Pearl obstetrics | gynaecology


Maximising the chance of vaginal birth

  • Natural birth
    Using the latest evidence to make decisions together
  • birth
    Normal birth
    Tips & tactics

Helping vaginal birth | Glengarry Private, Perth

Many women have a preference for vaginal birth when they’re pregnant. For most, this is a safe choice. The likelihood of success varies considerably with age, medical history, obstetric history, general health and events during pregnancy and labour. Women who have had a vaginal birth previously, even if they needed an instrumental birth, have a very high chance of success in their following birth.

There are many things that you can do to help your chances of success when having a natural vaginal birth. Labour and normal birth can be tough for some (not all) women. The best results occur when you have prepared.

The following are a list of things that you can do or choose to try & enhance your birth at Glengarry to keep it problem free.

1. Having a trusted obstetrician

Confidence in your obstetrician/other care givers, by having continuity of care and a good relationship, is very important to reduce anxiety. This has been proven to encourage healthy labour and a natural birth.

2. Training for the labour

It has been traditional for women to go to birth classes and learn breathing exercises and other techniques to prepare for natural birth. We run these classes at Glengarry Private Hospital. These techniques provide some preparation for coping with contractions in normal labour, but they don’t help with the actual pushing.

The second stage of labour (the pushing stage) often needs (if it’s your first baby):

1) A lot of physical exertion for 30-60 minutes.
2) Relaxing your pelvic floor at the right time as the baby’s head comes down, while still pushing.

The human body performs better in any physical activity with training and preparation.

You can prepare your body for normal birth using a new trainer called the EPI-NO. This (1) helps the pelvic floor muscles get ready for stretching during birth and (2) also trains the pushing muscles.

When a woman prepares for natural birth using the EPI-NO, the following benefits have been seen in research studies.

• Significant reductions in the rate of tears & the rate of episiotomy (reduced from 50% to 10-20%).
• Reductions in urinary incontinence, prolapse, problems with sex, and third degree tears.
• Significantly reduced chance of a need for forceps or vacuum instrumental delivery.
• The second stage of labour is significantly reduced in length putting less strain on you and your baby.
• Fewer painkillers are needed afterwards.
• Babies have better APGAR scores after normal birth and are less distressed. This potentially improves bonding, breast feeding & reduces crying.
• Anxiety surrounding natural birth is reduced.
• Confidence in normal birth is much increased.

There are few downsides, apart from the need to commit to train with the EPI-NO. 98% of women who used the EPI-NO after a recommendation from their obstetrician would recommend it to other women. We strongly recommend this natural birth trainer, which costs $179 from a chemist or online. You can also use it to do pelvic floor exercises afterwards. No women who has delivered with us has had a third degree tear, or even anything other than a straightforward 2nd degree tear. Our episiotomy rate is 8%.

3. Perineal massage

Regular, frequent massage with olive oil reduces tears during natural birth, but this technique is not as good as the EPI-NO.

4. Being well rested

This is really important but is overlooked by just about everyone. Pregnant women have often had poor sleep leading up to their normal birth for multiple reasons. Read our guide to sleep and try to optimise this as much as possible.

If you have young children, can someone else look after them if they wake during the night? Can someone else get them ready in the morning so you can have a lie-in? Can you get a good afternoon nap after lunch?

Don’t watch TV or surf the net after 8pm. Get the pets out the bedroom. If the other half snores send him to the spare room until after the birth! Go to bed and wake at the same time every day. Have a warm milky drink before bed. Have a tepid bath a couple of hours before bedtime. If hot, use air-con if you have it, fans if not.

If you have heartburn try some antacids from the pharmacist, or even some over-the-counter Zantac – it’s safe in pregnancy. We can also prescribe this from our rooms opposite Glengarry Private Hospital.

Try an antihistamine like Piriton at night for its drowsy effects – it’s safe in pregnancy.

5. Having a birth supporter

There is evidence that having the support of an additional trusted person in labour is important in achieving natural birth and reduces anxiety & the length of the labour. A mum, sister, or a good friend (in addition to your partner) can be a great help.

