How do I know I’m in labour?

Every woman comes into labour differently. To be in labour your cervix (the opening of the uterus or womb) must be fully dilated at 10 cms.  The cervix must dilate to ten centimetres (ouch) for the baby to be born vaginally. Most women are aware of ‘painless contractions of pregnancy’ that are called Braxton Hicks Contractions (BHC).  The difference between BHC contractions and labour is that BHC do not dilate your cervix and they (although can be very intense) stay the same. Compared to labour contractions that are progressive and your cervix dilates.  The midwife or doctor will do a vaginal examination to asses if you are in labour and how many centimetres your cervix has dilated.

Signs of early labour include the following –

  • Progressive pain / contractions
  • Period – like cramps
  • Backache (constant or with each contraction)
  • Lower abdominal pressure
  • Indigestion
  • Frequent bowel actions (the day before or on the day labour begins)
  • Bloody thick mucous vaginal discharge (also known as ‘the show’)
  • Maybe ruptured waters
  • You are still able to talk to your partner during contractions
  • Awake and alert.

Signs of more established labour include the following –

  • Progressive pain with contractions
  • Vocalising with contractions
  • Strong lower pain with or without backache
  • Maybe ruptured waters (classically at 2nd stage of labour)
  • Not interested in talking to anyone
  • Maybe nausea and vomiting

When do I go to the hospital?

Remember it’s a hospital not a hotel booking so go into hospital whenever you feel worried about your health or the baby’s health. You can go in anytime during pregnancy or early labour and as a curtesy to the labour ward staff it is always best to phone them…can you imagine 10 people arriving at once!!

This may be if you are experiencing any bleeding, feeling unwell, bad headaches or have any decreased movements.  Its always best to be checked by a doctor or midwife. You will have your blood pressure checked, temperature and pulse checked and of course the baby monitored. If all is ok with you and the baby it is possible for you to go home.  If the doctor has any concerns you may need to stay in the hospital for rest and more tests or in some cases induce labour. Everything is done on an individual basis.

Once you come into labour every woman is different.  There are SO many variables when it comes to going into hospital when in labour. It is best to ring the labour ward and talk to one of the midwives.  They are experienced in assessing you over the phone and asking the right questions to ‘diagnose’ what stage of labour you are in. They can also tell by the way you are coping (or not) with the contractions.  It is always best for the labouring woman to talk to the midwife (rather than your partner) as there are plenty of questions and only the labouring woman can answer. If you are having an elective (planned) caesarean section and you come into labour prior to the date of the c section, the doctor will deliver the baby.

Going into hospital depends on a few or all of the following –

  • The gestation of the pregnancy (premature or really overdue)
  • The positon of the baby (head first/ breech)
  • What number baby this is (get moving if its your second, third baby etc.)
  • If you are having a planned c section
  • If you have had any bleeding
  • If your waters have broken
  • If you are having contractions really close together
  • Multiple pregnancy (twins / triplets etc)
  • Age of the mother
  • Doctors request
  • Emotional state of the pregnant mum

Am I supposed to stay at home as long as possible?

If you are well, your baby is well and you have plenty of support at home (plus you have checked in via phone with the hospital) it is ok to stay home until your contractions are about 3-5 minutes apart. In saying that go into the hospital if you feel like you require extra support and the safety and comfort of the staff in the labour ward.

Another thing to take into account is traffic!! If you live out of town and require to drive through peak hour traffic it is not ideal to be in full blown labour! My advice is to leave early.

Will my waters break? What does it feel like?

Your waters (the amniotic fluid) can break anytime during pregnancy or during labour or not at all.  Sometimes the midwife or doctor is required to break the waters to augment (help you along) during the labour process. If you are being induced, breaking the waters is part of the procedure. As the vagina does not have a sphincter (a circular muscle that normally maintains constriction of a natural body passage) to control the flow of the water, when your waters break, it feels like you are wetting your pants with no control at all…nice!

