Labour and Birth Information
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Congratulations, you are nearly there! “D” day is fast approaching - what now?
We are getting closer to the birth of your beautiful baby. Now is the time when we need to start talking about labour and birth, and what your expectations are, along with coping mechanisms for you and your support person/s.
In this section we will discuss the different stages of labour and break them down into the phases — which we, as midwives, refer to. We will talk about strategies to cope with early labour at home when it is way too early to go into the hospital. What to discuss when formulating a labour and birth plan, what to pack for the hospital stay, pain relief options, and other coping strategies, Vitamin K what is it what are the recommendations etc. How you know labour might be starting, when to phone your midwife, support during labour and what your support people should know, helpful positions for you during the first and second stages of labour.
First off, let's pack your birthing bag – make sure your partner and support people know exactly where it is and what last minute things they need to put in it.
What to pack to bring to the Hospital:
Although it’s nice to have all your own possessions around you, the rooms at the hospital cannot accommodate lots of bags and suitcases etc. You will only require the bare essentials; your support people can bring you in anything else you may need. The following is a list of items you will require for your immediate stay. We suggest you have your bag packed with everything but your day-to-day articles from about 36 weeks gestation. Remember the hospital holds no responsibility for missing, lost or stolen items etc
For you:
- Your pregnancy booklet
- 3 pairs of good nana knickers, NOT G-strings. You need good sturdy undies to safely hold your maternity pads
- 2-3 good supportive maternity bras
- Toiletries - shampoo, conditioner, body wash, tooth brush, toothpaste, body lotion, make-up, hair brush etc
- 1-2 sets of comfortable easy to wear day clothes
- Snack type foods for middle of the night hunger bursts, and food for your support people
- A 750ml plain water bottle
- Cell phone and charger. Camera - Optional
Maternity pads are supplied by the hospital while you are an inpatient. I suggest not using expensive pads – Home Brand, Pam's and Budget brands are ideal for this.
For baby:
- Clothes to be dressed in after initial feed and check-up: ideally merino vest and stretch and grow plus hat, socks/booties and wrap.
- A shawl or warm blanket to go home in
- Car seat – can be brought in on your discharge day (baby must be carried out of the hospital and strapped in)
- Nappies are supplied by the hospital while you are an inpatient
- Bottles, teats and artificial formula (if you are choosing not to breast feed as the hospital will not supply this unless clinically indicated by the paediatric team)
Optimal foetal positioning or getting your baby into a great position for labour and birth:
If your baby is coming head first and it is a single baby (not a multiple pregnancy), then from approx. 34 weeks gestation this advice is recommended to encourage your baby to lie with its back to your left/front. This will also encourage your baby to ‘engage’ there by an enjoying as normal and straightforward birth as possible. Please note this advice is given to complement your antenatal care and may not be suitable for all women or all pregnancies. If you have a concern please discuss it with your midwife.
By going on all fours, you relax the uterus and it becomes like a hammock. The weight of your baby should the help bring its back forward. Ideally his/her back should be uppermost for labour. Try kneeling for at least 30 mins each day, washing floors on your hands and knees with a scrubbing brush or the skirting boards is also a great way to fix the ‘nesting’ and move baby into a good position.
DO:
- Regularly use upright and forward leaning positions. This allows more free space in your pelvis for baby to turn
- Sit with knees lower than hips, with your back as straight as possible (think J-lo or Beyoncé boobs and bum). Use pillows or cushions under your bottom and in the small of your back
- Sit to read on a dining chair with elbows resting on the table, knees apart, leaning slightly forward (similar posture when sitting on a stool) or on a Swiss ball
- Sit astride a chair facing the back and resting your arms on the back of the dining chair
- Kneel on the floor leaning over a large beanbag or cushion to watch TV. Use an office stool or pregnancy conform rocker. Make sure the knee pad is wider than the seat to allow your knees to be kept wide apart and hips to turn outwards
- Put a wedge cushion under your bottom when driving
- Sit with your abdomen forward
- When resting/sleeping, lie on your side preferably LEFT with a pillow between your knees with the top knee resting on the bed
- Rest smart - nap or sleep in positions that let your bay settle in your hammock.
