Posterior position The vertex position (head down) is the normal position for a vaginal birth, usually in the anterior position where the baby’s back is to the front of your body. If the baby is in the posterior position (with the baby’s back towards your back), it can make labour longer and more painful than in the anterior position. Forward leaning positions prior to labour and during labour may help to turn the baby to an anterior position. You may still have a normal birth in this position. Your baby may be born in the posterior position, or may turn itself to the anterior position during the labour. It is sometimes necessary to have a forceps or ventouse assisted birth. Forceps assisted birth Forceps are used to help the baby out of the vagina. They may be used when you are too exhausted to push, when your baby is in an awkward position or when there are concerns for your baby’s wellbeing. Sometimes the forceps may leave marks on your baby’s cheeks but these soon fade. You may need an episiotomy to allow more room for the birth. An episiotomy is a cut in the perineum (the tissue between the vagina and anus). You will require stitches afterwards. The stitches will dissolve by themselves and you will be offered ice packs to reduce swelling and pain. Ventouse assisted birth This is more commonly used than forceps. The vacuum cup is made of plastic. The cup is inserted into the vagina and creates a vacuum against the baby’s head. This allows your obstetrician to gently pull as you continue to push with contractions. It may cause a raised bruise on the baby’s head, but this soon fades, usually within a day. You may need an episiotomy (see above). Procedure for a forceps or ventouse assisted birth You will be positioned on your back with your legs supported by stirrups. Local anaesthetic will be administered if an epidural is not being used. The forceps are gently inserted to cradle the baby’s head, or if a ventouse is used the suction cap is gently placed on the top of your baby’s head. Your obstetrician will pull with the instrument as you push during a contraction. Post partum haemorrhage (PPH) Following the birth of your baby, you may have a normal blood loss of up to 500mls. More than 500 ml blood loss is considered to be a post partum haemorrhage. This may be caused by the uterus being too relaxed. Your obstetrician or midwife will massage the uterus to encourage it to contract. An intravenous line will be inserted and an infusion of Syntocinon (a drug used to help contract the uterus) will be given. A urinary catheter may be inserted to drain urine and allow the uterus to contract more fully. You will be observed closely until the bleeding returns to normal. If the bleeding is due to a tear, your obstetrician will suture the tear to manage the bleeding. Retained placenta Occasionally, it may not be possible to deliver the placenta vaginally. The cord may snap, or the placenta may be adhered to the uterus. In these instances, you will be taken to theatre and the placenta removed by your obstetrician either by general anaesthetic or under epidural/spinal anaesthesia. Greenslopes Maternity Childbirth and Parent Education 23
Childbirth and Parent Ed Book 1015 PI448
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