Pregnancy: Types of Delivery

Medical assistance during the delivery of a baby can vary from use of medicines to
emergency delivery procedures.
What is an assisted delivery?

Vaginal delivery is the most common type of birth. When necessary, assisted delivery
methods are needed. While labor can be a straightforward, uncomplicated process, it
might require the assistance of the medical staff. This assistance can vary from use of
medicines to emergency delivery procedures.

What are some assisted delivery procedures that might take place during my
labor?

The procedure your doctor might use will depend on the conditions that might arise
while you are in labor. These assisted delivery procedures can include the following:

Episiotomy

An episiotomy is a surgical incision made in the perineum (the area of skin between the
vagina and the anus). The incision enlarges the vaginal opening to allow the baby’s
head to pass through more easily and to prevent tearing of the mother’s skin. Most
women will not need one. This is reserved for special circumstances.

There are two types of incisions: the midline, made directly back toward the anus, and
the medio-lateral, which slants away from the anus. A local anesthetic might be used in
mothers who do not opt for an epidural during labor.

Amniotomy (“Breaking the Bag of Water”)

An amniotomy is the artificial rupture of the amniotic membranes, or sac, which contains
the fluid surrounding the baby. The amniotomy can be done either before or during
labor. An amniotomy is usually done to:

 Induce or augment labor

 Place an internal monitor to assess the uterine contraction pattern
 Place an internal monitor on the baby’s scalp to assess the infant’s well-being
 Check for meconium (a greenish-brown substance, which is the baby’s first stool)

Your healthcare provider will use an amniohook, which looks like a crochet hook, to
rupture the sac. Once the procedure is completed, delivery should take place within 24
hours to prevent infection.
 Induced labor

Induction of labor usually means that labor needs to be started for a number of reasons.
It is most often used for pregnancies with medical problems or other complications.
Labor is usually induced with Pitocin®, a synthetic form of the drug oxytocin given
intravenously.

Medical reasons for inducing labor might include:

 Diabetes
 High blood pressure
 Ruptured membranes
 Small baby
 Past-due pregnancy

Fetal monitoring

Fetal monitoring is the process of watching the baby’s heart rate. This can be external
or internal.

 In external fetal monitoring, an ultrasound device is placed on your abdomen to record

information about your baby’s heart rate, and the frequency and duration of your
contractions. This can be used either continuously or intermittently.
 Internal monitoring involves the use of a small electrode to record the baby’s heart rate.
While the membranes must be ruptured before the electrodes can be attached to the
baby’s scalp, this is the most accurate way of obtaining this information. A pressure
sensor can also be placed near the baby to measure the strength of contractions.

Forceps delivery

Forceps look like two large spoons that the doctor inserts into the vagina and around
the baby’s head during a forceps delivery. The forceps are put into place and, the doctor
uses them to gently deliver the baby’s head through the vagina. The rest of the baby is
delivered normally.

Vacuum extraction

A vacuum extractor looks like a small suction cup that is placed on the baby’s head to
help deliver the baby. A vacuum is created using a pump, and the baby is pulled down
the birth canal with the instrument and with the help of the mother’s contractions. The
pump can often leave a bruise on the baby’s head, which typically resolves over the first
48 hours.
 Cesarean section

A cesarean section, also called a c-section, is a surgical procedure performed if a

vaginal delivery is not possible. During this procedure, the baby is delivered through
surgical incisions made in the abdomen and the uterus.

When would I need a cesarean section?

A cesarean delivery might be planned advance if a medical reason calls for it, or it might
be unplanned and take place during your labor if certain problems arise.

