How will I know I'm in labour?
Liz: First question I am going to ask you Alison, I think what mum's tend to feel, and certainly what I felt nervous about is going into hospital. "How will I really know that I am in established labour, and I need to be going into hospital, and I'm not going to hospital too soon" Is there any sort of first signs that I really should be looking for?
Alison: It's a very common question, I get asked all of the time, the times that we encourage you to phone the hospital is when your contractions are about 5 minutes apart. We like them to be all of the same strength, all of the same distance apart. When you're in early labour you tend to get contractions very irregularly, some are a little bit stronger than others, and they suggest you have a little bit of a way to go. When they are regular, all of the same strength and distance apart, about 5 minutes that's the time to give us a call and we will probably invite you in for a checkup.
Liz: Does this apply if you are having a home birth or going into hospital? Do you still need to call the midwives?
Alison: Absolutely, whatever the plans are for a home birth in your area. In my area you call the labour ward and they notify your community midwife or the midwife on call for the home birth.
When should I contact my midwife/hospital?
Liz: I heard about movement, baby's movement as well, just to keep an eye on that.
Alison: That's right, the time that we like ladies to contact us is if you have noticed that your baby's movements are slowing down. There is a little bit of a myth out there that babies slow down as you have started to go into labour. We don't like that, we like babies to be continue with their usual movement pattern. Babies communicate to us through their movement, that's how they tell us they're happy with the situation. If they start to slow down it sometimes means they are a little bit unhappy about something. And we need to get them checked out, so we would encourage any mums who feel that their baby's movements have slowed down, to give us a call.
Please contact your midwife:
- If your waters break
- You have any bleeding
- Are worried about anything
Who should be my birthing partner?
Alison: The most important thing about your birth partner is that they are going to support you and I think that's the key thing that you have got people you know and trust, and that they are going to support you and be your advocate as well whilst you're there. It's very common that partner's do feel a little bit out of their depth and don't know how they are going to be when the time comes. From my point of view if you can, if it's possible, take them along to your antenatal classes. There are quite often couples classes that go on, and if they are especially nervous about it, it can be a way that they can find out more information. They can also speak to other dads.
Liz: Just talking to friend's and other women I think occasionally they sometimes get their friends or their mother to be, and to share it a little bit with the dad to be. So the poor dad doesn't have to be there for 6 hours or however long labour might be, it might be a bit longer than that! So if mum comes along...
Alison: Most women if they are having their baby in hospital, most hospitals allow you to have two birthing partners. First babies do tend to take that little bit longer. It is a long process, so if you have got two birth partners that can share that support, over the day or the night whenever it is, that's usually a good thing. At home obviously it's your house, who you have is up to you, we will work around that I've had some ladies that have had their children present at the birth of their baby. That was right for them, in that situation. Other people may be a little uncomfortable about that, but at home you're not really restricted on who can be with you. But the same principles do apply, make sure you are surrounded by people who will support you.
Do I need a birth plan?
Alison: I strongly advise a birth plan. As a midwife, if you come in, in labour and you can't talk to me because you're in that zone as ladies do, at least I have something written down on how you want this labour to go, how you have envisaged it happening. So at least I can address some of those wishes that both you and your partner have. I am a great advocate of birth plans, but they have to be flexible, because with birth it can change. They are not set in stone, and sometimes if you do have to do something a little bit different we just try and pick it up where we left it.
Liz: My experience even though it was not the route we thought we were going to go, we still got to do some of the things we wanted to do.
Alison: If we do end up with a caesarian section, we can still do the skin to skin in theatre. Potentially breast feed the baby in theatre, the dad can -- not necessarily cut the cord, but he can trim the cord. So we can still try and accommodate some of the wishes that may be in that birth plan.
What are the stages of labour?
Liz: I know labour has different stages, so it goes through the first, second, or third, can you give us a bit of a summary about the stages?