It is best to call your doctor or the labour ward to inform them that you think your waters have broken. It is wise to have a shower and put on a fresh pad so you can assess the fluid los and colour of the waters.  The colour is usually clear, some times pinkish (due to the cervix opening and some blood staining the waters) or a prune juice colour. This happens when the baby had been anxious or worried at some time during your pregnancy and the baby’s first bowel action (meconium – which is black and sticky) discolours the clear amniotic fluid (the waters).

The midwife will ask you what colour the fluid is and is it came out like a gush of water or a trickle of fluid.  This is all important information for the midwife / doctor to know. This will inform them if your hind waters (slow leak) or fore waters (big gush) have broken. Once the waters have broken and if you are not in labour

Some women actually give birth to babies with the waters still intact and born – this is called ‘within the caul’. This is when the membranes are still intact and the baby is born vaginally or by c section. Although babies born within a caul is rare, (occurring in less than 1 in 80,000 births) it is one spectacular sight.

If your contractions have not started but your waters have broken the doctor has a few options. It all depends on a balance of factors regarding the mother and baby.  There must be a balance between the mothers’ health and the baby’s health.

  • Your labour can be augmented, that is, stimulate you into labour.
  • Wait, watch and see if you come into labour spontaneously.
  • Antibiotics are often given to prevent ascending infection to both mother and baby, as once the waters have broken the sterile environment within the uterus has changed.
  • At 36 weeks most women are tested for group B streptococcus(GBS) via a gentle swab of the vagina and anus.  If the mother is positive for GBS the risk of infection to the baby is high so, appropriate antibiotics are given to the women in labour plus the baby once he has been born.

What if the hospital tells me to stay home but I want to come in because I’m feeling like things are moving quickly?

It’s not a hotel booking it’s a hospital booking so you don’t have to rock up on a certain day or date, in saying that the hospital does like to know who is coming into the labour ward.  If you think you are in labour ring the labour ward and talk to one of the midwives. If things are moving along quickly and you feel you a re progressing (pains get more intense when you are in labour) hop into the car and ring the hospital on your way…especially if it is your second or subsequent baby as things can go from slow to go rather quickly!

Some women come into labour early for an unknown reason so if you are feeling regular painful contractions again ring the hospital and talk to the midwives, remember the labour ward has staff rostered on 24 hours a day, so there is always someone to talk to.

If you are feeling pain that is increasing in intensity, feeling ‘unwell’, any bleeding, watery or smelly vaginal discharge, gush of fluid vaginally (your waters), excessive vomiting, a headache that is not resolved by panadol, decreased foetal movements or just not feeling fantastic please call the hospital or your doctor and be checked.

What will happen when I get to the hospital?

Remember where you parked the car…it’s not fun leaving the hospital with a new baby and not able to find your car. Once up in the labour ward, assuming you are not about to give birth there and then, important paper work needs to be filled out and checked. Take in your Medicare card, health insurance card and advise the hospital if you have changed names (recently married) or your address has changed.

Then a midwife will formally ‘admit’ you and fill in paper work and ask you what seems like 1000 questions but they are all relevant, like obstetric history, medical history, blood group etc. then name tags are placed on you and your husband and the midwife will ask you to check the name tags for your new baby.  Really important to check these are accurate! The midwife will collect a onesie, singlet and muslin wrap for when your baby is born and place it in the heated cupboard so its nice and warm for your new baby.

All your vital signs are checked, your blood pressure, pulse, temperature and the baby’s heart rate all recorded.  Depending on your doctors wishes, how far into labour you are and the time of day your obstetrician is notified. Most doctors have instructions on when they like to be notified.

You then it’s a waiting game.  As you progress the midwife or obstetrician will check to see how dilated your cervix is and how far the head is down the vagina. During the time is labour ward pain relief is discussed with your midwife and obstetrician.

What does a contraction feel like?

As the uterus is a muscle it has the capacity to contract and relax, just like when you have a leg cramp your muscle cramps tightly causing pain then relaxes. It is very hard to describe what a contraction feels like but ladies, it does hurt. It starts like a period pain (and amazingly some women have never had a period pain in their life!!). Contractions can also be felt in the back so be aware if you have rhythmic back pain as this also can be early or your body establishing labour.

