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I'm Pregnant
Procedures During LabourLabour and Birth

Introduction

During labour and birth, your health care provider may suggest one or more medical procedures to help you or your baby. They will talk with you about the benefits and risks.

On this page, you’ll get to know these procedures ahead of time to help you be prepared if you need any of them.

Fetal monitoring

Overview

A fetal monitor is a machine that keeps track of your contractions and your baby’s heart rate during labour. Labour can be stressful for your baby—their heart rate may get faster or slower. It’s serious when a baby’s heart rate is too fast or too slow. By checking how your contractions affect your baby’s heart rate, your health care provider can monitor how your baby is doing. There are two ways to monitor your baby’s heart rate during labour—intermittent or continuous monitoring.

Intermittent monitoring

This method means that your baby’s heart rate is being checked when needed. Health care providers will likely listen to your baby’s heart rate every 15–30 minutes during the first stage of your labour and every 5 minutes while you’re pushing.

If your pregnancy is low risk and your labour is going well, this method works as well as listening to your baby’s heart rate continuously.

Continuous monitoring

This method means that your baby’s heart rate is always being checked. The monitor measures both your contractions and your baby’s heart rate. Continuous monitoring is used in active labour when intermittent checking is not enough, such as with synthetic oxytocin infusions or after a previous caesarean birth. There are two types of continuous monitoring, external and internal. External monitoring is the most common.

External monitoring

Two sensors are placed on your abdomen and held lightly in place by elastic belts. One sensor measures your baby’s heart rate through ultrasound. The other sensor measures and times each contraction by picking up the pressure of your uterus as it tightens.

External monitoring doesn’t measure how strong the contractions are, just how often they’re happening. Although fetal monitoring doesn’t cause discomfort, sometimes you may not be able to move around very much while it’s being done. Check with your health care provider to see if you can move around or if you can stand next to the bed or sit on a birth ball.

Pregnant person lying on hospital bed with continuous external monitoring in place. Two sensors are on the abdomen and held lightly in place by an elastic belt.

Internal monitoring

When your baby needs closer monitoring, a thin wire (electrode) is guided through your vagina and cervix and placed on your baby’s scalp (the skin covering the head, not the face). It will feel the same as having a vaginal exam done. The electrode is plugged into a machine.

The electrode doesn’t hurt your baby, although it will leave a small scratch on their scalp for a few weeks. Monitoring by this method is more accurate, as it picks up the electrical impulse of your baby’s heart. Check with your health care provider to see if you can stand beside the bed or take short breaks to use the bathroom to empty your bladder while the monitor is in place.

Wire runs from a fetus’ (baby’s) scalp in the uterus, through the cervix and vagina to a sensor held in place on a pregnant person’s upper leg.

Inducing labour

While many pregnant individuals go into labour on their own, sometimes labour needs to be stimulated (induced). To get your labour started your health care provider may sweep (strip) the membranes during a vaginal exam. This is done by inserting a gloved finger into your cervix and separating the membranes from the lower part of your uterus at the edge of the cervix. There may be some discomfort during the procedure or light spotting after.

Normally, your cervix begins to ‘ripen’ near the end of pregnancy. If it doesn’t, your health care provider may help it get ready for labour by inserting either:

  • prostaglandin gel into your vagina close to your cervix
  • a slow-release packet of prostaglandin gel close to your cervix
  • a catheter with a balloon on one end into your cervix

If an induction has been suggested, your health care provider will talk with you about the benefits and risks.

There are 3 ways to induce labour:

  • Breaking the amniotic sac (manually rupturing the membranes): this procedure is done during a vaginal examination. It can be done before or during labour. It releases some of the amniotic fluid that surrounds your baby. It may also help to stimulate contractions by letting your baby’s head press on your cervix. This pressure causes prostaglandins to be released, which ripen or soften the cervix and stimulate contractions.
  • Using prostaglandin: this can be a gel or in the form of a tampon that can be inserted into the vagina to stimulate contractions.
  • Giving synthetic oxytocin: this is given through an IV. The IV rate is increased until you’re having regular contractions that start your labour. Everyone responds differently to this medicine and in rare cases, it may not always start labour.