You might need to have a planned cesarean delivery if any of the following conditions
exist:

 Cephalopelvic disproportion (CPD)---is a term that means that the baby’s head or body
is too large to pass safely through the mother’s pelvis, or the mother’s pelvis is too small
to deliver a normal-sized baby.
 Previous cesarean birth---Although it is possible to have a vaginal birth after a previous
cesarean, it is not an option for all women. Factors that can affect whether a cesarean is
needed include the type of uterine incision used in the previous cesarean and the risk of
rupturing the uterus with a vaginal birth.
 Multiple pregnancy---Although twins can often be delivered vaginally, two or more
babies might require a cesarean delivery.
 Placenta previa---In this condition, the placenta is attached too low in the uterine wall
and blocks the baby’s exit through the cervix.
 Transverse lie---The baby is in a horizontal, or sideways, position in the uterus. If your
doctor determines that the baby cannot be turned through abdominal manipulation, you
will need to have a cesarean delivery.
 Breech presentation---In a breech presentation, or breech birth, the baby is positioned
to deliver feet or bottom first. If your doctor determines that the baby cannot be turned
through abdominal manipulation, you will need to have a cesarean delivery.

An unplanned cesarean delivery might be needed if any of the following conditions arise
during your labor:

 Failure of labor to progress---In this condition, the cervix begins to dilate and stops
before the woman is fully dilated, or the baby stops moving down the birth canal.
 Cord compression---The umbilical cord is looped around the baby’s neck or body, or
caught between the baby’s head and the mother’s pelvis, compressing the cord.
 Prolapsed cord---The umbilical cord comes out of the cervix before the baby does.
 Abruptio placentae---In rare occurrence the placenta separates from the wall of the
uterus before the baby is born.

During labor, the baby might begin to develop heart rate patterns that could present a
problem. Your doctor might decide that the baby can no longer tolerate labor and that a
cesarean delivery is necessary.
 What can I expect before the cesarean?

If the cesarean delivery is not an emergency, the following procedures will take place.

 You will be asked if you consent to the procedure, and in some hospitals, you might be
asked to sign a consent form.
 The anesthesiologist will discuss the type of anesthesia to be used.
 You will have a heart, pulse, and blood pressure monitor applied.
 Hair clipping will be done around the incision area.
 A catheter will be inserted to keep your bladder empty.
 Medicine will be put directly into your vein.

What is the procedure for a cesarean?

At the start of the procedure, the anesthesia will be administered. Your abdomen will
then be cleaned with an antiseptic, and you might have an oxygen mask placed over
your mouth and nose to increase oxygen to the baby.

The doctor will then make an incision through your skin and into the wall of the
abdomen. The doctor might use either a vertical or horizontal incision. (A horizontal
incision is also called a bikini incision, because it is placed beneath the belly button.)
Next, a 3- to 4-inch incision is then made in the wall of the uterus, and the doctor
removes the baby through the incisions. The umbilical cord is then cut, the placenta is
removed, and the incisions are closed.

How long does the procedure take?

From beginning to end, a cesarean takes anywhere from 1 to 2 hours.

What happens after the delivery?

Because the cesarean is major surgery, it will take you longer to recover from this type
of delivery than it would from a vaginal delivery. Depending on your condition, you will
probably stay in the hospital from 2 to 4 days.

Once the anesthesia wears off, you will begin to feel the pain from the incisions, so be
sure to ask for pain medicine. You might also experience gas pains and have trouble
taking deep breaths. You will also have a vaginal discharge after the surgery due to the
shedding of the uterine wall. The discharge will be red at first and then gradually change
to yellow. Be sure to call your healthcare provider if you experience heavy bleeding or a
foul odor from the vaginal discharge.

What are some of the risks involved in a cesarean delivery?

Like any surgery, a cesarean section involves some risks. These might include:
 Infection
 Loss of blood or need for a blood transfusion
 A blood clot that may break off and enter the bloodstream (embolism)
 Injury to the bowel or bladder
 A cut that might weaken the uterine wall
 Abnormalities of the placenta in subsequent pregnancies
 Difficulty becoming pregnant
 Risks from general anesthesia (if used)
 Fetal injury

Can I have a baby vaginally after a cesarean delivery?

The majority of women who have had a cesarean delivery might be able to deliver
vaginally in a subsequent pregnancy. If you meet the following criteria, your chances of
vaginal birth after cesarean (VBAC) are greatly increased:

 A low transverse incision was made into your uterus during your cesarean.
 Your pelvis is not too small to accommodate a normal-sized baby.
 You are not having a multiple pregnancy.
 Your first cesarean was performed for breech presentation of the baby.