Preparing for Labour

After all the weeks of anticipation and planning, your big day is finally here.

Labour and the birth of your baby is one of the most exciting journeys that you will ever go through. At the end of this journey you will get to hold your baby that has been kicking away inside you for months and months.

Labour is different for every woman, every time. It is difficult to anticipate exactly what your journey will be like, but in this section we will cover: birth plans; packing your bag for labour; the signs of labour; how to cope at home in the early stages of labour; and when and how to contact the hospital. This section serves as a guide only. Your midwife or doctor will give you more individual advice towards the end of your pregnancy.

Birth Plan

When preparing for labour, a birth plan is a way for you to highlight particular requests that you may have for your labour and birth. You do not have to have a birth plan – our aim is for you to have as natural a birth as possible. However, once you have completed your parent education classes, you may wish to make a birth plan.

It is very important that you discuss your birth plan with your midwife or doctor well in advance of your labour. This discussion will give everyone a chance to go through your requests and discuss them with you. If there are any areas where the hospital may be unable to meet a particular request, then you will be given an explanation for this. Once the discussion is completed, your midwife or doctor will sign your birth plan and a copy will be put in your healthcare record. We aim to work in partnership with you and to keep you informed and involved in your care during labour and birth.

When will labour start?

There is no way to accurately predict when labour will actually start. If your pregnancy goes past your expected due date, there is nothing to worry about as long as you are feeling well and your baby is moving and kicking. Be sure to attend all your antenatal appointments especially towards the end of your pregnancy.

Baby's Movement

Right up to the moments before birth, your baby will be moving around inside you. At the end of pregnancy the type of movements may change and they may feel more like pokes, prods or wriggles. Babies do not stop moving before labour! They may have sleep periods but these will last for no longer than 45 minutes to one hour.

If you are unsure about your baby’s movements, there are a few things you can do to wake your baby up:

gently rub your tummy and talk to your baby;
drink some cold water or eat something sweet; or
have a warm bath or shower.

These things will often wake your baby up and normal movements will start again. You will be very aware of your own baby’s pattern of movement. If you have any concerns about the amount or type of movements you are getting, please contact your midwife, doctor or the EAU. Your awareness of your own baby’s movements is very important, particularly at the end of pregnancy.

Signs of Labour

Signs of early labour

Waters breaking

For some women, the very first sign that anything is happening is that their waters break. Sometimes, it is obvious that the waters have broken by the fact that you soak your underwear or bed. (In fact, it is a good idea to sleep with a towel under you towards the end of your pregnancy to avoid damage to your mattress.)

However, for a lot of women it may be difficult to be sure if the waters have broken. Many women describe feeling their underwear damp due to the increased amount of vaginal discharge which is normal at the end of pregnancy. If you find that you have to wear a sanitary pad due to the amount of fluid you are losing, you need to consider if your waters could have broken. One way for you to check is to have a shower, dry the vaginal area well and put on a maternity sanitary pad. If that pad quickly becomes damp or wet, it is likely that your waters have broken.

When the waters break, the fluid may be clear or slightly straw coloured. Sometimes there may be a vague tinge of pink in the waters. This is normal and should not alarm you. If your waters have broken, you should come to the EAU for an assessment to ensure all is well with you and your baby. If the fluid is green or green/brown in colour or heavily blood stained, you should come into the EAU immediately.

Show

As the cervix (neck of the womb) starts to stretch, a plug of mucous may be released. Typically, this plug or ‘show’ is bloodstained and sticky. This bloodstaining will be old brown blood or light pink. Many women describe a show as being like the very beginning or very end of their period. You should not see bright fresh blood. Not all women will have a show before labour starts and a show is not a sure sign of labour.

Pain

Very early in labour, you may experience irregular cramping pains, like period pains. You may also have backache and a heavy sensation in your pelvis. This is all completely normal and is an encouraging sign that your body is getting ready for labour.

