Clinical Review ABC of labour care

Operative delivery

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7193.1260 (Published 08 May 1999) Cite this as: BMJ 1999;318:1260
  1. Geoffrey Chamberlain,
  2. Philip Steer

    In Britain all operative deliveries are now performed in a hospital. Caesarean sections must take place in hospital, but the National Birthday Trust's 1994 survey of home births reported that all ventouse and low forceps deliveries also took place in hospital (Chamberlain, 1997). However, not only obstetricians have to know about these deliveries—general practitioners and midwives need to know too, so that they can brief women and prepare to deal with any complications that may arise.

    View this table:

    NHS hospital deliveries England, 1980-94 (from NHS Maternity Statistics England, 1997)

    An operative delivery is performed if a spontaneous birth is judged to pose a greater risk to mother or child than an assisted one. Operations are divided into abdominal methods (caesarean section) and vaginal assisted deliveries (forceps delivery and vacuum extraction).

    Preparations for operative delivery

    • Discuss operative delivery with the woman and her partner (if time is short, at least outline what will happen)

    • Follow the woman's wishes—no operative delivery can proceed without her consent even if the doctors think that the baby will die if it is not done

    • Get written consent for elective procedures

    • A paediatrician should attend any delivery where problems are anticipated; local guidelines should be drawn up and followed for all operative deliveries

    Indications for caesarean section

    • Cephalopelvic disproportion—When it is obvious either antenatally or in    the early stages of labour that the fetus, presenting by the head, is not going to pass through the pelvis

    • Relative cephalopelvic disproportion—The fetus descends initially during    labour but is then arrested, possibly due to a malposition such as occipito-posterior

    • Placenta praevia—Particularly if it is overlapping the internal os

    • Fetal distress—In the first stage of labour

    • Prolapsed cord

    • To avoid fetal hypoxia—When there is poor perfusion of the placental    bed (for example, pre-eclampsia)

    • Malpositions—For example, brow

    • Malpresentations—For example, transverse lie, breech

    • Bad obstetric history …

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