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Special Procedures

Newborn

Induction of labour

When the risk of leaving the baby in the mother is greater than if the baby is born, labour can be brought on artificially. This is known as induction of labour.

Depending on the readiness of the cervix, different methods can be used:

  • If the cervix is not ready, that is thick, firm and closed, prostaglandin preparations can be applied to the outer portion of the cervix.

  • If the cervix is very ready, that is thin, soft and already open to more than 2-3 cm, then simply breaking your water (amniotic sac) artificially can bring on labour.
    We only do inductions when medically necessary.
  • After the cervix begins to dilate and soften, the most common way to induce labour is by an oxytocin infusion. This is given by intravenous (IV). It is connected to a pump and regulated by the nurse, to give the desirable strength and frequency of contractions. When switched off, the effects disappear quickly. It is, therefore, one of the safest methods.

Your doctor will review with you what is the right method for you.

We only do inductions when medically necessary. Inductions have not been shown to increase the rate of C-section. Learn more by reading a CMAJ research article.

Reasons you might need an induction

  • Being more than 7–10 days past your due date
  • Medical issue with the mother On the day of your induction, the nurse will call you and let you know what time to come in.
  • Gestational diabetes on insulin
  • High blood pressure
  • A baby that's not growing well
  • Concerns about the baby's health
  • Your water has broken

If you are booked for an induction, you will be given a day, but not a time. On the day of your induction, the nurse will call and let you know what time to come in. If the labour floor is very busy you will be asked to come later in the day; if it is not that busy, you will be asked to come in the morning.

Remember, it can take 1–3 days from the start of induction to actually having the baby.


Episiotomy

An episiotomy is an incision that is made at the opening of the vagina when:
An episiotomy is only done when necessary

The following situations increase the likelihood of needing an episiotomy:
  • First baby
  • Forceps birth
  • Large baby
  • Breech baby

 
Assisted vaginal birth

At the end of the first stage of labour, when the cervix is fully dilated, every mother should attempt to have a vaginal birth. The instruments commonly used for an assisted vaginal birth are the vacuum and forceps.

Vacuum

A vacuum extractor is connected to a small plastic cup that is put onto the baby's head. The cup is applied to the baby's scalp. The baby's head will advance by the pushing efforts of the mother and the pulling efforts of the vacuum used by the doctor. Some tissue swelling on the baby's head is common. It usually disappears within 1-2 days. A bruise or collection of blood under the scalp is an unusual complication, but not serious. Neither you or your baby can feel this; the feeling is the same as a spontaneous birth.

Forceps

Forceps are spoon-like instruments that are placed on both sides of the baby's head to guide it through the birth canal. Forceps allow a safe vaginal birth which otherwise would have resulted in a cesarean section. Sometimes attempts to deliver the baby still fail. To avoid excess force or injury to the mother or the baby, the doctor may recommend a cesarean birth. Forceps birth requires some form of anaesthesia.
 
Reasons for an assisted vaginal birth


Cesarean section birth

A cesarean section is the birth of the baby through an abdominal incision. The objective of a cesarean section is to preserve the health of the mother and/or her baby when a vaginal birth is unsafe.

Most cesarean sections are done under spinal or epidural anaesthesia and the mother is awake (see anaesthesia for cesarean section). Your partner may be present for emotional support and to see the baby during the birth. An epidural blocks the pain, but you may still feel touch and stretching.

The baby is usually born within about 10 minutes and it take about 30-40 minutes to close the incision back up again. General anaesthesia may be necessary is it is an emergency situation, if the epidural is not working adequately or cannot be used. When general anaesthesia is used, the mother will not be aware of her support person, and therefore, this person is not usually permitted in the operating birthing room.
 
Reasons for a c-section
 
  • The baby's head is too large to pass through the mother's birth canal. There is no progress in cervical dilation or the baby does not come down into the birth canal despite good labour and effective pushing.
  • The mother has had a previous cesarean section.
  • The baby is not tolerating labour.
  • Unusual positions such as a breech presentation, transverse lie (baby lying sideways instead of up or down)
  • Placenta covering all or part of the cervix (placenta previa) or premature separation of the placenta (placental abruption)
  • Serious medical conditions which may affect the health of the baby
  • Induction of labour is unsuccessful or not possible
 
There are situations when your health care provider knows before labour that a cesarean birth is necessary.
Preparing for an elective cesarean section

There are situations when your health care provider knows before labour that a cesarean birth is necessary. If you are having a planned cesarean birth, here are some suggestions:

In the weeks before your cesarean birth
 
  • If possible, arrange for household help for several weeks after you come home with your baby
  • Pack your suitcase
  • If you go into labour before your scheduled cesarean section date, go to the Assessment Room (2S-177). Please do not eat or drink anything from the time you think you are in labour.

The day of your cesarean birth

  • Do not eat or drink anything, not even water after midnight.
  • Take a shower.
  • Do not wear any jewellery.
  • Arrive at the Assessment Room (2S-177) 2 hours before your scheduled cesarean time.
  • Your caesarean section is an elective procedure and delays are possible if any emergency occurs with another patient in the Birthing Centre. This will be communicated to you.
In the Assessment Room

  • Your nurse will give you a hospital gown, then will ask you a few questions about your health.
  • Your nurse will check your temperature, pulse, respiration, blood pressue and listen to your baby's heart rate.
  • An intravenous (IV) will be started.
  • Your nurse will walk with you to the operating room and prepare for the birth.
  • The anaesthetist will give you an anaesthetic; a spinal is most commonly used.
  • Your nurse will insert a catheter into your bladder to keep it empty during the surgery.
  • In most cases, your support person is welcome to attend the operative birth. He/she will be asked to remain outside the room until you are comfortable with your anaesthetic. Then he/she will sit at the head of the delivery bed to be a support for you. Other support persons will not be able to enter the recovery room and may be asked to wait elsewhere.
  • Your anaesthetist may give you an ilioinguinal nerve block to provide additional pain relief after your cesarean section. Injections will be performed around your hip bone region while you are still frozen from the spinal or epidural. The medicine will freeze the area of the "bikini line" incision for a further 12–16 hours after the spinal/epidural has worn off. Side effects include transient leg weakness.

