Procedures During Labor and Delivery

We want to make sure your labor and delivery is safe for you and your baby. Sometimes certain procedures are needed in order to ensure a healthy and safe delivery. 

Signing a consent form does not mean you or your baby will need the following procedures. These procedures often need to be done quickly when the need arises. But if you do need one, your doctor will discuss it with you before it's done.

The information below describes treatments you may need. It also describes some of the risks and benefits of each.

Please read this information so you will be ready to give your consent if you need to. Keep in mind that these treatments are only done if your doctor believes they are needed for your health or your baby’s health.

Episiotomy

An episiotomy is a cut in the skin between the vagina and anus. This allows the baby to be delivered more easily.

The doctor may do an episiotomy if the baby’s head or shoulders are too big. Or if we need to deliver the baby quickly if there are concerns about the heart rate.

In the past, this was very common. Now it is done only when needed.

Risks of episiotomy include bleeding, swelling and infections. Another risk is that the cut can tear or become larger and extend into the rectum.

Long-term risks include painful intercourse and problems controlling gas or stool, but these are very rare. All of these problems also can occur with a natural tear at the time of delivery.

Breaking Your Water (Artificial Rupture of Membranes)

Artificial Rupture of Membranes (AROM) is also known as “breaking your water.” It is done after the baby’s head has moved down into the pelvis. The doctor makes a hole in the membranes. This allows the amniotic fluid to leak out.

You may have AROM to help start your contractions or to make the contractions stronger. If the baby seems to be in distress, the doctor may break your water in order to check on your baby.

A risk is that the umbilical cord may fall through the cervix. This is very unlikely if the baby’s head is in the pelvis. Another risk is infection if the bag of water is broken for a long time before delivery.

AROM has several benefits. It can shorten the length of labor. It can decrease the chance of cesarean section. It also allows us to check your baby more easily.

Intrauterine Pressure Catheter (IUPC)

An IUPC is a thin, flexible tube with a small device on the tip that senses pressure. The tip goes into the uterus next to the baby. It measures the actual pressure inside the uterus. This helps the doctor check the strength of the contractions and how the contractions affect the baby. In order to place the IUPC, the bag of waters must already be broken and the cervix already slightly dilated.

The IUPC can also be used to put sterile fluid into the uterus. This is known as an amnioinfusion. Sometimes the umbilical cord gets pinched or squeezed during labor. This causes the baby’s heart rate to slow down. Amnioinfusion may help cushion the cord and decrease the stress on the baby.

Risks include injury to the wall of the uterus, bleeding and infection. Benefits include better use of oxytocin (a medicine to increase contractions) and fewer C-sections.

Internal Heart Rate Monitoring

Internal heart rate monitoring is also called Fetal Scalp Electrode or FSE. It is the most accurate way to measure a baby's heart rate during labor. You may need FSE if it's hard to hear the baby’s heartbeat or if there may be a problem with the baby’s heart rate.

It uses a thin wire attached to the baby’s scalp. The wire sends electrical signals from your baby's heart. This allows the doctor to track the heartbeat and see how the baby responds to the contractions. In order to place the device inside the mom, the bag of waters is broken and the cervix must be dilated.

FSE allows us to track the baby’s heart rate very closely. A risk is that the electrode may make a tiny mark where it was attached to the baby. The mark will go away.

Forceps or Vacuum Assisted Delivery

Sometimes women need help to complete a vaginal delivery. Your doctor may need to pull gently on the baby’s head while you push. We use a vacuum or forceps to help with this kind of delivery.

It is not an option if your cervix is not fully dilated. But it can be very helpful when a baby is in the birth canal but is not moving down the birth canal as we expect. In some cases, a baby needs to come out more quickly than just by pushing. Often this is because the baby has a slow heart beat.

Another common reason is that you have been pushing for a long time and you are getting too tired. If a little extra power will make the difference, vacuum or forceps delivery can help.

Forceps are smooth metal instruments, shaped like long, narrow spoons. The doctor carefully places them on the sides of the baby's head.

A vacuum extractor is a soft plastic cup. It is placed on the top of the baby's head and attached to a suction device. If the baby still does not move down the birth canal, we stop using the vacuum or forceps and do a C-section instead.

Forceps and vacuums are safe and effective when properly used. The forceps may leave red marks on the baby's cheeks for a short time. There may be red marks on the top of the head if vacuum is used. These go away in a few days.

In rare cases the forceps may cause nerve damage or bruises on the face. In rare cases blood may collect under the scalp from the vacuum.

Both forceps and vacuum increase the chance that your vagina may tear or that you may need an episiotomy. However, you may prefer this small risk over having an incision from a cesarean.

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