Everything You Need to Know About Assisted Deliveries

This blog post is to help you prepare for the ‘what if’ scenario if you need an assisted delivery for the birth of your baby.

An assisted delivery means when a doctor uses an instrument such as forceps or ventouse cup (sometimes called a Kiwi cup) to deliver your baby’s head. Around one in eight women deliver their baby in this way in the UK. This can be because

• there are concerns about the baby’s heart rate
• your baby is in an awkward position
• you’re too exhausted and have been pushing for a long time

A forceps consists of two smooth metal long ‘salad spoon’ type instruments which are curved to shape around the sides of your baby’s head.

These are fitted carefully by the doctor and the handles of the forceps are then locked together securely. As you get a contraction the doctor will gently pull down onto the forceps as you push to guide your baby’s head to entrance of your vagina. When your baby’s head begins to crown and stretch your perineum the doctor may make a cut called an episiotomy to make the space in your vagina and perineum to allow for the baby’s head to be born. Once to the head is delivered the doctor will remove the forceps from around your baby’s head and wait for another contraction to deliver the shoulders and rest of your baby.

THINGS TO CONSIDER WHEN HAVING A FORCEPS DELIVERY:

• you are more likely to have an episiotomy which will require stitches which are done by the doctor (these are disolveable.)
• if you don’t have an epidural, local anaesthetic will be injected into the area before the doctor makes the cut so you not feel it
• you are more likely to bleed from the ‘cut’ (episiotomy) therefore your overall blood loss will be more
• if after 3 pulls the baby cannot be delivered in this way the delivery should be abandoned and a caesarean section should be considered
• therefore most forceps deliveries happen in theatre for this reason
• you should still be able to have skin to skin with your baby
• your can still have delayed cord clamping
• your birth partner can cut the cord
• you will require a catheter to be inserted into your urethra to empty your bladder of urine which usually stays in for 12 hours following the birth of your baby
• you have an increase chance of having short term incontinence problems such as not be able to control your wind or bowel movements
• you may feel more internal and external bruising from the forceps delivery than a ‘natural’ delivery
• you may therefore need stronger pain relief after the delivery to make you more comfortable especially when sitting to feed your baby or going to the toilet
• your baby is likely to be born with some markings on its face such as bruising on the side of the forehead and circular red marks around the cheeks. These should go after 24-48 hours
• due to bruising around your baby’ jaw and mouth they can find breastfeeding more difficult and you both may require extra support. Some women choose to use a Cranial Osteopath once discharged from hospital

A ventouse delivery (or kiwi cup) is when a doctor applies a small silicone cup to the top of your baby’s head inside your vagina. Once the cup is in place, the air is sucked out of it using a foot-controlled vacuum pump, or a hand-held pump.

It can be noisy if a machine is used, so be prepared. When it is securely fixed, the doctor will ask you to push with your next contraction. The doctor will pull on the cup to help your baby out. Sometimes the cup comes off the baby’s head, which even if it sounds alarming, won’t cause any harm to your baby. After 3 pulls the baby’s head should begin to crown and stretch the perineum. Unlike a forceps birth where more space is require, with a ventouse delivery you are less likely to need an episiotomy. As the head is delivered the cup is removed so the doctor can deliver the rest of your baby.

THINGS TO CONSIDER WHEN HAVING A VENTOUSE DELIVERY:

• it can often be performed in the delivery room rather than theatre
• it is more likely to leave your baby with a temporary swelling on her head (cephalhaematoma).
• and more likely to cause bleeding inside your baby’s eye (retinal haemorrhage) which look like blood shot in the whites of your baby’s eyes
• you may not always need an episiotomy as less space is required of the instrument being used by the doctor
• you may still need a catheter inserted for up to 12 hours following the birth
• you should still be able to have skin to skin with your baby
• your should still be able to have delayed cord clamping
• your birth partner can still cut the cord

It is important to remember that if a doctor recommends an instrumental delivery you still have the choice to question their decision and where possible take time with your midwife and birth partner to discuss what is best for you and your baby. A good acronym to remember and to use at any point of your pregnancy or labour is BRAIN.

