Labour and birth

Where you give birth is your choice. Here at Bradford you may choose to give birth at home, at our along-side birth centre and our labour ward. Women with more complex needs may be advised to give birth on our labour ward where their care can be more specialised. Women who have midwife led care will be encouraged to consider a birth at home or on the birth centre.

Speak to your midwife about the available options.

The start of labour is called the latent phase. This is when your cervix becomes soft and thin, and starts opening for your baby to be born. This can take hours or sometimes days.

You’ll probably be advised to stay at home during this time. Please see the video with some useful tips and coping strategies.

Latent phase of labour – Punjabi

A birth plan is a record of what you would like to happen during your labour and after the birth. You don’t have to create a birth plan but, if you would like one, your midwife will be able to help.

Discussing a birth plan with your midwife gives you the chance to ask questions and find out more about what happens in labour and gives you the opportunity to explore your own preferences. It also gives your midwife the chance to get to know you better, and understand your feelings and priorities, and allows you to think about or discuss some things more fully with your partner, friends and relatives.

During the 1st stage of labour, contractions make your cervix gradually open (dilate). This is usually the longest stage of labour.

The 2nd stage of labour lasts from when your cervix is fully dilated until the birth of your baby.

You’ll usually be able to hold your baby immediately and enjoy some skin-to-skin time together.

The 3rd stage of labour happens after your baby is born, when your womb contracts and the placenta comes out through your vagina.

We now have a class specifically aimed at partners.

It’s helpful to know which pain relief options are available before the birth. If you know what you can have, you may find it easier to stay calm and try to relax as much as you can, which can mean an easier birth. If you are stressed and tense, your contractions may feel more painful and become less effective.

Write down your wishes in your birth plan, but remember you need to keep an open mind. You may find you want more pain relief than you’d planned.

After your baby is born, hold him against your skin as soon as possible, and for as long as you want. Skin to skin contact reduces baby’s stress level by 75%. This will calm him and give you both the chance to rest, keep warm and get to know each other.

If you want to breastfeed, this is a great time to start as your baby might move towards the breast and work out the best way to suckle for himself. Breastfeeding also releases lots of oxytocin in baby and mother, which will help you to feel close and connected. If you choose to bottle feed, giving the first feed in skin contact while holding your baby close and looking into his eyes will also help you bond.

You have lots of decisions to make during pregnancy, in labour and when you have had your baby. In order to make informed decisions about your care you can use a decision making tool like the BRAIN tool.

B Benefits. What are the benefits?

R Risks. What are the risks and considerations?

A Alternatives. What are the alternatives, and what are the risks and benefits of those?

I Intuition / information. How do you feel? Do you need more information?

N Nothing / not now. Do I need to decide now? What if I do nothing?

Sometimes a doctor or midwife may need to make a cut in the area between the vagina and anus (perineum) during childbirth. This is called an episiotomy.

An episiotomy makes the opening of the vagina a bit wider, allowing the baby to come through it more easily.

Sometimes a woman’s perineum may tear as their baby comes out. In some births, an episiotomy can help to prevent a severe tear or speed up delivery if the baby needs to be born quickly.

If your doctor or midwife feels you need an episiotomy when you’re in labour, they will discuss this with you. In England, episiotomies are not done routinely.

Up to 9 in 10 first-time mothers who have a vaginal birth will have some sort of tear, graze or episiotomy.

The National Institute for Health and Care Excellence recommends that an episiotomy might be done if:

• the baby is in distress and needs to be born quickly, or
• there is a need for forceps or vacuum (ventouse), or
• there is a risk of a tear to the anus

Around 1 in 7 deliveries in England involves an episiotomy.

If you have a tear or an episiotomy, you’ll probably need stitches to repair it. Dissolvable stitches are used, so you will not need to return to hospital to have them removed.

Massaging the perineum in the last few weeks of pregnancy can reduce the chances of having an episiotomy and perineal trauma during birth.

The type and frequency of massage varies across research studies. Most involve inserting 1 or 2 fingers into the vagina and applying downward or sweeping pressure towards the perineum.

