This is the time at the end of pregnancy when the muscles of your uterus start to contract, or pull up and help your cervix (the neck of the womb) to open. The cervix starts out as a long fairly solid piece of muscle that stays tightly shut to keep your baby safe inside for nine months. When the time comes for your baby to be born, this muscle will start to soften and thin out allowing the contracting muscles of the uterus, to open the cervix sufficiently to allow the baby to be born.
This is also called the latent phase and is the time when the cervix is softening and thinning ready to dilate or open.
Rest and relaxation is key to managing the latent phase of labour. During the latent phase of labour your body is releasing birth hormones that soften your cervix to allow it to open for birth. The latent phase is the first part of labour and ends when labour becomes established, when the cervix is open to around 4-5cm of dilatation and contractions are regular and strong.
During this stage some women report that they feel aches down the inside or outside of their thighs. Some women say that their early labour felt like the sensations of having their period. Some women notice that their Braxton Hicks increase or that their contractions come and go irregularly.
Pacing yourself during the latent phase is important because at this stage, labour can start and stop and sometimes it can take 2-3 days before active labour begins. During the early phase most women can find that they will go about doing their usual activities. Sleep, eat and drink well and find activities to distract yourself. Talk to your baby and let them know how much you are looking forward to meeting them. Use a relaxing bath if you have any discomfort or a hot shower. It is extremely important that, as well as staying active, you get plenty of regular rest. It maybe that the contractions will keep you from sleeping through the night and it is easy to become exhausted quite quickly. Take every opportunity to rest throughout the day. Snuggle up and get as much sleep and rest as you can.
Some women find it useful to use aromatherapy massage to help them feel comfortable during this stage. Distraction also helps - so that you don’t clock watch, put on a film, comedy or TV programme, or listen to a preselected play list of your favourite music. Keeping your mind gently active by baking a ‘birth’ day cake or cooking some soup, doing ironing etc will stop you dwelling on what is happening and allow your body to get on with it.
Do let your midwife know how things are progressing so that she can advise you and decide whether you need her to come to see you. At Neighbourhood Midwives, we help women to prepare for this experience and women know that they can call to chat things over at any time.
Many women worry about not getting to their place of birth in time or worrying that the midwife will not make it for their home birth. The clever thing about labour is that your body will tell you when the time comes. Unlike in the movies, your water are not always the first sign that you may be in labour!
In order for your cervix to open and for you to birth your baby, your uterus (womb) will contract. Did you know that your uterus is made of muscle? Contractions open your cervix which is the door way to the opening of your womb.
Contractions during labour cause your womb to tighten and then relax. Some mothers describe the sensations of contractions being similar to the sensations of their period whilst some mothers prefer to think of the contractions as waves or surges as they feel that using positive language to refer to labour can help them to stay relaxed.
Established labour is usually associated with contractions that are getting progressively LONGER, STRONGER AND CLOSER TOGETHER.
The following things may or may not have occurred:
- Braxton Hicks: These are known as practice contractions. Some mothers notice that they have Braxton Hicks from around 30 weeks’ gestation. Some mothers do not get them at all. The difference between real contractions and Braxton Hicks is that real contractions tend to start like a small wave, build to a peak and then flow away, whereas Braxton Hicks tend to come suddenly. You may notice that your bump feels tight and then all of a sudden the sensation disappears. During early labour, some mothers find that their Braxton Hicks increase. Another difference to real contractions is that Braxton Hicks tend to be irregular and may be felt all over the abdomen. Established labour contractions are usually felt in the lower abdomen, back and hips/thighs.
- An ache in your back or down your legs: Some mums will say they feel their labour sensations in their lower back, their hips or up and down the inside and outside of their thighs.
- Mucus plug “the show”: The ‘show’ is the human glue that keeps the cervix closed during your pregnancy. As you get closer to birth, your body releases hormones that cause the cervix to soften up which causes the plug to loosen. Although seeing the mucus plug is a sign that labour is on the way, it could still be a couple of days or week before labour actually starts. Women often notice their show when they have been to the bathroom. If you have ever had a bad cold and blown your nose, what you see in the tissue is similar to what you might find in your knickers. Sometimes, it can look a light pinkish or dark brown colour or mixed with some blood like the beginning of a period.
- Contractions: Contractions that come 3-5 minutes apart and last for around a minute or so, for around an hour is a good sign of active labour. You can tell how far apart contractions are by timing them from the start of one until the start of the next one.
