Vaginal birth

Dr Richard Murphy

Focus on vaginal birth

When you choose an obstetrician in private practice one of your first questions might be: where is this doctor’s focus in terms of delivery methods. A good guide is the Obstetricians rate of vaginal delivery. Mine is consistently the highest across all Obstetricians at St John of God Hospital Subiaco, 15-20% higher than the hospital average! Of course I can do a safe caesarean section delivery but I believe I can use my skills to achieve a positive vaginal birth with a relaxed labour experience. When the time comes, as your Obstetrician I will be able to adapt to the situation and focus on the safest way to bring your baby into the world.
Obstetrics and gynaecology consultations at my private practice in Subiaco.

Fertility consultations at Genea Hollywood Fertility

Delivering at the Labour Ward of SJOG Subiaco Hospital

Vaginal childbirth

A positive, life-affirming experience

As a Perth Obstetrician my preferred method of delivery, barring some obvious situations, is vaginal birth. This has always been one of the drivers for me to choose this speciality: the magic of childbirth as nature wants it. The experience of vaginal delivery is amazing. So that is why I use my skills to help you get the positive, life-affirming experience that most women and their partners hope for.

Risks of a vaginal birth

Of course, as you prepare for a vaginal birth, you will read or hear about the risks. The biggest risk of having a vaginal birth is that your baby is distressed in labour, gets stuck, or some rare complication occurs and that you then have a caesarean section. There is no added risk to your baby having a vaginal delivery compared to having an elective Caesarean section.

“Bleeding can occur after a vaginal delivery but this is usually less than the bleeding at caesarean section. Major bleeding is rare. Your risk of infection is also lower after a vaginal delivery than after a Caesarean birth.”

Finally, there is a risk of pelvic floor injury with vaginal delivery. Risk factors for pelvic floor injury include the actual pregnancy itself, irrespective of your mode of delivery, the state of your connective tissues, aging, menopause, or chronic strain on your pelvic floor because of chronic constipation or coughing.
Women with Ehlers-Danlos Syndrome, hernias, varicose veins or joint hypermobility are all at increased risk due to weaker connective tissues.

"Forceps are more likely to damage a mother’s pelvic floor than spontaneous delivery or vacuum. I very, very rarely use forceps."

Dr Richard MurphyPerth Obstetrician
vaginal birth perth

Vaginal birth after pregnancy loss

The impending arrival of a new baby is always accompanied by a sense of nervous anticipation. If you have had a loss in the past this natural sense of nervousness can be overwhelming. For the majority of women however, there is no additional risk in having your baby delivered vaginally and often there are some very positive advantages.

“If you have had a previous late pregnancy loss and are going to be delivered earlier, at 36 or 37 weeks for example, your baby is much less likely to end up in the Neonatal Intensive Care Unit (NICU) if delivered vaginally.”

If your baby does still need NICU admission you will be able to see your baby in the nursery on the way to the postnatal ward which is not possible after a Caesarean. This keeping mothers and babies together is important.

Home birth, water birth?

An unhurried, relaxed labour experience

The process of delivering a baby can be amazing. It can also, sometimes, be truly awful or tragic. My role as your obstetrician is to be there for you, to guide you to that ideal, relaxed labour process and for a safe birthing experience.

“Your baby is an active partner in your birth experience. At the forefront of my mind at all times in your pregnancy, but especially during delivery, is the health and wellbeing of your baby. I want your little person to grow into the best adult they can be.”

With this in mind it is important that your baby is monitored appropriately during your labour. If there are signs your baby is not able to tolerate labour, rapid Caesarean delivery is available if needed. It is important to remain flexible: we aim for that ideal, vaginal and natural birth, and we keep everything ready in case we have to change plans to safely deliver your baby.

"St John of God Subiaco Hospital provides an unhurried, relaxed labour ward experience. It also has world class fetal monitoring facilities, where I can monitor your baby’s health in labour at all times."

Dr Richard MurphyObstetrician at SJOG Subiaco Hospital
Unfortunately it is not really possible to monitor babies properly in a bath during a water birth. When rare complications occur being in a bath is not the safest place to be. The same applies to home births. With home births, even the lowest-risk women do get worse outcomes than they would with delivery in hospital.
It is routine practice to rely on heart rate monitoring during labour, to check your baby’s wellbeing. As a screening tool, it often triggers a decision to perform a Caesarean section. That is why I often find it helpful to use fetal scalp sampling: we collect a few drops of blood from the top of the baby’s head and 90% of the time the baby is actually well and labour can safely continue.

