Help in labour
- Being prepared
- Gas and oxygen
- Injections
- Complications
- Caesarean section
- Vacuum extraction
- Forceps delivery
- Apgar score
- Mix-ups impossible
- Premature babies
- Overdue babies
In debating whether to give you pain relief, the obstetrician always has to consider two persons: you and your baby. Giving birth is a great strain on both, both physically and mentally.
Being prepared
The birth pangs are not dangerous; rather, they help the
birth along. Knowing what to do and what to expect is the best form of pain
relief. The more you know about the delivery, the easier it is to be
sensible. People always fear the unknown and new experiences, and they feel
pain more when they are afraid. The main thing is to learn to relax and to
breathe properly at each stage of labour. This is the best possible way to
help your baby, because it ensures that it gets as much oxygen as possible.
Unlike many painkillers, it does not sedate the baby in any way.
If necessary almost every mother can, however, receive effective pain relief
during delivery. About 15-20 % of mothers feel the pain is so bad that
special measures have to be taken. The trouble is that the painkillers
quickly spread through the placenta to the baby's blood system and may
hinder the newborn baby's breathing if the birth comes within 2-3 hours of
the last dose of medicine.
Painkillers are not, therefore, recommended towards the end of labour.
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Gas and oxygen
A mixture of nitrous oxide and oxygen can safely be
administered throughout the first stage of labour because they are very
quickly expelled from the circulation. Inhalation is timed to coincide with
the contractions, but the effect is so slow that you must begin inhaling
before the contraction begins. The same applies to other gases, too.
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Injections
Local anaesthetics also pass through the placenta and may
slow down the baby's heartbeat. They may also temporarily impair the
circulation of the uterus and placenta and cause an oxygen deficiency in the
baby. Such anaesthetics can, therefore, only be given if the baby is in
extremely good condition, which can be determined from its ECG.
The most effective and safest type of nerve block is an epidural, which
relieves the pain either entirely or al- most entirely during the first
stage of labour. The anaesthetic is injected into the lower part of the back
and can be added to throughout the delivery. It must, however, be
administered by an anaesthetist and cannot therefore be given in every
hospital.
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Complications
On average, 15 % of deliveries call for some special
measure: caesarean section, vacuum extraction, breech or forceps delivery.
Breech delivery. About 3 % of babies are born bottom first, a few even feet
first. This is usually spotted at the clinic and the hospital may try to
turn the baby into the right position. If it fails to turn, however, the
delivery mode will be decided beforehand according to the size of the baby
and the mother's pelvis.
Caesarean section tends to be recommended more often than normal for a
breech delivery, especially for a first or premature baby.
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Caesarean section
About one mother in eight has a caesarean section in
Finland. The most common reasons are if the baby is becoming short of oxygen
during labour, if the placenta is low-lying or there is a risk of
haemorrhage, or if the pelvis is too narrow for a normal delivery.
The baby is delivered by an operation to enter the uterus through the lower
abdomen. The placenta and foetal membranes are removed at the same time. It
usually takes longer for the mother to recover from a caesarean than from a
normal delivery and she will not usually be discharged from hospital until
8-10 days after the birth.
Caesarean sections can be done under a general or epidural anaesthetic. In
the latter case the mother is awake and can experience the birth. The
operation usually takes 30-40 minutes.
A mother who has had a caesarean section may still have a normal delivery
for another baby. Normal delivery is not, however, considered possible after
repeated caesareans.
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Vacuum extraction
If the baby is suffering from lack of oxygen or the uterus
is not contracting sufficiently strongly and the pushing stage is delayed,
the baby may be helped into the world with a suction cup. The doctor applies
a plastic or metal cup to the baby's head, creating a vacuum that makes it
stick to the baby's skin. He can then get a firm grip on the baby.
The mother must still push; the suction cup merely helps. 2-3 % of all
deliveries are by vacuum extraction. The method does not harm either mother
or baby. The bump forming on the baby's head vanishes in a few days.
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Forceps delivery
At one time forceps deliveries were just as common as
vacuum extractions are today. Forceps were used instead of caesarean
sections in the case of difficult deliveries. This is why they are often
feared. Forceps deliveries have once again become more common during the
past few years. They are in particular resorted to if the baby's heartbeat
gets slower in the final stage of labour and the baby is becoming short of
oxygen. It is then possible to help the baby out much faster with forceps
than with a suction cup, thereby avoiding the danger of oxygen deficiency.
Forceps are in this case a quick, good, safe method.
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Apgar score
Immediately the baby is born the mucus and amniotic fluid
are removed from its nose and mouth. It is then given what is known as an
Apgar score to indicate its heart rate, colour, breathing, general body tone
and reactions to stimuli.
The maximum score is 10. In practice one point is almost always lost for
colour. The score should not be given too much importance.
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Mix-ups impossible
Even before the umbilical cord is cut, babies are marked to
ensure they cannot get confused. They are usually given a plastic wristband
and a chain round their neck with a number plate while still in the delivery
room. Mother and baby are given the same number.
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Premature babies
A premature baby is one born more than four weeks before it is due. In this case not all its organs are fully developed. A premature baby easily loses heat and needs to be fed often to give it sufficient energy .To begin with it is usually kept in an incubator, where it is easier to keep an eye on and where its heat loss can be prevented. The baby can go home when its weight has risen to 2,200 grams. Its parents should visit it and care for it as much as possible while it's in hospital.
Overdue babies
A baby is said to be overdue when the pregnancy has lasted
for 42 weeks. A special watch must then be kept on both mother and baby.
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