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Labour & Delivery

Dr Kylie Isaacs chooses to offer Labour and birthing options at Buderim Private Hospital, Buderim.

It is important to recognise the signs of labour. When you are experiencing regular contractions, coming every 5 minutes or you have ruptured your membranes (‘waters’) you should ring either the rooms or the midwives in the Maternity Unit at Buderim Private Hospital on 5430 3303 or 5430 3152 and they will advise you what to do.

When you present in labour, Dr Kylie Isaacs will assess you initially and then at regular intervals during the labour until the baby is born. When Kylie is not there the midwives supervising your care with her will pass on any concerns. Together with Kylie you will make all the major decisions regarding your obstetric care.

The midwives are given clear instructions on when to call DR Kylie Isaacs. This will ensure that Kylie has time to attend your birth. On the rare occasion, She may miss a birth. This often means that the labour and birth has progressed quickly and efficiently.

Pain Relief in Labour

The pain experienced through childbirth varies between women and so too does the desire or requirement for pain relief.

Psychological Support

  • Some women find the breathing and relaxation techniques taught in antenatal classes are all they require.
  • Hypnobirthing and Calmbirthing techniques have also been shown to reduce the need for pharmacological pain relief.

Sensory Stimulation

  • Sensory stimulation, e.g. massage, TENS, sterile water injections, use innocuous stimulation to compete with painful stimuli.

Opioids

  • Pethidine and Morphine are usually given as injections into the muscle.
  • Fentanyl and alfentanil are shorter acting and are often given through a patient controlled analgesia pump (PCA).
  • Opioids are often more effective in early labour where they have a sedative effect. They work less well in later stages of labour at which time they may also be associated with breathing difficulties in the baby.

Nitrous

  • Nitrous has been shown to be effective in 50% of women in early labour.
  • It can also be used as an adjuvant with other local anaesthetic for forceps delivery, perineal repair and manual removal of placenta.

Perineal Infiltration

  • Interrupts pain transmissions from the nerves to the outer parts of the vagina.
  • Useful for the repair of perineal tears sustained during birth.

Epidural Anaesthetic

  • One of the most effective methods of pain relief for labour and birth.
  • Analgesia titrated as required and topped up for operative birth, such as, caesarean, forceps or vacuum assisted birth.
  • Adequate sensory analgesia with minimal motor blockade is the goal, to allow a sense of pressure, without pain, with each contraction.

Water Immersion

  • Women using warm water immersion (either bath or shower) have a significant decrease in the need for other forms of analgesia.
  • Warm water immersion and water birth are available at Buderim Private Hospital with guidelines to ensure safety of our mums, babies and staff.

VBAC ‘Vaginal Birth After Caesarean’

VBAC refers to the birth of a baby through the vagina during a subsequent labour after Caesarean birth. With careful selection of patients and good obstetric care, VBAC can be successful and safe.

Benefits of VBAC

  • Quicker recovery and shorter hospital stay
  • Avoidance of complications related to surgery, e.g. Clots in the legs
  • Lower risk of complications, such as, bleeding and infection when compared to repeat caesarean section
  • If successful, it facilitates vaginal birth for subsequent babies

Risks of VBAC

  • Small risk (1 in 200 VBAC attempts) of uterine rupture related to the force of the contractions during labour and the pressure on the scar. In those women who have a uterine rupture:
    • It may be life threatening to mother and baby, and an emergency caesarean section will be necessary
    • 1 in 10 risk of requiring a Hysterectomy (following uncontrollable bleeding)
    • 1 in 20 risk of still birth
    • Need for emergency caesarean section due to failure to progress, uterine rupture or foetal concerns

Unsuitable conditions for VBAC

  • A ‘Classical’ scar or inverted-T uterine scar
  • The position of the uterine scar is unknown
  • When a woman does not wish to have a vaginal birth
  • Following some types of previous uterine surgery
  • Previous rupture of the uterus
  • Unusual shape of the pelvis
  • A baby in transverse position
  • The baby appears too big to pass through the birth canal
  • Presence of a medical condition that may complicate labour
  • Any other contraindications to labour

Women who are attempting vaginal birth after caesarean section are monitored throughout the labour to ensure both the wellbeing of the mother and of the baby. This is done by continuous CTG monitoring of the baby’s heartbeat and monitoring contractions, any bleeding or any pain between contractions.

Success rates for suitable women are high and as mentioned will result in a shorter hospital stay and recovery.

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