- Water’s breaking: This can either present as a slow trickle or as a gush. The colour should be clear or like a very faint straw yellow colour. If it is green or heavily blood stained, call your midwife urgently. Have a look at the clock so that you can let the midwife know what time they broke. This is important because there is a slight increase in the risk of infection the longer the waters have been broken before the baby is born. For your comfort you can put a pad on and this will also help you to check what colour the waters are. Some mothers are not sure if their waters have broken as they may have been dealing with stress incontinence during pregnancy and during the last weeks of pregnancy the cervix can produce very watery discharge. Waters will tend to keep coming and will make the pad very wet. When you call your midwife to let her know that you think they have broken, she can assess you over the phone and together you can decide on a plan. At Neighbourhood Midwives, we discuss these issues with women and your midwife will visit you at home if you are unsure.
If you speak to ten different mothers they would describe the sensations of their labour in a different way. If at anytime you are unsure or feel that you need talk to a midwife, call the number on the front of your notes to either speak to your own midwife or the delivery suite of your hospital.
REMEMBER, established labour is associated with a sense of progression with contractions getting longer, stronger and closer together. Trust in your body’s ability to deal with the labour as it progresses.
Again, every woman is different but contractions usually increase to the point where they are coming every three minutes or so and lasting 60 seconds. That means with each contraction, you have up to two minutes without one!
Towards the end of your pregnancy, your midwife will discuss with you when you should call her or the delivery suite to say that you need their support. Where you plan to have your baby will determine whether or not your midwife will come to your home to assess you or whether you should go to your place of birth for an assessment. At Neighbourhood Midwives, you can decide once you are in labour and your midwife will always come to you at home and help you decide on the next step.
You should contact your midwife if:
- You feel like you are in active labour
- Your waters break
- Any labour symptoms appear before 37 weeks gestation
- Your baby is not moving as much as s/he normally does
- You are bleeding
- You need any support and advice
During the first stage of your labour, your baby will still move and let you know how they are doing. With your consent, your midwife will feel your tummy to determine the position of the baby, she will listen to your baby’s heartrate regularly to see how your baby is coping with labour. If you have had a straightforward pregnancy, the recommendation is to listen to baby’s heartbeat every 15 minutes using a pinard, stethoscope or Doppler.
If there are any risk factors that were apparent during pregnancy or have occurred after you go into labour, then the recommendation is to listen to baby’s heartbeat continuously using a CTG machine in hospital. You can, of course, discuss this and agree a different plan and your Neighbourhood midwife can help you to do this.
Your midwife might recommend that she assesses the progress of your labour by doing a vaginal examination to see how dilated your cervix is. Again this is your decision.
Generally the midwife is quietly assessing you and will regularly check your observations (BP, pulse and temperature), how strong and progressive the contractions are and how you are coping, and of course how the baby is coping with the process. If, at any time, she is concerned she will explain her concerns to you and recommend a plan of action, either transfer to hospital or if already there, the opinion of a doctor.
Most women find relaxation, breathing, visualisations, baths and/or showers and massage all extremely helpful in first stage of labour. Keeping upright and active too.
Upright positions for labour and birth help to shorten labour. Labouring mums find that upright and forward leaning positions help them to feel more comfortable during a contraction. Upright positions can also help your baby to get into the optimal position for birth using gravity.
Using a birth ball can be very comfortable to lean over and it helps you to remain upright but rested.
Remember to eat lightly and drink plenty and go to the bathroom every 2 hours at least.
Some women use TENS machines, (transcutaneous electronic nerve stimulation) which helps to stimulate your natural endorphins (the body’s own pain relief) and can ease the discomfort somewhat.
Once your midwife is with you, you can try Entonox which is a gas to inhale and allows you to manage each contraction individually. Neighbourhood midwives all carry Entonox for labours.
In hospital there are other drugs, Pethidine or Diamorphine and, of course, epidurals. The good news is that many women find they cope very well with good support and kindness and the reassurance of a midwife that they know and trust.
- First things first…It may sound strange, but look after yourself on the labour and birth days! Make sure that you are eating and drinking well and taking care of your physical needs to that you can take care of your partner. She will need you to be on top form for her. Make sure that you have nutritious food and snacks packed or change for the snack machine! Don’t forget to take breaks regularly too. Pack a little bag with toothbrush and paste, freshen up pads, deodorant etc. You might be out for a long time. Wear comfy, loose layers and comfy shoes. Being a supportive birthing partner means that you will be verbally encouraging her, reassuring her, massaging your partner, listening attentively, advocating where necessary and being her “go to” person. It’s important to look after your needs so that your partner is not worrying about you worrying about them.
