Posts Tagged ‘labour contractions’

I’m over my due date

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

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

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

How will I know I’m in labour?

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