Childbirth: Medical interventions

There are a number of routine medical interventions performed during labour, such as monitoring your vital signs, measuring the frequency and duration of contractions, assessing your overall condition and level of pain, measuring the thinning and opening of your cervix, and monitoring your baby’s heart rate.

Several factors can determine whether these interventions are necessary, so it’s important to talk to your doctor or midwife about which procedures they recommend. Once you go into labour, don’t hesitate to ask questions or share your fears with the nursing staff.

Taking the mother’s vital signs

Vital signs include blood pressure, heart rate, respiratory rate, and body temperature. A nurse will check your vital signs regularly while you are in labour.

Your vital signs may be monitored at much closer intervals than usual if, for example, your temperature or blood pressure is higher than normal, if you are undergoing any of the procedures described below, or if you or your baby develop complications.

Evaluation of progress during labour

Health care professionals evaluate labour in several ways:

• They look at whether the mucus plug (blood-tinged mucus discharge) has passed, which can occur before or during labour. They also check whether your membranes have ruptured (i.e., whether your water has broken).
• They measure the frequency, duration, and intensity of your contractions. This can be done manually or with a monitor.
• They also perform an internal exam by inserting two gloved fingers into your vagina to check the dilation of your cervix. Your cervix needs to be thin and dilated to 10 cm before you can push. To reduce the risk of infection, this procedure is performed as infrequently as possible once your water has broken.

Fetal monitoring

The condition of your baby can be assessed in two ways:

• By intermittent auscultation, which involves listening to the heart for a few minutes before and after a contraction
• By continuous electronic fetal monitoring

If you and your baby are healthy, the medical team will prioritize intermittent auscultation. However, if the situation changes during labour or if there are any irregularities in your baby’s heartbeat, they will switch to continuous monitoring.

Continuous fetal monitoring may also be used if your health care team is concerned about how your baby is responding during labour or if medications are used to stimulate labour or provide pain relief.

In addition, electronic fetal monitoring may be used temporarily to ensure that your baby is doing well after certain procedures, such as an epidural or an artificial rupture of membranes.

Do you have a birth plan? A birth plan lets you indicate your preferences for labour and delivery.
 

Both types of fetal monitoring involve placing two sensors on your belly, each held in place with a belt. One measures your baby’s heart rate, and the other records contractions and measures their frequency and duration. The data is charted so that the medical staff can assess your baby’s response before, during, and after contractions.

Many hospitals now have wireless sensors, which enable you to move, walk, and even take a bath during fetal monitoring. If the sound of the monitor bothers you, let the nursing staff know.

Continuous fetal monitoring is associated with a higher rate of caesarean delivery. This may be because increased monitoring is required if a baby or mother shows signs of being at risk during labour. The likelihood of delivery by caesarean section is therefore higher in these situations. However, data collected through continuous fetal monitoring is not infallible. Monitors may report a problem when there is none, thereby increasing the number of unnecessary caesarean sections. This is why continuous fetal monitoring is only recommended for high-risk births or when intermittent auscultation reveals an abnormal heart rate.

IV fluids

Intravenous (IV) fluids are solutions that can be injected during labour to give you moreenergy or to administer medications. Solutions may contain salt (to maintain the balance of blood and fluids) or dextrose (sugar to provide energy).

Administering IV fluids to all mothers in labour used to be a common practice in some hospitals. Today, this option is used only for medical reasons, such as administering epidural anesthesia, stimulating or inducing labour, or treating an infection, low blood pressure, or dehydration.

If you require IV antibiotics as a preventative measure because you carry group B streptococcus (GBS), you can ask for a heparin or saline lock, which allows you to be connected to the IV catheter intermittently.

Oxygen

Oxygen is a gas that can be administered during labour through a mask or nasal prongs. Oxygen will be administered if a medical issue surfaces, or if your health care provider wants to make sure you have enough oxygen in your bloodstream, which is important for your baby’s health.

Stimulating labour

Stimulating labour involves the use of mechanical or chemical methods to strengthen contractions or speed up labour that is progressing slowly. Methods include artificial rupture of the membranes and the administration of oxytocin (Pitocin or Syntocinon).

Rupturing the membranes

Artificial rupture of the membranes is also known as amniotomy or breaking the water. For this procedure, your baby must be engaged in the pelvis and your cervix must be at least partially dilated.

Your doctor or midwife will insert a sterile hook-like device into your vagina and gently tear the membrane through the opening in your cervix. You may feel mild discomfort similar to that experienced during a cervical exam. Once your membranes have been ruptured, amniotic fluid will leak from your vagina. If the procedure isn’t successful, your health care provider will choose another option to induce labour.

After the rupture, fetal monitoring will be needed to make sure that your baby has tolerated the procedure, as it can affect their heart rate.

Oxytocin (Pitocin)

Pitocin is a synthetic form of oxytocin, a hormone that is naturally produced by your body during labour. This hormone helps bring on the strong, regular contractions needed to dilate your cervix. Oxytocin is administered by IV and can be used to induce labour or help it progress.

Oxytocin is a powerful drug that works almost immediately. The frequency and intensity of contractions usually increase gradually, as the procedure starts with just a few drops being administered per minute. The dosage is slowly increased every 20 to 30 minutes until the contractions become effective.

The dose can be adjusted according to how your uterus and your baby respond. Continuous electronic fetal monitoring will be performed to monitor your baby’s heart rate and the strength and frequency of your contractions. If contractions become very strong, you can ask for pharmacological pain relief such as narcotics or an epidural.

If cervical dilation does not progress, even after several hours, oxytocin will be discontinued and a caesarean section will likely be necessary. A caesarean section will also be considered if the baby shows signs of fatigue, which is indicated by the fetal heart rate.

Episiotomy

An episiotomy is a 2.5 to 5 cm incision made at the entrance to the vagina to make the opening of the vagina larger and facilitate the baby’s passage during delivery. During this procedure, your doctor will numb the area with a local anesthetic before making the incision. It will be stitched closed following delivery.

According to the Society of Obstetricians and Gynaecologists of Canada, an episiotomy should only be performed when necessary. This may be the case if the baby is in distress, if there is a concerning tear near the clitoris, or if forceps are urgently needed.

Disadvantages:

• Pain and swelling at the incision site
• Risk of infection
• Risk of increased blood loss
• Increased risk of deep tears in the perineum
• Minor risk of long-term pain during vaginal sex

Before you go into labour, talk to your doctor about when an episiotomy might be necessary.

Things to keep in mind

• Some interventions are used to ensure that the mother and baby are stable.
• Others can help speed up labour when it slows down or stops.
• There are many reasons why an intervention may be used during labour. It’s best to discuss them with your doctor or midwife.

Scientific review: Dr. Chantal Ouellet, physician Research and copywriting:The Naître et grandir team Updated: October 2021

Photo: GettyImages/Fly View Productions