- Walk with your left foot on the road and your right foot on the kerb, to help tilt your pelvis and encourage baby to move to your left side
DON’T:
- Relax in semi-reclining positions where your knees are higher than your hips. This will cause baby to sit on your spine in an OP position. This includes recliner chairs, couches and using foot stools
- Take long trips in cars with bucket seats. If you must then please use a wedge cushion
- Sit with legs crossed
- Use squatting exercises in the late stages of pregnancy as this may force the baby’s head into the pelvis before the correct position is achieved
- Sit or lie anywhere where you are slumped over and shoulders dropping or where your back is angled outwards (like a cat arching in the sun)
A baby in an OA (anterior) position is much more efficient. Baby is lined up perfectly to your pelvis. Labour is generally easier and less painful and a quick exit strategy for your baby.
A Baby in an OP (posterior) position is a much longer more drawn-out labour that is harder to establish into a good contractile pattern. This labour is felt mainly in your lower back and abdomen.
Birth Pain
When we think of labour pain, we automatically think it will be like other pain. We immediately think of the pain of injury or sickness. We judge it as bad, wrong or damaging... that it must be stopped; fixed quickly. Labour pain is not like this; in fact we should think of another word for the pain of labour. A specific word for the kind of energy that is productive and healing, some people use the word “surges”. Labour pain is giving our bodies an important signal. It is telling you that your uterus is contracting, your cervix is opening, and your baby is moving down. Everything in your body is working in synergy with itself to birth your baby. Everything is happening as it should. Although you may be having the painful contractions your baby is being intermittently “squeezed” with every one too so remember it is not just you going through this
“Pain means power and power means progress”
There is no real strenuous effort that isn’t painful. The pain of childbirth is from your body working hard. Muscles hurt when we are doing hours of strenuous exercise, be it running a marathon, chopping wood, or giving birth.
Also, it is important to remember that contractions or labour pain is ALWAYS worse at night and sometimes can make you feel like it is worse than it actually is. Contractions also feel like they come more frequent at night. Imagine a normal night, dark and quiet, everyone in the house and neighbourhood is sound asleep. There aren’t the ambient noises of during the day to take your mind off things; birds chirping, cars driving up the road, kids yelling and playing, dogs barking, TV and radio noises etc; it is simply quiet and still. So, imagine now being in pain with a labour and you’re trying to lie still in bed; you’re worried about making noise, there is nothing to distract you. This makes it all feel so much worse than it might if it was happening during the day.
We recommend that you use a red scarf or shawl over a lampshade in the corner of your room. The light isn’t bright enough to disturb anyone else but gives a comforting glow for you to feel safe and secure. Use your iPod and play music that you like. If you can continue to sleep in between the contractions this will help you when you get to the business end of labour. One of the worst things anyone can do is keep themselves awake just because they are ‘niggling’, even if it’s exciting and you can't wait to meet your baby. These niggling pains can continue on and off for several days to a week or so, before it becomes good labour that is called a latent phase. Can you imagine how exhausted you will be when you are actually in good labour? You can have 2 Paracetamol and a nice warm bath before going to bed; this will help lull everything and may allow you to have a little snooze.
HOW MIGHT YOU EXPERIENCE THE PAIN?
Some women experience their pain in their lower abdomen. Others feel it in their lower back, hips, and the outside or inside of their thighs. For every woman who has ever had a baby, there is probably a different description of pain. A common one is “like a period pain”. Others say “mild to intense discomfort” or “a dull ache becoming severe”. Some women describe it as a “tight vice across my abdomen”. How pain will feel for you is one of the many mysteries of childbirth.
WHY IS LABOUR PAINFUL?
Why does such a joyous, rewarding and exciting event as the birth of a baby cause so much pain? It seems likely that there are two main reasons for the presence of some pain during birth — one physical the other psychological.
The first concerns the need for a mother to know she is in labour, and also to have some feedback mechanism so that she knows just where she is in the process and can judge the arrival time of the baby. The sensory nerve fibres in the uterus are capable of registering sensations caused by stretching and pulling. They do not respond to other stimuli such as cutting, application of heat, cold or pressure etc. The primary source of pain is the stretching of the cervix and the uterine muscle. The need for a clear signal that the uterus is tearing is obvious. The amount of pain a woman will feel is modified by many factors, some physical and some psychological. Pain will be increased if a woman is frightened or anxious, is in an uncomfortable position which places undue pressure on surrounding tissues and structures, if her baby is mal-positioned, e.g. posterior, or if there is a mechanical problem such as cephalopelvic disproportion, a full bowel or bladder obstructing progress.
