Explaining birthing options

Question 1

When meeting a patient to discuss birthing options, how should you begin the consultation?

Answer 1

Break the ice:

• congratulate them on their pregnancy
• do they know if the baby is a boy or girl?
• do they have a name yet?
• If they do have a name, use it when discussing the baby and birthing options
• find out what they hope to get out of the consultation

Question 2

How do you do go about addressing risk factors re delivery?

Answer 2

” We can talk through a variety of options today to determine which might be best for you and your baby. However, your’s and your baby’s/(name’s) safety is our absolute priority, so I just need to ask you a few questions first to determine the most appropriate options.”

Question 3

What risk factors indicate the hospital birth is the safest option?

Answer 3

Previous births:

• Previous C-section
• ≥6 previous children
• Serious PPH

Current baby:

• Expecting twins
• Breech/transverse presentation
• Placenta praevia
• Problems with baby

Maternal factors:

• Anaemia
• Gestational diabetes
• Pre-eclampsia
• Age >40 years
• Obesity (BMI >35)

Question 4

What are the advantages and disadvantages of hospital births?

Answer 4

Advantages:

• Safest environment - presence of obstetricians and paediatricians
• Can have epidural

Disadvantages:
- Less personal

Question 5

What are the advantages and disadvantages of midwife-led birthing centres?

Answer 5

Advantages:

• More comfortable and homely
• More likely to have a midwife you know

Disadvantages:

• May need to be transferred to hospital if any complications
• Cannot have epidural

Question 6

What are the advantages and disadvantages of home birth?

Answer 6

*Evidence shows that it’s as safe as a hospital/birthing centre if it is your second or subsequent baby

Advantages:

• More personal, relaxed environment
• Privacy
• Light candles
• Pay for a birth pool

Disadvantages:

• May need to be transferred to hospital –> how far is it?
• Cannot have an epidural
• More planning involved

Question 7

When are caesarean sections recommended?

Answer 7

• Multiple pregnancy
• Labour doesn’t progress
• Placenta praevia/accreta
• 2+ C-sections
• Malpresentation
• Cephalopelvic disproportion
• Pelvic cyst/fibroid
• Maternal infection (HSV/HIV)
• Severe hypertensive disease
• Foetal distress

Question 8

What are the disadvantages of caesarean section?

Answer 8

• Major surgery
• Longer recovery
• Scar
• More likely to need it again in the future

Question 9

What pain relief options are available during child birth?

Answer 9

• Natural (none)
• Paracetamol
• Codeine
• Entonox (gas + air)
• Pethidine
• Morphine
• Epidural
• Spinal anaesthesia (C-section)