The most benefit was in women who repeated this every day.

An important part of maternity care is listening to your baby’s heart rate throughout your labour. This enables us to monitor your baby’s wellbeing and can help to identify if there are any problems developing.

At all times you will be given information that allows you to make an informed choice about all aspects of your care.

Your community midwife will have a conversation with you about monitoring your baby in labour as part of your antenatal care and document your discussions and decisions in your personalised care plan. This conversation will take into account your pregnancy, your well-being and your birth preferences.

Most babies come through labour without any problems, but there are a few babies who run into difficulties. The best way of finding out which babies are having trouble is to listen to every baby’s heartbeat regularly throughout labour.

There are no current guidelines to suggest when your midwife should listen to your baby’s heartbeat during pregnancy, however it is possible to hear it from approximately 16 weeks.

From 24 weeks, your midwife will ask you about your baby’s movements every time you see them and, if there are any concerns, they will ask to assess you and your baby. This may result in a visit to the Maternity unit at the hospital.

How do we listen?

If you are healthy and have had a problem free pregnancy, your midwife will ask to listen to your baby’s heartbeat using a Pinard stethoscope or a hand-held doppler.

Intermittent Auscultation

When you are in labour, the midwife will ask to listen to your baby’s heartbeat at least every 15 minutes, immediately following a contraction, and more frequently as labour advances. This method of monitoring is called intermittent auscultation. The advantage of this method is that it enables you to move around freely and can be used in water.

It is important that the midwife starts listening to your baby’s heart beat just as your contraction is going away, and they will need to count the heartbeat for a full minute.

It is helpful if you know about this as your midwife may ask you to change position to make this easier.

The midwife will need to count your baby’s heart beat for a full 60 seconds every time they listen in.

If your midwife notices a change in the baby’s heart rate that suggests your baby might not be coping well, they will tell you and they may recommend continuous monitoring.

The midwife will ask to manually feel your pulse on your wrist every hour during the first stage of labour and if you are still having intermittent auscultation during the second stage, they will ask to feel your pulse every 5 minutes. This helps your midwife be sure that it is definitely your baby’s heartbeat that is being picked up and not yours.

Continuous electronic fetal monitoring (CTG)

This type of monitoring produces a continuous ‘trace’ of the baby’s heart rate throughout your labour and is referred to as a cardiotocograph or CTG.

The CTG monitor has 2 sensors that are strapped around your abdomen, one to monitor the frequency of your contractions and the other to monitor your baby’s heart rate.

Continuous monitoring can limit your ability to move around, however it is still possible to mobilise, or to change your position to standing or sitting on a birthing ball.

A wireless monitor may be available. This allows you to move more freely.

Risk assessment is an ongoing process and the recommended method of fetal monitoring may change throughout labour. If there are no identified risk factors for fetal compromise, there is a risk of increased interventions with continuous CTG monitoring compared with intermittent auscultation, which may outweigh the benefits.

Advice given by the midwife or obstetrician on the method of fetal heart rate monitoring will take into account the whole clinical picture.

When performing CTG monitoring your midwife may find it difficult to get a clear trace on the graph (particularly when you are pushing or mobilising). If this happens, they may ask permission to monitor your baby with a fetal scalp electrode (FSE). If this method of monitoring is recommended during your labour your midwife or doctor at the time will discuss this with you and support you to make an informed choice.

Things to remember

• A normal CTG trace indicates that the baby is coping well with labour
• Changes to your baby’s heart rate pattern during labour are common and are not always worrying
• Sometimes these changes can show which babies are having trouble coping with the stress of labour.
• If your midwife has concerns with the CTG they will ask your permission to invite a senior midwife and/or doctor to be involved in your care and they will make an assessment to find out if there is an identifiable cause that can be corrected.
• Such causes include an infection developing which can be treated with antibiotics or if there are other signs that your baby may be distressed such as the baby opens their bowels inside (passes meconium).
• This will be all be considered along with how your labour is progressing to make a personalised plan of care for you and your baby taking into account your preferences.