The psychological advantages of experiencing pain in labour have often been mentioned by women. To feel the powerful sensations created by the labouring uterus, to accept and ride with those strong painful contractions to produce at the end the miracle of birth gives women the potential for self-discovery and growth. Labour is an empowering process for the mother, which she should not be denied unless critical for her or her baby’s well-being. Contractions are also vitally important for your baby, so even though you are experiencing pain your baby is experiencing a tight squeeze. With every contraction, this allows your baby to prepare for being born and breathing on its own when on the outside and it is very important for this to happen.
WHAT PART DO ENDORPHINS AND CATECHOLAMINES PLAY IN LABOUR?
When considering pain, it must also be remembered that nature provides its own inbuilt mechanism for modifying the pain and the mother’s perception of it during and after labour. This is achieved through the release of endorphins into the mother’s bloodstream. Our bodies produce endorphins in response to physical stress at various times during our lives. A common example of endorphin release is one that is familiar to most people – ‘the runners high’ that runners experience when they reach a point of physical stress beyond which they would not normally be able to continue. In pregnancy a woman's body is undergoing a natural state of stress as her body copes with the increased workload due to the developing baby in the uterus. As pregnancy progresses the level of endorphins are threefold: they help reduce physical pain, they provide a sense of well-being, and they have an amnesic effect. During labour the endorphins will increase as needed in response to the labour pain.
When a person Is frightened, fearful or in a potentially dangerous situation, the body triggers survival mechanisms and releases hormones called catecholamines, commonly known as adrenalin. This is also commonly known as the ‘fight or flight’ response.
We have probably all felt their action at some time in our lives; remember the heart pounding, or rapid breathing and a feeling of wanting to run away from danger. In labour if you are subjected to additional stress from external sources; your body may register alarm (a poor environment, frightening comments from support people, uncomfortable positions that increase the pain and the anxiety), then the body will automatically cause the adrenalin to be released. This has several effects on the labour – it is important that the anxieties are kept at a minimum and every attempt is made to enable the mother to labour with her own hormonal system intact.
Breathing and Relaxation
Labour requires that you yield rather than take control or fight. Taking control of labour is the role of the caregiver in times of distress or abnormality. In a normal course of labour, you must react to the energy travelling through your body; don’t fight it, go with it. Give yourself permission to express yourself during labour; whether it is yelling through a contraction, moaning, grunting or cursing, each woman must find her own way of releasing tension. This release is a far more important goal than complete relaxation through contractions. Finding ways to express and release tension during contractions will ensure that you can relax and rest more completely between them. When we refer to relaxation, we are referring to not only the art of ‘letting go’, which is the opposite of tension; but also to a relaxed atmosphere. A relaxed atmosphere comes about if you have peace of mind, privacy and protection. Bring your iPod and speakers into the birthing room and play music that you like; dance, rock, sing, whatever you need to do. If the music is good we’ll join in too so let’s have a party to welcome this gorgeous wee baby’s birthday.
RELAXATION IN LABOUR:
Whatever is working for you will be your best tool as far as remaining relaxed. There is no ‘right way’ to labour; only you will know what feels right for you. However, at times you may benefit from some gentle reminders and suggestions.
Support your body, and flop into pillows in a comfortable upright position. Change your position often, to remain comfortable. Being upright and rocking, mobilizing and leaning will help the baby to move down into your pelvis.
First time mothers-to-be often worry about the amount of pain involved in having a baby, but it would be wrong to assume that every birth is agonizing and many women find that they can cope by using natural pain relief techniques.
- Take your mind off your contractions in early labour, by going for a walk, watching TV or talking to a friend.
- Stroke the pain away. Gentle massage helps to relieve surface tension.
- Don't fight the contractions. Tension is very exhausting and makes you feel pain more acutely. Check that your shoulders are relaxed by pulling them down, and relax your jaw by having your lips slightly parted.
- Breathe gently through the contractions. Try to keep your breathing slow and rhythmical. Concentrate on breathing out and groan if it helps.
- Keep on the move. Movement is soothing so rock or rotate your hips in time with your breathing. Movement helps your baby descend into your pelvis putting pressure on your cervix to help it open more quickly
- Find positions that ease the pain. Kneeling on all fours helps a backache labour, or try squatting on your heels with your partner supporting you from behind
- Play loud music dance and sing at the top of your lungs
- Concentrate your mind. When the contractions become very strong, focus your attention on something else such as a picture or imagine you are somewhere else – your ‘happy place’
- Change of temperature can help. Wrap a hot water bottle or a cold pack in a towel and place it on your back.
