08 Nov Birthing methods

Normal birth

A normal birth is where the baby is born through the vagina.

Pros

• You remain actively involved in decisions regarding your labour. You are the key player
• You are able to be active during the labour
• You have more control over the events of labour without the adverse effects of pain medication as you remain in control of your body
• You remain an active participant throughout labour
• Your partner will feel involved in the process as you work together to manage your pain
• You can move around freely and find positions that help you stay comfortable during labour and remain able to assist the birthing process when it’s time to push your baby out
• Can be performed by a midwife or a doctor
• Women feels empowered by having a normal birth
• Feeling of achievement and satisfaction of doing it normally and naturally
• The correct birthing hormones come into play to set both mom and baby up for breastfeeding and bonding
• Baby receives the correct seeding of microorganisms in the correct order which helps set up the baby’s immune system in the best healthiest manner for a lifelong pathway to health.
• Best opportunity to let baby go through the 9 instinctive stages and to have immediate and continuous skin to skin
• Breastfeeding is likely to be more successful
• Best for mom and baby
• Quick recovery after the birth

Cons

• You do not know when the birth will occur
• You have to work with the pain and use natural pain relieving options
• Transition and second stage (pushing the baby out) of labour are emotionally intense and physically hard
• It can be hard on your partner to see you in pain

• Natural pain-reduction techniques don’t eliminate pain – so if you’re not willing to feel and work with the pain, you’ll be happier with an epidural.
• Natural approaches may not offer adequate pain management, particularly if you end up with a prolonged or a complicated labour

• In an emergency a doctor needs to be available to do a caesar
• Possible perineal pain from an episiotomy that may lead to painful intercourse for a time after birth
• Possibility of rectal or bladder problems after birth

Natural childbirth

A term used to encourage the concept that having a baby should be a normal and natural process rather than a medical or surgical event, operation or emergency.

Induction

Induction of labour is the stimulation of uterine contractions prior to the onset of spontaneous labour. It is an obstetric intervention that should be used when elective birth will be beneficial to mother and baby. It can be done with prostaglandins and or oxytocin drips.

Pros

• To end a prolonged or post-term pregnancy
• To prevent foetal and maternal complications in high blood pressure conditions
• To end a pregnancy when the mom is a diabetic to avoid a too big a baby or if the baby is not growing any more
• To prevent infection if the membranes rupture before going into labour and spontaneous labour does not follow

Cons

• Contractions are more painful
• Prolonged labour can occur if done too early
• More continuous and intense foetal monitoring, leading to less freedom to move
• Higher risk for caesarean section if induction is done on a cervix that is not ripe and ready for labour
• Prolonged use may cause increased postpartum bleeding
• Can cause foetal distress
• Can cause increased neonatal jaundice

Epidural and spinal

An epidural refers to total or partial loss of sensation in the abdomen between the fundus and the pubis. An anaesthetic agent, a narcotic or a combination of the two, is injected in the lower back in the epidural space between lumbar vertebrae two and five through a catheter placed into the epidural space. The injection blocks the transmission of signals through nerves in or near the spinal cord. The epidural space is the space inside the bony spinal canal but outside the membrane.

Spinal anaesthesia is a technique whereby a local anaesthetic drug is injected into the cerebrospinal fluid.

There is almost always a trade-off when medications and interventions are used during labour. Each woman must know and consider the potential benefits and risks and apply them to her own circumstances.

Pros

• Only pain relief that eliminates all sensation of pain
• A well-timed epidural can be left to wear off so that the mother can push the baby out herself
• A mobile epidural can still give you the opportunity to move around with an epidural
• Tendency to lower blood pressure can be an advantage in the mom with high blood pressure problems
• If labour is prolonged and mother is very stressed, gives effective pain relief allowing mother to rest
• Can cause a baby to turn if in the wrong position like a posterior position
• Can rectify abnormal uterine activity especially in over stimulation of the uterus
• It assists in certain medical conditions, some heart conditions, diabetes and respiratory disease to prevent too much strain on the mom
• Provides relief or reduction of labour pain without affecting the mother’s mental state. It enables an exhausted mother to relax or sleep during labour and calms the woman who is anxious and tense because of pain
• It can be quick to do a full epidural if it becomes necessary to do an emergency caesar
• It does not depress the respiratory centre of the foetus

Cons

• Can fail to work in about 5% of cases
• Inadequate pain relief in about 15% of cases
• Slackens pelvic-floor muscles and so can prolong labour, requiring more use of oxytocin
• A mom lying down for long periods of time with a full epidural can cause foetal distress
• IV therapy (drip) must always be up before an epidural can be performed, and in the majority of cases a urinary catheter will also be inserted
• A drop-in blood pressure can cause short term foetal distress
• The medication crosses the placenta, so the baby can show signs of sleepiness
• There is a higher rate of episiotomies
• Increased risk of forceps and vacuum births, because of poor pushing efforts
• Itching can occur because of certain drugs
• Long-term backache can occur
• Long-term headache can occur
• Baby may be born with a high temperature which may lead to the administration of unnecessary antibiotics
• Some mothers feels that they have been robbed from participation in the birth of their baby
• Delayed onset to breastfeeding

Caesarean section

The baby is birthed through an incision made through the lower abdomen and uterus.  The main advantage is to reduce birth complications and not pregnancy complications.

Pros

• Safe birth of the baby in cases like placenta praevia, high blood pressure, unstable heart condition, where a normal birth is contra-indicated
• Can be performed quickly in cases of foetal distress or foetal tachycardia (fast heart rate)
• No trauma to the vagina or perineal area
• In cases where the baby is not growing because of malfunction of the placenta and the cervix is not favourable for an induction
• Safer birth for certain conditions like eclampsia, diabetes, placenta abruptio

Cons

• It is a major abdominal operation
• It has a higher maternal morbidity rate than vaginal births
• There must always be an intravenous drip and urinary catheter in place
• Greater chance for complications like infection and anaesthetic problems
• Babies are often born prematurely because a caesar is scheduled too early
• Difficult to establish breastfeeding afterwards, as some hospitals will keep baby separated after the Caesar and the anaesthetic and pain medication has an effect on breast milk production
• More pain experienced after the birth, so you need to take more pain medication
• There is often an impact on future births, and so many women are denied the opportunity to give birth vaginally afterwards, although it is safe to have a VBAC
• Although most doctors can perform the operation safely, there is still a 5 times higher risk for a maternal death with a caesar
• Scarring