Posts Tagged ‘contractions’

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.

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.

Sex in pregnancy

Can having sex in pregnancy harm the baby in any way?
Unless you have been told by your midwife or doctor to avoid intercourse because of specific problems, such as a history of miscarriage or unexplained bleeding, then sex is perfectly safe as your baby is cushioned in fluid in the amniotic sac inside your womb and protected by a cervical plug, and even deep penetration isn’t harmful. Enjoying intimacy with your partner will also be beneficial for your relationship.
I’m either uncomfortable when we make love or not in the mood. Should I fake it?
Levels of sexual desire in pregnancy vary greatly, with some women finding their sex drive is heightened, while others feel too ill, anxious, hormonal, or just too uncomfortable to attempt sex at all. If you really don’t want sex, be as honest and open as you can about your lack of sex drive. Don’t be pressurized into doing something you really don’t want to do, as this could complicate your relationship. Communication is very important at this time, so talk to your partner about how you are feeling — you may find that he is completely unaware of your feelings, anxieties, and worries.
You could use the presence of your ”bump” as an ideal excuse to experiment with different positions, as most couples find the missionary position very uncomfortable in late pregnancy Some couples prefer it if the woman is on top as this allows her more control over the amount of penetration and there is less weight on her bump. A ‘’spooning” position, with your partner behind you, also allows for shallower penetration and removes pressure on your bump totally Having a baby is all about adapting to new experiences, and most couples find they need to adapt their sex life too
Since we hit the second trimester I’ve wanted sex more than ever - why is this?
Often, in the second trimester, women find that once early pregnancy symptoms wear off they feel far more energetic and sexier than ever! However, this may not be the case for everyone as each woman is affected differently by the physical and psychological changes that occur in pregnancy, and women have different views about their changing bodies, which can affect their libido.
From a physiological point of view, an increased blood flow to the pelvic area combined with an increased lubrication of the vagina means that, in theory, having sex can be better than ever So if you and your partner are quite happy with your increased sex drive, this is not a problem.
My placenta is low and I’ve been told to avoid sex. Why is this? I’m only 30 weeks’ pregnant.
As the baby develops and grows so does the womb, with the result that the placenta is carried upwards away from the opening of the womb. However, in
10 per cent of women, the placenta remains low-lying during late pregnancy and then poses a risk because of potential bleeding (see p 92). A low-lying placenta is often first detected at an early scan and, if this is the case, it is usual for a repeat scan to be carried out at around 34 weeks of pregnancy to determine if the placenta is still low and exactly where it is situated in respect of the opening of the cervix (neck of the womb).
The biggest risk from a low-lying placenta is bleeding and if you have already experienced any bleeding, it is usual to recommend that you avoid sexual intercourse, as agitation of the cervix, which happens during sex, can encourage more bleeding If in doubt, it’s probably best to discuss your particular circumstances with your midwife or consultant obstetrician
My partner hasn’t wanted sex at all since I’ve become pregnant. Will he ever fancy me again?
It isn’t uncommon for either partner to experience a reduced sexual desire in pregnancy for a variety of reasons. It is important that you talk to your partner and ask about his feelings while also explaining your own thoughts and feelings.
Some partners find pregnancy a little scary, and some of these fears centre around sex and concerns about harming the baby or you. Sometimes, these worries may be based on real concerns, for example if there have been any problems in early pregnancy such as threatened miscarriage, bleeding, pain, or excessive morning sickness. Equally they can be based on misunderstanding, and this is where discussion between the two of you will help.
Although you may feel more attractive and sexy, perhaps your partner is feeling clumsy and
Talking to each other
Maintaining a healthy relationship
It is essential that you and your partner keep the lines of communication open during this time of change and some uncertainties.
* If you have gone off sex completely, reassure your partner that this is a
temporary situation and explain how the pregnancy is making you feel mentally and physically.
* Likewise, if your partner seems reluctant to initiate lovemaking, don’t take it
personally. Try to find out how he is feeling. * Don’t allow a quieter sex life to stop you being affectionate at other times.
uncomfortable. Each couple is different and you will need to talk to each other to find your way through this. You may also feel that you want to talk to someone who isn’t so closely involved, such as your midwife, doctor, a trusted friend, or a relative
Is it best to stick to oral sex during pregnancy?
Research on the benefits and risks associated with oral sex in pregnancy is limited and the findings are very often contradictory There is nothing that indicates that oral sex is recommended in place of penetrative vaginal sex unless you have been advised to avoid sexual intercourse because of the risk of bleeding, threatened miscarriage, or premature labour, when avoiding orgasm is also advisable and so complete abstinence is the better option for a while. Apart from this, it is important to remember that some infections can still be passed on easily by oral sex.
Will having an orgasm cause me to go into labour?
In a pregnancy without problems, an orgasm alone will not cause premature labour, and at full term orgasm will only cause the onset of labour if your body is ready for labour anyway. If you have had any signs of premature labour, or if you have had premature rupture of your membranes (see p.167) you will be advised to avoid sexual intercourse. This is because the hormone oxytocin increases during sexual arousal and the effect from the oxytocin is to cause the muscles of the uterus to contract.
During pregnancy the muscles of the uterus experience practice contractions, known as Braxton Hicks (see p 168), which are not harmful, and orgasm may increase these practice contractions
If you have gone past your due date and are at a point when your body is ready to go into labour, then sexual intercourse may help things to start for two reasons the prostaglandins in semen will help the cervix to soften at this stage of pregnancy, and the contractions stimulated by orgasm have more chance of developing into early labour contractions.
I’ve got problems with my pelvis - is there a comfortable way for us to have sex?
Problems with the pelvis, particularly symphysis pubis dysfunction or SPD (see p.82), tend to be made worse by moving your legs too far apart, so it is a matter of finding a position that you feel comfortable in that doesn’t involve too much stress on the pubic area. Many women find the “missionary position” the most difficult as it involves significant parting of the legs, plus there is the weight of a partner to consider Some, although not all, women find an all-fours position for intercourse more comfortable, both for sexual intercourse and for giving birth. If intercourse is really proving difficult, then it could be that while you are experiencing significant problems you will need to find alternative ways for you and your partner to be intimate that don’t involve penetrative sex.
Many women find that pelvic discomfort improves significantly once they have had the baby. A very useful organization that has a lot
of information and advice on pelvic pain during
pregnancy is the Pelvic Partnership (see p 310). You can also talk to your midwife or doctor for a referral to a physiotherapist, which may be beneficial and help you to achieve a greater degree of comfort during pregnancy
I’m 36 weeks. My boyfriend insists on regular sex and has been a bit abusive. Is this normal?
It is not normal for someone to be abusive to another person or to force them to have sexual intercourse when they don’t want to You should never be forced to do something that is against your will. In almost 30 per cent of all domestic abuse cases, the first incidence occurs in pregnancy. It is very important that you talk to someone about how your boyfriend is treating you, perhaps to a close friend or relative There are also organizations that offer confidential advice and help you if you really feel there is no one you can talk to or trust (see p.3 10). You could also try talking to your midwife, who will treat everything you say in the strictest confidence and will have details of local organizations that can help and advise you.

