Labour and giving birth

Most labours start spontaneously with irregular contractions. They will become more often, last longer and feel stronger. This process can take a while, and you can stay at home until your contractions become stronger and more regular. You may also have backache. The contractions are widening and shortening the neck of the womb. Sometimes the waters break before labour starts, this is called spontaneous rupture of membranes (SROM). It can be a gush, leak or a trickle of amniotic fluid which you cannot control.

If you think your waters have broken or you are having stronger regular contractions you should contact staff in the Labour Ward who will advise you what you need to do.

You may need an assessment which could include a vaginal examination. Labour often starts within a day of SROM, but can take up to four days. When you do go to hospital remember to bring your notes and an overnight bag with you. If there have been any pregnancy complications e.g. you have developed diabetes in your pregnancy or scans have shown growth restriction with your baby, contact the Labour Ward as soon as you start having regular contractions.

In the final few weeks of your pregnancy, some people will experience a thick, mucousy discharge, which can be mixed with blood or brown discharge. This is sometimes referred to as a ‘show’. This is unlikely to be a sign of labour, just a normal physiological change towards the end of your pregnancy.

It may be necessary to start your labour if there are problems in the pregnancy e.g. high blood pressure, concerns about the baby’s growth or if you are 10-14 days overdue. If you are ‘overdue’ your Midwife will offer you a membrane sweep at 41 weeks. This is a vaginal examination which stimulates the neck of the womb, which may trigger labour.

Contractions can be started by inserting a pessary into the vagina. The pessaries are not designed to get you into established labour, however most people experience some form of contractions or cramping during this time. The aim of the pessaries is to soften and open the cervix enough that it is possible to break your waters. While the pessaries can sometimes cause you to go into labour, most of the time, a hormone infusion (drip) is needed to speed up the labour. You and your baby will be closely monitored throughout the induction process.

Delays are common in this process, in order for us to provide safe care to families, we must prioritise providing 1:1 care to people in established labour, and therefore we may need to pause the continuation of the induction process while we manage those who are already in established labour.

There are many ways that midwives can tell how the labour is progressing. The most commonly used way is to perform vaginal examination, to determine how open the cervix is, how stretchy and thin it is, and how the baby is positioned. Midwives also look for other signs of progress, such as the behaviour of the person in labour, contraction length, strength and frequency.

Your baby’s heart beat will be monitored during labour. This is to detect any changes that could suggest your baby is becoming distressed. The Midwife can use a stethoscope or a fetal Doppler to listen intermittently, or continuously with a monitor. This will depend on your risk at the onset and during your labour.

You will be encouraged to move around during labour unless your chosen pain relief makes this difficult. During the active pushing phase, many mothers wish to remain upright; there is evidence that birth can be easier in a sqatting or kneeling position. It is important that you find the position which is most comfortable for you.

If you feel like eating and drinking during labour, it is advisable you eat light meals and drink fluids, to keep your energy levels up. Sometimes it is recommended you do not eat and drink, the Midwife caring for you during labour will advise you based on your individual circumstances.

Labour is painful, it is important to learn about all the ways you can ease the pain. There are many options and most mothers do not know how they will feel or what they need until the day. In early labour, you may find that a warm bath, ‘TENS’ machine, breathing exercises or massage is helpful. Other methods include: Entonox (gas and air), intramuscular injections of pain relieving drugs, and epidurals. It is important to keep an open mind, choose what you feel you need.

If you have had one caesarean section in the past, you have a good chance (around 75%) of having a vaginal birth this time. This is know as VBAC (vaginal birth after caesarean section). Your Midwife/Obstetrician will discuss with you the reason for your last caesarean and options for childbirth this time. Labour after a previous caesarean section is monitored more closely in hospital to make sure the scar on your uterus (womb) does not tear. If you have had two or more caesarean sections in the past, your Obstetrician will discuss the safest type of birth for this pregnancy.

There are times when it is the safest option to have a caesarean section. A caesarean section involves major surgery and should only be carried out for good reasons. The operation involves delivering your baby through a cut in your abdomen. The cut is usually made just below the bikini line. It is usual for you to be awake during the operation, with an epidural or spinal anaesthetic. A caesarean section may be planned e.g., if the baby is breech and did not turn, or it may be done in an emergency during labour if your baby is distressed or the labour is unduly prolonged.

Extra help may be needed if you have already progressed to pushing but the delivery needs to be sped up. This could be because you are tired or your baby is becoming distressed. The ventouse method uses a suction cup that fits on your baby’s head, while forceps are a pair of spoon-shaped instruments that fit around the head. The Obstetrician will decide which one to use at the time, based on the clinical situation.

The perineum (area between the vagina and anus) stretches to allow the baby to be born. It usually stretches well, but sometimes may tear. An episiotomy is a cut to make the vaginal opening larger

The placenta and membranes usually deliver soon after your baby is born. You will be offered an oxytocin injection in your thigh which helps the uterus to contract more quickly and reduces the risk of heavy bleeding (postpartum haemorrhage, PPH)/ Putting the baby straight to the breast helps release natural oxytocin hormone. Your baby’s umbilical cord will usually be clamped and cut within 1 – 5 minutes following birth. This delay allows your baby to carry on benefiting from blood from the placenta. This will depend on the way your baby responds immediately after birth.