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.