Comfortable lovemaking
You and your partner may need to experiment more during pregnancy to find lovemaking positions that are comfortable for you and your rapidly growing bump As pregnancy progresses, most women find that lying on their back in the missionary position becomes increasingly uncomfortable as your partner presses on your bump. You may find being on top an enjoyable position, which allows you to control penetration and does not put pressure on your tummy. Lying in the spoons position, with your partner behind you, can be pleasurable and puts no pressure on your abdomen. Other positions that don’t restrict your pleasure and are comfortable include sitting together, kneeling while your partner enters from behind, and lying side by side with your legs bent over your partner’s legs.

What’s happening to my baby?
fetal development
Is it true that much of the really important brain development happens in the first trimester?
Your baby’s brain starts to develop soon after conception when brain cells begin to form at the tip of the embryo After about three weeks, a structure called the ”neural tube” begins to change in order to form the spinal cord, and the brain and brain cells (neurons) start to develop and send messages to each other In the early weeks, brain cells multiply at a rate of about 250,000 per minute.
After about 20 weeks of pregnancy, the rate at which brain cells multiply begins to slow down and the brain starts to organize itself into over 40 systems to direct vision, language, movement, hearing, and other functions By the time you are half way through your pregnancy, almost all the brain cells your baby needs for life are present
During the third trimester, the connections between the brain cells start to mature and the baby’s nervous system becomes more developed. Brain development is not totally complete by the time the baby is born and many important brain connections that help your baby develop skills and personality are made after the birth.
So, although fetal brain development occurs throughout pregnancy, and after, crucial foundations are certainly laid during the first three months
Is there anything I can do to help the development of my baby’s brain?
You can ensure that your diet includes good sources of omega-3 fatty acids, as these are thought to play an important part in the development of the brain They can be found in oily fish such as mackerel and salmon (limit to one or two portions a week) ; omega-3 supplements designed to take in pregnancy are available.
When will my baby’s face be formed?
The development of the face starts as early as the sixth week of pregnancy, when grooves that
will form the structures of the face and neck start to grow. A week later, the eye starts to develop and a primitive mouth and nose are evident. By the end of the first trimester the face is well formed and has a definite human appearance, although the skin is still transparent By the 24th week of pregnancy, the eye is fully developed, the eyebrows and lashes have formed, and the skin becomes less transparent, but the eye remains fused shut and does not open until around the 28th week of pregnancy
During the last trimester, your baby’s hair begins to grow on the head and fatty deposits give your baby rounded cheeks
I would like to communicate and bond with my baby before the birth. Is there anything I can do?
As your pregnancy progresses, there are many ways to focus on your baby and communicate with him, and these occasions area chance for you to relax and take time out, too.
* Relax in a warm bath and concentrate on feeling your baby’s movements, imagining what he is doing inside you.
* Talk to your baby. Your baby can detect sounds from outside the womb by the second trimester and is especially likely to tune in to your voice. You can give a running commentary on your activities, or even read to your baby Get your partner to chat too! * Rub or massage your bump. You may find that your baby responds by kicking; it’s almost like having a conversation!
* Spend some time making plans for your baby’s arrival, for example, choosing colours for the nursery
or even just buying a few sleepsuits
* Sign up for birth preparation classes for you and your partner This will give you both a chance to think about labour, birth, and your baby
* Start reading through a book of baby names and make a list of those you and your partner like * Some couples enjoy taking regular photographs of their growing bump
I’ve got a full-on career and have hardly thought about the baby. Will this stop us bonding?
Even if you work full time during pregnancy, this doesn’t have to have a negative effect on your relationship with your baby. As your baby grows, you will probably find that you start to develop a relationship with your ”bump” as you anticipate your baby’s movements and perhaps talk to your baby Make sure you plan enough maternity leave before your due date as this gives you time for practical and emotional preparations, as well as time to rest There is some evidence to suggest that too much stress in a mother can affect her unborn baby’s brain development although this is not conclusive. However, it does highlight the importance of regular opportunities to relax during pregnancy
I’m trying to get my partner involved; I keep letting him feel the baby move, what else can I do?
This is a common concern Feeling the baby move inside you is a great way for your partner to begin to connect with the baby as a separate person and seeing the baby on an ultrasound scan can help too, as can hearing the heartbeat.
It is often difficult for partners to feel involved with a pregnancy since it is not physically happening to them and can feel quite an unreal experience Try to spend time together finding out about pregnancy labour, and birth as this will help your partner to feel as informed as you and discover ways to help -you during the labour and birth and care for the baby after the birth. Some of the suggestions in the box above may also help.
My husband didn’t talk about the baby before the scan. Now he is over-protective. Is this normal?
Many fathers-to-be find it difficult to come to terms with the fact that their partner is carrying their baby, and that the baby will eventually be born and bring all the joys, trials and responsibilities of parenthood. This is all even harder to envisage when they are not physically experiencing the changes that pregnancy brings - not feeling the symptoms or feeling the movements. The ultrasound scan is often a pivotal point for partners - suddenly they are ”face to face” with their baby, and it becomes more real Perhaps your partner is now realizing his responsibilities and affection for the baby and is showing these feelings by taking care of you. If you are finding that his cosseting of you is a little too much, you might want to discuss other ways he can feel involved with the pregnancy and prepare for the baby (see box, above)! Try to embrace his involvement and enthusiasm for the pregnancy - it is a great way for you to strengthen your relationship as a couple and prepare to face parenthood together.
When can a baby first suck its thumb?
Ultrasound scans have shown unborn babies sucking their thumbs from as early as 12 to 14 weeks of pregnancy However, this is likely to be a reflex at this stage as the brain does not have any conscious control over movement until the fetus is much more developed later on in pregnancy,
Some research has suggested that if an unborn baby shows a preference for sucking, for example its right thumb, then it will prefer to lie with its head turned to the right after the birth The same research also suggested that this preference in the womb could be used to predict right or left handedness in the baby as it grew older
When will the midwife be able to hear my baby’s heartbeat?
Your midwife should be able to hear your baby’s heartbeat by the time you are around 12 weeks pregnant using a hand-held device called a sonicaid”. The heartbeat sounds rather like a galloping horse, and the rate is usually somewhere between 120 and 140 beats per minute — around double the rate of your own pulse.
There are factors that can influence whether or not the baby’s heartbeat can be picked up. For example, if you are overweight, or the baby is in an awkward position, it may be harder to hear the heart. If your midwife is unable to locate the baby’s heartbeat at 12 weeks, try not to worry, At this stage, the baby is only about 5cm (2in) long, so it’s still very tiny’ Your midwife will try again in a few weeks. Certainly by 16 weeks it should be easier to pick up and listen to the heartbeat.
When will I first feel my baby move?
Although ultrasound scans have shown that babies may start to move slightly from around 6 weeks, it is not usually until the second trimester (13-26 weeks) that the fetus will make active movements. The sensation known as ”quickening” is described as a fluttering type of feeling usually felt by mums between 16 and 20 weeks, although exactly when a movement is felt can vary from woman to woman and may be affected by various factors. If it is your first baby, you may not notice any movement until later as you won’t know what to expect. Also, if you are an active person, these slight flutters may be missed. Women with an anterior placenta (lying at the front of the womb) may feel movements later, as may larger women, as there is more flesh for the movement to be felt through.
It is not until around 28 weeks that it becomes more important to monitor the pattern of movements. From this stage, the amount your baby moves, as well as the type of movement and the time it happens, are relevant as these indicate that the placenta is sustaining the pregnancy and your baby’s muscles are developing. If you are concerned about lack of movement, contact your midwife or hospital.
What sounds can my baby hear in the uterus?
The baby’s outer ear is visible at around eight weeks and the first reaction to loud noises has been recorded at nine weeks. This has been measured in studies by playing a range of sounds through the mother’s abdomen and recording any responses, such as movement, through ultrasound scans. It is thought that babies start off hearing low tones and then higher tones are heard later on as the hearing system continues to develop.
Studies also suggest that a fetus can determine
its mother’s voice and the voices of close friends and family significantly during pregnancy One study revealed that not only did the fetus hear its mother’s voice, but its heart rate decreased, indicating that her voice had a calming effect. By 16-20 weeks, hearing is considerably developed. Premature babies born at this time react to sounds, so they are living proof that babies inside the womb at that gestation can hear Research also suggests that babies respond to stories read to them or music played during pregnancy after the birth
I’m 25 weeks’ pregnant, and my baby seems to “jump” when it hears loud noises - is this likely?
Babies born prematurely react to sounds, and loud sounds will produce a ‘’startle reflex’, so this provides strong evidence that babies inside the womb at that gestation will hear and react to loud sounds too, possibly with sudden movements
As mentioned above, studies have shown that a baby can react to sounds in the womb from as early as nine weeks’ gestation. As the fetus grows, the hearing develops, with babies responding to a greater range of sounds.