Reasons for inducing labour

  • You’re more than one week past your expected due date.
  • The placenta is not supplying the proper amount of nutrients and oxygen to your baby.
  • Your baby is not moving as much as usual.
  • Your baby is not growing as expected or has a health problem.
  • You have high blood pressure or diabetes.
  • You have a normal twin pregnancy that is 37–38 weeks or more.
  • Your amniotic sac has broken, you’re at your due date and your contractions haven’t begun after 12–24 hours.
  • Your amniotic sac has broken and your Group B Strep swab is positive. Antibiotics will also be started.

Things to know

  • It may increase the need for an epidural, vacuum or forceps assisted birth, or a caesarean birth.
  • It may stimulate the uterus too much—contractions that are too close together may stress your baby.
  • It may not start labour.
  • It may increase the risk of infection and other interventions.

Augmentation

If active labour has started, but the contractions slow or stop, your health care provider may suggest stimulating contractions (augmentation). This can help the contractions come more often and become stronger. Augmentation can be done by manually rupturing the membranes and by giving synthetic oxytocin through an IV.

Episiotomy

To make the vaginal opening bigger, a cut is sometimes made through the perineum (episiotomy). An episiotomy is not a routine procedure. It may be recommended by your health care provider if they feel that more room is needed for your baby or your baby needs to be born quickly.

Things you can do that may help prevent an episiotomy:

  • Do perineal massage during your third trimester.
  • Use warm compresses on your perineum.
  • When pushing, use positions such as sitting upright, lying on your side or kneeling on all fours.
  • Control your pushing, when and how hard you push, during your baby’s birth. Your health care providers will guide you with the pushing.

If you’ve had an episiotomy or a tear, your health care provider will stitch it up. A local anesthetic (freezing) is injected in the area, unless you’ve had an epidural. The anesthetic will decrease the pain during the stitching. These stitches do not need to be taken out—they’ll dissolve with time as your perineum heals.

Reasons for an episiotomy

  • To speed up the birth if your baby is having trouble.
  • To make more room if it your health care provider thinks that a tear will be bigger if no episiotomy is done.

Things to know

  • It may increase the risk of infection.
  • It can be uncomfortable and painful.
  • It could lead to a tear.
  • It usually heals in about 4 to 6 weeks.
  • It may cause painful sexual intercourse the first couple of times after it heals.

Forceps

Forceps are metal, spoon-like instruments. Between your contractions, your health care provider may use forceps to gently cradle the sides of your baby’s head. When you push, they will gently pull to help guide your baby out through the birth canal.

Reasons for the use of forceps

  • To speed up the birth if your baby is having trouble.
  • To help with the birth if you’re not able to push or if you’re too tired to push.
  • To help adjust the position of your baby’s head if it’s not in the right position.
  • To protect the head of a premature baby during birth.
  • To avoid a caesarean birth when a vaginal birth can still be done safely.
  • To help deliver your baby’s head during a vaginal breech birth (when your baby is buttocks or feet first in your uterus).

Things to know

  • Can cause tears to the vagina, rectum or perineum.
  • There may be some bruising or swelling on your baby’s head or face.
  • In very rare cases, it can cause bleeding inside the baby’s skull.

Vacuum assisted birth

A vacuum used for an assisted birth is a small, soft, plastic cup connected to a suction pump. The cup is inserted through your vagina and is placed on your baby’s head. Your health care provider uses a controlled amount of suction to help guide your baby out through the birth canal while you push.

Reasons for a vacuum assisted birth

  • To speed up the birth if your baby is having trouble.
  • To help with the birth if you’re not able to push or if you’re too tired to push.
  • To avoid a caesarean birth when a vaginal birth still can be done safely.

Things to know

  • Can cause tears to the vagina, rectum or perineum.
  • There may be some bruising or swelling on your baby’s head or face.
  • In very rare cases, it can cause bleeding inside the baby’s skull.

Caesarean birth

What is a caesarean birth?

A caesarean birth (c-section) is when your baby is born with the help of a cut (incision) made into your abdomen and uterus. Some caesarean births are planned and others are unplanned and done in an emergency. If a caesarean birth is suggested, your health care provider will talk with you about the benefits and risks and how you can prepare. If you have a caesarean, you‘ll be in an operating room for the birth of your baby.