After the birth

  • When you reach the recovery room, your nurse will place your baby skin to skin and encourage you to hold your baby. Your nurse will also help you to start breastfeeding.
  • You will spend about an hour in the Birthing Centre's recovery room and then you will be transferred to the Mother and Baby Unit.
  • Your baby will be with you in your room.
  • The nurses are always available to provide and assist with the baby's care.
  • Expect to stay in hospital for 2-3 days.


Vaginal birth after cesarean (VBAC)

If you have had a previous cesarean birth, talk to your health care provider about having a trial of labour for a vaginal birth after cesarean section (VBAC).

VBAC is a safe delivery option, but in order to decide if this is the right for you, your care provider may need to see the hospital note from your previous c-section which will tell them:
  • The reason for the first c-section
  • The kind of cut that was made to the uterus in the first c-section
  • The way the uterus was sewn up in the first c-section
  • How long ago the first c-section was
  • If you have had any other surgery to your uterus

If you plan to try for a VBAC, your chance of having a vaginal delivery varies from 50-80%. There are no completely reliable ways to predict whether a trial of labour will result in a vaginal birth. Even if you choose a VBAC, it may be necessary to have a repeat c-section during a trial of labour. If this happens, there may be an increased risk of complications for you and your baby. You and your care provider will talk about your individual risks and benefits of a trial of labour or a planned repeat c-section to help you decide which option is best for you.
Overall, 50-80% of women who try will have a successful vaginal birth after c-section!
Overall, 50-80% of women who try will have a successful vaginal birth after c-section!

Why attempt VBAC?

  • Cesarean birth requires abdominal surgery with an anaesthetic and has a risk of infection, bleeding and other problems that can occur with any surgery or anaesthesia.
  • For a vaginal birth, the hospital stay is shortened. You have less postpartum discomfort and a shorter recovery time at home.

What is the risk of attempting a VBAC?

  • There is a risk that the scar on the uterus may tear during labour. You and your baby are monitored very closely by a nurse and your health care provider. Although this is a rare complication (0.2–1.5%), it is serious and may be harmful to both you and your baby and may require an emergency cesarean section.
  • If the attempted VBAC is unsuccessful, the resulting cesarean section may result in more complications than an elective repeat cesarean section without labour.
Factors that increase your chance of having a successful VBAC

  • You have had a vaginal delivery before.
  • You are younger than 40 years old.
  • Your labour begins on its own and progresses normally.
  • The reason for your previous c-section isn't a factor this time (such as a breech baby or an emergency c-section or a drop in the baby's heart rate).

Factors that decrease your chance of having a successful VBAC

  • You have had more than one c-section before.
  • You are past your due date.
  • Your labour doesn't start on its own.
  • You are significantly overweight.
  • Your baby is expected to weigh over 4,000 grams (about 8.8 pounds).

The best outcomes for mother and baby are with a successful VBAC. The best outcomes for mother and baby are with a successful VBAC. However, the worst outcomes are with a trial of VBAC that ultimately requires a c-section. Therefore, we try to increase the number of successful VBACs by selecting the right patients with factors that increase their chance of a successful VBAC to have a trial of labour after a c-section.

Speak to your care provider about whether this is a good option for you.
 
Breech birth

When the buttocks, knees or feet of the baby settle down into the mother's pelvis, this is called a breech presentation. About 3-4% of all deliveries are breech births and in 1/3 of all twin births, at least one baby will be in a breech presentation. It is also most common in premature births.

A vaginal breech birth is more difficult and risky as the head which is the largest part of the baby is delivered last. Only very few obstetricians are trained in vaginal breech delivery and these are only done under certain circumstances. Speak to your doctor about which delivery is option is right for you.

Options when your baby is breech
 
  • Elective c-section
  • External cephalic version
  • Accupuncture
  • Vaginal breech delivery
    Read about breech childbirth (The Society of Obstetricians and Gynaecologists of Canada).  Download: Breech childbirth

Twins

Twins occur in 1 out of 90 births. Twins occur in 1 out of 90 births. In fraternal twins, two separate eggs are fertilized. In identical twins, a single fertilized egg divides into two fetuses. Fraternal twins are more common. The use of fertility drugs, which stimulate ovulation, increases the chance that more than one egg will be released, and results in an increased chance of fraternal twins.

Certain complications are more likely to occur in twin pregnancy, such as premature birth, high blood pressure and smaller babies. During such pregnancies, it is advisable for the mother to limit excessive activity. Your health care provider can provide you with guidance about your appropriate activity. Ultrasound examinations are necessary to check the growth of the babies. More visits to your health care provider will be needed to detect early complications.

Delivering twins requires complex decision making. Such factors as gestational age, position, condition of the babies and mother all need to be considered. The chance of having a cesarean section is increased. Multiple births always take place in the Operative Birthing Room, in case an emergency should arise with the babies or the mother. A paediatrician and respiratory therapist are always present at these births.


NOTE
You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider. If you have any specific questions about any medical matter you should consult your healthcare provider. If you think you may be suffering from any medical condition you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.