Labor and birth | Your guide to childbirth.

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Women should be offered the choice of planning birth at home, in a midwife-led unit or in a hospital.

Where you choose to have your baby and whom you choose to look after you in labour will affect the type of birth you have and the care you receive!!!

Homebirth

Advantages
You can labour and give birth in familiar surroundings. You are likely to be more relaxed and this can help your labour to progress
You don't have to make a decision about when to go to hospital or interrupt labour with a journey
You will probably be looked after by a small team of midwives who will have got to know you during your pregnancy, and they will also look after you in the days following the birth of your baby
You may find labour less painful and are less likely to want strong pain-relieving drugs
You are less likely to have medical interventions.
If you have older children, you will not need to leave them;

Considerations
You will need to transfer to hospital if you want an epidural or there are complications (e.g abnormalities of the fetal heart rate,significant meconium-stained liquor,epidural pain relief,haemorrhage, cord presentation/prolapse,retained placenta,malpresentation or breech presentation,raised blood pressure,uncertainty about the presence of baby's heartbeat, third- or fourth-degree tear or other complicated perineal trauma requiring suturing,etc)

You may feel more anxious if you are not in hospital. Most women actually feel more relaxed at home, but if you were to start feeling anxious either before or during labour, you can still choose to go to hospital

You may find that there is disapproval from family or friends, although this should not deter you if you think that giving birth at home is the right decision for you. There are also some health professionals who are not particularly supportive of home births, despite the research on their safety

There are specific safety issues for you to carefully consider if your baby is breech, if you are having twins or if you have had a previous Caesarean birth, although it may still be possible to have a home birth in these circumstances. You also need to take your own health into consideration when planning a home birth. If the birth is not likely to be straightforward, you may find it more difficult finding support from health professionals.





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Natural
Breathing and relaxing techniques,water submersion (your bathtub or even better - a pool!),aromatherapy,acupuncture,and TENS machine

Medical

Entonox (a 50:50 mixture of oxygen and nitrous oxide)
may make you feel nauseous and light-headed

Pethidine, diamorphine or other opioids
limited pain relief and may have significant side effects for both the woman (drowsiness, nausea and vomiting) and baby (short-term respiratory depression and drowsiness which may last several days).

Epidural

only available in hospitals;
provides more effective pain relief than opioids;
associated with a longer second stage of labour and an increased chance of vaginal instrumental birth;
It will be accompanied by a more intensive level of monitoring and intravenous access;
Modern epidural solutions contain opioids and, whatever the route of administration, all opioids cross the placenta and in larger doses (greater than 100 micrograms in total) may cause short-term respiratory depression in the baby and make the baby drowsy;

This is a great article on epidurals:
Ecstatic Birth: The Hormonal Blueprint of Labor

Spinal block
A narcotic or anesthetic, such as fetanyl, bupivacaine or lidocaine is injected below the spinal column directly into the spinal fluid and provides pain relief for up to 2 hours.

It is easy to confuse a spinal block and spinal epidural because they are both injections into the spinal area. For a spinal block, narcotics or anesthetic is injected once with a needle. For a spinal epidural or combined spinal epidural, a catheter is placed in the epidural space to allow continuous anesthesia. Spinal blocks are not widely administered today because of the popularity of epidurals, though they may be used in a more complex birth situation or cesarean delivery.

Baby bestsellers

Trust me I know how frustrating it can be! You have had enough! GET THAT BABY OUT OF ME RIGHT NOW! The worst thing is when family and friends start calling you everyday: "Are you in labor yet?" Take that phone off the hook,girl! Have a good moan/cry and now PULL YOURSELF TOGETHER!

I will remind you of popular natural stimulation methods. However, there is no medical evidence that it actually works, and those who swear by it?-well,it could have been a coincidence. I know you are fed up but you have waited for so long,surely another few days will not make such difference? Plus, even if it's hard to believe right now - you will actually MISS being pregnant! It's a magic time, and second time mothers will support me in saying that each pregnancy feels so different to the last one. TREASURE IT WHILE IT LASTS!!!

Only like 5% of births happen on the actual due date. The NORMAL gestation period is 38-42 weeks.

Some of us cook our babies longer than others!!!

Pressure from medics - Potential complications
Recent studies have shown an increasing risk of infant mortality for births in 41st and particularly 42nd week of gestation, as well as a higher risk of injury to the mother and child.The recomended date for induction of labor has therefore been moved to the end of the 41 week of gestation in many countries including Sweden and Canada.

