INDUCTION OF LABOUR.

Unless there is a medical reason to dictate otherwise, your labour is generally only induced, when you reach 10 days or more over your due date.  Labour is induced in more than one-way, but the most common is: -

1) PROSTIN GEL.

Prostin gel is an artificially produced version of a naturally occurring hormone, known as Prostaglandin.  This hormone is normally produced in response to the baby's head pressing down on to the cervix, and is responsible for acting on the muscles in the womb, making them contract.

HOW IS IT GIVEN?

It comes in a special syringe, in the form of a clear jelly.  Your midwife will usually administer it.  She will first do a tracing of your baby's heartbeat before she gives it, to make sure that the baby is OK.  Then she will perform a gentle vaginal examination to assess your readiness for labour.  If your cervix is ready or "ripe", she will gently slide the syringe down her fingers and squirt the jelly in the small pockets that surround your cervix.  You will then normally be reattaches to the monitor for a short while afterwards, to ensure that your baby remains happy.  If nothing happens after this dose, she will repeat the whole thing again 6 hours later, using the same jelly but a stronger dosage.  Normally, 2 doses are enough to start labour, but in some cases, a third or fourth may be needed.

SIDE EFFECTS?

Not many normally.  The most commonly felt side effects are usually seen with the beginning of uncomfortable, sharp contraction like pains, known as "prostin pains".  Your midwife will be able to tell whether they are contractions or not.  Occasionally, you may also notice a stinging or burning sensation of your vulva; this is a reaction to being in contact with the gel, and only lasts a few minutes.

2) ARTIFICIAL RUPTURE OF THE MEMBRANES (A.R.M)

This is the procedure during which your midwife will break the bag of waters that surround your baby, with a long plastic hook, that resembles a crochet hook.  She will perform a gentle vaginal examination to assess if your cervix is dilated (open) enough to feel the bag of waters.  Normally, if your cervix is 2 or more centimetres dilated, she should be able to do this.  This procedure causes the baby to press more heavily on the cervix, so as to stimulate labour (see under Prostin)

SIDE EFFECTS?

None really unless you are already contracting, then you may feel the contractions to be more painful.

3) SYNTOCINON DRIP

This is used when both of the above fail to be sufficient in starting or maintain labour.  This is an intravenous (drip) fluid that acts on the muscles of the womb, causing them to contract.  It is a similar type of hormone, called OXYTOCIN, to that in prostin gel.

HOW IS IT GIVEN?

A small needle is inserted into the back of your hand and a drip attached.  The fluid usually runs through a pump, as it needs to be a carefully controlled dosage.  You are started on a low amount, which is gradually increased until a satisfactory level of contractions has been achieved.

SIDE EFFECTS?

Contractions can be very painful and rapid if the dose is not controlled properly.  You may need an epidural for pain relief if you find this too uncomfortable.

Pain relief

Q. WHAT OPTIONS ARE THERE FOR PAIN RELIEF IN LABOUR?

A. There are many types of pain relief for use in labour, from self-help techniques to drugs.  Here are the most common: -

1) Paracetamol: - A dose early in labour can make the period pains and backache more bearable, but is no good for more advanced labour.

2) Hot bath: - A good soak in a nice warm bath, not only eases aches and pains, but helps you to relax muscles which need to stretch to allow baby through, thus speeding up the process of labour.  A water birth pool can be used as an extension of this type of pain relief, with the added bonus that you can stay in the water to have your baby.

3) Gas and air: - Known as Entonox, it is a harmless mixture of nitrous oxide (laughing gas) and oxygen.  It can be used at any stage of labour and allows you still to remain mobile.  It can also be of benefit to the baby in that it allows extra oxygen into the baby's blood stream to help the baby cope with labour.

4) Pethidine: - given by injection into your leg or buttock.  This drug relaxes you between contractions and takes the edge off the pain of the contractions.  It does not take the pain away completely.  There are drawbacks to this method of pain relief, in that it can make you feel drunk and out of control.   If given close to the time you give birth, it may prevent the baby from breathing at birth, and the baby may require a small injection itself to reverse the effect and stimulate its breathing.

5) Epidural: - An injection of a local anaesthetic through a small tube into your spine.  Can provide complete pain relief although this is not guaranteed and effects may be felt in certain areas or even down one complete side of your body.  Side effects include numbness to the point of not being able to move your legs, meaning that you may be confined to the bed.  Some women suffer backache or rarely, severe headaches which need to be treated medically.  Generally speaking though, a safe and efficient method of pain relief. 

