Helping the Baby out-Part one

As we have discussed in previous editions of Pregnant, pregnancy is a normal, natural and healthy process, says Lillian Karanja a nurse at the Aga Khan hospital. She lets us in on how medical experts make it possible for the baby to have his way out, despite challenges during labour.

One of the Lamaze philosophies that support medical interventions is that women have the freedom to go in labour free from routine medical interventions (interventions that are done without any reason).

When both mum and baby are fine, there are some interventions that are done that are not really beneficial to the outcome of birth.

As far as nature is concerned, interventions are only necessary if there is a problem with the baby, with the mum, or both, because interfering with the normal natural process increases chances of complications. Once an intervention is started, in many cases it becomes a cascade of events, whereby it calls for another and another intervention leading to numerous medical implications at the end.

Head to toe tests
These are entire body check-ups that include blood-pressure and urine tests done when mum is in labour. It is also important to check the baby’s wellbeing—especially the heartbeat.

Cervical check-ups
This confirms if indeed mum is in labour. The cervix has to become soft and start to open up. Usually, the cervix starts dilating from zero with the complete dilation at 10cm.

The cervical examination is repeated after four hours to check for progress. It helps doctors to know if the labour is progressing well or is taking too long. With these reviews they will know if and when to call for an intervention.

Enema
This is a soap solution that is introduced to the mother’s rectum to help her open up her bowels. It is usually a routine intervention but studies have shown that giving an enema during labour, and not giving an enema, the benefits or the outcomes are the same. Most of the time before mum goes into labour, naturally her body helps her to empty her bowels. Therefore if mum has passed stool, an enema is not a needed intervention as it may not improve the outcome.

However, if mum has had constipation thus not being able to pass stool yet. then enema should be administered.

After the soap solution is introduced into the rectum, it takes a minute or two before feeling like emptying the bowels.

Induction

This is where labour is started off artificially. It may happen that mum. for some reason, has not gone into labour and there is need to start off the labour as mum and the baby may be at risk.

Why Induction?

Maternal reasons
o If mum has a medical condition that is threatening her or the baby’s life, like high blood pressure that is not well controlled by medication, or high blood sugar that causes gestational diabetes, the doctor may then want to deliver the baby.
o If the mature baby’s stay in mum’s uterus poses a risk to both mum and baby’s health.

Baby’s reasons
o If mum has gone past the due date. We can allow between 38 to 42 weeks (the common practice). Most doctors prefer to give ten more days after mum’s due dale. If mum does not go into labour after ten days, induction may be called for.
o There are babies who don’t seem to grow well in the womb (inter-uterine growth restriction). There is need to deliver the baby so that they can have room to grow as required.

If an induction is to happen, plan with your doctor. Once you are in hospital, a cervical examination is done to see if the cervix is ready.

Since labour is being started artificially, it means the mum’s body has not produced the hormone that will allow you to start labouring. The doctor will put a hormonal tablet, called prostaglandin, up the vagina and leave it outside the cervix, which is meant to help the cervix soften completely and possibly start to open up. After they put the tablet, mum will be asked not to move around, for about one hour, so that the tablet can be well absorbed by the muscles of the cervix. After that she can move around, but is given eight hours for the tablet to work.

In some cases, mild labour may kick off and progress with the evidence of good contractions. If that doesn’t happen, we will put another tablet and give her another eight hours and monitor what happens.

If contractions come but they are not regular, there is need to do another intervention. The doctor may want to break the amniotic fluid. He will then confirm if the amniotic fluid is clear, which should be the case. After that, the doctor may also want to give an enema as indicated.

After the breaking of waters, the doctor will put an intravenous line using one of mum’s veins and start the drip containing oxytocin (hormone that causes the uterus to contract) to help the baby come out.

The drip is usually set and the number of drops going through the vein are regulated; starting with a few drops and increasing with time.

As all this is going on. we will still keep checking on the baby’s foetal heart-rate. If the heartbeat of the baby is not good and the amniotic fluid has changed to green, an emergency C-section is opted for because the baby is at risk. If an induction fails then an emergency C-section is also done.

NOTE: During induction, you are still required to use labour-coping skills. Be in an upright position (as you still need to help the baby move down the pelvis) unless the doctor tells you otherwise.

Augmentation
This is where mum’s labour has started spontaneously, but her uterus stops contracting at some point—labour goes off.

The doctor will put up a drip with oxytocin to remind mum’s uterus to keep going, something called augmentation. This is after ruling out any contraindication.

Occasionally, the uterus may be contracting but the contractions are not as effective. So the doctor may want to help mum increase by giving artificial oxytocin to help build up the contractions.

Keep in mind that medical interventions are not coping strategies. In Lamaze, coping has to be natural.

END: PG22/48-49