- Take a bath. Water is very soothing and relaxing, and is an effective way to relieve tension. A deep bath can reduce pain and make contractions easier to cope with.
- Use a TENS machine. This is a small hand-held battery-operated machine, which passes a mild electric current to your nerves to block out pain.
Greet your contractions; don’t tense up, take a deep calm welcoming breath, allowing a sense of relaxation to flow through your body. Concentrate on longer, slower breaths out (through your mouth).
Think of your contractions as a hill. Imagine you are peddling a bike up a steep hill; it gets harder and harder, the closer you get to the top. The top of the hill is the apex or peak of your contraction, the hardest part. Then it’s all downhill from here, so take your feet off the pedals and glide down the hill as the contraction recedes.
Try to gently rock or roll your pelvis (think dirty dancing).
Farewell each contraction with calm farewell breathing, to let go of any tension that has built up inside of you during the contraction. Between contractions, breathe normally; become soft and relaxed so that you can enjoy the interval between contractions. Sip water, move and change positions, wipe your face and rest.
Harder, stronger contractions begin as above, but don’t worry if you can’t breathe very deeply over the peak of the contraction. Your support team will assist you in reminding you to breathe.
Eye to eye breathing with your partner will help you to stay calm over the strong peaks of the contractions. Use this as it is very effective.
Remember that every contraction that you have is one less that you will have to have and brings you that one step closer to holding your baby in your arms. This is what we have been waiting for and we are all here to help you through this exciting time.
Penny Simpkin's Roadmap of Labour
©Penny Simkin, Childbirth Graphics
childirthgraphics.com
How to Use Penny Simkin's Road Map of Labor
Penny Simkin, PT
In many ways, labor is a journey into the unknown. As with any new journey, having a map to guide you is helpful. The journey has three elements:
1) The winding yellow brick road, with twists and turns and no fixed timeline, which eventually ends joyfully with the birth of the baby.
2) The detour for back pain—a longer, rougher road that eventually rejoins the yellow brick road.
3) The turnoff from the yellow brick road, which represents a choice to have an epidural for pain relief.
Use this road map to guide you on your labor journey. Its landmarks and signposts will tell you where you are. The road map will also remind you of positions, comfort measures, and activities to use to ease the journey. Refer to it whenever you are wondering what you might try to ease pain or discomfort or to improve labor progress.
In the upper left corner, you see the couple in early labor as they begin their one-way journey. Put yourself in the couple’s place. The signs and pictures are reminders of how to care for yourself. They also suggest good distractions to use during early labor. Distractions can help keep your mind from racing ahead of your cervix and thinking you are further along in labor than you actually are.
As labor progresses, you travel past the “3cm” sign and shift to activities that help you find your own best way to cope with the discomfort and uncertainties of labor. If you wonder where you are in labor, show the road map to your caregiver or doula. She or he can guide you.
If you have back pain, you will have to take the detour and use different comfort and labor promoting measures to deal with the unique challenges of back labor.
At some point, you may consider using pain medication, which is represented on the map by the epidural highway. The epidural may be given at almost any time during labor. As you can see, the road changes dramatically with an epidural. Once you receive an epidural, you become much more comfortable, but your nurse, midwife, or doctor will now take over all responsibility for keeping you and the baby safe, managing your labor progress, and delivering your baby. More precautions, medications, and procedures are necessary when you have an epidural. You will recognize that labor has become more of a medical procedure. Your own role becomes passive as you await the end of your journey.
When you reach the “10cm” sign, it will soon be time to begin pushing, and your destination—the birth of your baby—is not too far away. The pictures show different positions for you to use for pushing both with and without an epidural.
The final picture, which shows the couple holding their baby in their arms, only hints at the amazing rewards that await you at the end of your long, hard journey. Congratulations!
Positions for Labour
PRE-LABOUR or EARLY LABOUR:
Try these positions to help you through this early stage of labour, constantly moving and rotating your pelvis can help your baby descend through your pelvis and get into a really good position. Don’t stay static or lying on the bed or couch you need to keep moving but interspersed with rest periods too. Remember keep hydrated a sip of water after every tightening and emptying your bladder once an hour.
