Medical interventions during labour and birth: assisted birth and caesarean birth

Every labour and birth is different, and sometimes medical intervention may be recommended to support the health and wellbeing of you or your baby. While many women have an uncomplicated vaginal birth, interventions such as artificial rupture of membranes, an episiotomy, an assisted vaginal birth or caesarean birth may sometimes be needed.

Medical interventions can be recommended for a range of reasons, including concerns about your health or your baby’s wellbeing, a labour that is not progressing as expected, or if your baby needs to be born more quickly.

Your obstetrician and midwifery team will discuss any recommended intervention with you, including why it may be needed and what to expect.

Artificial rupture of membranes

Artificial rupture of membranes, sometimes called breaking your waters, involves making a small opening in the membranes surrounding your baby so that the amniotic fluid can drain.

It may be recommended to help start labour as part of an induction, or to help labour that has already started to progress.

During the procedure, your obstetrician or midwife uses a small sterile instrument to make a small opening in the membranes. You may feel some pressure or discomfort during the procedure and your midwife will support you throughout.

Episiotomy

An episiotomy is a surgical cut made in the perineum (the area of skin and muscle between the vagina and anus) to widen the vaginal opening during birth.

An episiotomy is not routinely required for every vaginal birth. It may be recommended when your baby needs to be born quickly or when additional space is needed for an assisted vaginal birth using forceps or vacuum.

If an episiotomy is recommended, your healthcare team will explain why it is needed. Local anaesthetic is used if you do not already have adequate pain relief, and the incision is repaired with dissolvable stitches following the birth.

Assisted vaginal birth

An assisted vaginal birth is when an obstetrician uses an instrument to help guide your baby through the vagina during the pushing stage of labour.

The two main types of assisted vaginal birth are forceps birth and vacuum (ventouse) birth.

An assisted birth may be recommended if labour has been prolonged, you are finding it difficult to continue pushing, or there are concerns about your baby’s heart rate or wellbeing and your baby needs to be born more quickly.

Before an assisted birth, your obstetrician will assess your individual circumstances and discuss the recommended option with you.

Vacuum or ventouse birth

A vacuum-assisted birth, sometimes called a ventouse birth, uses a soft suction cup placed on your baby’s head to help guide your baby through the birth canal while you push.

The reasons for using a vacuum are similar to those for forceps, including prolonged labour, maternal exhaustion or concerns about your baby’s wellbeing.

The cup is carefully positioned on your baby’s head, and your obstetrician gently assists your baby’s descent while you push with contractions. Once your baby’s head is born, the cup is removed and your baby is born normally.

It is common for babies born with vacuum assistance to have a temporary swelling or mark on their scalp. This usually settles relatively quickly.

Vacuum assistance is not suitable in every situation. Your obstetrician will consider factors such as your baby’s position, gestation and individual circumstances when deciding whether it is an appropriate option.

Forceps birth

Forceps are specially designed instruments that are placed around your baby’s head to help guide them through the birth canal while you continue to push with contractions.

Forceps may be recommended when:

• the second stage of labour is taking longer than expected
• your baby needs to be born quickly because of concerns about their wellbeing
• you are unable to push effectively or have become too exhausted to continue
• a medical condition means prolonged pushing may be harmful to you
• your baby needs assistance because of their position

If you have an epidural, additional anaesthetic may be given if required. If you do not already have adequate pain relief, your obstetrician will discuss your options depending on the clinical situation.

Your obstetrician will carefully position the forceps and gently guide your baby down while you push during contractions.

An episiotomy is often recommended to create additional space for the forceps.

Caesarean section

A caesarean section, also called a C-section, is an operation to deliver your baby through an incision made in your abdomen and uterus.

A caesarean birth may be planned during pregnancy, known as an elective or planned caesarean, or it may become necessary during labour or pregnancy because of an unexpected complication, known as an unplanned or emergency caesarean.

There are many reasons why your obstetrician may recommend a caesarean birth. These can include:

• placenta praevia, where the placenta is covering or close to the cervix
• your baby being in a position where vaginal birth is not considered the safest option, such as some breech or transverse positions
• concerns about your baby’s wellbeing
• labour not progressing as expected
• certain pregnancy or maternal health complications
• concerns about your baby’s growth or size
• some multiple pregnancies
• a previous caesarean birth, depending on your individual circumstances

Having a previous caesarean does not necessarily mean you will need another caesarean. Your obstetrician can discuss your options, including whether a vaginal birth after caesarean (VBAC) may be appropriate for you.

