INDUCED LABOUR
Induced labour is one that is started artificially. It's fairly common. Every year in the UK, one in five labours are induced. There are a number of reasons labour may need to be started. The baby is overdue or if there is any sort of risk to you or your baby's health. This risk could be if you have a health condition such as high blood pressure, for example, or if your baby is failing to grow. It's normally planned in advance and you're able to discuss it with your midwife and doctor. Every woman has the right to refuse an induction though. Most women go into labour spontaneously by the time they are 42 weeks pregnant. If your pregnancy lasts longer than 42 weeks and you decide not to have your labour induced, you should be offered increased monitoring to check your baby's wellbeing. It is usually more painful than if you go into labour naturally.
Membrane sweep
Your midwife may offer you a sweep if you are full-term and waiting for labour to start. She'll suggest a sweep at your 40-week appointment if this is your first baby, or at your 41-week appointment if you've had 2 or more babies before.
During a sweep, your midwife carefully separates the membranes that surround your baby from your cervix to stimulate the production of prostaglandin. If your cervix is not dilated enough to do a sweep, she may stretch or massage your cervix instead. You may be offered two or three membrane sweeps.
It can be uncomfortable if your cervix is difficult to reach, and you may need to have several membrane sweeps before labour starts. If you are unclear about anything, ask your midwife to explain.
If you're being induced, you'll go into the hospital maternity unit.
Contractions can be started by inserting a pessary or gel into the vagina. A pessary looks a bit like a tampon. Induction of labour may take a while, particularly if the cervix needs to be softened. Walking around usually helps.
If you have a vaginal tablet or gel, you may be allowed to go home while you wait for it to work. You should contact your midwife or obstetrician if:
your contractions begin
you have had no contractions after six hours
If you've had no contractions after six hours, you may be offered another tablet or gel.
If you have a controlled-release pessary inserted into your vagina, it can take 24 hours to work. If you aren't having contractions after 24 hours, you may be offered another dose.
Sometimes a hormone drip is needed to speed up the labour. Once labour starts, it should proceed normally, but it can sometimes take 24-48 hours to get you into labour.
INDUCED LABOUR
Induced labour is one that is started artificially. It's fairly common. Every year in the UK, one in five labours are induced. There are a number of reasons labour may need to be started. The baby is overdue or if there is any sort of risk to you or your baby's health. This risk could be if you have a health condition such as high blood pressure, for example, or if your baby is failing to grow. It's normally planned in advance and you're able to discuss it with your midwife and doctor. Every woman has the right to refuse an induction though. Most women go into labour spontaneously by the time they are 42 weeks pregnant. If your pregnancy lasts longer than 42 weeks and you decide not to have your labour induced, you should be offered increased monitoring to check your baby's wellbeing. It is usually more painful than if you go into labour naturally.
Membrane sweep
Your midwife may offer you a sweep if you are full-term and waiting for labour to start. She'll suggest a sweep at your 40-week appointment if this is your first baby, or at your 41-week appointment if you've had 2 or more babies before.
During a sweep, your midwife carefully separates the membranes that surround your baby from your cervix to stimulate the production of prostaglandin. If your cervix is not dilated enough to do a sweep, she may stretch or massage your cervix instead. You may be offered two or three membrane sweeps.
It can be uncomfortable if your cervix is difficult to reach, and you may need to have several membrane sweeps before labour starts. If you are unclear about anything, ask your midwife to explain.
If you're being induced, you'll go into the hospital maternity unit.
Contractions can be started by inserting a pessary or gel into the vagina. A pessary looks a bit like a tampon. Induction of labour may take a while, particularly if the cervix needs to be softened. Walking around usually helps.
If you have a vaginal tablet or gel, you may be allowed to go home while you wait for it to work. You should contact your midwife or obstetrician if:
your contractions begin
you have had no contractions after six hours
If you've had no contractions after six hours, you may be offered another tablet or gel.
If you have a controlled-release pessary inserted into your vagina, it can take 24 hours to work. If you aren't having contractions after 24 hours, you may be offered another dose.
Sometimes a hormone drip is needed to speed up the labour. Once labour starts, it should proceed normally, but it can sometimes take 24-48 hours to get you into labour.
