Baby and You

Special delivery

Side view of a happy family in the maternity hospital, father holds elder son, mother stands with infant
You might not want to dwell on it too much, but when the time is right your baby, or babies, have to come out somehow! If you approach your imminent labour with excitement and, if possible, a relaxed attitude, then your body will be better prepared to deliver your baby, whichever route it ends up taking out of there. Anna Tobin outlines the options available

Natural Birth
Giving birth without any medical intervention is right for some mums, but not for others. So don’t feel guilty if you can’t give birth naturally. You need to follow your doctor’s advice and do what is best for the health of you and your child. If, however, you are considered low risk and plan to have a natural labour, you need to first decide where it’s going to happen.

HOME BIRTHS
You can have your baby at home, but if it’s your first baby and you don’t know how you are likely to labour, you may feel more secure giving birth in a birth centre or hospital. The results of the NICE Intrapartum Care Guidelines, published in December 2014, show that there are benefits for women who have already had a baby and have a straightforward pregnancy in planning a home birth.

When you give birth at home, a midwife will come and be with you throughout your labour, and if the midwife is concerned at any point, such as your labour is taking a long time, your baby is showing signs of fetal distress, you request an epidural or you have a complicated tear, arrangements will be made for you to be transferred to a hospital.

Being at home means that you are in comfortable relaxed surroundings, you don’t need to worry about childcare for your other children whilst you are in hospital and your partner can be with you throughout the birth and after it to help with the newborn.

You won’t have access to all the pain relief options you can receive at a hospital such as an epidural, but you may be able to get natural birthing aids such as a birthing pool and statistics show that home births are less likely to require the assistance of forceps or a ventouse. Figures from the Office for National Statistics show that 2.3% of women in England and Wales gave birth at home in 2015.

BIRTH CENTRES
Birth centres are run by midwives and may or may not be attached to a hospital, so if complications occur you may need to be transferred to hospital and you need to consider how long this could take should the need arise. Having immediate access to a hospital with specialised medical care would be preferable in such an eventuality. You are less likely to be transferred to a hospital if it is not your first baby.

Birth centres, however, have a much more relaxed, homely feel than a hospital environment, and you are more likely to have a midwife with you who has cared for you throughout your pregnancy than you would if you gave birth in a hospital.

If the birth centre is a standalone unit, not connected to a hospital, certain pain relievers such as epidurals will not be available to you, but there may be other facilities such as birthing pools and birth centre births are less likely to require forceps or ventouse.

HOSPITAL BIRTHS
When you labour in a hospital maternity unit, midwives look after you, but doctors are on hand should you require further medical assistance, plus there will be a specialist doctor on hand and a special care baby unit should a complication arise. You will also have access to anaesthetics such as epidurals. When you give birth in a hospital you are less likely to know your midwife. Your birth partner can remain with you for a hospital labour.

ASSISTED DELIVERY
About 10-15% women undergo an instrumental (assisted) delivery, where forceps or a ventouse suction cup (ventouse) are used to help deliver the baby’s head. This can be because there are concerns about the baby’s heart rate, your baby is in an awkward position or you’re too exhausted. Both ventouse and forceps are safe and only used when necessary for you and your baby.

Sometimes during the process of giving birth, a doctor or midwife may make a cut (episiotomy) in a woman’s perineum (the area between the vagina and anus). The cut makes the opening of the vagina a bit wider, allowing the baby to come through it more easily.

Pain Relief options
There are a number of natural and medical interventions that you can draw on to help to relieve the pain of labour:

AND BREATHE
Deep breathing helps to calm and relax your body, and if you attend antenatal classes during your pregnancy you will learn different breathing techniques or your midwife may run through this with you during a routine appointment.

WATER
Many women find that being in warm water helps to relax muscles and reduce the pain of contractions. Find out whether birthing pools are available where you plan to give birth or consider hiring one if you are having a home birth. You can choose to have your baby in the pool or to leave the pool once you are ready to give birth. Water births are for low risk term pregnancies only.

GAS AND AIR

Gas and air or Entonox to give it its medical term, contains oxygen and nitrous oxide. It is taken during regular contractions. You breathe it in through a mouthpiece. It reduces the pain, but may make you feel nauseous or light-headed and can make your mouth dry.

A TENS MACHINE
Small amounts of electrical current are delivered through pads taped to your back with a Transcutaneous Electrical Nerve Stimulation (TENS) machine. You control the strength of the current with a hand-held device. This works by blocking pain signals and encouraging your body to produce endorphins, its natural pain killing chemicals. It’s particularly useful in the early stages of labour.

INJECTED MEDICATION
You may opt to have an injection of a painkiller such as pethidine, ideally early on in labour only as it can affect how awake the baby is upon delivery. These take around 20 minutes to take effect and last from two to four hours. They may make you feel woozy or forgetful and could make it hard to push when you are ready to deliver. If they are given too close to delivery, they can also affect baby’s breathing and could disrupt breastfeeding.

EPIDURAL
This is a local anaesthetic that is injected into your spine to numb the nerves sending pain signals to your brain. It is a very effective treatment, particularly for long labours and is only available at hospital births.

As the effects of the anaesthetic will mean you won’t be able to tell if you need a wee, you may have a catheter inserted into your bladder just before the procedure to empty it and this may remain in place for a while afterwards (catheters are not always used routinely when a woman has an epidural). Epidurals can cause headaches, nausea and backache and very rarely more serious side effects, which your midwife should run through with you.

ALTERNATIVE THERAPIES
Some women find acupuncture, aromatherapy, homeopathy, massage, music and reflexology soothing during labour. A doula can provide effective support too. Do your research to see which you find helpful during pregnancy, and make sure you include the relevant kit in your hospital bag and get your birth partner ready to administer it.

Caesarean
Your or your unborn child’s medical history may mean that you need to deliver via an elective caesarean section. Or, if complications arise during labour, you may have to have an emergency caesarean.

AN ELECTIVE CAESAREAN
If you are having a planned caesarean, your midwife or doctor will arrange a date for it, generally close to your due date. Before the operation you will need to have a blood test and be asked to sign a consent form.

AN EMERGENCY CAESAREAN
If you begin to get vaginal bleeding, if baby is not thought to be getting enough oxygen or if labour is not going to plan and baby is becoming distressed an emergency caesarean will be performed.

WHAT DOES A C-SECTION INVOLVE?
A doctor will make an incision in the front of your tummy through to your womb. Most caesarean sections are performed under epidural or spinal anaesthesia. You remain awake throughout the procedure, as it is safer for you and baby. A general anaesthetic (which puts you to sleep) is sometimes used, particularly if the baby needs to be delivered quickly. You will also be offered antibiotics to reduce the risk of developing an infection after the operation. Your birth partner can remain with you the whole time (this will almost certainly not be the case If you have a general anaesthetic).

Once your baby has been delivered, the surgeon will remove the placenta. Your stomach will then be stitched back together again with dissolvable stitches. You will then be given an oxytocin hormone injection, which encourages your womb to contract and minimises blood loss. The whole operation takes between 30 and 45 minutes.

It takes longer to recover from a C-section than a natural birth. You will usually be fitted with a catheter for up to 24 hours. You will normally remain in hospital for two or three days and you will be prescribed painkillers for the first few days. It will take around six weeks for you to completely heal.

About the Author
Mum of two Anna Tobin writes regularly for the national press and women’s magazines on pregnancy, parenting and consumer issues.

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