Dr Karuna Raja

Labour

Booking into the Hospital

  • Labour Ward - Booking can be made at around 20 weeks gestation. You can do this personally in the Diagnostic Centre or you can visit the front desk at RPA Women and Babies to book your appointment.
  • The Birth Centre - Booking needs to be made preferably before 11 weeks. A waiting list is kept in vacancies occur. book in person ant the Birth Centre or by calling 95156405.

 

What to Expect in the Delivery Suite

When you come to the delivery suite in labour, you will be looked after by midwives who will take care of the routine management of labour. They will inform me about your arrival, clinical findings and any concerns that may be had. I will review you based on the clinical situation. They will also discuss with you the option of analgesia and will answer to any of your queries. You are free to mobilize in the room and even go outside the delivery suite to walk around if in early labour. Various interventions (i.e: CTG Monitoring, IV cannula and drip) may be needed, you will be explained about these by either myself or one of the midwives. Feel free to ask questions and take active participation in the management of your labour.

An anesthetist is present in the hospital 24 hours a day and will see you to discuss with you the risks and complications of regional anesthesia, if you requested to have any during your birth. Soon after the delivery the baby is checked and weighed by the midwife. Once the placenta is delivered and suturing (if required) is finished, you will be given some refreshments and will be transferred to the Post Natal Ward. This is where postnatal midwives will take over the responsibility of looking after you.

 

Tests/Monitoring in Labour

  • CTG (Cardiotocography) - This is a test that records the baby’s heartbeat and uterine contractions and can help to assess if the baby is stressed during labour. It is usually preformed to confirm the well being of the baby and may be offered to you when you present for the delivery. The heart rate pattern is an important sign of the baby’s over all well being. The heart beat can be checked by ultra sound Doppler (hand-held monitor) or electronic foetal heart monitoring (CTG). In electronic heart monitoring, two censors are held in place against the mother’s abdomen with belts around her waist and hips to pick up the baby’s heart beat and also the uterine contractions. If the baby is stressed, the CTG graph may show some specific signs which may require intervention.
  • Foetal Scalp Electrode - Sometimes a small electrode (called a scalp clip) may be applied to the baby’s head during labour. This is to detect the foetal heart more accurately. This does not cause any long term harm to the baby.
  • Foetal Blood Sampling - in some situations, where foetal distress in labour is demonstrated on the cardiotocograph, a confirmatory test for foetal distress may be preformed by taking a small drop of blood from the baby’s scalp. This blood is tested in a special machine to test for biochemical markers of distress. This does not hurt the baby and does not have any short or long term effects on the baby.

 

Unexpected/Emergency Situations in Labour

Foetal distress leading to emergency caesarean section or instrumental delivery, significant abnormal bleeding during or after the delivery are some of the most frequent emergency situations which can happen and can cause significant anxiety in the patient and her attendants.

At times the medical and nursing staff might be busy dealing with the emergency and may not have time to answer all your questions. However, you will always be briefed about the event after the emergency is over.

 

Instrument-Assisted Delivery

Most births occur vaginally without any intervention. However, in some cases we may need to use an instrument (forceps or vacuum extraction) to deliver the baby. This only happens in about 10% of all births. As an instrument assisted delivery poses some risks to the mother and the baby (i.e: vaginal tears). The decision to deliver by this method is only made in the best interest of both the baby and mother.

The most common reasons for considering an instrument assisted delivery are poor descent of the baby’s head, foetal distress, maternal exhaustion, inability to push effectively and abnormal position of the head. Sometimes it is necessary to cut short the labour and pushing due to maternal reasons such as medical conditions in the mother. General risks of instrumental delivery are: bruising and abrasions of the perineum, pelvic floor injury to the mother which may lead to long term prolapse, as well as bladder and bowel problems and bruising of the baby.

Local anaesthesia or epidural or spinal block may be required for instrumental delivery. A urinary catheter may be inserted to empty the bladder during delivery. An episiotomy may also be given.

Instrumental assisted delivery has slightly higher risk of complication in the mother and baby compared to spontaneous vaginal delivery. However most of these are of minor nature. A decision to deliver by instruments is only made when the risk to mother or baby is higher if waiting for spontaneous delivery in comparison to instrumental delivery.

The general risks of instrumental delivery are bruising and tearing of tissue which may include cervical tear, rectal, sphincter and pelvic floor damage. As well as bruising of face or scalp or injury to facial nerve of the baby (these usually resolve within days). However significant scalp bleeding can occur in rare instances.

