Sunday, 22 October 2017

Giving Birth

Your baby is overdue

Pregnancy normally lasts about 40 weeks. Most women go into labour within a week either side of this date, but some women go overdue.

  • If your labour doesn't start by the time you are 40 weeks pregnant, your midwife will offer you a 'membrane sweep'. This involves having a vaginal examination, which stimulates the neck of your womb (known as the cervix) to produce hormones that may trigger natural labour. You don't have to have this – you can discuss it with your midwife.

  • If your labour still doesn't start naturally after this, your midwife or doctor will suggest a date to have your labour induced (started off), usually at around 10 days overdue. If you don't want your labour to be induced, and your pregnancy continues to 42 weeks or beyond, you and your baby will be monitored. Your midwife or doctor will check that both you and your baby are healthy by giving you ultrasound scans and checking your baby's movement and heartbeat. If your baby is not doing well, your doctor and midwife will again suggest that labour is induced.

Induction is always planned in advance, so you'll be able to discuss the advantages and disadvantages with your doctor and midwife, and find out why they think your labour should be induced. It's your choice whether to have your labour induced or not.

You may be offered induction of labour earlier if you have complications in your pregnancy or if you are aged 40 or over.

Your baby's heart monitoring in labour

Your baby's heart will be monitored throughout labour. Your midwife will watch for any marked change in your baby's heart rate, which could be sign that the baby is distressed and that something needs to be done to speed up the delivery. There are different ways of monitoring the baby's heartbeat:

  • Your midwife may listen to your baby's heart intermittently, but for at least one minute every 15 minutes when you are in established labour, using a hand-held ultrasound monitor – this method allows you to be free to move around. This will be offered if you are low risk and all is well in labour.
  • Your baby's heartbeat and your contractions may also be followed electronically through a monitor linked to a machine called a CTG (cardiotocography) – the monitor will be strapped to your abdomen on a belt.
  • Alternatively, a clip can be put on your baby's head to monitor their heart rate – the clip is put on during a vaginal examination and your waters will be broken if they have not already done so. Ask your midwife or doctor to explain why they feel that the clip is necessary for your baby.

Vitamin K

You'll be offered an injection of vitamin K for your baby, which is the most effective way of helping to prevent a rare bleeding disorder (haemorrhagic disease of the newborn). Your midwife should have discussed this with you beforehand. If you prefer that your baby doesn't have an injection, oral doses of vitamin K are available. Further doses are needed for babies who received vitamin K by mouth.

The pushing stage

When your cervix is fully dilated you can start to push when you feel you need to during contractions. The urge to push can be irresistible and the pressure of the baby's head may make you feel like you need to empty your bowels. This is your body's way to tell you where and when to push. Your midwife will support and encourage you.  If you have had an epidural you may not feel a strong urge to push. You may only feel some pressure sensations and may need more guidance from the midwife to help you push.

This stage of labour may take an hour or so of hard work but you are near the end.

The birth

During the second stage, the baby’s head moves down until it can be seen. When the head is almost ready to be born, the midwife will ask you to stop pushing, and to pant or puff a couple of quick short breaths, blowing out through your mouth. This is so that your baby’s head can be born slowly and gently, giving the skin and muscles of the perineum (the area between your vagina and anus) time to stretch without tearing.

The skin of the perineum usually stretches well, but it may tear. Sometimes, to help the baby be born quickly, or if a significant tear seems likely, the midwife or doctor will inject local anaesthetic and cut an episiotomy. Afterwards, the cut or tear is stitched up again and heals.

Once your baby’s head is born, most of the hard work is over. With one more gentle push the body usually follows. You can have your baby lifted straight onto you before the cord is cut by your midwife or birth partner.

Your baby may be born covered with a white, greasy substance known as vernix, which has acted as protection in the uterus.

Caesarean Section

As a Caesarean Section involves major surgery, it is usually only performed when the benefits of this kind of birth outweigh the risks involved with the operation.

Your baby is delivered by making an incision on the lower abdomen (just below your bikini line) and then into your womb (uterus).

Most Caesarean Sections are performed under epidural or spinal anaesthesia, which minimises risks to you and means that you're awake for the delivery of your baby. A general anaesthetic (which puts you to sleep) is rarely used, but may be necessary in some instances if your baby needs to be delivered quickly.

If you have an epidural or spinal anaesthesia, you won't feel pain, just some tugging and pulling as your baby is delivered. A screen will be put up so that you can't see what's being done. The doctors will talk to you and let you know what's happening.

It takes between five to 20 minutes to deliver the baby, and the whole operation takes about 40-60 minutes. One advantage of an epidural or spinal anaesthetic is that you're awake at the moment of delivery and can see and hold your baby immediately. Your birth partner can be with you. Your recovery after a Caesarean Section may take some time and you will need to remain in the hospital for at least 48 hours after the delivery. Most women who have one Caesarean Section are able to give birth vaginally when they have another baby.

Caesarean Section (planned)

How to best prepare for a planned caesarean?

The following infornation will help prepare you for your planned Caesarean Section. It also provides information on what you can do after your baby is born to help speed your recovery.

On the night before Your Caesarean

We advise that you eat and drink normally until midnight before your Caesarean Section. From midnight until 6am on the day of your operation, your diet will be restricted and you will be asked to take one of your Ranitidine tablets at 10pm on the night before your operation and 8am on the day of your operation.

As with all operations, we ask that you do not wear any make-up, nail varnish, false nails or jewellery, apart from a plain wedding ring which can be taped around your finger. If you wear contact lenses, you will be required to remove these before you go into theatre so it would be advisable to bring your glasses.