Alison: Traditionally, yep we all think of labour as having three stages, first stage, second stage, and third stage, personally after 20 odd years of midwifery I feel that labour has four stages. Unfortunately. And the first part of that being the latent stage. When the neck of the womb is ripening, getting ready to go into labour and that can last a few days sometimes, and can be quite tiring but resting, eating well through that stage - making sure that your body is prepared for when you do eventually go into established labour. Then we go into the first stage of labour, that is where the neck of the womb is about 4cm dilated right the way through to 10cm dilated. Then we go through to the second stage of labour, which is when the baby passes through the birth canal and is born.
Liz: And is this true? - The second stage of labour generally happens, or is there a time limit during that stage that midwives try to keep. What is ideal?
Alison: When we are talking about time, we have a watchful eye on the first stage and the second stage and the third stage. So the first stage of labour we're looking at the cervix dilating a centimetre every 2 hours. That's what we would allow. The second stage of labour, we're looking at the baby to be born within about 2 hours really. Sometimes it's a little bit longer than that, the vast majority of the time it is quicker than that. With your second baby it can be minutes. Literally. And then we move onto the third stage of labour which is the delivery of the placenta, and depending on how your labour has gone you can opt for an active management of your third stage where we give you a drug to help you deliver the placenta or you can go for a physiological third stage. Where we do nothing, and we just sit and wait for the placenta to deliver. If we are doing an active management, where we are giving you an injection to help release the placenta - we're looking at it being delivered in about 5 minutes. If we are going for a physiological stage, where the placenta is just being allowed to come away naturally we're looking at that taking around about an hour to deliver.
Liz: Okay, it's good to know that sort of thing. The other thing as well is with communication, you can get embarrassed and when the baby's head if being born, what happens to all of the other organs around there. Will I become slightly incontinent? Or will something messy happen at that point, and being quite embarrassed about it all.
Alison: A common concern that ladies have is that they are going to have their bowels open whilst they are giving birth. Our job when we are doing our vaginal examinations throughout labour is to check if the bowel is full. And if the bowel IS full, we may well offer some suppositories to help you have your bowels open prior to the birth of the baby. We don't routinely give enemas, it used to be in the olden days! We don't do that anymore, and in actual fact most ladies will have had loose bowel movements in the run up to.
Liz: I have heard before, labour starts.
Alison: If we do find the bowel is full we will help with that. And if by any chance it does happen or something, you just shouldn't worry about it. Not at all. In the scheme of things, of what is going on anyway... Absolutely! For me it's a positive sign, it means the baby's not far away. That's good!
What do contractions feel like?
Liz: I was keen to know this as well, what does a contraction really feel like? What is the sensation like? And I know that I very much think it gradually builds up as well, for most women, what would you, as an experienced midwife -- What do I tell them it feels like?
Alison: So I would tell the mums, is that a contraction feels like a very very very strong period pain, a dull ache, usually in the lower abdominals. Some ladies do feel it in their back, some ladies feel it in the tops of their legs, but it's that real crampy muscle period-like pain that you get. And it is quite intense when it comes, ladies often say 'How will I know I am in labour?' We all say, you'll know. And that's right, because when it comes you will know.
Liz: And how does this differ from Braxton Hicks?
Alison: Braxton Hicks, or practice contractions, as we call them. Some ladies do feel them, some don't. They can take your breath away a little bit, but there is no regularity to them and as I mentioned earlier, 'How do I know I am in labour?' It's the regular painful contractions that you get, the Braxton Hicks, are not regular and they tend not to be painful.
How can I cope with contractions?
Liz: So Alison, I know one of the key things that mums to be will ask is, when labour does start to get hard work, and can get uncomfortable, and a little bit painful at various times. What is the best way, the sort of things mums should be thinking about, when they are in the middle stages of their labour. What are the options available to them?
