What happens during your labour will depend on your choice of delivery: cesarean section or vaginal delivery. During your antenatal visits, your doctor will go through your birth plan with you and your partner, as well as discussing events that can occur during the course of labour.
While most women will have uncomplicated deliveries, the nature of childbirth is unpredictable. Scenarios can change rapidly during labour and prompt swift actions that are necessary to safeguard the baby and mother’s well-being (regardless of what it says on your birth plan). In such situations, there will be little to no time to give a detailed explanation of what’s happening, so it’s important to have a general sense of understanding of what can happen in any labour scenario.
Vaginal delivery may be spontaneous, induced, augmented, or instrumentally assisted. Let’s go through some things that can happen during vaginal delivery labour.
All vaginal deliveries have the risk of perineal (vaginal opening) tears; in fact, more than 85% of women will experience some degree of perineal trauma. The tear may be small and can be repaired in the delivery suite, or can be deep and necessitate repair in an operating theatre. Deep tears are called third and fourth-degree tears.
The risk for tears is increased in women who:
- have never had a vaginal delivery before
- have big babies
- have instrumental deliveries
- have a very quick second stage of labour
An episiotomy is when a cut is made at the vaginal opening just as the baby’s head is coming out. It’s not a routine procedure during vaginal delivery but may be done in certain circumstances to facilitate the delivery of the baby.
An episiotomy may be used in situations when:
- there may be a major perineal tear impending.
- during instrumental delivery.
- the baby’s condition is not reassuring and swift delivery is necessary.
Episiotomies are only done when necessary. If you do not want an episiotomy under any circumstances, have this in your birth plan and discuss at length with your doctor.
Induction of labour
Induction labour (or sometimes called augmentation of labour) is whereby your doctor starts the process of labour. This is usually done when there is a need to deliver the baby but the situation isn’t urgent enough to necessitate a cesarean section. For example, it may be used when there’s a prolonged pregnancy that’s passed the expected delivery date.
There are different ways to start labour, here are a few examples:
- mechanically by breaking the waters
- using medications such as vaginal prostaglandins or intravenous syntocinon infusions
Depending on your situation, some methods may or may not be suitable for you. Your doctor will discuss your options with you.
Once labour has started, the duration you experience should be like usual. Some women may find induced labour more painful due to the strength of contractions, but rest assured, you should still have a normal vaginal delivery.
Some women will have spontaneous labour that may slow down or subside after the initial onset. In these cases, they may need to use mechanical methods or medications mentioned above to resume or speed up (augment) the course of labour. This is necessary as excessively long labour is associated with an increased risk of infection and bleeding after delivery.
This is when a specially designed metallic or plastic cup is applied to the baby’s head using a suction/vacuum force. It’s used to help in vaginal delivery when the cervix is fully dilated and the baby’s head is low down in the pelvis.
A vacuum-assisted delivery may be used:
- to speed up a delivery when the baby’s condition is not reassuring
- when the mother is exhausted
- if labour is prolonged
The procedure is usually safe but there are risks involved. Some of the following complications have a higher chance of occurrence when an instrument is used:
- shoulder dystocia: difficult delivery of the baby’s shoulder and body
- bleeding underneath the external layer of the skull (can occur in 1 in 300)
- skull fracture and/or bleeding inside the skull (can occur in 1 in 1,900 unassisted vaginal deliveries and in 1 in 860 vacuum-assisted vaginal deliveries)
- retinal haemorrhage
- cervical spine injury (very rare, less than 1 in 1,400 vacuum-assisted vaginal deliveries)
After an assisted vacuum delivery, the baby’s head will likely swell due to the suction force of the cup. The swelling doesn’t hurt the baby, is transient, and will resolve spontaneously in one to two days. There is no need to massage or rub the swelling.
Forceps assisted delivery
When the baby’s head is low down in the birth canal, specially designed metal forceps can be applied to the baby’s head to assist the birth. Similar to a vacuum-assisted delivery, forceps-assisted delivery is usually done when:
- Mother is too weak to push.
- Mother has a condition that prevents her from pushing.
- Baby is less than 37 week’s gestation.
- When there’s difficulty delivering the head in a breech vaginal delivery.
To note, this method of assisted delivery can only be used when the baby is lying in the correct position. The risks are similar to vacuum-assisted delivery:
- shoulder dystocia
- skull fracture and/or bleeding inside the skull (1 in 664 forceps deliveries)
- bleeding underneath the external layer of skull
- injury to the facial nerve
- cervical spine injury
- third or fourth-degree perineal tear
- small abrasions to baby’s face and forceps marks (common and should resolve in one to two days)
Whether or not you’ve elected a cesarean section for your delivery, sometimes mothers may have no choice due to their pregnancy condition or if it’s an emergency. A C-section is normally done under regional anaesthesia, so the mother remains awake during the surgery. This is so that after the baby is immediately born, it can still have skin-to-skin contact.
Although safe, there are some risks involved when undergoing a C-section:
- bleeding that may require a blood transfusion
- infection of the wound, urinary tract or chest
- injuries to other organs near the womb, such as bladder or bowel
- lacerations on the baby’s face or buttock
- a blood clot forming in the veins (deep vein thrombosis)
- failure of regional anaesthesia requiring general anaesthesia
- hysterectomy (removal of the womb/uterus)
- death (life-threatening bleeding)
- possible need for future cesarean section
- persistent numbness, itchiness, or pain of the cesarean section scar
- keloid formation of the cesarean section scar
Often, women who’ve given birth via cesarean section may not be able to have a vaginal birth with their future pregnancies (VBAC). This is because, during your cesarean birth, the type of scar created may not be strong enough to hold together during labour contractions and cause a uterine rupture.
There are also other risks for the future you will need to consider – be sure to discuss any of these concerns with your doctor.
OT&P pregnancy support in Hong Kong
If you’re looking for pregnancy support, advice and help in Hong Kong – look no further! Here at OT&P, we’ve got a team of dedicated midwives and obstetricians with plenty of experience handling pregnancies in Hong Kong. Should you wish to book an appointment or discuss your options, you can contact us here.
Alternatively, we also have a range of maternity packages that mothers-to-be can choose from. Whether it’s your first pregnancy or if you’ve given birth before, our packages offer peace of mind from the prenatal/antenatal stages to postnatal stages of your pregnancy.
Most information is taken from The Royal Australian and New Zealand College of Obstetricians and Gynaecologists’ Recommendation on Instrumental Vaginal Birth, March 2016.