Restlessness

Not being able to focus on one thing, or being unable to sit still but not really being sure what you want to do. Not all women feel like this.

What to do in the early part of labour

Rest

It is important not to get exhausted in the early part of labour so rest is vital. If you are getting period-like pains, try to go to bed for a few hours. Even if you cannot sleep, just relaxing and listening to some music may help you later on.

Diet

Labour is hard work for your body so you will need food to maintain energy levels, eat small meals. It is also important not to get dehydrated during labour. While at home, keep a bottle of water near you and keep sipping it.

Use of warm water

In the early stages of labour, many women find a warm bath a great way to relax and to cope with the contractions. Standing in a warm shower with the water directed at your lower back is also helpful.

Breathing

There is no magic formula to describe breathing in labour. The advice is to take slow, easy breaths. Some women tend to hold their breath during a contraction while others breathe too fast. It is always better to breathe slowly – in through your nose and out through your mouth.

Music and hypnobirthing

The use of calm, quiet music is great for keeping you relaxed. Imagine holding your new baby and how happy you’ll feel as your baby is placed into your arms for the first time. Try to imagine your baby’s face and the feel of their skin. Hypnobirthing is the use of hypnosis and positive thinking techniques to promote childbirth as a natural bodily function. We encourage all women to practice hypnobirthing during labour and to attend a class antenatally.

TENS machine

The ‘transcutaneous electrical nerve stimulator’ or TENS machine works by delivering small electrical pulses through the skin via electrodes placed on your back. The TENS machine consists of four pads that are placed on your back and a small hand-held battery-operated device. The electrical pulses are thought to ‘block’ pain messages reaching the brain and stimulate the body’s naturally occurring painkillers – the endorphins mentioned above. Women using TENS often report less pain.

TENS machines work best if used early in labour. TENS machines can be rented prior to labour and can be used at home and left on when coming into hospital. If you are considering hiring a TENS machine, you should contact your local supplier for further information. It is a good idea to become familiar with the instructions for placing the pads on your back and how to work the machine before the big day.

Stages of labour

Contractions

Your body is designed to cope with labour. As your labour starts, your body produces natural pain relievers called endorphins. These morphine-like substances flood through your system and allow your body to cope with the increasing frequency and strength of contractions as your labour progresses.

Pains/contractions will become more regular and last for longer as labour progresses. Between contractions, you will have no pain. The advice for coping with contractions at home is:
Keep active – movement is great for helping with pain and for encouraging labour. Stay upright during the contraction and try swaying and rocking your pelvis as the contraction reaches the peak. Sitting and swaying on an inflated gym ball is also a great way of staying active.

Use of warm water – in the early stages of labour, many women find a warm bath a great way to relax and to cope with the contractions. Standing in a warm shower with the water directed at your lower back is also helpful.

Breathing – there is no magic formula to describe breathing in labour. The advice is to take slow, easy breaths. Some women tend to hold their breath during a contraction while others breathe too fast. It is always better to breathe slowly – in through your nose and out through your mouth.

Music and visualisation – the use of calm, quiet music is great for keeping you relaxed. Imagine holding your new baby and how happy you’ll feel as your baby is placed into your arms for the first time. Try to imagine your baby’s face and the feel of their skin. Visualisation (imagining) is great for reminding you of the end point of this journey.

TENS machine – the ‘transcutaneous electrical nerve stimulator’ or TENS machine works by delivering small electrical pulses through the skin via electrodes placed on your back. The TENS machine consists of four pads that are placed on your back and a small hand-held battery-operated device. The electrical pulses are thought to ‘block’ pain messages reaching the brain and stimulate the body’s naturally occurring painkillers – the endorphins mentioned above. Women using TENS often report less pain.

Contacting the Hospital

The Rotunda Hospital has a FREEPHONE telephone service – 1800 522 687, which provides information to women throughout their pregnancy, including at the onset of labour. You will also have the option to speak to a midwife, if necessary.

