There is arguably nothing more exciting than the birth of a newborn baby and this has long been the case throughout human history. Over time medicine has advanced, and childbirth options have developed to make it safer for both mothers and babies.
We know that even the most planned birth may have some twists and turns so it is useful to empower yourself with an understanding of different types of birth and what your options are so that when the time comes you can understand which route you may need to take.
It is important to remember you cannot fail at labour or birth. Birth is beautiful and is equally as momentous whichever form it may take. Women should be able to give birth in an informed and safe way, feeling empowered by their understanding of the process and free from fear (wherever possible). Today I want to talk through the different types of birth and why different methods are used so you can understand how each works, remember knowledge is power.
Vaginal Birth (unassisted):
Often referred to as ‘normal’ or ‘natural’ birth. It is generally recommended to plan for an unassisted vaginal birth unless there is a medical reason why this would not be the safest option. Your midwife will make this clear to you if this is the case and this may also change throughout your pregnancy depending on a number of factors. So how does it work? During labour, your baby will gradually move and navigate through your pelvis to reach your pelvic floor, they then pass under your pubic arch and through your vaginal canal to be born. You may feel a pressure or like you need to poop! At this stage you will be asked to push with each contraction to help guide your baby safely into the world, this can take anywhere between a few minutes and a few hours, every delivery is different so try not to have an expectation on how long your labour will last or to compare to others. You are on your own unique journey.
There are benefits to this type of birth which include; a shorter hospital stay, quicker recovery, lower risk of infection for mothers and lower risk of respiratory problems for babies. Generally this is the recommended birthing method if you are physically able, however there are other methods that can be used alongside vaginal birth such as a ventouse birth and forceps birth detailed below.
Ventouse Birth (assisted vaginal birth):
A ventouse birth is often referred to as a ‘kiwi’ or ‘suction cup’ if you have ever heard one of these terms from a friend or relative! Your baby is still born vaginally but an obstetrician provides some assistance. For a ventouse birth your baby’s heartbeat will be monitored continuously through a machine called a CTG. You will be assisted into a position called lithotomy where your legs are supported in stirrups and a paediatrician (doctor for the baby) will likely attend. This process will usually take place in your room on labour ward. A round plastic or metal cup with a handle is attached to your baby’s head using suction. When you have a contraction your obstetrician will gently pull to help guide your baby’s head out. During this process some people may require an episiotomy - this is a cut on the perineum at an angle to prevent a tear that could extend into your anal sphincter muscles - but don’t worry this will be repaired afterwards! This is nothing to worry about, we all want the safest arrival for your baby and sometimes little obstacles may occur during birth. Rest assured even by reading this blog, you are actively learning about all the different pathways or situations that may arise, which will help you feel more at ease.
A ventouse will typically be performed if your baby is close to being born but there is an indication to speed up the birth. The most common indications are concerns about your baby’s heart rate or simply that you are exhausted. This method can sometimes leave a circular mark on your baby’s head (called a chignon) but this usually disappears within 48 hours so please don’t worry! A bruise on your baby’s head called a cephalohematoma also typically occurs in between 1-12 in 100 babies and it disappears with time. It doesn’t usually cause any further problems except for a rise in jaundice in the first few days. If this occurs, the doctor will explain all this to you at the time so you need not worry.
Forceps Birth (assisted vaginal birth):
Like with a ventouse birth your baby’s heartbeat will be monitored continuously, if there is anything of concern you will be assisted into lithotomy and a paediatrician will be present. An obstetrician will usually ask to perform a vaginal examination to ensure your cervix is fully dilated and to check the position of your baby.
If it is decided that you need forceps to help assist the baby, this may take place in your room on labour ward if your baby is in an optimal position. However it is good to be aware that more often a forceps birth will take place in theatre and this is referred to as ‘a trial’. It is called this because if the forceps birth is not successful it is often necessary to proceed to a caesarean section. You are therefore in theatre already which is the place you need to be for a caesarean section to be performed without delay.
A forceps birth requires adequate analgesia as two metal spoon-like instruments are carefully fitted around your baby’s head and are joined together at the handles. If you already have an epidural an anaesthetist may give you some stronger medicine to make it work a little more so that it can help reduce the pain. If you do not have an epidural, then you will be given a spinal anaesthetic in theatre to ensure that you do not feel pain during the forceps birth. You will be encouraged to push as the obstetrician gently pulls to help your baby be born. An episiotomy is commonly performed to reduce the risk of a more extensive tear occurring. This may sound scary, but again it is important to remember that the safest method will be used to ensure both you and baby are kept safe and well throughout.
The indications for a forceps birth mirror that of the ventouse but an additional one is that your baby may be in a slightly awkward position that makes a ventouse not possible. It is important to note if you need a forceps birth, that they may cause some superficial marks on your baby’s face that will usually fade within 48 hours and 1 in 10 babies’ may also have some small cuts on their scalp or face, though these will usually heal quickly so please don’t panic!
Caesarean Section (or C-Section):
A caesarean section may be performed as an elective, recommended or as an emergency procedure. The type of birth selected in your birth plan is completely your choice however it is recommended to have a vaginal birth if possible. Caesarean section is an operation whereby a cut is made just below your bikini line approximately 10-20cm long and your baby is born through the incision. It usually takes around 45 minutes. Around 25% of women in the UK give birth by caesarean section so it is nothing to be scared of.
Indications for caesarean section late on in pregnancy include; breech position, low lying placenta, certain infections, concerns over your baby’s heartbeat or that your labour is not progressing. Some women may also choose this method of birth due to a previous caesarean or tocophobia (fear of birth).
How does it work? You will require a cannula in your hand for medicine to be administered. A catheter will be inserted to make sure your bladder is empty to reduce risk of bladder damage during surgery and because for a period of time afterwards you won’t be able to mobilise or feel the urge to pass urine. The procedure is performed in theatre and it is important to note there will be quite a few people present. Sometimes this many people can feel overwhelming but try to remember they all have a role to play in keeping you and your baby safe. Usually you will be awake during the operation and your birth partner will be sat next to you with a screen up so you cannot see the operation. However sometimes a general anaesthetic may be needed and then he/she may have to wait in a separate room. If you are awake and your baby is born well then delayed cord clamping can still happen and you can have skin to skin with your baby in theatre.
Recovery from a caesarean section is longer than that of a vaginal birth and hospital stay is usually 2-4 days. As with any operation there are risks including; bleeding, infection, blood clots and damage to nearby structures such as your bladder and bowel. If you are concerned about any of these things or want more information on the procedure / post procedure then please speak to your midwife.
Remember, birth is birth. Every journey to motherhood is amazing regardless of the path you take to keep you and your baby safe. If you are pregnant and planning the healthiest, most informed journey through pregnancy, birth and the postpartum then ‘Midwife Pip’s exclusive Your Pregnancy Journey Course’ may be for you - head over to midwifepip.com to find out more. If you have any concerns about any of the birthing options make sure to talk them through with your birthing partner and midwife and ask any questions to make sure you fully understand the process. We find that the more research and knowledge you have about the birthing options the less scary they can be.