When You Need Help

These are the most common interventions used during labour to help you deliver your baby.

Episiotomy

An episiotomy is a cut made in the perineum (the skin and muscle between the vagina and anus). It is used to enlarge the vaginal opening and make the birth of the baby easier if the perineum is not stretching. Local anesthetic can be used and the cut will be stitched up after the birth. It should heal within seven to 10 days.

Episiotomies used to be performed routinely; however, several studies showed that with normal births, women who did not have episiotomies generally fared better than women who had one.

The procedure makes it more likely that a woman will have a larger tear that extends into the rectum, that her tear will take longer to heal, and that she will have pain in the weeks and months following the birth. There are times when an episiotomy is needed – for example, if the baby is in distress – but there is no evidence to show that routine episiotomies benefit women or their babies.

Most doctors no longer perform episiotomies routinely but a few still do. Midwives can perform episiotomies but are far less likely to do so than doctors.

Whether or not you will need to have an episiotomy will likely not be decided until the baby is about to be born, but you should discuss your feelings about episiotomy with your midwife or doctor beforehand.

To read about caring for an episiotomy, click here.

Electronic Fetal Monitoring

This is a machine used to record the baby's heartbeat and the frequency of the mother's contractions during labour. Electrodes that record the baby's heartbeat can be put on the mother's belly with a belt (external monitoring) or can be placed onto the baby's scalp, through the mother's vagina (internal monitoring). Electronic fetal monitoring is not used routinely but it may be used to check the baby's health during the birth. When internal monitoring is done, your water must be broken if this has not already occurred naturally. The monitor will be attached to your baby's head with a scalp clip. Support people may need to make an extra effort to focus on the mother rather than the machine.

Some women feel that electronic fetal monitoring interferes with the natural birthing process, while others, especially women who may have had complications with previous births, find it reassuring to know that the baby’s heartbeat is being monitored. Discuss the pros and cons with your care provider.

Forceps and Vacuum Extraction

These instruments are designed to guide the baby out of the vagina, when the woman can't push her baby out completely. These methods may be used if:

• you are exhausted
• the position or size of the baby makes the birth difficult
• there is fetal distress
• you are having difficulty pushing due to medication

If forceps or a vacuum extractor is used, you will be given a local anesthetic and an episiotomy will often be done.

Both procedures can cause temporary changes in your baby's appearance but these will disappear with time. Forceps may leave marks on the side of the baby's face and a vacuum extractor may cause temporary swelling on the top of the baby's head.

Induction/Augmentation

These interventions may or may not use drugs to start (induce) or speed up (augment) labour. They are used when a more rapid childbirth is needed to protect the health of the mother or the baby, or when you are significantly past your due date.

A fetal heart monitor is often used during an induced labour to ensure that all is well. The most common ways of inducing labour are:

• artificial rupture of membranes (ARM)
• prostaglandin gel
• oxytocin

Artificial rupture of membranes
In the hopes of starting labour, your caregiver may break the bag of amniotic fluid surrounding the baby. This may be done with a long thin plastic hook called an amniohook. This procedure can increase the risk of infection of the fetal membranes and amniotic fluid.

Prostaglandin gel or oxytocin
Both prostaglandin and oxytocin are hormones. Prostaglandin gel can be used when the cervix is less than three centimeters dilated. It is applied to the back of the vagina where it softens and "ripens" the cervix, to help it dilate. It is a milder way to induce labour and may be done on an outpatient basis, depending on the hospital. Oxytocin may cause intense contractions and usually makes the birth proceed rapidly. It is given through an intravenous line after the woman is in the birth room.

Cesarean Section

A cesarean section is a surgical procedure used to deliver a baby. Use this link to learn more about cesarean birth.

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