B – what are the benefits of doing what you recommend?
R – what are the risks?
A – what are the alternatives?
I – what does my intuition tell me?
N – what happens if we do nothing?

Sometimes it’s not always possible to avoid an assisted birth but good planning and preparation during your pregnancy can help you and your partner understand the options available to you. For example having an epidural increases your chance of having as assisted delivery because:

• It may slow your labour down, especially the second stage of labour when you have to start pushing, because it can be very difficult to know if you’re pushing correctly as you are numb in the area you need to focus on
• It increases the risk of your baby moving into the wrong position and therefore forceps or ventouse may be required to help turn the baby into a better position

But it’s equally important to weigh up the advantages and disadvantages. No one is going to think you’ve given up or couldn’t do it if you require an instrumental delivery. And the same goes for an epidural. Your birth is about it being positive for you and I have been at many many births where women had an epidural and a ventouse delivery and it’s been wonderful, beautiful and empowering. Milli Hill founder of The Positive Birth Movement says ” A good birth doesn’t have to be a hippy dippy ‘natural’ birth, all candles, knitting midwives and placenta smoothies. Many women who have hospital births that don’t go the way they planned and end in interventions such as an instrumental delivery, report feeling positive about what happened. Milli goes on to explain why, “This is because how a woman is spoken to and treated as she has her baby is much much more important than the actual mode of delivery. Women need to feel that they have been consulted, respected and given the information they need to make free choices in the best interest of themselves and their child. This allows them to begin motherhood feeling strong, capable and mentally healthy.”

And also please be reassured that eight out of 10 women who have an assisted birth have a normal birth next time around.

Has anyone else had an assisted delivery and would like to share their experience? Any tips on coping afterwards?

For more information about assisted deliveries please see:

NHS Choices

NCT Assisted Vaginal Birth

 

So Did Kate Do It Her Way?

Unless you’ve been living under a large rock for the last 24 hours or have no access to the media, Twitter, Facebook or any human contact, then you will know that Kate delivered a baby boy yesterday afternoon. My (invisible) midwife hat has been firmly on my head since the news broke that she was in early labour. I could not help speculating what has going on inside The Lindo wing and neither could my colleagues either. Heading over to Twitter this evening proved I wasn’t the only one with my spies out and here’s why.

The wonderful Rebecca Schiller aka The Hackney Doula has written a fantastic piece on her thoughts (and mine) on what we hope and believe Kate achieved to birth her baby boy.

‘I’ll admit this is entirely speculation. I have no idea what has been going on inside the Lindo Wing for the last 36 hours and it’s good that I don’t know. Very few people, with the exception of Romola Garai , want the world’s media to have knowledge of the state of their post-partum perineum.

However on careful viewing of the footage of Kate emerging 27 odd hours after birth, I’m putting myself on the record saying that I think she had a spontaneous vaginal birth without instruments and without an epidural. Why? Well, as @midwifeyhooper, @beverleyturner and I have been saying on twitter she is walking and carrying her baby with ease. There’s no hesitation or grimacing when going down steps or into the car; all of which would be pretty impossible so quickly after a caesarean.

The baby has no tell-tale lumps from a ventouse cup or forceps marks on his face. Kate herself has no bruises on the back of her hands or wrists suggesting no epidural or synthetic hormones.

Of course, anything is possible, but her apparent lack of discomfort, her energy and her short stay in hospital and seemingly quite speedy timeline all point to a straightforward birth.

In many ways I feel guilty for speculating, for grubbily pouring over the photos searching for evidence. She’s just a woman adjusting to one of the most momentous changes in her life and I’m sure she doesn’t need us all wondering about ‘mode of delivery’ (hateful phrase). It’s her business and as long as she feels happy, well-supported and that it was a good and safe experience who cares if she had an elective caesarean or a water birth?

Yet, I can’t help feeling it does matter. If Kate was really keen to have a natural, vaginal birth and had really spent time practising antenatal yoga, Natal Hypnotherapy and the like I feel delighted for her that she had the birth she wanted and prepared for. In many ways the odds were stacked against her. Like over 90% of UK women she gave birth in a consultant-led unit (in her case with two dedicated consultants) when the evidence clearly shows that midwife-led care is the most appropriate, safest and cost-effective for low-risk women. She also gave birth at a private hospital with, reportedly, a 100% epidural rate, a high caesarean rate and no birth pool. (Though I wonder if an inflatable pool is being deflated as I type).

