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Giving Birth Hospital birthMost women give birth in a hospital maternity unit. If you choose to give birth in hospital, you’ll be looked after by midwives and doctors. You’ll still have choices about the kind of care you want. Your midwives and doctors will provide information about what your hospital can offer. The advantages of giving birth in hospital include:
Your midwife can help you decide which hospital feels right for you. If there is more than one hospital in your area you can choose which one to go to. Find out more about the care provided in each so you can decide which will suit you best. Here are some questions you might want to ask:
QuestionsHere are some questions you might want to ask if you’re considering having your baby in hospital:
Forceps or vacuum delivery Assisted deliveryAbout one woman in eight has an assisted birth, where forceps or a ventouse suction cup are used to help the baby out of the vagina. This can be because:
Both ventouse and forceps are safe and only used when necessary for you and your baby. A paediatrician may be present to check your baby's health. A local anaesthetic is usually given to numb the birth canal (the passageway the baby travels to be born, from womb to vagina) if you haven't already had an epidural. If your obstetrician has any concerns, you may be moved to an operating theatre so that a caesarean section can be carried out if needed. As the baby is being born, a cut (episiotomy) may be needed to make the vaginal opening bigger. Any tear or cut will be repaired with stitches. Depending on the circumstances, your baby can be delivered and placed onto your tummy, and your birthing partner may still be able to cut the cord if they want to. VentouseA ventouse (vacuum extractor) is an instrument that uses suction to pull the baby out. A soft or hard plastic or metal cup is attached by a tube to a suction device. The cup fits firmly onto your baby's head and, with a contraction and your pushing, the obstetrician or midwife gently pulls to help deliver your baby. The suction cup can leave a small mark on your baby's head, called a chignon. The cup may also leave a bruise on your baby's head, called a cephalhaematoma. A ventouse is not used if you're giving birth at less than 34 weeks pregnant, because your baby's head is too soft. A ventouse is less likely than forceps to cause vaginal tearing. ForcepsForceps are smooth metal instruments that look like large spoons or tongs. They're curved to fit around the baby's head. The forceps are carefully positioned around your baby's head and joined together at the handles. With a contraction and your pushing, an obstetrician gently pulls to help deliver your baby. There are many different types of forceps. Some forceps are specifically designed to turn the baby to the right position to be born, for example, if your baby is lying with its back to your back. Forceps can leave small marks on your baby's face but these will disappear quite quickly. AfterwardsYou will sometimes be fitted with a catheter (a small tube that fits into your bladder) for up to 24 hours. You're more likely to need this if you have had an epidural because you may not have fully regained feeling in your nerves. Episiotomy
Sometimes during the process of giving birth, a doctor or midwife may make a cut in a woman’s perineum (the area between the vagina and anus). The cut makes the opening of the vagina a bit wider, allowing the baby to come through it more easily. An episiotomy should be considered if the baby is in distress and needs to be born quickly, or if there is a clinical need, such as a delivery that needs forceps or ventouse. Around one-in-seven deliveries involves an episiotomy. In some women, the perineum may tear during childbirth as the baby comes out. If you have a tear or an episiotomy, you will probably need stitches to repair it, depending on the nature of the wound. If your doctor or midwife feels that you need an episiotomy when you’re in labour, they will discuss this with you. The stitches used during an episiotomy should heal within one month. Usually, dissolving stitches are used so you won't need to go back to hospital to have them removed. You’ll probably feel some pain around the episiotomy for two or three weeks after your baby is born. Sex can also be painful for the first few months after an episiotomy. Why you might need an episiotomy
An episiotomy may be recommended if your baby develops a condition known as foetal distress. Foetal distress is where the baby’s heart rate significantly increases or decreases before birth. This means that the baby may not be getting enough oxygen and has to be delivered quickly to avoid the risk of birth defects or stillbirth. If a caesarean section is not appropriate – for example, because the baby's head is already moving down the birth canal, an episiotomy can be the best way to speed up birth. Another reason for carrying out an episiotomy is when it is necessary to widen your vagina so that instruments, such as forceps or ventouse suction, can be used to assist with the birth. This may be necessary if:
If you’ve had a severe tear in a previous delivery, this doesn’t make it more likely that you’ll need an episiotomy in subsequent deliveries. How an episiotomy is performedAn episiotomy is usually a simple operation. Local anaesthetic is used to numb the area around the vagina so you will not feel any pain. If you’ve already had an epidural, the dose can be "topped up" before the cut is made. Whenever possible, the doctor or midwife will make a small, diagonal cut from the back of the vagina and directed down and out to one side. Following the birth of your baby, the cut is stitched together using dissolvable stitches. Recovering from an episiotomyEpisiotomy cuts are usually repaired within an hour of the baby's birth. The incision (cut) may bleed quite a lot initially, but with pressure and stitches this should soon stop. Usually, dissolving stitches are used so you won't need to go back to hospital to have them removed. Stitches should heal within one month of the birth. Talk to your midwife or obstetrician about which activities you should