Archive for the ‘Labour and Birth’ Category

Procedures
Sling
1. Take a strong cotton cloth, 210 x 90 cm (80 x 36 in). Fold the cloth over one shoulder (if you are right handed over the left shoulder, if you are left handed over the right shoulder), and knot it with a strong knot on the opposite hip.
2. Move the knot onto your back until it is two thirds of the way up the back (in the hollow of your back).
3. Take the baby on the arm on the side where you have knotted the cloth.
4. Place the baby in the cloth with its stomach facing you. Place the baby’s head on the edge of the cloth. Hold your arm under the baby until the baby is lying in the right place. Then move your arm from under the baby and support it with your other arm. Check that the knot oil your back is still in the right place.
5. Raise the baby slightly with the carrying arm, and hold the side of the cloth that is next to the baby’s neck.
6. Fold over the cloth by the neck back over your shoulder. This means that the baby’s weight is distributed over the shoulder, so that carrying it does not put too much pressure on the neck. In addition, it means that the baby’s head is in a slightly higher position.
The first reaction of many parents is that the child is lying on the wrong side of the cloth, and can almost fall out of it. We have opted for this method because it is easier for the baby to get fresh air than with other methods. The danger that the baby will fall out is prevented by folding the cloth back over the shoulder. With this method it is a good idea to give the baby some support with the arm.
When you carry the baby, also look at your own position. Carrying a baby, even a light baby, with a hollow back will soon lead to problems. If the child moves down after being carried for a little, this can be corrected by pulling the cross over part of the cloth down slightly at the front, so that the head is automatically higher up.
Of course there are many other ways of tying a sling. There are baby slings on the market which give clear instructions.
Swaddling
Use a large, non-stretch cotton cloth
1. Fold one point in and place the baby on it, so that the fold in the piece of cloth falls just above the shoulders.
2. Move one arm down, slightly bent along the body, and fold the point of the cloth fairly tightly over the arm to the other side under the baby, so that the cloth is secured.    1
3. Now take the bottom point and place it diagonally across the baby up to the shoulder that has already been swaddled so that the cloth is also secured here. Make sure there is some room for the legs and hips.
4. Finally take hold of the last point and fold it firmly over the bent arm (so that the baby can find its thumb), or over the arm which has been bent down (see point 2) to the opposite side. Secure the cloth with one or more safety pins.
5. Experience has shown that very restless children who are swaddled with one arm pointing up will manage to undo the cloth. In that case it is better to swaddle both arms down.
Never place a swaddled child on his side, but always on his back. Make sure that the baby is not too warm, because a swaddled child will retain his own heat better. In principle, one layer of clothes under the swaddling clothes provide sufficient warmth. Then place the baby, firmly tucked in with a blanket, in a cot or bed.
Camomile cloth for stomach cramps
Sprinkle some camomile oil on a cotton cloth the size of a postcard. Heat the cloth in a plastic bag between two hot water bottles. Also heat up a non-itchy woollen or flannel cloth.
Remove the warm compress from the plastic bag and place it on the stomach, wrapping the cloth around it and wrap the child up warmly. It can be left
wrapping
until the next time the baby is changed.
Walking round with a hot water bottle between yourself and the child, wrapped up in a warm cloth with a compress on her stomach, can also be very helpful.
Lemon wrap for a high fever
Squeeze half a lemon into a bowl of hot water with the palm of your hand. Soak the bandage in the lemon water. Ring out the bandage thoroughly and wrap around the child’s feet and lower legs. The wrap must feel pleasantly warm to the child. Then put some woollen socks on the child.
Make sure that the child’s feet are warm – if necessary, first place a warm hot water bottle at the bottom of the bed, but make sure that it is not overheated.
Product Information
The ingredients used in this book in the recipes for bottle-feeding and porridge are explained below in greater detail for each age.
Bottle-feeding 0-3 months
Full fat cow’s milk
Try to use unhomogenized milk if possible, where the cream rises in the bottle so that there is a creamy layer at the top. Shake the bottle thoroughly or stir it before use.
Water
Do not use water from the boiler or hot water heater, but water from the cold water tap.
White almond paste and lactose
Both lactose and almond paste are available in most health shops.
Bottle-feeding 4-6 months
Types of flour
The types of flour that can be added to the bottle feed at this age are: Rice flour
Organic baby flour from 4 months
Whole rice baby flour
Sweeteners
From five months it is possible to use a different sweetener instead of lactose; unprocessed sugar, baby malt, rice malt syrup or maple syrup.
Bottle-feeding and porridge 6-9 months
Types of flour
The choice depends on the baby’s potential for digestion and pattern of excretion. At this age it is possible to use:
Organic baby flour from 6 months
3 cereals with spelt
wholewheat baby food
Sweetener
Unprocessed sugar, baby malt, rice or barley malt syrup or maple syrup
Oil
Cold-pressed sunflower oil
Porridge made of cereal flakes 6-9 months
Cereal flakes
Buy the flakes in small quantities at a time to make sure that they are fresh. Flakes which are suitable include rice, buckwheat, millet, oats and barley flakes. Oats and barley are the most difficult to digest.
Porridge 9-12 months
Types of flour Wholewheat infant flour

They said I need a Caesarean
all about Caesarean births
What’s the difference between an emergency and elective Caesarean?
Caesareans are classified as elective or emergency An elective Caesarean indicates that a pre-planned decision was made during pregnancy to deliver the baby by Caesarean before the onset of labour. An emergency Caesarean is when a situation arises, usually in labour, that means the safest route for delivery is by Caesarean section.
Is it fair to say that most doctors prefer Caesarean deliveries these days?
Although the Caesarean rate has risen over the years, it would be unfair to say that this is due to doctors’ personal preferences; it is more likely to be due to over-caution on the part of the medical staff. NICE guidelines on Caesareans are quite specific on the reasons why a Caesarean should be considered and offered as an alternative to a vaginal delivery However, they also recommend that as currently one in five women will have a Caesarean section, all women should be offered some information about the procedure in antenatal classes If a Caesarean section is considered to be the most appropriate mode of delivery for you, then you should also be made aware of the benefits and the risks to you and your baby and of the possible implications on future pregnancies before you give your consent
Are there any factors that might reduce the likelihood of having a Caesarean?
Research shows there are certain factors that decrease the likelihood of having a Caesarean section and these include!
* Having one-to-one support from another woman
during labour; whether a midwife, a doula, or a supportive friend or relative. This is thought to reduce your chances of having a Caesarean.
* Waiting until after 41 weeks to have an induction of labour, if your pregnancy has been uncomplicated. * Having a home birth reduces the likelihood of a Caesarean if you have had an uncomplicated pregnancy. * Having appropriate tests during labour, such as a fetal blood sample and fetal electronic monitoring, will confirm any indications that your baby is distressed before going ahead with a Caesarean
I’ve got a small pelvis; I’m not too posh to push, but they said I may need a Caesarean. Is this right?
Cephalopelvic disproportion (CPD) is the term used to describe a labour that is not progressing due to the size or shape of the mother’s pelvis in relation to the size and position of the baby entering it. Problems may occur if a baby is unusually large or a mother unusually small. True CPD is rare and even if it is a concern in pregnancy, it is often thought best to give labour a try, although you may be cautioned that a Caesarean is a possibility. Certain signs signify CPD in labour; for example if the baby does not descend through the pelvis, or the cervix does not dilate; in these situations, a Caesarean would be necessary.
The midwife wrote LSCS in my notes - what does that mean?
The most common type of Caesarean section is a lower segment one (LSCS). This refers to the 12-15cm (5—bin) cut made along the bikini line The other type of incision is a “classical” or vertical cut, although this is extremely rare nowadays and would only be used if, for example, there was a vertical scar from a previous Caesarean, or in an emergency situation, such as a haemorrhage, although even then it is rare.

I want to be asleep during the Caesarean section. Will I have that option?
It is preferable that you are awake in the operation as most surgeons and anaesthetists agree that it is safer for mothers and babies to have an epidural or spinal anaesthetic. Also, you will be able to have your
partner with you, and will see and hold your baby straight away. In addition some women even manage to breastfeed while the operation continues or straight after the operation in the recovery room There are also greater post-operative risks for the mother and baby with general anaesthesia, including respiratory problems. If you are afraid of the operation talk to your midwife or doctor You may be able to visit an operating theatre and discuss the procedures.
I haven’t had problems, but I just don’t want to go through birth. Can I opt for a Caesarean?
If there are no medical grounds for a Caesarean and this is purely down to your fear of labour pains, then to opt to have a Caesarean is a drastic decision A Caesarean is major abdominal surgery, and although it is sometimes preferable, it is not a favoured method for many reasons, such as the risk of post-operative problems occurring as a result of surgery; a higher risk of secondary fertility problems, or the second baby being born by Caesarean; and an increased risk of postnatal depression It would be better to talk to your midwife about the pain-relief options available and ensure you receive the most effective type for
you. Having somebody you know and trust with you in labour can reduce your anxiety levels greatly. If you still feel that you cannot go through with labour, you may need to talk to your consultant obstetrician as the final decision will probably be his or hers.
I’ve had two Caesareans and now have been advised to have an elective one. Is this necessary?
It is common practice to advise women who have had more than one Caesarean section or operation involving cutting the womb to have an elective Caesarean This is because the risk of the womb rupturing during labour is slightly higher with each of these procedures. Usually, women who have had one previous Caesarean can have a ”trial of labour’ (see p. 182), but this will depend on the reason for the last Caesarean and how your current pregnancy is going If you do have a trial of labour, this will be carefully monitored and any indications that may suggest a rupture beginning would result in a Caesarean without question It is usual to prepare the mother for a Caesarean in case an urgent one is required by having an epidural anaesthetic in place, as this will reduce the time delay if intervention is needed. Ultimately, whether you opt for an elective Caesarean or for a trial of labour is your decision and the consultant will be able to advise on the risks and benefits of each method.
I heard that Caesarean babies are brighter because they don’t have a traumatic birth. Is this true?
No. this is not the case at ail Full term, healthy babies are designed to cope with the stresses of a natural labour and birth and should not be affected in any way by this experience The type of birth on its own does not affect a baby’s abilities, although if a baby becomes” distressed” during the delivery, on rare occasions this can cause problems that persist into later life (although usually the baby is born fit and well) It is the case that you can help your baby by staying healthy in pregnancy, for example by eating well and not smoking or binge drinking.

A Caesarean birth is when your baby is born during an operation in which the surgeon lifts out your baby through a short incision made through your abdomen (generally below the bikini line) and through the wall of your womb. This operation is carried out under anaesthetic, which could be spinal anaesthesia, epidural, or occasionally by general anaesthetic. There are many different reasons why a Caesarean birth happens. Sometimes the decision can be made during the pregnancy, which is called an elective Caesarean, and sometimes the decision is made during labour, which is known as an emergency Caesarean.
Today the Caesarean birth rate is 25 per cent
in the UK and rising. Look at the statistics from your local hospitals to see what their Caesarean rates are to help you decide where to have your baby. If you are considering an elective Caesarean, you should bear in mind that this is not without risks to you or your baby, or even to your next pregnancy, The decision to have a Caesarean section should be made by weighing up all the risks and then making a decision that is right for you
Can I avoid a Caesarean? There area few things you can do to help prevent a Caesarean section, for instance having someone with you throughout your labour, especially a midwife; having a homebirth (if you have no risk factors like high blood pressure); having an external cephalic version (turning your baby while you are about 37 weeks pregnant) if your baby is in a breech position (their bottom coming first); having a senior obstetrician involved in the decision not to have a Caesarean; and, if it is thought your baby is distressed, taking a fetal blood sample before deciding to carry out an emergency Caesarean.
What type of anaesthesia will I have? There are different types of anaesthesia for Caesareans all of which prevent you from feeling the operation General anaesthetics (which make you go to sleep) are only used if your baby needs to be born quickly or you have a rare blood disorder with low levels cf platelets (these help your blood to clot) Vlore offer_, an injection is put into your back, which is either a spinal block, when the drug is injected into the spinal fluid, an epidural, or a combined spinal epidural; you are awake to experience your baby being born and there are fewer complications this way

Caesarean, and these will stay in place for about 24 hours. If you wish to breastfeed, you can feed as soon as the baby is born, while the operation is still happening It is important that you are pain-free after your Caesarean, so ask the midwives for more pain relief if you need it, ideally before the pain builds up. To prevent blood clots forming in your legs, you will be given an injection and after 24 hours or preferably sooner, you will be encouraged to get up and walk around
How much can I do after a Caesarean? Once you get home, take it easy and let the pain guide you as to how much you do. You can start gently exercising as soon as you want and most hospitals give you information as to which exercises you can do safely. Using your vacuum cleaner, driving, and strenuous exercise are definitely not recommended You can drive again after six weeks, depending on your insurance company.
Will I have to have a Caesarean next time? The reason you had a Caesarean this time will determine the advice from your doctor as to whether you have a VBAC (vaginal birth after Caesarean) or have further Caesareans for subsequent babies. If you feel negative about the birth of your baby, you should try talking to your doctor or hospital and get expert help, as it is common to feel unhappy if you had an emergency Caesarean when you were expecting a vaginal birth.

