Intervention in labour – our midwife answers your questions

Caesareans and inductions – our midwife explains about intervention during your labour

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Q. I’ve been booked in for a caesarean section, but I’ve never had an operation before. What can I expect?

A. You’re right to think of a caesarean section as surgery as you’ll need time to recover. Before the operation you’ll be given an anaesthetic, usually through a spinal block (a single pain-killing injection), which will numb from the top of your bump to the tips of your toes. Your baby will be born within around 10 minutes of the start of the surgery and while the procedure won’t hurt, you may feel pushing and pulling inside. A cut is made of about 13cm long, don’t worry it won’t be very noticeable once it heals. It’s worth noting that you’ll still bleed afterwards too, in the same way as you would after a vaginal birth, so get in sanitary towels and big disposable pants that won’t dig into your wound. Recovery time varies, but avoid driving and lifting for the first four to six weeks.

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Q. My midwife has told me I’ll only be allowed to go one week past my due date before I’m induced, but my sister went two weeks past hers. How strict are the rules?

A. Guidelines vary slightly around the country, but there is evidence there is a greater likelihood of health problems in babies born after 42 weeks. Having said that, remember that a normal gestation is 37 to 42 weeks and many women will still go into labour of their own accord at the end of that time, like your sister did. At 41 weeks you‘ll be offered an internal examination, which can kickstart labour, but it’s not a guarantee. Many hospitals suggest an induction at 10-12 days overdue. Some women wait longer than 42 weeks for labour to start on its own, but your midwife would advise a scan to check there’s enough amniotic fluid, and would want to monitor the heartbeat at least twice a week.

Q. My daughter was born by c-section as she became distressed during labour. I’m expecting again, will I need another caesarean?

A. No, there’s no reason to assume the same thing will happen again. Having a vaginal birth after a c-section is known as VBAC and statistically you’ve got a 70% chance of achieving it, but rates vary between maternity units. Women who have had one c-section aren’t automatically booked in for another. Now your body has healed it’s assumed that it’s capable of a vaginal birth. There’s a tiny risk associated with VBAC, which is that during labour the contractions cause the scar to become thin or start to separate. While this is serious, it’s very rare, and you’ll be closely monitored so that if it does start to happen, you’re taken to theatre straight away. Make sure it’s clear in your notes that you had a c-section previously, and keep your midwife informed of any changes in pain throughout this labour.

Q: The thought of having an episiotomy really worries me. Can I say no?

A: An episiotomy is a cut made to the perineum area between the vagina and the anus to widen the opening during childbirth. Your midwife might suggest one if your baby’s showing signs of distress and needs to be born quickly, or if you need a forceps or ventouse delivery. It’s a common worry among mums-to-be, but most women say that they didn’t actually feel anything during an episiotomy.

Speak to your midwife about your fears and look at different birthing positions that can help you avoid an episiotomy. If you still feel strongly, write on your birth plan that you don’t want one. You might still get a small tear involving skin (first degree) that may not need stitches, or a tear involving muscle (second degree) that will be stitched straight after the birth using local anaesthetic. It might not seem like it now, but during labour, you’ll be so eager to meet your baby that it’ll be the last thing on your mind.

Q: I have a real fear of stitches and I’m worried about tearing. Please help!

A: You’re not alone in your fears but even though 90% of women suffer some sort of trauma down there, it could be just a tiny graze that won’t need stitches. Even if you do tear, you won’t always need stitches, as a small wound will heal on its own. If you do need them, you’ll be given a local anaesthetic so you won’t feel anything and the stitches will dissolve later of their own accord. So many women worry about this, but if it does happen you probably won’t even be aware of it as you’ll be too preoccupied.

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To help avoid tearing, try perineal massage (from 34 weeks) by inserting your thumb 2-3cm into your vagina and applying pressure on the perineum (the area between the opening of your vagina and anus) for about a minute, stretching and massaging it with olive oil.

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