FORCEPS
About one in eight women have an assisted birth. This can be because
There are concerns about the babies heart rate
The baby is in an awkward position
The mother is just too exhausted
Forceps are safe and are only used when necessary. If the baby's head is in an awkward position, it will need turning (rotating) to allow the birth. A paediatrician may be present to check your baby's condition after the birth. A local anaesthetic is usually given to numb the vagina and perineum (the skin between the vagina and anus) if you haven't already had an epidural.
Forceps are smooth metal instruments that look like large spoons or tongs. They're curved to fit around the baby's head. The forceps are carefully positioned around your baby's head and joined together at the handles. With a contraction and your pushing, an obstetrician gently pulls to help deliver your baby.
There are many different types of forceps. Some forceps are specifically designed to turn the baby to the right position to be born, for example, if your baby is lying facing upwards (occipito-posterior position) or to one side (occipito-lateral position).
Forceps can leave small marks on your baby's face but these will disappear quite quickly.
You will sometimes need a catheter for up to 24 hours. You're more likely to need this if you have had an epidural because you may not have fully regained sensation in your bladder and therefore don't know when it's full.
CAESAREAN
A caesarean section is an operation to deliver a baby. It involves making a cut in the front wall of a woman’s abdomen and womb.
The operation can be:
a planned procedure, when a medical need for the operation becomes apparent during pregnancy
an emergency procedure, when circumstances before or during labour call for delivery of the baby by unplanned caesarean
A caesarean section is usually carried out under epidural or spinal anaesthetic, where the lower part of your body is numbed. It usually takes 40-50 minutes, but can be performed quicker in an emergency. Some caesarean sections are performed under general anaesthetic.
A caesarean section is usually carried out when a normal vaginal birth could put you or your unborn baby at risk – for example, because:
your labour doesn't progress naturally
you have placenta praevia (where the placenta is low lying in the womb and covering part of the womb's entrance)
you have had two or more previous caesarean sections
your baby is in the breech (bottom first) position
It takes longer to recover from a Caesarean section. You will usually need to spend three to four days in hospital after surgery, compared to one or two days after a vaginal birth.
Epidurals
Will numbs the nerves that carry the pain impulses from the birth canal to the brain. For most women, an epidural gives complete pain relief. It can be very helpful for women who are having a long or particularly painful labour, or who are becoming distressed. An anaesthetist is the only person who can give an epidural, so it won't be available if you give birth at home. Some hospitals offer 'mobile' epidurals, which means you can walk around. However, this also requires the baby's heart rate to be monitored remotely (by telemetry) and many places don't have the equipment to do this. Epidurals are good but it has been found out that one in eight women who have an epidural during labour, need to use other methods of pain relief.
What are the side effects?
An epidural may make your legs feel heavy, depending on the local anaesthetic used.
Your blood pressure can drop (hypotension) however, this is rare because the fluid given through the drip in your arm helps maintain good blood pressure.
Epidurals may prolong the second stage of labour. If you can no longer feel your contractions, the midwife will have to tell you when to push. This might mean that forceps or a ventouse may be needed to help deliver your baby's head.
Sometimes, less anaesthetic is given towards the end so that the effect wears off and you can push the baby out naturally.
You may also find it difficult to pass urine as a result of the epidural. If so, a small tube called a catheter may be put into your bladder to help you.
Some women get a headache after an epidural. If this happens, it can be treated with painkillers.
Your back might be a bit sore for a day or two but epidurals don't cause long-term backache.
TENS machines
TENS stands for transcutaneous electrical nerve stimulation. Some hospitals may have TENS machines. If not, you can hire your own machine, from your local chemist. TENS has not been shown to be effective during the active phase of labour (when contractions get longer, stronger and more frequent). TENS may also be useful while you're at home in the early stages of labour or if you plan to have a home birth.
How it works?
Electrodes are taped onto your back and connected by wires to a small battery-powered stimulator. Holding this, you give yourself small, safe amounts of current through the electrodes. You can move around while you use TENS. It will also reduces the number of pain signals that are sent to the brain by the spinal cord.
What are the side effects?
There are no known side effects for either you or your baby.
HypnoBirthing
HypnoBirthing is a complete birth education programme, that teaches simple but specific self hypnosis, relaxation and breathing techniques for a better birth.
You can discover that severe pain does not have to be an accompaniment of labour. And learn how to release the fears and anxieties you may currently have about giving birth, and how to overcome previous traumatic births.
With HypnoBirthing doesn't mean you'll be in a trance or a sleep. Rather, you'll be able to chat, and be and in good spirits - totally relaxed, but fully in control. You'll always be aware of what is happening to you, and around you.