- Be prepared! Make sure that you know where the maternity notes are as they need to go wherever bump goes until your baby is born. They are very important as they contain important details about your partner and the health of your baby. On labour day make sure the notes are packed in the bag. Make sure you have spoken with your partner about her choices and preferences for birth so that you can support her with her birth plan. Many birthing partners find it useful to pack the birth bag or check it after mum has packed it. This way you won’t be scrabbling around looking for that one elusive T shirt that your partner REALLY wants. Make sure you have checked the route if you plan to drive and find out where you can park and do not forget change for the parking meter. However if you plan to get a taxi make sure you know who you are using beforehand, check they will take labouring women and find out which entrance to access your place of birth as many birth places have different entrances depending on whether it is 1pm versus 1am! You might need to take the carseat too for the return journey.
- Relax! Did you know that the hormones for labour and birth work really well when the labouring women is surrounded by birth supporters who are themselves relaxed and calm? Oxytocin is the hormone that causes the womb to contract during labour this hormone is also known as the love hormone. Feeling relaxed is a crucial ingredient to a romantic evening. Think about the necessary ingredients of a romantic evening for you and your partner and think about how you can recreate this especially whilst your partner is labouring at home. Turn the lights down low, play some music that your partner will find calming. Giving your partner a kiss and a cuddle as this also helps not only to reassure but to boost those birth hormones. Your partner knows you well enough to know when you are not feeling calm or relaxed so think about what you need beforehand in order to feel as relaxed and calm as possible on the day.
- Be practical. Make sure she has food and water regularly. In early labour make sure that you are on hand with protein packed and nutritious meals and snacks. Help your partner energise her body and give it the fuel it needs. Sometimes in active labour mums to be lose their appetite but you can still help her to hydrate and provide small nutritious snacks. Encourage your partner to the bathroom regularly as a full bladder can slow down labour and your partner may be too distracted to notice that she needs the bathroom. Do everything that you can to help her to sleep, especially at night. Walking around all night will do neither of you any good if the labour continues for another day or so.
- Positions. Help her to be as upright and as comfortable as she can and support her to change positions regularly. Upright and forward leaning positions help to shorten the length of labour. Your partner’s comfort comes first and upright does not mean that she needs to be in a squatting position the whole time, she could be walking, leaning against a wall, sitting astride a dining chair, on all fours using a birthing ball or even lying down on her left side. Most labouring women find it easy to listen to their bodies and adopt comfortable positions in their home environment and birthing units that look very similar to the bedroom. But, remember; rest is also a crucial aspect of labour support your partner to find the balance of pacing herself with rest and relaxations so that she can conserve her energy.
Use your BRAIN when conversing with the health professionals looking after your partner and your baby. The evidence shows that when birthing mothers are a part of the decision making process and feel listened to they feel more positive about the birth itself - even if all their carefully thought through plans have to be abandoned. Using your BRAIN can help you to have a more assertive discussion about your care with your health professionals.
BRAIN stands for:
Benefits; what are the benefit of the procedure or intervention that is recommended.
Risks; are there any risks associated with the procedure?
Alternative; is there something else that you can do?
Instinct; what does this decision feel like for you?
Nothing; Do you need to make a decision now or can you have some time to think about it?
- Encourage her; tell her how well she is doing. Hold her, massage her, breathe with her. Touch her and remind her to let go of any tension that she feels. Tell her how awesome she is with a quiet and gentle voice and thank her all the work she has done growing your baby. Massage her bump, thighs legs and arms. Kiss her, cuddle her and surround her with your positive energy. Help her to see how well she is doing even if she thinks she is not.
- Get her in the bath! Water has been shown to help relax the labouring woman. Fill the bath, turn the lights down low and support her to get into the bath. Ensure the water is not too hot and try to make sure that bump is as covered by the water as much as possible. Maybe lie her on her side with a rolled towel in her neck and pour water over her bump or back. Play some music that she likes and be there to mop her brow and massage her shoulders. If she likes you can try using the warm shower over her bump. If you do not have a bath using a shower can be an equally calming technique.
- Observe her and be watchful, notice whether she has been in the same position for a long time or maybe you might notice that there is some tension in her face. Observing your partner will help you to offer the necessary support more swiftly.
- Keep the end in sight! Keep in mind that at the end of this process you will start your new journey together as a family, indeed, the birth is really only the beginning!
pain relief options
When considering your pain relief choices, it is important to take into account your hopes for your birth and where you choose to have your baby. Where you choose to birth and who you have to support you during labour can make a huge difference as to how you cope with the labour and birth itself. Having a tool kit of techniques you can use to help yourself cope with the challenges of labour is really important, and is something you should be considering and planning while you are pregnant. You have a range of pain relief options to choose from which are outlined below. It is important is for you to choose what works for you. Some factors to consider are:
Where you are planning to have your baby?
e.g. epidurals are only available on the delivery suite, not on a birth centre or at home. However, women who choose to labour and birth at home or at a birthing centre, are generally less likely to need pain relief during labour.
- How mobile would you like to be during labour?
- Who will be there to support you?
- Would you prefer to avoid pain relief?
- Will the pain relief have any consequences for you and/or your baby?
Simply, those activities and actions which you can organise and do for yourself, they don’t rely on external input although some of the techniques can be learnt. The choices are endless but do depend on your preference and experience. Here are a few of the options:
- Using the bath or shower at home
- Using a warm compress on your back
- Using a cool compress
- Breathing and relaxation
- Making a low, rhythmic sound
- T.E.N.S (see below)
- Hypnobirthing – self hypnosis is becoming very popular and often helps women avoid strong pain relief
- Natal Hypnotherapy
It is important to feel at ease as this helps your natural pain relief hormones, called endorphins, to be released. Having a midwife you know and trust, as with Neighbourhood Midwives, helps enormously in this respect as women find it easier to relax and allow their labour to progress with the support of someone they have developed a strong relationship with.
The advantage of using self-help techniques is that they can be used wherever you are during labour and whatever stage of labour you are in. You are in control of what you do and you can often use two or three methods at the same time and even in conjunction with any other methods of pain relief you choose. Self-help techniques can be used whilst you labour at home before going into hospital or at any time once you are admitted. Some mothers use their self-help strategies until having an epidural sited and some will use only these as their only method of pain relief during labour. The choice is yours.
Using water to help support you during labour is not just about having a water birth. Many women find having a bath at home or using the shower during labour can help them to manage the increasing challenge of early contractions. Using a small towel with either cool water or warm water can also be soothing on your lower back or legs.
Some women like to use the birthing pool to help them manage their contractions during labour and will go on to give birth in the pool. Others prefer to labour on land and then get in the pool when baby’s birth is imminent. Again, the choice is yours. Your midwife is able to monitor you and your baby whilst you are in the pool so once in you can let yourself relax into the sense of relief deep warm water usually brings without having to worry about getting in and out all the time.
Mothers who have had a water birth report that they felt more comfortable in the water, more able to change positions and sustain active birth positions compared with labouring outside of the pool. Many women find that as soon as they get in the birthing pool they feel a sense of calm and often say that their baby appears to be equally calm after their water birth.
T.E.N.S stands for transcutaneous electrical nerve stimulation which in english means that the device stimulates your nerves through your skin. You can either buy or hire your T.E.N.S machine. Each unit comes with very sticky pads that are placed on your back during labour and send pulses through your skin. This works in two ways.
- Just like rubbing your arm when you bang it the pulse sends fast messages to the brain and blocks the pain temporarily.
- It works like a massage and helps to release endorphins which are your natural pain relievers.
It is suggested that you start using the T.E.N.S machine as early as possible during labour on the lowest setting and as labour progresses you can turn up the sensations if necessary. Many mothers like using the T.E.N.S machine during labour as it is small and portable and you are in complete control. Some mothers say that they use their T.E.N.S machine throughout their labour and other mothers report that they used their T.E.N.S machine until they were ready to get into their birthing pool as part of their self-help strategies. There are good instructions that come with the T.E.N.S and show you clearly how to use it.
The official name for gas and air is Entonox, which is commonly known as laughing gas. It comprises nitrous oxide and oxygen. It is one of the most commonly used comfort measures during labour and it is available if you have booked to birth at home, at a birthing centre or on a labour ward. Some of the advantages of entonox are that it works quickly and if you do not like the effects, you can stop breathing it in and the effects will wear off quickly.
Just a tip - gas and air can make your lips and your mouth feel a little dry so make sure that your birthing partner is aware so they can be on hand to give you sips of water and some lip balm if necessary. It has no lasting effect on you or your baby.
It takes about 30+ seconds for the effect to peak so you need to start inhaling it strongly as soon as you feel the contraction begin, then when the contraction recedes, you can take a break and breathe normal air. Your midwife will be able to help you use it to greatest effect.
Both of these drugs have been used for many years and if used properly are safe. Pethidine and Diamorphine are pain relieving drugs that come from the morphine family. They can be administered by your midwife by an injection in your thigh. Whether Pethidine or Diamorphine are used depends on where you choose to have your baby. Some mothers find that they can be helpful in managing early contractions if they are particularly strong or are accompanied by persistent backache as the drugs typically start working within 30 minutes. They are ideally used early on in the first stage of labour but preferably not administered too close to the actual birth as the drug crosses the placenta and can make baby a little sleepy. It may also affect the sucking reflex and can make breastfeeding a little less straightforward. The drugs are often also given with an anti-sickness medicine as some mothers find it can make them feel nauseous. Some mothers will say that they found having either Pethidine or Diamorphine during labour helped them to get some much needed sleep during the first stage while others say that they did not like the effects of the drug.
Some mothers found that by using Pethidine or Diamorphine to manage the early, often long pre or early labour phase, it enabled them to go on and have a water birth which is still possible as the effects wear off after a few hours. The greatest problem is that it can be difficult to predict how you will react and how close to birth you may be. A baby born with the effects of these drugs in their system will need a further injected drug as an antidote and will be sleepy during the important period just after the birth.
When can I have an Epidural? My friend was told it was too late.
Strictly speaking, it is never too late but if you are really close to giving birth and there are no complications, having an epidural might slow things down and lead on to further interventions. If you are well supported and are reminded that the end is in sight, it may be enough to help you cope with the intensity of the final part of the journey to meet your baby. Once the baby is born, that intensity is usually forgotten almost immediately in the euphoria of having done it!
The epidural is only available on a delivery suite in hospital and it is administered by an anaesthetist (a doctor trained to give this sort of pain relief). It is a local anaesthetic given into the epidural space in the back which helps to numb the lower part of your tummy and legs. You should still have some sensation and should be able to feel and move your legs and feet. Once the anaesthetist has given the first dose they leave a small tube in the lower part of your back where the drugs can be topped up during labour as required by you. At most units the epidural is used with a patient controlled device which means that you are in control and every 20 or 30 minutes you can press a button and another dose will be delivered. You will probably have a urinary catheter in situ to ensure that your bladder remains empty.
An epidural can cause your blood pressure to drop so you will be given intravenous fluids to avoid this and the midwife will check your blood pressure regularly whilst it is in place. Whilst you have the epidural it is recommended that baby is continuously monitored with a cardiotocography machine (CTG) during labour.
Having an epidural can have the effect of reducing the frequency of your contractions which in turn will slow your labour, especially in second stage and reduces your chances of a normal vaginal birth, meaning you are more likely to need an intravenous (IV) drip to stimulate the contractions and/or a ventouse or forceps delivery. Some women may get a severe headache after an epidural and others report back ache.
About a third of labouring women choose to have an epidural, with many reporting that they preferred the epidural as it helped them to manage labour better. Others report that, although it was very effective as a form of pain relief, it also made it more difficult to push the baby out in the second stage of labour. An epidural can take up to an hour to arrange, depending on how busy the unit is, which is why having some other ideas for helping manage the contractions can be really useful while you are waiting.
REMEMBER, having positive confident people around you who believe in you can make a big difference. Your Neighbourhood Midwife will be by your side throughout, supporting and encouraging you to believe in yourself and to remind that your body is designed to deliver your baby. Your job is to make sure your mind knows you can do it too!
That really depends on whether this is your first or second baby as first babies usually take a good bit longer to arrive.
Is the baby in a good position with his/her head tucked in and with the back on your left to the front? This is known as the optimal position and being active in pregnancy, (trying not to slouch on the sofa) walking, swimming and giving up work by 36/37 weeks can all help.
As a general rule first stage for a first baby will be 7-14 hours while a second baby will be 1-6 hours. This is, however, just a guide and there are big variations. The old adage that babies come when they are ready really is true!
second stage of labour
The second stage of labour is the actual birth of your baby. It’s the time when you will get to meet the little baby you have been waiting for! During the second stage, you will feel the pressure of your baby's head low down in your pelvis, and with each contraction, may have two or three strong urges to bear down. Some women describe this sensation as wanting to open your bowels. The contractions will ease your baby down the birth canal and you may want to push to help this process. The contractions feel different during this stage and many women feel really tuned in to the messages they are getting from their body. During this stage the contractions may be a little more spaced out which gives you time to rest between contractions. With every contraction, your baby will move through your pelvis a little, but at the end of the contraction, he'll probably slip back a little again. Don't despair. As long as your baby keeps gradually moving down, you're doing fine.
