Types of birth

There are a few different options when it comes to giving birth. In some cases, you might be able to choose how you give birth to your baby as part of your birth plan.

Sometimes the way you choose to give birth may have to change due to an unexpected medical problem, as is the case in an emergency caesarean or assisted birth.

Vaginal birth

A vaginal birth is when a baby is born through the vagina. You can have a vaginal birth at home, in a birth centre or in hospital. Vaginal births are supported by midwives, obstetricians and midwifery/medical students (supervised by midwives/doctors). At Leicester Hospitals, the vaginal birth rate is around 46 in 100 births.

Assisted vaginal birth

Sometimes, instruments may need to be used to make sure you have a safe vaginal birth. At Leicester Hospitals, the assisted birth rate is around 12 in 100 births. Doctors specialising in birth and pregnancy, known as obstetricians, are trained to do assisted births.

What you need to know:

• Assisted births are not possible at home or at St Mary’s Birth Centre.
• You will be supported by an obstetrician if you need to have an assisted birth
• Assisted births are less likely if you do not have any complications in your pregnancy
• Upright positions or lying on your side during labour can reduce the need for an assisted birth
• Having an epidural in labour may raise the chance of needing an assisted birth
• You may need to have a cut to your vagina to make more space for your baby to be born and prevent tearing badly (episiotomy), which will be repaired with dissolvable stitches afterwards

You might need an assisted birth if:

• There are concerns about your baby’s heart rate
• Your baby is not in the right position, such as facing upwards or to one side
• Your labour is not progressing as would usually be expected
• The midwives and doctors are worried about your wellbeing
• You are unable to or have been advised not to push during birth

What happens during an assisted vaginal birth?

• The doctor caring for you will speak to you about why they think you need an assisted birth and what it involves. Your consent will be needed before any assisted birth treatment can begin
• They will examine your tummy and do a vaginal examination to check your cervix is fully dilated. During the examination, they will check the position of your baby’s head to make sure an assisted birth is safe for you and your baby
• You will be helped into a position where your legs are supported (using leg supports on the bed)
• Your bladder will be emptied using a small tube (catheter)
• You will be given pain relief. The pain relief you are given will depend where the assisted birth is going to happen (in the birthing room or in theatre). This could be local anaesthetic or spinal anaesthetic
• Your legs and tummy will be covered in drapes to keep the area as clean as possible to prevent any infection
• You may need to have a cut to your vagina to make more space for your baby to be born and prevent tearing badly (episiotomy). This will be repaired with dissolvable stitches afterwards
• A member of the neonatal team will be present to check your baby over once they are born. You will be supported to have skin to skin contact if your baby is well
• You will be given antibiotics through a drip after your birth to reduce the chance of you developing an infection

Instruments used for assisted births

There are two instruments that are used for assisted births:

• Vacuum/suction cup (ventouse)
• Forceps

During a vacuum (ventouse) delivery

• A vacuum/suction cup, known as a ventouse, will be attached to your baby’s head using suction
• The doctor will wait until you are having a contraction and ask you to push while they pull on the ventouse to help you give birth to your baby
• It may take up to three contractions to deliver your baby’s head
• Sometimes the ventouse can detach itself and it might need to be re-applied before continuing
• A ventouse is not suitable if you are less than 34 weeks pregnant because your baby’s head is softer and more likely to be bruised by the suction cup

During a forceps delivery

• Forceps are smooth, curved, metal instruments and fit carefully around the baby’s head
• Similar to ventouse, the doctor will gently pull using the forceps whilst you are pushing during a contraction
• Some forceps are specifically designed to correctly reposition your baby for birth if they are facing upwards or to one side

Do I have a choice between ventouse and forceps?

Which instrument is used will depend on your personal situation and what is happening at that time.

Your doctor will recommend the method that is most suitable for you. If you have any concerns about the use of ventouse or forceps, you should discuss this with your midwife or doctor at any time during your pregnancy or labour.

If the use of one instrument does not work, the doctor may recommend trying the other instrument. They might recommend an emergency caesarean birth depending on your individual situation.

