The risk has dramatically reduced with growth of modern technology. There is more security and confidence of the to-be-mother with time. However, not all are fortunate enough. Some women have even gone C-Section or forceps delivery due to certain complications at the last minute.

WHAT IS IT?
WHAT YOU CAN DO ABOUT IT
Care in labour
Monitoring
Induction of labour
Forceps delivery
Vacuum extraction or Ventouse
Cesarean section
Pre-term labour

WHAT IS IT?

Natural childbirth means giving birth with minimum medical intervention. Over the last fifty five years, doctors have invented different low-tech approaches to childbirth ranging from antenatal preparation by means of mental and physical exercises, to delivery in comfort and privacy, sometimes in subdued lighting with music playing, sometimes in a warm bath.

Supporters of natural childbirth point out that it avoids many of the situations, which call for medical intervention. For example, lying on your back (the position required for foetal heart monitoring) may reduce your blood pressure and therefore the flow of blood and oxygen to the baby, and the force of gravity will be opposing the birth process rather than helping it. This in turn increases the need for episiotomy or forceps delivery.

If you follow these few basic guidelines it would help you have normal delivery:

· Walking and normal activity should be encouraged during pregnancy.

• The expectant mother should decide herself what position she would be comfortable to adopt during delivery.

• Routine use of electronic foetal monitoring, anesthetics and episiotomy should be avoided as far as possible.

• Induction of labor should be reserved for specific medical emergencies.

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WHAT YOU CAN DO ABOUT IT

Majority of births undergo the natural birth process. However medical assistance during birth may be necessary for the safety of the mother and the baby, in case of emergencies.

After months of development in the womb, the hormones progesterone, oxytocin and relaxin produced by the pituitary glands triggers off the labour contractions, which in turn initiates the labour process and leads to the birth of the baby During the third trimester the uterine muscle gently limbers up, causing spasms. The labour contractions are more painful than the limbering-up spasms, and they occur at regular intervals.

Labour starts in one of these three ways. Usually it is signaled by contractions starting in the small of the back and moving round to the front of the stomach to just above the pubic bone. When you have had several contractions at regular 20 to 30 minute intervals, you can feel sure that you are in labour and should go to the hospital or obstetrical unit where you are supposed to have your baby.

A blood flow accompanies sometimes-labour pains in which case, it is advisable to lose no time in getting to hospital. The release of amniotic fluid and the breaking of the amniotic sack at the end of the first stage of labour create the passage for the baby.

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Care in Labour

During labour, most women are advised not to eat or drink too much. Sips of water may be taken to relieve thirst but it is not wise to drink large amounts of fluid. The stomach does not pass food and fluid on to the intestines during labour and so everything just sits there and may lead to vomiting later on. If labour is to be long, often fluids can be given intravenously to the mother, as they reach straight into the circulation system directly, avoiding any blockage in the intestines.

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Monitoring

During labour the state of the baby is watched carefully by the nurse or the midwife by checking the baby’s heartbeat at regular intervals through the abdominal wall. Many a time the patient would be offered a continuous check of the foetal heart by a monitor strapped on your abdomen. This should not be uncomfortable but if it is, ask the midwife to adjust it, for the belt is made of elastic and has a big buckle on it. For most women, occasional short runs of monitoring are sufficient, but for others monitoring is continuous if the obstetrician or midwife is concerned about the baby.

If monitoring shows that the fetus is coping well in labour then the rest of the process proceeds normally. If, however, there are signs of any danger for the baby, the doctors will learn about it as a result of close monitoring. The early stages of distress may not cause harm to the baby. If the baby shows signs of lack of oxygen in the earlier part of labour, it may mean the doctor has to act fast to help your baby while he is still in a good state. If you are still in early labour, this may lead to Caesarian section; in the second stage of labour, a forceps delivery may be also required.