"As an example of my commitment to vaginal birth - and to my knowing - I am the only private Obstetrician in Perth who regularly uses fetal scalp sampling to assess a baby’s well being in labour. "

Using a meditative technique like hypnobirthing can be very effective

Let me make this clear: hypnobirthing is fantastic! Labour, as the name implies, can be very hard work. We all have different pain thresholds but fatigue and tiredness, as well as stress and anxiety, make everything more painful. So using a meditative technique like hypnobirthing can be very effective for some women in labour.
If you have made enquiries about hypnobirthing and you want to use this in your labour, then I am here to help, and to make sure that you are well informed about the techniques and how to prepare for hypnobirthing.

Vaginal delivery after a previous Caesarean section

VBAC: Discussing your future pregnancy

I regularly help women deliver vaginally when they have had a previous caesarean section. If you have a caesarean section then understanding why and discussing what to do in your next pregnancy will be covered both in hospital and at your 6 week postnatal visit. Once we make sure that you fully understand the risks and benefits of a vaginal birth after a previous caesarean, then we can plan this safely.

Vaginal twin delivery

Giving birth to twins vaginally

You may be wondering what happens if you are expecting twins. Chances are that you still want to deliver your babies vaginally. In our antenatal consultations and using the information we get from your ultrasounds, we will explore what vaginal twin birth would mean in your situation and then talk about benefits and risks. If I think we can deliver your babies safely vaginally then that is my preference.
If some of the information has led you to believe that having twins automatically means that you will need a caesarean section, then please bear in mind the soaring rates of caesarean section for twins has not resulted in improved safety for mums and babies.

"Vaginal delivery of twins is a little riskier than the delivery of just one baby at a time. This risk is mostly to the second baby. That said, with some simple rules vaginal twin delivery can be done safely and enjoyably."

Dr Richard MurphyObstetrician at SJOG Subiaco Hospital

Advanced maternal age and vaginal childbirth

Yes, you can have a vaginal birth as an older mum

In over 10 years in private practice I have delivered a 48-year-old mother for the second time vaginally. I have also delivered a 45-year-old first-time mother vaginally. While the chances of caesarean section do go up with age, age alone should not stop you from being able to deliver vaginally. Again, it is about discussing benefits and risks, and because I so strongly believe that vaginal birth is ultimately what many women aim for, I will always make the time to have the conversation and to support you on your antenatal journey.

Immunisations during and after pregnancy

Vaccines before and after your delivery

Unfortunately, all babies are born vitamin K deficient. Vitamin K is essential for proper blood clotting, and without additional vitamin K, about 3 in 1000 babies have a bleed inside their brain after birth. This is why giving vitamin K at birth is important.

"One third of babies who have an intracranial bleed because of vitamin K deficiency at birth will have permanent disability. Vitamin K at birth is simply essential."

Dr Richard MurphyObstetrician at SJOG Subiaco Hospital
All babies will be offered hepatitis B vaccine at birth. We know that hepatitis B is transmitted from mother to child. We also know that babies are more likely to develop a chronic hep B infection. And the consequences can be dramatic: cirrhosis and liver cancer, and a high risk of passing the infection on to their children. This is why you are checked for hepatitis B during your pregnancy. Hepatitis B vaccination at birth will help with long term immunity for your baby.

If you are non-immune to Rubella you will receive a booster after delivery, before going home. As a live, weakened virus, Rubella cannot be given during pregnancy but boosting immunity prior to your next pregnancy is important.

During your pregnancy, you will be offered an Influenza vaccine as pregnant women are at risk for severe Influenza pneumonia. You will also be offered Whooping Cough vaccination late in the pregnancy, to boost your own immune system’s level of antibodies for whooping cough. The vaccine will come through your breast milk and help your baby if exposed between birth and 2 months, which is when the first routine baby vaccinations start.

Perth obstetrician

Why should I see Dr Richard Murphy?

Together we can work through your pregnancy to ensure the safest, most enjoyable delivery possible for you and your baby. There is nothing quite like seeing a newborn being passed to its mother’s arms, waiting for the cord to stop pulsing while your baby transitions from blue to bright pink. That is what has inspired me to specialise in this amazing medical specialty. The amazement you and your partner will feel is incredible.
You can count on me to use my experience and skills to help you get there.