Alison: To help them cope with the pain? Again it's a common question and worry about how they are going to deal with that pain. From my point of view, looking after mums that are going through labour, I always advise that they start off at the beginning with the less invasive methods of coping with pain. And they are very good if they are used at the right time, and they are used properly, they can get you through the vast majority
of that labour.
Liz: That's good to know, is that things like TENS? And hypno-birth?
Alison: So your TENS machine, and Hypno-Birthing, your water - water is absolutely fantastic for labour and birth if you want to birth your baby in the water. But certainly for labour pains, water is very very good. If you get to a point where labour is, and you are wanting a little bit more, if you're at home at the moment I think the advice is - if you are needing any kind of drugs to help you cope with the labour the diamorphine, the opiate drugs, the injections, you need to be in hospital. So we are looking at you being transferred into the hospital where you can have those kinds of medication. And then obviously, there is the epidural, and lots of ladies do end up having an epidural, it's a very common procedure. Epidurals these days are very safe procedures, and they are usual mobile epidurals. They are not as heavy, you don't get as heavy sedation as you used to years ago, they have evolved. Because we recognise that being mobile in labour is very important.
Can I eat and drink during labour?
Alison: Eating and drinking in labour is encouraged, up until you needing major forms of pain relief, and by that I mean an injection form of morphine or an epidural. Those are the times we say, maybe not to eat. You wouldn't not feed your baby. So although you might not feel like eating it is really important. Especially in the early stages of labour to stay well hydrated and eat little and often. During the labour, I quite often encourage dad's to go out and get some energy drinks just so mum can sip on those to keep the energy levels up. It's like running a marathon. And you wouldn't run a marathon on empty. You would take these things going along. When, or if their are complications, and if you start to need major forms of pain relief, then we would then advise you not to eat or drink too heavily. I still let the ladies sip on their energy drinks, again to keep the energy up.
Liz: That's really good to know. Just a small point, in case they need to have a caesarian or an operation, will this have an effect that she's been eating something because I suppose, if you think about needing an operation they tell you not to eat.
Alison: So the ladies that are more likely to need a C-section are the ladies that are bumping into complications, maybe they are needing the hormone drip to get the labour going, maybe they are having a long labour. We'll recognise that early on and will advise the ladies at that point. But if the labour is progressing normally, we will actively encourage them to keep well hydrated.
Does someone check tha baby after birth?
Liz: When my baby's arrived, Alison, I know I might only be staying in hospital a short time, but does somebody check over the baby when the baby has just been born or fairly soon after that.
Alison: Yes, that's right, they do, the first initial quick check by the midwife, she'll weigh the baby, check that fingers and toes that kind of thing. We don't measure the baby's head anymore, and we don't measure their length. It has no clinical benefit, measuring those things after the birth but it is something that people like because Grandmas are asking all of those details. If you would like it done, ask the midwife and she'll do that for you. Those are the first checks. You will also be offered vitamin K, which baby's have shortly after they are born, within the first couple of hours. It can be given orally, but the paediatrician would recommend that it is giving via injection. And then the baby gets a much more thorough examination, at around 6 hours of age, between 6 - 24 hours of ages. Maybe by a paediatrician, maybe by a midwife who has got that extended role. Lots of midwives are doing that now, they are doing those more extensive newborn checks. They listen to the baby's heart, we check their eyes, and just a bit more of a thorough examination.
Liz: That's really good to know. I think the other thing is, which crosses mums mind, or a parents mind when do the little name tags go on. When are they put on? So they might be worrying, that they have the wrong tag or something!
Alison: Baby will never leave you, if baby does have to leave you we will make sure the baby is labelled. Those labels will be checked with you to make sure that the correct labels have gone onto baby. On that note: if I can just mention, and it does sometimes cause a little bit of (I'm just trying to think of the word) not tension, but just be aware that if mum and dad have different surnames when in the hospital the baby will automatically be labelled with the mums surname. So they won't have the dad's name if they haven't got the same surname. When you go to the registry office, that's fine because if the baby is going to take the father's name that will be done there and that will be the name that appears on the birth certificate and then that will be the name that appears on the medical records.
