Types of birth: labour and delivery are just some of the many decisions any mom-to-be has to make as part of her pregnancy journey.
Delivery can be quite a daunting prospect for any mom-to-be.
But this can be made so much easier with a discussion between the patient and her provider early in the pregnancy.
This discussion should entail the route and timing of delivery, where the delivery will be performed, and any particular requests or concerns that mom-to-be may have.
Types of birth: labour and delivery
The two routes of delivery are:
- the “natural” or vaginal route,
- and a cesarean section or “c-section”.
The choice of route of delivery will be influenced by maternal and fetal factors.
- Previous successful natural delivery: This increases the chances of a successful vaginal delivery.
- The size of the birth passage (pelvis) relative to the baby: If the birth passage is considered to be small on examination, or the baby is considered to be large, then a c-section may be offered to the patient.
- Does mom have any conditions that may impact how she is able to tolerate labour and delivery, or any conditions that would make a c-section not ideal? This could include the presence of any pelvic masses, such as a fibroid, which may impede babies progress.
Fetal factors that will influence the route of delivery, natural or c-section, will include:
- Position of the baby: If the baby is “head down”, cephalic, or “bottom down”, breech. The ideal position of baby for a normal delivery is head down.
- The size of the baby: An estimated weight can be done in the late third trimester to provide insight into whether a normal delivery can be attempted or not.
- Number of fetus’: Women with three or more fetus’ are more likely to require a c-section.
- Location of the placenta: Women with a placenta which is low lying or blocking the pelvis altogether, known as “Placenta Praevia”, will require a cesarean section.
Once a c-section always a c-section?
Once a c-section doesn’t always mean a c-section.
Women who meet a particular criteria may be allowed a “V-BAC” - vaginal birth - after cesarean section.
This criteria would include:
- What was the indication for the previous cesarean section? If it is a recurring indication, such as a small pelvis, then a vaginal birth would not be recommended.
- How long ago was the previous cesarean section? An ideal target would be 18 months between cesarean section and attempting V-BAC.
- What type of c-section was it? This can be a “lower segment cesarean section” where a horizontal incision is made through the lower aspect of the uterus, or a midline incision through the uterus which is a “Classical”. Patients who have had a midline incision through the uterus would not be candidates for V-BAC.
- Has the patient had a successful vaginal delivery after having the cesarean section? These patients are most likely to have a successful V-BAC.
- The size of the baby: Women with large babies would be at increased risk of attempting a V-BAC.
- The position of the baby: Patients with baby in the breech position would not be advised to attempt V-BAC.
- The institution: The institution in which the patient is scheduled to have the baby will also impact the choice of V-VBAC or not. V-BAC should only be offered at an institution that can facilitate immediate conversion to c-section if there is any maternal or fetal compromise during labour.
Timing of delivery
The aim for every pregnancy is for delivery after 37 weeks however, there are instances when a planned delivery may occur prior to this.
Conditions impacting the stability of the mother or that may have been worsened by the pregnancy, such as severe heart disease, may necessitate a planned early delivery.
Pregnancy-related conditions leading to significant compromise of mother and/or fetus - such as severe pre-eclampsia - may necessitate a planned early delivery.
But most commonly, an early or “pre-term” delivery is unplanned.
In the event of pre-term delivery, an institution that can care for a pre-term infant should be considered and may require a change of the birth plan.
This should be discussed with your caregiver.
The institution being chosen for delivery should also be discussed and it is wise for the patient to become familiar with it and all the routes to get there quickly!
Patients have been known to go to the wrong hospital when it is time for delivery.
Does the institution have facilities to accommodate any changes to the birth plan should the need arise?
Any special concerns/requests that mom-to-be may have, such as epidural or not, birthing positions, presence of family members, cutting of the cord and for male infants, circumcision, should also be discussed prior to delivery.
The new journey of motherhood
Delivery is not just the end of pregnancy but the beginning of a new journey called Motherhood.
Having a detailed birth plan will help to prepare both mother and child for this beautiful new beginning.