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Birthing options

Introduction

  • Wash hands; Introduce self; ask Patient’s name and what they like to be called; Explain
  • Break the ice
    • Congratulate them on their pregnancy
    • Do they know if it’s a boy or girl?
    • Do they have a name? (If so, use it when talking about the baby.)
  • Find out what they know so far and what they hope to get from the consultation

First ask a few questions

β€˜We can talk through a variety of options today to determine which might be best for you and your baby. However, your and your baby’s safety is our absolute priority so I just need to ask you a few questions first to determine the most appropriate options…’

Risk factors (if present, hospital birth is usually recommended)
  • Previous births
    • Previous C-section 
    • β‰₯6 previous children
    • Serious post-partum haemorrhage
  • Current baby
    • Expecting twins
    • Breech/transverse presentation
    • Placenta praevia
    • Problems with baby
  • Maternal factors
    • Anaemia
    • Gestational diabetes
    • Pre-eclampsia
    • Age >40 years
    • Obesity (BMI >35)

Locations

β€˜What options have you heard about so far?’ 

β€˜Do you have any particular questions or shall we go through the options?’

β€˜Choosing the right place can have a really positive effect on your relationship with your baby.’

Hospital birth

  • Birth on the labour ward of the hospital
  • Advantages

    • Safest environment – there are obstetricians and paediatricians around if problems arise
    • Can have epidural

  • Disadvantages

    • Less personal

Midwife-run birthing centre

  • Centres separate from the hospital run by midwives specifically for labour
  • Advantages

    • More comfortable and homely
    • More likely to have a midwife you know

  • Disadvantages

    • May need to be transferred to hospital if any complications
    • Cannot have epidural

Home birth

  • A midwife will come to your home and guide you through labour
  • Evidence shows it’s as safe as a hospital/birthing centre if it’s your second or subsequent baby (slightly higher risk for first babies)
  • Advantages

    • Most personal, relaxed environment
    • Privacy
    • You can light candles
    • You can still pay for a birth pool

  • Disadvantages

    • May need to be transferred to hospital if any complications – how far is it?
    • Cannot have epidural

Modes of delivery

  • Vaginal  
  • Caesarean section
    • Recommended if: multiple pregnancy, labour doesn’t progress, placenta praevia/accreta, 2 or more previous Caesarean sections, malpresentation (breech/transverse), cephalopelvic disproportion, pelvic cyst/fibroid, maternal infection (Herpes simplex/HIV), severe hypertensive disease, fetal distress
    • Disadvantages: major surgery, longer recovery, scar, will be more likely to need it again in the future
    • Patients can request one but, if they don’t need one, try to find out why – are they worried about pain?

Pain relief

β€˜Have you thought about pain relief?’

β€˜Pain relief is really important because if you’re in control of your pain, you’re in control of your labour.’

Options
  • Natural (none) 
  • Paracetamol
  • Codeine
  • Entonox
  • Pethidine
  • Morphine
  • Epidural
  • Spinal (for C-section)

Water birth and hypno birth

  • Water birth
    • Water birth is available in any environment (although one will have to be rented privately if they decide on a home birth)
    • It is a large warm pool 
    • It helps with anxiety, pain and muscle relaxation
  • Hypnobirth
    • Mother can be taught self-hypnosis and controlled breathing by a local practitioner 

Concluding 

  • Summarise
  • β€˜Is there anything else you’re concerned about or would like more information on?’
  • β€˜There’s no pressure to choose anything now. It’s a big decision so take some time to think about what you would prefer and discuss it with your partner.’
  • β€˜You can visit the local birthing centres to help decide.’
  • Suggest getting more information and making a birthing plan on the www.nhs.uk website
  • Give leaflets and contact details, and book follow-up

Test your knowledge

List some indications for instrumental delivery

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What are the two types of instrumental delivery? What are the advantages and disadvantages of each compared to the other?

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