My tummy measurement has been the same for three weeks. Why isn’t my baby growing?
In pregnancy, your abdomen is measured to establish the height of the top of the womb, which indicates how the baby is growing It is important
to know whether the same person is measuring you, as there is an element of subjectivity depending on techniques. In early pregnancy, it is not necessary to measure you as this doesn’t give an indication of fetal growth, but from 26-28 weeks, growth can be assessed this way. However, even with your own personalized growth chart and with the same person measuring you at the correct time, on their own these are not an accurate means of estimating your baby’s growth. If there are any concerns, you will probably be referred to a consultant to decide whether you need further investigations, for example ultrasound scans. If you are at the end of your
pregnancy, one possible explanation may be that your baby’s head is engaging into the pelvis, so although your baby is still growing, some of his head has not been measured due to its position If you are worried, talk to your midwife and, if necessary, she can refer you for a ”growth scan”,
Do babies have hiccups in the womb? I’m sure I can feel them.
Babies hiccup from early in the third trimester. This is a normal phenomenon that is usually short-lived but often recurs at similar times each day It feels like a quick, spasmodic sensation in your abdomen. Hiccups are not harmful to the baby and in fact are a sign that your baby is healthy, in the same way that your baby’s movements are a positive sign.
It is thought that the hiccups may be caused when, occasionally, babies take a deep breath in and ingest the amniotic fluid that surrounds them. The sudden change in chest cavity pressure when they take in fluid can cause the hiccups, just as when we drink something fast. These deep breaths help to exercise breathing muscles and stimulate their lungs to produce “surfactant”, which is essential for the lungs to function. The baby cannot drown, as it receives its oxygen supply from the placenta.
When will my baby grow fingernails?
Babies begin growing fingernails from the end of the first trimester and the nails reach the fingertips between 34 and 36 weeks of pregnancy It is possible for babies to scratch themselves inside.
After birth, cutting a baby’s nails can be a cause of concern for parents. Newborn nails grow rapidly and the best time to shorten them is after a bath, when they are at their softest and the baby is more relaxed. There is some controversy over whether to use scissors, clippers, or simply bite them off. Scissors and clippers may easily cut the skin, but biting carries a higher risk of infection if the skin is broken. Pressing the nail helps to distinguish nail from skin. Using emery boards or simply peeling them off can be slightly safer options, or put your baby in scratch mittens.
At what stage could my baby survive outside of the womb?
Until relatively recently, babies born under 28 weeks’ gestation often did not survive Today, with medical advances in special care baby units, babies of 22 weeks’ gestation have survived outside the womb, although this is still very rare. The guidelines for most hospitals is that 24 weeks is the earliest point at which they will resuscitate a baby, unless the baby shows signs of life at birth.
Extremely premature babies have an increased risk of disability, even with the best medical care, and often the delivery itself can put an enormous strain on the baby.
Very experienced doctors, midwives, and nurses will be involved in the care of extremely premature births If possible, the delivery should take place in a hospital with a dedicated special care baby unit (SCBU) If this is not possible, babies are often transferred to a specialist centre when they are stable enough to be moved.
As each day and week is a milestone for your baby, the nearer to your due date you deliver, the better the chances for your baby.
I like to rub my tummy and talk to my baby as even now I feel like my baby is here - is this daft?
No, this is perfectly normal and may be soothing for him as babies can determine their mother’s voice in the womb and sometimes their heart rate decreases in response. However, I wouldn’t recommend that
you rub your tummy too vigorously or too often as, in some cases, this can cause contractions and may trigger a premature labour if you are around 37 weeks’ gestation.
Many women feel that the mother-child bond
is there before the baby is born. It is good that you are having these positive thoughts during your pregnancy, as this is an excellent foundation for your future relationship with your baby
Can my baby see bright lights? I’m 32 weeks’ pregnant.
A baby’s eye structures begin to develop from as early as 4-5 weeks, with the eyelids forming at around 8 weeks and closing between 9 and 12 weeks. By 24 weeks, all of the eye structures are fully developed and at around 28 weeks, the eyelids start to open and shut Although we tend to presume the uterus is dark, this is not so Between 30 and 32 weeks, the baby experiences light and dark environments, depending on where the mother is and the time of day. It has even been reported in studies that not only do babies react to light, but have been seen on ultrasound scans trying to grasp at the light source. When a baby is born, he reacts to lights by frowning or blinking and can see to a distance of around 15-20cm (6-8m) (the same distance to mum’s face from the breast!).
Is it normal for babies to stop moving around so much towards the end of pregnancy?
Towards the end of pregnancy, your baby’s range of movements may change as there is less room for him to extend his limbs and trunk However, you should still be aware of a regular pattern of movement. Over the last 30 years, women have been actively encouraged to count how much their babies kick However, in 2003, the National Institute for Clinical Excellence (NICE) recommended that this practice of counting movements stopped, as counting how many kicks a baby makes is not an accurate indication of whether the baby is well and each baby makes a different number of kicks Nowadays, women are encouraged instead to tune in to their babies’ pattern of activity, including the type of movement they make and the periods when they are most active. Studies have shown that over 50 per
cent of women who had a stillbirth noticed a change in the pattern of movement. The general advice is, if -you are worried about your baby’s movement pattern you should speak to your midwife or hospital.
When will my baby’s head engage?
Engagement, when your baby’s head moves from higher in your abdomen down into your pelvis in preparation for the birth, can happen at any time from 36 weeks until the onset of labour (see p 148). The head tends to engage earlier in a first pregnancy
Can my baby’s position in the womb affect when his head engages?
A baby’s position can affect how it engages into the pelvis. For example, if the baby is lying in a ”back-to-back” position, with his back lying along the mother’s back; this can make it more difficult for the baby’s head to move through the pelvis. Similarly, if the baby is in a breech, feet first, position or a transverse position (see p. 145), then engagement will not be possible unless the baby moves and a Caesarean delivery may be necessary.
It is thought that the mother’s level of activity and the positions she adopts can influence the position of the baby in the womb. Nowadays, it is more common for babies to lie in a back-to-back position and it is thought that this may be due to people leading a more sedentary lifestyle. In the past, when women were possiby more active, perhaps performing tasks such as scrubbing the floor on their hands and knees, there was less incidence of this position
Will my baby develop much in the last month of pregnancy?
During the final month of pregnancy, your baby is busy preparing for birth. He will be practising breathing movements and sucking, and will start to turn towards light. You may notice that there are fewer vigorous movements now — this is natural as there is less space within the uterus. However, you should still be noticing plenty of nudges and wriggles.The downy hair that covered your baby’s body starts to disappear and the hair on the head and your baby’s nails continue to grow Meconium, the waste product that will be your baby’s first poo, starts to form in the bowels at this time. During this last month, most of your baby’s organs are fully mature and the lungs will continue to develop. ”Full term’ is considered to be from 37 weeks.
I feel very emotional at times and am scared that I won’t love my baby - is this normal?
The feelings you have are not uncommon An increase in hormones during pregnancy can cause some extreme and deep feelings, some of which are irrational Pregnancy is a major life event and, as well as the physical changes that are going on in your body, the emotional pressures are vast. There may be a range of pressures that are adding to how you are feeling, such as relationship problems, financial pressures, caring for other children, lack of space in your house, or returning to work after the birth. It is fine if these are occasional feelings, but if you find
that you are constantly snapping or crying, tired, having difficulty sleeping and eating, or sleeping and eating too much, are unable to concentrate, feel reluctant to leave the house, feel sad and anxious most of the time, or have developed obsessive compulsive disorder (OCD), then you need to speak to your midwife or doctor for help and advice as these are all symptoms of depression.
I’ve recently lost a parent and am very traumatized. Can stress affect my baby’s development?
This is a major life-changing event and with the additional fluctuation in hormone levels and the physical changes that are occurring in pregnancy you are obviously under a great deal of stress However, it may be helpful to bear in mind that your body is designed to deal with episodes of stress
There are studies that have suggested that women experiencing long-term stress may have an increased risk of pre-eclampsia (see p.89) and premature birth, although how reliable this evidence is has been questioned It has also been suggested that there may be a link between extreme stress in pregnancy and children becoming hyperactive, but again this is inconclusive The most important thing to do, now that you have recognized you may be at risk of long-term stress, is to speak to your doctor or midwife, particularly as there has been a recent increase in levels of support and treatment offered
to pregnant and new mothers in your situation, which may help to limit any adverse effects of stress.
YOUR BABY’S MOVEMENTS
First kick
The moment when you feel your baby’s first movements is a truly emotional experience, as you start to become completely aware of, and connect with, the baby growing inside
you. Usually, the first movements are felt as a fluttering sensation, or a ”quickening”, as your baby starts to stretch and turn. This can be felt from around 18 weeks, although for some women it is much later; if you have had a baby before you are likely to be aware of these movements earlier, but for a first baby, awareness of the baby’s movements is usually later, around 22 weeks It is not until about 24 weeks that you will really start to feel regular, more definite movements and you will soon become accustomed to your baby’s activities.

