Pain is a normal part of labour. Different women may choose to have different options of pain relief, or none at all.
Please click this link here for more information.

We will support you and help you choose the option that suits you best.

Most babies are born without the help of instruments. In some cases, this may be
recommended to help your baby.

Reasons for an assisted birth:

• Fetal distress: if your baby becomes distressed during the second (pushing) stage of labour, and a quicker delivery is needed
• Your baby is in a difficult position and not coming through the birth canal despite your pushing
• If you have twins or triplets, you are more likely to need an assisted delivery
  particularly for the second baby
• If you have a medical condition that limits your duration of pushing.

There are 2 types of instruments that may be used

Ventouse

A ventouse is a metal, silicon or rubber cup that is placed on your baby’s head and creates a suction.

Forceps

Forceps are a pair of smooth, curved tongs which slide down the side of baby’s head. We use either instruments to guide your baby out through the birth canal as you push.

What to expect during an assisted birth

If you consent to an assisted birth, you will be offered pain relief, and your bladder will be emptied with a small catheter to minimise bladder injury.

The choice of instrument to help deliver your baby safely will depend on your clinical situation and urgency of birth. An episiotomy may be recommended to minimise injury to your perineal tissues.

If the assisted birth does not help

A caesarean may be needed.

Sometimes, we may recommend transferring you to the operating theatre before the assisted birth. This means a caesarean can be done faster if it is necessary.

Risks and side effects of an assisted birth

Most assisted births do not have more problems compared to a normal vaginal birth. An assisted birth is only needed if there are concerns about you or your baby.

There are many benefits to an assisted birth, rather than a caesarean, when you are fully dilated.

Caesarean delivery at full dilation increases the risk of:

• bleeding
• infection
• injury to other organs
• preterm birth in future pregnancies.

Some of the risks of an instrumental birth:

• bruising around your vagina and perineum
• there is a chance of injury to your pelvic floor muscles, bladder or bowels
• baby may have bruising on the scalp and face, or a collection of blood under the skin (haematoma)
• there is a rare chance of a ventouse causing a significant bleed under the baby’s scalp (subgaleal haemorrhage)
• there is a very rare chance of forceps causing a nerve injury to the baby’s face — this does not affect the brain and will heal
• there is a higher chance of shoulder dystocia, where the baby’s shoulders do not come out as intended

In extremely rare cases, baby may have a:

• skull fracture
• bleed into the brain
• spinal cord injury

This can be a planned/elective or an emergency caesarean section.

Planned (elective) caesarean section

An elective caesarean section is planned before going into labour. This may be
recommended where there are reasons where a vaginal birth is not appropriate for you and your baby.

Emergency caesarean section

An emergency caesarean section is usually done unplanned, when you are already in labour. This can happen when delivery is needed immediately due to complications that happen during pregnancy or labour.

Anaesthesia

A caesarean section is usually done with regional anaesthesia, where you remain awake and your support person can be in theatre with you. General anaesthesia (where you are put to sleep) is less common.

Before your caesarean section

If you are having a planned or elective caesarean section, you will have a
preoperative assessment.

The anaesthetist will meet you to review your health, pregnancy, medical history and previous anaesthetic.

You will be sent forms for blood tests which you should do prior.

On the day of your caesarean section

You will be given a time to come to the hospital on the day of your caesarean section. However, occasional delays can happen if there are emergency operations.

After your caesarean section

Once your baby is delivered and checked by a paediatrician or midwife, you should be able to have skin-to-skin contact. You and your baby will be transferred to the recovery area, where your support person can usually stay with you.

Most women stay in the hospital for 24-48 hours, after which you would transfer to Birthcare Postnatal Unit for another 2-3 days prior to going home.

For more information on caesarean delivery, click here.

https://info.health.nz/health-topics/pregnancy-maternity/labour-and-birth/caesarean-section

It is common for the area between the vagina and anus to tear during childbirth.
Tears can be minor and heal on their own, but many tears will need stitches.

Types of perineal tear

Perineal tears are described by how severe they are.

• First degree – small tears of just the skin and do not usually need stitches.
• Second degree – most common type : deeper and affects the muscle and skin and need stitches.
• Third degree – involves tearing of the vaginal wall and the anal sphincter (the muscle that controls the back passage). This type of tear is rare.
• Fourth degree – extends to the lining of the anus. This is very rare.

Episiotomy

An episiotomy is when a small cut is made in your perineum to make it easier for your baby to be born.

An episiotomy may be offered if:

• there is fetal distress and your baby needs to be birthed quickly, either by natural vaginal or assisted birth
• you are at risk of third or fourth degree tears.

Please click here for more information on treating and caring for perineal tears
https://info.health.nz/health-topics/pregnancy-maternity/labour-and-birth/perineal-tear

Induction is when labour is started artificially instead of letting it happen naturally. Some of the reasons of why an induction may be recommended:

• your baby is overdue/ concerns of your baby’s well being, eg growth restriction,
  slowing of movements, low fluid around your baby
• your waters have broken before labour
• your age
• you or your baby have a medical problem

Labour can be induced by either:

• breaking your waters ( ARM), or using medicines/ balloon catheter
  Please click here for more information about induction of labour