avoid during the healing period. After having an episiotomy, it is normal to feel pain around the cut for two to three weeks after giving birth, particularly when walking or sitting. Passing urine can also cause the cut to sting. Coping with painIt’s common to feel mild to moderate pain after an episiotomy. Painkillers, such as paracetamol, can help to relieve pain and are safe to use if you are breastfeeding. Ibuprofen is safe to use as long as your baby was not premature (born before 37 weeks of pregnancy), was not a low birth weight and has no medical condition. Aspirin isn't recommended because it can be passed on to your baby via your breast milk. Using a doughnut-shaped cushion or squeezing your buttocks together while you are sitting may also help to relieve the pressure and pain at the site of your cut. Research suggests that, after an episiotomy, around one percent of women will feel severe pain that seriously affects their day-to-day activities and quality of life. If this happens, it may be necessary to treat the pain with stronger prescription-only painkillers, such as codeine. However, if you are prescribed prescription-only medication, it may affect your ability to breastfeed safely. Your doctor or midwife will be able to advise you further about this. It is unusual for post-operative pain to last for longer than two-to-three weeks. Placing an ice pack or ice cubes wrapped in a towel on the incision can often help to relieve pain. Avoid placing ice directly on to your skin because this could damage it. Exposing the stitches that were used to seal the incision to fresh air can encourage the healing process. Taking off your underwear and lying on a towel on your bed for around 10 minutes once or twice a day may help. Going to the toiletKeep the cut and the surrounding area clean to prevent infection. After going to the toilet, pour warm water over your vaginal area to rinse it. Pouring warm water over the outer area of your vagina as you pee may also help to ease the discomfort. You may find that squatting over the toilet, rather than sitting on it, reduces the stinging sensation when passing urine. When you are passing a stool (poo), you may find it useful to place a clean pad at the site of the cut and press gently as you go. This can help to relieve pressure on the cut. When wiping your bottom, make sure that you wipe gently from front to back because this will help to prevent bacteria in your anus infecting the cut and surrounding tissue. If you find passing stools particularly painful, taking a short course of bulk-forming laxatives may help. This type of medication is usually used to treat constipation and makes stools softer and easier to pass. Pain during sexThere are no rules about when to start having sex again after you've given birth. In the weeks after giving birth many women feel sore as well as tired, whether they’ve had an episiotomy or not. Don’t rush into it. If sex hurts, it won’t be pleasurable. You can get pregnant as little as three weeks after the birth of a baby, even if you’re breastfeeding and your periods haven’t started again. Use some kind of contraception every time you have sex after giving birth, including the first time (unless you want to get pregnant again). You’ll usually have an opportunity to discuss your contraceptive options before you leave hospitaland at the postnatal check. But you can also talk to your doctor. If you’ve had a tear or an episiotomy, pain during sex is very common in the first few months. Studies have found that around 9 out of 10 women who had an episiotomy reported that resuming sex after the procedure was very painful, but that the pain improves over time. If penetration is painful, say so. It’s not pleasant to have sex if it causes pain. If you pretend everything is all right when it isn’t, you may start to see sex as a nuisance rather than a pleasure, which won’t help either of you. Pain can sometimes be linked to vaginal dryness. You can try using a water-based lubricant (available at pharmacies) to help. Don’t use an oil-based lubricant, such as Vaseline or moisturising lotion, as this can irritate the vagina, and damage latex condoms or diaphragms. InfectionLook out for any signs that the cut or surrounding tissue has become infected, such as red, swollen skin, discharge of pus or liquid from the cut, or persistent pain. Tell your doctor as soon as you can about any possible signs of infection, so that they can make sure you get any treatment you need. ExercisesStrengthening the muscles around the vagina and anus by doing pelvic floor exercises can help to promote healing and will reduce the pressure on the incision and surrounding tissue. Pelvic floor exercises involve squeezing the muscles around your vagina and anus, as though to stop yourself from going to the loo or passing wind. Your doctor can show you how to perform the exercises correctly. Scar tissueIn a few women, excessive, raised or itchy scar tissue forms around the place where a tear happened or where an episiotomy was performed. A small operation can be carried out to remove the scar tissue. This is done at least six months after childbirth, when the tissues have healed from the stretching, bruising and tearing of childbirth. The operation involves neatly cutting out the scar tissue and sewing together the clean-cut edges with small stitches. As with all wounds, there is a small risk of infection, so keep your stitches clean at all times. Preventing an episiotomyThere is no clear evidence that gently massaging your perineum in the last six weeks of pregnancy helps to prevent the tissue tearing or to avoid an episiotomy. The only way to try to avoid a tear or episiotomy is during labour when the baby’s head becomes visible. The midwife will ask you to stop pushing and to pant or puff a couple of quick short breaths, blowing out through your mouth. This is so that your baby’s head can emerge slowly and gently, giving the skin and muscles of the perineum time to stretch without tearing. The skin of the perineum usually stretches well, but it may tear. Sometimes, to avoid a tear or to speed up delivery, the midwife or doctor will inject local anaesthetic and cut an episiotomy.