How long do I need to stay in hospital?
Alison: You've had a normal uneventful labour and birth, you're looking at probably being able to go home within the first few hours - 6 hours is the average there. Most ladies will stay with us for about a night, at least a night. And if you have had a C-section, around about two nights just to get over that operation. Don't worry when you do go home, the community midwife will come and visit you the day after and then you will get a few more visits in the next week or so after birth. And then the health visitor takes over, to help support you and your baby at home.
Liz: Well that's really good to know, if you do have your baby and the midwife suggests after 6 hours, you are fine to go home now, if mum is feeling rather nervous and a bit worried and not quite, well just very nervous I suppose. Is it possible, can mums stay a night if they wish to? Do they have to go home?
Alison: No, absolutely, we're there for you and if you want to stay it's up to you.
What is the policy with feeding after birth?
Liz: One of the things that, I, when I had my baby, and trying to breastfeed quite soon after the birth, I assume that this is what all midwives try to encourage and help mum's do that wherever possible, to put their baby straight on their chest. What's the policy about feeding baby that's just arrived?
Alison: Skin to skin is something we would recommend whether the mum is breastfeeding or bottlefeeding, it regulates the baby's temperature, it regulates their blood sugars. It calms them and relaxes them, it's just a better way of welcoming them into the world. If you are going to breastfeed, it is a fantastic opportunity to at least start that and most babies will have a go within that first hour of birth and we like them to at least have a go. If they are bottle feeding, again, we would like them to have a little bit of a feed within that first hour.
Liz: And it's good to know that skin to skin contact a thing for mum's to know, whether they are going to breast feed or bottle feed. That skin to skin contact is a really good thing.
What happens when I get home?
Liz: What is the sort of in place, for post natal care that mums can expect? Certainly with their first baby and they have had a normal birth or they have had a home birth - what do you expect on day two? After baby has arrived!
Alison: When you leave hospital, the hospital midwives inform the community midwives, no matter where you are going. If you give birth in London and you live in Scotland we'll inform the midwives in Scotland to come and see you so which ever area. If you're going home to Grandmas, that kind of thing, we'll inform the midwives in that area to come and see you that day after you have left hospital to check you and your baby out. We tend to do the routine visits that we do, the day after you've left hospital, day 5 and then again day 10. Now, if you are needing a little bit more support with breastfeeding or just a little bit of a closer eye kept on you, community midwives will put in extra visits if you need that.
Liz: I did find that with my first, with breastfeeding, I needed a bit of help and I am sure it's better now but there were groups I could go to and midwives did come and a few extra visits to help with that.
Alison: And they can point you in those directions for those groups that can help you. Once the midwives have finished visiting, around day 10, the health visitor comes in, and she's there responsible and helping you with your baby from birth right up until they go to school. She doesn't come every week, but they tell you about the baby clinics that you can take your baby along to, to get weighed. They will help you with immunisation of baby.
Liz: Do they come and visit most mum's at home for the first visit? Or do they sometimes suggest that mum goes to the surgery?
Alison: The first visit is usually at home.And then the other visits will then be in the clinics or the GP surgery wherever they are.
Liz: One of the most important things is, for mums if they are worried about anything when they get home, they have a number to call if they get worried and something is going to be arriving in a few hours they can always call.
Alison: I take many a call, on the labour ward day and night, for mums, so if they are worried about anything.
Liz: And maybe for the dads, if they are worried, if their wife is having, or partner is having - they can make the call if they wish to.
What happens if my baby is breech or tranverse lie?
Liz: Alison, I just want to mention, I had a C-section with my babies. I had planned to have a natural birth as possible, but my baby went into transverse lie, so it ended up going down that particular route. Is this breech/transverse, if mums may not be be aware beforehand and does this come up occasionally? Where you have to go another route that you didn't expect.
