Epidural anesthesia is considered a a safe, effective and easily adjustable pain control modality for childbirth. It can be used to partially or fully numb the lower body, either allowing you enough feeling to push with your contractions or blocking all feeling for a cesarean delivery if that becomes necessary. With a low dose of medication (light epidural), you may also be able to walk around, which can make you more comfortable.
Epidural pain medication is given through a very thin tube (epidural catheter) into the area surrounding the spinal cord, within its outer membrane (epidural space). From the epidural space, medication goes through the membrane directly to the spinal nerves that cause feeling in the lower body. Meanwhile, you remain alert, because the medication doesn’t travel through your blood to your brain and central nervous system.
Because epidural pain medication doesn’t go directly into your bloodstream, your baby is unlikely to be affected. (Research data aren’t yet clear enough to say that there are no effects.) By comparison, when medication is given through a vein (intravenous, or IV) or by injection into a muscle (intramuscular), it travels to your baby across the placenta after an hour or so. If your baby is born before the medication wears off, he or she may suffer side effects such as breathing difficulty and grogginess (which are reversed at birth with another medication).
A combination spinal-epidural anesthesia is gaining more use for labor and delivery. Before the epidural line is installed, medication is injected into the spinal fluid around the spinal cord. This spinal injection acts more quickly than the epidural will. Then the epidural line is placed and used for ongoing anesthesia needs.
Instrumental Delivery –
in my opinion this is too lengthy and not required. Beyondthe reasons there is no need to get into details.
It has an assisted birth, where forceps or a ventouse suction cup (ventouse) are used to help deliver the baby’s head. This can be because:
- there are concerns about the baby’s heart rate
- your baby is in an awkward position
- you’re too exhausted
Both ventouse and forceps are safe and only used when necessary for you and your baby.
If the baby’s head is in an awkward position, it will need turning (rotating) to allow the birth. A paediatrician may be present to check your baby’s condition after the birth. A local anaesthetic is usually given to numb the vagina and perineum (the skin between the vagina and anus) if you haven’t already had an epidural.
If your obstetrician has any concerns, you may be moved to an operating theatre so that a caesarean section can be carried out if needed, for example if the baby can’t be easily delivered by forceps or ventouse. This is more likely if your baby’s head needs turning.
Sometimes, as the baby is being born, a cut (episiotomy) may be needed to make the vaginal opening bigger. Any tear or cut will be repaired with stitches. Depending on the circumstances, your baby can be delivered and placed onto your tummy, and your birthing partner may still be able to cut the cord if they want to.
A ventouse (vacuum extractor) is an instrument that is attached to the baby’s head by suction. A soft or hard plastic or metal cup is attached by a tube to a suction device. The cup fits firmly onto your baby’s head. During a contraction and with the help of your pushing, the obstetrician or midwife gently pulls to help deliver your baby.
The suction cup leaves a small swelling on your baby’s head, called a chignon. This disappears quickly. The cup may also leave a bruise on your baby’s head, called a cephalhaematoma. A ventouse is not used if you’re giving birth at less than 34 weeks pregnant, because your baby’s head is too soft.
A ventouse is less likely to cause vaginal tearing than forceps.
Forceps are smooth metal instruments that look like large spoons or tongs. They’re curved to fit around the baby’s head. The forceps are carefully positioned around your baby’s head and joined together at the handles. With a contraction and your pushing, an obstetrician gently pulls to help deliver your baby.
There are many different types of forceps. Some forceps are specifically designed to turn the baby to the right position to be born, for example, if your baby is lying facing upwards (occipito-posterior position) or to one side (occipito-lateral position).
Forceps can leave small marks on your baby’s face but these will disappear quite quickly