Miscarriage FAQs. I’ve had a miscarriage why did it happen to me?

What is a miscarriage?
A miscarriage is the spontaneous loss of a baby at any time up until the 24th week of pregnancy After 24 weeks the loss is referred to as a stillbirth. The signs of a miscarriage are vaginal bleeding and period-like cramps. As not all miscarriages follow the same pattern, there are various terms to describe what occurs:
* A threatened miscarriage occurs when there is bleeding and possibly pain, but the fetus survives. * An inevitable miscarriage occurs when there is bleeding and pain due to contractions in the uterus, the cervix opens, and the fetus is expelled.
* A missed miscarriage occurs when the fetus dies but remains in the womb and either is expelled naturally later or removed in an operation

I’ve recently miscarried - why did this happen?
Miscarriage occurs in 10-20 per cent of pregnancies In the vast majority of these the cause is never identified, but it’s unlikely to be related to anything you did or didn’t do. There are thought to be several reasons why miscarriages occur (see p 25) There may be a genetic problem, in which the baby or placenta doesn’t develop normally, levels of the pregnancy hormone progesterone may be low; there may be an immune disorder m which the mother 3 immune system reacts against the pregnancy; an infection may be present; or there may be problems with the uterus or cervix. Miscarriages tend to be more common in older women.
The Miscarriage Association (see p.310) offers support and up-to-date advice and information about miscarriage. You may feel comforted to know that, statistically, any future pregnancy you have is likely to progress normally.
My period was late and now I’m bleeding really heavily -could I be having a miscarriage?
In the absence of a positive pregnancy test or a pregnancy confirmed by an ultrasound scan, it is difficult to know whether or not you were pregnant If you have had unprotected intercourse in the time since your last period, it is possible that you could have been pregnant and this is a miscarriage The lateness of your period may give a clue, but won’t confirm one way or another. If you have any other symptoms of pregnancy it might be worth doing a pregnancy test as sometimes, even when there has been bleeding, a viable pregnancy is discovered
However, it could also be a late period for no other reason than that this happens on occasion to everyone. A delayed period can be caused by  weight loss or gain, stress, or if you have been taking the oral contraceptive Pill but missed a dose.
Talk to your doctor if the bleeding continues:
you feel faint or experience palpitations; your period lasts for longer than seven days; you have more than six well-soaked pads a day; or if you have any severe abdominal pain Your doctor can carry out a blood
test to check your iron levels and possibly determine if you have been pregnant, in which case an incomplete miscarriage or ectopic pregnancy will need to be ruled out (see p.25)

I’m 10 weeks pregnant and getting cramping pains. Do I need to rest to avoid a miscarriage?
Cramping pains on their own without vaginal bleeding or spotting can occur at this stage of pregnancy. Sometimes pain can be felt as the ligaments stretch when the baby and -your uterus grows. There are also other possible causes for the pain aside from miscarriage, such as constipation or a urinary tract infection
Many doctors advise rest to avoid a ”threatened” miscarriage, but there is no strong evidence that this makes any difference to the outcome of a pregnancy If you feel like resting because you are in discomfort from the cramping pains then do rest, but if you feel happy continuing as normal then that may be the best option for you Soaking in a warm bath and practising relaxation techniques may ease the intensity of the pain If the pain increases or you get any bleeding or spotting, contact your doctor.
Does bleeding in pregnancy mean that miscarriage is inevitable?
No, many women experience bleeding in early pregnancy and then proceed to have a healthy pregnancy and baby. Indeed, some women have intermittent bleeding throughout pregnancy, Despite this, any bleeding should be investigated. This is usually done with a scan to determine if the pregnancy is viable (going to continue) and to identify if there is any indication of where the
bleeding is coming from. In very early pregnancy, it can be hard to see the pregnancy on a scan and a blood test to measure levels of the pregnancy hormone human chorionic gonadotrophin (hCG) may be done, mainly to rule out the possibility of an ectopic pregnancy (see p.25) Unfortunately for you this is a time of waiting; the timing of any further scans is usually determined by the findings of the initial scan and blood tests and the symptoms you are experiencing.

I’ve had three miscarriages before and I’m scared of trying again - is there anything I can do?
It is understandable given your experiences that trying to get pregnant again is a scary proposition. Following a third miscarriage, it is usual for your doctor to offer you a number of investigative tests
to see if a reason for the miscarriages can be found. In some cases, a cause is identified and treatment can be offered to help improve the outcome for subsequent pregnancies.
You are likely to be given a number of blood tests. These are to look for antibodies (proteins in the blood that fight any substance they recognize as foreign to your body), chromosomal abnormalities, and infection. You may also have a vaginal examination and swab and an ultrasound scan to check your womb and tubes. If a chromosomal abnormality is found, genetic counselling should be offered to discuss the implications for future pregnancies. The levels of the hormones progesterone and prolactin may also be checked as these can play a role in miscarriage. Sometimes, the cervix is found to be weakened and likely to open early If this is the case, you may be offered a cervical stitch that acts like a drawstring on the cervix and hopefully prevents future miscarriage or premature delivery
If you haven’t already been offered these tests, talk to your doctor about them before trying to get pregnant again so that you can begin any recommended treatment as soon as possible
My mum had two miscarriages -does that mean I am more likely to miscarry?
Ask your mum if she was given any particular reason for her miscarriages If for example, she knows that they were due to a chromosomal abnormality, such as sickle-cell disease, or if she had a medical condition such as heart disease, then there is a possibility that the condition is hereditary and the risk of miscarriage may be the same for you too.
However, it’s most likely that your mother’s miscarriages were unfortunate chance occurrences for which no reason was found If this is the case, then you are at no more risk of experiencing a miscarriage than any other woman your age. However, if you do become pregnant, it would be worth mentioning your mother’s pregnancy history at your initial antenatal appointment, as your family medical history is an important part of your medical notes during pregnancy.

I’ve had several miscarriages and my doctor has referred me to a genetic counsellor - why?
A genetic counsellor is a highly trained professional who supports families before and after conception. Quite often a miscarriage is caused by a genetic abnormality in the fertilized egg or embryo. This is usually a one-off and can affect any woman. However, if a woman has recurrent miscarriages, it may be that she is carrying a genetic condition
Women and their partners are referred to a genetic counsellor if either partner has a condition that can affect future children or the chances of becoming pregnant or continuing with a pregnancy (as they may be more likely to miscarry or be offered a termination) For example if there is a history of sickle-cell disease, a blood disorder that causes chronic anaemia and increases the risk of a preterm birth and health problems in the baby, it may be that either or both couples are carrying a gene that can affect a baby.
A genetic counsellor helps you understand how your genes could affect conception and pregnancy and about the tests available to determine if a fetus is affected. The counsellor will discuss a range of
issues, including the moral and ethical issues related to genetic testing, as it is common for couples to feel stress, guilt, and confusion in this type of situation.

I lost my baby, but I want to get on and try again - is this OK?
Although there are no hard rules about when to try for another baby, it is important that you allow yourself time to grieve and your body to recover before trying to conceive again. Some women feel able to try again within a month, while others may not feel ready for at least a year. Whatever you feel, it’s wise to let your hormones and body settle down after a miscarriage before considering another pregnancy. The usual advice is to wait for at least three months before trying to conceive again so that you feel both emotionally and physically prepared for another pregnancy. Your partner also needs to feel that the time is right for you both to try again.

We had a miscarriage at 20 weeks. Will the doctors find the cause so that we can move on?
Coping with the loss of a baby well into pregnancy is difficult and upsetting. Many women ask themselves why a miscarriage happened and feel unable to move on until that important question is answered. Unfortunately, unless this was a recurrent
miscarriage of three or more, there may not be an investigation, although it may be suggested that you have a cervical stitch in future pregnancies to stop the cervix dilating too early (see p 24)
It may be worth talking to a counsellor who
is trained to support women and families through such difficult times, your doctor or midwife may be able to refer you. You may find that discussing your miscarriage directly with a health professional helps to answer any concerns you or your partner have, and by communicating in this way you will have started to move forward and may begin to feel able to consider planning another pregnancy

My partner had a miscarriage. I’m being supportive, but I’m devastated too. What should I do?
Dealing with a miscarriage is very difficult for both women and men, but often far more attention is given to a woman, and a man’s feelings are simply ignored However, it’s important that you don’t internalize your loss and do acknowledge your feelings, which may range from feeling scared, disappointed, and out of control, to blaming yourself for not being supportive enough and mourning the loss of your identity as a father. Although you want to support your partner, you also need to recognize your own need to grieve, as working through your emotions can help you to come to terms with your loss more quickly
A good support network is important for both of you and it can help to find a sympathetic listener outside of your relationship. Initially, you may find discussing your feelings with another male easier than talking to your partner. You could also talk to your doctor, the midwife, or a counsellor, or contact the Miscarraige Association helpline.

What is a “D and C”?
D and C stands for dilation and curettage, a surgical procedure in which the opening to the uterus, called the cervix, is stretched (dilatation) and the tissue that lines the uterus is scraped away or removed (curettage). This procedure is sometimes carried out after a miscarriage to ensure that any of the remaining products of the conception and pregnancy have been removed
There are advantages and disadvantages to consider before having a D and C. The procedure is usually completed within two hours and most women resume their usual activities within a week. However, the need for routine surgical evacuation, or a D and C, following a miscarriage has been questioned because of potential complications, such as bleeding and infection. Ask your doctor for advice There are less invasive options than a D and C for dealing with a miscarriage. One method is simply to watch and wait to see if the uterus will spontaneously expel any remaining products of conception. Another option is a drug treatment that works by stimulating the uterus to contract and naturally expel pregnancy tissues.

The risk of miscarriage
There are several factors that can increase your risk of miscarriage.
Older women have an increased risk of having a miscarriage. It is thought that this is largely due to the fact that older women are more likely to have babies with chromosomal abnormalities, which may have problems developing and miscarry Some underlying medical conditions can also increase your chances of miscarriage, such as polycystic ovary syndrome or fibroids. Other factors that can increase your risk are if you are particularly underweight or overweight, smoke drink heavily, or take recreational drugs.
Miscarriages are also more likely the more pregnancies you have had.

Talking to others
Losing a baby during pregnancy can be devastating, leading to feelings of grief such as anger, depression, guilt, and anxiety. Talking to others can help you to work through your feelings.
* Ask your midwife or doctor to put you in touch with a counsellor who specializes in pregnancy loss
* Let close friends and family members know how you are feeling
* The Miscarriage Association is a great source of support and advice (see p.310). * Talk to your doctor or midwife about why the miscarriage may have happened.