Second Stage (pushing)
We will be very active during this stage too! By changing your position this will help baby descend further through the birth canal and help by giving you a good gravitational pull to push into. The further down into the birth canal we can get your baby will mean the real push won’t be as hard or long
Don’t give up you can and are doing this well keep it up!
The 'Nitty Gritty'
Many mothers-to-be worry about the amount of pain involved in having their babies. It must be said that labour and child birth DOES hurt and it will be the hardest work you will ever have to do in your life. You will be sore, physically and emotionally tired, and feel like giving up on several occasions. BUT this will also be the most rewarding, most empowering, and the most self-satisfying event to happen to you. It is true that some women (less than 1%) have an almost pain-free labour, but it would also be wrong to assume that every birth is agonising. Many women find that they can cope very well by using natural pain relief techniques together with really good thoughtful and caring support from family right to the end. If your head is in the right space you will cope very well with labour.
REMEMBER: that with every contraction you have, your baby is getting a huge tight squeeze as well. You’re having the pain but your baby is being gripped in a vice too! You need to breathe through these surges to take as much Oxygen across the placenta to your baby which will allow your baby to cope with labour as well as you.
Labour Instructions
Labour can take several days or several hours. If this is your first baby chances are labour will be at least two days including pre-labour. Prepare yourself and your support people by reading this information carefully several times and keep it handy!
Pre-Labour
This is NOT established labour your cervix is NOT opening at this time
- Works on ripening your cervix, toning your uterus and helping baby to flex its head into a good position and descend into the pelvis ready for birth
- It can last for several days, so don’t waste your energy, and don’t worry about it or try to speed it up. It is safest and kindest for your baby to ease into labour this way
- It could involve having a bloody show, more vaginal discharge, and frequent contractions. The contractions are like waves of power surging through your body. They may be a little painful, but are mostly just uncomfortable, like strong period pains. Ignore them for as long as you can (look above at the list and find things to distract you).
- During this time be encouraged that your baby is going to be born soon, so relax, and enjoy the build up to labour. Eat a healthy protein high meal, drink plenty of fluid, and take Paracetamol - 2 tabs every 6 hours. Don't walk around at this point, or use your labour positions yet, instead go to bed and rest, rest, rest. Sleep if you can. You will need to fuel and rest your body for the BIG event.
The following are tips for you to discuss with your support person/people and your midwife to help you cope with Pre-Labour in the early stages at home.
- Take your mind off your contractions. Go for a walk, watch TV, talk to a friend. Continue on with daily activities. Bake, cook meals for the freezer, do yoga, dance and sing.
- Stroke away the pain. Gentle massage helps to relieve surface tension. Maybe burn some essential oils to help keep you calm and relaxed (lavender is a great choice)
- Don't fight the contractions. Tension is very exhausting and makes you feel the pain more acutely. Check that your shoulders are relaxed by pulling them down. Relax your jaw by keeping your lips slightly parted, and relax your “bottom”
- Breathe gently through the contractions. Try to keep your breathing slow and rhythmical. Concentrate on breathing in through your nose and out through your mouth. Allow your body and mind to relax in between the contractions.
- Keep on the move. Movement is soothing so rock or rotate your hips in time with your breathing, lean on something to support your weight
- Warm bath/shower. Water is very soothing and relaxing and an effective method of natural pain relief. A deep bath can reduce the pain and make the contractions easier to cope with. Your body will also become weightless as you alternate body positions in the water. Alternately a warm shower can also provide a rhythmic massage on your lower back or bump.
- Positioning. Find a position that is most comfortable for you that eases the pain. Kneeling on all fours helps the backache of labour, squatting on your heels while being supported from behind by your partner.
- Visualisation. Use your mind and visualise a safe and happy place while breathing through your contractions. This enables you to relax and feel safe. Concentrate on a nursery rhyme or simply count. Some women concentrate on their babies and talk to them and reassure them during each contraction.
- Temperature changes. Wrap a hot water bottle in a towel and place it under your bump or on your lower back for relief or using an ice pack or a packet of frozen vegetables wrapped in a towel and placed on your back
Active Labour
This is counted from when your contractions are long, strong and regular; around 3-5 minutes apart and 90 seconds long. Your cervix is now dilating and your baby is slowing, moving down into the birth canal.
Contractions may remain at 5 minutes apart or they may get a little closer to 3 minutes apart. The good news is that they only last 90 seconds and then you get a break from the pain.
They will be painful but not TOO painful. It is normal, healthy pain; the only time when pain is not caused by injury. You CAN cope with this pain as your body is made for this process. Do your deep breathing when you get a pain; in through your nose and out through your mouth like you are blowing the pain away, blowing down through your feet, long, slow and controlled. This breathing not only helps with the pain but by oxygenating the uterus, it also gives your baby more oxygen and keeps him/her calm and unstressed.
While you're doing your breathing, stand with your legs apart, knees slightly bent and rock your pelvis in big lovely circles like doing a ‘hula Hoop’. This helps rock your baby gently downwards, calms baby, and eases pain for you.
As your contraction eases off, relax your body, and slow your breathing back to normal. Start walking, even if it is around and around your living room. When the next wave of contraction comes, stop, open your legs, do your hula hoop rocking and your deep breathing; blow that pain away.
Don’t be afraid of your contractions and don’t anticipate pain. Just let the surge of power from your uterus wash over you, imagine you are in a boat riding a wave gently floating on top of the wave, and then peacefully floating back down again.
Visualise your body opening up and feel positive and powerful! Welcome your baby; welcome the surges that will bring your baby to your arms. This is the way your baby needs to be born and your body is very good at it. Keeping calm and relaxed means your baby will also feel safe and reassured. Labour can be frightening for babies because they have no idea what is going on, so if you get scared and release adrenaline, you baby will become very distressed. Keep yourself calm, relaxed and positive. Focus on the things and people you love, remind yourself you are a STRONG woman, and your body is AMAZING and POWERFUL. During active labour you need to drink plenty of water, at least one glass every 15 minutes. Sip away at your water bottle regularly. Suck on some sweets or have a teaspoon of honey every now and then to keep your energy up. Eat if you want to, but many women feel nauseous or vomit in active labour so lose their appetite.
Now is a good time for your support people to be around you, quietly and positively encouraging you, reminding you to drink, and do your deep breathing and rocking. They can walk with you between contractions and breathing with you as you rock.
During active labour, you MUST NOT LIE DOWN! You need to be active upright and proactive. WALK, WALK, WALK! ROCK, ROCK, ROCK!
If you get tired, straddle a chair for a little while (with the chair backwards), or rest on your hands and knees leaning into a pillow on your sofa. Do this only for 20 minutes at a time to restore your energy, ready to walk and rock again.
If you are comfortable, some flat-footed squatting during contractions is very helpful; even though it will make the pain feel a little more intense, it will make labour go faster. In between pains go walking, then sink down into a squat and breathe the pain way.
REMEMBER: Labour takes time. This is not the time to lie down or rest this is the time to be upright, active, proactive and STRONG. You CAN do this. Keep POSITIVE, trust your body, and stay CALM. Visualize your baby moving downwards and welcome the pain to bring your baby into your arms. Don’t be afraid of the pain, it is only a few hours and so worth it for the beautiful new life you will soon be holding.
BIRTH: second stage/pushing:
Some mothers find just before they are fully dilated at around 9 cm, that they feel panicky and afraid, unable to go on or cope anymore. This I call TRANSITION. Things feel overwhelming and you may want to give up. Of course you can do it, but you feel like you can’t. With support and encouragement and love from your midwife, your family and support people, you will get through this part. It only lasts a few minutes and is a wonderful sign that your baby is almost here. We can give you homeopathic help in your water that can help you feel more in control and calm, and together we will get through this bit.
With a few more contractions, your cervix will open fully (10cm) and you will have a strong desire to push. Your midwife may need to quickly check you to make sure that everything is ready to go. Wait until you absolutely CANNOT stop pushing then go for it. It is a bizarre feeling at first, and some women don’t like it much, but it is the only way to get your baby out. For many women it is SO powerful and amazing to get to push the pain away, and feel your baby moving downwards. Embrace this as your finale. You control the process now it is all up to you! The harder you work, the quicker your baby will be born.
Pushing can take 1-2 hours for a first baby, but many mothers can do it much quicker if they focus completely and put 100% effort in. All your preparation, active birthing and beautiful breathing will now pay off. Gather your strength, dig deep within yourself and harness your inner ‘stroppy woman’ to get the job done. Tell yourself “I CAN do this; I AM doing this”. Your baby is only minutes away from being in your arms and gazing into your eyes. You have waited many months for this moment, so seize it and go hard!
