The Choices in Childbirth
November 2nd, 2008 Posted by: admin
Episiotomy This is a surgical cut to enlarge the vaginal outlet at delivery, and is the most commonly performed operation in the West. Episiotomies are used in order to avoid tears, which have ragged edges and are difficult to stitch together. Also, they can take longer to heal. But you can avoid tears if you stop pushing while your baby’s head is being born, and allow your uterus to ease out the head gradually rather than suddenly. If your baby’s head is delivered suddenly, you are likely to tear, so an episiotomy will be done if the perineum is under stress.
If an episiotomy is done too early, before your perineum has thinned out, muscle, skin, and blood vessels are damaged and there may be heavy bleeding. Tissues are crushed by the scissors as they are cut, and this can lead to bruising, swelling, slow healing, and a perineum that is stitched too tightly. This tightness can be very uncomfortable during the postnatal period, and may even leave a painful scar, which can prevent you from making love for months afterward. If you want to avoid an episiotomy, it’s a good idea to make it clear in your notes and birth plan that you don’t want it to be done unless entirely necessary. If you do have to have an episiotomy, you have the right to have a local anesthetic in the perineum before it’s done, so insist on that.
Breech birth Research shows that normal vaginal delivery is riskier than a cesarean for a breech birth. Most breech babies are delivered by cesarean section, but usually with epidural anesthesia. Few midwives have experience of breech deliveries, so a breech baby will generally be delivered by a doctor.
Time What hospitals judge to be the normal length for labor differs from place to place. For example, the “right” length for the second stage can be two hours or 30 minutes, or somewhere in between, depending on the obstetrician or midwife. In fact, the length of labor varies from woman to woman, and from birth to birth, and it’s the combination of what’s normal for you with the hospital’s policy that may cause problems.
In most cases, if the first stage is thought to have gone on too long, the membranes are ruptured (if this hasn’t been done already), or an oxytocin drip is set up to increase the rate and strength of contractions. If the second stage is taking a long time, a doctor may suggest an episiotomy and forceps delivery. Many midwives, though, say it’s usually obvious when labor is going well but is just taking some time, rather than being slow because something’s wrong.
Being together It’s rare for babies to be separated from their mothers after the birth unless they need special care or the mother asks for her baby to be taken away for a while. But your partner won’t be able to stay with you in the hospital, as there just aren’t suitable facilities in most places, and this can be difficult for him after all the excitement and emotion of the birth. Before you go into the hospital, ask how long your partner can stay with you after the birth. Many women say that they were too excited to sleep afterward and wished they had someone to talk to.
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