Labour & Birth

Labour Care

When you go into labour we will care for you throughout your labour and birth. If your LMC is not available one of the other midwives will take over your care. When you arrive at the hospital in labour we will check all is well with baby and examine you to see how far your labour has progressed. If you are too early or not in established labour we will suggest that you return home as it is better for you to be at home in your own environment in the early stages of your labour. If any interventions are needed this is discussed with the obstetrician on call in consultation with you and your partner.

Giving birth should be your greatest achievement, not your greatest fear 

Labour is different for every woman, and even for every pregnancy. It is unique in the way it starts, how long it takes and the way it unfolds.

Below is a general guide to the process of labour.

THE FIRST STAGE OF LABOUR:

Latent Phase (0 – 4 cm’s dilation)

If this is your first baby, the early phase of labour can take hours, sometimes even a few days. You may notice some discomfort, or it can happen without you even realising. However, it is an important part of the birth process, as it allows your cervix to soften and thin out (effacement) and begin to open (dilatation). During pregnancy, your cervix is about 4cm long and quite firm and is sealed with a ‘plug’ of mucous. When your cervix begins to change, this plug can come away as a show. It is thick, stretchy and jelly-like. It can be milky coloured, pink, clear or be blood-streaked. It may come away as one large plug in your underwear, or in bits and pieces over a few days. It is a good sign that changes are beginning to happen, however it is not a definite sign that you are going into labour and some women may not experience plug-loss at all. Therefore, we do not need to know immediately if you have this show.

Most women begin to feel labour as dull, achy, period-like cramps which are short, infrequent and irregular and over time begin to increase in length, strength and frequency. Sometimes they come for a few hours, and then they subside again. They are usually felt in their lower pelvic area, abdomen or lower back. During this time, it is important to rest even though you are excited, as you may have a long, intense, exhausting and painful journey ahead of you. Try taking some paracetamol then going to bed to sleep for a few hours. When you cannot sleep any longer, move around. Go for walks, rock your pelvis, squat, go onto your hands and knees, take warm showers or use heat packs, whatever feels comfortable. This will allow your baby’s head to descend into your pelvis and help him or her to be in the best position for birthing. You may notice some nausea, vomiting or diarrhoea, all of which are completely normal. Make sure you drink plenty of water, but instead of large meals, try having regular snacks of nuts, fruit, or raw vegetables.

Stay home as long as possible!

While you may be tempted to come to the hospital to see how things are progressing, research has proven that women progress much better when they are well supported in their own environment. Therefore, it is important to stay home unless you are concerned, feel unsafe or unable to cope any longer.

Active or Established Labour (4 – 7 cm’s dilation)

This is the time when your labour contractions will become regular, usually 3 -4 every 10 minutes and will each be lasting over a minute long. You may find it difficult to talk and relax at this point, and become irritable and restless. When you have a contraction, you may find that all your energy and focus goes into breathing through that pain. It is still important to be active in this phase of labour. Move freely, be upright, and listen to your body. Research shows that by being active in labour allows for a shorter labour, less risk of your baby going into distress, and reduces the likelihood of needing pain relief. If you are in hospital, your midwife will be listening in to your baby’s heart rate often through contractions, either with a hand-held Doppler or with a machine called a CTG. This records your baby’s heart rate over longer periods, and also records how often your womb is contracting. She will also regularly take recordings of your blood pressure, pulse and temperature.

Occasionally, even though your body is working hard during this phase of labour, your contractions may be too short or not strong enough to dilate your cervix and bring your baby down into your pelvis. If this is the case, the midwife may talk to you about starting an infusion of syntocinon, which is an artificial version of ‘oxytocin’, a hormone in your body which makes your womb contract.

Transition (7 cm’s – full dilation)

Your contractions will become more intense and painful during transition. You may feel that you get no rest between contractions, and may experience feelings of not being able to continue on much longer, or wanting to give up. On the other hand, you may also have a longer gap between contractions, and may even be able to sleep between pains. This is called the ‘rest and be thankful’ phase. Your body is getting ready to begin pushing your baby out. Some signs that you may be coming up to full dilation are a feeling of pressure in your back passage or an urge to push or bear down.  

