OBSTETRIC TECHNOLOGY
Operative Vaginal Delivery
In some circumstances , a non-reassuring fetal heart-rate tracing or maternal exhaustion makes operative delivery necessary . If you are completely dilated and the fetal head has descended far enough into the pelvis , delivery can be accomplished using either forceps or a vacuum extractor . Obstetric forceps are metal instruments that fit on the sides of the baby ’ s head and allow the obstetrician to assist you with outward force . The vacuum extractor is a soft plastic device that attaches to the baby ’ s head by suction and allows your obstetrician to assist you by gently guiding the baby out of the birth canal .
The use of forceps or a vacuum is usually determined by the situation and the preference of the physician . If an emergency delivery is required due to a non-reassuring fetal heart-rate tracing and you are close to delivery , your baby can be delivered more quickly and safely by an operative vaginal delivery than by C-section .
Episiotomy
An episiotomy is an incision that is made in the area between the vagina and the rectum . It is usually performed as the baby ’ s head emerges from the birth canal . Episiotomies are performed to increase the size of the vaginal outlet .
We do not routinely perform episiotomies . Some obstetrical conditions may make the episiotomy advisable . These conditions include non-reassuring fetal heart tracings and difficulty with delivery of the baby ’ s shoulders .
External Cephalic Version
External cephalic version involves turning the fetus from an unfavorable presentation , usually breech , to vertex ( head down ) by manually rotating the fetus . By converting to a vertex ( head down ) presentation , a vaginal delivery is much more likely .
External cephalic version is performed on fullterm , non-vertex pregnancies in women who have intact membranes , adequate amniotic fluid , reassuring fetal testing , and who are not in labor . The success rate of external cephalic version in most studies is approximately 50 %. The risks of external cephalic version include placental abruption , fetal-maternal hemorrhage , and non-reassuring fetal testing resulting in C-section .
38 My Prenatal Care Book