Debby Gould
AS A MIDWIFE I place a high value on normal birth. However, the reality is that many women will need an instrumental delivery. For some women this can result in feelings of disappointment, failure and loss of control. Childbirth is a peak life experience for women, for many it is a rite of passage into womanhood. As such it has huge implications for the woman's sense of self-esteem.
Since Winterton (l992)(1) and Changing Childbirth (1993)(2) there has been overt acknowledgment of the need for psychological and social needs to be placed alongside issues of safety. However, from my experience of working on a busy labour ward, I suggest that this is not usually the case once obstetricians are involved in the birth. In my experience, when operative delivery becomes necessary many obstetricians take over completely. The maternity care team (midwives included) then become so focused on the task of delivering the baby that the psychological needs of the woman are disregarded and the important intimacy of the birthing moment is forfeited in the name of safety.
Yet, recently, I was privileged to work with an obstetric registrar who demonstrated how it is possible to restore a degree of control over the birth process to a woman needing a Ventouse delivery. With just a little thought and respect for the moment of birth, her experience was transformed.
A Case History
I had first met Janet (not her real name) concerned the previous night when she was admitted to the labour ward with a history of painful contractions for most of the day. It was her first baby. It was now l0 am the following morning. Although Janet had a good working epidural she was very tired and demoralised. Concern over the fetal heart rate pattern led to an obstetric decision to deliver the baby by Ventouse extraction. The obstetric registrar calmly discussed with her the need for early delivery of the baby. Everything was then prepared. The atmosphere in the room remained calm and relaxed, Janet was kept informed of every stage of the birth process. The obstetric registrar then used the Ventouse equipment to bring the baby’s head down to the perineum whilst encouraging Janet to push. The suction cap was released between contractions.
The striking difference between this and other Ventouse deliveries at which I have been present then occurred. Just prior to the moment of crowning the registrar removed the cup from the baby’s head, telling Janet gently that she no longer needed his help as she could give birth herself. She then pushed the head out easily with the next contraction and her baby’s body followed soon after.
She was thrilled that she had managed to give birth ‘by herself’ after all and seemed to have a sense of achievement more commonly seen in women who give birth spontaneously.
The reason for the title of this piece is now clear. Janet had an assisted birth, which re-emphasised her active role in the birth process in what were difficult circumstances. This is different from the notion of assisted delivery with all its connotations of passivity and being done to, rather than working alongside the labouring woman.
This may be a practice which is worthy of exploring further in terms of safety, efficiency and psychological outcomes for woman and their babies. Maybe this is already common practice in other units. I have seen similar instances only when the Ventouse cap came off inadvertently, not intentionally.
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AH updated 16 September 1999