There are times when there can be concerns about the health of the mother, baby or both. It is always important to inform the person responsible for your maternity care (LMC) or Hospital if you are worried. I have listed some of the things that need to be reviewed if they happen during pregnancy.
- Vaginal bleeding
- Preterm (<37 weeks) contractions or ruptured membranes (waters break).
- Severe abdominal pain
- Urinary tract infection (going to toilet more frequently, pain or burning when you urinate, urine may be smelly)
- Smelly vaginal discharge
- Generalized (all over, not just ankles) swelling, headaches or visual disturbances
- Unwell with vomiting, diarrhoea or high temperature
- Constant severe itching
- Persistent leg cramp or calf pain
- Accident involving injury to abdomen
- If your baby isn't moving, or movements have decreased noticeably
Possible reasons for interventions such as monitoring, induction of labour, assisted birth or caesarean section can be when the birth process is not following what is considered normal.
Normal is always a hard word to use, as labours and births can be different and do not need to fit a textbook definition but LMC's will usually want to observe or refer to an Obstetrician if there are unexpected concerns such as the following:
- Preterm Labour or induction of labour for post- term (there can be debate of when is post term)
- Labour is not progressing; this may be due to the baby not fitting through the pelvis.
- Mother unwell eg high temperature or high blood pressure
- Fetal Distress (babies heart rate is faster or slower than what is normal or baby stops moving over a period of time. Also the baby may pass a bowel motion/poo creating meconium liquor (fluid around baby green in colour)
- Malpresentation (baby lying in a different position other than head down in the pelvis)
- Placenta praevia (Placenta over the opening to the birth canal)
- Cord comes first (cord prolapse) this is rare but if happens it is an emergency because if the cord is compressed the baby will lack in oxygen.
You will be asked for your consent for any form of intervention. Some interventions include:
Induction of labour (to cause labour to begin) or augmentation (speed labour up). This may be needed if:
- You have gone overdue and haven't gone into labour yourself.
- The waters break and you don't start labouring especially if there is a risk of infection eg Group B Strep bacterium (GBS)
- The mother or baby is unwell and needs to be born early.
Natural methods of induction when 40 weeks plus. This is looking at ways to increase the hormones oxytocin (causes contractions) and prostaglandin (helps soften the cervix).
- Sex: There is prostaglandins in semen.
- Nipple Stimulation. This encourages oxytocin release.
- Use of acupuncture, or homeopathy.
Medical induction in the hospital:
- Prostins. Prostaglandin gel inserted onto the cervix at the top of the vagina.
- Artifical Rupture of Membranes (ARM) Breaking the waters with a small plastic hook.
Syntocinon (artifical oxytocin) which goes via a vein into your body to cause contractions.
Forceps are metal blades that fit around the baby's head. They look a bit like salad servers. You will need to be fully dilated (cervix open) and usually have an episiotomy (a cut to make the opening bigger).
Ventouse is a suction cap that goes on top of the baby's head. With forceps and ventouse you will need pain relief and sometimes a urinary catheter which is a tube into your bladder to empty it. An Obstetric Doctor will pull on them as the woman pushes. They may be used if the baby needs to be born fast due to signs of distress; the mother is exhausted or can't push.
Caesarean Section is usually done while the mother is awake under an epidural or spinal anaesthetic so she can see her baby. General Anaesthetics (asleep) is usually only done in an emergency when the baby needs to be born very quickly.
Most Caesarean Sections are done via a horizontal incision low on the abdomen about 15cm in length just above the pubic hairline. Possible reasons for needing one are distress in the baby, failure to progress in labour, malpresentation, placenta bleeding, placenta previa. More than two previous caesareans. Stay in the Hospital is approximately 4-5 days.
If there is excessive bleeding after the birth hormone injections may be used to make the uterus contract and slow bleeding and in rare cases a blood transfusion. If the placenta (after birth) doesn't separate and come away completely from the uterus then you may need to go to theatre to have it removed vaginally.