Mode of Delivery

Most women prefer to have an uncomplicated vaginal delivery.

Occasionally some women elect to have a caesarean section.

Some pregnancies must be delivered by caesarean section.

The birth of a baby is a major life experience for all women.

It is important as much as possible that their expectations are met.

Vaginal delivery

Vaginal deliveries are often completely normal:

• No assistance with any medical intervention is required.

Not all labours however progress normally:

• Sometimes progress is inadequate.
• Sometimes there are signs of fetal compromise.
• Sometimes an emergency caesarean section needs to be performed.

If labour is not progressing well assistance will be necessary:

• Membranes may need to be ruptured.
• Contractions may need to be augmented with a syntocinon infusion.
• Intravenous fluids may be needed to maintain hydration.
• Adequate pain relief may be required sometimes with an epidural.

Vaginal deliveries may be complicated:

• Some vaginal deliveries will require assistance with forceps or ventouse.
• Some vaginal deliveries are complicated by vaginal or cervical tears.
• Some tears are associated with anal sphincter involvement and occasionally haemorrhages. Pelvic floor weakness may also result in bladder weakness and pelvic floor exercises may be required.

Assisted Deliveries

Maternal exhaustion, or sometimes fetal distress may prompt the need for assistance in the second stage. Many women are fearful of assisted deliveries.

It is important to recognise that all decisions to assist are calculated by weighing up the risks and benefits. It is important that the:

• Obstetrician has a high level of skill.
• Safety criteria are maintained in performing forceps or ventouse delivery.
• The procedure is abandoned if any difficulty is encountered.
• An emergency caesarean section should be performed if risks are too high.

Forcep or ventouse deliveries are usually straightforward.

They may facilitate a quick delivery of a distressed baby and they can overt the need for an emergency caesarean section.

Rotation forceps deliveries are performed when babies are in a persistent posterior position. They are more complicated and are performed in theatre.

Safety is the first of all criteria. No procedure or assistance will be performed until all risks are explained and consent is obtained from the patient and her partner. As long as the baby is well, all women who want to have a vaginal birth should be given a proper trial of labour.

Caesarean section

Some pregnancies must be delivered by caesarean section and are planned in advance. Sometimes they are emergency procedures.

They are almost all lower segment operations. These involve a horizontal incision above the bikini line and a horizontal incision in the uterus.

Most operations are completely straightforward. Some cases are potentially more complex:

• Obstructed labour.
• High-grade placenta praevia.
• Morbidly adherent placenta (placenta accreta).
• Fibroid uterus.

All operations have risks and these need to be discussed in advance.

The risks are different in individual patients and we need to discuss these thoroughly either antenatally or in labour ward.

A good delivery is one where both mother and baby are well.

The mode of delivery is important, but it will be determined by the circumstances pertaining to each individual pregnancy.

The safety of both mother and baby are the ultimate denominator.