Giving birth What to expect and what you can do

MonashWomen’s MonashHealth

Contents

Preparing for labour and birth 3

Signs of labour 4

When should I ring the hospital? 4

Induction of labour 5

Labour and birth 5

Other methods of pain relief 7

Forceps and ventouse (vacuum) 9

Caesarean section 10

Photography 11

Monitoring your baby during labour 11

A summary guide to stages of labour and birth 13

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Preparing for labour and birth

There are some things you may like to do

• Think carefully about which of your friends or family would be most helpful to support you in labour. We suggest you limit support people to two• Arrange to attend birth and parenting workshops / education sessions • View www.monashwomens.org for a virtual tour of the maternity services and other helpful information and ‘fact sheets’ • Discuss the pros and cons of different methods of pain relief in labour with your midwife or doctor. Think about how you can be involved in decisions about your care in labour• Discuss your wishes about your care with your support person, doctor or midwife• Talk to your doctor or midwife about any concerns you may have• Pack a bag for your hospital stay some weeks before your due date (see fact sheet: What to bring to hospital?)• Find out what to do when you think you’re in labour – where to go• The numbers to ring are on your ‘contacts card’. Keep this handy at all times.

Be aware that sometimes things don’t always go to plan, but no matter what happens you will be supported.

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Signs of labourSometimes it is difficult to know if labour has really started. The signs may come and go for a day or two before a regular pattern begins. You may have a burst of energy towards the end of the pregnancy or feel a bit anxious and restless.The most common signs of labour beginning are:

• contractions, that become more regular, frequent, longer lasting and stronger with time

• a show – the mucous plugging the cervix comes away without any pain. This may be bloodstained. You usually find you’ve had a show when you go to the toilet

• ‘waters breaking’ (‘membranes rupture’). You may have a gush of amniotic fluid (the fluid surrounding the baby) or you may just leak a little bit at a time. This may happen before you feel any contractions

• low back pain• loose bowel motions.

When should I ring the hospital?• If you think you are leaking fluid (membranes ruptured)• If you are having regular contractions at about five minute

intervals• If you have bleeding (more than bloodstained mucous discharge)• If you are feeling anxious• If you have not felt your baby move within two hours, or the

movements have been much less than usual.

When you ring the hospital birth suite the midwife will ask you some questions and give you advice on what to do next.

Some questions you might be asked are: • how long was your last labour?• how far from the hospital are you? • how you are feeling and what you would prefer to do?

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• do you have any pain, have your ‘waters broken’, is your baby moving as much as usual, are you bleeding? (These are important changes).

Induction of labourInduction of labour is a medical process used to start labour. In most pregnancies it is best if labour starts naturally. Induction of labour will be discussed and offered when continuing the pregnancy is thought to be a higher risk than inducing labour. There are a number of reasons why induction of labour may be recommended. These may include:

• prolonged pregnancy• spontaneous rupture of membranes• high blood pressure• diabetes or suspected poor growth of the baby.

In women with these conditions, it is thought that induction of labour is safer for mother and baby than continuing the pregnancy.Prolonged pregnancy is the most common reason to induce labour. At Monash Health induction of labour for prolonged pregnancy is not recommended until pregnancy has extended at least 10 -14 days past your due date. A detailed Induction of labour fact sheet will be provided by your doctor if considering an induction.

Labour and birthLabour and birth is hard work, a bit like running a marathon. Labour takes effort and stamina - it can be a long physical process but being informed about the process can help.The pain of labour does not indicate injury, like much pain we experience. It is a sign your body is working hard to bring your baby into the world. There are many things you, your support people and your carers can do to help you during labour.

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Having encouraging and supportive people caring for you is also very important.What you can do:

• relax between and during contractions• take fluids at regular intervals - this helps to prevent

dehydration and loss of energy• try to keep in a positive frame of mind• use a variety of positions during labour such as: o standing o walking o lying on your side o kneeling o leaning on your partner or support person or on a beanbag o squatting.

Your midwife may suggest that you try different positions as labour progresses.

You may find it easier to relax if you:• have a deep warm bath [see Water immersion in labour

and water birth fact sheet] • have a warm shower • place a heat pack over the area where you feel the most pain• have someone give you a massage• listen to music• use aromatherapy with scented oils • turn off the bright lights in your room• use your breathing as a focus• use visualisation (positive imagery to assist relaxation).

What your support person can do:

• be available to give you support in person or by phone • help with last minute arrangements and take you to hospital • understand and accept your wishes and preferences • help you settle into the birth room and make it your space

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• take cues from you – understand your needs will change as time goes by

• keep calm• give you constant reassurance – this is the most important

thing they can do• remind your how well you have done• listen and take the lead from the midwife – work together

to give you the best support• take responsibility for answering and making phone calls• give support in any way you need• stay focussed on what’s happening, this is a very special time• take photos• give the new family some time together• let the midwife know if they need an occasional break or

some time out to eat or rest.