Possible causes of miscarriage

About 1 in 4 first pregnancies ends in miscarriage, generally within the first 12 weeks. Often no cause is identified and it may not be investigated unless a woman has had three or more miscarriages in a row, known as ‘recurrent miscarriages”
Why has it happened? Some miscarriages occur because of a one-off genetic problem (caused by a faulty chromosome) when the baby does not develop properly. Genetic problems account for 60 per cent of early miscarriages If you think this may have been the cause, you can request tissue tests from the baby. Based on these results, you may be able to receive specialist counselling to discuss the risk of it happening again (see p.24). After 12 weeks, the chances of you losing your baby because of a chromosomal disorder reduce to about 10 per cent: however, if
Ectopic pregnancy
you are over 35, this risk is higher. Other less common causes of miscarriage include fibroids (non-cancerous growths), infection, problems with the uterus, hormonal imbalances, and immune system disorders. An ectopic pregnancy. below, occurs when the embryo implants in a Fallopian tube and needs to be removed
What can cause late pregnancy loss? A late pregnancy loss (referred to as a stillbirth after 24 weeks) can be due to the cervix being weak (or ‘incompetent’), causing the cervix to dilate too early. This accounts for 15 per cent of repeated miscarriages. In future pregnancies, a stitch around the cervix can strengthen this muscle and prevent it opening early Another cause of a late miscarriage can be if the placenta does not function properly and affects the baby’s growth.
fertilized egg implants in tube

Glossary
Abruption The detachment of part of the placenta from the wall of the uterus during late pregnancy, which may result in bleeding. Accelerated labour The artificial augmentation of contractions, after the cervix has started to dilate, by the injection of oxytocin through an intravenous drip Often used to speed up a long labour. Active birth An approach to childbirth that involves upright positions and movements during labour.
Active management of labour The constant monitoring and technical control of labour to monitor its duration
Alphafetoprotein (AFP) A substance produced by the embryonic yolk sac, and later by the fetal liver, which enters the mother’s bloodstream during pregnancy Alveoli Milk glands in the breasts, which produce a flow of milk when they are stimulated by prolactin and the baby’s sucking.
Amniocentesis The surgical extraction of a small amount of amniotic fluid through the pregnant woman’s abdomen. This procedure is usually carried out as a test for fetal abnormalities.
Amniotic fluid The fluid that surrounds the fetus in the uterus. Ultrasound scans may be done in late pregnancy to ensure that enough is present
Ammotomy The surgical rupture of the amniotic sac, often done to speed up labour This is referred to as ARM (artificial rupture of the membranes).
Anaemia A condition in which there is an abnormally low percentage of haemoglobin in the red blood cells, it is treated by iron supplements
Anaesthetic Medication that produces partial or complete insensibility to pain Anaesthetic, general Anaesthetic that affects the whole body, with temporary loss of consciousness.
Anaesthetic, local Anaesthetic that affects a limited part of the body
Analgesics Painkilling agents not inducing unconsciousness
Antenatal Before the birth
Anterior position See Occipital anterior Antibiotics Substances capable of
destroying or limiting the growth of micro-organisms, especially bacteria Antibodies Protein produced naturally
by the body to combat any foreign bodies, germs or bacteria
Anti-D An injection of antibodies given to women who have a Rhesus negative blood group if it is thought they may have been exposed to Rhesus positive fetal blood cells
Antihistamines Tranquillizers that are used in the treatment of nausea vomiting and certain allergies.
Apgar scale A general test of the baby’s wellbeing given shortly after the birth to assess the heart rate and tone respiration blood circulation, and nerve responses. Areola The pigmented circle of skin surrounding the nipple.
ARM See Ammotorny
Bile pigment See Bilirubin.
Bilirubin Broken-down haemoglobin, normally converted to nontoxic substances by the liver. Some newborn babies have levels of bilirubin too high for their livers to cope with See also Jaundice, neonatal. Birth canal See Vagina
Blastocyst An early stage of the developing egg when it has divided into a group of cells. Braxton Hicks contractions Practise contractions of the uterus that occur throughout pregnancy, but which may not be noticed until towards the end. Breast pump A device for drawing milk from the breasts.
Breech presentation When the position of the baby in the uterus is bottom down rather than head down
Caesarean section The delivery of the baby through an incision in the abdominal and uterine walls
Candida See Thrush,
Cardiotocograph (CTG) An electronic monitor that is used to measure the progress of the mother’s contractions and the baby’s heartbeat during labour.
Carpal tunnel syndrome Numbness and tingling of the hands arising from pressure on the nerves of the wrist In pregnancy it is caused by the body’s accumulation of fluids
Catheter A thin plastic tube that is inserted into the body through a natural channel to withdraw fluid from, or introduce fluid into, a particular part of the body This can be used to draw off urine from the bladder after an operation, or to maintain a constant input of fluids into a vein, or to introduce anaesthetic into the epidural space.
Cephalic presentation (Vertex presentation) The position of a baby who is head down in the uterus The most common presentation. Cephalopelvic disproportion A state in which the head of the fetus is larger than the cavity of the mother’s pelvis Delivery must therefore be by Caesarean section
Cervical dilatation See Dilatation.
Cervical incompetence A disorder of the cervix, usually arising after a previous mid-pregnancy termination or damage to the cervix during a previous labour, in which the cervix opens up too soon, resulting in repeated mid-pregnancy miscarriages. It is sometimes treated by suturing to hold the cervix closed. Cervix The lower entrance to the uterus, or neck of the womb
Chloasma Skin discolouration during pregnancy, often facial.
Chorion The outer membranous tissue that envelops the fetus and placenta
Chorionic gonadotrophin See Human chorionic gonadotrophin (HCG).
Chorionic villus sampling A method of screening for genetic handicap by analysis of tissue from the small protrusions on the outer membrane enveloping the embryo that later form the placenta.
Chromosomes Rod-like structures containing genes occurring in pairs within the nucleus of every cell. Human cells each contain 23 pairs. See also Gene
Cleft palate A congenital abnormality of the roof of the mouth
Club foot A congenital abnormality in which the foot is painlessly twisted out of shape. Colostrum A kind of milk, rich in proteins, formed and secreted by the breasts in late pregnancy and gradually changing to mature milk some days after delivery
Conception The fertilization of the ripened egg by the sperm and its implantation in the uterine wall.

