Interventions during labour

An intervention is an action your doctor or midwife may recommend during the birthing process to help with the birth of your baby. Interventions during labour can help keep you and your baby safe.

In Australia you have the right to be informed and make decisions about what happens during your labour and birth. Talk to your doctor or midwife so you understand your options and what is right for you.

During labour and birth you might need an intervention to:

• induce labour (help start your labour)
• augment labour (support your labour while it progresses)
• directly help your baby be born

There are many reasons your doctor or midwife might recommend an intervention during labour, including if:

• you have a health condition that puts you at a higher risk of complications during labour
• you have had complications during your pregnancy or labour
• your waters have broken but you have not gone into labour
• your labour is progressing very slowly
• your baby is in a position that will make vaginal birth more difficult
• your baby is showing signs of distress

It's a good idea to think about how you would like to give birth before your labour begins. This can help you create a birth plan. Discuss your birth plan, including the possibility of interventions during labour, with your doctor, midwife and birth partner.

If you aren't sure whether you want an intervention, ask your doctor or midwife for more information to help you decide. Many women also find it helpful to involve their partners or other support people when making a decision.

It can help to bring a written copy of your birth preferences or birth plan with you to the hospital or birth centre. Particularly if you are not receiving continuity of care (seeing the same doctor or midwife throughout your pregnancy).

A written birth plan helps the team caring for you quickly understand your preferences, including how you feel about different interventions during labour.

However, it is not always possible to have total control over what happens during labour and birth. Your body and your baby may have plans of their own.

Different types of intervention can help at different stages of labour and birth.

The intervention recommended will depend on:

• your health
• your baby's health
• what stage of pregnancy you are
• the state of your cervix at the time

Induction of labour

Induction of labour is when your doctor or midwife tries to start your labour, instead of waiting for your body to go into labour by itself.

There are a few ways your doctor or midwife could do this, including:

• using intravenous medicines (medicines given through a vein) to cause contractions
• using medicines placed in your vagina to help prepare your body for labour
• artificial rupture of membranes (breaking your waters) by making a small cut in the amniotic sac

It's common to need a combination of induction methods for a successful induction.

Augmentation of labour

Augmentation of labour is an intervention to help your labour progress (keep going). This is done with intravenous medicines (medicine given into a vein). The medicine stimulates your uterus to increase the frequency or intensity of your contractions.

Augmentation of labour may be used when your labour starts naturally, but the contractions are not strong or regular enough to progress labour.

Other things you can try to help your labour progress include:

• changing position
• moving around and being active
• relaxation techniques
• pain relief

Assisted birth

Assisted birth is also known as instrumental delivery. It involves your doctor or midwife using forceps or a vacuum cup (ventouse). An assisted birth can help your baby descend (come down) through the birth canal during a vaginal birth.

It's important to discuss with your doctor or obstetrician the options for assisted birth. You have the final say on which method of assisted birth is used.

Episiotomy

An episiotomy is a cut made in the area between your vagina and anus (perineum). This is done to make the vaginal opening bigger. It's sometimes recommended during an assisted birth. It can help if your baby is distressed and needs to be born quickly.

Caesarean

A caesarean section, also known as a C-section or caesarean birth, is an operation in which your baby is born through a cut in your abdomen and uterus. Caesarean births may be elective (planned) based on your and your baby's circumstances. A caesarean section may also be performed during labour. This is known as an emergency caesarean.

Your doctor or midwife may recommend an emergency caesarean if:

• your labour is not progressing
• there are signs that your baby is distressed
• a complication has occurred that may be life-threatening for you or your baby

If you choose not to have an intervention during labour, you can keep trying to birth your baby on your own. Your doctor or midwife will give you information about the risks and benefits of intervention during labour versus the risks and benefits of having no intervention.

As your labour progresses, you and your healthcare team can review your options again.

In most situations when your doctor or midwife suggests an intervention, there will be time for them to explain why it's recommended. In Australia, your healthcare rights mean that you can ask questions and make decisions about your labour and birth.

Some questions you may wish to ask include:

• Why has this intervention been recommended?
• What does the intervention involve?
• What are the potential risks of having the intervention?
• What are the potential risks of not having the intervention?
• What are the potential risks of waiting and reconsidering the intervention a bit later (a 'wait and see' approach)?

An intervention is only done when you give informed consent. To give consent, you must be given enough information about your options to make the right decision for you and your health.

Your doctor or midwife is legally required to act in your and your baby's best interest, unless you have made other wishes clear.

Emergency situations

In an emergency, your doctor or midwife may make choices on your behalf to protect your health or your baby's health. Where possible, your doctor or midwife will try to discuss the reasons for this with you.

If you don't want certain lifesaving interventions (for example, blood transfusions), even in an emergency, it's a good idea to record your wishes in an advance care directive. Make sure your healthcare team is aware of your wishes before your labour begins.

If I am unconscious

If you are unconscious, your doctor or midwife may discuss this with your partner or family to understand your preferences.

Once you regain consciousness, your healthcare team will talk you through what was done and why it was needed.

If I speak a language other than English

If English isn't your preferred language, your healthcare team must offer you a medical interpreter. This is to help you understand the information and make informed decisions.

You can request an interpreter at any time during your pregnancy, labour or after birth.

Learn more about informed consent and your rights when having a baby.

The risks associated with choosing not to have a particular intervention will vary depending on your situation.

Interventions are recommended because your doctor or midwife considers that they are in your or your baby's best interest.

Ask your doctor or midwife to explain why they suggest an intervention. Ask about any potential risks to you or your baby if you choose not to go ahead with a recommendation.

The Royal Australian and New Zealand College of Obstetrics and Gynaecologists has a pamphlet outlining the various options during labour and birth.

Learn more about informed consent on the Australian Commission on Safety and Quality in Healthcare webpage.

Languages other than English

The Royal Women's Hospital has resources available in various languages, including information on:

• variations to spontaneous labour and birth
• assisted birth
• induction of labour
• caesarean birth