Hi everyone my name is ilao and I'm a registered Midwife and childbirth education instructor I practice Midwifery in a large Urban setting in Canada and I'm the mom to two children so this is all familiar to me as a parent for the second time around in addition to my clinical practice in today's video we're going to talk about special circumstances so what exactly are special circumstances we're going to talk in this video about assisted vaginal birth forceps or vacuum deliveries induction of Labor otomy and cesarian section assisted vaginal births happen in the second stage of Labor when there's a delay in pushing or it's taken a really long time and Mom's really tired or if the baby's heart rate is abnormal depending on the baby's head position the doctor will decide whether or not to use forceps or vacuum the vacuum is a little suction cup that's placed on the crown of baby's head and with hand pressure applying a bit of extra traction while Mom Bears down and still pushes the baby out with forceps metal salad tongs they look like salad tongs are applied very gently to cup the sides of baby's head and again with traction and pushing effort from mum the doctor pulls down and up gently to safely deliver baby's head with an assisted vaginal birth sometimes baby will have a little bit of bruising or swelling on the scalp where the vacuum was placed or scrapes and grazes little bruising on the cheek or Temple where the forceps were most of the time this resolves on its own without any intervention but we keep a really close eye on these babies after birth most of the time we're doing forceps or vacuum deliveries because we have concerns about baby's well-being in the labor in those cases baby will be taken to the warmer immediately assessed by our team and then when baby is transitioned and all is well brought back as soon as we can to do skin to- skinin with Mom let's chat about otomies otomies are done when the healthc care team has a concern about babies heart rate or sometimes when we use instruments for an assisted vaginal birth like the vacuum and forceps to make extra space for that baby's head and the instruments prior to cutting an a pie photomy we need to make sure we have consent from Mom and that pain relief is in place so that could be the epidural that's running and if you don't have an epidural your doctor Midwife will take a few seconds to inject some local freezing like lidocaine into the area so you can't feel that cut with an otomy a small cut is made into the skin at the back of the vagina angling off towards the side away from the rectum after baby's birth your care team will carefully suture the area back into place and give you instructions on how to care for the skin and the healing of those tissues acetaminophen and ibuprofen work really well to help with the pain and inflammation in the area in addition to the application of ice a tip to try and avoid an otomy is to start paranal massage in the last few weeks of the pregnancy this is done either by yourself or with a partner and a little bit of oil is applied to the fingertips and we massage at the back of the vagina sweeping side to side and giving those tissues a little bit of extra elasticity so they stretch out nicely when baby's head is coming through that space sometimes babies come into this world through a C-section or what I call the sunroof delivery for a planned C-section you'll present to hospital on the day chosen by your care provider and yourself and you'll be admitted to the unit at that point your Midwife will help you put on a gown take off your jewelry better yet leave the jewelry at home and check baby's position and listen to baby's heart rate we'll make sure to check your Vital Signs and do some blood work and then you'll meet your team generally that's your oby and your anesthesiologist the person who will make you comfortable and at that point we'll likely suggest bringing a robe and some slippers as we walk to the operating room it can be quite quite chilly in there once you're situated in the operating room you'll be given a spinal anesthetic very similar to having an epidural put in but this time no tube stays in your back it's just one dose of medication and that's it it takes effect very very quickly so you will lay down quite soon after the spinal goes in and then we will clean your tummy with antiseptic and insert a catheter into the bladder to keep it empty throughout the surgery and as well in the postpartum once the antiseptic has dried and the urinary catheter is in place will pull up a drape and your surgeon will test your skin to make sure that the anesthesia is working well once you're nice and comfortable we'll have your partner come into the room and join you at the head of the bent as the surgery progresses you'll notice touching and pulling and a little bit of pressure but you should not be feeling pain at any time baby is born quite quickly after things get started and usually handed to the warmer where our team is ready to receive baby and give them a quick once over nowadays even during a cesarian section most hospitals are waiting at least 30 to 60 seconds for delayed cord clamping and encouraging skinto skin with mom as soon as we can of course if you're not feeling well for any reason whatsoever we can place baby skin to skin with your partner and have them there until you're feeling well enough to have baby play skin- to- skin with you an unplanned C-section happens very similarly to a planned C-section but things move a lot more quickly and generally we're doing an unplanned C-section for a few different reasons we may be concerned about baby's heart rate or we may not see much progress in either the first or second stage stage of