What are they worried about?

The risk of fetal death and stillbirth is considerably higher in postmature babies.
The risk of macrosomia (very large baby) and dysfunctional labor is higher.
There is an increased risk for operative delivery (cesarean, forceps and vacuum).
More intervention is done for postdates pregnancies (induction, monitors, IVs and testing).
The risk of infection and hemorrhage goes up slightly.
The most critical factor in a postdates pregnancy is fetal and neonatal health. Meconium, which is often present in the fluid of a postdates baby, can be aspirated into the lungs.

Natural induction of labor methods

Sex
A lot of it! Semen contains natural stimulants -prostaglandins. Prostaglandins cause the cervix to "ripen", or soften and prepare to open. This one "worked" for me.
Nipple stimulation
Reflexology
Acupuncture/Acupressure
Relaxation and visualization
Spicy Food
Pineapple
Clary Sage
Castor oil
Blue cohosh

Medical Induction of labor

Of course there are other reasons for induction of labor. Those include complications,such as raised blood pressure,gestational dibetes,large babies,fetal growth restriction(IUGR),etc

Assessing the cervix
If induction is attempted on an "unripe" cervix may result in failure to dilate in response to uterine contractions and, as a consequence, in prolonged and exhausting labors,high c-section rates,etc.
There are several scoring systems,but the most popular

Bishops score system

Assessment score

Dilation(cm)

Effacement(%)

Fetal station

Consistency

Position

0

0

0-30

-3

firm

posterior

1

1-2

40-50

-2

medium

middle

2

3-4

60-80

-1;0

soft

anterior

3

5-6

90-100

1; 2; 3

Sweeping of the membranes
Your baby is contained inside of a sac of amniotic fluid in your uterus. A number of membranes attach this sac to the inside of the your uterus. In order to encourage dilation of your cervix, these membranes need to be separated from the lower part of your uterus. To do this, your health care provider will insert a finger into your cervix, and, using a rotating motion, "sweep" the membranes from the side of your uterus. This helps your body to release prostaglandins, which will encourage contractions and the dilation of your cervix.
This procedure can be quite uncomfortable or painful.There are some risks, including: infection, bleeding, and accidental rupture of the amniotic sac.

Prostaglandin Gels and Suppositories
Prostaglandins are special hormones that help to stimulate contractions, thereby softening your cervix. Using a syringe, the prostaglandin gel is placed around your cervix. A prostaglandin suppository, much like a tampon, can also be inserted into your vagina, producing the same effect.

Oxytocin
Oxytocin is a hormone that is naturally produced by your body during labor. It helps to stimulate contractions and allows labor to progress. However, this hormone is also available in synthetic form and can be administered by your health care provider thereby inducing labor

The first stage of labour results in the neck of the womb - the cervix - dilating to a full ten centimetres and consists of early, active, and transitional phases.

Duration
It differs for each woman! According to medics, first labors last on average 8 hours and are unlikely to last over 18 hours. Second and subsequent labors last on average 5 hours and are unlikely to last over 12 hours.
Hmmm, my first labor lasted 30 hours from first contraction to C-section...I'll let you know how the second labor goes :)

Early (latent) labour

Definition - a period of time, not necessarily continuous, when there are painful contractions, and there is some cervical change, including cervical effacement and dilatation up to 4 cm.

Active (established) labour

Definiton-when there are regular painful contractions, and there is progressive cervical dilatation from 4 cm.

Transition

During the transitional phase, the cervix dilates from eight to ten centimetres. Contractions may last as long as one to one-and-a-half minutes and occur every two to three minutes. You might feel shaky, shivery and sick. (Or you might feel none of these things!) Many women report that this phase is so intense they feel as if they're having an out-of-body experience.

Hospital protocols and procedures

Now I know how important it is to find out your hospital protocol for certain things. Especially,if you are in US as here, in UK, they are pretty much similar to one another. Ask questions,A LOT of them. If something seems unreasonable,ask to see it on paper. Prepare a birth plan and ask your doctor to sign it. Warn them if they do something without your consent, you will sue! I know it seems a bit extreme,but you don't need to be rude, it's normal - your body,your baby,your concerns. Better be safe than sorry afterwards!