Alison: Absolutely. So we check the position of baby at about 36 weeks, and we are looking for baby to be in the head down position. There are some babies that arn't in the head down position, they are either in the breech position or like you say, in transverse lie, lying across the tummy. Those babies, for those mums rather, we would arrange a consultant appointment to speak to a consultant and we would look at maybe trying to turn that baby if possible. They have to look at the pregnancy as a whole, and to see whether that is something that is safe to do and offer that to them, to try and turn the baby into the head down position, so hopefully they can facilitate a normal birth. Now, in your case, your waters went. Very much, yes. And your baby was in a transverse lie, They found out at that point.
So we wouldn't have been able to turn the baby into the right position, so if that happens, and the baby is in the breech or transverse lie position we are looking at a C-section. Also, if we go to turn the baby and baby just doesn't want to know, and wants to stay in that position, we would then obviously elect to have a planned C-section. You would be advised to have a planned C-section. Again, with a breech baby it's your choice and if you specifically really wanted to have a vaginal birth we will speak to you about it and council you and make sure you're fully informed about the choices that your making.
What is the recovery time after a caesarean?
Liz: Of course, I slightly know this in my situation, but generally for women how do they, the recovery time afterwards. Of course I stayed in hospital for 5 days but now the stay in hospital is between 2-3 days at the most. So what's the best advice in those early weeks, with regards to driving or the best things to do to help.
Alison: It's a major operation. And any operation, we're going to be looking at a normal recovery time of about 6 weeks to recover. Now, it's going to be a little bit hard going initially but things get easier very quickly. And you can help yourself by making sure that you rest, you eat well, and that's quite difficult to do when you have a new baby around, the day all rolls into one and it's very easy to just eat convenience food but we really must be eating as healthy as we can. Our bodies is repairing and we really must be making sure we have a healthy diet at that point. Of course, after the operation you'll be given your painkillers to take regularly. For thefirst few days, you will need them.
Liz: I definitely found that I needed that, and they did help. Just moving around, it was really uncomfortable to move to start with, very much so, but also it helped because I was breastfeeding, I could get into a better position and didn't feel quite so uncomfortable. But you're right, I also hesitated about the painkillers to start with thinking, oh maybe I don't need it. But the midwife said 'No, you will and they really will help' And they did.
Alison: I think if you are worried about them getting through into your breastmilk, these are common analgesics that we use on all ladies that have a C-section, and they are perfectly safe to take whilst you are breastfeeding. Take them quite regularly for the first week, and then you can start to sort of tail them off a little bit.
Liz: That's good to know. The other thing is, do mums need to keep an eye on their scar? Is there anything they need to --? I know the midwife will be keeping an eye on them and coming to their home.
Alison: So your wound will have a dressing on for the first 24 hours in some hospitals, 5 days in others. Again, different hospitals do different things. But when we take that dressing off, obviously we leave the wound to the air, to let it just breathe and heal on its own. The body is very clever at healing on its own. If you have any stitches, they are normally removed around day 5 and the community midwife will do that for you.
Will I need a caesarean again with ny second child?
Liz: So Alison, sadly, unfortunately when I had my second baby, Rebecca decided to go into transverse lie as well. And I ended up having another C-section. But I think for lots of mums, that are on their second or third baby, they are fine to go with a normal birth route. What happens most of the time?
Alison: When ladies that have had a C-section with their first baby, or sometimes they have one with subsequent pregnancies we will look at their next pregnancy around about 36 weeks again and just look at as a whole, how things have gone about the previous birth. Why the C-section was done before. And usually, offer a vaginal birth and almost encourage a vaginal birth. And we are looking at, a vaginal birth after a C-section being a successful thing that ladies do go on to do. But at the end of the day, that choice is there for mums and if they would prefer to go for a C-section that is a choice they do indeed have.