Common Obstetric Procedures
| Procedure | Description | Purpose[s] | Indicated or Desirable if: | Optional if All is Normal | Not Necessary or Desirable if: |
| Enema in early labor* | Spout attached to bag of watery solution is gently inserted into anus. Solution empties into intestine. You hold it in, then expel it into toilet or bedpan |
To empty your bowels | You are constipated and it is slowing labor | Yes * | You have emptied your bowels early in labor. You do not mind passing some feces during late labor |
| Intravenous Fluids | Bag containing special hangs by bed. Tube from it is inserted into vein in hand or arm | To ensure that you remain hydrated without drinking fluids. To provide a route to administer medication |
Labor is very long. You have continual nausea and vomiting You were given regional anesthesia You received oxytocin to speed labor | Yes* | Labor is not prolonged You can drink and hold down fluids |
| Fetal Scalp Blood Sampling | Blood sample is drawn from baby’s scalp during labor. Tested for oxygen and carbon dioxide levels and Other factors. Takes two to thirty minutes to get results. | To confirm whether fetal distress observed on monitor is real To help decide if a caesarian is necessary | Interpretation of monitor tracing is unclear There is strong desire to avoid caesarian section | Yes | Baby’s heart rate seems normal. Doctor feels there is no time to wait for results. Hospital does not have facilities to do lab work. Mother has infection and use of procedure would increase chances of baby catching it. |
| Electronic Fetal Monitoring [extreme or internal]* | External: Two belts around your waist. One contains ultrasound device to detect baby’s heartbeat. One contains device to detect contractions. Both connected to machine that records baby’s heart rate and contraction strength Internal; Two devices placed into uterus via vagina. One is attached to baby’s scalp and detects pulse; the other picks up contractions. Internal method is more accurate than external. |
To provide continuous recording of fetal heart tones and the contraction pattern. | You received oxytocin A nurse or midwife cannot be with you continuously There are doubts about the baby’s condition *[many obstetricians feel that all laboring women should be monitored] | Yes* | [Highly controversial] |
| Artificial Rupture of Membranes [breaking the bag of waters] | On vaginal exam, doctor inserts long “amnihook”and painlessly breaks bag of waters. Gush of fluid flows | To speed labor To check amniotic fluid for meconium, infection or bleeding To apply electronic fetal monitor | Labor is prolonged Fetal distress is suspected Internal electronic fetal monitoring is to be used | Yes | Labor progress is normal Fetal heart rate seems to be reassuring |
| Pain Medications | Injections containing drugs given into skin, muscle, or intravenous tube. Also, medications can be injected into area of spine or pelvic floor to decrease pain and cause numbing. | To reduce labor pain To enhance sleep or relaxation | Painful procedures need to be done Labor progress is slowed by mother’s anxiety You want them | Yes | You do not want them You are coping well using alternatives to pain medication Labor progress is normal |
| Vaginal Exams | Doctor or nurse washes hands, puts on sterile glove, and inserts two fingers into vagina to feel cervix and baby’s head | To determine labor progress [dilation and thinning of cervix, descent of baby] |
Labor is prolonged. Decisions are about to be made on interventions and medications | To some degree | Vaginal examinations are necessary to determine the progress of labor. However, an excessive number of vaginal exams during labor is undesirable because bacteria may be introduced into the uterine cavity, which may lead to infection |
| Intravenous Oxytocin | Oxytocin [a hormone causing uterine contractions] is given in the same way as intravenous fluids. Amount given is precisely controlled with special infusion pump | To contract the uterus to start or speed up labor To contract the uterus after the birth | You are well beyond your due date Inadequate contractions have caused slowing of labor There is excessive postpartum bleeding | Yes | Labor is normal or extremely intense Pregnancy is not yet at term Placenta delivery is normal. Uterus is contracting well |
| Restriction to Bed | Mother kept in bed, sometimes in only one position | To lower blood pressure To provide rest To slow labor contractions | Blood pressure is elevated Premature labor is threatened A particular position benefits the fetus who is thought to be in distress | Yes | Labor is normal Fetus is normal |
| Vacuum Extraction | A suction device is placed on baby’s head. Doctor pulls on it during second stage contractions to assist of speed birth. | To speed delivery when necessary | Medications have reduced your pushing effectiveness The baby’s size or position is slowing delivery Fetal distress is suspected | Not used in normal cases | Baby’s decent is normal and there is no fetal distress |
