Procedures that may take place during labor and delivery

Once you arrive at the hospital in labor, there are various procedures that may be done. Your health and the baby's health will be monitored while you are in labor. In some cases, it is necessary for the doctor to assist with the delivery using forceps or vacuum extraction.

Fetal Monitoring During Labor

In order to check the well-being of the baby while you are in labor, the baby's heart rate will be monitored. While fetal heart monitoring does not prevent a problem from occurring, changes in the baby's heart rate can help to alert the doctor or nurse that something might be wrong.

• Auscultation: This term refers to when the nurse or doctor listens to the baby's heart at set intervals during labor. They will either listen to the heart rate using a stethoscope (putting it on your abdomen), or they will listen by ultrasound (which will amplify the sound of the heartbeat, and be monitored and recorded after a contraction at set times).
• External electronic fetal monitoring: This method is done by strapping an ultrasound transducer over your abdomen that will pick up the sound of the baby's heartbeat. The heartbeat will be recorded continuously on a paper strip. There will be another device strapped on top of your abdomen -- a pressure gauge that measures the frequency and power of your contractions. The combination of these two measurements will provide detailed information as to how your baby is doing during labor.

figure 1

• Internal electronic fetal monitoring (fig. 1): An internal monitor can only be used once your "water has broken" and your cervix has dilated enough. This method is performed by inserting a small, spiral-shaped electrode (Fetal scalp electrode or FSE) into your vagina and attaching it to the baby's scalp to record the fetal heart rate. Usually a small catheter is placed in your uterus to measure the strength of your contractions (Intrauterine pressure catheter or IUPC). This type of monitoring may give a more precise reading of the baby's heart rate and your contractions compared to external monitoring.

Assisted Vaginal Delivery

figure 2

There are times when it is necessary to help the delivery along using forceps or a vacuum extractor (fig. 2). Forceps resemble two large salad spoons, and the doctor uses them to guide the baby's head out of the birth canal. Vacuum extraction is a soft plastic cup that looks similar to an ice cream cone, and it is applied to the baby's head and stays in place by suction. There is a handle on the cup that allows the doctor to use this to assist with delivery through the birth canal. The choice between using forceps or a vacuum extractor is usually made by the doctor.

These methods are sometimes used during:

• Signs of fetal distress
• Prolonged second stage labor
• A difficult delivery due to the baby's position
• The mother is too tired to push

Studies have shown that assisting with delivery this way does not pose any greater risk to the mother or the baby than a C-section.

When applied properly, forceps or vacuum deliveries would very rarely cause any permanent injury to the baby. The forceps' marks on the baby's cheeks usually disappear in a few days. Very rarely, the baby's facial nerves may be temporarily injured. The resulting drooping of facial muscles almost always recovers completely in a matter of weeks. Caput succedaneum is diffuse swelling of the scalp due to molding after prolonged labor. A vacuum delivery may leave a more noticeable caput. Caput usually disappears in 2-3 days.

Review Date: June 29, 2001
Reviewed By: Peter Chen, M.D., Obstetrics and Gynecology, University of Pennsylvania School of Medicine. Review provided by VeriMed Healthcare Network.

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