Contact the EAU if you have:

been advised to come straight to hospital once labour starts by your doctor or midwife;
contractions every 5 minutes, with pains lasting more than 60 seconds;
any vaginal bleeding that is not a ‘show’;
concerns about your baby’s movements;
severe, lasting abdominal pain;
headaches or blurred vision;
been feeling generally unwell;
your waters have broken;
if you have any concerns about yourself or your baby.

Contact the hospital

When you arrive in the Rotunda

Once you arrive in the hospital, the staff at the main reception desk will check some information with you and inform a midwife in the EAU that you have arrived. The midwife see you as soon as possible, discuss your symptoms, review your medical records, and carry out an examination to make a plan of care for you and your baby.

As part of the assessment, the midwife may:

take your temperature, pulse and blood pressure and do a urine test;
palpate (feel) your tummy to check the position of your baby and listen to your baby’s heartbeat;
examine you internally (vaginal examination) to check how much your cervix has opened.

The midwife will discuss this assessment with you and your partner and plan the next stage of your care. If you are in established labour you will be transferred to the delivery suite. If you are in early labour and the observations are all normal, you may be supported to return home. If there are any concerns about you or your baby or if you require pain relief, you will be admitted to the hospital.

Delivery Suite Environment

The delivery suite rooms are designed to provide an environment that is relaxing, personal and calm. The birthing rooms are single occupancy rooms that contain many home comforts, for example, dimmed lighting, labouring mats.

Staff caring for you

The team on the delivery suite consists of midwives who are the main care providers, doctors, care assistants and non-clinical support staff. Student midwives, care assistants and medical students are supervised by the midwives.

The obstetric doctors are always available if there are any concerns regarding you or your baby during labour. The doctors and midwives carry out ward rounds at regular intervals throughout the day and night. The Anaesthesiology team provide a 24-hour epidural service and provides anaesthetic support if surgery is needed. Paediatricians provide care for your baby at birth, if necessary and afterwards.

If you are attending for private care, the midwife will be in contact with the consultant during your labour to inform them of your progress and they will attend the birth. If you are attending for semi-private care, the midwife will be in contact with the doctors on duty, informing them of your progress. The registrar or consultant may attend the birth and may undertake any perineal suturing (stitches) that is required.

The staff will keep you informed of your progress in labour and they will discuss various options of care available to you. The health and safety of you and your baby is always the most important consideration when care options and choices are discussed.

Birth partner

At the Rotunda, we support your right to choose a birth partner. Your birth partner might be the baby’s father, a close relative or friend. It is your choice. One named birth partner is permitted to stay with you during labour and birth. The midwives will advise and assist your birth partner to support and encourage you throughout your labour and the birth.

Spontaneous Labour

There is no right or wrong way to go into labour. Every woman does it differently and no two labours are the same. There are three stages to labour – throughout the first stage, your womb (uterus) will contract repeatedly causing your cervix (neck of the womb) to thin, shorten and dilate. The first stage ends when your cervix has fully dilated to 10 cms. During the second stage of labour, the baby is pushed down through the birth canal and is born. In the third stage, the placenta (afterbirth) is delivered and bleeding is controlled.

When you are admitted, you will be shown to your birthing room and a midwife and student will be assigned to support and care for you. If you like, you can change into more comfortable clothes. We recommend loose clothing, preferably made from cotton, as you may feel hot during labour. The midwife will ask you about your pregnancy and labour so far, review your healthcare record and carry out an assessment of you and your baby.

As part of the assessment, the midwife will:

take your temperature, pulse and blood pressure and also do a urine test;
palpate (feel) your tummy to check the position of your baby and listen to the baby’s heartbeat;
examine you internally (vaginal examination) to check how much your cervix has opened.

Induction of Labour

Induction involves starting labour artificially. Labour may be induced if there is some risk to you or your baby’s health or if you are overdue. Induction of labour can take up to 24 hours: the longest part is getting the cervix to soften and open to about 2 cm. If your labour is induced, your contractions and your baby’s heartbeat will need to be continuously monitored.

