Most babies are born head first, through the vagina. However some vaginal births require assistance. Two types of instruments are used to aid vaginal delivery:



a) Forceps - this is a metal instrument which looks like tongs. It is used to remove baby's head from the pelvis without injuring mother and baby. It is also used to help rotate baby's head hence ensuring a better birth position.



b) Vacuum extractor - it consists of a soft, synthetic cup attached to a suction device; the cup is placed on fetal head, suction is applied and with traction the baby is removed from the birth canal.

Both methods are used only when cervix is fully dilated and the head is within 2 inches of the mouth of the vagina. Operative deliveries are conducted in the following instances:


• Prolonged second stage - poor contractions, a large fetus, small pelvis or any combination of these



• Maternal emergency - shock or exhaustion



• Fetal emergency - slowing of fetal heart beat is indicative of potential fetal distress


Operative delivery is very safe and a good alternative, when appropriate, to a cesarean. Using either forceps or vacuum showed no increase in incidence of birth injuries.



C- Section


Cesarean has come to mean the birth of a child by abdominal operation. It can be elective (planned in advance by mother and surgeon) or an emergency cesarean. An incision is made in the abdominal cavity of the mother, and then in the uterus. Cesarean deliveries were once feared and viewed with caution but now with improved operation techniques and improvement in preoperative and postoperative care as well as reduced infection, C-section is now considered a safe procedure. The advances in anesthesia methods, blood banks, surgical care, and antibiotics have reduced the risks to the mother. It is a major surgery and sometimes is preferred under emergency circumstances. The most common reasons to opt for C-section include:

• Mother's narrow pelvis


• Baby's abnormal position - e.g. breech or across the abdominal cavity


• Poor contractions - not forceful enough to push baby down


• Previous cesarean has increased the chance of uterine rupture


• Pelvic tumors


• Fetal distress which in turn endangers the fetus


• Some abnormality of the placenta - e.g. placenta previa, placenta abruption causing emergency delivery


• Maternal diabetes and preeclampsia causing complications


• Rh disease


To reduce the rate of C-section procedures since (it is still a major surgery that is not entirely risk-free), VDAC or vaginal delivery after Cesarean has been encouraged. Vaginal delivery after a previous operation is regarded safe if:


• in the previous C-section the incision was in the lower part of the uterus. If the incision was made in the top part of the uterus, all subsequent deliveries must be made by cesarean to prevent uterine rupture.


• the trial of labor is closely monitored and facilities are available for emergency care i.e. blood transfusion and surgery


• labor is not induced as this increases the chances for rupture (labor should not be induced unless in special cases as decided by your doctor)


The Preparation


1. Medications may be given to help dry the secretions in the mouth


2. The lower part of abdomen will be washed and maybe shaved


3. A catheter is placed in the urinary bladder to keep it empty; this reduces injury to the bladder during the operation and aids in the birth process


4. An IV will be started, permitting fluids to be given during the surgery; certain medications may also be administered this way


The Procedure itself


1. An incision through the wall of the abdomen is made by the surgeon - it can be vertical, midline (incision from navel to the pubic bone) or transverse popularly known as bikini incision (extending from side to side just above the pubic hairline). Your surgeon will decide on this.


2. An incision is made in the uterine wall to facilitate delivery. This may either be transverse or vertical; transverse is more popular but vertical is resorted to depending on baby's position and certain emergency situations


3. After delivery of the baby, the placenta follows immediately


4. The incision in the uterus and abdomen are closed with sutures


5. You will be taken to the recovery room where your where your BP, pulse rate and respiration rate will be checked and monitored; you will be observed for excessive vaginal bleeding


6. You will see your baby at delivery and may even hold your baby for a while before baby is transferred to the nursery for observation. This is possible if you were given regional anesthesia


Postoperative Care


1. You will be kept in bed for the 1st day post delivery, though you will be encouraged to move about with assistance despite the discomfort


2. After the 1st day it is important to get out of bed and be more mobile with help from nurse or relatives


3. The bladder catheter is usually removed soon after delivery and you should resume urination without problem.


4. IV fluids continue for the first 24 - 48 hours


5. The incision will be uncomfortable for several days after the operation. Painkillers may be prescribed. You may also check with your doctor on using rubbing alcohol to clean the incision area


6. In most cases discharge depends on how you heal and how soon you are able to resume normal functions (2-4 days)


7. The stitches or clips on the abdominal incision will usually be removed within 4-5 days after surgery.


8. You will rapidly regain normal bodily function after 4-6 weeks


The Down Side


• Despite the advances, the mother is open to risks such as infections, blood clots, excessive blood loss and occasional complications from anesthesia; all said and done, these complications are temporary and treatment is available


• The procedure is more costly than vaginal birth due to longer hospital stay, the cost of anesthesia which is compulsory and the cost of using the operation room along with the personnel and the equipment during surgery.