Contractions come and go, they intensity in pain then as the uterus relaxes the pain goes then the body has a break.  In early labour contractions may last 10-15 minutes and last 20-30 seconds, then a break with no contractions at all. As the labour progresses and the cervix dilates the pain intensifies and the contractions are closer together.

Your cervix needs to be 10 cms dilated for the baby to be delivered vaginally and a woman having her first baby the cervix dilates about I cm per hour once in established labour. This is an average as some women labour quickly and other women take longer to establish labour and give birth.

When can I get pain relief?

You can get pain relief at any time.  The earlier the better for some women. In 2017 we can now offer women pain free labour offering an epidural prior to labour even beginning.  This choice is fabulous for women who are pathologically fearful of labour and birth. Pain relief can be requested by the women at any time or the doctor may suggest pain relief to assist in the progress of the birth.

Pain relief consists of pethidine an intramuscular injection that is injected into the mothers’ muscle, absorbed thorough the mothers’ blood stream and passes through to the baby. Pethidine does not take the pain of labour away. Two things take the pain of labour away – one is an epidural and the second one is to have the baby!!

Epidural anaesthetic is very popular and has no effect on the baby. The epidurals these days can provide pain relief where the mother can feel the pressure but not the pain of labour. Epidurals are given by a specialist anaesthetist and stay in place until the baby is born, the placenta is expelled and the staff are happy with the condition of the mother.  The epidural is then removed and the mother is not encouraged to stand or shower until the epidural has fully worn off. An epidural like pethidine usually won’t be given if you are nearly fully dilated and the birth of the baby is immanent.

Nitrous oxide is another option.  This is also known as ‘the gas’ or ‘laughing gas’.  It doesn’t take the pain away and is most effective when the mother is 9-10 cms and close to commencing pushing. Nitrous oxide is not encouraged to be used from the beginning of labour as it is not effective as a pain relief and can cause nausea.

Will I still be able to push? What if I can’t push? How does the baby get out?

The epidurals these days enable you to feel the pressure (when the head is descending) but no pain, in fact the perfect pain relief. As you still have the sensation or pressure in your anus you will be able to push when it’s time to, when your fully dilated. The doctor and midwives can feel when you are having a contraction (by your tummy going hard) and instruct you to take a deep breath and push. Once the baby’s head starts to descend you will feel the fullness and pressure and will be able to push with the contractions. The doctor can help the baby around the corner by using a device called a vacuum extractor which helps guide the baby out of the vagina while the mother pushes.  The vacuum extractor has a soft cup that attaches to the baby’s head. It is used if the baby isn’t progressing down the vagina when you are pushing, or the baby is distressed. A vacuum extraction may be an alternative to a forceps delivery and caesarean section.

Will I pooh? What do you do with the pooh?

Because you have a head coming down your vagina you rarely poo during birth!! Often pre labour you have some regular bowel actions so mother nature makes sure everything is empty! If you pass a small amount of poo when pushing the midwives or doctor just scoop if up in a pad and away it goes down to Werribee!!!

How is the baby monitored during labour?

The baby and mother are monitored by a machine called a cardiotocography or a CTG machine.  These machines monitor the baby’s heart rate during pregnancy and also during labour. It also has the ability to measure the pressure of the uterus as it contracts during labour. Two belts are placed around the abdomen with a transducer placed over the baby’s heart and another one at the top of the uterus (fundus).

Antenatally the CTG offers pre natal monitoring to asses the wellbeing of the baby during high risk pregnancies by assessing how the baby is coping in utero during pregnancy.  This is assessment by shows the doctor and or midwife a graph of the baby’s heart rate and they are able to assess how the baby is coping in utero pre labour. Women who have any medical conditions, gestational diabetes, past history of a small baby or a foetal death may have frequent monitoring during pregnancy, especially in the third trimester.

During labour the CTG monitors not only the baby’s heart beat but the frequency, duration and strength of the uterine contractions.  The CTG assesses how the baby (by the graph) is coping before the contraction, during the contraction and after the contraction. Often id the CTG shows distress of the baby early delivery of the birth is indicated.

How long is a typical first labour?