You don't need any particular belief system, or prior experience. Some of our mums (and especially their husbands!) have been very sceptical at first, until they experience it for themselves.
Ventouse assisted delivery
A ventouse is an instrument that is attached to the baby's head by suction. A soft or hard plastic or metal cup is attached by a tube to a suction device. The cup fits firmly onto your baby's head. During a contraction and with the help of your pushing, the obstetrician or midwife gently pulls to help deliver your baby.
The suction cup leaves a small swelling on your baby's head, called a chignon. This disappears quickly. The cup may also leave a bruise on your baby's head, called a cephalhaematoma.
A ventouse is not used if you're giving birth at less than 34 weeks pregnant, because your baby's head is too soft. A ventouse is less likely to cause vaginal tearing than forceps.
Your midwife and doctor might recommend an assisted birth if:
*your baby has become distressed during the pushing stage of labour
*you are very tired and can't push any more
*your baby isn't making any progress through your pelvis
*there's a medical reason why you shouldn't push for too long (for example, you have heart disease or raised blood pressure, called pre-eclampsia.
You will be given pain relief, which may be a local injection inside the vagina (called a pudendal block) or epidural or spinal anaesthetic.
A paediatrician (a doctor specialising in the care of babies and children) may be called to the delivery room. This is usual for instrumental births, so try not to worry.
Home birth
You and your birth partner should talk about your hopes for a home birth with your consultant, midwife, or the supervisor of midwives. They'll help you to weigh up the risks before you make a decision. If the advice given is to come into hospital, but you're certain you want a home birth, your choice should be respected.
Benefits to a home birth include;
*A less painful labour due to being more relaxed
*Knowing the midwives who will be at your birth
*One to one midwifery care
*More privacy and control in labour and afterwards
*Greatly reduced need for medical intervention
*Healthier mum and baby
*Baby is more likely to breastfeed
*Lower rates of postnatal infections for mum and baby
*Dad is never sent away or reduced to visitor status: you can start family life from day one.
*If you have other children they can be as involved as you want them to be.
You can opt to give birth in a birth centre or labour ward instead at any time during your pregnancy. And once you're in labour your midwife can transfer you. Your decision may change as you get nearer the birth of your baby, and your midwife understands this.
Community midwives usually provide the care for home births. A midwife will come out to you when you are in labour to see how you are getting along. She'll talk to you and your birth partner, and watch you having a few contractions. She may carry out an internal examination to see how far dilated your cervix is, if that is what you want.
She may stay with you, or she may come back later. It all depends on how far along in your labour you are, and how you're coping with it.
Your midwife will organise a second midwife to join her for your baby's arrival. Ideally, two midwives should be with you when your baby is born. Then, if there's an emergency, one midwife can look after you, while the other one looks after your baby.
After the birth Your midwife will stay until she is happy that you are comfortable and well. She'll see you into bed, and clear up any mess.
Water birth
The relaxing effect of water, with its support and warmth, can help you through your labour. Your contractions may lose their rhythm if you become tense. This means that your labour may stop and start without moving on. Being bathed in water is likely to help you go with your contractions in active labour, so that they are less stressful for you and your baby.
The water buoys you up and makes you feel lighter. It's easy for you to move about, so you can make yourself comfortable. The best position for you is likely to be one that helps your baby move most easily through your pelvis.
Being in warm water can make it easier for you to cope with the pain of contractions. It's just the same as having a bath to soothe a tummy ache or back ache. Hospital guidelines state that you should not be left alone while you are in a birth pool. This means that either your midwife or your birth partner should be with you at all times.
You may be worried that your baby will inhale water with his first breath if he is born in a birth pool. However, healthy babies don't take their first breath until nerves in their face, mouth and nose have been stimulated by contact with air and a change in temperature.
You will be asked to leave the pool if:
*Monitoring your baby's heartbeat shows that there is a problem.
*Your labour is progressing very slowly. Your midwife may suggest getting out and mobilising for a while until your contractions get going again.
*You start bleeding during labour.
*Your blood pressure goes up.
*Your baby's first poo (meconium) is detected in your waters. If you are in the second stage of labour and meconium is detected, you may be able to stay in the pool. Your midwife will check how much meconium is in your waters and your baby's heart rate.
*You feel faint or drowsy.
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