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Delivery

Planning your delivery

You and your obstetric team will decide the method of delivery of your baby with input from your EB specialist. You should be reassured that women with EB have delivered babies successfully by vaginal delivery as well as caesarean section. If you feel anxious about a vaginal delivery because of the fragility of the vagina or vulval area, you should discuss this with your obstetrician. Our experience to date has been that women are usually given a choice, unless obstetric reasons dictate a particular method of delivery. All the women that we have worked with who have had a caesarean section have healed well, or if not this has been for reasons other than EB.

Vaginal delivery

If you and your obstetric team have decided that you will have a normal delivery, there are a few issues with regard to EB that should be borne in mind:

  • Any vaginal or abdominal examinations should be performed with care.
  • No adherent products should be used, as there are adequate substitutes.
  • If you use Entonox you may need to apply lubrication to your lips (e.g. Vaseline) to stop the mouthpiece causing damage to your lips.
  • Most hospitals allow you to labour and deliver on an ordinary bed, which for a limited number of hours should not cause a problem. However, the delivery couch, if used, can often be quite hard, and you may have to ask for it to be padded.
  • If you need an infusion to 'speed up' labour, ask for Mepitel or Mepiform (see below) to be used to secure it in place.
  • In an effort to help you when you are 'pushing' your baby out, people will sometimes hold your legs – if this is the case you should ask them to use padding between their hands and you. This is particularly so if you are sweaty (as many women in labour are) and if they have gloved hands.
  • The midwife may offer to rub your back – this can be very soothing but you may need to apply cornflour or use a massage oil to stop friction damage.
  • Occasionally women are catheterised prior to delivery if they have difficulty emptying their bladders (this may delay the descent of your baby's head). Again staff should be warned to carry this out with great care, particularly if you have had any blistering or signs of fragility in the urinary tract. If they need to tape the catheter in place, a thin strip of Mepiform (see below) or a bandage should be used rather than tape.
  • Many women sustain a slight tear or have an episiotomy to prevent an extensive perineal tear whilst delivering their babies head. There is no particular reason you should have an episiotomy just because you have EB, as tears do normally heal well. However, this is a decision that will be made by your midwife, in consultation with you as she observes your perineum during delivery.

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Caesarean Section

Usually a caesarean section will have been planned in advance allowing for staff to be briefed about your special needs. However, occasionally the obstetric team will decide that for your and your baby's welfare an emergency caesarean section is needed. This can be quite alarming, particularly if you have EB. Try not to panic and show staff the briefing notes regarding the care of women with EB during childbirth. Staff should have been prepared for this possibility in the antenatal period.

Dressings that can be used over your caesarean section wound:

  • Mepilex
  • Mepilex Transfer
  • Mepilex Lite
  • Mepitel with a secondary dressing

All these dressings are made by Mölnycke and are available on prescription from your GP.

For further details about caesarean section in women with EB, please see the section at the back of the booklet 'Information for health professionals' which can be obtained at the DEBRA UK office.

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Take with you

You should have an information pack regarding your condition to give to the obstetric team. Along with the information pack, you should also have a supply of suitable dressings to be applied if you have a caesarean section. Even if you have planned a normal delivery you should have suitable dressings in case of an emergency caesarean section. The dressings we commonly supply are:

  • Mepilex
  • Mepilex Transfer
  • Mepilex Lite
  • Mepitel with a secondary dressing

All these dressings are made by Mölnycke and are coated with silicone to aid ease of removal. All can be obtained on prescription from your GP.

  • Mepitel and Mepiform can be cut into thin strips and used to anchor intravenous cannula. If you use Mepitel, a soft bandage will also be required.
  • Mepitac, a silicone coated tape can also be used.
  • Mepiform or Mepitac can be used to secure the epidural catheter (if you have one), but Mepiform should be cut into thin strips and removed with care by rolling it back on itself rather than lifting it at a 90-degree angle to the skin. Children with EB use Mepiform frequently, however some adults feel it is too sticky and we have had one case of it adhering. You are therefore advised to try a small piece cut into a thin strip on a less fragile area before using it to anchor IV's, epidurals etc. 

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