What happens during a c-section?

Before your caesarean birth, you will be prepared for theatre, and your healthcare team will explain what to expect.

A drip will usually be placed into your hand or arm, and a catheter will be inserted into your bladder after your anaesthetic has taken effect. Your abdomen will be prepared for surgery, and a sterile screen will be positioned so you do not need to watch the operation.

Most caesarean births are performed using a regional anaesthetic, such as a spinal or epidural, which means you are awake for your baby’s birth but should not feel pain. You may experience sensations of pressure, pulling or tugging as your baby is delivered.

A general anaesthetic may be required in some circumstances, particularly when your baby needs to be born immediately or a regional anaesthetic is not suitable.

Your obstetrician makes an incision through the abdomen and uterus, generally at your ‘bikini line’, and gently delivers your baby. Sometimes forceps may be used during a caesarean to assist with delivering your baby’s head.

Once your baby is born, the team will check that they are well. Where possible, you may be able to have immediate skin-to-skin contact with your baby. Your support person may also be able to be present in theatre, depending on the circumstances and type of anaesthetic used.

The placenta is then delivered, and your obstetrician closes the incisions with sutures or, where appropriate, other methods of wound closure.

A caesarean is major surgery, so your obstetrician will discuss the potential benefits and risks with you before the procedure where circumstances allow.

Anaesthesia for a caesarean birth

There are three main types of anaesthesia that may be used for a caesarean birth.

Epidural: If you already have an epidural during labour, it may be topped up to provide the level of anaesthesia required for surgery. You remain awake during the birth.

Spinal anaesthetic: A spinal is a fast-acting regional anaesthetic that provides numbness for the operation. It may be used when you do not already have an epidural.

General anaesthetic: A general anaesthetic puts you to sleep and may be used when a regional anaesthetic is not suitable or when your baby needs to be delivered immediately. If a general anaesthetic is required, your support person will generally not be able to remain in the operating theatre for the birth.

With an epidural or spinal anaesthetic, you can usually be awake for your baby’s birth and, when you and your baby are well, may be able to see and hold your baby soon after birth.

Immediate care after birth

After your baby and placenta have been delivered, your body begins the process of recovering from pregnancy and birth. Whether you have a vaginal birth, assisted birth or a caesarean birth, your midwife will closely monitor you in the hours following birth.

Your observations may include:

• temperature, pulse, blood pressure, breathing rate and oxygen levels
• the position and firmness of your uterus as it contracts
• vaginal blood loss
• urine output
• bowel movements
• your pain and comfort
• your perineum, if you have experienced tearing, bruising or had an episiotomy
• any stitches or wounds

Your midwife will also support you with feeding, hydration, mobility, personal care and caring for your baby.

Additional care after a caesarean birth

Following a caesarean, your healthcare team will provide additional monitoring related to your surgery.

This may include:

• checking your surgical wound for bleeding or signs of infection
• monitoring your intravenous line
• monitoring your catheter and urine output
• checking and managing any surgical drains, if required
• providing appropriate pain relief
• monitoring your movement and sensation as your anaesthetic wears off
• assisting you to mobilise safely
• providing medication to reduce the risk of blood clots, when prescribed

You will generally be encouraged to begin moving as soon as it is safe to do so. Early movement, together with other measures such as compression devices or anticoagulant medication when prescribed, can help reduce the risk of deep vein thrombosis (DVT) following surgery.

Your midwife will also support you with showering, feeding your baby and finding comfortable positions for holding and caring for your newborn.

Supporting you through every type of birth

There is no single way to give birth, and sometimes the safest birth for you or your baby involves medical intervention.

Whether your baby is born following an uncomplicated vaginal birth, with forceps or vacuum assistance, or by caesarean birth, your maternity team is there to support you and your baby throughout the experience.

If an intervention is recommended during your labour or birth, your obstetrician and midwife will explain why it is being recommended, what it involves and what your options are wherever circumstances allow. Asking questions and talking openly with your healthcare team can help you feel informed and supported as you prepare for your baby’s birth.