Vaginal examinations
Ok, those can range from uncomfortable to super painful! First of all, make sure they explain the reason for those and get your consent first. In some case,they might be necessary (although I know of ladies giving birth at home and never having one just fine) - because my blood pressure was through the roof, the docs needed to ensure I was dilating "efficiently". However, if everything is fine, and you feel pressured to be examined with no apparent need (apart from the doc getting tired for you to pop), remember you CAN refuse those!

Eating and drinking

Many hospitals forbid eating and drinking during labor. However, more and more studies show that food and fluids can benefit mom during childbirth.

Monitoring

Intermittent monitoring can be undertaken by either Doppler ultrasound or Pinard stethoscope.This type of monitoring allows you much more freedom of movement to walk, use the toilet, use a shower or tub, seek more confortable positions,etc.

Continuous monitoring Should complications arise (or if you are VBAC-ing), you will be strapped to monitor for the entire labor.Because your mobility is restricted, you run the risk of having an instrumental birth which, in turn, increases your chances of tearing.
Many studies have shown that babies are not born in better condition with continuous EFM in comparison with babies who are monitored intermittently.

Comparing continuous electronic monitoring of the baby's heartbeat in labour using cardiotocography (CTG, sometimes known as EFM) with intermittent monitoring (intermittent auscultation, IA)

Positions during labor

A recent Cochrane review found that women who assume upright positions during the first stage of labour - such as walking, sitting, standing or kneeling as opposed to lying down - experience a shorter first stage of labour. The review also found that women who laboured in upright positions were less likely to seek pain relief through epidural analgesia.
The Royal College of Obstetricians and Gynaecologists (RCOG) encourages women to mobilise and remain upright as much as possible during the first stage of labour. It is likely that being upright helps that baby's head to descend and turn into the right position. The pressure of the baby's head on the cervix may also help to strengthen contractions.

In the past, traditional epidural methods meant that it was impossible for women to walk around. However, most hospitals now offer a mobile epidural, which allows women to walk around and remain upright. A mobile epidural contains a different mixture of medication, providing pain relief while limiting loss of sensation in the legs. It is consequently possible for most women to choose pain relief and to remain mobile during the first stage of labour.

Fetal monitoring need not interfere with mobility. Intermittent monitoring of the baby is recommended for low-risk women, while high-risk women may require continuous monitoring. Fetal monitoring equipment can be attached by a lead that allows for freedom of movement. All women having a vaginal birth are encouraged to ambulate during the first stage of labour, provided that they feel capable of doing so. The RCOG recommends that women be encouraged to assume whatever position is most comfortable to them.

Directed ("purple")pushing

The second you get fully dilated (10 cm),they might ask you to start pushing (bearing down) whether or not you have an urge to do so. They might tell you to hold you breath and push while they are counting till 10 and screaming "PUSH! PUSH! PUSH!".
Some women actually break blood vessels around their eyes and cheeks from straining.

In fact, there is no evidence that pushing right from the very start is particularly effective in speeding labor along. It may actually have the opposite effect, or might put your baby into an awkward position.

Furthermore,holding your breath and pushing like crazy may seriously reduce the amount of oxygen the baby receives, or affect your blood pressure.

Most women will feel the urge to push naturally with each contraction. They say that's what helps them to ease that burning pain.Sometimes the midwives will ask you to slow down and pant so you don't tear and they say it's very hard not to push.
Many women will not feel an instant urge to push once they are fully dilated. Some may take break. Some may not ever feel a strong pushing urge . All of these scenarios are NORMAL.

Occasionally, a woman will want to push before her cervix is fully dilated. That might bruise or tear the cervix. It can help to pant softly to avoid bearing down. You can also get on your hands and knees or lie down on your left side for a moment to slow things down a bit.

Pushing and Birthing Positions

The best positions are kneeling, squatting or standing, as all of these use gravity to help the baby out. Lying on your back isn't a good position as you will be pushing the baby up hill, and it makes the pelvis smaller.

Side-lying - This is a great position to conserve energy as well as rotate a baby whose head is either posterior (OP) or transverse (OT). It can also help reduce tearing.

Hands & Knees or All fours -One of the hands-down (no pun intended) best positions to slow a fast second stage, rotate a baby, relieve back pain or reduce tearing.

Squatting - This has long been a favorite position in other cultures to open the pelvis and increase the urge to push. This is not a good position if the baby is OP or OT since you should encourage your baby to rotate first. It also is not ideal if the labor is going fast since it can increase tearing. In addition, squatting is not a position most women in the US are comfortable in for too long so it can be exhausting.