What type of pain relief will I be given before the operation?
There are two main types of anaesthesia, or pain relief, prior to a Caesarean section! general and regional. A general anaesthetic is the procedure whereby the mother is put to sleep before the
Caesarean. Although this is a relatively quick
and safe method for the mother and baby, it is not common practice as it is thought preferable for the mother to be awake during the operation so that she is able to expereince the birth of her baby, rather than having to wait until she recovers from the anaesthetic and is possibly too groggy to respond to her baby. There is also a slight risk of the mother inhaling vomit during the operation and the possibility that the anaesthetic will affect the baby’s responses after the birth (see p.207).
A regional anaesthetic is given either as an epidural (see p 176), a spinal block, where the anaesthetic drug is injected into the fluid surrounding the spinal cord, or a combined spinal epidural. In both cases, a needle is inserted into the back and medication is given through a narrow tube to numb the abdomen downwards Although this takes longer to perform than a general anaesthetic, the anaesthetist will be very skilled at inserting the needle He or she will use a cold spray to ensure that you are totally numbed and the procedure will not start until the anaesthetist is completely happy that this is the case. On very rare occasions when the procedure can be felt, a general anaesthetic will be given straight away. The regional option is safer and
the birth experience is not missed The choice will ultimately be yours, unless certain conditions dictate the safest option
Who will be in the operating theatre?
Although it may seem like a crowd, all of the people in the operating theatre have a role. An anaesthetist will be present to make sure you do not feel the procedure and he or she will be helped by an operating department assistant. The main surgeon and his or her assistant will be performing the Caesarean section A midwife and sometimes a paediatrician will receive the baby A scrub nurse will pass the instruments to the surgeon and a runner’ will be there to fetch things and count the instruments with the nurse Your permission must be gained for students to be present You may wish to have your husband partner friend, or a family member present with you, which is usually agreed with the team leader in advance (although it is very common for your partner to be there).
How will I be stitched and how long will my scar be?
If you have the most common type of Caesarean, a ”lower segment Caesarean section”, a 12-1 Scm cut is made along the bikini line. The other, less common, type is a ‘classical” or vertical incision. During a Caesarean, the surgeon needs to cut through several layers of fat and tissues before making an incision in the uterus These internal layers will then be restitched after the operation using soluble stitches and then the layer of skin will be stitched or clipped at the end. Clips, or staples, are usually removed about three days after the operation whereas stitches are left in for about five days. The removal of clips or stitches is usually a fairly painless procedure.
Can my partner still cut the cord?
It is important during a Caesarean section that the procedure is carried out under sterile conditions. This means that all of the staff around the operating table, and the instruments, will be sterile (the highest level of cleanliness). The staff have to undergo a specialized washing technique called ‘’scrubbing” and then use a gown that has been washed and packed to certain standards This is to reduce the risk of infection to the mother and baby. If your partner was allowed to cut the cord, this would mean that the same principles would apply. It would therefore not be practical or possible to ensure that every partner was trained in this technique However, it may be possible for your partner to “trim’ the cord away from the table as an alternative. This is sometimes necessary when the midwife has cut the cord and applied the cord clamp; but there is still too much cord length, and it is often a good opportunity to involve dads
Will I be able to watch my Caesarean section operation if I want to?
Usually the mother is fully awake for her Caesarean section, with the exception of some emergency situations when it might take too long for the anaesthetist to insert the spinal anaesthetic, in which case a general anaesthetic will be given However, whether the mother would literally be able to watch the Caesarean section is a different matter. During
•    Caesarean when the mother is awake, it is usual for
•    screen to be erected to stop her and her partner from seeing anything. To see the operation, the screen would have to be taken down. You would also need to have your head raised, which would present difficulties for the surgeon, as the operation requires that the mother lies fairly flat so that the surgeon can get to the baby and the abdomen. Although the operation itself may sound thrilling, you may not be thinking this when it is actually happening to you On occasion, even a planned Caesarean section can run into difficulties, and in the worst case scenario, the mother will have to be given a general anaesthetic.
Many obstetricians, however, do drop the screen, if you wish, at the point of your baby being delivered from the abdomen, and the parents are shown the baby so that they can see what the baby looks like.
Is a baby born by Caesarean section any different to a baby born vaginally?
The condition of a baby following a Caesarean section depends greatly on the reason for the operation. If the Caesarean section is being performed as an emergency situation because the baby’s wellbeing is in question, there will be differences between this baby and one born by
a planned Caesarean section or vaginal birth. For example if the baby is distressed, its skin colour, activity levels, and breathing rate may all be affected Each baby is assessed, initially by the midwife and/ or a paediatrician, and is then given a score out of 10, known as the Apgar score (see p.217).This looks at the baby’s colour, heart rate, stimulation response, how the baby is breathing and the muscle tone, and the midwife will perform a detailed examination of the baby a little later to examine the baby’s skin, fontanelles, ears, eyes, mouth, nose, body, genitals, spine, anus, and heart and breathing. A baby born by a planned Caesarean will have a nice rounded head as it hasn’t been pushed through the birth canal, and about and this will. in itself, speed up recovery and reduce the risks resulting from immobility such as deep vein thrombosis.
Will I still be able to hold my baby straight after the birth?
In most units, the midwife or paediatrician will show you your baby quickly before reviewing your baby’s condition (see p.217) Once the paediatrician and the midwife caring for you are happy that your baby is well, she will be well wrapped and placed across your chest while you are on the operating table. Although it might be hard for you to hold your baby at this point due to your position, this will be the first opportunity for you to feel and see your baby.
Once you have been transferred to the recovery area after the operation, the midwife will first make sure that you are well by checking your pulse, breathing, and blood pressure, and by looking for any signs of heavy bleeding She will then attempt
to get you into a comfortable position, probably lying on your side, to enable you to enjoy some skin-toskin contact with your baby and to breastfeed your baby should you so wish.
How soon will I be able to go home after a Caesarean section?
Only a relatively few years ago, women who had had a Caesarean were kept in hospital for around five to seven days, and a few years before that, 10 to 14 days was the average amount of time spent in hospital Nowadays, mainly due to the recognition that women do recover much better in the comfort of their own homes — where they are likely to get more sleep and rest as they are not being disturbed by other babies — and also sometimes due to economics, lack of space, and reduced maternity staffing levels, women are usually discharged from hospital at around two or three days after their Caesarean operation.
There are individual circumstances when this might not be the case, for example if the mother is not coping well after the birth, if she is on her own at home, or if she is having problems breastfeeding her baby, then her discharge home may be delayed. If a baby has been admitted to the special care unit in the hospital, many maternity units will allow the mother to stay for up to 10 days.

You may think that there is little a
partner can do during a Caesarean, but this is not the case as your birth partner still has the important job of supporting you during the operation.
* If the Caesarean is an emergency procedure, partners can make sure that the reasons why this is necessary are clear. * If you are awake for the procedure, your partner can remain in the theatre, sitting by your head and offering you reassurance throughout the operation.
* Once your baby is born, you and your partner can welcome her together,
and its gender Then the screen is put back up to deliver the placenta and stitch up the incision. If you do wish to watch more of the operation, you should discuss this with the surgeon and the anaesthetist prior to the operation Likewise, if you don’t want the screen to be lowered at all, make this clear to the operating team beforehand.
What are the reasons for Caesarean sections?
There are various reasons why a Caesarean section might be carried out. You may be advised to have a Caesarean if the baby cannot enter the pelvis due to the baby’s size or position or the shape and size of the pelvis; if you have a low-lying placenta; for a multiple pregnancy or breech baby, if your labour is not progressing; if you had a previous Caesarean section or traumatic birth: if you have severe pre-eclampsia; if the baby’s growth is severely reduced; if you have had heavy bleeding in pregnancy; and for certain other medical conditions The doctor will advise you of the reasons why a Caesarean section may be the safest option.

Recovering from a Caesarean
Although you should remain mobile after a Caesarean operation,
it is also important that you get plenty of rest A Caesarean is major surgery so you will need to avoid lifting and carrying heavy loads for the first few weeks. As this may be difficult if you have other small children or are at home alone, you should try and recruit as much help as possible after the operation You should avoid doing any shopping, which usually involves lifting, or driving for a few weeks Check with your insurance company when they are happy for you to drive again and make sure that you feel comfortable wearing a seatbelt and doing manoeuvres, including emergency stops. It is generally thought to take up to six weeks to fully recover.

Why isn’t the baby out yet?
assisting the birth
What is an assisted delivery?
An assisted delivery is one that uses either forceps or a ventouse, or suction cup (see p.204), to help extract the baby from the birth canal if the baby is not making good progress during labour or there are complications during the second stage of labour in a vaginal delivery You will still be helping to deliver your baby with your contractions, but the instrument used will be helping to guide the baby out of the birth canal.
How is an assisted delivery carried out?
Assisted deliveries are carried out using either forceps or ventouse (vacuum extraction) by a doctor (or specially trained midwife) Forceps are metal instruments specially shaped to fit around the baby’s head, whereas in the ventouse method, a vacuum is created by attaching a cup-like fitting to the head and using a mechanism to create suction to help draw your baby out.
How do they decide whether to use ventouse or forceps? Will it be my choice?
Both forceps- and ventouse-assisted births are relatively safe procedures and, although each has pros and cons, it’s best to be guided by the doctor, as the choice of instrument usually depends on the position of the baby and the doctor’s preference or experience, although your opinion will be taken into consideration. Although forceps used to be the most widely used instrument, ventouse has increased significantly in popularity. Many consider ventouse easier to use and less likely to cause damage and tearing to the mother. However, this method is also more likely to cause swelling to the baby’s head where the cup was placed
What is a “prolonged second stage” and does this mean that the delivery will be assisted?
It is difficult to define a ”prolonged second stage” as it depends on certain factors, for example if it is your first baby the position and size of the baby, if you have an epidural, if the contractions are effective and how often they are coming, how well you are pushing, and if the pelvis is an adequate size There is some evidence to suggest that if the baby has progressed further into the pelvis, and there is no sign of distress. then there is no need to put a time limit on labour. However, it does tend to be the case that hospitals have guidelines as to how long they will allow a woman to push for before deciding that intervention may be necessary Usually, after about one and a half hours, doctors may decide to assist the delivery to reduce the risk of fetal distress and of the mother becoming exhausted.
I had a forceps delivery as in the end I was too tired to push. Is this likely to happen again?
An assisted delivery is more common during a first birth than in subsequent ones. The first pregnancy and birth causes the pelvic ligaments to stretch, which can make subsequent births easier, and the uterus is often more efficient in contracting the second and subsequent times around, which also means that labour is usually shorter Often, even if the baby’s head is not in the best position for birth, for example if the baby is in a posterior position, where the back of the head is towards the mother’s spine and lower back, it may be delivered without assistance during a second delivery Therefore, it is likely, but by no means certain, that you will have a normal vaginal delivery next time.
Can I refuse to have forceps or vacuum extraction and what are the alternatives?
No-one can go against your wishes if you do not want to have a particular procedure. However, it’s usually best to have a flexible approach to labour. Although you may wish for certain things not to take place, the doctor or midwife is likely to have a good reason for wanting to carry out a procedure and has your and -your baby’s best interests at heart. If an assisted delivery is suggested, asking the midwife or doctor to explain and support this decision can help you to come to terms with it. Usually the only other alternative to an assisted delivery would be a Caesarean section: however, this may be difficult if the baby has gone too far into the pelvis
Will I have an anaesthetic before they use the forceps?
Suitable pain relief, such as a local anaesthetic injection, or an epidural, will be given before the procedure The doctor will then help to pull the baby out while the mother pushes. The forceps and ventouse cup are removed after the head has been delivered, and the body is delivered normally,
What can go wrong at an assisted birth?
Forceps and ventouse can cause bruising, swelling, and marks on the baby’s head or face, although these usually resolve without any problems within a few days In rare cases, cuts and severe bruising on
Assisted delivery
An assisted delivery, using forceps or a ventouse vacuum extraction, may be carried out for one or more of the following reasons:
* The mother is exhausted from a long labour and has insufficient energy to push.
* The baby is showing signs of distress during the second stage of labour.
* The baby’s head is in a slightly wrong position -if you are in the second stage of labour, forceps or ventouse can often be used to turn the head around and deliver the baby.
* Forceps are sometimes used to protect the delicate head of a premature baby during birth
* Forceps are sometimes used to deliver the head of a breech baby
* If the baby is particularly large - this can be the case when the mother has had gestational diabetes .
the baby can occur. The paediatrician, a doctor who specializes in babies and children, may prescribe a paracetamol-based medicine to ease any discomfort that the baby may feel There is also an increased
risk of the baby developing jaundice, where the baby looks yellow due to the presence of the waste product bilirubin (see p.164), particularly in cases of severe bruising The levels of bilirubin in the baby will be checked if the doctor is concerned and the condition can be treated, if necessary
For the mother, the two main concerns are that there is an increased risk of tearing or being cut during the procedure - and hence an increased risk of more bleeding (which can be dealt with straight away) - and, rarely, damage may occur to the tubes that lead from the bladder.
If the situation warrants an assisted delivery, the benefits of delivering babies by these methods far outweigh the risks. If the procedure is not successful, an emergency Caesarean may be necessary.

Helping your baby’s birth

A delivery may be assisted using either vacuum extraction (or ventouse), which involves a small suction cap (metal or plastic) being placed on the back of your baby’s head and very gently pulled, or forceps, metal tongs that guide the baby out.
Why might this be necessary? There are several reasons why the obstetrician, and in some units the midwife, will advise this type of birth.  Generally an assisted delivery is carried out because the mother is too tired to carry on pushing after a prolonged second stage of labour, and the ventouse suction cap or forceps can help accelerate the baby’s progress through the birth canal. An assisted delivery may also be necessary if your blood pressure has risen suddenly or if there are signs of fetal distress You will be given either an epidural or local anaesthetic before the procedure is carried out
Is it safe? This is a safe way for your baby to be born, although there is a very small chance that your baby may bleed under his scalp and may need to go to the neonatal unit to be cared for and monitored after the birth, After vacuum extraction, most babies will have a little bump (a ”chignon”) where the soft cup has been attached to the head, and the baby s head may look slightly elongated Babies delivered by forceps may have marks on the sides of the head where the tongs were. However, any swelling or marks should disappear within a few days
Will I need an episiotomy? An episiotomy - a cut made between your vagina and back passage to make more space for your baby to be born in order to prevent tearing - is sometimes carried out if you have an assisted delivery, and is more likely with a forceps delivery.

Episiotomy
An episiotomy is an incision, or cut, made with scissors into the area called the perineum, which is the piece of tissue between the vagina and the anus. This area stretches and thins during the birth to allow for the baby’s head to be born with ease An episiotomy is performed only in an emergency situation An example of this is if the baby needs to be born quickly, or sometimes during an assisted delivery for example with forceps (see opposite), to prevent uncontrolled tearing Before the procedure is performed, a local anaesthetic is gently injected into the muscle to reduce the discomfort or pain during the procedure. An episiotomy will need stitching afterwards, and this is usually done by the midwife who has been involved in your delivery or by the obstetrician involved in the birth. Although episiotomies used to be routine around 10 to 15 years ago, they are now performed only when really necessary You should be informed why one is being recommended and give your verbal consent before the procedure is carried out.

MEDIO-LATERAL CUT:
What is an episiotomy and why might this be done?
An episiotomy is a cut along the muscle between the vagina and anus, known as the perineum, to widen the area where the baby will be delivered (see above) This is done only when absolutely necessary and will not be performed without your consent. There are several reasons why an episiotomy may be recommended including if the baby is in distress, to speed up the delivery of the head; in cases of forceps or ventouse deliveries! if the baby’s head is too large to pass through the vagina; if the perineum has not stretched sufficiently by the end of the second stage of labour to allow the smooth passage of the baby’s head through the vagina; if there is a complication in the vaginal delviery of a breech baby: or if the mother is finding it difficult to control her pushing while the baby’s head is crowning (see p. 186), which means she is more likely to tear significantly during the delivery
Usually, local anaesthetic is injected into the muscular area first and the procedure is performed at the strongest part of the contraction, as this distracts you from what is being done and assists with a quick delivery
The thought of having a cut down there is terrifying. What can I do to prevent this?
Some studies have shown that massaging the perineum regularly in pregnancy, using an unscented vegetable oil, can reduce the risk of tearing (see p.111) as this helps to make the area more flexible and may consequently help to stretch the area as the head is being born Wash your hands thoroughly before massaging the perineum. Although an episiotomy may be a worrying prospect, if you are advised to have one, this may prevent uncontrolled tearing.
Why might they do an emergency Caesarean section?
Emergency Caesareans are carried out for several reasons. The baby may be showing signs of being very tired, picked up by the fetal heart monitor or a blood test carried out during labour, and this could lead to the baby being distressed, known as fetal distress, in which case a Caesarean may be recommended Rarely, the umbilical cord comes down before the baby, a condition known as cord prolapse, and this is an emergency that requires immediate delivery by Caesarean.

