Your birth options

Giving birth to your baby is one of the most creative, challenging and life-altering events you'll ever go through. Preparing for your baby and gaining knowledge is not only essential, it is the most responsible thing you can do.

The key to a fulfilling birth is to keep an open mind and ensure that you have full information about the types of delivery available and how labour is managed.

HOSPITAL BIRTH

Although labour and delivery are normal physiological events, they are not without potential hazards. Approximately 94% of births take place in hospital because medical expertise and emergency equipment are close at hand.

One of the advantages to delivering in a hospital is that there are facilities available for any emergency. All high-risk and most first births are recommended to take place here. Hospitals today are making great efforts to change the environment from clinical to more friendly.

Advantages:

• Should you have complications, immediate medical back-up is available.
• An epidural is readily available.
• After the birth you have access to help and advice on breastfeeding and baby care as well as support and rest for yourself while you recover.
• In most hospitals you can still opt for an active birth.
• Vaginal and caesarean births both take place in a hospital setting.

Disadvantages:

• Higher risk of intervention, whether it be speeding up labour, assisted delivery or caesarean.
• Hospitals cater for the masses not for the individual, although they’ve come a long way in trying to overcome this.
• Lack of privacy, noise and odd routines are all part of hospital life. You will be monitored throughout the birth process. Should complications arise, trained medical staff are on hand to ensure that you and your baby are healthy. The disadvantage is that excessive monitoring of the birth process can lead to intervention, which may or may not be necessary.

ASSISTED DELIVERIES

Assisted deliveries take place when complications arise during the second (pushing) stage of labour. There are two types of delivery processes:

The Ventouse or vacuum:

A suction cap is attached to the baby’s head, which enables medical staff to gently ease your baby out.

Forceps:

This instrument is positioned on either side of the baby’s head to ease baby out.

You may need assistance because:

• Your baby is in distress and needs to be delivered quickly, or your baby is in an awkward position.
• You may be tired and unable to assist in pushing out your baby.

Both may leave the baby’s head a little bruised and misshapen. You, the mother, will experience bruising and swelling which usually dissipates within 10 days.

HOME BIRTH

This is a normal delivery conducted at home and the mother will be assisted by a midwife, with the backup of a doctor should an emergency arise.

This option is safe provided that your pregnancy remains normal and your midwife uses up-to-date portable equipment she brings to your home. She also needs to be able to reach your home in time.

Some opt for home birth because they may wish to have their other children at the birth. Some may have had a bad hospital experience with previous babies, and there are those who want to be more in control of their birthing situation.

You will have to make sure that you are well prepared when you go into labour. Bear in mind that over 90% of healthy pregnant women receiving good antenatal care will give birth spontaneously. However if things don’t run smoothly, you might need to be transferred to hospital.

The key advantage is that the mother is in familiar, comfortable surroundings while going through the birthing process. She also doesn’t have to go to the people who will help her; rather, they come to her.

The disadvantage in this situation is that, should complications arise, there will have to be a quick transfer to a hospital and this may prove stressful and frightening for the mother. The choice of medicated pain relief is available but you cannot have an epidural at home, should you decide you want one.

WATER BIRTH (HOME OR A HOSPITAL)

This is a normal vaginal delivery conducted under water. Water is known for its pain-relieving properties and many women use water before trying medicated forms of pain relief. Many women have commented on the soothing feelings and sounds of water.

Water holds and supports you; it envelops and protects you – which is what you need when you are in labour. Should you decide on an epidural or you develop a complication, you will be asked to leave the bath immediately.

VAGINAL BIRTH AFTER A CAESAREAN OR ‘VBAC’

VBAC means exactly that. A mother succeeds in her attempts to have her baby born vaginally after having her first child born by caesarean section. In the past doctors were cautious about encouraging VBACs because they knew little about them, but are now responding to the requests made by many women wanting to explore the possibility of a vaginal birth.

Many of the former contraindications for VBAC are being revised. Medical attitudes, training and experience and practice style of doctors as well as the acceptance of new research and ideas will greatly influence your caregiver’s willingness to allow a VBAC.

If you are investigating the possibility of a VBAC, it is helpful to know why you had a caesarean the first time. If the reason for the first caesarean still exists it is doubtful that you will be a candidate for a VBAC. These reasons include: diabetes, chronic high blood pressure, serious pelvic abnormalities or active genital herpes around the time of your due date.

CAESAREAN BIRTH

Obstetrics today is a lot safer due to better knowledge, safer practices and the advent of antibiotics and basic hygiene. Caesarean section is a safer procedure now than it ever has been. Still it carries with it a higher risk of maternal death, and a higher risk of infection than vaginal birth.

In both cases the risks are small, but women need to know that it involves major abdominal surgery. Birth by caesarean means a baby is delivered from the mother’s uterus through an incision of about 15cm into the abdomen.

It may be done electively for personal or medical reasons or as emergency when the safety of the mother or baby is questioned before or during labour. [If you're prepared, it can also be a beautiful experience.]

Elective

Elective caesarean is a planned caesarean. You will know in advance the day and time your baby will be born.

More and more women are choosing to have elective caesareans. Reasons range from previous traumatic labours to anxieties about vaginal deliveries. Be sure to become fully informed on all aspects of birth and to get facts – not myths or opinions that are not scientifically based.

You may opt for an elective caesarean for personal, non-medical reasons or for medical reasons such as:

• You have pre-eclampsia or diabetes
• You have had previous birth complications of any kind.
• Your placenta may be lying low or even blocking the cervix.
• You are expecting more than one baby.
• Your baby is in a breech (bottom down) position.
• Your baby is in an abnormal position (such as transverse).
• Cephalopelvic disproportion: sometimes a baby is too big for the mother’s pelvis and just will not fit through. Many feel that it’s impossible to judge this until a woman goes into labour with her first baby.

Emergency

• This may happen if a complication occurs during labour or even before labour starts, such as:
• Your baby’s cord prolapses (comes out before the baby).
• Your baby starts showing extreme signs of distress – low heartbeat, meconium in the amniotic fluid.
• Your labour is not progressing (failure to progress – this may not be a true emergency).
• Any life-threatening situation for mother or baby for example pre-eclampsia, diabetes, previous scar rupturing, placenta rupturing.
• Maternal Distress.

Childbirth is a normal, healthy life event for most women. Of course there can be problems – perhaps minor, perhaps more serious. For most women however birth is a healthy challenge – one of many she will face as a mother. It can be the most rewarding work you will ever do. You should look forward to your baby’s birth with anticipation and celebration, not gloom, dread and fear. It should be the happiest day of your life, however it happens.