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Sometimes, there is a strong feeling of an imminent bowel motion. What should I do?
This is quite common. Again, it is the effect of the pressure of the baby in the birth canal transmitted to the rectum, which is immediately adjacent. Even when the rectum is empty, a strong feeling of an imminent emptying of the bowel may be there. Many women find this hard to cope with because, culturally, opening the bowels is a very private thing. It should really never be a worry because midwives and doctors are used to it and half-expect it to happen anyway. Ideally, a woman should go in labour with an empty rectum but this does not always happen and should never be a cause for worry.
Sometimes, when a woman is seen in the latent phase of labour and is examined vaginally, a loaded rectum may be felt. Since there is still time, a suppository or even an enema may then be administered, to facilitate a bowel movement before the establishment of labour.
Sometimes a midwife uses a catheter to empty the urinary bladder; is this really necessary?
Yes, sometimes this is necessary. A full bladder may impede both contractions and the descent of the baby down the birth canal. In the first stage of labour, normally the woman will be encouraged to pass urine herself from time to time. If an epidural has been used, then she may lose the sensation and therefore a catheter will be left in place to continuously drain the urine.
In the late first stage and in the second stage, it is usually impossible for the woman to pass urine herself. If her bladder is rather full, then a catheter may need to be used for the reasons explained above.
Is an episiotomy always necessary?
An episiotomy is the incision or cut that is made on the perineum to increase the size of the opening, thereby facilitating delivery. It is not always necessary. To do or not to do an episiotomy is one of the most important (and quick) decisions the person assisting delivery has to make.
An episiotomy will prevent a perineal and/or vaginal tear and also hasten delivery. It is also believed to prevent future urinary problems, to some extent, by protecting the pelvic support muscles from damage that may be caused by overstretching.
It is, however, unnecessary to perform an episiotomy where progress in the second stage is smooth and the risk of a tear is deemed minimal.
It is impossible to be precise every time in this assessment and sometimes the judgement is wrong and a tear occurs where it was least expected.
An episiotomy will prevent a perineal and/or vaginal tear and also hasten delivery. It is also believed to prevent future urinary problems, to some extent, by protecting the pelvic support muscles from damage that may be caused by overstretching.
It is, however, unnecessary to perform an episiotomy where progress in the second stage is smooth and the risk of a tear is deemed minimal.
It is impossible to be precise every time in this assessment and sometimes the judgement is wrong and a tear occurs where it was least expected.
It is said an episiotomy is mandatory in the first pregnancy (vaginal delivery). Is this true?
It is never wise to be dogmatic in these things.
The truth is, many, if not most first-timers will have an episiotomy, but there is a significant minority where this will be correctly judged to be unnecessary. It is up to the midwife or doctors assisting in the delivery to make that decision rather than hide behind a blanket policy. By the same token, some mothers who have had a previous baby may require an episiotomy.
With forceps delivery, an episiotomy is necessary, regardless of the number of past deliveries. This is because the risk of a tear is quite high with this method of instrumental delivery.
With forceps delivery, an episiotomy is necessary, regardless of the number of past deliveries. This is because the risk of a tear is quite high with this method of instrumental delivery.