Work with your contractions, don’t fight them. Be stubborn and stroppy to renew your energy to push baby out. Take a deep breath and hold it — relax your face and push down, almost like you are doing a huge poo. Ideally you can get three good strong pushes with every contraction. We will guide you and suggest different positions to push in. Moving and changing positions is very helpful. Walking to the toilet for a few pushes is fantastic and often moves baby under your symphysis pubis bone - ready to be born.
As your baby descends into the birth canal your tissue starts to stretch this can feel weird. Most women find it easier to cope with that than labour contractions, because you can push the pain way.
As the baby rocks under your pubic bone, it feels like you are working so hard and getting nowhere, but you are! This process is gently helping baby’s head to mould and fit through, and your tissues to slowly thin out and stretch. It is normal and healthy for this part to take some time. We will be monitoring your baby’s well-being closely at this stage.
Once we see the baby’s head, things are really happening and your baby is almost here. Slowly, over a few contractions, the head will advance stretching your vaginal opening. We will talk you through slowing down your pushing now as the widest part or the baby’s head comes slowly and gently. We may use hot compresses on your vaginal opening and may use oil to massage to help the process if needed. With us talking you through it, you will breathe your baby’s head out gently and calmly.
You and your support people will need to be calm and quiet during this time so you can hear our instructions. Screaming will terrify your baby, making it distressed, and you won't be able to hear what we are saying.
Once baby’s head is born, he/she turns to one side and lines up ready to be born. With one more push, baby slips out into the world and your loving arms. Baby will be put straight up onto your chest, and very gently dried with warm towels. It is best for baby and you to be skin to skin at this time. Baby will open her/his eyes and look at you and your partner, immediately bonding with you. You are now parents! Look when you are ready, to see if you have a boy or a girl, looking into those perfect eyes and enjoy the amazing moment of birth!
Unless your baby is in trouble or not breathing, we don’t clamp or cut the cord until it has stopped pulsating or the placenta has been born. It is best for your baby to get the extra blood from the cord. Your partner/support person is welcome to cut the cord when it is time.
Third Stage
This is the easy part because it requires very little effort and virtually no pain. The third stage is from then the baby has been born until the placenta is born. There are no bones in the placenta; it is soft and easy to push out. Your body will give another contraction when the time is right and you may feel a mild backache. This means it is ready to be born. And we will ask you to give one more push. The placenta will plop out easily with no interference from us. This may take from a few minutes to an hour. We have no need to rush and can trust your body to do this. If there is a concern or a risk factor, we will discuss it with you and ask your consent to give you an ‘ecbolic’ - a drug that will make you have some big contractions and expel the placenta quickly. If there is heavy bleeding you may need an IV line and further drugs, but this is relatively uncommon, so don’t be concerned. We will keep you safe and only interfere if it is really necessary.
Once your placenta is birthed, we will check it and make sure everything is healthy. It has nurtured and protected your baby for nine months, and is a very interesting organ. You may like to have a look at it. Many women take it home to bury it under a special tree, or have a ceremony with. We can parcel it up safely for you if you wish, and it must go home with your partner or support person when they leave the hospital. it cannot remain with you.
The last thing we need to do is have a check inside your vagina to see if there is any damage requiring stitches. It is a bit stingy when we do this, but it is important to get a good view to make sure there are no problems. If you need stitches, we will give you plenty of local anaesthetic to numb the areas before we stitch. Very rarely the tear is bad enough to need a specialist Obstetrician to do it, and this is done either in the room or in an operating theatre. You will get plenty of pain relief for this but remember it is very rare, so unlikely to happen to you.
WHEN TO WORRY:
Remember that you may experience pre-labour for several days before the real thing. The contractions might be painful and regular but they won’t be debilitating and they won’t get closer than 5 minutes apart. These contractions are working on ripening your cervix, toning your uterus and helping your baby to flex into a good birth position. It is best to eat, drink, rest and ignore these pains for as long as possible. There is really nothing that we can do about this as you are NOT in labour at this time. Consider pre-labour as like going for a walk on the flat. You get tired and breathless but it’s not that hard. Real labour is like walking up a steep hill – it gets harder, stronger and takes more work. Pre-labour is no need to worry, just go with the flow.