During Your Caesarean Section

We would like to make the birth of your baby a comfortable experience, one birthing partner can be with you and staff will introduce themselves and their role and will be able to answer any questions you may have.

You will usually be in theatre for about an hour in total:
  • The anaesthetist will make preparations for you to have your spinal anaesthetic to make you numb from the chest down (you will be able to stay awake ready to see your baby being born)
  • Your midwife will then listen to the baby's heart beat
  • When you are numb; a urinary catheter will be sited, a tube that goes into your bladder which will help to keep your bladder empty during the operation.
  • A screen will then be put up so that the doctors can prepare for your operation.

Your baby will be born through a cut or 'incision' into your lower abdomen (tummy). You may feel some pulling or tugging sensations as your baby is born but you will not feel any pain.

When your baby is born:

If you wish, you can have the screen dropped so that you can see your baby.

  • Your baby will then go to the midwife to be dried and then come to you for a cuddle.
  • You may wish to have skin to skin at this point or you can have skin to skin after your Caesarean Section has been stitched.

After your Caesarean Section

You will initially be taken to a shared recovery area after your Caesarean Section and then back to the Maternity Ward.

You will be offered skin to skin contact with your baby regardless of your chosen method of feeding and will be given assistance to feed your baby should you require it.

Getting back to normal after your Caesarean Section

It is important that you begin to eat and drink as soon as you feel able to after your Caesarean Section. This will help your body to recover much faster after your surgery.

  • Prevent thrombosis or blood clots

When your spinal anaesthetic has worn off; staff will help you to get out of bed, being mobile helps to prevent thrombosis or blood clots. You will also need to wear your surgical stockings and you will be given blood thinning injections daily for five to seven days following your Caesarean Section.

  • Looking after your bladder

When you are mobile, your catheter can be removed and you should measure the first void of urine in the jug/bowl provided. If you have any problems passing urine such as pain or leaking, even when you are at home, please inform your midwife or doctor.

  • Prevent pain

You will be prescribed regular pain killers to take in hospital. Please make sure you have a supply of paracetamol and ibuprofen ready for when you go home, providing that you are not allergic to them or have been advised against taking them.

  • Looking after your wound

You should take a daily shower to keep the wound clean and dry. You should wear loose fitting cotton underwear that are big enough to pull up above the wound so that it does not rub. You may notice some bruising and a loss of feeling/sensation in the area around the scar. This is normal after a Caesarean Section and should not be permanent.
If you notice any redness, oozing, offensive smell from the wound or you feel feverish (going hot and cold or you have a temperature) you should tell your midwife or doctor.

  • Observe your bleeding

You may bleed vaginally after your caesarean for up to six weeks. You should change your maternity pads frequently, every 3-4 hours and make sure that you wash your hands both before and after going to the toilet and changing your pads.
You should tell your midwife or doctor if your vaginal bleeding increases, you are passing clots or it becomes irregular or painful.

After you go home

You will be visited at home by one of the community midwifery team on the day after you go home from hospital. They will check both you and your baby and help you with feeding if you require it. Staff will then make another appointment to see you and your baby depending on your individual circumstances. Staff will then make another appointment to see you and your baby depending on your individual circumstances.
If you have any concerns or questions please let them know.

You will be discharged from the community midwives from 10 days after the birth of your baby, at which point, your health visitor will take over your baby's care. However we can visit up to 28 days should you or your baby require it. You will usually hear from the health visitor at around 10 to 14 days after the birth of your baby and they will monitor your baby's progress up until school age.

You should make an appointment to see your GP at 6 weeks after the birth of your baby. This appointment is a routine general wellness check and will also give you an opportunity to discuss contraception and future smear tests.

Ventouse and Forceps

About one woman in eight has an assisted birth, where forceps or a ventouse suction cup are used to help the baby out of the vagina. This can be because:
  • your baby is distressed
  • your baby is in an awkward position
  • you're too exhausted

Both ventouse and forceps are safe and only used when necessary for you and your baby. The obstetrician caring for you will decide whether to use either ventouse or forceps depending on which is most likely to be safe and effective. A paediatrician may be present to check your baby's health. A local anaesthetic is usually given to numb the birth canal (the passageway the baby travels to be born, from womb to vagina) if you haven't already had an epidural. If your obstetrician has any concerns, you may be moved to an operating theatre so that a Caesarean Section can be carried out if needed.

As the baby is being born, a cut (episiotomy) may be needed to make the vaginal opening bigger. Any tear or cut will be repaired with stitches. Depending on the circumstances, your baby can be delivered and placed onto your tummy, and your birthing partner may still be able to cut the cord if they want to.

Tears and Episiotomies

Sometimes during the process of giving birth, a doctor or midwife may make a cut in a woman's perineum (the area between the vagina and anus). The cut makes the opening of the vagina a bit wider, allowing the baby to come through it more easily. An episiotomy may be recommended if your baby develops a condition known as foetal distress. Foetal distress is where the baby's heart rate significantly increases or decreases before birth. This means that the baby may not be getting enough oxygen and has to be delivered quickly to avoid the risk of birth defects or stillbirth.

Vitamin K

You'll be offered an injection of vitamin K for your baby, which is the most effective way of helping to prevent a rare bleeding disorder (haemorrhagic disease of the newborn). Your midwife should have discussed this with you beforehand. If you prefer that your baby doesn't have an injection, oral doses of vitamin K are available. Further doses are needed for babies who received vitamin K by mouth.