Other methods of pain relief

Nitrous oxide and oxygen• A gas you breathe in through a facemask or mouthpiece. • It is a mild anaesthetic which lasts for a short time. • The gas doesn’t harm your baby in any way. • Some women find it makes them nauseous or can give

them a dry mouth.

Pethidine

• A narcotic drug given by injection • It acts as a sedative (makes you sleepy)• Recent evidence suggests that pethidine does not provide

good pain relief, and that the negative side effects for mother and baby may outweigh the benefit.

Some disadvantages for the mother include:• nausea (an anti-nausea drug will need to be given to help with this)• feeling sleepy and or woozy.

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Some disadvantages for the baby include:• it may affect baby’s breathing - this is only temporary• it may affect baby’s ability to suck and begin

breastfeeding which can last 48 hours or more.

Epidural analgesia

This is a small tube inserted into the space around the spinal cord through which local anaesthetic is injected.It must be inserted by a doctor trained to give an anaesthetic (anaesthetist).There may be some delay in having an epidural as an anaesthetist needs to be available to perform the procedure.An epidural numbs you from the waist down. Most women have close to total pain relief.Before the procedure, an anaesthetist will explain the disadvantages to you, which include the possibility of:

• a longer labour• interventions such as an assisted birth using forceps or

ventouse and an episiotomy (a cut through the vaginal wall and perineum to make more space for your baby that needs to be stitched afterwards)

• uncontrollable shivering• severe headache after birth (rare)• tenderness at the insertion site.

You will need to have an intravenous drip to prevent your blood pressure dropping and continuous electronic fetal monitoring of your baby’s heart rate. You will also need an indwelling catheter to drain your bladder as you will not have the sensation to pass urine or be able to walk to the toilet.You may like to ask for a vaginal examination to check on your progress before choosing epidural if labour is well established.If you require a caesarean section an epidural is usually the anaesthetic used for your operation.For more information see Epidural for pain relief in labour fact sheet.

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Forceps and ventouse (vacuum)

Sometimes it may be necessary to assist the birth of a baby with the use of forceps or ventouse. These are used only after your cervix is fully dilated.The most common reasons are:

• baby is not coping with labour (baby’s heart rate pattern is not normal)

• a long second stage of labour which may be the result of:• mother’s condition (e.g. exhaustion)• baby’s position• an epidural that has slowed progress• mothers’ medical condition.

Before an assisted birth you have a catheter inserted into your bladder to drain urine. You will need pain relief. Depending on the situation this may involve local anaesthetic to numb the perineal area, an epidural or a spinal block.You may need an episiotomy. If this is required, it will be sutured after the birth and usually heals very well without problems.The choice of forceps or vacuum depends on the circumstances and the preference of the doctor.

Ventouse (Vacuum)A suction cup is placed on the baby’s head. During a contraction the doctor pulls on the cup while you push.

Forceps birth

Forceps are metal spoon-shaped instruments designed to fit around the baby’s head. During a contraction the doctor pulls on the forceps while you push.

Caesarean section

An elective or planned caesarean may be considered necessary because:

• you had a caesarean with a previous birth

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• you have placenta praevia (the placenta lies very close to or covers the cervix)

• you have a medical condition that makes labour more risky for you or your baby

• there are risks for baby in a vaginal birth e.g. baby is in a breech position or in another abnormal position at the end of your pregnancy.An emergency caesarean is usually done if:

• baby is not coping with labour• labour is not progressing• there are maternal complications such as severe bleeding

or severe pre-eclampsia (high blood pressure).

What can I expect during a caesarean?

In most cases you are awake during a caesarean birth and have your partner beside you. Before the caesarean begins a urinary catheter is inserted into your bladder. You will be shaved where the caesarean incision is to be made, usually low down around your pubic hair line. An anaesthetist gives you a spinal block or adjusts your epidural, if you already have one.In some circumstances (usually in an emergency situation) a caesarean is done under a general anaesthetic (you will be asleep).Quite soon after the operation begins baby will be born.A doctor and midwife in the operating theatre will care for your baby. If all is well the midwife will assist you to hold your baby with direct skin-to-skin contact while you are still in the operating theatre.Overall you will be in the operating theatre for at least an hour. You then spend about 30 minutes in the recovery room before going to the maternity ward. During this time you may be able to breastfeed your baby.At first you may have pain relief from the epidural or spinal anaesthetic. Most women start taking pain relief tablets shortly after the operation to prevent pain when the block wears off.

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Your stay in hospital will be longer (usually three nights).For more information see Going home after a caesarean section fact sheet.

PhotographyA regular camera is permitted during birth with the permission of the doctors and midwives who are present. The use of video or DVD recording equipment is not permitted during the birth of your baby or during medical or emergency procedures. Please respect this request and let your support people know.