What can I do to help?
partners at the birth
Should I be with my partner as soon as she goes into labour? I’ve heard that first babies take ages.
It’s true that first labours often take quite a few hours, although this is certainly not the case with everyone! When your partner notices signs that labour is beginning, such as a mucousy ’show”, the waters breaking, or irregular period-type pains, she may wish you to be with her. On the other hand, she may be happy to be alone, or with a friend or relative,
and keep you updated by phone Whether or not -you are there really depends on how she feels so good communication between the two of you is the key.
Once your partner is having regular, painful contractions about every five minutes, it would probably be best to be with her, if you aren’t already It is usually around this time that you should be making your way to hospital, if that is where you are planning to have the baby, or contacting the midwife if you are planning a home birth.
I feel very panicky about getting my partner to hospital on time. How can I calm down?
Your anxiety is understandable. However, not many babies are born on roadsides or in hospital car parks — that’s why these stories make their way into newspapers and magazines! It is hard to advise on a definite time to go into hospital as every labour is different and follows a slightly different pattern. However, as a general rule, you should think about going in to hospital if:
•    Your partner has had any vaginal bleeding.
•    Your partner’s waters break (see p.167), She may notice this as a gush of fluid from the vagina, or a more gradual leaking.
* Your partner’s contractions (which are often described as strong period-type pains that are
accompanied by a hardening of the bump) are lasting around 45 seconds each and coming regularly, at least every five minutes.
If you or your partner are unsure about how to proceed, don’t hesitate to give the labour ward a call. An experienced midwife can tell a lot about how far into her labour a woman is likely to be just from talking to her about what is happening.
I’ve heard lots of stories about blokes in the labour ward - I want to be helpful, but I am nervous.
Many men are very anxious about being with their partners during labour and birth. This is often due to the fact that they will be watching their partner experience one of the most intense things a woman can ever do and they may be unsure of how to help
Probably the best way to help overcome your fears is to talk to your partner about how you feel and try to discuss ways in which you could help. You will probably find that there are plenty of ways in which you can support her, such as being aware of her wishes and speaking for her if she is unable to because of the pain, repeating what midwives and doctors have said if she didn’t hear or process the information, passing her a drink, rubbing her back, holding a flannel to her face, switching music on or off, and generally encouraging and reassuring her.
Attending birth preparation classes together can be very useful You will be able to learn more about the process of labour and birth, which can be helpful, and you will learn about how to support -your partner both physically and emotionally. Some classes teach birth partners massage techniques that can be an effective form of pain relief during tabour You will also be shown how you can support your partner in certain birth positions. Your partner’s midwife will be able to advise you on classes available in your area.
I really don’t want to be there - how will I tell her and who should go in my place?
Honesty is the best policy, so you need to talk to your partner about your concerns well in advance of the big day. Although she may feel disappointed at first that you don’t want to be there, she should appreciate your reasons if they are valid ones. Perhaps you could try to reach some sort of compromise whereby you will be with her during the earlier stages of labour, go out for the actual birth (if you are worried about this), and then come back in again straight afterwards to support your partner and meet your new baby
It is up to your partner who else she has with her during labour Women often choose their mum, sister, another female relative, or a close friend to be with them However, if she can’t think of anyone suitable, you may want to consider hiring a doula, who support women in labour (see p. 196); there are websites that can help you with this (see p.310). Your partner may also wish to have more than one birth partner, which most hospitals are happy to accommodate.
What should we do when my partner goes into labour?
Although it is often hard to define when labour has started, if the signs are that your partner is in the early first stages of labour (see p.167), you can both continue with normal activities as long as she feels comfortable. Being aware of how labour progresses and how contractions build up can help you to plan your course of action. For example, if your partner’s waters have broken, established labour usually follows within a few hours (although not always) and it is best to inform the hospital
While you wait for the contractions to become stronger and more regular, try to relax as much as possible between contractions You could make a healthy snack for you both to provide fuel for the hours ahead, practise breathing and relaxation techniques together, or run a warm bath to help your partner relax Once the contractions are around every five minutes and last about 45 seconds, you may wish to consider going into hospital, if that is where you are planning to have your baby. Ring the labour ward first to let them know what is happening
Is massage useful, or will my partner find it irritating when she’s trying to cope with the pain?
Many women find massage, particularly of the lower back to be very helpful during labour. The sensations of warmth and pressure can be soothing and give some relief from pain during labour. Massage stimulates the body to release endorphins, which are the body’s natural painkillers, and also acts as a ”distraction” from pain, providing another focus Communication is the key when it comes to massage. For example, your partner can tell you whether she wants to be massaged during contractions. or just between the contractions, or whether she wants firm or light pressure. You will probably learn simple massage techniques during birth preparation classes, or you may find some classes dedicated to massage techniques for labour. Ask the midwife what is available in your area
It can be the case that some women find that they do not want to be touched at all during labour If your partner feels this way, try not to take it personally -this is her way of dealing with the pain
Apart from massage, are there other ways I can help my partner cope with the pain?
Every woman’s experience of pain during labour is different, and they will have different ways of coping It can be difficult to know in advance if a particular coping technique will help, but many couples find
it helpful to talk before labour about how they might feel, and how the partner may be able to help. While some women find massage beneficial (see above). others will need help to focus on keeping their breathing slow and steady It’s worth practising labour positions that require the support of a partner before the actual birth (see p.182 and p 186). Having some favourite music on in the room may help your partner to relax Above all, most women appreciate encouragement and gentle loving support from their partner, and just the fact that you are there will go a long way in helping her to cope with the pain and exhaustion of labour and birth.
My friend’s husband won’t be at the birth. She wants me to be her birth partner. How can I prepare?
It’s a great privilege to be asked to be a birth partner for a friend and there are plenty of things you can do to prepare for the event. Obviously you will need to talk in advance about your friend’s expectations for labour and familiarize yourself with her birth plan if she has prepared one (see p 149). It’s important to be sensitive to your friend’s wishes, for example does she want you to remain with her throughout, or would she like you to leave the room if she has an internal examination? Talk to her about how she thinks she might react under stress and in pain - is she likely to shout or perhaps become more withdrawn? - so that you can prepare yourself mentally to deal with this. It would also be wise to find out as much as possible about what birth entails - the different stages of labour and what can help or hinder them. You could suggest attending antenatal classes with your friend so that you feel fully informed. It may also help to talk to someone else who has been a birth partner and who may have some useful tips. Bear in mind that you may need to be with your friend for a fairly lengthy amount of time. so you may want to have some provisions for yourself, such as snacks and drinks. You may also need periods of relief during the labour, and there may be times when you feel your morale is flagging. in which case it can be a good idea to have someone on standby who you can phone for encouragement and support.
How will I feel when I see a male doctor examine my partner? Will I feel jealous?
If labour and birth are straightforward, it is unlikely that your partner will need to be examined by a doctor. It is only if there is some concern over the wellbeing of either your partner or the baby, or both, that a doctor’s opinion is sought Even in this situation, an internal examination is not always necessary.
If your partner did need to be examined, you would probably find that you would be too worried to be aware of any feelings of jealousy Doctors, whether male or female, have only your partner’s and baby’s health in mind when they are performing any kind of examination.
I secretly want a boy - I haven’t told my partner - how will I cope if it’s a girl?
This is certainly not an unusual feeling to have and I think that many prospective parents have a preference, secret or otherwise, for a baby of a particular sex While it may take you a little while to become accustomed to having a baby of your less preferred” gender, you may well find that you have no problems at all bonding with the baby if it is a girl Seeing your own newborn baby for the first time is something that no-one can prepare for, and many parents feel a strong rush of emotion straight away. Others take a little longer to fall in love with their baby, and this is fine too.
Whichever sex your baby is, it takes time to get to know him or her. You will probably find that you relish watching every little movement and expression,
touching and stroking his or her little body, and will enjoy learning about all the different aspects of baby care. By being involved with your baby from the beginning, you will quickly experience the joy of parenting your son or daughter
I can be quite panicky in stressful situations. What if I pass out?
The image of the father-to-be fainting onto the floor of the delivery room is often portrayed in cartoons and on birth congratulation cards, but it is far from funny if it actually does happen! Fortunately, it is probably much less common than you may think.
It is understandable for any birth partner to
feel anxious and tense — you are watching someone you care about in pain, and you are m unfamiliar surroundings experiencing probably the most significant moments of your life! Focusing on your partner and attending to her needs may help to keep you occupied and distracted and less likely to dwell on your own anxieties. Also, developing a trusting relationship with your partner’s caregivers will help you feel able to express any worries you are having, and hopefully you will be given the reassurance and information you need
If you do find yourself feeling even the slightest bit woozy, try and leave the room as the midwife will be focused on caring for the mother and baby If you do not have time to leave the room to seek help, and you feel faint, dizzy, or light-headed, try to sit down immediately, with your head lower than your hips, or lie down with your feet raised Try to stop yourself “panic breathing” (breathing quickly and lightly), and take slow, deep breaths You should find that the feeling passes quite quickly. The midwife will probably ring the buzzer for assistance. A good tip is to ensure that you are not too hot — take shorts and a T-shirt with you as delivery rooms can be quite stuffy — and make sure you eat and drink regularly to prevent your feeling faint due to low blood sugar.
Our little boy suffered a lack of oxygen at his birth. He is fine, but I’m anxious about this delivery.
Unborn babies are designed to cope with a moderate lack of oxygen during the birth, which is quite normal Some babies do suffer a greater lack of oxygen, and midwives are often alerted to this by observing the baby’s heart-rate pattern If there is any cause for concern, the baby can be delivered quickly either by forceps or ventouse, or by a Caesarean section In most cases, the baby is born in a healthy condition, or responds quickly to resuscitation after the birth.
Every labour is different and there is no reason why your next baby should react to labour in the same way as your first, but your baby’s heart rate will, of course, be monitored very closely, so you should feel reassured by this.
Will I be able to help the midwife cut the cord after the birth?
It is popular for the baby’s father, or another birth partner, to cut the umbilical cord after the birth. Midwives and doctors are usually happy for this to
happen, as long as there are no problems with the mother or baby that would necessitate the cord being cut very quickly
The cord is tougher than most people think, but the midwife will guide you and show you how to cut it safely. Be warned that it usually takes quite a few attempts to sever it completely!
Will I be able to video or photograph the birth and do I need to agree this in advance?
Most hospitals are happy for you to film or photograph the birth of your baby if that is what you both want However, before you embark on this, you should first check that the midwives or doctors who will be conducting the actual delivery have no objection, as some professionals do not wish to be filmed for legal reasons.
While some couples treasure having a visual record of probably the most special and momentous time of their lives, other couples prefer to start filming or photographing their baby after the actual birth. It is important to consider the impact that being filmed or photographed at such an intimate and vulnerable time could have on your partner, and she should not feel in any way pressured to be filmed Also, it might be worth thinking about how filming the event may affect your actual participation in the birth. If you are concentrating on filming or taking photographs, you may not be as involved in the birth as you could be and may not be providing your partner with all the support that she needs.
When planning how to record the birth of your baby, bear in mind that clear communication between you and your partner before the labour, and with the midwife and doctor once labour has started, is important to ensure that everyone’s wishes in this matter are respected
Can we take food into the delivery room?
Most hospitals are happy for you to bring your
own food and drink into the delivery room, although most are able to provide your partner with light refreshments should she want something It used
to be the case that women in labour weren’t allowed to eat or drink, but nowadays this is not the case. Research on the subject has concluded that it is perfectly safe for women to control their own food and drink intake during labour
However, hospitals don’t tend to provide food for birth partners, so it would be wise to pack plenty of snacks There is usually a canteen on the hospital campus somewhere but getting supplies from there may mean you are away from your partner for a time Alternatively, vending machines may be available.
What and how much your partner eats should be guided by her appetite. She should try, however, to stick to light, easy-to-digest foods that will give her plenty of energy, such as fruit juices, bread and honey, dried fruit, digestive biscuits, or bananas. Once labour is well established, it is likely that she won’t feel much like eating as her body needs to focus on delivering the baby,
I’ve heard that natural or water births are best for the baby. Should I ask my wife to have one?
Most childbirth experts would agree that a straightforward vaginal birth is the safest form of birth for both mother and baby. It is also generally considered safe to use water as a method of relieving the pain in uncomplicated labours (see p, 156) However, it is sometimes not possible to achieve a straightforward vaginal delivery due to certain situations that can arise during pregnancy, labour, and/or the actual birth If a problem with either the mother or baby occurs, the medical team will advise on the safest way of delivering the baby.
It is important that your partner thinks herself about the type of birth she would prefer and does not try something she is uncomfortable with. So it is not really your job to make decisions on behalf of your partner, and it’s also wise to be prepared to be flexible and to see how labour unfolds.
My wife doesn’t remember much about the birth. How much should I tell her?
It’s best to be honest about your memories of the labour and birth, even if this was a daunting experience for you both. You are likely to be the best person to explain to your partner about how she coped, and sharing your memories may help her to feel comfortable about expressing her own emotions about the birth, particularly if it was fairly traumatic. In this case an important part of your partner’s (and your) acceptance of what happened during the birth is to recall the sequence of events and to try to understand why things went the way they did This is especially important if you feel that your partner’s care didn’t go according to the birth plan. If this is the case, you may even want to talk to the midwife who cared for your partner during labour and birth about what happened. You can ask her to go through your partner’s notes with you both and explain exactly what happened. You can also ask for a postnatal ”briefing” to discuss the birth by contacting the head of midwifery at -your local unit.

Extra birth partners

Most hospitals are happy for women to have more than one birth partner, although some do set limits, depending on the amount of available space.
* It’s common for women to have their mum, sister, or close friend with them in addition to their partner.
* If labour is particularly long, having more than one birth partner can mean that they can relieve each other for breaks knowing that the mother has someone with her, * Some evidence suggests that having a female birth partner reduces the amount of pain relief and intervention needed.

Birth partners
The aim of a birth partner, whether this is your husband or life partner, a friend, family member, or hired doula, is to offer practical and emotional support to you throughout labour and birth.
How can birth partners help? As a birth partner’s role is to support you through labour and birth. it is important that they are aware of your wishes and are prepared to liaise on your behalf or keep track of events when you are not able to. It is important that they are knowledgeable about the stages of labour and have discussed with you in advance ways in which they might help, whether through practical support such as massage or helping you with labour positions, or by offering you encouragement and reassurance
What is a “doula”? Doula is a Greek word that means ”woman servant” or ”caregiver”. Nowadays, this refers to someone who gives emotional and practical support to a woman before, during, and after birth. The aim is for a woman to have a positive experience of
pregnancy, birth, and early motherhood This help and support is extended to the partner and other children Doulas can offer support in pregnancy which gives time for the family to get to know her, In labour and birth, she can help with massage, suggesting different positions, liaising with professionals, and giving emotional support. After birth, doulas can help with feeding and baby care, as well as care of the mother, Some do housework, prepare meals, and entertain older children.

Your role as go-between
One of the most important roles of a birth partner, whether you are the baby’s father or someone else chosen to be the birth partner, is to be aware of what is happening during the labour and birth and to liaise with the medical professionals on behalf of the mother if necessary There may be instances when you or your labouring partner don’t understand why a certain course of action is being taken, and your partner may be in too much pain, or too preoccupied with labour, to be able to ask.Your job is to talk to the midwife or doctor and gather information about what is happening. This means that you will both feel fully informed about what is happening in labour and will be able to participate in any decisions that have to be made about the labour or birth.

Remaining calm

Even though the birth of your baby is one of the most memorable and exciting events of your life, it can also be hard to witness your partner’s pain and to stay calm under pressure. * Being mentally prepared to see your partner experience considerable pain can mean that you are more likely to respond in a reassuring, rather than anxious, way. * Breathing and relaxation techniques can help you to stay calm and focused too. * If you do start to feel flustered, it may be wise to leave the room briefly, if there is an opportune moment, to refocus.

I’m over my due date

What is happening to my baby after 40 weeks?
In many pregnancies, there are no changes to your baby’s activities after 40 weeks and his movement patterns will be the same, although your baby’s head will probably move lower into your pelvis as he gets ready for labour, resulting in a lighter feeling under your ribs and a heavier feeling down in the pelvic area. In other pregnancies, mothers may notice a slowing down of movements as the pregnancy progresses. The placenta, which feeds the baby, operates on a lower efficiency after about 38 weeks, and certainly after 41 weeks This means that your baby’s growth tends to slow down the further your pregnancy goes. As it is not possible to accurately predict whether or not the placenta will continue to function well, most hospitals have an induction policy to avoid the risk of distress to the baby, which increases the longer the pregnancy continues.
What happens if you go over your due date?
This varies slightly from area to area, however you would normally be offered an induction of labour between 41 and 42 weeks of pregnancy, which means that your labour will be started off artificially (see opposite). Different hospitals have their own criteria for how long past your due date they will wait before suggesting an induction of labour, but this is usually between 10 and 14 days after your expected date of delivery (EDD).
If an induction is considered, your doctor or midwife should discuss all your options with you before any decision is reached. Although you are within your rights to decline induction, you should make sure that you are fully aware of the reasons why it has been suggested so that you can make an informed decision.
I have a long menstrual cycle. I don’t think I’m as overdue as they say. Can nature take its course?
The ”due date” is calculated from the first day of your last period, and assumes you have an average 28-day menstrual cycle. However, if you have, for example a 35-day cycle, your due date would be a week later If this is the case, an ultrasound scan during the first 20 weeks of pregnancy would have measured the growth of the fetus and this would have given you a due date that reflected your menstrual cycle more accurately.
Current guidelines recommend inducing labour between 41 and 42 weeks of pregnancy if it has not begun on its own. If you choose not to be induced, you will be monitored regularly.
What is a “membrane sweep” and could I have this instead of being induced?
Prior to an induction of labour, at 41-plus weeks of pregnancy, it is recommended that all women are offered a membrane stretch and sweep to assess the readiness of the cervix for labour. A membrane sweep involves your midwife or doctor placing a finger just inside your cervix and making a circular, sweeping movement to separate the membranes from the cervix. The aim of this is to stimulate the release of hormones that may start labour contractions. Although this is likely to be an uncomfortable procedure, it should not cause you actual pain; you may also experience a mucus/bloodstained ‘’show” -like a discharge - following this, which is quite normal (see p.167).
Membrane sweeps have been shown to increase the chance of labour starting naturally within the next 48 hours and therefore reduce the need for other methods of induction.
I don’t like the sound of the amniotic hook. What exactly is this?
An amniotic hook is a long thin piece of plastic with a hook shape at one end. This is used to make a hole in the membranes surrounding your baby to release the amniotic fluid in an attempt to kickstart labour. The procedure, known as ”breaking the waters”, amniotomy, or ARM (artificial rupture of the membranes), is as uncomfortable as an internal examination, and isn’t usually painful, although some women do need some form of pain relief, such as gas and air, during the procedure. An amniotomy is carried out by the midwife or doctor, who will carefully guide the hooked end of the instrument into the vaginal canal with his or her fingers He or she will then press the end against the membranes to pierce them, which can help to stimulate contractions and in turn start labour.
In some cases, contractions become established quite quickly after this procedure. If this is not the case, then you will need to remain in hospital and be induced with an oxytocin drip (see p. 191)
Fetal monitoring in labour
During labour in hospital, you may spend some time attached to a cardiotocograph (CTG) machine This monitors your contractions and your baby’s heartbeat to check whether your baby is showing any signs of distress in labour Two straps are placed around your waist. One records the movement of your uterine muscle and the other measures your baby’s heart rate. The machine you are attached to produces a printout of the two readings so that the midwife or doctor can review the progress of you and your baby. If your labour is straightforward and the CTG readings show no problems, then you can be unstrapped and disconnected from the machine so that you are free to move around. Your midwife may then want to monitor you and the baby again at regular intervals throughout labour.
Can an amniotic hook harm my baby?
An amniotic hook, which is rather like a long crochet hook used to tear a little hole in the amniotic membrane surrounding the baby and the amniotic fluid, is actually fairly blunt and shouldn’t come into contact with your baby at all, so there isn’t really any risk that he could be harmed
Why do I need to be induced?
The main reason for induction of labour is when your pregnancy continues past your EDD, or estimated delivery date, as after this stage the efficiency of your placenta can decline, which can put the baby at risk.
Can I refuse an induction of labour?
You have a right to say no to any intervention
and when induction is considered, your doctor or midwife should discuss all your options before any decision is reached. However, if you wish to delay induction beyond 42 weeks, then it may be suggested that you attend the maternity unit for regular monitoring to check on your baby’s and your own health which may include a Doppler ultrasound to check the blood flow in the placenta You will also be offered an ultrasound scan to check on the amount of water surrounding your baby, as this can be a good indicator of how efficiently the placenta is working and the overall wellbeing of your baby
I’m scared about sudden full-on contractions after induction. Will it be more painful?
Some women do report that an induced labour is more painful than a spontaneous labour. This may be because induced labours can be longer, although this is not always the case. In a spontaneous labour, the body responds to the gradual onset of contractions with the release of natural painkillers called endorphins. In the case of induction, where the onset may be more sudden the body has less of a chance to do this However, some women do still get a gradual build-up of contractions after induction.
It is quite natural to be scared of pain, but -you may find it a help to be prepared mentally and physically by planning which pain relief options you are going to consider and ensuring that your birthing partner knows your plans so that he or she can give you plenty of support Many women opt for ”low-tech” forms of pain relief, such as TENS, massage, being active and changing position, and aromatherapy, in early labour, and these are all options with an induced labour. If you find these
are not enough, you can try gas and air, drugs such as pethidine, and even consider an epidural. If you know in advance how you are going to cope then you will be better able to deal with the pain
Will I need to be monitored continuously throughout labour if I’m induced?
If a syntocinon (hormone) drip is used to stimulate the contractions then, yes, continuous monitoring
of your baby’s heart rate is normally recommended. This is so the midwife and doctor can ensure that the
contractions are not too close together and that your baby is coping with the contractions and not becoming distressed. During the early stages of induction you will be monitored before, during, and following induction procedures Then intermittent monitoring of your baby’s heart rate will take place If you do need continuous monitoring, many units now have “wireless” monitors, which means that you are not physically attached to the machine and can still move around during labour.
Can my partner be present throughout?
Yes, -your partner can be with you throughout your induction and labour, and his continued support is likely to have a positive impact on your wellbeing and help your ability to cope with the pain and stress of labour. Ensure that your partner is aware of your birth plan too (see p.149) so he can support you in any decisions you need to make A lot of units allow up to two birthing partners, which can be a good idea if things are going to be long and drawn out.
What if I don’t go into labour after the induction?
Very rarely, women will experience an unsuccessful induction. especially if their cervix is unfavourable, meaning that it has failed to soften and dilate. This may ultimately result in a Caesarean section being performed As always, discuss the options with your midwife or doctor so that you are fully informed about the procedures being offered.

Types of induction
When your baby is overdue
Induction, when labour is started artificially, may be necessary for health reasons (your health or your baby’s) or if you are over your due date. If the baby’s health is at risk, your obstetrician may consider it better for your baby to be born rather than stay m your womb. For instance, a scan may show that your placenta is not working properly and your baby not growing - in this case it would be better for your baby to be born and fed orally
How will I be induced? There are several methods that can be used to induce labour. To start with, your cervix needs to ripen (soften) and begin to dilate (see p.181) You can be given gel or pessaries of prostaglandin for this to happen These are placed at the top of your vagina so that the drug can work on your cervix. Most units keep you in hospital after this, as the midwives will be regularly recording the baby’s heartbeat on
the cardictocograph machine (CTC) to ensure that you and your baby are coping with the induction drugs Occasionally the cervix does not ripen; if this happens, you may be given a second gel or pessary in six hours.
What happens next? If the gel still does not work, the midwife or doctor will break the bag of waters around the baby (artificial rupture of membranes, or ARM), which may cause discomfort. If you still don’t have contractions, a drip will be inserted into your arm and a synthetic hormone, syntocinon, is given to start contractions. Your baby’s heartbeat will be monitored while you are on the drip, as there is a risk that you may contract too much and the heartbeat be affected. Some women find this type of labour more painful and may need more analgesia, such as an epidural. If none of these works, you will be offered a Caesarean.

How long will it last?
all about labour
How long will my labour last?
This is hard to determine as every woman is different and every labour is different. Also, how long your labour lasts depends on when you start timing it as the start of labour can be a gradual build-up that occurs over a fairly long period of time. Usually, labour is classed as being established when the contractions are regular and getting stronger and do not stop until the baby is born. This, coupled with the cervix opening, are indicators that labour has commenced. During the gradual build-up of contractions, labour is sometimes described as being in the ”latent” phase until it becomes more established. This latent phase may last for a period of around 6-8 hours in first-time mothers.
As a general rule, if this is your first baby -you should expect to labour for around 12-24 hours in total. If you have had a baby before, your labour may be a lot quicker, providing there are no other complications, particularly if you have had a vaginal delivery in the last 2-3 years. In some cases, usually with second or subsequent babies, labours can last for only a few hours, or even minutes, and in these situations the mother may not to make it into hospital. The best advice in all cases is to speak to your midwife or hospital if you think labour has started
I like to know what to expect. What will happen when I first arrive at the hospital?
Hospital routines vary, but generally you will be shown to a room on the labour ward, and one of the midwives on duty will come to see you. As
well as asking you about your labour so far, she will probably ask to check your temperature, pulse, and blood pressure, and listen to the baby’s heartbeat. She will also feel your tummy to assess the baby’s position and how far the head has engaged or
moved down in the pelvis (see p. 148) If -your contractions are regular, an internal examination may sometimes be done to reveal how far your cervix has dilated and therefore what stage your labour is at. This information will give the midwife an insight into the wellbeing of both you and your baby. and will help you both to decide on the next course of action. If your labour is in the very early stages, your midwife may suggest that you return home for a while or spend some time on an antenatal ward If your labour is well established, a delivery room will be found for you
How will the hospital check my progress?
An experienced midwife can tell a lot about your labour just by looking at you and observing your behaviour. For example, a woman who is chatting happily during each contraction is unlikely to be in well-established labour. A woman who is in established labour and starts to be restless and nauseous may be in the ”transition” phase; approaching the second stage of labour (see p.183)
Another way in which your midwife will assess your progress is by feeling your tummy to check the strength of the contractions, and also by feeling the position of the baby’s head in your pelvis
Internal examinations also reveal a lot about how your labour is progressing. By placing two fingers gently into the vagina, the midwife or doctor can feel how far the cervix is thinning out (effacing) and opening (dilating), how the baby’s head is moving downwards, and what position the baby’s head is in.
What is ARM, and is it routine?
ARM stands for”Artificial Rupture of the Membranes”. This means that a doctor or midwife, using a plastic ”crochet hook” with a long handle, control while taking gas and air and therefore you may find that you want to stop taking it while you are pushing if it is distracting you too much and stopping you focusing on the contractions Some women manage their entire labour on gas and air alone, while others find that they need another form of pain relief in the later stages of labour.
How will I use the gas and air and is it likely to make me feel sick?
Gas and air is breathed in through a mouthpiece or mask that is connected to a cylinder or pipes in the wall that lead to larger cylinders elsewhere. You administer it yourself, so are more in control of how much you take and when.
Gas and air can make your lips and mouth feel tingly and dry, and in some cases women report feeling nauseous while taking it. Using a mouthpiece rather than a mask may help to reduce feelings of nausea brought on by the smell of the gas and the sensation of having a mask over your face, and taking sips of water may help As the effect of gas and air is short-lived, you only need to use it during contractions; taking gas and air between contractions will not help with the pain of the next contraction and is likely to increase the sensation of nausea.
I want to have a great birth but you hear such awful stories -how can I stay positive?
For every awful birth story there is an equally positive one — it does tend to be the case that you are less likely to hear about the positive birth stories as these aren’t such good topics of discussion! However your labour and birth proceeds, the birth of your baby will be amazing because you will finally meet the little person who has dominated your life for the past nine months.
It is sensible to remain open minded about labour and birth, because it’s impossible to foresee exactly how things will go on the day However, there is a lot that you and your partner can do to help prepare yourselves for labour and birth so that -you
Gas and air
A form of self-controlled pain relief in labour
A mixture of oxygen and nitrous oxide that is self-administered in labour.
Gas and air, also known as Entonox, is taken through a mask or a mouthpiece during labour. This dulls the pain centres in the brain and produce a sense of euphoria This needs to be timed with your contractions as the effects are short-lasting, with the gas being breathed in just prior to and during a contraction. You will feel normal once you stop using it.
Gas and air tends to be the preferred choice for managing pain in women who want to labour as naturally as possible The reason for this is that gas and air has several advantages, including the fact that you can remain mobile and active while using it; it can he used during a water birth; it doesn’t affect the baby in any way; and it doesn’t make you feel drowsy during labour, which allows you to feel more in control throughout and to remain as focused as possible on your contractions. However, although it is a widely available and a popular choice of pain relief in the UK, it doesn’t tend to be used in the United States
have the best chance of having a positive overall birth experience. For example, you can both learn as much as possible about the process of labour and birth so that you can make informed decisions in labour. You can chat with your midwife, read books, find information on the internet, and attend antenatal classes. Also, knowing how labour progresses helps to demystify the experience and therefore removes some of the fear that accompanies labour and birth. Learning basic relaxation and breathing exercises also helps (see p.173), as being able to relax as much as possible during labour helps you to feel less anxious, which in turn can help the labour to proceed as quickly and smoothly as possible tears a small hole in the amniotic membrane that surrounds the baby and contains the amniotic fluid and the fluid then passes out through the vagina. This procedure is also referred to as ”breaking the waters” and may be uncomfortable. ARM can be used to try to induce, or speed up, labour (see p,191). The idea is that the layer of membrane between the baby’s head and the cervix is removed. This enables the head to press directly on the cervix, which in turn releases the hormones that stimulate contractions and start, or help to speed up, labour.
ARM should not be performed routinely. In a spontaneous labour that is progressing normally, there is no need, and the membranes will usually rupture on their own.
I’m worried about being strapped to a bed and monitored. Is that essential?
If there are no complications or reasons for concern, your baby’s heartbeat will usually be monitored using a hand-held device much like the one used during your antenatal appointments to listen to your
10cm dilated
baby’s heartbeat Once your labour is well under way, your midwife will listen to your baby’s heartbeat for about 30 seconds to one minute every 15 minutes or so, which means that you can move around as much as you like in between.
If you have had complications in pregnancy, or problems develop during your labour, the midwife may recommend that your baby’s heartbeat is monitored continuously using a ‘ CTO”, which stands for ”cardiotocograph” (see p.192). This means that you will have two monitors strapped to your tummy using thick elastic belts. One measures the baby’s heartbeat and the other measures the frequency of the contractions. The monitors are attached to a machine that prints out information in the form of a graph This allows the doctors and midwives to keep a close eye on your baby’s wellbeing and how she is responding to the contractions.
A CTO does make keeping active a little more difficult but by no means impossible. Leads can be moved out of the way and adjusted, and some maternity units have a wireless CTG You can talk to your midwife about how this will be managed.

When can I start pushing?
Ideally you can start pushing as soon as you feel the urge to, assuming that your cervix is fully open. The urge to push is usually stimulated by the baby moving down the birth canal, which happens at some stage once the cervix is fully open. You may experience a sensation of needing to open your bowels and may actually pass some stools or urine, as the baby is pushing on the back passage. This is a very common occurence in labour (see p 188)
If both you and the baby are well, you will be encouraged to follow the natural urge to push. Sometimes, you can feel an urge to push before the cervix is fully open If this is the case, it is important to resist this feeling as much as possible, as pushing at this stage can cause the cervix to swell, which makes it more difficult for it to dilate. Some women find that kneeling on all fours with their head and shoulders lower than their hips is a good position for this stage of labour.
What is “crowning” and should I continue to push during this part of the labour?
This term refers to the part of birth when the widest part of the baby’s head – known as the crown –eases out of the opening of your vagina. Your midwife will encourage you not to push at this stage so that the baby’s head can be born in a slow and controlled way, which can help to prevent serious tears to your vagina and perineum (the muscle and tissue around the outside area of your vagina and anus). Although stopping pushing can be hard, -you could try short panting breaths or slow steady breaths to help you achieve this.
Although many women are worried about the possibility of tearing during the delivery of their baby it can be reassuring to remind yourself that midwives are very experienced and practised at guiding women and helping them to avoid tears whenever possible.
Positions for the second stage of labour
Although by this point in your labour you may be extremely tired and the contractions are lasting longer, it is best to resist any urge to lie down as this will not help the progress of the baby through the birth canal.Your partner can help support you while you hold certain positions and help you to remain upright if possible so that gravity can assist your baby. Many women find squatting or kneeling on all fours the most comfortable, or if you really need to lie down, get your partner to support one leg so that the pelvis can remain as open as possible.