DELIVERY.

Otherwise known as the 2nd stage of labour.  This is the part of the labour that will culminate in the long awaited birth of your baby.  It is also the "hard work" part of the labour, during which you will expend much energy pushing your baby out into the world. 

When your midwife tells you that you can now push when your body tells you to, there are a few things that you need to try remember, to make the task a little easier.  First and foremost, relax the muscles in your bottom and legs.  If those muscles are tight your baby will have a lot of resistance on its way down the birth canal, so the pushing will take a lot longer to achieve the desired effect.

Technique is also important.  When you have a contraction, take a big breath and hold it.  Tuck your chin on your chest and push into your bottom, the same way that you would when having your bowels open on the toilet.  This may make you feel that you are going to the toilet, but most of the time, it is the pressure of the baby's head that is giving you that sensation.  Aim to push like this three times for each contraction, but try not to make sounds as you are wasting breath for pushing.

Eventually, the pain will change, and you will start feeling a burning sensation down below, and a feeling of tightness.  This is normal and is the sensation you get when the baby's head is stretching the skin ready to pass through.  This can be very frightening, and the instinctive reaction to this pain, is to clench your muscles back up to take the pain away.  This as you can imagine, only serves to "suck" the baby back in.  Instead, go with the pain and push to the point where it hurts.  Your midwife will guide you.

At the point at which the baby's head is emerging (crowning), your midwife will instruct you to stop pushing, and "pant".  This will let your body take over, to push the baby's head out slowly to minimise damage to you.  Once the head is delivered, the midwife will check that the umbilical cord isn't wrapped around the baby's neck, so she will ask you not to push at that time.  If all is well, she will ask you to push really hard with the next contraction, and your baby will be born!

CONGRATULATIONS!  

COMPLICATIONS

Labour and birth, are the most dangerous times for your baby, although with proper care from qualified midwife, it will safe and rewarding for you and your partner.  However with all things, there are times when things can go wrong.  Following are a few of the most common complications in labour and how they are treated.

1) PROLONGED LABOUR OR "FAILURE TO PROGRESS".

This is a term used to describe a woman whose labour, for whatever reason, is not progressing normally i.e.: -too slowly or not at all.  Initially, the woman would be put on a Syntocinon drip (see induction of labour for Syntocinon), to increase the frequency and the strength of the contractions, as although they may feel very painful, they may still not be quite enough to progress the labour.  This will usually be allowed to run for 4 -5 hours, and then the woman would be re-examined.  If there was still little or no progress, then caesarean section may be considered.

2) FETAL DISTRESS.

A term used to describe the condition of the baby, when it is showing signs of not coping with the labour.  Such signs are usually, problems with heartbeat, or the baby opening its bowels inside the womb, which can be seen as a greenish loss or discharge from the vagina.  These things can happen to varying degrees, and in their mild form, are actually very common.

In mild cases, little more treatment than observation is needed, and you would just be put on a machine to watch the baby's heartbeat.  In severe cases, the doctor may say that he needs to take a small sample of blood from the baby's head, known as FETAL BLOOD SAMPLING.  This is done by inserting a metal instrument called a speculum, into your vagina.  A light is then shone down the speculum, so that the doctor can see the baby's head.  He then makes a tiny "nick" in the baby's skin, and takes a very small sample of blood, which is put into a machine that measures the oxygen concentration, in the baby's blood.  If the baby's result is normal, it is safe for labour to continue, although a repeat test may be needed.  If the result is not normal, then the baby will need immediate delivery, either by forceps, ventouse (suction cup) or by caesarean section.

3) SHOULDER DYSTOCIA

This problem that can occur during delivery, when the baby's shoulders become stuck and the baby cannot be delivered easily.  It can be quite common, and is usually overcome by using a variety of positions, such as on hands and knees, that take the pressure off the bottom of your spine, so allowing more space for the baby to pass through.

4) HAEMORRHAGE

Can occur at anytime after delivery.  It is the sudden excessive loss of blood, due mainly to either; an internal tear that is bleeding, or more likely, it is a result of the womb not contracting down after delivery, which normally minimises blood loss.  Major haemorrhage is treated with special drugs that cause the womb to contract artificially, and may be given over a period of time via a drip.  If a tear is suspected, either your doctor or your midwife will investigate and put some stitches in, which should minimise the bleeding.