Congenital abnormality An abnormality or deformity existing from birth, usually arising from a damaged gene, the adverse effect of certain drugs or the effect of some diseases during pregnancy
Contractions The regular tightening of the uterine muscles as they work to dilate the cervix in labour and press the baby down e birth canal
Cordocentesis A fine needle is passed trough the mother’s abdomen into the fetal –vein in the umbilical cord. The technique allows fetal blood to be tested, facilitates intra-urine blood transfusions, and enables drugs to be injected directly into the baby Corpus lutuem A glandular mass that forms n- the ovary after fertilization It produces progesterone. which helps to form the placenta, and is active for the first 14 weeks of pregnancy
Crowning The moment when the baby’s head appears in the vagina and does not slip back again.
CVS See Chorionic villus sampling.
D and C The surgical dilatation (opening) of the cervix, and curettage (removal of the contents) of the uterus
Dehydration A physical condition caused by the loss of an excessive amount of water from the body, often resulting from severe vomiting or diarrohea
Depression, respiratory Breathing difficulties in the newborn baby
Diabetes Failure of the system to metabolize glucose, traced by excess sugar in the blood and urine.
Diamorphine A narcotic opium derivative used as an analgesic.
Dilatation The progressive opening of the cervix caused by uterine contractions during labour.
Distress See Fetal distress
Dizygotic See Twins
Domino scheme A scheme operated by some hospitals in which community midwives provide antenatal care and are present at hospital for the delivery.
Doppler A method of using ultrasound vibrations to listen to the fetal heart
Doula A supportive woman helper who provides physical and emotional support during childbirth
Down’s syndrome A severe congenital abnormality caused by an incorrect number
of chromosomes that produces physical abnormalities and reduced intelligence. Drip See Intravenous drip.
Eclampsia The severe form of pre-eclampsia, which is characterized by extremely high blood pressure, headaches, visual distortion, flashes, convulsions and, in the worst cases. coma and death The condition is now rare since the symptoms of pre-eclampsia are treated immediately See also Pre-eclampsia.
Ectopic (Tubal pregnancy) A pregnancy that develops outside the uterus, usually in one of the Fallopian tubes. The mother has severe pain low down on one side in her
abdomen at any time from the 6th to 12th week of pregnancy. The pregnancy must be surgically terminated.
EDD The estimated date of delivery Electrode A small electrical conductor used obstetrically for monitoring the fetal heartbeat during labour.
Electronic fetal monitoring The continuous monitoring of the fetal heart by a transducer placed on the mother’s abdomen over the area of the fetal heart, or by an electrode inserted through the cervix and clipped to the baby’s scalp
Embryo The developing organism in pregnancy from about the 10th day after fertilization until about the 12th week of pregnancy, when it is termed a fetus Endometrium The inner lining of the uterus. Engaged (Eng/E) The baby is engaged when it has settled with its presenting part deep in the pelvic cavity. This often happens in the last month of pregnancy
Engorgement The over congestion of the breasts with milk. If long periods are left between feeds, or the baby is not well latched on painful engorgement can occur. This can be relieved by putting the baby to the breast or expressing the excess milk Entonox A mixture of 50 per cent oxygen and 50 per cent nitrous oxygen, breathed in through a mask during tabour, that gives pain relief as contractions peak
Epidural (Lumbar epidural block) Regional anaesthesia used during labour and for Caesarean sections, in which an anaesthetic is injected through a catheter into the epidural space in the lower spine. Episiotomy A surgical cut in the perineum to enlarge the entrance to the vagina.
External version (External cephalic
version, or ECV) The manipulation by gentle pressure of the fetus into the cephalic position This may be done by an obstetrician at the end of pregnancy if the baby is breech or transverse
Fallopian tube The tube into which a ripe egg (ovum) is wafted along after its expulsion from the ovary along which it travels on its way to the uterus
False labour Braxton Hicks (rehearsal) contractions, which are so strong and regular that they are mistaken for the contractions of the first stage of labour,
Fertilization The meeting of the sperm with the ovum or egg to form a new life See also
Conception.
Fetal distress A shortage in the flow of oxygen to the fetus, which can arise from numerous causes
Fetus The developing child in the uterus, from the end of the embryonic stage at about the 12th week of pregnancy until birth FH Fetal heart.
Fibroid A benign (non-cancerous) muscle growth in the uterus.
Forceps Metal tong-like instruments placed either side of the baby’s head during labour to help deliver the baby
Hormone A chemical messenger in
the blood that stimulates various organs to action.
Human chorionic gonadotrophin (HCC) A hormone released into the woman’s bloodstream by the developing placenta from about six days after the last period was due. Its presence in the urine means that she is pregnant
Hyperemesis gravidarum Almost continuous vomiting during pregnancy Hypertension (High blood pressure) During pregnancy this can reduce the fetal blood supply.
Hypnosis A state of mental passivity with a special susceptibility to suggestion. This can be used as an anaesthetic, and can be self-induced.
Hypotension Low blood pressure.
Identical twins See Twins
Implantation The embedding of the fertilized ovum or egg within the wall of the uterus
Induction The process of artificially starting off labour and keeping it going.

Insulin A hormone produced by the pancreas that regulates the level of carbohydrates and amino acids in the system. It may be used as a means of controlling the effects of diabetes.
See also Diabetes.
Internal monitoring See Electronic fetal monitoring
Intravenous drip The infusion of fluids directly into the bloodstream by means of a fine catheter introduced into a vein Intravenous injection An injection into a vein
Invasive techniques Any medical technique that intrudes into the body
In vitro fertilization (IVT) A type of assisted conception where fertilization occurs outside of the womb and fertilized embryos are tranferred back into the womb.
Jaundice, neonatal A common complaint in newborn babies which is caused by the inability of the liver to break down successfully an excess of red blood cells See also Bilirubin
Lanugo The fine soft body hair of the fetus Lateral position Transverse lie or horizontal position of a fetus in the uterus (sometimes occurring if the mother has a large pelvis), where the presenting part is either a shoulder or the side of the head
Let-down reflex The flow of breast milk into the nipple.
Lie The position of the fetus within the uterus Linea nigra A line of dark skin that appears down the centre of the abdomen over the rectus muscle in some women during pregnancy
Lochia Postnatal vaginal discharge Longitudinal lie The position of the fetus in the uterus in which the spines of the fetus and the mother are parallel
Low-birthweight baby A baby who weighs below 2,5 kg (57 lb) at birth.
Meconium The first contents of the bowel, present in the fetus before birth and passed during the first few days after birth The presence of meconium in the amniotic fluid before delivery is usually taken as a sign of fetal distress
Miscarriage The spontaneous loss of a baby before 24 weeks of pregnancy
Monitoring See Electronic fetal monitoring Monozygotic See Twins.
Morula A stage in the growth of the fertilized
egg when it has developed into 32 cells. Moulding The shaping of the bones of the baby’s skull, which overlap to allow the baby to pass through the birth canal.
Mucus A sticky secretion.
Multigravida A woman in her second or subsequent pregnancy
Multiple pregnancy The development of two or more babies, See also Twins Mutation A damaged genetic cell. This can occur naturally or more commonly as an effect of outside agents, such as radiation. Neural tube defects Abnormalities of the central nervous system See also
Anencephaly, Hydrocephalus Spina bifida. Nicotine A highly poisonous substance that is present in tobacco During pregnancy this can enter the bloodstream of a woman who smokes and may affect the efficiency of the placenta, which often results in a lowbirthweight baby
Nucleus The central part or core of a cell, containing genetic information.
Occipital anterior The position of the baby in the uterus when the back of its head (the crown or occiput) is towards the mother’s front (anterior)
Occipital posterior The position of the baby in the uterus when the back of its head (the crown or occiput) is towards the mother’s back (posterior)
Oedema Fluid retention, which causes the body tissues to be puffed out.
Oestriol A form of oestrogen.
Oestrogen A hormone produced by the ovary
Opioids (Narcotics) Painkilling drugs that induce drowsiness and stupor,
Ovary One of the two female glands, set at the entrance of the Fallopian tubes, which regularly produce eggs until the menopause Ovulation The production of a ripe ovum or egg by the ovary
Oxytocin A hormone secreted by the pituitary gland that stimulates uterine contractions during labour and stimulates milk glands in the breasts to produce milk Palpation Feeling the parts of the baby through the mother’s abdominal wall. Pelvic floor The springy muscular
structure set within the pelvis that
supports the bladder and the uterus, and through which the baby descends during tabour,
Pelvis The pelvis is a solid ring of bone at the base of the abdomen: it shields the bladder and portions of the genital tract. Perinatal The period from the 24th week of gestation to one week following delivery Perineum The area of soft tissues surrounding the vagina and between the vagina and the rectum.
Pethidine See Analgesics
Phototherapy Treatment by exposure
to light, which may he used when a baby has jaundice
Pituitary gland A gland set just below the brain that among other functions, secretes various hormones controlling the menstrual cycle. In late pregnancy it releases a hormone, oxytocin, into the bloodstream, which stimulates uterine contractions and also the milk glands.
Placenta The organ that develops on the inner wall of the uterus and supplies the fetus with all its life-supporting requirements and carries waste products to the mother’s system.
Placental insufficiency A condition in which the placenta provides inadequate life support for the fetus, often after 40 weeks, resulting in a baby at special risk.
Placenta praevia A condition in
which the placenta lies over the cervix at the end of pregnancy. This part of the uterus stretches in the last few weeks of pregnancy, but the placenta cannot stretch, so it may separate, the result is bleeding during late pregnancy, A woman with a complete placenta praevia is delivered by Caesarean section
Posterior See Occipito posterior
Postnatal After the birth.
Postpartum After delivery.
Post-traumatic stress disorder Panic and anxiety experienced by some women after traumatic and disempowering childbirth Pre-eclampsia (Pre-eclamptic toxaemia or PET) An illness in which a woman has high blood pressure, oedema, protein in the urine, and often sudden excessive weight gain See also Eclampsia.
Premature A baby born before the 37th week of pregnancy and weighing less than 2.5 Ing (5 lb)
Presentation The position of the fetus in the uterus before and during labour,

