Normal vaginal delivery
It is the natural way of birth through the vaginal canal.
It is the default method of delivery of the baby for all women unless there is a contraindication. At Athens Reproduction we encourage women to experience a normal vaginal delivery because it has many advantages, like less pain after the delivery, quicker recovery and less hospital stay. Also most mothers have a sense of accomplishment after a normal delivery.
All women get counseling about labor and its stages and are educated so that they know what to expect when the time comes.
Cesarean section is the delivery method of the baby through a surgical incision in the mother’s abdomen and uterus. A C-section is often performed in circumstances that would put the fetus or the mother at risk.
When there is a known contraindication for vaginal delivery then the C- section can be scheduled for approx. 39 weeks.
Nowadays it is performed under epidural anesthesia so that the mother can be awake and experience the birth of her baby. Also C-section with epidural anesthesia has better recovery, does not cross the placenta and has less post-operative pain.
Cesarean section has been optimized over the years and complications from this type of surgery have been significantly decreased.
An incision is performed (approx. 12cm long) bellow the “bikini” line and a low transverse incision is done on the uterus in order for the baby to be delivered. All the layers are meticulously reapproximated and the patient is transferred to the recovery room. The duration of the procedure is about 30-40 min.
C- section is a safe alternative method of delivery when the vaginal approach is not feasible or when there is a risk for the baby or the mother.
Induction of Labor
Induction of labor is an artificial start of the labor process through medical or other intervention in order achieve a normal vaginal birth.
Induction of labor is performed when prolongation of the pregnancy is considered risky for the mother or the fetus. It is not always successful (i.e. lead to vaginal birth) as this depends on many factors, like the softness or opening of the cervix, the parity of the mother and other. Health care providers have developed a scoring system called “Bishop” score to rate the readiness of the cervix for delivery (0-13). A bishop score of less than 6 indicates that the cervix may not be ready for labor.
Sometimes before the provocation of contractions of the uterus, cervical ripening might be necessary. This can be done with medications (Prostaglandins) or mechanically with balloon catheters or laminaria (water absorbing material that swells and expands its volume).
VBAC (Vaginal Birth after Cesarean section)
In the days where C- sections were performed with a vertical uterine incision the risk for uterine rupture at a subsequent VBAC was high hence the moto used: “once a C-section, always a C-section”.
Over the past 3 decades the uterine incision is done in a low transverse fashion which reduced significantly the risk for uterine rupture on a subsequent labor. This has given the opportunity for many women to undergo a trial of VBAC. A case by case assessment is necessary.
The estimated risk for uterine rupture according to ACOG ranges between 0.2 – 1.5 %. In order to be a candidate for VBAC the following criteria need to be met:
– No more than 2 previous low transverse Cesarean sections
– No additional uterine scars (e.g. Myomectomy)
– 24/7 presence of Anesthesiologist
– The personnel of the Hospital should be readily available and the operating room must be on “stand by” mode throughout the labor.
Good candidates for VBAC are:
- The original reason for C-section is not repeated in this pregnancy.
- No major medical problems of the mother
- Normal size baby (head down)
- Acceptable thickness of previous uterine scar.
Nowadays epidural analgesia or anesthesia is the preferred method of pain relief during labor and anesthesia in Cesarean sections.
It is a procedure where medication is instilled in the epidural space in order to have regional anesthesia. This results in decreased sensation of pain in the lower half of your body.
You will be asked to arch your back in order to facilitate the anesthesiologist to access the right space. Thereafter antiseptic solution is applied to the skin and a small area in your back is injected with local anesthetic in order to numb it. A fine needle is inserted then to locate the epidural space. Once that is achieved the anesthetic medication is administered and a small catheter is left in place in order to administer extra doses of epidural anesthetic again if needed at later stages.
Complications from the epidural anesthesia are rare. These can include local irritation and very rarely severe headaches in case spinal anesthesia was also performed. These complications recover over time.
Sometimes the obstetrician or midwife might need to make a cut in the area between the vagina and the anus (perineum) during the last stages of labor. This is called episiotomy and makes the opening of the vagina wider in order to facilitate the delivery and avoid uncontrolled rupture of the area.
Episiotomy should be performed only when it is absolutely necessary.
Local or epidural anesthesia should be given before an episiotomy is performed so that the patient will not feel any pain, then after the delivery the episiotomy is repaired within the first hour after birth with sutures.
The pain during recovery from the episiotomy usually dissipates within the following 2-4 weeks. Only 1% of the women continue to experience pain that interferes with their day to day activities and quality of life.
Instead of immediate clamping and cutting of the umbilical cord, it seems that delayed cord clamping has significant benefits in term and especially in preterm babies. Improving transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion and lower incidence of necrotizing enterocolitis and interventricular hemorrhage.
There are though situations that delayed cord clamping cannot be performed like when immediate infant resuscitation is needed or maternal hemorrhage occurs.