One of the most keenly anticipated phases of pregnancy is childbirth for an obvious reason. It is the stage where all the preparations, investments and expectations are suddenly replaced with the birth of a child. From what initially looks difficult to comprehend, there is a baby crying in the cot. For most women, pregnancy will progress without ill incidents and labour will start spontaneously at term. The baby is then delivered with little assistance. In some pregnancies, the process of parturition is started artificially because continuation of the pregnancy endangers either the mother or the baby or both. Others may have the process of labour interrupted by a Caesarean section because there is a sudden change in the condition of the mother and baby, which requires immediate delivery. A small proportion will be booked for an elective caesarean birth because the risk associated with a vaginal birth is high.

1. Dr. Henry Osazuwa
M B B S ( B e n i n ) , F WA C S ( O & G )
Consultant Obstetrician/Gynaecologist
The 5 Important Factors in
Selecting the Safest Route for
Childbirth

3. Childbirth is a timely end to ALL our expectations

4. Others - Caesarean section
Planned or Unplanned
Majority of pregnant women will have a Vaginal birth

5. The safest route maybe straight-forward
Should involve careful and timely decision
Couple’s input is always essential

6. The notion of what is normal has changed
Safetyfor the mother and baby

7. The uterus is a good learner.
Women with previous vaginal birth
are encouraged accordingly.
First timers are also encouraged
to do same.
When to anticipate Normal vaginal delivery

8. Presentation - Head
Weight - < 3.5 kg
No Foetal or Maternal complication
Type of CS is less important unlike in the past
One (1) previous CS – Carefully selected (50 – 60%)

9. General favourable features vaginal birth.
Previous Vaginal birth
Cephalic – Head
Foetal weight < 4kg
Maternal height > 1.5 meters.

10. Labour can go on for hours.
Be patient & mentally prepared
- to avoid unnecessary Intervention.
Companionship & Support
PARTOGRAPH

11. Often refers to the use of medications to start labour
Induction of Labour maybe necessary
There are Non-medications procedures like membrane stripping

12. When continuation of the pregnancy – Endangers the mother
or baby.
No contraindication to vaginal delivery.
Adequate explanation and education.
When done properly, the experience is similar to natural labour.

13. Important indications
Prolonged pregnancy –
Induction carried out at 41+ 3
weeks.
Rupture of foetal
membranes
Elevated blood pressure
Anaemia
Rhesus negative mothers

14. Two (2) or more Caesarean sections.
Previous uterine surgeries - Myomectomy
When vaginal delivery is CONTRAINDICATED
Successful vaginal delivery maybe be possible, but risk to the
mother and baby is high
Risk for uterine rupture
3%
12%
1 CS 2 CS
Babies don’t do well when rupture occurs
- Asphyxia/Death

15. When vaginal delivery is CONTRAINDICATED
Abnormal presentation/Lie – Breech presentation; Transverse lie.

16. Placenta praevia
Previous major perineal injury with successful repair

17. When the preparation is <24 hours.
The labour progress may cease.
Emergency Caesarean section
Baby is big for the pelvis or the pelvis is narrow.

18. Baby is distressed – Oxygen delivery is poor.
Umbilical cord can fall out through the cervix/vagina.
Placenta can separate prematurely.

19. Preterm birth
Birth of a child before 37 weeks.
Problems expected < 34 weeks.
Asphyxia
Poor lung development
Jaundice
Infection

20. < 30 weeks – Mode of delivery has little effect on outcome.

21. > 30 weeks – Important factors to consider.
Foetal presentation – Breech or cephalic
State of the mother and baby.

22. Birth in a hospital with Neonatal care facilities is mandatory
Paediatrician.
Incubator.
Laboratory support.