lying directly over the cervix
Preterm See Premature
Primigravida A woman having her first pregnancy.
Progesterone A hormone produced by the corpus luteum and then by the placenta Progestogen A synthetic variety of the hormone progesterone used in oral contraceptives.
Prolactin A hormone that stimulates milk production for breastfeeding Prostaglandins Natural substances that stimulate the onset of labour contractions. Prostaglandin gel may be used to soften the cervix and induce labour
Proteinuria The presence of protein in the urine, which may be a sign of pre-eclampsia. See also Pre-eclampsia
PTSD See Post-traumatic stress disorder Pubis The bones forming the front of the lower pelvis.
Quickening The first noticeable movements of the fetus felt by the mother.
Respiratory depression See Depression, respiratory.
Rhesus factor A distinguishing characteristic of the red blood corpuscles. All human beings have either Rhesus positive or Rhesus negative blood If the mother is Rhesus negative and the fetus Rhesus positive, severe complications and Rhesus disease (the destruction of the red corpuscles by antibodies) may occur, unless prevented by anti-D gamma globulin.
Rooting The baby’s instinctive searching for the breast
Rubella (German measles) A mild virus that may cause congenital abnormalities in the fetus if it is contracted by a woman during the first 12 weeks of pregnancy
Scan (Screen) A way of building up a picture of an object by bouncing high-frequency soundwaves off it. The sonar or ultrasound scan is used during pregnancy to show the development of the fetus in the uterus. See also Transducer.
Show A vaginal discharge of bloodstained mucus occurring before labour, resulting from the onset of cervical dilatation. A sign that labour is starting
Small-for-dates Babies who are born at the right time but who for a range of reasons have not flourished in the uterus. See also
Placental insufficiency
Sperm (Spermatozoon) The male reproductive cell that fertilizes the female ovum or egg.
Spina bifida A congenital neural tube defect in which the fetal spinal cord forms incorrectly, outside the spinal column Spinal anaesthesia An injection of local anaesthetic around the spinal cord.
Steroids Drugs used in the treatment of skin disorders, asthma, hay fever, rheumatism, and arthritis. Because they alter the chemical balance of the metabolism they may very rarely cause fetal abnormalities if used extensively during pregnancy
Stillbirth The delivery of a dead baby after the 24th week of pregnancy
Streptomycin A broad-spectrum antibiotic that should not be taken in pregnancy See also Antibiotics
Stretch marks Silvery lines that sometimes appear on the skin after it has been stretched during pregnancy
Supplementary feeding Additional bottles given to a breastfed baby.
Surfactant A creamy fluid that reduces the surface tension of the lungs so that they do not stick together when deflated. Preterm babies may have breathing difficulties if surfactant has not developed sufficiently Suture The stitching together of a tear or a surgical incision.
Syntocinon A synthetic form of
oxytocin, which is used to induce or accelerate labour.
TENS machine See Transcutaneous electronic nerve stimulation
Term The end of pregnancy this is measured at 38-42 weeks from the first day of the last menstrual period. Tetracycline A wide-spectrum class of antibiotic that should be avoided during pregnancy. because it can affect the development of the fetal teeth and hones See also Antibiotics.
Thrombosis A blood clot in the heart or blood vessels.
Thrush A yeast infection that can form in the mucous membranes of the month, genitals, or nipples.
Toxoplasmosis, congenital A parasitic disease that is spread by cat faeces. If it crosses the placenta during pregnancy, it can cause eye or central nervous system damage in the baby
Transcutaneous electronic nerve stimulation A method of pain relief that uses electrical impulses to block pain messages to the brain.
Transducer An instrument that translates echoes of very high-frequency soundwaves bounced off the developing fetus in the uterus to build up an ultrasound image on a monitor. See also Scan.
Transition A phase between the first and second stages of labour when the cervix is dilating to between 7 and 10 cm
Trial of labour A situation in which, although a Caesarean section may be necessary, the mother labours in order to see if a vaginal delivery is possible
Twins The simultaneous development of two babies in the uterus, either after two eggs are fertilized independently by two sperm - dizygotic or fraternal twins - or, more rarely, after one fertilized egg divides to produce monozygotic or identical twins.
Ultrasound See Scan, Transducer.
Umbilical cord The cord connecting the fetus to the placenta
Uterus (Womb) The hollow muscular organ in which the fertilized egg becomes embedded, where it develops into the embryo and then the fetus
Vacuum extractor An instrument, used as an alternative to forceps which adheres to the baby’s scalp by suction and with the help of the mother’s bearing down, can be used to guide the baby out of the vagina
Vagina The canal between the uterus and the external genitals It receives the penis during intercourse and is the passage through which the baby is delivered
VE Vaginal examination.
Vernix A creamy substance that often covers the fetus in the uterus
Vertex presentation (VX) See Cephalic presentation.
Vulva The external part of the female reproductive organs, that includes the labia and the clitoris
Water birth Birth of a baby under water.