6. Inducing labour

You will hear more opinions on induction of labour than just about anything else in childbirth. Very strong evidence (Grade “A”) is now available that clearly demonstrates the benefit of induction. It’s reasonable to be wary of induction, as labour can be more intense, more painkillers or an epidural may be needed, and it’s interventional, not natural.

However, the need for an emergency Caesarean is reduced, and healthy babies & a vaginal birth is more likely with induction. Other benefits are reductions in third degree tears, baby getting distressed, and stillbirth. It’s not “natural”, but the benefits are there, even in women with no medical reason for the induction. For the evidence, go here and here.

• Chance of death of the baby is probably reduced by two thirds. This is rare whatever you do however. Further trials are needed to confirm this.
• 50% reduction in meconium (“baby poo”) aspiration into the lungs during labour.
• 11-17% reduction in emergency Caesarean section.
• 25% reduction in very large babies.

The optimum time for induction to get these benefits is between 39-40 weeks of pregnancy for women who are already favourable. If you decide to have an induction with us at Glengarry, we go slow and try & mimic natural labour & birth as much as possible, and aim for plenty of rest during the process. For those who aren’t “ready”, the benefits are perhaps less clear, and there may be no reduction in emergency Caesarean if induction is done at 39-40 weeks. However at 41-42 weeks, the evidence strongly favours induction for all women, and this is routine practice in all developed countries.

7. Upright positions in labour

In early labour, walking around helps reduce discomfort and encourages baby’s head to move down. In active labour, upright positions encourage good natural labour. Even if you have an epidural, stay upright as much as possible. All-four positions during pushing can be helpful for many women, but we find that a change to a different position half way through is often helpful. The left lateral position is an effective & currently very underused pushing position.

8. Having some nourishment in labour

It’s important to keep your energy levels up. If it’s looking like you’ll need a Caesarean at Glengarry, we’ll ask you to be “nil by mouth”. But if not, it’s important to keep eating and drinking – nothing too “heavy” but have easily digestible high energy food.

9. Having an injection of a muscle relaxant – relaxes the cervix and shortens labour

A single injection of hyoscine in active labour can be prescribed by your obstetrician. It is well proven, has been used in pregnancy for decades, has no downsides, and will shorten labour by 1-2 hours, without increasing contractions or pain at all. It’s ideal for those not having an epidural. There may be a 20% reduction in forceps or vacuum rates too, but this isn’t quite confirmed by research yet. The baby is completely unaffected by this medication.

10. Epidurals

An epidural does increase the chance of a longer labour and assisted delivery. These are freely available at Glengarry Private Hospital. They do not increase the risk of a C-section however, despite what many people think. The techniques listed above help reduce the instrumental delivery rate, but some babies are more likely to remain “back-to-back” with an epidural and hence the following new technique, manual rotation before pushing, is offered.

11. Manual rotation

A new technique for reducing Caesareans, tears, forceps and vacuum delivery rates and improving normal birth rates. A manual rotation is where we turn the baby from back-to-back to the correct way before pushing, using the obstetricians hands. This manual rotation is performed when you reach full dilatation, and only if baby is healthy and it is safe.

The steps involved are
• “Topping up” the epidural to make the manual rotation more comfortable.
• The obstetrician scans to check baby’s position
• Making a judgement that a vaginal birth is realistic, even if the baby is turned
• The obstetrician places a hand on baby’s head inside the vagina and a hand on the abdomen
• Whilst you push, the obstetrician turns the baby, by rotating the head and shoulder to an anterior position
• The baby’s heartbeat is monitored while this is happening.
• It takes up to 3 contractions to do this.
• You then push the baby out yourself in a normal manner.

It is successful a lot of the time and reduces the length of the pushing stage and the chance of Cesarean section, forceps or vacuum delivery. The risks are very small. The main risk is that the cord comes down (or prolapses) before the baby births. In research studies, this happened only 1:600 times.

12. If it’s your first birth and you have an epidural

An oxytocin drip started when you’re fully dilated if contractions aren’t great, reduces the forceps or vacuum rate significantly.


Normal vaginal birth

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PEARL obstetrics | gynaecology

We strongly recommend this natural birth trainer, which costs $179 from a chemist or online. You can also use it to do pelvic floor exercises afterwards.