Assisted Delivery in Southern New England

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.

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, although not considered a routine procedure.

There are two types of incisions: the median, 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 that 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 health care 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 intravenously.

Medical reasons for inducing labor might include:

• Diabetes
• High blood pressure
• Ruptured membranes
• Rh disease
• Past-due pregnancy

Cesarean section

A cesarean section, also called a C-section, is a surgical procedure performed when a vaginal delivery is not possible or safe, or when the health of the mother or the baby is at risk. During this procedure, the baby is delivered through surgical incisions made in the abdomen and the uterus.

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

Fetal monitoring

Fetal monitoring is the process of watching the baby’s heart rate for indicators of stress during labor and birth. There are different types of fetal monitoring, but the most common is electronic fetal monitoring. 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.

Other types of monitoring include the fetoscope, doper and telemetry monitoring. Be sure to discuss with your doctor which monitoring method is right for you.

Forceps Delivery

Forceps are twin steel blades that the doctor inserts into the vagina and around the baby’s head during a forceps delivery. The blades are locked in place and as the mother bears down, the doctor uses them to pull the baby’s head through the vagina. The rest of the baby is delivered normally.

Vacuum Extraction

A vacuum extraction is an alternative to forceps delivery, and your doctor will decide which is more appropriate for your circumstances. During this procedure, the doctor uses an instrument called a vacuum extractor, which has a suction cup that is placed on the baby’s head. 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.