Sadly many UK women aren’t so lucky. Shunted in to consultant-led care through lack of available options they have a 45% chance of having an operative birth. Shocking when you think that the birth centre down the road would have dropped that chance by nearly 30%, while costing the NHS less and giving identical outcomes for the baby.

While medical intervention is life-saving, much-needed and also for some a positive choice there are too many women wanting to have Kate’s birth who end up feeling that the decisions have been snatched out of their hands.

So, perhaps I’m justifying my tabloid curiosity as I guiltily examine the backs of Kate’s hands, but the fact that the most high-profile birth of our time seems to have been a natural one, in a sea of rising interventions and rising dissatisfaction amongst women, seems important.

The headline “Woman has birth experience that she wanted and planned for” wouldn’t probably go down too well at The Sun’s news desk, but sadly it is becoming almost deserving of the front page.’

Follow Rebecca here @HackneyDoula

Birth Story Of The Week – Rachel and Ted

Summer is in full swing (I think I actually said yesterday to my husband in a teeny tiny voice that it was too hot). I’m doing my visits on my bike today and life is good!  Hope you all had a wonderful weekend and nobody got too burnt. Saw some hideous sun burn at our local Lido yesterday, ouch! Factor 30 people or you will look like a stripy lobster.

Today’s birth story comes from Rachel who writes a hilarious blog which I discovered when the Kirsty Allsop vs NCT row erupted on Twitter. Rachel writes with such honesty about Motherhood and says exactly what most of us are thinking, but don’t have the balls to say it. Here is her story

Blog: When The Baby Sleeps

Twitter: whenthebabysleeps

There are many things people tell you about giving birth that are true. The rest of what people tell you is irrelevant. One of the truest things I’ve read about giving birth is this: 

“When you’ve done it (given birth) you look back and realised that everything that happened, somebody had … told you would happen, but nobody put the information in the right order and they failed to really stress the important bits. They will tell you curiosities with more energy than they tell you about the main bits, where an actual baby comes out.” Zoe Williams, Bring it on, Baby (2010)

‘Ms Williams is 100% correct. As it turned out my labour featured a lot of the trivial details people had suggested it might, but the delivery was something else altogether.

It started with a sweep. A really vigorous and painful sweep, given as a way of trying to avoid a 39 week induction due to a (mistaken, in my humble opinion) diagnosis of gestational diabetes. Four hours later I was cramping and shitting and texting my husband urgently to ‘BRING HOME LOO ROLL!’. Body clearing out for labour? Check. We had a quiet evening in the bath, trying to time what were very half arsed contractions. There was a lot of standing up, sitting down and wondering if this was it.

I had a doula sorted to try and support me through an experience I was expecting to find very difficult. My husband’s amazing but he was keen to have a doula too, to help with practical things and provide a different dynamic to the one we feared might kick in if we both got tired and scared. I had many fears about childbirth which I’m sure most women share, and I felt I’d spent literally years preparing for something that I knew I couldn’t really prepare for.

My doula came over about midnight and we sat up for the next few hours talking, listening to music and pausing silent for contractions when they came. I’d had lots of things lined up to support me through labour such as a TENS machine, birthing ball and the like but when it came to it I just didn’t fancy any of it. As the contractions got stronger my doula got out her homeopathy kit, read me a poem and rubbed my back; all of these things seemed preposterous at the time (because they were) and I was still very much thinking through my labour at this point. I knew I time would come when I’d stop thinking, go inside myself and probably turn a bit feral but it hadn’t come yet.

About 5am I got a bit restless so insisted we go to hospital. Looking back on it I was wildly perky at this point and if my doula had been firmer with me she could have persuaded me out of going and kept me at home to progress. We arrived, I puked on a few people, peed in a bucket and then was told I was only 1cm dilated. Obviously. So home we went in a taxi that I had to get out of half way home because I was convinced I’d peed myself. I hadn’t. This was the thing that shocked me about labour; the total loss of control I felt. I was doing all of the bodily functions all the way through and it was weird. My body was starting to become ‘not-my-own’. Eeek.