How long will the first stage of labour last?
The first stage of labour lasts until the cervix is fully open, or ”dilated” (see p.181). Women tend to time their labour from the first contractions, but midwives and other healthcare professionals don’t start to time a labour until it is ”established” once contractions are coming regularly, roughly once every three or four minutes, and lasting for about 45 seconds to one minute, and the cervix is around 3cm dilated Due to the difference in how labours are timed, you may hear about labours that lasted 50 hours and others that lasted two! On average, for first-time mothers labour lasts around 12-14 hours. If it continues after this time, the doctor may want to investigate why labour is not progressing
Once labour is established, healthcare professionals usually expect the cervix to open at an average rate of half a centimetre an hour. However, there are huge variations in this average,
and a labour can still be progressing normally with a slower or faster rate of dilation Your midwife will keep you informed about how things are going during your labour, and don’t be afraid to ask how things are progressing.
Is it best to stay upright in early labour?
It is thought that keeping upright and mobile can help labour to progress and make the pain easier
to manage. This is because in an upright position the baby’s head can press down onto the cervix and in turn stimulate it to dilate, and also gravity helps the baby to move down through the pelvis.
I’m having a trial of labour-how long will I be allowed to be in labour for?
A trial of labour is something that is done if, for example, a woman has had problems in pregnancy.
I’m scared in case I poo in labour, how will I feel?
You are not alone — lots of women are very nervous at the idea of pooing while they are in labour. It may not be what you want to hear, but in fact a large number of women do poo, usually during the second, or pushing, stage of labour. This is totally natural and happens as the baby’s head comes down the vagina and pushes against the rectum, where faeces are stored. The faeces are then forced out of the anus and this is totally beyond your control. It is unlikely that you will be aware of pooing at this stage — the overwhelming sensations of birth will be more powerful! Midwives and doctors are very used to women pooing, and will simply wipe it away without a second thought. Also, sterile cloths will be placed around so it will be easily cleared away.
Will I tear when the baby comes out?
Some women do sustain some degree of tearing during the birth of their baby Unfortunately, it is impossible to tell whether you will tear or not until the actual delivery Some tears only involve the skin and may not require any stitches However, others can involve the skin as well as the muscle underneath and the vaginal canal, and this will require stitches Stitching will be performed by an experienced midwife or doctor after you have had a local anaesthetic injection. There is some evidence to suggest that regularly massaging the perineum, which is the area between the vagina and anus, during late pregnancy may help avoid tearing (see p.111) Allowing the baby’s head to be born slowly can also help to prevent tears (see p 186).
What does a “skin-to-skin” birth mean?
”Skin-to-skin” is a phrase that means cuddling your naked baby against your bare skin. Many women wish to have skin-to-skin contact with their baby straight after the birth. This can help with bonding, the baby’s temperature control, and the initiation of breastfeeding. As long as you and your baby are well, there should be no reason why this cannot be done — having your baby cleaned, weighed, and dressed can wait a moment. Most health professionals now recognize the importance of this early skin-toskin contact, and will help you achieve this if that is what you wish. Communicate your thoughts and desires to your midwife as early as you can following admission to the labour ward, so that the midwife can plan your birth to try and meet your wishes.
What is the third stage of labour?
The third stage of labour lasts from after the birth of the baby until the placenta, or afterbirth, and membranes (the amniotic sac your baby has been growing inside) have been delivered. This stage can last for around 10-15 minutes to an hour, depending on whether you have drugs to speed it up (see below).
How does the placenta come out?
After the birth of your baby, the uterus starts to contract again and the placenta shears away from the wall of the uterus and passes out through the vagina. This will not feel the same as giving birth to the baby as the placenta is soft and squashy and much smaller! You may have had an injection to speed up this part of labour, and this is referred to as a “managed” third stage (see below). If this is the case, your midwife will apply gentle traction to the umbilical cord to guide the placenta and membranes out. If you are having a natural third stage, you won’t need an injection, which may mean that this part of labour lasts a little longer, and the midwife will encourage you to deliver the placenta and membranes by pushing, and perhaps squatting over a bedpan Your midwife will advise you as to whether a natural or managed third stage, or a choice between the two, is most suitable for you
What happens when you have an injection for the third stage of labour?
Women are usually offered an injection of syntometrine during the baby’s birth. This is a mixture of two drugs, syntocinon and ergometrine, both of which help the uterus to contract and so speed up the delivery of the placenta and membranes This is also thought to help prevent the risk of heavy bleeding. Having this injection means that the third stage of labour lasts about 10
to 15 minutes. If you have raised blood pressure you will be offered a slightly different injection - just the syntocinon - as ergometrine is known to stimulate a rise in blood pressure.
What happens to the placenta?
checking the afterbirth
The placenta has sustained your baby during her nine months in the womb, and what happens to it after its delivery is a common question.
* The placenta will be checked to ensure it is complete and has been delivered successfully If it looks healthy, it will be disposed of in the hospital
* It may be taken away for analysis in a laboratory if there is anything untoward in its appearance.
* Some cultures perform ceremonies with the placenta; and in some parts of the world there is even a tradition of eating the placenta
However, if your pregnancy, labour, and birth have been straightforward, there is no reason why you should not have a ”physiological”, or natural, third stage of labour.
What will happen once my baby has been delivered?
Once your baby has been born, if all is well, you will be encouraged to hold him and get to know him. The placenta and membranes will be delivered and the midwife will examine your vagina and perineum to see if you need stitches, which will be done under a local anaesthetic When you are ready, your baby will be checked over (see p.217), labelled with your name and her date of birth, weighed, and dressed. If she hasn’t fed already, the midwife will help you with the first feed You and your partner may also be offered tea and toast, which is usually most welcome! Before going onto a postnatal ward, you will be helped to wash and go to the toilet. If you and the baby are fit and well, you may be able to go home within a few hours, sometimes straight from the labour ward, providing you have all the help you both need.
If you have a Caesarean, you will be moved to a ‘recovery” room near to the theatre for up to two hours to observe your breathing rate, pulse, and blood pressure. Your incision and vaginal blood loss will be checked as will your fluid levels, and the midwife will help you to breastfeed your baby. You will then be moved to a postnatal ward.
It all sounds very “busy”. Will we be left alone at all once the baby is born?
Many couples look forward to having some time alone together after the baby’s birth in order to start to get to know, and bond with, their baby in private. There shouldn’t be a problem with this, as long as neither mum nor baby has any medical problems The midwife will make sure you know how to call for assistance if you need it. You would usually be taken to a postnatal ward about two hours after your baby’s birth, if all is well Or an early discharge home may be an option.

The three stages of labour
How your labour -progresses
Your labour is divided into three stages. The first stage begins when you have regular contractions that widen your cervix: the second stage starts when your cervix is fully dilated and ends with the birth of your baby; and the third stage is the delivery of the placenta and membranes
What is the first stage of labour? The first stage of labour describes the process in which your cervix dilates (progressively opens because of the womb contracting) from being tightly closed to being around I Ocm - wide enough to get the baby out, or ”fully dilated”. During this first stage
of labour, contractions generally start off gently and don’t last very long - about 30-45 seconds. It is now recognized that you are in established labour only if you are 4cm dilated. Prior to this stage, the contractions you have been feeling have been
The birth of your baby
ripening (effacing) your cervix During the early stages of labour, it is a good idea to rest and eat carbohydrates such as toast or pasta, so that you will have some energy when the contractions really kick in. This is called the latent stage of labour. Once the contractions do start coming regularly, staying active is beneficial in that it can help labour become established, as gravity will help press your baby against your cervix Going to bed could result in labour ceasing altogether. In a first labour, the time from the start of established labour to full dilation is between 6 and 12 hours, although it is often quicker for subsequent labours.
What is “transition”? Towards the end of the first stage of labour, you may feel a great urge to push with each contraction. This period, when you are between 8-1 Ocm dilated, is called transition. It may
be brief, or could last up to an hour, and is often seen as the most challenging part of labour. You will need to resist the urge to push if you are not fully dilated, and may need to use breathing techniques - such as blowing out in little puffs - to help you.
What is the second stage of labour? Once your cervix is fully opened (fully dilated), this is known as the second s-age of labour At the beginning of the second stage, you may experience a pause in contractions, but they will resume and you will be ready to push your baby out with each contraction. Your contractions will now be very close together and very strong, lasting 60-90 seconds, for which you will probably need pain relief (see p. 174). Most hospitals will limit the length of the pushing stage to less than three hours You will soon see your baby
What is the third stage of labour? The third stage of labour is the delivery of your placenta. This is the afterbirth that has been feeding your baby during pregnancy You will be offered an injection
of syntometrine to speed this process up and reduce the risk of heavy bleeding, or you can to wait until the placenta comes away naturally If you choose a natural, or physiological, delivery of the placenta, this can take from 30 minutes to one hour, and you tend to bleed a bit more than if you have an injection.

A natural breech birth
If you are having a natural vaginal delivery with a breech birth, this will be carefully handled by an obstetrician. A vaginal breech birth can be slower than a head-first, cephalic, delivery as the bottom doesn’t push down as much The obstetrician will
guide the baby out. Usually, the buttocks are delivered first and then the legs will be carefully guided out The baby may then be rotated to deliver the shoulders as smoothly as possible Lastly, the weight of the baby helps to draw the head down for delivery
or has had a previous Caesarean. This allows a woman to be in labour long enough to determine if a vaginal birth may be possible. It is hard to say how long you will be allowed to labour for, as the length of time depends on how your labour is progressing and the opinion of the medical staff caring for you.
Your labour will be closely monitored, with your midwife regularly assessing its progress to check that the cervix is dilating as expected and that the baby is moving down through the pelvis. You may be offered continuous monitoring of the baby’s heartbeat (see p.192) and would be close to medical assistance in the event of a Caesarean being needed.
When will I be fully dilated?
”Fully dilated” means that your cervix is fully open so that your baby can move down the vagina and be born. When your labour begins, your cervix is either closed, or only one or two centimetres open The contractions of the uterus gradually open it further until it is completely open. Once this happens, you are in the second stage of labour, which lasts until the birth. The point at which your cervix is fully
dilated can occur quite quickly after the onset of strong, regular contractions, or can take many hours.
What is meant by “transition” and why do people say it’s the worst bit?
Transition describes the.period of time between the end of the first stage of labour and the onset of the second, or pushing, stage. Contractions are usually at their strongest and most frequent at this point It can last from a few minutes to over an hour, and in some cases may not happen at all. The transition period is often characterized by a woman feeling exhausted, fed up, unable to cope, shaky, or nauseous. In films and books, this is often the time when a woman swears and gets a bit mad with her partner! It is usually around this time that the first feelings that you need to push begin.
If you experience any of the unpleasant symptoms of transition, it helps to focus on the fact that your baby will soon be born. Try to keep your breathing slow and regular, and focus on your partner and midwife for additional support.

Positions for the first stage of labour
In the early stages, many women prefer to walk around, and being active helps labour progress. If you get tired, sitting on a chair leaning forwards can be comfortable, as can kneeling over a birthing ball or pillows Some women find sitting on the toilet comfy! If you want to lie down, lying on your left side is best as the pelvis isn’t restricted and can open as the baby moves down, and the blood flow to the baby is not affected

Dilatation
In the early stages of labour, the cervix begins to soften, known as effacement, and then starts to widen, or dilate, so that the baby can pass through it and out of the vagina The baby’s head cannot pass through
the cervix until it is I Ocm wide and fully dilated The time this takes varies with each labour, Some women are several centimetres dilated at the start of labour while others take several hours to reach this stage.
2CM DILATED:
6CM DILATED:
10CM DILATED:

LABOUR AND BIRTH
It’s all your fault, stop the pain!
choices for pain relief
What is the best form of pain relief in labour?
As each woman and labour is very different, it is difficult to say which is the ”best” form of pain relief. This will also depend on an individual’s coping mechanisms and pain threshold. There are many different types of pain relief (see p 174) including alternative therapies such as aromatherapy acupuncture, homeopathic kits, reflexology and hynobirthing (using self-hypnosis to reach a state of deep relaxation); natural methods, such as water, massage, TENS, and the positions you adopt; and drugs, such as gas and air and pethidine, and epidural. Your midwife will talk to you about the different choices available and the advantages and disadvantages of each one.
Last time I made a real idiot of myself. I don’t want to lose control again - what do you advise?
The best advice is to know your options, have an open mind, and be guided by labour and how you are feeling. Being positive and having appropriate support can not only result in a good experience, but can reduce your preception of the pain, and feeling empowered helps you to stay in control
Are relaxation and childbirth classes helpful?
Relaxation and breathing techniques taught in antenatal chidbirth classes are extremely useful when used together and at the correct times in labour (see p.176). This, combined with working with your partner and the midwife, can help to make the pain more bearable and thus the birth experience more pleasurable. It is worth pointing out that people have different pain thresholds and relaxation and breathing techniques alone may not be enough to help you cope with the pain of labour, especially as
labour advances. Practising breathing and relaxation techniques before labour begins increases the benefit so classes are helpful.
Can moving around during labour help with the pain?
Providing the labour is straightforward, it does
seem to be the case that being as active as possible can help the progress of labour. Not only does this help with the pain, but it can also encourage more effective contractions so that labour is faster As the labour advances, it may be difficult to get into a position that is comfortable, and often women move around to try to find the best one. Favoured positions are standing, kneeling, or squatting, and rocking the pelvis, either on a birthing ball with your legs astride or leaning onto the bed or into the wall
Being prepared
practical and mental preparation for labour
Inevitably, labour will involve a degree of pain. Although this can be a frightening prospect, accepting this and thinking in advance about how you might deal with the pain may help you to cope better when the time comes. * Be as informed as possible about pain-relief options to help you make choices you are happy with in labour, Find out if you need to do anything in advance, such as inform staff if you want a water birth. * Try to think about the final outcome of labour and view the pain as part of the process that brings you closer to your baby.
How can a birthing ball help during labour?
Using a birthing ball during labour has the advantage of opening up the pelvis to allow the baby to move down more easily You can take your own birthing ball into hospital, and this may be advisable as supplies may be limited.
What is a TENS machine and how do they work?
TENS (transcutaneous electrical nerve stimulation) works by stimulating the production of endorphins, the body’s natural painkillers, and also by blocking some of the pain pathways Electrodes placed on
your back or abdomen are attached to a unit that fires electrical impulses when a button is pressed, blocking pain pathways The strength and frequency of the current can be altered according to your needs. This is a natural form of pain relief that requires no drugs and is a good way to involve your partner, who can position electrodes.
The machines will produce a tingly sensation,
but this does not hurt. Some people do not like the sensation, while for others it works very well, so it’s a good idea to hire a machine before labour to see if this form of pain relief suits you.
The advantages of TENS are that you are in control of your pain relief and are free to move around while you are using it. Check in advance whether the unit supplies TENS, or whether you need to hire one before going to hospital
Will I be able to use my TENS machine at the same time as other types of pain relief?
TENS can be used with pethidine or diamorphine and gas and air, but not with water (because it is electrical) or with an epidural (because of the position of the electrodes on your back).
My midwife says that I can have my baby at home, but what pain relief will I be able to have?
There are a variety of, mainly natural forms of pain relief that you can use in your own home. Alternative therapies, such as aromatherapy, homeopathic kits,reflexology. and acupuncture can all be used, as long as an appropriately trained person is providing them. Many women having home births opt for warm water. either in the bath or in a hired pool, as this is an effective form of pain relief. The midwife can also offer gas and air and pethidine as alternatives, if natural forms of pain relief are not working.
However, you may find that just by having your baby at home, you are less likely to need much pain relief. This is because evidence suggests that women who stay at home for as long as possible during tabour, or for the whole of their labour, have a more positive experience, which includes needing less pain relief. By adopting the correct positions, using massage, and breathing and relaxation techniques, you may find that you limit the amount of medical pain relief you need.
How an epidural works
An epidural is an injection into your back that numbs your body so that you are unable to feel the contractions. For about 90 per cent of women it completely blocks the pain. Epidurals work by blocking pain nerves as they enter the spinal cord Setting up an epidural is a medical procedure that can only be done by an anaesthetist. A local anaesthetic is injected to numb the area of the lower back before the procedure is carried out. A special needle is then carefully inserted into the space near to where the nerves enter the spinal cord. A fine tube is pushed carefully through the needle and left in place so that drugs can be run through it The procedure usually takes around 20-30 minutes, and it takes approximately 15-20 minutes for the epidural to start working effectively.
HOW THE EPIDURAL IS INSERTED:
Will I be able to cope through all the stages of labour using breathing techniques alone?
Relaxation and breathing techniques are extremely useful when used together and used at the correct times. It is common for women to breathe short, rapid breaths at the strongest part of the contraction. Studies show that this can cause a panic-type response in your body that can increase tension and heighten the pain. Learning to “sigh out slowly’ (SOS) and keeping your shoulders down can help you in labour, if you have practised during pregnancy, At the end of tabour, when it is necessary to control the head as it delivers, the midwife will ask you to pant or blow. This is two short breaths out followed by a longer breath out. Combining breathing techniques with working with your partner and the
midwife can help to make the pain more bearable and thus the birth experience more pleasurable. It is worth pointing out that people have different pain thresholds, and breathing alone may not be enough, especially as labour advances.
Can a water birth help with pain?
It is well documented that water can help with labour pains (see p 156). The heat of the water reduces muscle spasms, and the buoyancy of the water relieves pressure on the pelvis, which lessens the overall pain experienced The water is kept around body temperature by topping up with warm water and needs to be covering your ”bump” to be effective. Studies have shown that it can reduce the length of labours and the risk of tearing. Babies can be born completely under water so that they do not gasp until they hit the cold air. Most hospitals allow you to use gas and air in a pool as an additional form of pain relief.
I want to remember everything about the birth - how can I achieve this?
Probably the most effective way to remember as much as you can about your labour and the birth of your baby is to try to remain as healthy and rested as possible prior to the start of your labour, which will give you the best chance of staying strong and clearheaded during labour Feeling strong and having plenty of energy may also help you to remain upright and active during the course of your labour, reducing the need for opioids, such as pethidine, which can create a mild state of amnesia, meaning that you may have some difficulty remembering the finer details of the birth It’s also helpful to have a partner or close friend with you throughout your labour so that they too can help fill in any blanks later, and photographs and videos are good prompts If you do find after the birth that there are parts you can’t remember, you could ask your midwife to let you see your birth notes Or you could try to keep a birth journal between contractions!
I want an epidural but I’m afraid about having one -should I be worried?
Epidurals work by blocking pain nerves as they enter the spinal cord (see opposite). The doctor performing the procedure will be very experienced as it is a very small area they need to aim for. You need to sit very still in the position demonstrated to avoid any problems. There is a slight chance that if the needle goes in too far, it can cause a leak of fluid causing a aural tap”, which can result in a severe headache Other fears include future backache, which may be prevented by changing your position frequently in labour There is a very small risk (although this is highly unlikely) that damage is caused to the nerves.
I’m scared to death about going into labour - will I get an epidural?
The availability of epidurals will depend on each hospital It is best to ask your midwife what the procedure is at the hospital you are booked at If you think in advance that you would like an epidural, or decide in labour that you would like one, let the midwife know as soon as possible so that she can contact the anaesthetist and arrange this.
Will having an epidural slow down my labour?
As epidurals numb your feelings, this can make it hard to know when to push As a result, it may slow the labour or increase the risk of a forceps
or ventouse delivery slightly However, if this occurs the midwife or doctor will gently lay a hand on -your abdomen and will be able to feel as soon as a new contraction begins in your uterus. This will be a
sign to them to encourage you to actively push, even though you do not feel the sensation of the actual contraction due to the epidural anaesthesia. Following the advice of the midwife in this way may reduce the need for an assisted delivery, as pushing with a contraction is safer and more effective in terms of easing your baby through the birth canal.
I’m very keen to stay active in labour - can I do this if I have an epidural?
One of the side effects of an epidural is that your legs may feel numb and unable to hold your weight, which can restrict your movements. Some maternity units do offer “mobile” epidurals. These work in the same way as a standard epidural, but you are given a lower dose of the analgesic drug. This means that you are unable to feel the pain of the contractions, but the nerves controlling your legs, abdomen, and bladder are relatively unaffected so you are still able to remain mobile. This leaves you free to move around and be upright during labour and can also mean that you do not need to have a catheter inserted to empty your bladder. A mobile epidural can also increase the likelihood of a vaginal delivery, as being able to move around will assist the progress of labour, and being less numb means that you will be able to push more instinctively during labour contractions You may want to check in advance with your midwife whether your local maternity unit provides this facility
I’ve heard that pethidine can make you feel sick, and the baby drowsy after birth. Is this true?
Pethidine is from the family of drugs called opiates and is the most commonly used drug during labour. It is usually given by injection and its side effects include nausea, vomiting, dizziness, or drowsiness; it can also delay the baby’s breathing.
To combat the nausea and vomiting, an anti-sickness drug is usually given with pethidine If the baby’s breathing is noticeably affected, an antidote injection is sometimes given to reverse the effects of the pethidine, although this is not usually necessary and would only be given if the baby didn’t respond well to other types of stimulus, such as gently rubbing the baby’s back with a warm towel, or gently stimulating and rubbing the feet of a baby, which can be enough to make him inhale. Your baby’s ability to breastfeed can be affected if he is drowsy, and midwives are now encouraged to
provide extra support to mothers choosing to breastfeed if they have had pethidine during labour in an attempt to overcome this side effect.
When is it best to start using gas and air?
Gas and air, or Entonox, is a combination of 50 per cent oxygen and 50 per cent nitrous oxide (laughing gas). It is widely available in maternity units and can be used in home births. This method of pain relief works by reducing the pain messages that the brain receives. It starts to take effect within 20 seconds, so it is advisable to time your intake of gas and air with your contractions, so that you start taking it just before or at the beginning of a contraction to get the maximum benefit, at around 45-50 seconds.
Gas and air can be used from the onset of your labour. However, some women report that they feel slightly drowsy and light-headed and therefore out of
Pethidine and diamorphine
Opiate drugs used for pain relief during labour
These drugs are useful in the early stages of labour, helping you to relax and deal with the pain, and pethidine in particular is widely used. They can only be administered in the form of an injection by a midwife or doctor, usually in the hospital or a maternity unit. As with much pain relief, these drugs have advantages and disadvantages.
* Pethidine has a sedative effect, relaxing the muscles of the uterus, and is especially useful if you are feeling anxious or experiencing a long labour as it helps you to rest.
* Both drugs can make you feel nauseous and they can enter the baby’s system. If given too close to the time of delivery, they can make the baby sleepy and can even cause problems with the baby’s breathing.
control while taking gas and air and therefore you may find that you want to stop taking it while you are pushing if it is distracting you too much and stopping you focusing on the contractions. Some women manage their entire labour on gas and air alone, while others find that they need another form of pain relief in the later stages of labour
How will I use the gas and air and is it likely to make me feel sick?
Gas and air is breathed in through a mouthpiece or mask that is connected to a cylinder or pipes in the wall that lead to larger cylinders elsewhere You administer it yourself, so are more in control of how much you take and when.
Gas and air can make your lips and mouth feel tingly and dry, and in some cases women report feeling nauseous while taking it. Using a mouthpiece rather than a mask may help to reduce feelings of nausea brought on by the smell of the gas and the sensation of having a mask over your face, and taking sips of water may help. As the effect of gas and air is short-lived, you only need to use it during contractions; taking gas and air between contractions will not help with the pain of the next contraction and is likely to increase the sensation of nausea.
I want to have a great birth but you hear such awful stories -how can I stay positive?
For every awful birth story there is an equally positive one — it does tend to be the case that you are less likely to hear about the positive birth stories as these aren’t such good topics of discussion! However your labour and birth proceeds, the birth of your baby will be amazing because you will finally meet the little person who has dominated your life for the past nine months.
It is sensible to remain open minded about labour and birth, because it’s impossible to foresee exactly how things will go on the day. However, there is a lot that you and your partner can do to help prepare yourselves for labour and birth so that you
Gas and air
A form of self-controlled pain relief in labour
A mixture of oxygen and nitrous oxide that is self-administered in labour.
Gas and air, also known as Entonox, is taken through a mask or a mouthpiece during labour. This dulls the pain centres in the brain and produce a sense of euphoria. This needs to be timed with your contractions as the effects are short-lasting, with the gas being breathed in just prior to and during a contraction You will feel normal once you stop using it
Gas and air tends to be the preferred choice for managing pain in women who want to labour as naturally as possible. The reason for this is that gas and air has several advantages, including the fact that you can remain mobile and active while using it; it can be used during a water birth; it doesn’t affect the baby in any way, and it doesn’t make you feel drowsy during labour, which allows you to feel more in control throughout and to remain as focused as possible on your contractions However, although it is a widely available and a popular choice of pain relief in the UK, it doesn’t tend to be used in the United States.
have the best chance of having a positive overall birth experience For example, you can both learn as much as possible about the process of labour and birth so that you can make informed decisions in labour. You can chat with your midwife, read books, find information on the internet, and attend antenatal classes. Also, knowing how labour progresses helps to demystify the experience and therefore removes some of the fear that accompanies labour and birth. Learning basic relaxation and breathing exercises also helps (see p 173), as being able to relax as much as possible during labour helps you to feel less anxious, which in turn can help the labour to proceed as quickly and smoothly as possible

