Delivery and Pain Relief Options

Expecting the birth of a new baby is one of the most exciting, yet uncertain times in a mother’s life. That’s why Dr Ljiljana ensures that all her patients understand their options where it comes to delivery and pain relief.

Ideally, we’d all like to be able to follow our birth plan perfectly, but sometimes life has other plans and it’s important to be prepared for alternative delivery methods.

Advantages of Private Obstetrician:

Choosing a private obstetrician comes with many benefits, the main benefit is that you will be able to choose your obstetrician and have them by your side from when you first discover you’re pregnant till the day your little one arrives. This means that you can form a relationship with your doctor; someone who will know every detail about your medical history, the health of your pregnancy and your birthing preferences.

You will also be able to see your obstetrician at a time that is convenient for you before the birth for regular check-ups and the postnatal period.

When you choose Dr Ljiljana, you also have the choice of having your baby at a private hospital or as a private patient in a public hospital.

As a private patient you will deliver your baby at Newcastle Private Hospital, where you will have the privacy of your own room, great food, a longer and more relaxed stay as well as more personalised one on one care – this includes access to extra support such as breast feeding assistance.

If you choose to be a private patient in John Hunter Hospital, most of the time you will get a single room but this is not guaranteed.

Types of Delivery:

Dr Ljiljana believes you should have the birthing experience you want and offers a variety of delivery options to choose from:

  • Vaginal Delivery:

Vaginal births are the most common and natural option you can choose from, where the baby arrives via the birthing canal, and Dr Ljiljana recommends that you plan for a vaginal birth unless there is a medical reason for a Caesarean.

The benefits include shorter hospital stays, lower infection rates, quicker recovery and a lower risk of respiratory problems for your baby.

  • Caesarean Section (C-Section):

Whether elected or performed as an emergency procedure, a Caesarean Section is the delivery of a baby through a surgical incision in the mother’s abdomen and uterus.

There are a few cases where Dr Ljiljana may recommend a C-Section, which will be planned in advance, these include:

  • Having multiples – twins, triplets, etc.
  • Cephalopelvic disproportion (CPD) – when the baby’s head or body is too large to pass safely through the mother’s pelvis
  • Previous C-Sections or other uterine surgery or conditions
  • Baby is in breech or transverse positions
  • Placenta previa – where the placenta is low in the uterus covering the cervix
  • Fibroids or other large obstructions

Emergency Caesarean delivery might be needed where the following conditions arise during labour:

  • Failure of labour to progress
  • Cord compression – the umbilical cord is being compressed because it is looped around the baby’s neck or body, or caught between the baby’s head and the mother’s pelvis
  • Prolapsed cord – the umbilical cord comes out the cervix before the baby. Should this happen at home call an ambulance immediately as this can be life threatening
  • Abruptio placentae – Is a life threatening condition where the placenta separates from the wall of the uterus before the baby is born
  • Your baby may develop heart rate patterns that could present a problem where it can no longer tolerate labour and a C-Section delivery is required.

• Vaginal Birth After Caesarean (VBAC):

Due to advances in modern medicine, vaginal births after a Caesarean Section are now possible in many cases. Your chances of a vaginal delivery are greatly increased if you meet the following criteria:

  • A low transverse incision was made into your uterus during your C-Section
  • Your pelvis can accommodate a normal-sized baby
  • You are not having multiples
  • Your first Caesarean section was performed for breech presentation of your baby
  • It is important to discuss the option of VBAC with Dr Ljiljana as a pregnancy complication or underlying condition may prevent the possibility of a successful VBAC.

• Assisted Delivery Methods:

While vaginal delivery is often straightforward and uncomplicated, it often requires the assistance of your obstetrician and her team, which varies from the use of medicines and medical instruments to emergency delivery procedures.

  • Vacuum Extraction: – A soft or rigid cup with a handle and vacuum pump is applied to the baby’s head during vaginal childbirth to help guide the baby out of the birth canal. The vacuum can leave a bruise on the baby’s head, which typically resolves over the first 48 hours.
  • Forceps Delivery: – An instrument shaped like a pair of large salad tongs is sometimes required during vaginal delivery to assist the baby’s head through the birth canal.
  • Episiotomy: – A surgical incision made in the area of skin between the vagina and anus call the perineum helps enlarge the vaginal opening to allow the baby’s head to pass through more easily and prevent tearing the mother’s skin.
  • Amniotomy: – Dr Ljiljana uses an amnicot which is a finger stall with a plastic hook at the end (much less invasive than your classic amnihook) to artificially rupture the amniotic sac that contains the fluid surrounding the baby. This can be done before or during labour to induce labour, place an internal monitor to assess the uterine contraction pattern or the infant’s wellbeing and/or check for meconium. Once the procedure is complete, delivery should take place within 24 hours to prevent infection.
  • Induced labour: – In the cases of pregnancies with medical problems or other complications such as diabetes, high blood pressure, ruptured membranes, small baby or past due date, induction of labour is often recommended. Labour is usually induced using a synthetic form of the drug oxytocin which is given intravenously.
  • Foetal monitoring: – This is the process of watching the baby’s heart rate during labour and can be done externally using an ultrasound device placed on your abdomen or internally using a small electrode attached to the baby’s scalp.

Pain Relief Options For Childbirth:

Labour and childbirth is usually a painful experience and every woman responds differently to how they would like to manage that pain. Some women prefer to avoid drugs and other medical interventions, however it is always good to be aware of the options available for pain relief, particularly if this is your first baby.

• Non-medical pain relief options

There are a few things you can do before and during labour which may help you cope better with pain and reduce anxiety. These include:

  • Gentle exercise throughout pregnancy
  • Attending antenatal classes to educate you on what to expect
  • Breathing techniques
  • Constant, support from your partner or loved one for the duration of labour
  • Playing music to take your mind off the pain
  • Massage, wheat bags, ice, warm showers or baths
  • Hynobirthing
  • Acupuncture and acupressure
  • Transcutaneous electrical nerve stimulation (TENS)

• Medical pain relief options

  • Nitrous oxide (laughing gas) – This is a great option for those who would like to take the ‘edge’ off the intensity of each contraction while still remaining in control. The other advantage is that it does not linger in either the mother’s or baby’s body.  Nitrous oxide however can cause nausea/vomiting, confusion/disorientation or lack of pain relief.
  • Pethidine: – A strong pain reliever, which is injected into the muscle of the buttock and can last up to four hours. Pethidine does provide good pain relief for some women and does not affect the baby if it is given not too close to the birth.  Pethidine does have some possible side effects on the mother such as nausea, disorientation or difficulty breathing.
  • Epidural anaesthesia: – This is the most common and effective pain relief option available, used for both vaginal and Caesarean births because they allow the mother to stay awake and alert during the birth. An anaesthetic is injected into the lining of the spinal cord through the back, making the mother feel numb from the waist down. The baby’s heart rate is then monitored continuously through labour.

If you have any questions regarding the delivery of your baby, please don’t hesitate to contact Dr Ljiljana for advice.