When your baby's head is far down in your pelvis, you'll probably feel a hot, stinging sensation. This will happen as the opening of your vagina starts to stretch around your baby's head and is sometimes called crowning.
Your birthing partner can help in this stage by offering you drinks, using a cool cloth on your face and by continuing to reassure you and giving you loving support. A wash and freshen up to change the energy is also helpful.
Your midwife will tell you when she can see your baby's head, and may ask you to stop pushing and to take short, panting breaths. This helps you to resist the urge to bear down for two or three contractions, so that your baby is born gently and slowly over the perineum.
Taking this approach also helps you to avoid a tear or an episiotomy. Your midwife may use warm compresses to support your perineum as this relieves any discomfort and reduces the risk of damage to this area.
During the second stage, it’s important to have a relaxed jaw and release any tension you find in your face because the muscles or your face and jaw are connected with your perineum. Some mothers like the idea of breathing their baby down with each contraction and not “pushing”. Other mothers like to make a low vocal sound and may not be able to resist the sensation. Breathing in through your nose and out through your mouth, imagining that you are blowing out a candle, can be helpful.
Crowning is the stage just before you give birth to baby’s head. It may feel a bit like burning in your perineum as your baby’s head stretches the tissues. Your midwife will support you to gently ease your baby’s head to be born. You might find it easier to pant at this stage, to help you slow down your urge to push.
At Neighbourhood Midwives, we always try to use a hot compress at this stage, as it eases the sensation and reduces damage to the perineum. By the next contraction, baby will usually be born and will be in your arms.
The second stage of labour is much shorter if you are using upright and active labouring positions. This is because using gravity helps you to ease your baby down the birth canal and using different positions creates more space in the pelvis. The second stage of labour can take up to a couple of hours for a first time mother and an hour for a second time mother. If you have used an epidural for pain relief, the second stage can take a little longer than average.
During this stage your midwife will usually listen to your baby’s heartbeat a little more regularly than in the first stage. National guidance recommends after every contraction and using a hand held Doppler unless there are concerns over your baby in which case, if you are in hospital, she may use a continuous monitor (CTG) with a visual print out.
It can sometimes seem as though you are making no headway but even just a little progress is good if it is steady and constant. Thinking about the journey your baby is making and keeping upright and mobile can really help. The baby has to negotiate a bend around your pubic bone and being upright helps that journey. Changing position and moving your legs and pelvis can be very useful. Squatting with flat feet and a straight back may also help for a few contractions. Many women find an all fours or kneeling position is useful for actually giving birth. If you have had epidural anaesthesia, you may find it harder to use mobility and this can slow the second stage down. If you are getting tired, or if the baby is in an awkward position the doctor may suggest an instrumental birth, using a ventouse or forceps. Make sure that you understand what this involves and that you are in agreement then get your partner and midwife to help you to coordinate your efforts with those of the doctor to enable your baby to be born as soon as possible.
Lots of women will find that the tissues will stretch but may ‘give’ a little leading to a tear. This can easily be stitched afterwards. An episiotomy is a cut in the perineum and should not be done to avoid a tear. It should only be necessary in rare situations if the baby is in extreme distress and needs to be born quickly or if forceps are used. At Neighbourhood Midwives, we encourage women to do perineal massage during late pregnancy or to use something called an Epi-no in the last few weeks, which is designed to reduce the risk of tearing.
third stage of labour
This is the time after the baby is born when the placenta will be delivered.
You have just had your lovely baby and you are introducing yourselves to one another but it is not all over just yet. Unlike what you may see on the movies or TV, childbirth does not end with the birth of your baby, childbirth is complete once you have birthed your placenta.
The placenta is the extraordinary new organ that you grow during pregnancy which ensures your baby has the right nutrients and oxygen to help him grow and develop.
Delayed cord clamping is where your baby’s cord is left alone and not clamped and cut as soon as he is born. At birth, approximately one third of the baby’s blood supply is still in the placenta so by allowing the umbilical cord to continue to pulsate, this richly oxygenated blood, complete with precious stem cells, is transferred from the placenta to your baby after birth. The process is usually complete after a few minutes, indicated by the cord becoming limp and white after which it can be clamped and cut, although some mothers prefer for the cord not to be clamped at all until and remain intact until after they have delivered the placenta.