Back at home I rested in the bath while my husband got some sleep, and my lovely doula stroked my hair, kept me positive and helped me relax enough to sleep through what were some intense contractions. I’d done hypobirthing during my pregnancy and it was at this point that I think it really kicked in. I was definitely in unrest mentally and physically very uncomfortable but what I felt wasn’t pain. That is until my waters broke. Two hours after getting into the bath I bit into a biscuit, threw up immediately and with my sick came the most almightly gush of stuff. I was sitting in a bath of puke, wee, womb water and all manner of bits that I could not identify. As well as the gunk there was this hard, intense pain and all I could think was ‘Get! This! Baby! Out! Of! Me! Now!

This is where labour memories become hazy as I shut my eyes and didn’t open them until it was more or less all over. Getting to the hospital was the hardest bit by far. I have vivid memories of trying to sit in the back of the car thinking it would be much less hassle to get out of the car and have the baby on the goddamn road. I think it may have been transition, folks. My doula and I shuffled into the hospital and were found a room on labour ward, while my husband left the car somewhere hugely inappropriate for which we got a parking ticket around the time my boy was born.

I was hoping to get straight into a birthing pool but the midwives had other ideas. My diagnosis meant close monitoring so I was strapped up to monitors – pre-labour I was adamant I’d still try for an active labour and wouldn’t be getting onto any beds to push. As it turned out I was so far gone by this point both physically and mentally that it was all I could do to crawl onto that bed and stay there. I was good for nothing else, too weak to stand and plus I was already ready to push. I tried gas and air around this time but it made me feel too light headed and scared to persevere, and although I did politely request an epidural even I knew that was pointless by now. Gulp. “You can start pushing on the next contraction.” It all felt too sudden and I had no time to acclimatise to the hospital setting, although the pain was telling me this baby couldn’t come soon enough.

The pain stopped for the first time in what felt like hours and I had a real moment of clarity. I looked around the room and asked ‘Will this bit really hurt?’ The answer was an emphatic No, as apparently I’d done the hard bit. Well, pushing a baby out is really hard to get the hang of isn’t it? I got all the ‘like you’re having a poo’ instructions but just couldn’t cut it. After every contraction I got the strong sense that I was doing pretty poorly as the midwives all looked very disappointed. And then they looked concerned. They were gathered around the monitor which was printing out my baby’s heartbeat, telling me to ‘push whenever you want!’ and then all of a sudden everything changed. An emergency cord was pulled and about 6 new extra people appeared out of nowhere. Equipment was gathered, lots of instructions were barked, and it became clear we had to get this baby out PDQ.

First up the doctor tried a ventouse, which hurt like hell and was ineffective, so thanks for that guys. She tried a cut too, which didn’t really hurt at all much to my surprise. It was the big guns that brought out my baby in the end: the dreaded forceps. Which, turns out, aren’t as bad as you think. I mean, it’s no picnic and I did immediately report it as ‘like being ripped apart by wild animals’ but considering what a brilliant job they do of getting your baby out they’re not quite deserving of their terror inducing status. I had a local for the forceps so couldn’t feel anything except pressure, and when baby came out he was just fine. It was all done there and then so there was minimal hanging around and the whole awful saga was over within 20 minutes. My boy came out screaming but well and he shot out with such force that he sprayed birth blood and gunk all over everybody – a fact I am more than a little proud of. Well, it’s the least they deserved for the drama right?

 He was well. 6Lb 5 and the spit of my husband as a baby. We were relieved beyond measure, swallowing our terror and trying not to think about what we thought might go wrong. Shell shocked, I think.

The next day I was visited by the doctor who delivered my baby. Now she’d definitely done an ‘oops’ face when she saw the state my genitals were in once my baby was born. She talked me through everything that had happened, reassured me that my baby was fine but that they’d been very worried, and explained that I’d take some time to heal. “Did I just not push hard enough?” I asked her. “No. You did a really good job.” I thanked her, and she left me to it.’