Breathing techniques
Using relaxation and breathing techniques can help you to relax and cope with the contractions throughout your labour. Try practising techniques with your partner before labour. Learning to control your breathing has many benefits, including helping you to increase your energy reserves and let go of tension and anxiety so that you can breathe with the rhythm of the contraction. In the earlier stages of labour, you may want to practise longer, deeper breaths between contractions to help keep you calm and focused You can also try breathing in slowly at the start of a contraction and then exhaling slowly and continuing this pattern until the contraction has passed. Later in labour as contractions become stronger, you may find taking shorter, lighter breaths helps you to ride over the contraction.

How to manage the pain

There are a range of pain relief options available It’s wise to think about which method you would prefer before going into labour.
Relaxation, breathing, keeping mobile,
and massage: You remain in control and avoid intervention. Being upright can help the position of the baby and there are no side effects. This may not be sufficient pain relief for strong contractions
Water: Using a birthing pool in labour and possibly for delivery can hale you to labour quicker and less painfully, with no side effects.
TENS (transcutaneous electrical nerve
stimulation): Sticky pads placed on your back send small electrical impulses to trigger the release of endorphins. You control the current
with a hand-held device. This may not provide sufficient relief for very strong contractions.
Gas and air: 50 per cent oxygen and 50 per cent nitrous oxygen. This is easy to use and drugs don’t accumulate in your body, Some women feel sick or sleepy and find this isn’t strong enough.
Pethidine or diamorphine: These can lessen
the pain, but can cause sickness and affect the baby’s breathing if given too close to delivery.
Epidural anaesthesia: A local injection near the spine, this is the most effective form of pain relief and doesn’t enter the baby’s system. It increases the chance of forceps, ventouse, and Caesarean, as you may not be able to feel when to push. You will be less mobile and will need monitoring

premature births
What is meant by premature labour?
Premature means that a baby is born several weeks earlier that the estimated “due date”. While only a tiny percentage of babies will actually be born on the day that they are supposedly ”due”, and predicting exactly when the birth will happen is virtually impossible, most women do have their babies somewhere between 37 and 42 weeks of pregnancy, The due date (EDD, or expected date of delivery) is calculated at 40 weeks (see p.41). Technically, any baby born before the 37th completed week of pregnancy is termed premature, but the closer to your EDD your baby is delivered, the fewer problems he should have in coping with life outside the womb
Can I do anything to reduce the risk of my going into labour early?
It is not totally understood why women go into labour, although it is thought that it is probably due to a combination of factors (see p.144). Unfortunately, most preventive measures to stop premature labour have not proved to be effective, so there may be little that an individual can do to reduce the risk of this happening. However, the most effective self-help measures towards a normal pregnancy, a positive outcome to birth, and hopefully avoidance of a premature labour, are to adopt a healthy lifestyle before and during pregnancy including not smoking or drinking alcohol, eating a well-balanced diet, and getting some form of daily exercise. Also, good social support has been shown to help reduce stress levels and worry during pregnancy, which can have a very positive effect on your general health and wellbeing and, in turn, hopefully on your pregnancy, labour, and birth
I’m pregnant with triplets -will my babies need to be delivered early?
A multiple pregnancy is more likely to result in a premature birth and the more babies you are carrying, the higher the risk of this happening. For triplets the delivery that carries the least risk is an elective Caesarean section (although there is a measured risk with all medical procedures) and, if this is agreed with your midwife and doctor, a delivery date will be decided on that is in the best interests of you and your babies.
The doctors will try to seek a balance between the risks associated with premature delivery, such as the babies’ development not being complete, against the increased chance of you going into your own natural labour as you get nearer to your expected date of delivery Your consultant should discuss the timing of this with you and you should be involved in all the decisions. Every maternity unit will have their own guidelines, but the final decision will be based on not just your health, but on the health of your babies This ensures that the babies are born at the optimum time and reduces the likelihood of problems occurring that are associated with premature deliveries.
Why are some babies born prematurely?
There are certain factors that may increase an individual’s likelihood of having a premature baby These include a previous obstetric history of prematurity of either themselves or a mother or sister: illness during pregnancy, the state of a mother’s health prior to pregnancy having a multiple pregnancy; smoking; and fetal problems, such as reduced growth, which may be due to lifestyle factors such as smoking and other fetal disorders. Most premature babies are placed in a special care baby unit (see opposite), where they will receive specialist medical care and attention until they are well enough to return home.
If I go into labour prematurely, can the doctors stop the contractions?
Usually, nothing can stop labour once it is under
way, but your contractions can be temporarily slowed down with drugs called tocolytics. However, these do not always work over a long period of time and can have side effects, such as increasing your heart rate and affecting blood pressure. In general, they are not given for longer than 48 hours. If they hold off labour for this amount of time, steroids can be administered to help to mature your baby’s lungs before the delivery, and this also allows you to be transferred to a hospital with an intensive neonatal unit
Occasionally, if there is an obvious cause for labour starting early such as an infection, then treating the infection with antibiotics may be enough to stop contractions
My partner is in hospital as
there is a risk of premature
labour. How can I prepare at home?
If there is a high risk of your baby being born early, I suggest that your priority should be supporting your partner while she is staying in hospital You will

CARING FOR PREMATURE BABIES:
have plenty of time to prepare for your baby’s arrival at home after the actual birth, as premature babies often need a prolonged stay in hospital due to a higher risk of complications
While your partner is in hospital, she is likely to be feeling low, anxious, and possibly fairly isolated. There are plenty of things you can do to boost her morale and keep her feeling positive about her situation. You can talk to her and make a list of things that need to be bought or done at home. This will help to keep her involved and not feel so isolated in hospital, and will also help to reassure her that things will be ready for the baby. You will need the same items for -your baby if he is born prematurely as you would for a baby born full term. Concentrate on the basics such as warm clothes for your baby a pram or buggy, and a car seat If you haven’t already done so you could think about where your baby will sleep This should be somewhere comfortably warm and close to you and your partner If your partner is in hospital for a long period of time, collect shop brochures so you can make your choices together You could also try to encourage your partner to read about breastfeeding, which will be of particular benefit to your baby if he is born early.
Why do premature babies have breathing difficulties?
Respiratory distress syndrome (RDS) is the most common complication of premature births and affects over 50 per cent of babies born before 32 weeks of pregnancy.
Lung problems occur in premature babies for several reasons The lungs are not fully developed until the later stages of pregnancy, and an important substance known as ‘’surfactant”, which enables a baby’s small lungs to mature and function effectively, does not develop until after 36 weeks of pregnancy Also the earlier the baby is born, the more underdeveloped the lungs and muscles of the rib cage are, which results in babies becoming increasingly tired as they require more effort to breathe Breathing problems are the commonest reason for babies being admitted to neonatal units Premature babies are much more prone to respiratory infections than fully grown babies and may require help breathing using mechanical ventilators, which, although life-saving, can themselves cause problems for the baby’s lungs.
Bonding with your special care baby
Having a baby in a special care baby unit can be an extremely anxious time and, apart from his physical development, you may be concerned about how you will bond with your baby However, the staff will encourage you to be as involved as possible in your baby’s care and will give you plenty of opportunity to have contact Touching, cuddling, and talking to your baby can be a real comfort for both you and your baby, The need to touch and be touched is a primal instinct and has been shown to play a significant role in the development of your baby, as plenty of research shows that babies gain weight more quickly, cry less, breastfeed more successfully and are discharged home earlier when continued close contact is maintained between the baby and parents
daily basis for any problems, especially those related to brain growth and development.
Following discharge from the neonatal unit, your baby will still be monitored very closely in outpatients. Although most serious defects can be detected from birth, it is often some time later before less obvious developmental problems can be identified, which is why this follow-up period is necessary Although these problems can include some learning and speech difficulties, medical staff are very knowledgeable about these and a full support programme would be available.
How can we reassure our baby while he is in the special
care unit?
Except in rare situations when your baby may be too ill to be touched, or if there is a high risk of infection, you and your partner will be encouraged to play a very important part in the care and wellbeing of your baby There are many things you and your partner can do to ensure that your baby knows you are there for him and is reassured by your presence. As well as having plenty of physical contact with your baby, touching and stroking him to help with bonding (see above), your baby will also love to hear the sound of your voice, so spend lots of time talking and singing to him. Your baby will soon come to recognize you as a comforting and loving presence.
My baby is in the special care baby unit. I’m trying to express milk every day - am I helping?
Breast milk helps to ensure that the mother’s natural immunity is passed on to her baby via her milk. As premature babies are more prone to infection, expressing your breast milk is a great way to help your baby while he is in the special care unit Breast milk is also much easier for a baby to digest, which is especially important for premature babies since their digestive tract may be less developed. This is also a great way for you to bond and develop a relationship with your baby.
This is a time of considerable stress and mothers can feel helpless Knowing that you are doing such a great thing to help your baby will help enormously.
Is it dangerous for my premature baby to have formula milk?
It is perfectly fine for a premature baby to receive formula milk and is not at all dangerous if the correct formula is given. Premature babies are given formula milks that are produced specifically for their needs These formulas are very specialized and prescribed by a doctor to meet the individual nutritional requirements of each premature baby as they grow. All artificial milks or modified infant formulas are highly processed products and have gone through rigorous health and safety checks.
Do all hospitals have facilities for premature babies?
Facilities vary throughout the country and while most maternity units and hospitals have a special care baby facility not all have a neonatal intensive care unit (NICU) where babies go if they need intensive life support This means that babies below a certain gestation, around 24 weeks, may have to be transferred either before or after the birth to receive more specialized treatment, such as intensive assistance with breathing.
If it is thought that you are at a greater risk of having your baby prematurely, then you may well receive some or all of your care at a hospital with more specialized facilities and you will be able to view the neonatal unit before giving birth
My first baby was born prematurely. How likely is this to happen again?
Fewer than seven per cent of all births in the UK are premature, and fewer than a quarter of babies born prematurely are below 32 weeks’ gestation. If your first baby was premature, the chance of this happening again depends on the reason for your premature delivery last time If it was because you went ”naturally” into premature labour with no identifiable reason, then there is a risk that it may happen again Sometimes there may be a genetic link, which may be the case if your mother or sister.

