Assisted vaginal delivery

During delivery there are occasions when it may be necessary to use external medical assistance to help your baby get delivered. Here are a few reasons why it may be necessary to use intervention:

• If baby is in ‘distress’ – shown in a slowing heart rate; or if the baby passes meconium (the contents of the baby’s rectum) which will stain the amniotic fluid; or shown in a blood sample taken from baby’s scalp.
• If baby’s way out is difficult, because he is in a poor position, or because the mother’s pelvis isn’t able to open wide enough.
• If your contractions have weakened, or you’re exhausted.
• If the baby is pre-term, which means his soft skull bones need more protection.

Induction

Induction is most often used if your baby is overdue or if your doctor feels that your health or your baby’s health is at risk. Your placenta starts to decrease in efficiency after about 41 weeks and may compromise your baby’s health by not delivering enough oxygen and food. 

Administering oxytocin via an intravenous drip may induce your labour if it has not started naturally. The use of this synthetic hormone is supposed to replicate your own hormones that your body would produce if it had started labour by itself. You may have the drip inserted throughout your entire labour and birth, if this is the case check with your medical staff that you will still have freedom to move around for an active labour and birth. 

If your labour is slow or your contractions have stopped, your doctor or midwife may recommend using the hormone oxytocin, administered via a drip, to help speed up or restart labour. This will usually bring on strong, intense contractions. 

Prostaglandin gels are commonly used as a first method of induction. They are inserted into your vagina and are designed to encourage your cervix to soften and begin the dilation process. You will often be asked to come to the hospital in the evening where the medical staff will insert the gel and then usually allowed to return home, and hopefully start your labour. 

Breaking Your Water

An Artificial Rupture of The Membranes (ARM) is often performed by your doctor or midwife during your labour if your contractions have slowed and your baby is not progressing well. It is a painless procedure where a tool similar to a crochet hook is inserted through your vagina and the membranes surrounding your baby are ruptured. You will feel a warm trickle, or rush, of liquid flow out from your vagina. Following the rupture it is usual for your contractions to intensify. 

Forceps and Ventouse

These tools are used if your baby has stopped progressing down the birth canal: 

• A ventouse extractor is a rubber cap that is suctioned onto your baby’s head and your baby is then pulled from the birth canal by vacuum. Your doctor or midwife will pull at the same time as you push during your contractions. Often after a vacuum extraction your baby’s head may show signs of being misshapen but this will return to normal after a couple of days.
• Forceps are only used if you have fully dilated to 10 cm and your baby’s head is close to the end of the birth canal. A forceps delivery will usually involve you having an episiotomy to allow your doctor or midwife more room to manoeuvre the forceps. Your doctor will pull on the forceps that are positioned on either side of your baby’s head while you bear down during your contractions. It is likely that your baby will have some bruising on their face after a forceps delivery. 

Your child birth educator will provide more information about these tools and might be able to show you exactly what they look like and how they are used. 

The most invasive form of intervention during your labour and delivery will be a caesarean. For more details on this subject go to the caesarean page in the Labour and Birth section.