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

‘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 
  • ≥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

‘What options have you heard about so far?’ 

‘Do you have any particular questions or shall we go through the options?’

‘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

A patient presents to ED with chest pain and this trace. What would you do?

Interpretation management

Covered in OSCE Stations

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

‘Have you thought about pain relief?’

‘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
• ‘Is there anything else you’re concerned about or would like more information on?’
• ‘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.’
• ‘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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