 

Caesarean Section

There are several reason why a caesarean may need to be preformed. Caesarean sections are usually preformed under spinal or epidural anaesthesia and you will be awake during the process. However there are times, particularly in emergency situations a general anaesthesia may be given, causing you to be asleep throughout the procedure.

Caesarean section is a major surgery and has risks that include, but are not limited to; bleeding, damage to bladder and bowel, clotting in legs and lungs, and wound dehiscence. Caesareans also can have implications on your next pregnancy.

 

Vitamin K

New born babies are deficient in vitamin K and this can rarely lead to haemorrhagic disease of newborns (bleeding in the baby) on day 2-3 of their life. To prevent this, babies will be offered a Vitamin K injection or oral Vitamin K after birth.

 

New Born Screening Tests

Every new born baby is offered a blood test on day 2-4. Few drops of blood are taken from the baby’s heel and tested for many congenital disorders such as congenital hypothyroidism and phenylketonuria (PKU). As well as, many disorders of protein and fat metabolism, cystic fibrosis and galactosaemia.

Some babies may require a repeat test, if the information from the first test is not clear. If the test results are normal, you will not be contacted.

A hearing test will also be offered to your baby while in the hospital.

You will also receive a booklet on the subject of labour and delivery from Parent Education, if you book your antenatal classes with them.

 

Birth Plan

Some of you may wish to write your birth plan. Birth Plans have been around for many years and are very useful to have. They originated to assist women to inform their midwife or doctor of their wishes during labour, particularly if they wanted to avoid routine interventions. The term “Birth Plan” implies that there is some control over the birth and that you are able to plan for it. The reality is that you have little control over labour and birth, making it difficult to formulate a plan. A better term would be “Birth Preferences”.

Birth Plans can be used to; help people around you know about your preferences before labour starts, as a tool to help you explore different issues surrounding labour, birth and what your plans are afterwards, as well as to help you formulate ideas on what you would and would not like to happen during labour.

You may find it very helpful to work on your Birth Plan with your partner, so he can be a part of the decision making process and be able to assist you in implementing your plan. You can gather your ideas for writing your Birth Plan from many different sources (i.e: friends, books, childbirth educators, midwives, doctors, hospitals or the internet). Every Birth Plan is very different and the sorts of issues that are important vary from woman to woman.

The following is a large list of issues that you may or may not want to include in your birth plan:

  • 1st stages of labour
  • Choice of birth place
  • Clothing during labour (own or hospital gown)
  • Monitoring during labour
  • Eating and drinking during labour
  • Students during labour
  • Vaginal exams
  • Pain medication
  • Positions during first stage of labour
  • Use of water
  • Use of heat
  • Self help techniques
  • Caesarean birth options
  • Induction/artificial rupture of membrane
  • Labour augmentation
  • Analgesia/nitrous oxide/epidural
  • 2nd and 3rd stages of labour
  • s
  • Positions during the 2nd stage of labour
  • Pushing during the second stage of labour
  • People present during the birth
  • Natural or managed 3rd stage of labour
  • Episiotomy and tears
  • Instrumental delivery/vacuum extraction versus forceps
  • Immediate contact after birth
  • Cutting of the baby’s cord
  • Baby’s first breastfeeding
  • Postnatal care
  • Vitamin K
  • Hepatitis B immunisation
  • Rooming in with mother during the postnatal stay
  • Newborn Screening Tests
  • Breastfeed/bottle-feeding
  • Preference if baby has complications

This list is by no means exhaustive. There are many other issues that can be considered, this list is only meant to be used as a guid to help you generate ideas about the topics you want covered in your Birth Plan.

When writing a Birth Plan, it is ideal to make a copy for each person who is going to be present during labour. This may include your partner, support people, your midwife and your doctor. A copy can also be made for your hospital records. Some women choose to have a meeting with there support people and discuss the issues raised on the birth plan. It is also important to make sure you discuss the contents of your Birth Plan with your midwife and/or doctor.

Birth Plans should be made to be flexible. Since you will not be able to actually control every detail of your labour, your Birth Plan would be more flexible with the use of words such as “I would prefer” or “if possible”. Many things can happen during labour and child birth, but having a Birth Plan will help indicate the preferences of the mother-to-be and provide an outline for those around her at time of labour to better understand how she would like the birth to be.

 

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