The evidence shows that babies that have delayed cord clamping have better iron stores for up to six months after birth. Once babies are born, they need to transition from receiving oxygenated blood through the cord in the womb to breathing by themselves and using their lungs. If your baby is slow to breathe after birth, keeping the cord intact ensures that they are still receiving high levels of oxygen thus protecting their brain and other vital organs. Delayed cord clamping is effectively nature’s life support.
There are two ways that you can choose to have your placenta delivered. They are known as physiological third stage and actively managed third stage.
You are said to have had a physiological third stage when you push out your placenta under your own steam. No drugs will be used and the process is an entirely natural one. Soon after your baby is born, your body will release more of the hormone oxytocin that causes your womb to contract. If you imagine you have a sticky label attached to an inflated balloon and you then deflate it, the label will peel away as there is no surface to adhere to. The same thing happens with your placenta as it contracts down. It may take a little while for this to happen but you will need to be aware of any sensations of cramping, fullness or a sense of wanting to push again as this is a sign that your placenta is probably in your vagina ready to come out. If you ignore these sensations, or don’t notice them, the process can take longer as the placenta can just sit there if you aren’t actively pushing it out, preferably using gravity to help!
To enable the process to unfold in its own time though, it is best if you can be relaxed and warm, preferably having skin to skin with your baby in quiet, dark surroundings - in other words the same conditions that facilitates normal birth - without too many distractions to enable you to focus on birthing your placenta.
Only women who have had a normal birth without an epidural or the use of synthetic hormone (Syntocinon) are generally considered suitable candidates for a natural third stage, otherwise your body may not release the right mix of hormones. Normally, you will feel a few contractions, especially if you are feeding your baby or s/he is nuzzling and licking at the breast which encourages the Oxytocin to flow. At this point, your midwife should encourage you to push to out your placenta. One of the benefits of having a Neighbourhood midwife, who you know well, is that you will have discussed this stage of labour during your pregnancy and will know what to expect. This part of the birthing process is generally not painful as the placenta is soft and about 1/6th the size of your baby.
In an actively managed third stage, if it is without delayed cord clamping, your baby’s cord is usually clamped immediately after birth and you are given an injection of synthetic hormone (called Syntometrine or Syntocinon) in your thigh shortly afterwards. This causes your uterus to contract (the same process as with a physiological third stage but using external hormones) and the placenta will usually separate from your uterus. You can still do skin to skin with your baby during this process. The midwife will then gently press onto your tummy, known as ‘guarding the uterus’ whilst guiding the placenta out by gently pulling on the cord. In an actively managed third stage, the placenta is normally delivered within 10-15 minutes, however on some occasions it can take longer.
Did you know that skin to skin is nature’s incubator? It is when your naked baby gets to cuddle directly against your skin. Cuddling skin to skin with your baby helps them regulate their temperature, lowers their heart rate, keeps them calm and even helps them to use less energy. It is also a great way to start your breastfeeding journey if that is how you are choosing to feed your baby. With your permission, anyone you choose can do skin to skin with your baby. For example, if dad would like to, it is a great way for them to bond and for baby to get to know them too. However, skin to skin with mum is the most important method for the baby and you. Skin to skin is also possible if you need a caesarean section – your baby can be placed on your chest in theatre and then both of you covered with towels or blankets.
Although your baby is born and physically separate, he/she can only survive and thrive if kept close to you. Therefore the newborn brain is primed to seek closeness, warmth, comfort and food. This is why babies cry when put down, simple really. We call this the fourth trimester because it is as though they are still attached via an invisible cord.
If you have never met a newborn baby before you may be surprised by his /her appearance. Most newborns do not look like the ones that you see on movies or TV, these babies have had a silicone and jam coating put on them which is quite unlike reality. Sometimes babies can look a little wrinkly and sometimes they are covered in a waxy white coating called vernix. Vernix is an oily coating that protects your baby’s skin whilst they are growing in the womb. It is designed to stop your baby’s skin from becoming waterlogged in the amniotic fluid. Vernix has properties that help to protect your baby’s skin.
Some newborns have a soft hairy down called lanugo. Lanugo covers the baby’s body when they are in the womb and it helps to keep baby warm. Most full term babies do not have much vernix or lanugo and it is more commonly seen on babies that are born a little early.