Planned caesarean

Sometimes a vaginal birth is not possible or would be a risk to you or your baby. Some reasons a caesarean birth may be needed are:

  • If you’ve already had a caesarean birth and your health care provider does not recommend a vaginal birth after caesarean (VBAC). Learn more about vaginal birth after caesarean (VBAC).
  • When your baby is in any position that is not safe for a vaginal birth, such as a breech or a transverse lie
  • If you have an active herpes virus infection, to prevent the virus from spreading to your baby as your baby moves down the birth canal
  • If you’re expecting more than one baby and there are problems with the position of the your babies
  • If your placenta lies partly or entirely over part of or over your cervix (placenta previa)
Illustration of breech presentation and transverse lie. Breech presentation: Fetus (baby) is positioned in uterus with head pointing upwards (towards pregnant person’s chest) and legs pointing down, towards cervix. Transverse lie: Fetus (baby) is positioned horizontally in cross-section of uterus, with back towards the cervix.
Tap or click image to expand

Unplanned caesareans

An unplanned caesarean birth may be needed when:

  • Your baby is too large to safely fit through your pelvis.
  • The position of your baby’s head causes the labour to not progress as expected.
  • Changes in your baby’s heart rate show they are not tolerating the stress of labour.
  • Your blood pressure is too high to tolerate labour.
  • You have an infection in your uterus.
  • Your placenta begins to separate from the wall of the uterus before birth (placental abruption).
  • The amniotic sac breaks suddenly. The umbilical cord can be carried along and become caught between your baby and your pelvis (cord prolapse). This can affect the amount of oxygen your baby gets.
  • Your baby has a certain birth defect or other health issue, and may not be able to tolerate labour and birth.

What will happen in the operating room

What happens during a caesarean birth is the same whether it’s planned or unplanned. You’ll be given either a regional anesthetic (spinal or epidural) or a general anesthetic.

With a regional anesthetic, you’ll only feel light touches below your breast line. You’ll be awake and alert during the surgery when you have a regional anesthetic.

With a general anesthetic, you’ll stay asleep during the birth of your baby. The general anesthetic is usually used when your baby has to be delivered very quickly because of a life-threatening problem with you or your baby. You may be able to talk with your health care provider about the kind of anesthetic you prefer. There may not be time to talk about all of these details in an emergency.

Here are some things to expect during a caesarean birth:

  • You’ll lie on an operating room table that tilts slightly to the left. There are supports on the side to keep you from slipping.
  • Your blood pressure and heart rate will be monitored.
  • Your abdomen and thighs will be washed and covered with a sterilized cloth or drape, leaving only a small area on your abdomen showing.
  • Your arm(s) with the IV will rest on an arm board, away from your body.
  • Your support person may or may not be able to stay in the operating room.
  • There will be many health care providers in the room to care for you and your baby.
  • Once the anesthetic is working, the surgery will begin.
  • If you have a regional anesthetic you won’t feel any pain but you may feel pressure.
  • Your baby will be delivered through a small incision on your abdomen.
  • A screen will be put up so you do not see the surgery. It may be lowered so you can see the birth.
  • A catheter will be inserted into your bladder.

Your support person

Your support person may be able to come with you into the operating room if you have a regional anesthetic, they’ll also be able to talk with you during the caesarean birth. They can help you to relax and get comfortable. This may not be possible if you’re having a general anesthetic, or if there’s an emergency.

After a caesarean birth

  • Ask to have your baby placed skin-to-skin with you or your support person right after birth so you can bond with your baby.
  • You’ll likely start on a liquid diet and then move to solid food as soon as you’re able.
  • The IV will come out once you’re eating well.
  • You’ll have some pain in your abdomen. Talk with your health care provider about pain medicine to help you feel more comfortable.
  • You may still have a catheter in place for a few hours.
  • If you have staples, or stitches that do not dissolve on their own, your health care provider will make arrangements to have them taken out.

For breastfeeding, your health care provider will help you cuddle skin-to-skin and find a comfortable breastfeeding position.

You’re not only recovering from the birth of your baby, but also from surgery. Taking care of yourself will help you recover faster. Eat healthy foods throughout the day, drink plenty of fluids and get enough rest to help you recover.

You may have many feelings depending on your expectations and the reason for your caesarean birth—happy, relieved, sad or disappointed. If the caesarean birth is an emergency, you may have had little time to get ready for it. If you have any questions or concerns, talk to your health care provider, partner or someone you trust.

Many pregnant individuals can have a vaginal birth after a caesarean birth in later pregnancies. Talk with your health care provider about this before or during your next pregnancy.

“I had a caesarean birth. Birth is ‘natural’ no matter where it happens or how—it’s about what is best for you, your baby and your family.”

~Jenika, mom of a toddler