selecting the safest route for childbirth
TRANSCRIPT
Dr. Henry Osazuwa
M B B S ( B e n i n ) , F W A C S ( O & G )
Consultant Obstetrician/Gynaecologist
The 5 Important Factors in
Selecting the Safest Route for
Childbirth
Childbirth is a timely end to ALL our expectations
Others - Caesarean section
Planned or Unplanned
Majority of pregnant women will have a Vaginal birth
The safest route maybe straight-forward
Should involve careful and timely decision
Couple’s input is always essential
The notion of what is normal has changed
Safety for the mother and baby
The uterus is a good learner.
Women with previous vaginal birthare encouraged accordingly.
First timers are also encouraged to do same.
When to antic ipate Normal vaginal delivery
Presentation - Head
Weight - < 3.5 kg
No Foetal or Maternal complication
Type of CS is less important unlike in the past
One (1) previous CS – Carefully selected (50 – 60%)
General favourable features vaginal birth.
Previous Vaginal birth
Cephalic – Head
Foetal weight < 4kg
Maternal height > 1.5 meters.
Labour can go on for hours.
Be patient & mentally prepared- to avoid unnecessary Intervention.
Companionship & Support
PARTOGRAPH
Often refers to the use of medications to start labour
Induction of Labour maybe necessary
There are Non-medications procedures like membrane stripping
When continuation of the pregnancy – Endangers the motheror baby.
No contraindication to vaginal delivery.
Adequate explanation and education.
When done properly, the experience is similar to natural labour.
Important indicationsProlonged pregnancy –Induction carried out at 41+ 3 weeks.
Rupture of foetal membranes
Elevated blood pressure
Anaemia
Rhesus negative mothers
Two (2) or more Caesarean sections.
Previous uterine surgeries - Myomectomy
When vaginal delivery is CONTRAINDICATED
Successful vaginal delivery maybe be possible, but risk to the mother and baby is high
Risk for uterine rupture
3%
12%
1 CS 2 CS
Babies don’t do well when rupture occurs- Asphyxia/Death
When vaginal delivery is CONTRAINDICATED
Abnormal presentation/Lie – Breech presentation; Transverse lie.
Placenta praevia
Previous major perineal injury with successful repair
When the preparation is <24 hours.
The labour progress may cease.
Emergency Caesarean section
Baby is big for the pelvis or the pelvis is narrow.
Baby is distressed – Oxygen delivery is poor.
Umbilical cord can fall out through the cervix/vagina.
Placenta can separate prematurely.
Preterm birth
Birth of a child before 37 weeks.
Problems expected < 34 weeks.
Asphyxia
Poor lung development
Jaundice
Infection
< 30 weeks – Mode of delivery has little effect on outcome.
> 30 weeks – Important factors to consider.
Foetal presentation – Breech or cephalic
State of the mother and baby.
Birth in a hospital with Neonatal care facilities is mandatory
Paediatrician.
Incubator.
Laboratory support.