Your baby has been living in water so will be wet when he is born and will start to cool down very quickly in the normal environment. Whether you have given birth on land or in the birthing pool, your midwife will usually dry him or her quickly with a soft towel to prevent too much loss of body heat before passing him straight to you, ready for you to greet him after all these months of waiting. Apart from a little blood or poo sometimes, babies are surprisingly clean, soft and smell wonderful.
Ideally you will be cuddling your baby skin to skin and offering the first feed. Also at this time your midwife will check on your blood loss – it will be like a heavy period in the first 24 hours or so. Some blood loss after birth is normal and your midwife will make sure that all is well. Your midwife will check your blood pressure, temperature and pulse. She will support you to feel comfortable after birth and with your consent will examine your perineum to see if you need any stitches. At some point after the birth it is time for a cup of tea and toast all round and then, once you have had as much time as you need and feel ready, your midwife will run you a bath which usually feels wonderful!
If you are at home, your Neighbourhood Midwife stays with you until the baby is feeding, you have settled back into bed and had something to eat. Then, once she leaves, she is only a phone call away if you are worried about anything and want to check with her.
Did you know that as soon as your baby is born, your midwife will be quietly assessing how your baby is doing? Within the first minute your midwife will do an assessment, known as the Apgar score, which will inform her as to how your baby is responding to life on the outside. She will score the baby out of ten: up to two points each for heart rate, breathing, colour, tone and response to stimulus. Most babies are still a little blue in their hands and feet at one minute of age so tend to score only one point for colour – so a total of nine at the first assessment is common. This check is repeated again at five minutes after birth to ensure that your baby continues to adapt to the world outside the womb by which time his whole body is usually pink and the total score is ten out of ten. The clever thing about the Apgar assessment is that you and your baby do not need to be separated whilst it happens so that you can be enjoying getting to know one another.
Some time after birth your midwife will carry out a further check from head to toe to ensure that all is well with your baby. The midwife will discuss with you if any problems have been observed and what they mean. Your midwife may listen to your baby’s heartbeat, check their breathing pattern and she will weigh your baby and check the head circumference. This is important information to share as family and friends always want to know how much the baby weighs!
Vitamin K is a fat soluble vitamin that is needed to help the blood clot, It is produced by the ‘friendly bacteria’ found in the gut, and is found in a healthy and varied diet.
Babies are born with lower levels of vitamin K than adults because their gut is immature and sterile at birth. The levels start to increase once the baby’s gut is colonised by the friendly bacteria at birth (particularly after a vaginal birth) and once feeding is established the baby can absorb the vitamin K from the milk and make use of it.
Between 1:10,000 – 1:25,000 babies have a problem with this level of vitamin K which means that if they were to have a bleed internally – a haemorrhage – for any reason, their system would have difficulty in stopping the bleed. In most cases, these babies have Vitamin K deficiency bleeding (VKDB), previously known as haemorrhagic disease of the newborn (HDN). Risk factors for this condition include prematurity, instrumental delivery, caesarean section and the mother taking drugs to stop their blood clotting or to control epilepsy. Although a potentially very serious condition, VKDB is very rare when there are no risk factors and you have had a straightforward physiological birth.
The Department of Health (DH) recommends that all babies are given Vitamin K soon after birth to minimise the risk of VKDB developing. It can be given by a single injection at birth or by mouth in three doses, at birth, at seven days and 28 days. The Vitamin K that is given to babies is a synthetic substance containing small amounts of hydrochloric acid and other substances. It also contains animal derived products and may not be suitable for vegetarian or vegans. It is your choice as to whether you choose to give your baby Vitamin K and this is something you will discuss with your Neighbourhood midwife prior to the birth and afterwards depending on the type of delivery you have had.
If I give birth in hospital, how soon can I go home after my baby is born?
This very much depends on the sort of birth you have had and how well you and the baby are. If all is well you should be able to go home within 8-12 hours. Often women are delayed by waiting for paperwork. You will be offered a more detailed check of the baby than the apgar assessment – known as the ‘examination of the newborn’ and that too can delay you leaving. Neighbourhood Midwives can arrange this at home for women booked with them.
The other delay is if the baby is slow to feed and the hospital staff are worried about you coping at home. They may want to be sure that the baby is feeding well before you leave as the community midwife may not be able to see you for a day or two. Your Neighbourhood Midwife will visit you as soon as you are home to provide the support needed so that can help ensure you are discharged sooner.
Get into your PJs and go straight to bed! Rest, eat well, cuddle your baby and feed him/her and don’t worry about any of the routine things. Keep visitors at bay for a day or two as well. This is your Babymoon.