You may be admitted to the general prenatal ward for induction of labour. As your labour becomes established you will be transferred to a delivery suite room.

There are several methods used to induce labour, both mechanical and pharmacologic. Some women might need just one method, while others might need more. You will be given an information leaflet in the clinic once the decision is made to induce your labour and the doctor will tell you about the possible methods needed to induce your labour when you arrive in the hospital.

Prostin gel

Prostin is a hormone used to soften and shorten the cervix, sometimes referred to as ‘ripening the cervix’. Before the prostin gel is inserted into your vagina, the midwife will carry out some assessments and observations on you and your baby, including monitoring of your baby’s heartbeat (CTG) for three minutes.

Once the prostin is inserted, you will be asked to stay in bed for one hour to help the gel to work. Continuous monitoring of the baby’s heartbeat will be undertaken for the first 30 minutes. After the hour you will be encouraged to walk about and to eat light food if you wish. At this stage, you might have pains like period pains. Some women may require a second or third prostin gel as part of the induction process.

Very occasionally, the prostin gel may cause your womb to contract too much and this in turn may affect the baby’s heartbeat. If this happens, you will be asked to lie on your left side and you may be given a drug to help your womb relax. Some women go into established labour following this method of induction.

Propess pessary

The pessary, which is like a very small tampon is inserted into the vagina and is left there for 24 hours. During this time, a hormone like prostaglandin will be slowly released and this helps to ripen the cervix. After this time, the pessary is removed and the membranes are then ruptured.

Artificial rupture of the membranes (ARM)

This method of induction is to artificially break the membranes – the bag of water surrounding the baby. The doctor will carry out a vaginal examination and break the waters. This is a painless procedure for you and your baby and is like bursting a fluid-filled balloon. Once the waters break, fluid called ‘liquor’ will drain throughout your labour. Sometimes, this method of induction is enough to start labour.

Oxytocin

This method of induction is by means of an oxytocin drip. This is explained in the next section – acceleration of labour.

Acceleration of Labour

If your labour slows down, the doctor or midwife may recommend accelerating your labour. This may be done by breaking your waters artificially or by starting you on a drip with a hormone called oxytocin, once your waters are broken. This hormone will encourage contractions and the dose of oxytocin can be altered according to the length, strength and frequency of your pains. Once the drip is started, it usually continues until the birth of your baby.

If the oxytocin drip is used to speed up your labour, the frequency and length of your contractions and the baby’s heartbeat are monitored continuously. A known side effect of this drip is that the contractions can become too frequent or too long. This may affect your baby’s heart rate. If this happens, you will be asked to lie on your left side, the rate of the drip will be reduced or turned off and a senior member of staff will review you. The contractions return to normal very quickly once the drip is stopped. You can move about (unless you have an epidural) and use upright positions even if continuous monitoring is required.

Monitoring your baby’s wellbeing

The midwife will monitor your baby’s heartbeat throughout your labour. This can be done by using:

Pinard stethoscope. This is a trumpet-shaped stethoscope that helps the midwife to hear your baby’s heartbeat through your tummy.

A handheld doppler is a small hand-held ultrasound machine that looks like a microphone. It is placed on your tummy and allows you, your birth partner and midwife to listen to the baby’s heartbeat.

Cardiotocograph (CTG): If there are any concerns about your baby’s heartbeat or if your pregnancy or labour falls into a ‘high risk’ category, continuous monitoring of the fetal heartbeat and contractions is recommended. This is done usingcardiotocograph (CTG). Two probes are placed on your tummy: one records the contractions and the other records the baby’s heartbeat. If there is any difficulty maintaining a recording of your baby’s heartbeat, the midwife might suggest putting a ‘clip’ on your baby’s head to improve the recording. This involves securing a thin curved wire to the skin of your baby’s scalp during a vaginal examination. Telemetry CTG is also available to allow you to remain mobile during labour.

Fetal Monitoring Information Leaflet