Pushing while on the toilet - This is one of the best positions if mom is having trouble in the second stage with pushing since it is a natural place to "let go." It is not a good position if you are having a fast labor or a strong urge to push as soon as you are 10 cm dilated.

Maternal-Fetal Ejection Reflex

So, your beautiful baby is finally here! Welcome earthside!!!
Put your baby on your stomach,cover him and enjoy some skin-to-skin contact.
Some babies start searching for the nipple straight away. Others take a bit longer, so be patient and follow your baby's lead. Once the baby begins to move her mouth or lick your nipple, try to help her to latch on. If you feel unsure or need a bit of help (and many new mothers do), ask your midwife/nurse to help you, or if you are in the hospital they should have a lactation specialist.

Clamping the Umbilical Cord

If you are in the hospital,they normally clamp it in 2 places within a couple of minutes of birth, and then cut between the clamps. However, you CAN request to clamp later.Proponents of late cord-cutting think it best to wait until the cord is no longer pulsing, allowing all of blood to go to the infant, and then to cut it.

Now, delivering the placenta (or afterbirth)

Physiological(natural)third stage

Active(managed)third stage

No drugs

Drug given to make the uterus contract

Cord not clamped until it stops pulsating

Cord cut and clamped following birth of baby although in some circumstances it may be delayed

No traction (pulling) applied to cord

Controlled cord traction(cord pulled gently to help deliver the placenta)

Placenta delivered through woman's effort

Placenta delivered by birth attendant

Process may take up to an hour (average about 30 min)

Process takes 4-7 minutes

To start with, you will produce colostrum. This special milk is yellow to orange in color and thick and sticky. It is low in fat, and high in carbohydrates, protein, and antibodies to help keep your baby healthy. Colostrum is extremely easy to digest, and is the perfect first food for your baby.
It is low in volume (measurable in teaspoons rather than ounces), but high in concentrated nutrition for the newborn. Colostrum has a laxative effect on the baby, helping him pass his early stools, which aids in the excretion of excess bilirubin and helps prevent jaundice...
For more info read here. Your milk then will come in 24-48 hours, and your breasts will be engorged and tender.

Assesment of your baby

Remember that any examination or treatment of your precious newborn should be undertaken with the consent and in the presence of you or your partner or, if this is not possible, with your knowledge!

Apgar score

Given for each sign at one minute and five minutes after the birth. If there are problems with the baby an additional score is given at 10 minutes. A score of 7-10 is considered normal, while 4-7 might require some resuscitative measures, and a baby with apgars of 3 and below requires immediate resuscitation.

Sign

0 points

1 point

2 points

Activity (Muscle Tone)

Absent

Arms and Legs Flexed

Active Movement

Pulse

Absent

Below 100 bpm

Above 100 bpm

Grimace(Reflex Irritability

No Response

Grimace

Sneeze;cough;pulls away

Appearance(Skin Color)

Blue-gray;pale all over

Normal except for extremities

Normal over entire body

Respiration

Absent

Slow;irregular

Good;crying

Perineal or genital trauma

First degree - injury to skin only.Normally does not require any stitching.

Second degree - injury to the perineal muscles but not the anal sphincter.The muscle should be sutured in order to improve healing.If the skin is opposed following suturing of the muscle in second-degree trauma, there is no need to suture it.

Third degree - injury to the perineum involving the anal sphincter complex:

Fourth degree- injury to the perineum involving the anal sphincter complex (external and internal anal sphincter) and anal.

After the surgery you will be offered antibiotics, pain relieving drugs and laxatives which will make it easier and more comfortable to open your bowels. Keep the area clean,drink a lot of water and eat a balanced diet.Once you doc OK's it, start doing pelvic exercises.

At first, your little one will sleep most of the time. Mine slept pretty much all day and kept me awake at night :). If your baby has been asleep for longer than 3 hrs, please wake him up for a feed!

Touch is especially essential to newborns. Your baby needs to be held in order to feel secure and uses touch to learn about his environment. You may be surprised how much your baby wants to be held-but it is just what she needs- her MAMA :)

Please do not listen to people who tell you to put your baby down cause that might spoil him...HE IS ONLY A BABY!!! Enjoy and treasure this magic time.

http://www.gentlebirth.org

http://www.midwiferytoday.com

http://activebirth.org

http://spinningbabies.simplwebsite.com/

http://www.homebirth.org.uk

http://www.mothering.com

http://www.kellymom.com - This one will become your Bible once your little one is here :)