Posts Tagged ‘labour ward’

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: