Intervention during Labour

Intervention is defined as an action taken to intentionally become involved in a difficult situation in order to improve it or prevent it from getting worse. During labour there may be an assumption that intervention is for the convenience of the Obstetrician, which is not true.

The main goal at the end of labour is to have a healthy mother and a healthy baby at the end. The secondary goal of a first labour is to achieve a vaginal delivery so that subsequent vaginal births will be more efficient. Managing a labour is like driving a car. There needs to be constant vigilance in case a change of plans or evasive action is required.

Ideally, we like women to have babies with as little intervention as possible and as little pain relief as needed. A very small number of women are able to achieve a vaginal delivery without assistance or pain relief for their first labour. Women who achieve a vaginal delivery with assistance, are more likely to have an efficient second labour without assistance or pain relief.

With some conditions, it is not safe for mother or baby to continue with the pregnancy. Delivery may be required by Caesarean section, or labour may be induced with the aim of achieving a vaginal delivery. A well-managed induction will not increase the chances of Caesarean section or assisted vaginal delivery any more than spontaneous labour.

There are methods of induction that encourage cervical ripening similar to that which occurs spontaneously in some women. Assisted rupture of membranes mimics spontaneous rupture of membranes and helps with inducing or augmenting labour. Synthetic oxytocin can be used to good effect to start contractions or make contractions more effective.

When contractions are appropriately augmented with Syntocinon, this usually results in good progress in labour and does not cause any problems for baby. A small number of labours will not progress or will result in fetal distress. This may result in Caesarean section. Use of a Syntocinon infusion is sometimes blamed for causing a Caesarean section. A trial of Syntocinon infusion can be used to confirm that baby is not coping with good contractions (fetal distress). A Syntocinon infusion can be used to confirm that labour is not progressing even with the best possible contractions. So almost always a Syntocinon infusion is in use prior to an emergency Caesarean section in labour. It is not the cause but the means to confirm that Caesarean section is necessary.

If there is inadequate progress or fetal distress at the pushing stage, then delivery may be assisted with vacuum or forceps. Vacuum extraction is used to make maternal effort more effective at pushing baby out, by encouraging baby’s head to turn in the pelvis in the same way as for an unassisted vaginal birth. Forceps are used to assist maternal effort in pushing baby out of the vagina. An episiotomy mimics the average perineal tear that allows baby’s head to pass through the vaginal opening.

Distraction techniques, nitrous gas, narcotic injections and epidural help women cope with their contractions. An epidural can be the safest way to manage maternal hypertension during labour. An epidural allows women to rest during the first stage of labour so they will have the energy they need for the maternal effort of pushing. Although intravenous fluids and a bladder catheter are required with an epidural, good hydration and an empty bladder may reduce excess postpartum bleeding. A well-managed epidural will not increase the chance of Caesarean section or assisted vaginal birth.