BLOODY SHOW:
You might get some bloody mucus or slimy blood stained mucous as a blob or smear. It might be when you wipe after going to the toilet, it might plop into the toilet, or it might just be on your pad or pants. A few women will get clear mucous that is like milky water, rather than blood. This is a sign that your cervix is ripening and getting ready to open/dilate. It usually means labour will start within the next 3-5 days, but sometimes it will be 2-3 weeks away. Relax and be happy that your labour will start soon but there is NO need to worry unless it is fresh bright red blood pooling on the floor at your feet or more than half a cup full of bright red blood running down your legs then THAT IS NOT NORMAL AND YOU SHOULD CALL US IMMEDIATELY.
WATERS BREAKING:
There is about a litre of water around your baby, and when they break it is usually a BIG gush, or at least a cupful and it will keep on running.
Your body continually makes more water until the baby is born, so you will not run out or have a “dry birth”. If the water is clear, pink or straw coloured this is great. If it is GREEN, PLEASE PHONE YOUR MIDWIFE STRAIGHT AWAY.
Mostly your waters break when you are in good strong labour, after several hours. Sometimes (around 10% of women) waters break before labour starts. This can mean your baby is in an OP position. For half of the women, labour will start on its own within 12 hours, but the other half will need to be induced to get labour going. DON’T PANIC, put on a maternity pad (not a regular pad or panty liner), take some Paracetamol, take a note of the time that they broke and go to bed and SLEEP! Unless the water is GREEN you do not need to call your midwife until after 8am. Sleep and be delighted that you labour is going to start very soon!
If you don’t go into labour by 18-24 hours after your waters have broken, you will need to have IV antibiotics in the hospital and the on-call obstetrician will decide what method is best to induce your labour. Remember this only happens to around 5% of women, so DONT WORRY. Your midwife has a few tricks to help get labour going and hopefully prevent the need for induction.
Some women are group B Strep Positive (GBS, we will we have discussed this antenatally), then you must call us as soon as your waters break even at night and please remember to remind your midwife by stating "I am GBS positive”. In the middle of the night, we won’t always remember these things.
CONTRACTIONS:
They usually start out as irregular and mildly painful. Over the hours they will get stronger, longer and closer together. Until they are 4-5 minutes apart and 90 seconds long it is NOT real labour, but pre-labour and you must rest while you can. Once they are 4-5 minutes apart and 90 seconds long, we consider that labour – but we like you to labour at home for a few hours before going to the hospital (unless you have planned a homebirth). Let your midwife know they are now close and strong, start using your active labour techniques – breathing, rocking, squatting, and walking. It is getting closer to your baby being born.
Every female body is made to labour and prepare for child-birth; your body will keep you safe. Listen to your body's rhythm; it will tell you what position it wants you to be in, it will tell you how far away from birthing your baby you are (by the spacing and timings of your labour pains), it will tell you when it is time to call, YOUR body will keep YOU safe. Don’t over think the process, don't fight your labour; go with it, breath and relax and allow your body to simply do what it is made to do which is to help you birth a beautiful baby. Remember good strong contractions will hurt; you will feel the tightening all over your abdomen. A good contraction starts at the top of the uterus (under your breasts) and will roll down your abdomen towards your pubic bone. A contraction that is felt in your lower back or lower abdomen only, although painful, is NOT good strong labour that you need to be in hospital for. This is usually still very early stuff and most commonly directly related to the way your baby is lying i.e. OP.
When to call your Midwife
- If your pains are: 3-5 minutes apart and 60-90 seconds long for 4 hours (first baby) or 2 hours (second baby)
- You have been having contractions for a few hours and suddenly feel a strong urge to poo or push
- If your waters break and are GREEN. Don't call for pink or clear waters until after 7am
- Excessive blood from the vagina
If in doubt or concerned: just call. We are happy to hear from you and delighted that your baby is finally coming to meet us all!
Please, please call us if you feel you need to go to hospital. It is disrespectful to just turn up to hospital without talking to your midwife first as we get into a lot of trouble for not notifying the hospital of your arrival!
By the end of the last month of pregnancy, many women feel that they have been pregnant forever and anxiously await their due date. You should keep in mind that this is an estimated due date (EDD) and that many women do not give birth until approximately two weeks past their due date. LESS THAN 5% of babies are born on their due date. Take advantage of this time to rest and enjoy being a couple and/or enjoy spending time with your other children.
Refer back to this Labour and Birth Information guide any time you need.