If your baby has to spend a substantial amount of time in a special care baby unit, it can be very hard to cope emotionally. There are steps you can take to help you through this difficult time.
* Spend as much time as possible with your baby in the unit and get involved in his care whenever possible.
* If your baby’s stay is prolonged, try not to feel guilty about spending time at home away from him. Instead, use this time to rest and reserve your energy for your baby. * Keep reminding yourself that your baby is receiving the best possible care.
My premature baby has jaundice - what will be done to help him?
Jaundice is one of the most common problems in all newborn babies and premature babies are even more at risk as they have an immature liver, which normally removes bilirubin, the substance that causes the yellow tinge common to jaundice, from the body Bilirubin is produced when the body breaks down red blood cells. It is a yellow pigment that, if not cleared by the kidneys and liver, builds up and is deposited in the skin. Babies who develop jaundice are given blood tests to measure the level of bilirubin, and the result of the blood test will determine whether they require any specialist treatment. Treatment for jaundice is given by phototherapy, which uses ultraviolet light to break down the bilirubin beneath the skin so that the baby’s kidneys can safely excrete bile pigments
Our baby, born at 24 weeks, is doing well in the baby unit, but is he likely to have brain damage?
The risk of any sort of disability in a premature baby is highest at around 23-24 weeks, becoming much lower at 30 weeks. The risk of brain damage to your baby depends on whether he is experiencing problems with his liver, kidneys, or breathing, is underweight, or has other existing medical conditions in addition to being premature Some of the most common long-term problems in babies born very prematurely are those to do with hearing, vision, or fine coordination skills. However, overall, the majority of babies born at 24 weeks with few other medical complications do well.
If your baby is doing well after a few weeks this is a good sign. It is perfectly natural for you to continue to worry, but you may find it reassuring to talk to the doctors and nurses looking after your baby. Most specialist baby doctors and nurses working in neonatal units carry out regular brain scans on any baby they may have concerns about and you would be kept fully informed if this was the case.
Special care baby unit

Some babies need specialist care when they are born A special care baby unit (SCBU) is a special ward in a hospital where these babies go if they need more care There are specially trained nurses and doctors (paediatricians) in the unit to care for your baby If you know that your baby will need to go to SCBU while you are still pregnant. you can ask for a tour of the unit and to meet a paediatrician. If your baby is very ill, he may need to move to a neonatal intensive care unit.
Why do some babies need special care? Sometimes a baby needs special care because he has been born early (preterm) and may need help to breathe and stay warm. Babies who are small for their dates may also require special care. Other babies may have an infection, be jaundiced, or have a congenital abnormality and therefore require special care.
What will happen in the SCBU?Your baby may be put in an incubator with monitors attached. This controls the temperature and keeps your baby warm. If your baby needs help with breathing, he will also receive oxygen through a special ventilator in the incubator. Some of the equipment looks very frightening, but the staff will be happy to explain what is going on, as they are keen for you to be involved in your baby’s care: they can also help you to breastfeed. If your baby is admitted unexpectedly, you will be given a photo of him, as you may be recovering from a Caesarean, making it difficult for you to visit your baby during the first day, If this is the case, do ask the midwifery staff to take you to your baby as soon as you are able. SCBU staff love having the baby’s family to visit, although they may have strict rules regarding visiting - so do ask what the policies are in your unit.

How will I know I’m in labour?

How will I be able to tell that I’m really in labour?
The one completely sure sign that you are in labour is that you are experiencing regular contractions that are causing your cervix (the neck of womb) to dilate or open, and this can only be determined by your midwife or doctor during an internal examination.
True labour contractions are usually painful, occur very regularly and grow stronger and more frequent as time goes on There are other signs that labour could be on its way, such as a mucous vaginal show or discharge (see below), but these are not true indicators that labour is actually underway.
If you are unsure about whether you are in labour, you could try timing your contractions from the beginning of one to the beginning of the next and note how often they occur. If you are in labour. then you will notice them becoming closer together and increasing in duration If you think you are in labour, always call your midwife or your nearest delivery unit for guidance and advice.
What is a “show”?
During pregnancy, a plug of jelly-like mucus seals the lower end of your cervix and this prevents infection getting into your womb. This “plug” comes
away towards the end of pregnancy, and although this can mean that labour is going to start soon, it
can also dislodge up to six weeks before your labour actually starts. When the plug comes away, this is commonly referred to as a ‘’show’.
There was some blood with my show - is that OK?
Yes, it’s normal for a show to contain a small amount of either fresh blood or dark old blood (like at the end of your period) as part of the clear or cloudy mucus of the plug.
At which point should I ring the hospital?
If you are experiencing regular contractions that are getting closer together and increasing in the amount of time that they are lasting, then labour may well have started. When your contractions are around 5-10 minutes apart, you should phone the birthing unit for further advice
Other situations when it is recommended that you phone are if you think your waters have broken, your baby’s movements have slowed and become less frequent, you experience any bleeding, or you are in pain and not due for delivery
Never worry about phoning for advice; it is better to be well informed than to sit at home worrying about things Always carry essential contact numbers in your bag and keep them by the phone at home, as you never know when you may need to seek advice or when your labour may begin
What do people mean when they talk about your “waters breaking”?
The ”waters’ are the amniotic fluid contained in the membranous sack surrounding and protecting your
baby in the womb These membranes usually split or break towards the end of the first stage of labour. This means that the fluid continues to cushion the baby’s head and prevents direct contact with the cervix at first, helping you to cope with the pain. Eventually, the pressure causes the membranes to burst, releasing the amniotic fluid, which leaks or gushes through the vagina.
What should I do once my waters have broken?
If there is quite a large gush then you will be in no doubt about what has happened Sometimes, however, the waters break and produce a small trickle, which leaves you in some doubt as to whether they have broken If you think your waters have broken, I suggest putting on a sanitary pad and examining it after a short while to see if there is amniotic fluid visible If you are still unsure then always phone your midwife or local maternity unit for individual advice. Occasionally, the membranes can break early for other reasons, for example if the mother has an infection, or they may break for no apparent reason.
Can I have a bath after my waters have broken?
If there are no complications in your pregnancy and labour then you should be able to have a bath which you may also be using for pain relief. Indeed, using water in labour has been assessed in many trials and most show that women report a significant reduction in pain (see p.156)
Studies have found that there is no increase in the risk of infection rates in women who bathe in water following the spontaneous rupture of their membranes If you are unsure about this, ask your midwife about your local hospital’s guidelines, as most maternity units have specific policies to ensure safe practice regarding the use of water for both labour and birth.
What is a false labour?
False labour can be a number of things It can be a series of contraction-type pains that subside after a number of hours and that do not have the length, strength, or regularity to actually dilate the cervix, or neck of the womb. Braxton Hicks contractions very close to your due date can also be
Relaxing in early labour
You will probably spend early labour at home with your partner, timing contractions and deciding when to travel to the hospital if that is where you are giving birth. As this part of labour can continue for a considerable amount of time, possibly with periods when contractions stop altogether, try to spend time relaxing in between contractions to conserve energy for later. There are simple things you can do at home to help you relax. You can have a warm bath, get your partner to massage your back, stay mobile but rest if you need to, eat nutritious snacks, and drink fluids to give your body fuel to work well later. Contact the maternity unit or your midwife if you have any questions confused for tabour. With these, you do experience your uterus tightening and relaxing and there is a degree of discomfort. Braxton Hicks contractions are a sign that your uterus is preparing for the contractions of tabour If this is your first pregnancy, you may be unsure how to tell the difference between these practice contractions and the real thing. Real labour contractions are more regular, powerful, and usually more painful Some women barely notice these practice contractions, while for others they are quite uncomfortable. If this is the case, it can help to move around or have a warm bath to ease the discomfort.
Is it true that I will have to go to hospital if my waters break, even if contractions haven’t started?
If your waters break before your contractions have started, most maternity units have a policy that you should be seen by a midwife, either at the maternity unit or at home, to determine if you and your baby are both well. The main concerns when the waters break are the position of the umbilical cord -whether it is stuck in front of the baby’s head - and to rule out any chance of infection, and the answers to these two questions will determine the plan of care you will be offered
You may be offered an examination to look at the cervix to see if there is fluid leaking and, if so, its colour, and to take a swab of the area to determine if there are any bacteria that could pose a problem for the baby A cardiotocograph (CTG) may be performed, which monitors the baby’s heartbeat over a short period to identify if there are any signs that the baby is distressed (see p 192). If all is well with you and the baby, you will be able to return, or stay at, home to await events, although a further appointment may be made to discuss further options should your contractions not start within a specified time. This timescale varies and may be as little as 24 hours or as long as 96 hours if all remains well.
Around 85 per cent of babies are born within 48 hours of the waters breaking, even if there are no contractions initially.
Calling the midwife
Although each woman has a different experience, here is a rough guide for when to call the midwife and when not to call the midwife.
* Don’t worry about calling the midwife if your contractions aren’t regular, occurring just once or twice an hour, as these may be Braxton Hicks (see opposite).
* Don’t call the midwife if you have only had a show (see p.167).
* Do call the midwife if contractions are strong and regular, every 5-10 minutes * Do call the midwife for advice if your waters have broken.
How will I be able to tell the difference between real contractions and Braxton Hicks?
Labour contractions have several specific characteristics. They are very regular and over time increase in regularity and length, and they are also painful Most start as a period-type pain or backache that again increases in intensity over time. The other difference that you may or may not be aware of is that the cervix dilates (opens up) in response to true labour contractions, but does not with Braxton Hicks. One thing that may indicate this is happening is if you experience a show (see p 167)
What do labour contractions feel like?
Generally speaking, women feel contractions as a painful tightening of the muscles of the uterus Although they actually start at the top of your bump and progress to the bottom of the bump, you may experience more pain and a feeling of pressure in the lower part of your abdomen and pelvis as the baby is pushed down by the contraction.
Some women experience the pain in their tummy, while others experience labour pain as backache Generally, contractions tend to start as something that can be compared to a severe period pain,
gradually increasing in intensity; however, the degree of pain felt will be different for all women.
We’re having a home birth -what if the midwife doesn’t show up?
Arrangements for contacting the midwife when you are having a home birth will vary depending on where you live; however, certain things will be the same no matter where you are. Once you are 37 weeks pregnant, the midwives will be ”on call” for your delivery Your midwife will talk to you about the local procedure for contacting the midwife on call, which may be directly through a mobile phone or pager, or indirectly through the labour ward at your local maternity unit If you experience labour before you are 37 weeks, you will be asked to go to hospital as this is considered ”preterm ‘ labour (see p.161).
Once you are experiencing strong regular contractions, contact your midwife via the route you have been advised. If your labour starts in the daytime, midwives will be on duty m the area; if ifs evening or nightime, it might take them a little while to reach you, so bear these differences in mind Also, bear in mind factors like the traffic on the roads during rush hours, which may make it advisable to let the midwife know about your contractions sooner rather than later!
Most NHS Trusts have a policy of two midwives attending your home birth; in some areas, both midwives will be there throughout the labour and birth, while in others the second midwife will be called by the first midwife nearer to the delivery so that two midwives are in attendance at the birth In the worst case scenario, if your labour progresses rapidly and a midwife hasn’t arrived, contact your local maternity unit who may be able to arrange for paramedics to attend you until the midwife arrives. Please bear in mind that it’s very rare to have a home birth without your midwife being present and that babies who do arrive quickly usually do so with very little added complication.
They sent my friend home from the hospital - I don’t want that to happen to me.
Labours differ and are dependent on so many factors, and your friend’s circumstances and your own are likely to vary enormously. Unless you have been specifically advised to go to hospital early once you think labour has started, then the best place to be in the early stages of labour is at home. In first pregnancies, the first stage of labour, when your cervix dilates to around I Ocm (see p. 181), averages at about 12-14 hours. So if you go to hospital very early on they may well suggest you go home until labour is a little more advanced. Although you may feel that you want to stay at the hospital ”just in case”, unless you have to travel a great distance to and from your local maternity unit, you are likely to be more comfortable and relaxed in your own surroundings
Are there situations when you can’t eat or drink in labour?
The recommendations by NICE for labour are that
all women should be allowed to drink water in labour, and that isotonic, or sports water, may be slightly more beneficial because of its higher calorie value and quick absorption into the body, Eating light snacks, even in established labour, is recommended as long as you haven’t had opioid painkillers, which include pethidine and diamorphine, and there are no other risk factors that would make a general anaesthetic more likely. Most women find that they want to eat in early labour, but find that they cannot face food later in the first stage although they still want to drink
Will I be able to drive myself to hospital when labour starts?
Driving while in labour isn’t advisable and could be very dangerous to yourself, your passengers, and any other road users, including pedestrians. If you are in labour, you will be having regular painful contractions and this will interfere with your ability to focus and drive a car and will also diminish your awareness of your immediate surroundings. In other words, -you will be very distracted!
As the general advice about labour is to stay at home for as long as you feel comfortable this means that by the time you are travelling to hospital you will be in very established labour and so your ability to drive would be very much diminished
Another consideration is your insurance cover; if your driving is impaired because of pain you may well invalidate your insurance cover. The safe option is to get someone else to drive or to take a taxi.
How likely is it for a first labour to progress so quickly that you don’t make it to hospital?
In first pregnancies, labour usually lasts for 12-14 hours, with contractions building in intensity and length. Most women are happy to stay at home for the early part of the first stage, and get an idea of when they want to be in hospital as their contractions get more regular It is unusual with first babies, but not unheard of, for labour to be so quick or for you to have no sign of contractions, that you leave it too late to get to hospital Although this also depends on your distance from the hospital, traffic delays, or other factors that may increase your journey time
What are the signs that it is too late to go to the hospital?
Generally speaking, if you are having an uncontrollable urge to push, then that’s the point
where it may be too late to reach the hospital before your delivery If you did find yourself in this unfortunate circumstance, contact your local maternity unit who will arrange for paramedics to attend you for the delivery of the baby In some areas, they will also ask an on-call midwife to attend the birth. Or you can contact the emergency ambulance services yourself
Can I check how dilated I am myself or get my husband to do this?
There is one school of thought that believes that vaginal examination of the cervix shouldn’t be done routinely in a normally progressing labour by anyone, and that would include you and your partner. There are several reasons for this One is that some women find it a very uncomfortable procedure and staff gain very little information other than that the woman’s labour is progressing. Another reason is that it introduces the the risk of infection If you are having strong, regular contractions, your cervix will be starting to dilate, and any examination should be carried out by a trained midwife or obstetrician under ‘’sterile” conditions to limit the risk of infection. There is also the potential that whoever is doing the examination may break the bag of waters that are surrounding the baby before they would have broken naturally.
So although it might be possible to feel your own cervix depending on what stage of labour you are in, this isn’t something that is generally recommended.