labor for example that could mean very little or almost no cervical change over a prolonged period of time despite all of our interventions sometimes in the second stage where we've started pushing there's not much descent that baby's head is not really coming down and Mom's exhausted and at that point we can also move to a unplanned C-section if you already have an epidural in place the n thst will give you a top up of that medication to make sure you're comfortable during the procedure if you don't have an epidural the entist will place a spinal which is very similar to having an epidural done but there is no tube that stays in place it's a single dose of medication that keeps you Frozen from the waist down in rare cases if neither the epidural or the spinal is working well or there isn't time to place one a general anesthetic might be recommended in either case plan C-section unplan C-section you can expect to stay in hospital for a minimum of 24 hours until you meet discharge criteria and can go home next let's chat a bit about inductions of Labor an induction of Labor could be recommended by your doctor Midwife for a number of reasons some of those reasons might include being wellp passed due date gestational diabetes or high blood pressure in the pregnancy or any other concerns we might have about baby's well-being or your well-being the way that we undertake induction varies widely from Patient to Patient and is decided by your care team depending on a few different factors induction of Labor generally happens in two different phases so the first part is preparing and ripening the cervix and the second part is starting good strong uterine contractions with a rupture of the membranes if that water hasn't broken yet so for the first phase ripening the cervix we want to move from an unripe green banana really firm really dense texture all the way to a squishy soft speckled Brown banana ready for baking banana bread so that's a pretty big change that needs to happen for cervical ripening we can use a medication called prostaglandin that mimics a hormone your body produces naturally in labor it makes the cervix nice and soft thins it out shorten it a little bit and prepares it for receiving the oxytocin or stronger medication to bring on uterine contractions another option for ripening the cervix is something called a fley catheter balloon very similar to Foley catheter that goes in the bladder to keep it empty but this time it passes through the cervix and sits on top of the cervix and applies pressure just like a baby's head would this helps your body release prostaglandin locally and softens and thins that cervix out once the cervix is nice and Squishy and soft and ready we move on to the next phase in this stage you'll receive intravenous medication oxytocin which again is meant to mimic the hormones your body naturally makes through the course of a labor with the oxytocin we start with a very very small amount and gradually increase at set intervals provided that babies tolerating that medication and the fetal heart rate stays normal if your water hasn't broken at this point we would rupture the bag of membranes to help the oxytocin work more effectively with an induction of Labor we really are trying to mimic the body's natural labor progress that's why it takes a few days and we start with preparing the cervix before we move on to the oxytocin infusion there are some risks with that oxytocin sometimes it brings on contractions that are much too close together too long too strong and they don't give baby enough of a break between the contractions in those cases we see signs that baby is in some distress the heart rate drops down a little bit and your care team will consider turning off the infusion to let baby recover if those interventions are not working and baby still shows an abnormal fetal heart rate we will move quite quickly to an unplanned cesarian section if you're hoping to avoid an induction in the first place here's a few tips you can try towards the last few weeks of your pregnancy the first is mle dates eating up to 10 Dates a day can help soften and ripen and prepare the cervix for those of you that have gestational diabetes best to skip this one because dates have a lot of sugar my next tip is drinking raspberry leaf tea once a day in the last few weeks of pregnancy to help that muscle in the uterus tone up and be a little more efficient in labor next you could consider intercourse there is prostaglandin present in male semen and as you remember it helps soften and thin out that cervix additionally there's a surge of oxytocin released with orgasm and that can bring on a round of uterine contractions those two things together can be just the ticket to push you into labor there are also complimentary therapies which can be quite effective acupuncture acupressure reflexology provided they're done by a qualified professional finally starting from about 38 weeks onward your health care provider may offer what's called a stretch and sweep a stretch and sweep is done by digital cervical exam where we sweep around the membranes to release prostaglandin and stretch the cervix A little bit if we're able to again this can help soften and prepare the cervix and move you a little bit closer to having your baby finally most important and this is easier said than done try to stay calm relax enjoy your time do the things that you like to do as you prepare and wait for your baby's arrival they'll be here before you know it and it's a big change and adaptation to becoming new parents that brings us to the end of this video I hope you found some information useful and please do check out our other videos in the series take care and we'll see you next time