Birth

Before labour

Before labour starts it is normal to worry about knowing when to come in to hospital - this is one of the most commonly asked questions toward the end of pregnancy. The answer is - if you need pain relief or if you need hands on reassurance then you need to come to Cabrini. Labour is a unique experience. While you are labouring at home it is safe to take panadol, use heat packs and massage and you may like to hire a TENS machine. In early labour try and get rest, stay well hydrated and DO NOT count every contraction.

When you are ready to come to hospital please phone and let the midwives know, communication is key. When you arrive they will ensure that both you and your baby are well, they will determine how frequent and strong your contractions are and will start to work through your birth preferences with you. A birth plan does not need to be in printed form, but it may be if this is right for you. It may be as simple as “see how it goes”. The midwives will then contact the obstetrician.

Pain relief in hospital includes nitrous oxide (also known as laughing gas), an injection of morphine and an epidural. Every birth suite has an ensuite with a limitless supply of hot running water in the shower. There are fit balls, gym mats and peanut balls all to help keep you active and mobile while you want to be. Epidurals are available 24 hours a day every day of the week, and it is only ‘too late’ when we can see the top of your baby’s head. The epidural insertion is performed by our on call anaesthetist who will aim to be with you within 30 minutes of being phoned.

Labour

For most pregnancies, labour will start spontaneously between 37-41 weeks. 37 and 38 weeks are considered early term, 39 and 40 weeks are at term and 41 weeks late term. Labour usually starts with contractions, and the ‘waters break’ (the membranes tear open with the pressure from contractions) during active labour. About 20 per cent of the time the ‘waters break’ before the contractions start.

Let’s get prepared - it may take up to 24 hours from your initial contractions until you meet your first baby. The good news is, the length of the active part of labour (when your cervix dilates from three centimetres to ten centimetres) is halved in subsequent pregnancies. Contraction pain is like period pain initially, it comes in waves, and over the course of your labour there is far more time spent without pain than there is with pain. Our brains are trained from a young age to recognise pain as a warning about something dangerous that can harm us - labour pains bring us to a safe place to give birth to our baby. Coping with labour pain is not about having a high pain threshold and it should not be about proving that you can do it ‘naturally’. It is about being prepared, understanding what is happening with your body, having strategies to manage the pain and being supported by people who love you and know how to make the journey safe for you and your baby.

After the active phase of labour comes the pushing stage. The cervix is ten centimetres dilated and the baby’s head is low in your pelvis. This often gives you a sensation like you need to poo. Pushing is physical and your midwife, obstetrician and even your partner will be involved in coaching and guiding you. It takes a bit of mind preparation to get pushing right, as the sensation is exactly the same as bearing down on the toilet. It is normal for the pushing stage to take up to two hours with your first birth.

Assisted birth

Another commonly voiced concern toward the end of pregnancy relates to assisted birth. If you have been actively pushing without the baby moving we will discuss an assisted birth, which may involve using obstetric forceps. We may also need to assist if the baby becomes distressed during the pushing stage of labour and needs to be helped out quickly. Forceps will often leave a temporary pink line where they cradle the baby’s head, occasionally this will bruise and rarely this leaves a skin imprint which takes longer to fade. Forceps do slightly increase the stretch on the vagina and perineum with the birth which leads on to the conversation about episiotomy.

An episiotomy will only be used when absolutely necessary and almost always with pain relief. On the very rare occasion that it is needed before pain relief can be used it is performed at the peak of a contraction, making it nearly imperceptible, and the baby is usually born with that same contraction. An episiotomy is only performed if a baby needs to get out quickly or we are worried about extensive ‘natural’ trauma to the perineum with the birth. It is not always appropriate/possible to have a long discussion about the pro’s and con’s of an episiotomy at the time so it is important to know that this decision is never taken lightly and an explanation will always be provided.

Birth by caesarean section

Birth is not always associated with labour. Some babies will ‘choose’ to be born by caesarean section, and some mothers will choose this mode of birth. Babies who are in the wrong position at term may need to be delivered by caesarean, or their placenta may be found to be blocking the natural exit, also necessitating an operative birth prior to labour. A vaginal birth will have a stretching effect on the pelvic floor and this consideration leads some women to opt for a caesarean section. During labour a caesarean section is necessary if it becomes the safest choice for either the mother or, more commonly, the baby. Caesarean birth is definitely not the easy way out as you are recovering from surgery while also learning to care for a newborn baby. A caesarean operation takes about 45 minutes and will involve an anaesthetist who provides the pain relief, a paediatrician who cares for your baby, a surgical assistant who helps with the surgery, as well as your midwife and the theatre team of nurses and support staff.