There is now a variety of tests to determine if the baby has developed enough to be able to cope with life outside the womb. Ultrasound can measure the baby’s size. A hormone excreted in the mother’s urine — oestriol — can be measured and is related to the function of the placenta or afterbirth. Prior to delivery, an amniocentesis — removing some of the fluid surrounding the baby — can be used to measure substances in the fluid to check whether the foetal lungs are fully developed.

But what do women think? Many feel cheated that they are not awake when their babies are born. Few hospitals will allow the father to be present at a caesarean birth.

One way to overcome this is for the operation to be done under a local or regional anaesthetic. Caudal or spinal anaesthetics are increasingly used to reduce the pain of childbirth or to allow forceps procedures to be carried out.

This form of anaesthetic is a skilled procedure and not all anaesthetists are sufficiently skilled to use it routinely. If the anaesthetic is being used and a decision to do a caesar is made, the operation can be done by this means. But under emergency conditions, there may not be time to induce anaesthesia this way.

*97/71/1*

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