Caesarean Section birth 

A caesarean section is an operation to deliver the baby through a cut in the lower tummy. It may be either considered as an emergency or planned (elective) operation.

There may be some reasons why a caesarean is more likely for you depending on your medical or pregnancy history. Doctors specialising in birth and pregnancy, known as obstetricians, will carry out caesareans in an operating theatre. At Leicester Hospitals, the planned caesarean section rate is around 17 in 100 births and the emergency caesarean section rate is around 26 in 100 births.

What happens during a caesarean section?

• Most caesareans are carried out under spinal or epidural anaesthetic so that you are numb and do not feel pain. This means you are awake for the operation and your birth partner will be able to be present
• A small tube (catheter) is inserted into your bladder to drain your wee until you are able to get out of bed and walk
• Your tummy is cleaned and a screen is used so that you cannot see the operation being done. The theatre team will talk to you during the caesarean to let you know what is happening
• A cut is made along the lower tummy (usually along the bikini line)
• You may feel some tugging and pulling as the baby is delivered, although this should not be painful
• You can see and hold your baby straight away after birth if you are both well; this includes skin-to-skin contact if you wish
• Most caesareans without complications take around 45 minutes, which includes the birth of your baby, removing the placenta and stitching

Why might I need a caesarean section?

There are many reasons why your obstetrician might recommend a caesarean section due to risks to the health of either you or your baby. This might be during pregnancy or more likely during labour.

Some of these reasons include:

• If your baby is in a breech position (feet/bottom down)
• If your placenta is low-lying
• If there are concerns about you or your baby’s health
• Personal preference

If you are thinking about having a caesarean section for your birth because it is your personal preference (maternal request), you can find more information using the resources below. Please speak to your community midwife by 32 weeks of pregnancy so that they can refer you to speak to a doctor.

• Royal College of Obstetricians and Gynaecologists- Considering a caesarean birth
• National Institute for Health and Care Excellence- Risks of caesarean birth compared to vaginal birth

What are the benefits and risks of a caesarean section?

Benefits and risks should be discussed as part of an informed consent process to make sure this is the right choice for your birth.

The main benefit of a caesarean section is to deliver the baby safely under circumstances where it has been advised that there is a risk to the baby should the pregnancy or labour carry on. Or, if the mother is unwell, it might be recommended the baby be delivered to improve the mother’s health.

The main risks of a caesarean section include:

• Bleeding (and needing a blood transfusion)
• Infection
• Damage to surrounding organs such as the bladder or bowel
• Blood clots
• An accidental cut to the baby
• Breathing difficulties in the baby
• Hysterectomy (rare complication)
• Complications to future pregnancies and births

What is an elective (planned) caesarean section?

This is when your caesarean is planned before the day of your surgery. There are different reasons why you might have a planned caesarean section, such as:

• For medical reasons affecting you or your baby
• Because you have chosen this as your birth choice

A planned caesarean section is usually booked for around the 39th week of pregnancy, depending on the reason for the caesarean, which will be discussed with your obstetrician. This is to reduce effects of breathing difficulties to the baby.

Before your caesarean birth, you will have an appointment to discuss the caesarean section, pain relief and to have some routine tests taken.

At Leicester Hospitals, most elective caesarean sections are done at the Leicester Royal Infirmary. This is because there is a dedicated caesarean section list, protected surgical and anaesthetic time and allocated staffing. Some elective caesarean sections are done on the labour wards at both the maternity sites in Leicester (Leicester Royal Infirmary and Leicester General Hospital) but these may be delayed due to the theatres being prioritised for emergency cases.

What is the recovery period from a caesarean section?

It is likely that you will need to stay in hospital for 24 to 48 hours after your operation, sometimes longer. You will be supported to care for your baby during this time.

You will be offered regular pain relief tablets and blood thinning injections to reduce the risk of blood clots. These will also be prescribed to you when you go home from the hospital.

Health care professionals such as midwives, doctors and physiotherapists will advise you on caring for your wound, mobility and exercise and future pregnancies after a caesarean section, such as information on contraception.