Monitoring, interventions and procedures

Vaginal examinations are offered to check how open the cervix is (neck of the womb), see if the waters are broken, break waters and to see if the baby is coping with labour. You can choose whether to have these examinations and can request a chaperone. How often vaginal examinations are offered will depend on each person. Examinations may occur every 4 hours during the first stage of labour and more frequently during the second stage to monitor the baby's position and progress. Post-birth, an examination will be offered if the placenta does not come out by itself. An examination will be offered after birth to check for tears and that your anus (back passage) is intact.

Your baby can be monitored intermittently or continuously to give a guide as to how they are coping with labour. Different methods of monitoring will be recommended in different situations, no way of monitoring is perfect .

There are interventions that may be recommended and offered to reduce particular risks, such as tears to the perineum (the area between the vagina and anus) or baby becoming distressed. Every vaginal birth has a risk of a more serious tear, there are ways we can try to reduce the risk of a serious tear. An episiotomy (a small cut made at the vaginal opening to assist birth) is never routine but can be used to prevent the risk of serious tear in certain situations. If an episiotomy is performed, local anaesthetic (a numbing agent) is injected into the area, and you will require stitches after birth. Interventions to speed birth can offered due to reasons associated with labour, the baby being distressed or at your request. There are two main ways of carrying out an instrumental vaginal birth: using forceps (like big metal spoons) or using a ventouse (like a suction cup). A caesarean birth may be offered if an instrumental birth is not possible, not achievable or you request it.

Immediately after birth, an assessment called the APGAR test will be done to see if your baby needs more support. If your baby has difficulty breathing or has a low heart rate at birth, they may need immediate help to breathe. This may involve encouraging breathing or helping the baby's heart to pump blood around their body. The baby may need to be taken to another location (e.g. neonatal unit) for further care and tests.