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Induction of labour

Three out of four women go into labour spontaneously. With the remainder, a doctor induces labour by injecting hormones that stimulate labour contractions, or by breaking the waters that surround the baby, or by a combination of both methods. High blood pressure during pregnancy or a long-overdue pregnancy are the two most common reasons for induced labour. An induced labour may be required to reduce the risk to the baby. This is no different from normal labour, except that the pains have to be induced to facilitate or hasten the birth process.

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Forceps delivery

After the neck of the womb is fully dilated and the mother is in the second stage of labour. If the pressure exerted by the mother or the vaginal passage is not dilated enough. The baby might start to show signs of distress. At this stage the delivery should be accelerated. Under local anesthesia, pair of carefully constructed guards or forceps is placed on either side of the baby’s head to cradle it, so that it can be eased from the vagina; thereafter the rest of the body follows.

Forceps have been used for many years and have saved millions of babies from asphyxiation or death.

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Vacuum extraction or Ventouse

Some doctors speed up the process when the baby is showing signs of distress by placing a small metal hollow cap over the baby’s scalp. The vaccum created between the metal cap and the soft tissue of the baby's scalp allows light traction, which in turn aids the baby's arrival. The baby then follows the normal line down the pelvis and is delivered. There is no negative pressure inside the skull but only on the outside tissues. Babies born with vacuum extraction may have a small raised ring on their head but this fades after 48 hours. This method is less formidable than a forceps delivery and is used in many hospitals to expedite the delivery during the second stage of labour. Vacuum extraction can also be used at the very end of the first stage of labour, before the cervix is quite dilated, by those who are experienced in its use.

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Cesarean section

About one out of nine babies is now delivered by Cesarean section. A C-section could be planned much before the onset of labour in order to prevent the foetus from the risks of uterine contractions in case of a delicate pregnancy. It is also undertaken in certain situations when the size of the pelvic bones is disproportionate to the baby’s head or when the placenta is low-lying and could interfere with the birth process. A Cesarean section is also sometimes done in emergencies when the cervix is not fully dilated after the onset of labour.

During a C-section an anesthetic is given; this may be a general anesthetic by inhalation or an epidural anesthetic just to numb the lower part of the body. The latter is becoming more popular with the non-emergency Cesarean sections, for this allows the mother to be awake, her partner can also be there and they can both take part in the delivery, seeing and holding their baby within seconds of birth. However during an emergency a general anesthetic is used for it is swifter. A small incision in the lower abdomen is made to create the passage for the baby by a surgeon and the operation takes about 30 to 45 minutes. The area of the incision might hurt for a few days after the C-section but this passes rapidly

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Pre-term labour

Whilst most women deliver their babies in about 40 weeks of the pregnancy, a few start uterine contractions before this. If the uterine contractions occur at about 36 weeks, it is not a serious problem. These babies are born weighing about 5½ 1b and usually do as well as other babies born with normal weight.

If the contraction starts before 36 weeks of the pregnancy, the problem becomes increasingly more complex. Generally speaking, labours before 24 weeks of the pregnancy do not have good results and so most doctors would try to postpone labour by the use of drugs to cause the uterus to prevent from contracting. Babies born before 24 weeks are very small, they are often only a pound or so in weight, and require expert delivery and neonatal care. If your obstetrician can help you gain a few weeks at this stage, it greatly improves the chances for your baby. If it is about 28 weeks then the chances of a safe delivery is much more brighter.

In case of pre-term labour, the delivery should be done at the hospital with the best neonatal facilities available in the area. This may mean moving the mother in early labour to aid the delivery of the baby and avoid the need for use of incubator post delivery.

During a pre-term labour, the obstetricians pay extra attention to the baby. They may recommend a Caesarean section to deliver a very small baby to ensure safe delivery. Once the baby is delivered, it is important to ensure that the breathing starts and is maintained. The baby may need to be kept in an incubator to provide warmth and a sterile environment. A pre-term baby may sometimes require oxygen for a few days after birth. If the delivery takes place in a place with few facilities, the baby could be moved in a special travelling incubator to a better-equipped place. A pre-term and a low birth weight baby usually has a normal growth pattern as there is no evidence that low birth-weights babies are in any way disadvantaged compared to full term babies.

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