Delivery and the postpartum period
Labour and delivery must be planned carefully and well in
advance. Ideally, decisions about timing and mode of delivery
should be agreed after a multidisciplinary case discussion
including the patient. These decisions must be communicated
appropriately to the patient and to the tertiary and local healthcare
teams. In our practice, we copy the notes, all investigations,
and the recommended delivery plan to the patient.
In principle, vaginal delivery carries a lower risk of complications
for both the mother and the fetus. Compared with caesarean
section, it causes smaller shifts in blood volume, less
haemorrhage, fewer clotting complications, and fewer infections.
23 However, prolonged and difficult labour should be
avoided, and detailed continuous monitoring of the mother and
fetus is mandatory.
The principle is to manage the stress of labour in such a way
that it does not exceed the woman’s capacity to cope with it.