What is an intervention during labour?

An intervention is an action taken by a doctor or midwife in the birthing process to help with the birth of your baby. Every labour and birth is different. In some cases, your doctor or midwife might recommend intervention to help you birth your baby safely.

Why might I need an intervention during labour?

Different types of interventions help at different stages of labour and birth.

You might need an intervention to:

• help start your labour (known as induction of labour)
• support your labour while it progresses (known as augmentation of labour)
• directly help in your baby's birth (by assisted birth or caesarean section)

There are many reasons your doctor or midwife might recommend an intervention during labour, including if:

• you have a health condition that puts you at a higher risk of complications during labour
• you have had complications during your pregnancy or labour
• your waters have broken but you have not gone into labour
• your labour is progressing very slowly
• your baby is in a position that will make vaginal birth more difficult
• your baby is showing signs of distress

What are the types of intervention I might be offered?

Induction of labour

Induction of labour is the use of medical methods to try and start your labour. This is instead of waiting for your body to go into labour by itself.

There are a few different ways your doctor or midwife may try to induce your labour, including by:

• using medicines given through your vein (IV)
• using medicines placed in your vagina
• breaking your waters (artificial rupture of membranes)

The method recommended by your doctor will depend on your and your baby's health, your stage of pregnancy and the state of your cervix on the day of your induction. It's common to need a combination of induction methods for a successful induction.

Augmentation of labour

Augmentation of labour is an intervention to help your labour progress by stimulating the uterus to increase the frequency or intensity of your contractions. Your doctor or midwife may recommend breaking your waters (artificial rupture of membranes) or giving you a medicine through your vein to increase the strength and/or frequency of your contractions.

Assisted birth

Assisted birth, also known as instrumental delivery, involves your doctor or midwife using forceps or a vacuum cup (ventouse) to help your baby descend through the birth canal during your vaginal birth.

Episiotomy

An episiotomy is a cut made in the area between the vagina and anus (perineum). This is performed to make the vaginal opening bigger. It is sometimes needed during an assisted birth, or if your baby is distressed and needs to be born quickly.

Caesarean

A caesarean section, also known as a C-section or caesarean birth, is an operation in which your baby is born through a cut in your abdomen and uterus. Caesarean births may be planned (elective) due to your and your baby's circumstances or due to complications during your pregnancy. A caesarean section may also be performed during labour, known as an emergency caesarean.

Your doctor or midwife may recommend an emergency caesarean if:

• your labour is not progressing
• there are signs that your baby is distressed
• a complication has occurred that may be life-threatening for you or your baby

How do I decide whether I want an intervention?

It's a good idea to think about your birth preferences before your labour begins, and to discuss them with your doctor or midwife. Having a birth plan is one way you can make your healthcare team aware of your preferences regarding interventions. This can include any you would prefer to avoid.

It's important to understand that you may also need to change your plans during labour if unexpected complications occur.

Remember that your doctor and midwife are there to support you throughout your labour and birth, and to make sure that you and your baby stay safe and healthy. They are trained to manage situations if something unexpected happens.

In most situations where your doctor or midwife suggests an intervention, there will be time for them to explain why it is needed, and you will be able to discuss your options. Shared decision making in healthcare is where a patient and healthcare professional make important decisions together that relate to the patient's health.

It's important to consider the risks and benefits to you and your baby of having an intervention. It is also important to consider any risks associated with declining the intervention.

Some questions you may wish to ask include:

• Why has this intervention been recommended?
• What does the intervention involve?
• What are the potential risks of having the intervention?
• What are the potential risks of not having the intervention?
• What are the potential risks of waiting and reconsidering the intervention at a later point (a 'wait and see' approach)?

Do I have to agree to an intervention?

You have the right to choose whether to have any intervention in your labour or birth.

If you aren't sure whether you want an intervention, it's a good idea to ask your doctor or midwife for more information to help you decide. Many women also find it helpful to involve their partners or other support people when making a decision.

In what situations might my doctor or midwife override my choice?

In an emergency, your doctor or midwife may make choices on your behalf to protect your health or your baby's health.

If you are unconscious, your doctor or midwife may discuss this with your partner or family (if possible) to understand your preferences.

In all situations, your doctor or midwife is legally required to act in your and your baby's best interest, unless you have made other wishes clear. If you don't want certain lifesaving interventions (for example, blood transfusions), even in an emergency, it's a good idea to record your wishes in an advance care directive and make sure your healthcare team is aware of your decision.

Learn more about informed consent and your rights when having a baby.

What are the risks if I don't want a particular intervention?

Every pregnancy and birth is different, so the risks associated with choosing not to have a particular intervention will vary depending on your situation.

Most interventions are recommended because your doctor or midwife consider that they are in your or your baby's best interest.

You can ask your doctor or midwife why they suggest an intervention, and any potential risks to you or your baby if you choose not to have the intervention.

It's a good idea to learn the risks and benefits of different interventions before birth, so you have time to consider how you feel about them. It is also helpful to discuss your preferences with your birthing partner, as well as your doctor or midwife, before your labour begins. This will help you to make decisions during labour and birth.

Resources and support

For more information about the different types of interventions during labour and why you may need them, see the following websites:

The Royal Women's Hospital has information on

• variations to spontaneous labour and birth (in various languages)
• assisted birth
• induction of labour
• caesarean birth

The Royal Australian and New Zealand College of Obstetrics and Gynaecologists labour and birth pamphlet outlines the various stages and options.

Call Pregnancy, Birth and Baby on 1800 882 436 or via video call to speak to a maternal child health nurse. Hours are from 7 am to midnight (AEST/EADT), 7 days a week (including public holidays).