
Sometimes the labour creates too much stress for the baby, especially if there are a lot of interventions and then a c section is proposed. Equally, if an IOL is started but is not successful in initiating labour, a c section may be the only solution. This will be an unplanned or emergency C section.
Ultimately, whether a woman chooses a caesarean section, or whether circumstances choose it for her, it is a valid choice that should be respected. She has still given birth.
If it is an elective section there should be the opportunity to plan the birth with the consultant and ask for a gentle approach with skin to skin and early feeding in theatre. Delayed cord clamping should also be possible.
In an emergency or unplanned situation there may not be so much opportunity to state preferences but a quick word with the midwife may help in this case. The partner should be able to take photos and these are a very important reminder for the woman.
BIRTH OPTIONS