Every woman labours differently.  Some women don’t even come into labour and need to be induced into labour. The placenta has a used by date and the baby needs to be born within 10 days of the due date.  A healthy mother and baby is what everyone wants often induction is the safest course of action if the mother has not come into labour.

Once labour begins it can take from 2 hours to 20 hours for the baby to be born.  These days with effective epidurals (which decrease the time the mother is in labour).

So an average labour for a first time mum is usually 7-10 hours…and it’s worth it!!

When do I push? Are there any rules?

You start pushing when you are fully dilated, and not before (as it can cause your undilated cervix to become swollen).

The rules are simple.

  • Try and relax taking quiet, deep breaths in between contractions.
  • Try and focus on having your next contraction and pushing hard
  • Visualize your baby coming down your vagina
  • If you are sitting, hold your legs behind your thighs
  • Open your legs wide, letting your knees flop out
  • If you have an epidural the midwives will feel the contraction starting and tell you when to stat pushing
  • When you feel a contraction coming you take a deep breath.
  • And push, holding your breath, right down into your bowel, like you are having a huge poo!
  • Curl up, puling your legs open and push really really hard.
  • Keep pushing and pushing until you run out of breath, then snatch a deep breath and push hard again.
  • Once the contraction has gone, stop pushing and rest, take a sip of water, close your eyes and prepare for the next contraction. One more contraction closer to meeting your new baby.
  • The pushing can be two pushes or two hours of pushing.  It all depends on how the baby is descending.
  • If there is no progress the doctor may put on a vacuum extraction cap onto the baby’s head and help you while you push.
  • When the baby gets to crowning or close to being delivered the doctor and midwives will encourage you to puff puff puff and not push (as you can’t puff and push at the same time) – the baby’s head it very close now.
  • One more push to deliver the anterior shoulder…one more bout of puff puff puff for the posterior shoulder
  • And before you know it you will have a beautiful baby on you.

If I swear at the midwife, will she forgive me?

Yes, definitely!! I’ve been sworn at, put in a headlock (by the mother), vomited on, hit, my hand squeezed till it has turned blue, screamed at and all is forgiven once the beautiful baby has arrived!!

 

What’s the likelihood of stitches and do they hurt?

Having an episiotomy is basically a surgical wound, so it hurts. It gets swollen and bruised and like and other wound it feels worse before it gets better.  Many years a go an old obstetrician told me a young midwife that the vagina is a really forgiving area. But it takes time. So be patient and let the wound heal.

Things that help are analgesic (anti-inflammatory dugs, paracetamol or stronger drugs).  Its important to have a laxative on day 2-3 to ensure you have your first poo after the birth (and it’s nice and soft!).  Nothing will split apart so never avoid pain relief as you need to be comfortable feeding your new baby and preparing for a few sleepless nights!!!

What happens in a caesarean?

An elective caesarean section is done prior to the due date ( so the mother doesn’t come into labour) and there is a medical, obstetric or social reason for the caesarean to take place. Once a spinal anaesthetic or epidural (or both) are given and the mother is comfortable and has no sensation, and both the obstetrician and anaesthetist are happy to commence the procedure begins.  The partner sits at the head of the operating table with his partner and within 5 minutes the the baby is delivered via the abdomen. It’s that quick.

The wound is about 15cm wide and for many and varied reasons a caesarean section is often a life saving operation for both the mother and or the baby.  The baby is delivered by the obstetrician, often putting forceps around the baby’s head to gently guide the head out. In a breech position the head again is helped out by forceps.  An elective c section is done for many reasons:

  • Pre eclampsia (high blood pressure)
  • Multiple births
  • Breech presentation
  • Previous c section
  • A maternal medical condition
  • Mothers request due to a pathological fear of vaginal birth
  • Previous traumatic vaginal birth
  • A previous stillborn or neo natal death of a baby
  • Maternal age
  • A very small baby
  • Placental insufficiency
  • Placenta praevia (placenta coming first)
  • Previous sexual abuse
  • Medical emergency

Once the baby is delivered the cord is clamped and cup and the baby is handed to a paediatrician. The paediatrician then shows the baby to the new parents and along with the partner takes the baby to a warm prepared baby cot and the baby is warmed, immunisation commenced, vitamin K is given, baby’s name tags are attached and in some cases the baby is weighed then and there. The partner trims the remaining cord to declare the baby open!! The baby, if in good condition is taken back to his mum for her first of many cuddles.