Monitoring your baby during labourDuring your labour it is important to make sure your baby is well. If you are healthy and your pregnancy has been normal we will check on your baby during labour by simply listening to the heart rate every half hour using a hand-held Doppler ultrasound, similar to what is used during the pregnancy care visits.If you or the baby have experienced, or may be likely to experience, problems during the pregnancy or during labour then your baby’s heartbeat may be monitored by a machine called a cardiotocograph (CTG). This machine produces a continuous record of your baby’s heart beat assisting the midwives and doctors to closely monitor your baby’s health and wellbeing.A CTG machine would also be used to monitor your baby if you had a medical induction of labour, an epidural or if you were in early labour and were planning to go home.

Apgar scoreAt one and five minutes after birth the midwives or doctors will check your baby for breathing, heart rate, colour, muscle tone and reflexes. This score will be done automatically and you may not notice it being carried out.In each category a score of zero, one or two is given, and a total of seven or more is considered good. A very low score means emergency medical care is needed.

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Cord blood lactate levelsThe level of lactate in the blood of the cord can give us information about your baby’s health when it is born.This is a simple test done from a drop of blood taken from the umbilical cord after the birth of the placenta. The cord blood lactate level is particularly helpful if your baby is not well at the time of birth and assists in planning your baby’s care.

A summary guide to stages of labour and birth

Before labour begins • You may have painless practice or “Braxton Hicks” contractions• You can eat and drink normally• Expect to feel the baby moving just as much as usual• Check you have the correct hospital telephone number • You may have an increase in vaginal mucous • Your cervix is still closed or slightly open and thick• You might be feeling expectant, excited, uncertain and anxious.

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Very early labour

• Very early (latent) labour varies considerably. An estimate is 12 hours for first time mothers (but could be as long as 20 hours) and six hours for women with subsequent labours.

• You may have contractions that feel uncomfortable but are not yet regular.

• Remember to eat and drink as you feel able.• Take notice of your baby’s movements. If you have not felt

your baby move within two hours, or the movements have been much less than usual please contact the hospital.

• A walk or stretching can help you relax.• You may not want to be on your own, a support person /

partner can hold you, rub your back and be reassuring. • You may pass a ‘show’. This is a plug of mucous from your

cervix, it may be streaked with blood. Your waters may break• Your cervix opens and thins.• Bathing, moving around, massage, relaxing music and

paracetamol (no more than 4g in 24 hours) may help.• You may feel excited but pace yourself; get as much rest as possible.

Active labour – first stage

• You are advised to contact the hospital at this stage • The active stage of first labours last on average eight hours and

are unlikely to last over 18 hours• Second and subsequent labours last on average five hours

and are unlikely to last over 12 hours• Contractions come regularly every 2-3 minutes and last up

to 60 seconds• Drinking fluids may help. You may not feel like eating much• Being upright and active may mean less need for pain relief

and a shorter first stage of labour• A midwife will care for you throughout labour. The midwife will

listen to the baby’s heartbeat and monitor your temperature, blood pressure and pulse rate regularly. The midwife will monitor your vaginal loss

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• Your midwife will be able to suggest changes in position or other alternatives to help you cope with the discomfort of labour

• Pain relieving drugs are available; your midwife will discuss them if you ask

• Your cervix gradually dilates (opens) up to 10cms • At the end of the first stage, you may feel emotional, or even

irritable and perhaps impatient with your support people. You may feel you can’t cope. This is a good sign – you are nearly there.

Active labour – second stage

• The second stage of active labour usually lasts one or two hours for your first baby and shorter if you have had a baby before

• Contractions are very strong and close together with strong urges to push

• The cervix is fully dilated (open)• If they have not done so already your waters will most likely

break before your baby is born • Sips of fluid can help if you have a dry mouth• Your midwife will listen to the baby’s heartbeat every 5 minutes• Movement and changing position can help• Your midwife and partner will encourage you with your pushing• You may feel very focused and concentrate on your efforts• Your midwife will support you and stay with you and help you

to focus on this final stage before your baby is born.

Labour – third stage

• This is the time from the birth of your baby to the delivery of the placenta • ‘Active management’ is recommended to reduce your risk of

bleeding after birth• With active management you are given an injection of a medicine

called an oxytocic just after your baby is born. The oxytocic makes the uterus contract and encourages the placenta to come away

• ‘Active management’ usually reduces the length of the third stage, with the average time being 5 – 15 minutes for the delivery of the placenta

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• Physiological management should only be considered for women who have had an uncomplicated pregnancy and birth

• An information sheet will be provided by your midwife or doctor if you are considering physiological third stage. Without an injection the third stage of labour usually lasts 2 up to 60 minutes

• Being upright can help your body expel the placenta • A small gush of blood is usually passed before the placenta is

delivered.

After the birth

• Your cervix closes after the placenta and membranes are delivered • Your baby will be kept skin-to-skin with you initially (unless you

don’t want this) • You may feel ‘after pains’ - a tender tummy as your uterus

contracts• Your midwife will perform regular observations on you and your

baby. • You will be assisted to feed your baby• Your vaginal loss can be like a heavy period for a few days• You may feel very tired after this amazing experience and your

efforts to bring your new baby into the world• You have earned a good rest and refreshments! • Congratulations!

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