Medical Interventions Explained

If your cervix is not yet dilated, labour can be induced using a balloon catheter. This is a small tube inserted into your cervix. At the end of the tube is a little balloon which is filled with fluid. The mechanical pressure from the balloon is intended to help the cervix open. Also, that pressure may release hormones which help the cervix become more ripe.

After up to 24 hours the balloon is removed (or it may have fallen out). If sufficient dilation has occurred, the membranes (waters) may then be broken.

CTG stands for cardiotocography. This method records both the fetal heart rate (“cardio”) and uterine activity (“toco”). This allows us to continuously monitor your baby’s heartbeat and see how your baby responds to contractions. This may be needed if there are concerns about the baby’s condition or if a medical intervention is underway.

External CTG: You will get two elastic bands placed around your abdomen. Under one band — over the baby’s back — a sensor called a transducer (≈10 cm diameter) is placed. It picks up the baby’s heartbeat via a display and speaker. Under the other band a pressure sensor is placed, so the frequency of contractions can be shown on the screen.
Internal CTG: If the baby’s heartbeat cannot be heard clearly via the external sensor, it may be necessary to monitor internally. In this case a scalp electrode is placed by the midwife or doctor. A tiny wire connects to the CTG device, and at the other end two small pins are attached to your baby’s scalp. The advantage of the scalp electrode is that the measurements are very accurate regardless of your position or movement. Also, you have one fewer elastic band around your abdomen. The downside: the baby has two small pins in the scalp for the rest of the labour and there is a small risk of infection. Also, an internal CTG can only be applied if the cervix is dilated and the membranes are broken.

If you are having few or weak contractions, you may receive synthetic oxytocin via an intravenous drip (IV).

Insertion of the IV: A needle is used to create a small entry in a vein in your hand or forearm, and a thin flexible tube (cannula) is inserted. The needle is removed and the tube stays in place. This tube is connected to a fluid line via a pump. The pump delivers a small, adjustable amount of oxytocin into your bloodstream. We always start with a low dose, which can be gradually increased.

The insertion of the tube may sting for a few seconds. Once the needle is removed, you should feel no pain.

Sometimes, during or after labour, you may be unable to urinate. In that case, we can empty your bladder using a catheter — a thin plastic tube specially designed for this purpose. Inserting the catheter into your urethra may be uncomfortable but should not be painful. Emptying the bladder usually takes just a few minutes.

If you receive an epidural, you will lose sensation in your bladder and won’t be able to urinate. That’s why a catheter is always placed after the epidural is administered.

We have a separate article on caesarean sections. Around 10% of women give birth via C-section — so be sure to read that article as well!

An episiotomy, or “epi”, is a small incision made in the perineum (the skin between the vagina and the anus) to help speed up the delivery.

When is it done? Most of the time, the perineum stretches sufficiently during birth. However, if your baby's heart rate indicates distress, a cut may be made to create more space, allowing the baby to be born more quickly.

Preventing tearing? There is much debate about making a preventive episiotomy. Research shows it offers few benefits. In many cases, a natural tear heals better than a cut.

Is it painful? No. Before the cut is made, the area is locally numbed so that you don’t feel the procedure.

How often? As midwives, we perform an episiotomy in less than 1% of births. In hospital births, the rate is higher — around 11%. That’s not because the doctor prefers cutting, but because hospital patients typically have medical indications (e.g. small baby, high blood pressure, twins) which increase the risk of fetal distress.

We monitor your baby’s heart rate to assess their condition. If the heart rate is too high, low, or irregular, we may need more information.

A micro blood test measures the pH level in a drop of blood taken from your baby’s scalp. A low pH (< 7.20) may indicate the baby is in distress. If so, delivery may be expedited via episiotomy, vacuum extraction, or C-section — depending on the stage of labour. If the result is normal, we can wait and avoid unnecessary intervention. If needed, the test can be repeated later.

How it’s done: You lie with legs apart. The doctor inserts a speculum into your vagina to view the baby's head. A small cut is made in the baby’s scalp, and a drop of blood is collected in a thin glass tube for immediate testing. This can only be done if you are a few cm dilated.

After birth, some women receive an oxytocin injection to reduce the risk of excessive bleeding.

Oxytocin is a hormone your body produces naturally during labour. It plays a key role in:

• Causing contractions for cervical dilation
• Helping push the baby out at full dilation
• Contracting the uterus to deliver the placenta
• Contracting the uterus post-placenta to stop bleeding

If you had a spontaneous, natural birth with no additional hormones or interventions, your body likely produces enough oxytocin to manage all of this. But if your oxytocin levels are low, or interventions were needed, we may give you an injection in the thigh right after birth.

Summary:
Purpose: Prevent heavy blood loss.
Timing: Immediately after birth or after the placenta.
When: Only when needed. We’ll discuss this with you.
Side effects: It may cause cramping — which is the goal — to help contract the uterus. Though unpleasant, it's necessary to reduce bleeding.

Sometimes extra help is needed — for example, if the baby is stressed, pushing is taking too long, or you're too exhausted to push effectively. In a vacuum extraction, the doctor attaches a suction cup to the baby's head and gently pulls during contractions, usually resulting in a birth within a few pushes.

Inserting the vacuum cup can be uncomfortable or painful, but pushing itself isn’t more painful than usual.

After birth, a mark from the suction cup may be visible on the baby’s head — it usually disappears in a few days. Some babies may have a headache; paracetamol can be given.

Note: Vacuum extraction can only be done when you are fully dilated and the baby is low enough in the pelvis. If not, a C-section may be required.

During labour it sometimes occurs that we break the membranes artificially. We only do this if there is a good reason — for example: if labour hasn’t started on its own, or dilation has stalled and extra contractions are needed, or if we want better monitoring of the baby’s condition. Sometimes the birthing person asks for it themselves in order to increase the pace of labour.

We never break membranes without a reason. It is always done in your consultation and agreed with you. If there is no clear indication, we prefer to let the membranes break naturally. That is often the most natural and safe route.

How is it done?
During an internal examination we assess whether dilation is sufficient to safely break the membranes using an amniotic‑hook. This is a thin rod with a hook at the end. You will not feel the baby being touched — you will only feel flow of amniotic fluid out of your vagina.