Labour and Birth
The Midwife's role is to work in partnership with women to support and facilitate the normal process of childbirth. Women can often minimise intervention in childbirth by taking personal responsibility for things such as:
> Eating a healthy and varied diet and avoiding overly processed and sugary foods.
> Keeping active and fit by taking a daily 20-30 minute walk.
> Using complimentary therapies such as Evening Primrose capsules, Birth Mix and Raspberry leaf tea in the last weeks of pregnancy, (your midwife will discuss this with you.)
In the latter part of your third trimester, from approximately 36 weeks gestation, you may experience some of the following symptoms as your body starts to prepare for birthing.
You may start to notice
> More vaginal mucous
> More pressure in your lower abdomen and into your groin as your baby starts to move deeper into the pelvis while correspondingly feeling less pressure under your ribs
> Pressure on your bladder- sometimes slight incontinence
> Low crampy pains across your pubic area that come and go
> Abdominal tightenings that come and go- known as Braxton Hicks contractions
> You may also feel increasingly uncomfortable and have trouble getting a good night's sleep
Try not to feel anxious as this is an indication that your pregnancy is coming to an end and you will soon meet your baby.
Signs of Labour
If this is your first baby, generally you can expect that labour will take several hours (typically at least 12-24 hours). If your pregnancy has been low risk then you can expect to spend much of your early labour at home. The time to come into hospital is when your contractions are strong and regular and take your breath away.
The following information is a guide to the difference between early and established labour.
> Irregular contractions variable in length and strength- in no particular pattern
> Short, sharp regular contractions between 20-30 seconds long, typically low down in the abdomen
> Water's breaking. This is experienced as a sudden significant gush of clear fluid that continues to constantly trickle. Contractions may or may not be present when this happens
If any of the above happens it is important to remain calm and find ways to keep comfortable until labour becomes more established.
Suggestions to keep comfortable at home include:
> Heat packs on your lower back and abdomen
> Warm bath or shower
> 2 Panadol every 4-6 hours
> Rest and keep well hydrated
If waters have broken during the night and fluid is clear, put a pad on, note the time it happened and inform the midwife in the morning.
Strong, regular contractions that come every 5 minutes and then every 3 minutes and last over 60 seconds. Contractions are felt high across the abdomen as well as low down in the pelvis and sometimes into the lower back.
When contractions are like this YOU WILL NOT BE ABLE TO TALK NOR WILL YOU BE ABLE TO HEAR SOMEONE SPEAKING TO YOU AS YOU ARE SO FOCUSED ON GETTING THROUGH THE CONTRACTION.
When contractions have been like this for at least one hour for your first baby and half an hour for your second baby at this intensity, this is a guide that it is time to think about going to the hospital.
CALL THE MIDWIFE IMMEDIATELY IF:
> Labour starts before 37 weeks gestation
> There is bright red fresh blood (no mucous) that fills a pad
> Waters break and the fluid is green or brown
> you are having strong regular pains that are 3 mins apart and over a minute long
It is appropriate to call your midwife anytime during the day to advise her that labour has started. However if labour starts in the night and you have had a low risk pregnancy then please wait until labour becomes established before calling.
Time to go to the hospital
When you think it is time to go to the hospital it is important to call your midwife before you go in. Your midwife will liaise with the hospital staff and arrange for you to be admitted.
When you arrive on the ward, your midwife will want to do a vaginal examination which will help her to assess the progress of your labour and to plan your care.
You would have discussed and documented a labour plan with your midwife in the last weeks of your pregnancy and your midwife will be guided by your preferences for pain relief etc.
Latent stage of labour
This is the very early stage of labour that involves the cervix (the neck of the uterus) softening and thinning out. The cervix cannot start to open (dilate) until it has thinned out. The latent phase of labour can often take several hours and sometimes days and occurs mostly in first time labour. It is important to rest during this phase and to keep well hydrated.
1st stage of labour
The first stage of labour is about the cervix opening to around 10 centimetres so that the baby can descend from the pelvis into the birth canal. Getting to 5 centimetres dilated can be hard work and may require a determined effort by you to keep upright and keep moblising as this will help baby to get into a good position and will enable progress of labour.
You will need lots of support and encouragement from your partner/family at this time as your body is working hard.
Typically when your cervix had dilated beyond 5 centimetres the labour progresses more quickly. As you approach 10 centimeters dilatation you may start to feel restless and a bit overwhelmed by the contractions which are now very intense. This phase is often referred to as transition and it is really important for your support team to encourage and support you to keep focused on manage contractions one at a time.
2nd stage of labour
When you are fully dilated, your baby will be able to start to descend into the birth canal and you will start to feel increasing pressure in your back passage and you may feel like bearing down (pushing) with the contractions. It is important to breathe through these contractions and try and rest and relax between the contractions so that your baby can more easily descend. Your body will tell you when it's time to push as you will feel an overwhelming urge to bear down.
As baby descends further down the birth canal you will start to feel burning in your perineum and your midwife may apply heat to the area to give some relief. The pressure of the baby's head helps to stretch the perineal tissue and it is very important to listen to your midwife as she will help you control your pushing so that baby can be birthed with minimal trauma or tearing of your perineum.
Episiotomy is very occasionally necessary. This entails a small cut to be made to the tissue between your vagina and your back passage (anus) in order to allow easier delivery of your baby. An episiotomy is typically only necessary if there is concern about the wellbeing of your baby.
3rd stage of labour
Once your baby has birthed your midwife will lay baby on your chest and cover him/her with a warm towel so that you can both enjoy skin to skin.
You can choose to birth the placenta Physiologically: awaiting the natural process and using maternal effort to birth the placenta. There is around a 50 ml more blood loss with this method but in the normal labour would be most preferable.
Active management should be used if you have any bleeding tendancies,induced labours, prelabour haemorrhages, or low Iron levels.
Ecbolic if the placenta fails to separate or if you are bleeding excessively, your midwife will administer an ecbolic which is a hormonal drug injected into your thigh that causes your uterus to contract and expel your placenta.
Delayed Cord Clamping
Blood and nutrients are transferred from the placenta to your baby via the umbilical cord. Once the baby is birthed the cord gradually stops pulsating as the last of these nutrients are transferred to baby. This sends a signal to the placenta to start separating from the uterus wall and be delivered.