Expert / 6 April, 2021 / Lesley Gilchrist

Episiotomies, Forceps, Ventouse And Induction: The Low-Down On Birthing Interventions

What is an episiotomy?

An episiotomy is a procedure performed during labour, where a small cut is made to your perineum by your midwife or doctor. An episiotomy will be performed following your consent, under local anaesthetic.

The purpose of an episiotomy is to widen the vaginal opening, enabling your baby to be born more quickly. For example, if your baby is showing signs of distress or the heart rate is significantly increasing or decreasing, an episiotomy will allow the baby a little more room. Another reason an episiotomy may be necessary is to widen the vagina so that instruments can be used to assist with the birth and prevent more serious tears from occurring.

The thought of an episiotomy can be daunting, however, there are methods that can be taken by mums-to-be which may help to reduce the chance of needing an episiotomy. For instance, performing perineal massage in the latter stages of your pregnancy (ideally from 34 weeks) is an effective way to prepare your perineum to stretch more easily during childbirth.

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Assisted birth

For those who need a little extra help during a vaginal birth, an assisted birth, using forceps or ventouse, may be carried out. As with an episiotomy, an assisted birth will require your consent.

There are two types of forceps that an obstetrician can use for an assisted birth. These include:

• Neville Barnes – designed to guide the baby through the birth canal alongside your contractions and pushing.
• Kiellands – designed to turn the baby’s head into a better position before guiding him or her through the birth canal alongside your contractions and pushing.

The other type of assisted birth is a ventouse – a small cup-shaped suction device that attaches to baby’s head. Once attached, the obstetrician will guide baby through the birth canal.

Induction

Induction of labour is a process where your labour is started artificially. There are several different procedures for inducing labour, including:

Membrane sweep

Also referred to as a ‘stretch and sweep’ or ‘membrane stripping’, this is usually offered after 40 weeks. If you accept, your midwife or doctor will do an internal examination by inserting two fingers into the cervix and sweeping around the opening and membranes. This can stimulate the release of prostaglandins and help contractions to start.

The advantage is it may start labour and reduce the need for further intervention. The disadvantages are it may not work, some women find this procedure uncomfortable, you may have sporadic contractions but not go into active labour, or it may be that your waters break during the examination.

Prostaglandin pessaries

These are artificial hormones that are used to replicate the natural process of softening and thinning your cervix. This will be done in hospital where you and your baby can be monitored.

An internal examination is performed where the prostaglandin is inserted next to the cervix. It may be in the form of a tablet, a prostaglandin gel or small string impregnated with the prostaglandin. This may start your labour without the need for further intervention, but the real aim of this is to soften and open your cervix to enable your waters to be broken.

Artificial rupture of membranes (ARM)

This is where an internal examination is performed and the amniotic sac surrounding your baby is broken using a small hook. You will need to wear a maternity pad afterwards, as your waters will continue to leak until after your baby is born. It also helps to monitor any colour change to your waters, which should be clear or pinky and not green, brown or heavily bloodstained.

Intravenous (IV) hormone drip

If active labour has not started with the previous procedures, the next step is to insert a cannula into your vein and start a hormone drip called syntocinon – the synthetic version of your own hormone, oxytocin. Due to your labour not starting naturally, it is recommended that you have continuous monitoring of baby’s heartbeat and your contraction pattern via a monitor.

If you’re healthy and your pregnancy and labour are straightforward, you may not need any intervention.  However, during pregnancy, you should discuss all of these methods with your midwife or doctor to ensure you understand when they might be considered and understand the risks and advantages associated with each process.

Article by Lesley Gilchrist, registered midwife and co-founder of My Expert Midwife.

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