Labour can be a scary time for a mum-to-be, some women opt for no help at all, whilst others prefer medicical intervention. Midwife, Anne Richley, looks at the different ways labour can be assisted and explores the debate surrounding each technique.
“I spoke to a mum-to-be this week who was worried about ‘intervention’ during labour. She wanted to know what it meant and how to avoid it, as it always sounded so negative.
We talked about how one medical intervention can lead to another, and the ways she could boost her chances of having a normal birth. But sometimes, intervention can be life-saving for both mum and baby, and it’s important to understand when it’s appropriate. Here are the most common forms”:
Labour can be induced – brought on artificially – before or after your due date, and there’s usually a serious reason, such as pre-eclampsia (which involves a rise in blood pressure and can affect the baby’s growth), or your baby being well overdue.
If you haven’t reached your due date, being induced increases the chance of having a caesarean, as your body’s not ready for labour. But if you or your baby are at risk, an induction is usually advised. Pregnancy usually lasts between 37 and 42 weeks, but an induction can be offered after 41 weeks. Most women will go into labour by 42 weeks and avoid intervention.
Your waters breaking
Having your waters (sac of amniotic fluid around the baby) broken with an amnihook (like a crochet needle) used to be routine, to speed up a normal labour. Nowadays, your waters will only be broken during an induced labour or, possibly, a very slow one.
Once this is done, the baby’s head puts more pressure on the cervix, which can increase the intensity of contractions. Most women find labour easier to cope with if their waters break of their own accord – usually at the peak of a contraction – or not at all. Some babies are born in the intact sac.
Women labour at different rates and many find labour slows down when they arrive at the hospital. This is because the body releases adrenalin when you’re afraid, which can stop production of the hormone oxytocin.
Once a mum-to-be feels comfortable, her labour usually starts again. The medical profession tends to worry that the baby might become distressed if labour goes on too long. All too often, women are advised to speed it up with the aid of a drug called syntocinon, which contains a sybthetic version of oxytocin.
In some cases contractions genuinely wane, particularly if your energy levels drop, and then drugs can certainly help. But alternatives, such as walking around, nipple stimulation and boosting your energy with a snack, might also work. You can always say no to syntocinon – it’s a strong drug that should be used with caution. It has its place in the labour ward, but if a woman is helped to relax her contractions usually speed up.
Babies are monitored with a hand-held Doppler (an ultrasound device) or a pinnard (ear trumpet). Research shows continual monitoring of the baby’s heart beat, using a monitor attached to the mum’s waist, doesn’t improve the outcome in low-risk labours.
Continual monitoring restricts a woman and she often ends up lying down. This can slow down labour, which may lead to a more intervention. However, some babies need continual monitoring, if there’s concern about their wellbeing or growth, or you’re being induced or you have very high blood pressure.
Forceps or ventouse can speed up birth and may be advised if your baby is showing signs of distress, or the mum is becoming exhausted and the baby doesn’t seem to be moving down the birth canal. These events are less likely if the mum stays upright and mobile, as gravity helps the baby move down.
Many women rely on pain relief, but it’s important to read up on the options and their side effects. Epidurals can slow labour and increase the likelihood of having an instrumental birth, using forceps or ventouse, for example. But they can be great for reducing high blood pressure.
An injection of pethidine may help you to relax but it could also slow labour as you may need to lie down. When it comes to it, you might not care, but at least if you know your stuff you’ll be able to make an informed choice.