Saturday, 25 November 2017

Giving Birth

Deciding where to have your baby is an important decision for you and your partner and we believe that you should give birth in an environment where you feel safe, comfortable and relaxed.

You and your family are placed at the centre of care and involved in all decision-making regarding your labour and birth. You can give birth at home, or in a Western Isles maternity unit. You can discuss your options of place at birth at any time throughout your antenatal period.

What To Do When You Go Into Labour

You're unlikely to mistake the signs of labour when the time comes. If you are in any doubt, please contact the Maternity unit.

The main signs of labour starting are strong, regular contractions, and a 'show' when the plug of mucus sealing your cervix comes away. Other signs that you are going into labour can include your waters breaking, backache, vomiting or nausea, diarrhoea. Later in labour, you may experience an urge to go to the toilet caused by your baby's head pressing on your bowel.

You will find below some information about items listed below. This is also available in your handheld maternity record.
  • Contractions
  • Coping at the beginning of labour
  • The "show"
  • Waters breaking
  • The stages of labour
  • Assessement of progress
  • Coming to the Maternity Unit

Make sure you can be contacted at all times and that transport and childcare has been arranged (day or night). Here is a short checklist of things you may want to pack:

  • Changing clothes for you
  • Snacks and energy drink (for you and your birthing partners)
  • Camera, why not some music (don't forget your charger and some speakers/headphones)
  • Your mobile phone or change for the telephone
  • Car seat for your baby

Pain Relief During Labour

Labour can be painful and knowing about the types of pain relief available to you will help you make informed choices about what is right for you and your baby through labour and birth.
Write down your wishes with your birth preferences, but remember that you should keep an open mind. You may find that you want more pain relief than you had planned, or your midwife may suggest more effective pain relief to help the delivery. Different ways of relieving the pain are listed below:
  • Gas and air (entonox)
  • Injections of opiates such as diamorphine
  • TENS machine
  • Epidural anaesthesia– only available at certain times.

Contractions

When you have a contraction, your womb (uterus) gets tight and then relaxes. You may have had contractions throughout your pregnancy, particularly towards the end. During pregnancy, these painless tightenings are called Braxton Hicks contractions. When you are having regular, painful contractions that feel stronger and last more than 30 seconds, labour may have started. Your contractions will become longer, stronger and more frequent.

During a contraction, the muscles in your womb contract and the pain increases. If you put your hand on your abdomen, you can feel it getting harder. When the muscles relax, the pain fades and your hand will feel the hardness ease. The contractions are pushing your baby down and opening your cervix (entrance to the womb) ready for your baby to go through.

Your midwife will probably advise you to stay at home until your contractions are frequent. When you are having regular contractions it is best to call the maternity unit for more advice.

Coping at the Beginning of Labour

If you have attended Parentcraft classes, this is the time for you and your birthing partner to use all the good tips other couples and midwives have shared with you... Here is a little reminder of the main ones:

  • You can be up and moving about if you feel like it
  • You can drink fluids and may find isotonic drinks (sports drinks) help keep your energy levels up
  • You can also snack, although many women don't feel very hungry and some feel sick
  • As the contractions get stronger and more painful, you can try relaxation and breathing exercises – your birth partner can help by doing them with you
  • Your birth partner can rub your back as it may help relieve the pain

Waters Breaking

Most women's waters break during labour, but it can also happen before labour starts. Your unborn baby develops and grows inside a bag of fluid called the amniotic sac. When it's time for your baby to be born, the sac breaks and the amniotic fluid drains out through your vagina. This is your waters breaking.

You may feel a slow trickle, or a sudden gush of water that you cannot control. To prepare for this, you could keep a sanitary towel (but not a tampon) handy if you are going out, and put a plastic sheet on your bed.

Amniotic fluid is clear and a pale straw colour. When it comes out, it may be a little blood-stained to start with.

If your waters break call the Maternity unit for you and your baby to be assessed and further information about the plan to follow as there is a risk of infection if labour does not start within 24-36 hours.

The Stages of Labour

There are three stages to labour:

The first stage, when the cervix gradually opens up (dilates)
  • The cervix needs to open about 10cm for a baby to pass through. This is called 'fully dilated'. Contractions at the start of labour help to soften the cervix so that it gradually opens.
  • Sometimes the process of softening can take many hours before you are in what midwives call ‘established labour’. Established labour is when your cervix has dilated to at least 4cm.
  • Once labour is established, the midwife will check you from time to time to see how you are progressing. In a first labour, the time from the start of established labour to full dilation is usually between 6 and 12 hours. It is often quicker for subsequent pregnancies.
The second stage, when the baby is pushed down the vagina and is born

This stage begins when the cervix is fully dilated and lasts until the birth of your baby. Your midwife will help you find a comfortable position and will guide you when you feel the urge to push.

Find a position

It will be a balance of which position you prefer and which will make labour easier for you. Gravity can be very helpful in labour and being upright can help speed labour along and relieve back pain. You might want to stand, sit on a birth ball, kneel or squat (although squatting may feel difficult if you are not used to it).

If you are very tired, you might be more comfortable lying on your side rather than propped up with pillows. This is also a better position for your baby. If you've had backache in labour, kneeling on all fours might be helpful. It's up to you. Your position is your choice.

The third stage is when the placenta comes away from the wall of the womb and is also pushed out of the vagina.

Assessment of Progress

The midwife will ask you about what has been happening so far and will examine you. If you are having a home birth, then this examination will take place at home.

The midwife will:
  • take your pulse, temperature and blood pressure and check your urine
  • feel your abdomen to check the baby's position and record or listen to your baby's heart
  • probably do an internal examination to find out how much your cervix has opened - they can then tell you how far your labour has progressed
These checks will be repeated at intervals throughout your labour. Always ask about anything you want to know. If you and your partner have made a birth plan, show your midwife so she knows what kind of labour you want and can help you to achieve it.

Your questions about:

We thought you may have some some questions about the following items on the next page. The answers displayed can also be found in your Handheld Maternity Record.