Complicated births and special cases
While the majority of births are straightforward, some deliveries can be more complicated. This might be because the baby is premature or either the baby or mother requires special medical care.
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About one in every 13 babies will be born before week 37 of pregnancy. In most cases, labour starts by itself. About one baby in every six is induced and about one early baby in four is delivered by caesarean section.
If your baby is likely to be born early, you will be admitted to a hospital with specialist facilities for premature babies. Not all hospitals have these facilities, so it may be necessary to transfer you and your baby to another unit, either before or immediately afterwards.
If contractions start prematurely, the doctors may be able to use drugs to stop your contractions temporarily. You will be given injections of steroids that will help to mature your baby’s lungs so they are able to breathe easier after birth. This treatment takes about 24 hours.
Many multiple births are premature and twins and triplets are more likely to need care in a neonatal unit. Your doctor may offer you a planned birth earlier than 38 weeks. The timing of the birth depends on the number of babies and whether they share a placenta.
If you have any reason to think your labour may be starting early, get in touch with your hospital or midwife straight away.
Pregnancy usually lasts about 40 weeks. Most women go into labour within a week either side of this date.
If your labour doesn’t start by 41 weeks, your midwife will offer you a ‘membrane sweep’. This involves having a vaginal examination, which stimulates the neck of your uterus to produce hormones which may trigger natural labour.
If your labour doesn’t start, your midwife or doctor will suggest a date to have your labour induced, usually ten to 14 days after your due date. If you don’t want labour to be induced and your pregnancy continues to 42 weeks or beyond, you and your baby will be monitored.
Your baby’s movements and heartbeat will be checked by ultrasound. If there are signs your baby is in distress, your doctor or midwife will again suggest that labour is induced.
Induced labour (induction)
Labour can be induced if your baby is overdue or there is any risk to your or your baby’s health. For example, if you have high blood pressure, or your baby is failing to grow and thrive.
Induction is always planned ahead of time, so you will be able to talk over the benefits and disadvantages with your doctor and midwife.
Contractions are usually started by inserting a hormone into the vagina. Induction of labour may take a while, particularly if the neck of the uterus needs to be softened with pessaries or gels. Sometimes a hormone drip is needed to speed up labour.
Once labour starts, it should continue normally, but can sometimes take 24-48 hours to get you into labour.
About one in eight women will have an assisted birth, where forceps or a vacuum-extractor are used to help your baby out of the vagina.
This can be because:
- your baby is distressed
- your baby is in an awkward position
- you are too exhausted
Both vacuum extractor and forceps are safe and are used only when necessary for you and your baby. A paediatrician may be present to check your baby’s health.
A local anaesthetic will usually be given to numb the birth canal if you have not already had an epidural or spinal anaesthetic. If your obstetrician has any concerns, you may be moved to a theatre so a caesarean section can be carried out if needed.
As the baby is being born, a cut may be needed to enlarge the vaginal opening. Any tear or cut will be repaired with stitches.
Depending on the circumstances, your baby may still be delivered onto your abdomen and your birthing partner can still cut the cord.
A vacuum extractor is an instrument that has a soft or hard plastic or metal cup that attaches to your baby’s head. 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 and can cause a bruise on your baby’s head. A vacuum extractor isn’t used if your baby is less the 34 weeks old, because the head is too soft.
A vacuum extractor is less likely to cause vaginal tearing than forceps.
Forceps are smooth metal instruments that look like spoons or tongs. They are curved to fit around your baby’s head. The forceps are carefully positioned around your baby’s head and joined at the handles. While you are pushing, an obstetrician will gently pull your baby.
Some forceps are specifically designed to turn the baby to the right position. These can leave small marks on your baby’s face which will disappear quite quickly.
You will sometimes have a catheter fitted for up to 24 hours. You’re more likely to need this if you have had an epidural, as you may not feel when your bladder is full.
If your baby is breech, it is positioned with its bottom downward. This makes delivery more complicated. Your obstetrician and midwife will talk to you about the best and safest way for your baby to be born. You will be advised to have your baby in hospital.
You will be offered the option of an external cephalic version (ECV). This is when pressure is put on your abdomen to try to turn the baby to a head down position. If this doesn’t work, you will probably be offered a caesarean section.