Breech Birth What is a breech birth?If your baby is breech, it means that she or he is lying with their bottom downwards. This makes delivery more complicated. Your obstetrician and midwife will discuss with you the best and safest way for your breech baby to be born. You will be advised to have your baby in hospital. External cephalic version (ECV)You'll usually be offered the option of an external cephalic version (ECV). This is when pressure is put on your tummy to try to turn the baby into a head-down (cephalic) position. If an ECV doesn't work, you'll probably be offered a caesarean section. This is the safest delivery method for breech babies, but there's a slightly higher risk for you. If you plan a caesarean and then go into labour before the operation, your obstetrician should assess whether to proceed with the caesarean delivery. If the baby is close to being born, it may be safer for you to have a vaginal breech birth. You may be advised against a vaginal breech delivery if:
Caesarean Section Having a caesareanThere are situations where the safest option for you or your baby, or both of you, is to have a caesarean section. As a caesarean section involves major surgery, it is only performed when there is a real clinical need for this type of delivery. Your baby is delivered by cutting through your abdomen and then into your womb (uterus). The cut is usually made across your abdomen, just below your bikini line. The scar is usually hidden in your pubic hair. If you are expecting twins, triplets or more, it's more likely that you'll be considered for a caesarean section. This will depend on how your pregnancy progresses, the positioning of your babies and if the babies share a placenta. Whenever a caesarean is suggested, your doctor will explain why it is advised, and any possible side effects. Don't hesitate to ask questions. Urgent (emergency) caesareansUrgent (emergency) caesareans are necessary when complications develop and delivery needs to be quick. This may be before or during labour. If your midwife and doctor are concerned about the safety of you or your baby, they will suggest that you have a caesarean straight away. Sometimes your doctor or midwife may suggest an emergency caesarean if your cervix doesn't dilate fully during labour. Planned (elective) caesareans
A caesarean is elective if it is planned in advance. This usually happens when your doctor or midwife believes that labour will be dangerous for you or your baby. If you ask for a caesarean when there aren't medical reasons, your doctor or midwife should explain the overall risks and benefits of caesarean section compared with vaginal birth. You should also be able to talk to other members of your healthcare team, such as the obstetrician, to make sure you have accurate information. If you ask for a caesarean section because you are anxious about giving birth, your midwife or doctor should offer you the chance to discuss your anxiety with a healthcare professional who can offer support during your pregnancy and labour. If, after discussion and support, you still feel that you do not want a vaginal birth, you should be offered a caesarean section. The caesarean operationMost caesarean sections are performed under epidural or spinal anaesthesia, which minimises the risk and means that you're awake for the delivery of your baby. A general anaesthetic (which puts you to sleep) is sometimes used, particularly if the baby needs to be delivered quickly. If you have an epidural or spinal anaesthesia, you won't feel pain, just some tugging and pulling as your baby is delivered. A screen will be put up so that you can't see what's being done. The doctors will talk to you and let you know what's happening.
It takes about five to 10 minutes to deliver the baby, and the whole operation takes about 40-50 minutes. One advantage of an epidural or spinal anaesthetic is that you're awake at the moment of delivery and can see and hold your baby immediately. After a caesareanAfter a caesarean section, you'll feel uncomfortable and will be offered painkillers. You will usually be fitted with a catheter (a small tube that fits into your bladder) for up to 24 hours. You may be prescribed daily injections to prevent blood clots (thrombosis). Depending on the help you have at home, you should be ready to leave hospital within two to four days. You'll be encouraged to become mobile as soon as possible, and your midwife or hospital physiotherapist will give you advice about postnatal exercises that will help you in your recovery. As soon as you can move without pain you can drive - as long as you can perform an emergency stop. This may be six weeks or sooner. Vaginal birth after caesarean (VBAC)If you have a baby by caesarean section, this does not necessarily mean that any baby you have in the future will have to be delivered by caesarean. Most women who have had a caesarean section can have a vaginal delivery for their next baby. It depends on why you had a caesarean section the first time. Women thought to have a small pelvis, for example, may be advised to have a planned (elective) caesarean section next time. Your doctor will be able to advise you. Most women who are advised to try for a vaginal delivery in subsequent pregnancies do have normal deliveries.
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