This section is all about ‘when nature needs a hand’ – when interventions may be needed in your labour and birth. Have a look at the links below for some useful information.
We offer antenatal classes that cover all the topics below and more.
When nature needs a hand
Assisted birth
An assisted vaginal birth is where a doctor or midwife uses specially designed instruments to help deliver the baby during the last part of labour.
Why might I need help with the birth of my baby? There are several reasons. The main reasons are:
- your baby is not moving out of the birth canal as would normally be expected
- there are concerns about your baby’s wellbeing during birth
- you are unable to, or have been advised not to, push during birth
The purpose of an assisted vaginal birth is to mimic a normal (spontaneous) birth with minimum risk to you and your baby. To do this, an obstetrician or midwife uses instruments (ventouse or forceps) to help your baby to be born.
Caesarean section
A caesarean section, or C-section, is an operation to deliver your baby through a cut made in your tummy and womb.
The cut is usually made across your tummy, just below your bikini line. A caesarean is a major operation that carries a number of risks, so it’s usually only done if it’s the safest option for you and your baby.
A caesarean may be recommended as a planned (elective) procedure or done in an emergency if it’s thought a vaginal birth is too risky.
Induction of labour
An induced labour is one that’s started artificially. Every year, 1 in 3 labours are induced in the UK. Sometimes labour can be induced if your baby is overdue or there’s any risk to you or your baby’s health. This risk could be if you have a health condition such as high blood pressure, for example, or your baby is not growing.
Induction will usually be planned in advance. You’ll be able to discuss the advantages and disadvantages with your doctor and midwife, and find out why they think your labour should be induced.
It’s your choice whether to have your labour induced or not.
If your pregnancy lasts longer than 42 weeks and you decide not to have your labour induced, you should be offered increased monitoring to check your baby’s wellbeing.
Monitoring your baby in labour – fetal monitoring
Your midwife will monitor you and your baby during labour to make sure you’re both coping well.
This will include using a small handheld device to listen to your baby’s heart every 15 minutes. You’ll be free to move around as much as you want.
Your midwife may suggest electronic monitoring if there are any concerns about you or your baby, or if you choose to have an epidural.
Electronic monitoring involves strapping 2 pads to your bump. One pad is used to monitor your contractions and the other is used to monitor your baby’s heartbeat. These pads are attached to a monitor that shows your baby’s heartbeat and your contractions.
Sometimes a clip called a fetal heart monitor can be attached to the baby’s head instead. This can give a more accurate measurement of your baby’s heartbeat.
You can ask to be monitored electronically even if there are no concerns. Having electronic monitoring can sometimes restrict how much you can move around.
Episiotomy and perineal tear
Sometimes a doctor or midwife may need to make a cut in the area between the vagina and anus (perineum) during childbirth. This is called an episiotomy.
An episiotomy makes the opening of the vagina a bit wider, allowing the baby to come through it more easily.
Sometimes a woman’s perineum may tear as their baby comes out. In some births, an episiotomy can help to prevent a severe tear or speed up delivery if the baby needs to be born quickly.
If your doctor or midwife feels you need an episiotomy when you’re in labour, they will discuss this with you. In England, episiotomies are not done routinely.
Up to 9 in 10 first-time mothers who have a vaginal birth will have some sort of tear, graze or episiotomy.
The National Institute for Health and Care Excellence recommends that an episiotomy might be done if:
- the baby is in distress and needs to be born quickly, or
- there is a need for forceps or vacuum (ventouse), or
- there is a risk of a tear to the anus
Around 1 in 7 deliveries in England involves an episiotomy.
If you have a tear or an episiotomy, you’ll probably need stitches to repair it. Dissolvable stitches are used, so you will not need to return to hospital to have them removed.
Antenatal perineal massage
Massaging the perineum in the last few weeks of pregnancy can reduce the chances of having an episiotomy and perineal trauma during birth.
The type and frequency of massage varies across research studies. Most involve inserting 1 or 2 fingers into the vagina and applying downward or sweeping pressure towards the perineum.
The most benefit was in women who repeated this every day.
More information
Breech at the end of pregnancy
Babies often twist and turn during pregnancy, but most will have moved into the head-down (also known as head-first) position by the time labour begins. However, that does not always happen, and a baby may be:
- bottom first or feet first (breech position)
- lying sideways (transverse position)
Bottom first or feet first (breech baby)
If your baby is lying bottom or feet first, they are in the breech position. If they’re still breech at around 36 weeks’ gestation, the obstetrician and midwife will discuss your options for a safe delivery.
Turning a breech baby
If your baby is in a breech position at 36 weeks, you’ll usually be offered an external cephalic version (ECV). This is when a healthcare professional, such as an obstetrician, tries to turn the baby into a head-down position by applying pressure on your abdomen. It’s a safe procedure, although it can be a bit uncomfortable. Around 50% of breech babies can be turned using ECV, allowing a vaginal birth.
Giving birth to a breech baby
If an ECV does not work, you’ll need to discuss your options for a vaginal birth or caesarean section with your midwife and obstetrician.
If you plan a caesarean and then go into labour before the operation, your obstetrician will assess whether it’s safe to proceed with the caesarean delivery. If the baby is close to being born, it may be safer for you to have a vaginal breech birth.
The Royal College of Obstetricians and Gynaecologists (RCOG) website has more information on what to expect if your baby is still breech at the end of pregnancy.