What happens in an emergency caesarean? What circumstances call for an emergency c-sec?

An emergency caesarean section is done when either the mother and or baby are unwell and a vaginal the birth may put both mother and baby at risk of illness or death. An emergency caesarean section is done once the women has commenced labour.  Even if the cervix is 9 cm dilated the two to three hours to progress to birth could be life threatening. An emergency caesarean section can have the baby delivered within minutes. The reasons are usually –

  • Maternal reasons
    • severe hypertension
    • sudden bleeding
    • failed induction or the cervix has not dilated
    • eclampsia (fitting during labour)
    • Motor car accident and the mother and baby are at risk
    • Drug / alcohol overdose
  • Baby reasons
    • Foetal distress
    • Decreased heart rate
    • Meconium passed (first bowel action)
    • A limb presenting like an arm or a leg
    • The cord has prolapsed (come out vaginally)

What happens in recovery?

Once the baby is born and safely in the arms of his mum, the baby and partner are usually taken to recovery to wait a few minutes for the end of the procedure, transferring to the bed from the operating table etc.

Once in recovery the baby (in most hospitals and if healthy) will stay with the parents for a cuddle and a breast feed.

The midwife checks the blood loss, pain level and assesses how quickly the spinal and or epidural is wearing off. The baby’s temperature is taken frequently to ensure he is warm enough. Pain relief is given so when the spinal and or epidural has worn off there is adequate pain relief as a caesarean section is major abdominal surgery. Once both the mother and baby are stable both the mother and baby are transfered to the post natal ward.  Then the fun begins

When I’ve had my baby (YESSSSSSSS), what will happen?

While you’re in hospital it is time to recover, feed your baby and have assistance and guidance by the midwives about the care of your baby. The midwives are there to help you in hospital you may have different midwives caring for and each and every one may have a different advice for you. All midwives have good intent but all have their own way on how to give advice on breastfeeding. Just go with your gut reaction and keep the baby fed.

You will be offered pain relief and assistance with breast feeding, changing nappies, bathing the baby and learning lots of information in the early days of parenting. There are so many people wanting to give you advice and it can become confusing, overwhelming and creates an anxiety in you that you don’t need. You need to have at least one person who is a constant and positive person in your life that will not confuse you in your early days as a parent.

The first weeks after birth are some of the hardest days you’ll ever endure and also the happiest. No one can prepare you for the sleep deprivation, the tears, the love and the confusion. So many women tell me ‘no one said it would be this hard’ the hard thing is you cannot even imagine how hard and wonderful life is with a new baby. Pregnant women think so much about labour and birth and think breastfeeding and parenting is easy and comes naturally, the post natal time and life with a baby is not really on the agenda.

It’s huge recovering from the birth of a baby we all think it’s going to be easy but the impact of childbirth and feeding to sleep deprivation, medications all take its toll on the new mother and takes a good six to eight weeks to recover. The happiness from having a beautiful new baby becoming a parent and also the changing dynamics between you and your partner certainly takes its toll. The days and the nights are long, sleep deprivation is indescribable and unfortunately the fear campaign begins about what you should and shouldn’t do with your baby, you are overfeeding or your baby is not sleeping enough.

Some babies are born little some babies are born big but all babies are hungry but they all need to be fed. You cannot overfeed a baby but you can underfeed a baby. Babies want to live. They want to suck to get milk and sustain life. So, make it easy for yourself. Keep your baby close; hold your baby in your arm and let the baby suck at the nipple. If your baby is sucking he is attached to the nipple. You don’t need to have the entire areola, which is the dark area around the nipple, in your baby’s mouth for some women that is virtually impossible as their nipple changes during pregnancy darkening and enlarging the areola. If the baby is sucking he is on!

Enjoy your baby, make it easy for you and your partner, keep the baby fed, warm and loved.  You can’t go wrong!!!