American Medical Association Family Medical Guide - American Medical Association [300]
An episiotomy (see previous page) is usually performed before forceps are used, and the woman is usually given a local anesthetic or epidural anesthesia. The doctor inserts the forceps into the vagina along both sides of the baby’s head and gently pulls the baby out as the woman pushes with her contractions. The risks of using forceps range from temporary marks on the baby’s cheeks or ears to nerve damage or injury to the woman’s vagina. Most nerve damage is temporary. A forceps delivery is usually less risky than a cesarean (see below) for both the woman and the baby.
Vacuum Extraction
Vacuum extraction is sometimes performed as an alternative to forceps delivery. The doctor places a suction cup (which is attached to a vacuum pump) on the baby’s head in the birth canal. The pump is turned on to secure the baby’s head to the cup, and the doctor gently pulls the baby out of the vagina with each contraction.
Vacuum extraction poses less risk of vaginal injury than a forceps delivery, although you may still have an episiotomy before delivery. The baby may have slight swelling of his or her scalp from the vacuum cup, but this will disappear in a few days.
Cesarean Delivery
Cesarean delivery (also called cesarean section or, for short, C-section) is a surgical procedure in which the baby is delivered through incisions in the wall of the uterus and in the lower abdomen. A cesarean delivery is usually done when it would be safer or easier than a vaginal delivery. Reasons for having a cesarean delivery include having a large baby or multiple babies, prolonged labor or failure of labor to progress, fetal distress, a breech presentation (see next page), or a medical condition the woman has.
If you have previously delivered a baby by cesarean, you and your doctor will weigh the benefits and risks of having another cesarean delivery. Many women who have delivered a baby by cesarean can later have a successful vaginal delivery. However, there is a risk of uterine rupture at the site of the cesarean incision.
The preparation for a cesarean delivery is similar to that for other surgical procedures. The incision area is washed and may be shaved, a catheter is inserted into the woman’s bladder, and an intravenous line is inserted to allow her to receive medication and fluids if necessary. Most cesareans are performed using epidural or spinal anesthesia (see page 532). General anesthesia is usually used for cesarean deliveries only in emergency situations.
Your doctor will make either a low horizontal incision (called the bikini incision) that may be hidden by your pubic hair, or a vertical incision from below the navel to the top of the pubic hairline. The incision into the uterus itself may be either horizontal or vertical and is not always in the same direction as the skin incision. The doctor will remove the baby from the uterus and cut the umbilical cord before removing the placenta. Both incisions will be closed with dissolvable stitches; in some cases, the skin incision is closed with staples that will be removed later.
Most cesarean deliveries pose no problems, but possible complications include infection, excessive bleeding, blood clots, and injury to the woman’s bladder. As with a vaginal delivery, a woman will probably be able to hold her baby very soon after delivery.
Possible Problems With Delivery
Labor and delivery usually progress with very little difficulty. However, sometimes unexpected problems develop. Hospitals are well equipped to handle these problems as they arise. Make sure your doctor and other health care professionals who are assisting you are aware of any unusual signs or symptoms you have.
Abnormal Presentation
A fetus usually rotates naturally into the normal, head-down position for birth. The part of the fetus that is positioned at the opening of the cervix immediately before birth is called the presenting part. In most cases, the part that presents is the top of the baby’s head, with the baby facing toward the mother