The RCOG advises against a vaginal breech delivery if:
- your baby’s feet are below its bottom – known as a “footling breech”
- your baby is larger or smaller than average – your healthcare team will discuss this with you
- your baby is in a certain position – for example, their neck is very tilted back, which can make delivery of the head more difficult
- you have a low-lying placenta (placenta praevia)
- you have pre-eclampsia
Lying sideways (transverse baby)
If your baby is lying sideways across the womb, they are in the transverse position. Although many babies lie sideways early on in pregnancy, most turn themselves into the head-down position by the final trimester.
Decision making
You have lots of decisions to make during pregnancy, in labour and when you have had your baby. In order to make informed decisions about your care you can use a decision making tool like the BRAIN tool.
B Benefits. What are the benefits?
R Risks. What are the risks and considerations?
A Alternatives. What are the alternatives, and what are the risks and benefits of those?
I Intuition / information. How do you feel? Do you need more information?
N Nothing / not now. Do I need to decide now? What if I do nothing?
Wound care
Most women experience some discomfort for the first few days after a caesarean, and for some women the pain can last several weeks.
- gently clean and dry the wound every day
- wear loose, comfortable clothes and cotton underwear
- take a painkiller if the wound is sore – for most women, it’s better to take paracetamol or ibuprofen (but not aspirin) while you’re breastfeeding
Non-dissolvable stitches or staples will usually be taken out by your midwife after 5 to 7 days.
The wound in your tummy will eventually form a scar.
This will usually be a horizontal scar about 10 to 20cm long, just below your bikini line.
Contact your midwife or a GP straight away if you have any of the following symptoms after a caesarean:
- severe pain
- leaking urine
- pain when passing urine
- heavy vaginal bleeding
- your wound becomes more red, painful and swollen
- a discharge of pus or foul-smelling fluid from your wound
- a cough or shortness of breath
- swelling or pain in your lower leg
These symptoms may be the sign of an infection or blood clot, which should be treated as soon as possible.
More information
Fetal monitoring
An important part of maternity care is listening to your baby’s heart rate throughout your labour. This enables us to monitor your baby’s wellbeing and can help to identify if there are any problems developing.
At all times you will be given information that allows you to make an informed choice about all aspects of your care.
Your community midwife will have a conversation with you about monitoring your baby in labour as part of your antenatal care and document your discussions and decisions in your personalised care plan. This conversation will take into account your pregnancy, your well-being and your birth preferences.
Most babies come through labour without any problems, but there are a few babies who run into difficulties. The best way of finding out which babies are having trouble is to listen to every baby’s heartbeat regularly throughout labour.
There are no current guidelines to suggest when your midwife should listen to your baby’s heartbeat during pregnancy, however it is possible to hear it from approximately 16 weeks.
From 24 weeks, your midwife will ask you about your baby’s movements every time you see them and, if there are any concerns, they will ask to assess you and your baby. This may result in a visit to the Maternity unit at the hospital.
How do we listen?
If you are healthy and have had a problem free pregnancy, your midwife will ask to listen to your baby’s heartbeat using a Pinard stethoscope or a hand-held doppler.
Intermittent Auscultation
When you are in labour, the midwife will ask to listen to your baby’s heartbeat at least every 15 minutes, immediately following a contraction, and more frequently as labour advances. This method of monitoring is called intermittent auscultation. The advantage of this method is that it enables you to move around freely and can be used in water.
It is important that the midwife starts listening to your baby’s heart beat just as your contraction is going away, and they will need to count the heartbeat for a full minute.
It is helpful if you know about this as your midwife may ask you to change position to make this easier.
The midwife will need to count your baby’s heart beat for a full 60 seconds every time they listen in.
If your midwife notices a change in the baby’s heart rate that suggests your baby might not be coping well, they will tell you and they may recommend continuous monitoring.
The midwife will ask to manually feel your pulse on your wrist every hour during the first stage of labour and if you are still having intermittent auscultation during the second stage, they will ask to feel your pulse every 5 minutes. This helps your midwife be sure that it is definitely your baby’s heartbeat that is being picked up and not yours.
Continuous electronic fetal monitoring (CTG)
This type of monitoring produces a continuous ‘trace’ of the baby’s heart rate throughout your labour and is referred to as a cardiotocograph or CTG.
The CTG monitor has 2 sensors that are strapped around your abdomen, one to monitor the frequency of your contractions and the other to monitor your baby’s heart rate.
Continuous monitoring can limit your ability to move around, however it is still possible to mobilise, or to change your position to standing or sitting on a birthing ball.
A wireless monitor may be available. This allows you to move more freely.
Risk assessment is an ongoing process and the recommended method of fetal monitoring may change throughout labour. If there are no identified risk factors for fetal compromise, there is a risk of increased interventions with continuous CTG monitoring compared with intermittent auscultation, which may outweigh the benefits.
Advice given by the midwife or obstetrician on the method of fetal heart rate monitoring will take into account the whole clinical picture.
When performing CTG monitoring your midwife may find it difficult to get a clear trace on the graph (particularly when you are pushing or mobilising). If this happens, they may ask permission to monitor your baby with a fetal scalp electrode (FSE). If this method of monitoring is recommended during your labour your midwife or doctor at the time will discuss this with you and support you to make an informed choice.
Things to remember
- A normal CTG trace indicates that the baby is coping well with labour
- Changes to your baby’s heart rate pattern during labour are common and are not always worrying
- Sometimes these changes can show which babies are having trouble coping with the stress of labour.
- If your midwife has concerns with the CTG they will ask your permission to invite a senior midwife and/or doctor to be involved in your care and they will make an assessment to find out if there is an identifiable cause that can be corrected.
- Such causes include an infection developing which can be treated with antibiotics or if there are other signs that your baby may be distressed such as the baby opens their bowels inside (passes meconium).
- This will be all be considered along with how your labour is progressing to make a personalised plan of care for you and your baby taking into account your preferences.