Fetal distress - This is when not enough oxygen reaches your baby. Changes in the baby’s heart rate may be seen on a fetal monitor. Changes in heart rate may be enough to diagnose fetal distress or we may confirm it by testing a sample of the baby’s blood, called a fetal blood sample or FBS. If we confirm fetal distress we need to deliver the baby straight away. This can be by assisted delivery if your cervix is fully dilated.
Problems with the mother
If you cannot push hard enough during labour and this causes a delay in the birth you may need an assisted delivery. There are various causes for difficulties with pushing, including:
Exhaustion - If you are exhausted during a long labour, you may not have the strength or desire to push properly. This is particularly true if you do not have enough pain relief, if your pulse rate and temperature are high, and if you are dehydrated because you have not had enough fluids to drink.
Medical conditions - If you have a medical condition affecting your blood pressure, heart or breathing, pushing may make it worse. We use an assisted delivery to reduce the time you need to push.
The aim is to safely deliver your baby and make sure you come to no harm.
You should safely and quickly return to normal health. You and your baby will avoid undue trauma or distress.
Are there any alternatives?
If your labour is taking a long time because your contractions are weak we may give you a drug called oxytocin to improve them. Oxytocin speeds up contractions and increases their strength. This may help you deliver your baby naturally without the need for instruments.
If your baby's head is in the wrong position the doctor may be able to move it into the correct position for delivery with their hands.
Eventually, the doctor may decide that a Caesarean section, where your abdomen and womb are cut open to deliver your baby, is the safest method of delivery for you. You may also prefer to have a Caesarean section rather than an assisted delivery after the doctor has discussed the risks and benefits of each technique.
What if you do nothing?
If you are having a long labour but are well, not too tired and your baby seems fine, we may wait a bit longer to see if you can deliver the baby on your own. You may want to try to push for a bit longer.
If this is the case, your midwife or doctor will agree a time limit and then assess things after that. However, it is important to discuss all the options carefully with your obstetrician.
Who should have an assisted delivery?
We only decide to help with a delivery using instruments after assessing the pregnancy, the progress of the labour, the condition of the baby and the condition of the mother. There are no hard and fast rules as every woman, pregnancy and labour is different. Therefore, each doctor will manage every woman's labour on an individual basis.
Author: Dr Chineze Otigbah MRCOG. Consultant obstetrician and gynaecologist.
© Dumas Ltd 2006