Delivery Interventions You May Receive
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Depending on your pregnancy and health history, some of the following intervention options may be helpful for you during your labor and delivery.
If labor has not started naturally, your doctor can use artificial means to begin this process. Induction can include medication to soften the cervix, rupture of the amniotic sac, and/or medication can be given to cause the uterus to contract. The most commonly used medications are prostaglandins and oxytocin (Pitocin).
Reasons that you may be induced include the following:
- Pregnancy has gone two or more weeks past your due date
- Your water has broken, but true labor contractions have not started
- You have a condition that may threaten the health of you or your baby
- Your baby has a condition that needs treatment, and a ]]>c-section]]> is not necessary
If your labor begins naturally, but then the contractions slow or stop, your doctor will take steps to resume labor. This is called augmentation. Your doctor may augment your labor by rupturing the amniotic sac or giving oxytocin (Pitocin).
Fetal Heart Rate Monitoring
]]>Fetal heart rate monitoring]]> tracks and records your baby’s heart rate and the strength and duration of your contractions. Monitoring can be done externally or internally. A common method of external monitoring involves two flat sensors that are placed on your abdomen. One sensor uses ultrasound to monitor your baby’s heart rate. The other measures your contractions.
Internal monitoring provides a more accurate measure of your baby’s heart rate and your contractions than external. The cervix must be dilated at least two centimeters and the amniotic sac ruptured in order to do internal monitoring. A sensor is strapped to your thigh, and a thin wire called an electrode is inserted into your uterus. An electrode attached to the skin on the baby’s head measures the baby’s heart beat. A separate tube inserted into the uterus measures the strength and timing of contractions.
Fetal heart rate monitoring provides information on how the baby is doing. An abnormal heart rate can be a sign that something is wrong and that action may be needed.
Continuous fetal heart rate monitoring for healthy pregnant women in normal labor is not necessary, and may generate more harm than good. Intermittent auscultation is a good alternative. For high-risk pregnancies, continuous fetal heart rate monitoring is the standard.
External Fetal Monitoring
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An ]]>episiotomy]]> is a small incision into the perineum. The perineum is the area between the vagina and the anus that stretches as the baby’s head is delivered. After the baby and placenta have been delivered, the episiotomy incision is closed with stitches. Episiotomies are more common during a woman’s first delivery.
Episiotomies were more routinely done in the past. Today, very few doctors routinely cut an episiotomy as they can result in greater damage than a natural tear. Controlled pushing and massage to the perineum can help reduce or prevent tearing.
Be aware that the current best evidence about episiotomy is that they should never be done without a medical indication (routine episiotomy is now viewed as doing more harm than good)—this is the position of the American College of Obstetricians and Gynecologists and you should expect your provider to voice a similar position.
If you are at the end of labor and the labor stalls, there are steps your doctor can take to speed up delivery of the baby. Two common methods are forceps delivery and vacuum-extractor assisted delivery.
If the baby is not moving down the birth canal and there is a medical need to speed the delivery, forceps may be used. Before inserting the forceps, your doctor will numb the area with an injection of anesthesia if you do not already have an epidural. The forceps, which look like a long pair of tongs. They are gently inserted along either side of the baby’s head and are used to gently grip the baby’s head to help pull it out as the mother pushes. The risks of a forceps delivery are low. The baby may have some bruising or swelling on the head or face, which usually fades in a few days. A mother may require an episiotomy or develop a severe tear in the perineum during a forceps delivery. A rare complication is bleeding in the baby’s skull.
Vacuum Extractor-assisted Delivery
Another means to help deliver the baby is with a vacuum extractor. This device has a cup on the end which attaches to the top of the baby’s head and allows the doctor to gently pull while the mother pushes during contractions. The risk to mother and baby is low, although the baby may have temporary bruising or swelling on the scalp.
Assisted Delivery—Forceps and Vacuum
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Banking Umbilical Cord Blood
The blood in your baby’s umbilical cord contains stem cells. These are immature cells that can develop into many different types of cells. Stem cell research is a growing field, with the hopes that stem cells can be used to treat many diseases and conditions, such as leukemia. There are options for handling your baby’s cord blood: you can pay to have your baby’s umbilical cord blood (and stem cells) stored for future use by a family member, you can donate the blood to a public cord bank where it is available to anyone who needs it, you can donate the blood for research purposes, or you can do nothing. Saving umbilical cord blood is not a routine procedure, so if you are interested, you’ll need to make arrangements during your pregnancy and tell your doctor and the medical staff assisting your delivery. The blood will not be removed from the baby; rather, it will be removed from the umbilical cord and placenta after the cord has been clamped and cut.
American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/from_home/publications/press_releases/nr03-31-06-2.cfm .
Birth plans. Nemours Foundation website. Available at: http://kidshealth.org/parent/pregnancy_newborn/pregnancy/birth_plans.html . Accessed August 12, 2005.
Labor and delivery: Cesarean birth (c-section). Sutter Health website. Available at: http://babies.sutterhealth.org/laboranddelivery/ld_c-section.html . Accessed August 12, 2005.
Labor and delivery: your birthing options. Sutter Health website. Available at: http://babies.sutterhealth.org/health/healthinfo/index.cfm?section=healthinfo&page=article&sgml_id=tp22258 . Accessed August 14, 2005.
Labor induction and augmentation. Sutter Health website. Available at: http://babies.sutterhealth.org/health/healthinfo/index.cfm?section=healthinfo&page=article&sgml_id=hw194662-sec . Accessed August 14, 2005.
Management of normal delivery. The Merck Manual of Diagnosis and Therapy online. Available at: http://www.merck.com/mrkshared/mmanual/section18/chapter249/249f.jsp . Accessed August 14, 2005.
Management of normal labor. The Merck Manual of Diagnosis and Therapy online. Available at: http://www.merck.com/mrkshared/mmanual/section18/chapter249/249e.jsp . Accessed August 12, 2005.
Problems in the first and second stages of labor. The Merck Manual of Diagnosis and Therapy online. Available at: http://www.merck.com/mrkshared/mmanual/section18/chapter253/253g.jsp . Accessed August 12, 2005.
Umbilical cord blood banking. Sutter Health website. Available at: http://babies.sutterhealth.org/health/healthinfo/index.cfm?section=healthinfo&page=article&sgml_id=tn9827-sec . Accessed August 14, 2005.
American College of Obstetricians and Gynecologists
Mayo Foundation for Medical Education and Research
Last reviewed May 2007 by ]]>Jeff Andrews, MD, FRCSC, FACOG]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.