| Use of Forceps | Two steel instruments [spoon-shaped at one end, with long handles] are placed in vagina on either side of baby’s head and locked together. Doctor pulls during second stage contractions to assist or speed difficult birth. [Doctor’s preference usually dictates choice between forceps and vacuum extractor] |
To speed delivery when necessary | Medications have reduced your pushing effectiveness The baby’s size or position is slowing delivery Fetal distress is suspected | Not used in normal cases | Baby’s decent is normal or use of vacuum extractor is successful Baby is high in the birth canal |
| Episiotomy* | Surgical cut between vagina and anus to, done shortly before delivery. Done with or without anesthesia |
To enlarge vaginal opening to speed delivery or take pressure off baby’s head To try and avoid a tear in the perineal tissues.* |
Fetus is in distressPerineum is rigid and unable to stretchYour doctor wants to prevent a tear | Yes* | Progress in delivery is good Your perineum will stretch Your fetus is doing well. You want to avoid an episiotomy |
| Cesarean Section | Surgical incision in abdomen and uterus to remove baby. Done with patient under anesthesia. | To deliver the baby without completing labor: If vaginal birth is dangerous or impossible if there are emergency problems for mother and baby |
Hemorrhage is present True fetal distress is suspected Cord prolapse is suspected. Labor has failed to progress. Position or size of baby will make delivery hazardous. Presentation is breech.This is a multiple birthYou have a certain illness that would make vaginal delivery hazardousA difficult forceps delivery is the alternativeThere is placenta previa | Not used in normal cases | Labor progress is normal and the fetus is not in distress Problems can be resolved with less risky procedures. |
| Suctioning of Newborn’s Breathing Passages | Tip of rubber suction device is placed in each nostril and then in mouth to suck mucous and fluid from airway. Done as head appears or immediately after birth. A longer tube may be inserted via nostril down into windpipe to remove deeper secretions. |
To clear the airway To remove the liquids and meconium that might impair breathing | Baby passed meconium into amniotic fluid before birth Baby is not breathing well Baby cannot cough or sneeze to rid airway of secretions. Baby has excess secretions in nose and throat | Yes, though most babies are suctioned with bulb | Baby is breathing well There were no signs during labor that baby might develop problems |
| Baby Placed in Warming Unit | Baby placed in special bed with heater above. Thermometer taped to baby’s skin turns up heat if baby cools |
To maintain or increase baby’s body temperature | Baby’s body temperature drops Observation in nursery is deemed advisable. Baby is premature | Yes | Baby can be placed skin to skin with the mother and covered with hat and warm blanket Parents want time with normal baby |
| Eye Care With Antibiotic Ointment or Silver Nitrate Drops | Medication placed in each eye of baby within the first hour of life | To prevent infection and blindness due to Gonococcal and chlamydial organisms sometimes present in vagina | Infection is present [State and provincial laws require it] | No, all states and provinces require it | |
| Bottle Feeding of Water, Glucose Water, or Formula | A substitute for breastfeeding | To “wash out” jaundice* to provide calories and liquid before milk comes in* To check baby’s ability to swallow*To feed baby if you are unwilling or unable. | You do not wish to or cannot breastfeed Tour baby has phenylketonuria [an inability to tolerate the protein in breast milk] or other rare problem in digesting breast milk. | Yes | You wish to establish breastfeeding You wish to avoid nipple confusion between breast and bottle for your baby |
| Limited time with baby | Baby is taken to nursery and cared for by nurses, except at certain times spent with mother | To let you rest To observe a sick or premature baby | Baby needs observation or special care You are unable to care for your baby | Yes | You wish more time to become acquainted with your baby and to become skilled in baby care and feeding |
| Circumcision | Skin is separated from end of penis and removed with surgical knife or tied to special plastic “bell” device [foreskin will drop off in days]. Usually done without anesthesia |
To remove the foreskin from a baby boy’s penis | Religious or cultural beliefs require it You prefer the appearance and ease in cleaning of the circumcised penis | Yes* | You wish to avoid the pain and risk of the surgery You prefer the appearance of the uncircumcised penis8 Your child’s penis is abnormal in structure. The baby is ill |
* Hospitals and doctors vary on this. For some it is optional; others believe every woman and baby should have it. You will need to investigate the policies in your area.