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FAQ: Forceps delivery, episiotomy and positions

 
Dr Martin Puzey, gynaecologist and obstetrician, answers questions on instrumental vaginal deliveries, episiotomies and birth positions.

Q: Under what circumstances does the mother have to have an enema?

A: In my opinion, there is no need to force the issue. Let the mother decide.

Q: What are the advantages of an episiotomy versus natural tearing and which will heal quicker?

A: If the birth is uncomplicated then I would suggest allowing the perineum to tear naturally. Only when there is a problem or need to have a forceps assisted delivery, would I institute an episiotomy.

Q: When is a forceps delivery used over a vacuum extraction?

A: Forceps are used when the mother needs to be assisted because there are insufficient forces to allow the baby to be delivered. A vacuum extraction is useful to assist the delivery such as when the head needs to be turned and the pushing reflex sets into motion.

Q: Regarding the various body positions for labour in hospital on your back seems to be the worst and most unnatural alternative. It is also the most painful because of the pressure of your uterus on your back and could be bad for the baby as it may reduce the amount of oxygen it receives. What alternatives are most hospitals equipped to provide?

A: I believe in empowering the woman to make her own decisions. So in this case, what ever the mother feels comfortable with. Use gravity to the best possible advantage.
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