Where should I give birth?
home or hospital?
Do I have options for where I can give birth?
Yes you do Choosing where to have your baby is
a personal choice and knowing all the relevant facts can help you to make an informed decision. You can contact an organization called BirthChoiceUK for more information (see p.310) and talk to your midwife and other mothers in your area to widen your perspective. Where you live will affect your choice, as will the decision to have NHS care, go to a private hospital, or hire an independent midwife, who can arrange to deliver your baby in the local maternity unit If your pregnancy has been straightforward, you should be offered the option of delivering your baby at home, in a birthing centre (if one is available in the vicinity), in a hospital birthing unit (see p 154), or in the hospital obstetric unit itself
Is it safe to have my baby at home?
Research has shown that for healthy women who have had a normal pregnancy. a planned home birth attended by an experienced caregiver is as safe as giving birth in hospital. There are similar findings for
birth centres and GP units. Statistically, women who have home births are less likely to use drugs to cope with the pain and less likely to have an assisted delivery or Caesarean, even if they have to be transferred to hospital during labour. They are also more likely to use upright positions for giving birth compared to hospital births. Likewise, women who give birth in a birthing centre (see p 154) are less likely to use drugs for pain relief and less likely to have their labour speeded up artificially. They are also more likely to be satisfied with the care they receive.
Can I choose which hospital to give birth in or does it have to be the one nearest to me?
Although, technically, you have a right to choose any hospital in which to give birth, you should consider the practicalities of distance for attending antenatal appointments and scans at the hospital you choose, as well as thinking about how far you want to travel while in labour. A local facility is therefore probably the most sensible choice. You may have a variety of services nearby, including hospitals, GP units, or birthing centres Discuss all your options with your midwife and doctor and try to talk to other mothers locally to see if they have recommendations.
My pregnancy hasn’t been straightforward. Will I have to give birth in hospital?
There are several reasons why you may be advised to deliver in hospital. If this is a second baby and there were complications before, such as bleeding in pregnancy or a Caesarean, your midwife might suggest you deliver in hospital. Or if this is your first baby and there are complications, such as diabetes or high blood pressure, or it is a multiple pregnancy, you may be advised to have your baby in hospital

What additional things do I need to think about if I’m having a home birth?
It may be worth having all the items you need for the labour and birth gathered in the place you intend to deliver, and it can also be helpful to organize your items separately from the baby’s items As well as practical items, such as clothing, toiletries, and sanitary pads, you may also want to have to hand music phone numbers, and a camera It’s a good idea to have a well-stocked fridge to ensure that you have nutritious snacks to hand during labour as well as helping you and your partner in the first few days after the birth. Your baby will need nappies, cotton wool, vests, clothing sheets and blankets If you have other children, you may need to make arrangements for them with family friends, or neighbours, or have meals planned for them in advance and plenty of activities to occupy them.
Even though you are planning a home birth, there are occasions when things don’t go quite as you wish and you need to be transferred to hospital. This can happen before, during, or after labour and so even though you may not wish to contemplate this outcome, it’s a good idea to have an emergency bag packed for such an occasion.

Hospital birthing units

Unlike ‘’stand-alone” birthing centres, which may be some way from a hospital unit with emergency equipment a hospital birthing unit is situated in the hospital delivery suite, or nearby, but there is still little medical intervention and doctors are not in the unit. However, if there is an emergency or you want an epidural, instead of having to await transfer to a hospital, the midwife can transfer you rapidly to the delivery suite on site
Do I have a right to give birth at home?
The issue of a legal right to home birth has become a bit complicated recently because there is no right in law for women to give birth at home, and the Department of Health has issued advice to NHS Trusts saying that they should provide a home birth service ‘ where practicable ‘, rather than insisting that they provide one However, the bottom line is that in law no one can be compelled to attend a hospital for treatment or care, and that includes for birth. Your local services are likely to influence your choices greatly and the organization BirthChoiceUK can help to inform your decision (see p 310).
What’s the difference between a birthing unit and a maternity department in a big hospital?
Birthing units are run by midwives and the emphasis is on a natural birth. They can be situated next to a hospital maternity unit or on a completely separate site. Some hospitals have a birthing unit facility in the actual maternity unit, known as a hospital birthing unit (see left), where midwives provide total care in a dedicated area of the maternity unit
As the majority of women give birth without needing medical intervention, these units provide a good alternative to a more medicalized hospital environment. The environment in a birthing unit tends to be more relaxed and flexible, which may appeal if -you want a home birth atmosphere with added support. You will also have continuous support from midwives and may even be attended by the same midwife throughout your labour and birth Furthermore, the midwives in these units are very experienced at handling a birth without medical intervention All of these factors therefore increase your chances of having a straightforward birth.
To be eligible to give birth in such a facility, you would need to have had an uncomplicated pregnancy and be unlikely to require specialized medical care or monitoring in labour and birth. If complications do occur in labour or birth at a birthing unit you would need to be transferred to the nearest maternity unit, although this is a rare occurence as most women in birthing units have been identified as being ”low risk’
If you labour in a standard maternity unit, you can be subject to a range of policies and not enjoy the same degree of flexibility However, you will have access to an epidural and, if emergency intervention is needed, doctors will be close at hand.
I’m booked for a Caesarean as my baby is breech, but I want a natural birth. Is this possible?
You need to discuss this with your midwife and obstetrician and express your preference, as your feelings are an important factor when deciding how to manage your birth. You may be able to have a procedure called external cephalic version (which is usually done around 37 weeks) to try to turn your baby to a head-first position (see p.144) However, if you have this procedure and your baby still remains in a breech position, you may be advised to have a Caesarean, although some obstetricians will support you if you wish to try for a vaginal birth (see p. 183).
I don’t want to be monitored in labour. Will the midwives and doctors listen to me?
Unless there is a medical or obstetric complication, such a previous Caesarean section or high blood pressure, you don’t need to be strapped continually to a monitor to listen to the baby’s heartbeat Instead, a procedure called ”intermittent auscultation’, which means listening in regularly to the baby’s heartbeat with a sonicaid, should be sufficient to monitor the baby’s wellbeing. Ultimately, the choice of monitoring or listening in if all is well, is yours. If a midwife or obstetrician wants to monitor the baby’s heartbeat continuously, they should explain why
It’s a good idea to make a note of your wishes during pregnancy in a birth plan (see p.149) and discuss this with your midwife before you go into labour If you don’t have a chance to discuss this before labour when you do go into labour, the midwife on duty will first take a medical and obstetric history and ensure that you and your baby are well, and will then ask if you have a birth plan, or you can show her the plan.
Can I bring food and drinks into the labour room?
The latest NICE guideline recommends that all women should be able to drink in labour. Water may be refreshing, but isotonic drinks may be more beneficial, as they contain energy-boosting ingredients. If established labour is progressing well and you and your baby are well, you can eat light snacks to give you energy and help labour to progress. However, if you require pethidine or diamorphine, which can make you nauseous or sick, or need an epidural, or other risk factors develop, you may be advised to drink sips of water only. You may also be offered an antacid tablet to reduce acid build-up in your stomach This is a precaution in case you need an emergency Caesarean
Who will be with me while I’m in labour?
If you have a home birth, you will be allocated a midwife who will stay with you throughout your established tabour As you near delivery, she will contact the hospital and a second midwife will be sent to support her and you through the birth. Whoever else you have at your home delivery is
up to you Things may be different in hospital, where it is generally recommended that you have just two birthing partners, simply because the space in most labour rooms is limited. Once in established labour, NICE recommendations are that you are cared for by one midwife throughout labour. In reality although each unit will endeavour to offer one-to-one support, this may not be possible If this is the case, the midwife will be with you as much as she can, will show you how to contact her if she is not in the room, and will be with you for the delivery. It may be wise to organize one or two people such as your partner and a good friend, to support you during labour
and maternity support workers to support midwives Unfortunately, there have been times when maternity units are full If no beds are available, staff will find a bed for you at another hospital: many hospitals have “sister” units, to which they will transfer you. Most
maternity units are not full for long and will organize for you to be transferred back as soon as possible
I keep reading about infections like MRSA and now I’m worried about having my baby in hospital.
Although there is a great deal of media coverage of ‘ superbugs” such as MRSA, most people have
no problems at all with hospital infections. Infections are caused by germs, of which there are four major types: bacteria; viruses; fungi, moulds, and mildew; and protozoa. Hospital infections are bacterial There are thousands of different types of bacteria. Some bacteria, known as helper germs, are friendly or good bacteria, which aid the digestion and absorption of food in the gut. Others can cause infection and illness, methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C difficile) being two notable ones of concern in hospital.
MRSA is a bacterium that can live completely harmlessly on the skin of healthy people, but can lead to serious infection in vulnerable individuals. Good hygiene, particularly in the form of simple precautions such as hand washing, is an effective method in the prevention of MRSA infection and your chances of acquiring this in hospital are low. Even healthy relatives and friends of patients with MRSA
I’ve heard about hospitals
being understaffed and women not getting a bed. Is this true?
There are concerns about shortages of midwives and beds. Many hospitals now employ ancillary staff carry no risk If cutlery and plates are washed using soap and water (preferably hot) this removes MRSA, and the risk of acquiring MRSA through contact with curtains, sheets, and pillows is very low Healthcare workers use antiseptic solutions, such as alcohol hand rubs, and more recently many hospitals have alcohol gels for hand cleaning at the end of each bed.
C difficile is another type of bacterium mentioned frequently in the media Hospitals prevent and control the spread of C. difficile with antibiotics general hygiene measures such as hand washing, and by detecting cases early so that they can isolate affected patients to prevent it spreading further.
What measures can I take to prevent my baby or myself getting an infection in hospital?
Regular hand washing by yourself, staff, and visitors are likely to be adequate measures to prevent infection. Take your own soap, a flannel, and moist hand wipes with you. Always wash your hands after using the toilet and always wash your hands or clean them with a hand wipe immediately before and after eating a meal Make sure your bed area is regularly cleaned and report any unclean toilet or bathroom facilities to staff. Breastfeeding will provide your baby with protection against infection. A new innovation, silver-lined pyjamas designed to protect against MRSA, are now on sale in the UK! Silver is thought to have particular antibacterial qualities and to be an effective agent against infection. Hopefully these measures will help you feel in control You are unlikely to be in hospital for very long, and you and your baby should be safe
My partner can’t drive. Can an ambulance take me to hospital?
An ambulance can transport you to hospital in an emergency for example if you are bleeding heavily As this is an emergency vehicle driven by trained operatives it is expensive to provide. If you call an ambulance for a non-emergency you could be taking it away from an emergency situation and putting others’ lives at risk.
Part of planning for labour is finding out which facilities your local maternity unit provides and what you might need to provide yourself to help you through the labour and birth.
* Check if your local unit supplies
equipment such as birthing balls or TENS machines or whether you need to hire these in advance.
* Check in advance if the hospital has a birthing pool and midwives trained to deliver babies in water.
* Find out if your hospital has a dedicated birthing unit (see p 154)
be on call when you go into labour? Or can you call a minicab in early labour? If you can’t organize transport, discuss this antenatally with your midwife or, once in labour, call the labour ward for advice.
Can I ask for a private room in the hospital for me and the baby after the birth?
Unless you give birth in a private hospital, there are few hospitals that offer private postnatal care Many hospitals have postnatal ”amenity rooms”, which are usually single rooms, with or without ensuite facilities, on the postnatal ward These may be allocated to women who need a private room for medical reasons in which case they are free. Otherwise, they are offered on a first come, first served basis, so state in your birth plan if you wish to have one and remind your midwife after the birth.
The cost of these rooms and their facilities can vary between units and covers the room only The midwifery care is given by the staff on the postnatal ward and, in most units, your partner and visitors will still have to abide by the ward visiting times.

Although there are no guarantees that your labour will proceed in the
way you would like it to and it’s probably best to approach labour with a flexible attitude, there are things you can do to make it more likely that you will end up having the type of experience you would prefer Attending antenatal classes and being as informed as possible about labour and your choices will help you to prepare in advance Other things women find helpful are having a supportive birth partner, making decisions with the midwife, being positive, and using a birth plan.

Water births
Relaxing in labour
Some cultures have used water births for centuries to provide a gentle birthing experience. Today, there is evidence to support the fact that labour may be quicker and less painful in water.
How can it help with the pain? Possibly women feel more comfortable and therefore more confident and in control in water. It is thought that water sets off a surge of oxytocin (the hormone that triggers contractions), making contractions more effective Some women find they can move around more easily in water, which helps them find a good position in which to give birth. Some feel the benefits of immersion in warm water as soon as they get into the pool, but for others it can take 15-30 minutes before they relax. Water can
be a natural aid to relaxation as it soothes muscles and releases tension. When we feel less anxious, our bodies produce fewer ’stress” hormones. This encourages the brain to produce endorphins, the body’s painkillers, and promotes wellbeing Dimmed lights and relaxing music can further aid relaxation. Some studies suggest that women have a shorter second stage of labour in water, and there may be less exertion needed to push the baby out If contractions are too intense you can still use Entonox (gas and air).
Can the baby be monitored in water? Your baby can still be monitored by the midwife using a Pinard (ear trumpet) stethoscope or a waterproof hand-held electronic sonicaid.
Will I be allowed to have a water birth?
You can use a birthing pool providing your pregnancy is normal and there were no problems in previous pregnancies If -you want a water birth in hospital and are going to be induced (without a drip), or there are other complications with the pregnancy, you may need to negotiate this with your doctor or midwife. You can talk to a Supervisor of Midwives (who can be contacted via the maternity unit) during pregnancy to help you to make a plan to meet your wishes
Is it possible to have a water birth in hospital?
This depends on the hospital maternity unit Some units have their own birthing pool; some have facilities for you to hire a pool and bring it in; some units have only room enough for a pool to labour in; and others do not have the facilities for you to bring one in or the structural ability to have one in the unit as the amount of water in the pool would be too heavy for the floor to hold.
If your maternity unit does have a birthing pool. it is possible that the pool might be in use when you go into labour. To improve your chances of being able to use a pool, you may want to consider a home birth and to hire a pool (see p. 153).
Can I use the birthing pool for labour and birth if I’ve had a previous Caesarean?
Unfortunately, it is recommended that if you have had a previous Caesarean section, your baby’s heartbeat and your contractions will need to be continuously monitored throughout a subsequent labour and delivery which cannot be done in a birthing pool The reason for continuous monitoring in this situation is that there is a chance, although quite a small one, that your uterus may rupture. This often causes no pain and the only indication may be a change in your baby’s heartbeat. If you decide you do want to labour and deliver in water after a Caesarean section, this is your choice, but you should be fully aware of the risks.
When can I get into the birthing pool?
You can get into the pool whenever you want, but some midwives suggest that you wait until you are 4-5cm (tin) dilated or in established labour. This is because some people are concerned that the water can be so relaxing that it may cause the contractions to slow down or even stop, although there is little evidence to support this However, if this does happen, getting out of the pool and walking around for a while is likely to increase the strength of the contractions You will need to get out of the pool if your baby passes meconium (see p.252) or if the midwife has any concerns about you or your baby.
The water temperature can be whatever you find comfortable, although 37°C (98 6′n body temperature is usual, especially if you are giving birth in the pool, as babies can get cold quickly once they are born.
Most units have guidelines on this.
Can I deliver my baby in a birthing pool, or are these just for labour?
You should ask your midwife to find out if the hospital that you have chosen to deliver at provides facilities for you to deliver in the water, or just use the pool for most of your tabour This often depends on whether the pool is big enough for the delivery, Occasionally, there may not be a midwife available who has been trained in delivering births under water, in which case you may only be able to labour in water and will have to get out for the delivery.

Home birth
Planning a birth at home

Although only around two per cent of women in the UK choose to give birth in their own home, this number is increasing. Research has shown that mothers may have shorter and less painful labours in their own home. It is not known why this is, although it may be due to them feeling more confident and comfortable in their surroundings. You will generally have at least one midwife with you constantly once you are in established labour during a home birth. Many women hire a pool for use during labour at home, and this may progress to a water birth.
Will I be allowed a home birth? If your pregnancy has been classed as ”low risk’ - you are healthy and have not had any complications in this or any previous pregnancies - then a home birth is a definite option If you desire a home birth and have experienced some complications during the pregnancy, talk to your midwife or contact a Supervisor of Midwives at your local maternity unit who will be able to advise you.
How do I plan for a home birth? If your midwife is happy for you to deliver at home, you need to talk to her about the type of home birth you wish to have, for example do you want a water birth (see p.156) or to use a birthing ball, and how do you plan to manage the pain? If you would like a water birth, you will need to hire a birthing pool in advance You may want to set up a special area in your home to have your baby, which ideally should be near bathroom facilities. Plastic sheeting and old sheets are advisable to protect your flooring, and shower curtains make a good surface for giving birth You will also need a supply of dustbin bags for waste.
What will happen? Most community midwives carry a homebirth pack with them, which they will bring along when you go into labour The kit includes a blood pressure monitor; a stethoscope and/or sonicaid; a thermometer; gloves; a gas and air cylinder; pethidine; scissors; antiseptic solutions; and emergency equipment Some midwives like you to provide towels and plastic sheets. You can use your TENS machine, and the midwife will arrange for gas and air (Entonox) to be delivered The midwife can also ask your doctor or obstetrician to prescribe pethidine or diamorphine if you wish.
What if there is a problem? If the midwives are concerned about you or your baby’s health, they will discuss this with you and it may be necessary to transfer you to hospital. This transfer is usually done by ambulance, accompanied by paramedics, your midwife, and your birth partner.