Rupture of Membranes (Water’s Breaking)

The bag of water’s around your baby can break at any time during your labour, sometimes before labour has started, or even as your baby’s head is being birthed. If your water’s break and the fluid is clear, light pink or straw-coloured, put a pad on and phone the 0800 number. The midwife will ask you a few questions to confirm your water’s have gone, or she may arrange to meet you at hospital to confirm they have broken. If it’s during the night, note the time and call the 0800 number in the morning or when labour is established. Please note that after your water’s break, or at any time during labour, your baby should still be moving. If you feel the movements are reduced, phone the 0800 number straight away. Sometimes, during the course of labour, your midwife may talk to you about artificially breaking the waters as a way to augment (assist) labour progressing. This is done using a small plastic hook which nicks the membranes, creating a hole in them.

If your membranes break before labour, contractions usually start within 24 hours. However, once your water’s have broken, the barrier protecting your baby from any infection is gone. For this reason, after 18 hours, we give you IV antibiotics in hospital to protect your baby. A plan will then be made regarding possible induction of labour.

If you are Group B Strep positive, you must call the 0800 number straight away if your water’s break, even if you are not in labour.

THE SECOND STAGE OF LABOUR:

When your cervix is fully open, and your baby is ready to be born, it is normal to feel a strong urge to bear down and push without anyone telling you to do so. It is important to utilise each contraction and push only when you have one to allow the uterus to do its work and move your baby down into the birth canal so as not to waste your energy stores. The midwife may coach you through pushing so that you can optimise each contraction and use it to its fullest potential. Most women find pushing in a squatting, kneeling or semi-reclined position more beneficial to allow gravity to assist, changing position during the pushing phase also helps baby descend. The second stage of labour can last anywhere from 10 minutes if you have had a vaginal birth before, to 2 hours if it’s your first. When your baby’s head begins to crown, you may experience a burning or stinging sensation in your vagina as all your muscles and skin are stretched out. It is really important to listen to the midwife as she will coach you through this to prevent excessive tearing to your perineum.

When your baby is born, he or she will be placed skin-to-skin on your chest and dried. Skin-to-skin allows you to initiate breastfeeding, bond with your baby and allow him or her to transition to life outside your womb in a calm environment. You can also gaze in wonderment at your gorgeous newborn!

THE THIRD STAGE OF LABOUR:

The final stage of labour is the birth or the placenta or whenua. If your labour has been intervention-free, your womb will contract down and the afterbirth will shear off the wall of your uterus. A few pushes will be required to birth the whenua, which usually takes no longer than half an hour. If you have had intervention, such as an induction of labour, epidural or syntocinon infusion, or you begin to bleed heavily; an ecbolic is given to stimulate your uterus to contract, either via an injection in your leg or through an IV leur if you have one. The umbilical cord will be clamped and cut (usually by one of your support people), and the midwife will then help deliver your placenta.

After the placenta has been delivered, the midwife will check your vagina and perineum to see if you have any tears which may require suturing. If this is the case, she will stitch you in the delivery room under a local anaesthetic. 

What Happens Next

•            The first breastfeed should ideally take place within 2 hours of birth. The midwife will assist you to latch your baby for this very important first feed of colostrum, which contains beneficial antibodies and proteins for your baby.

•            Baby will have a top-to-toe check, including weight, length and head circumference. If you consent for Vitamin K, it will be given now.

•            You will be offered pain relief such as paracetamol or diclofenac, then assisted to have a shower. The midwife will do recordings of your blood pressure, pulse, temperature and feel your uterus is still well contracted.

•            You will then be taken around to a postnatal room in the ward. Staff are available to assist you with breastfeeding and mother craft as you require. Most women stay for approximately 2 nights. One of the midwives from the practice will visit each day you are in hospital.

•            If you chose to go home after delivery, your birth has been relatively straight forward and your baby is well, you can usually be discharged approximately 2 hours after delivery. One of the midwives will visit you the day after you go home.

 

 

Call 0800 633 364 at any time if:

 

  • You think you may be going into labour (having regular contractions) or your waters break and you are less than 37 weeks
  • You begin to bleed from your vagina, especially if it is heavy, fresh, bright red blood with or without clots and with or without pain
  • Your waters break and they are green, brown or heavily blood stained
  • You do not feel your baby move when he or she normally moves, or you feel the movements are reduced