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Obstetrics

Procedures

Normal Delivery

A natural way to deliver the baby, normal delivery or vaginal birth, is delivery that happens on its own without any external assistance. Normal delivery is what is preferred unless complications are expected. It can be divided into three stages:

Stage 1: This stage sets in with contractions beginning. Dilation of the cervix happens in preparation for the baby’s delivery. The duration of this stage varies form 7-13 hours depending on whether it is the mother’s first or second baby. If it is the first child, delivery will take longer.

At the commencement of this stage, contractions will be spaced apart with the cervix dilating up to 4 cm. Slowly, the contractions will increase in strength and frequency. Dilatation of the cervix increases further to 7cm. The water is expected to break at this stage and once that happens, contractions become more frequent. Full dilatation of the cervix then happens (10 cm).

Stage 2: This stage involves the birth of the baby. The mother will be encouraged to push the baby with every contraction. The mother will experience pain and fatigue. The doctor might decide to do an episiotomy, which is a cut near the vagina, to make it easier for the baby to come out. The baby coming out concludes this stage.

Stage 3: The placenta which nurtured the fetus inside the uterus is now pushed out. This might take any time between few minutes to half an hour after the baby is born.

Advantages of a Normal Delivery

  • Risk of infection is low
  • Faster recovery period
  • Normal delivery sparks milk production in the mother (lactation)
  • Baby’s immunity is increased
  • Baby has reduced risk of respiratory issues

Caesarean Delivery

Caesarean, also known as C-section, is the surgical way of delivering a baby - it is usually done when a normal delivery is not advisable due to complications. This procedure involves making incisions in the mother’s lower abdomen and uterus to deliver the baby. Caesarean is not performed before 39 weeks of pregnancy so that the baby’s development is complete. However, if there is an emergency situation, caesarean can be performed before 39 weeks.

The surgery will be performed under anesthesia and the doctor will let the patient know the anesthesia options available. Hospitalization of around 3 days will be needed and even after discharge the mother will need help till healing is complete. The doctor will give painkillers to deal with any post-operative pain.

When is a caesarean done?

  • When the baby is very big
  • When it is a breech birth – baby’s legs come out first
  • Fetal distress - fluctuations in baby’s heart rate

Recovery after a caesarean takes longer compared to a normal delivery. The following tips might help:

  • The mother needs enough rest to recover fast. Getting help from family/friends or maybe even hiring extra help are all options to be considered.
  • Strenuous activity (including lifting anything heavy) should be avoided.
  • Gentle exercise like going for a walk is advisable.
  • Good nutrition is important even after delivery and the lactating mother has to make sure she eats healthy food and consumes enough fluids.

Ventouse Delivery

This is a vaginal delivery that is assisted by a ventouse (vacuum cup). This delivery might be decided upon when one of the following conditions is true:

  • When the mother is too tired to push the baby out
  • When the baby’s heart rate is not normal in second stage of labour, with baby’s head well descended in vagina.

In such cases, a vacuum cup is fixed to the baby’s head and the baby is gently pulled out through the vagina. An episiotomy can be done to aid delivery. Sometimes, instead of a ventouse, forceps will be used to assist delivery. If the doctor feels that the ventouse delivery is not going as planned, she might opt for a caesarean.

Vaginal Birth after Caesarean - VBAC

When the first child has been delivered through a caesarean, many people are under the impression that a caesarean for the second child is the only choice. However, this is not so. A vaginal birth after having undergone a caesarean is possible. It is important to note that some factors play a role in determining whether a VBAC is possible - the uterus should be strong enough to handle a vaginal birth after a caesarean and the hospital should have experienced surgeons and the necessary infrastructure to handle it. The doctor is the best person to judge if VBAC is a viable option.

Signs that help determine whether VABC is suitable for a woman include:

  • Previous VBAC done
  • Woman is lesser than 35 years of age
  • If the previous caesarean involved a horizontal incision and not a vertical one

Some scenarios rule out the possibility of VBAC. These include:

  • A vertical incision in the previous cesarean
  • A difficult labour which does not proceed quickly
  • If the pregnancy period is more than 40 weeks
  • Baby is large
  • Multiple cesareans previously
  • Mother suffers from heart or lung conditions

VBAC has the following benefits:

  • Lowered risk of infection
  • No incisions on the abdomen
  • Quicker recovery
  • Decreased loss of blood

The risk associated with VBAC - the scar in the uterus from the previous cesarean might break open during a VBAC. This condition called a uterine rupture might necessitate an emergency cesarean. Hence VBAC can be tried only in the hospitals which have the required infrastructure to handle it.

The VBAC procedure will be the same as a normal delivery. An option of epidural for pain management is also possible. It is best to talk to the doctor and get all doubts cleared before deciding on it.

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