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, your health care providers will monitor the baby's heart rate. While fetal heart monitoring does not prevent a problem from occurring, but changes in the baby's heart rate can help to alert the health care provider that something might be wrong.

• Auscultation: In this technique, 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: In this method, your health care provider straps an ultrasound transducer over your abdomen that will pick up 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 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. A small clip is placed on the baby’s scalp to directly monitor the fetal heart rate.
• Internal contraction monitoring: To gauge the strength of your contractions,a small catheter (Intrauterine pressure catheter or IUPC) is placed in your uterus. Combined with an internal fetal monitor, an IUPC may give a more precise reading of the baby's heart rate and your contractions.
  

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 uses a soft plastic cup that 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, or has a medical problem that makes it dangerous for her to push
  

Review Date: 2/20/2007
Reviewed By: Douglas A. Levine, MD, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY. Review provided by VeriMed Healthcare Network.

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