Every baby’s heart is monitored throughout labour. The midwife is watching for any marked change in the heart rate which could be a sign that the baby is distressed and that action should be taken in order to speed delivery. There are different ways of monitoring the baby’s heartbeat.
- Your midwife may listen to the baby’s heart intermittently with a hand-held ultrasound monitor (often called a Sonicaid). This method allows you to be free to move around in labour if you wish.
- The heartbeat and contractions may also be followed electronically through a monitor linked to a machine called a CTG. The monitor will be strapped on a belt to your tummy.
Sometimes it may be suggested that a clip is put on the baby’s head so that its heart can be monitored more exactly. The clip is put on during a vaginal examination and the waters are broken if they have not already done so. Ask your midwife or doctor to explain why they feel the clip is necessary for your baby. Throughout labour the heartbeat will be followed by a bleep from the machine and a print out. You cannot easily move around. Some machines use tiny transmitters which allow you to be more mobile. Ask if this is available.
What you can do
You can be up and moving about if you feel like it.
- You may be able to have sips of water, but once in established labour you will usually be asked not to eat anything. This is mainly in case you need an anaesthetic later on. Some units, however, allow fluids and/or a light diet.
- If you need the midwife while she is out of the room you will be able to call her by ringing a bell.
- As the contractions get stronger and more painful, you can put into practice the relaxation and breathing exercises you learned during pregnancy.
- Your partner or friend can help by doing them with you and by rubbing your back to relieve the pain if that helps.
Speeding up labour
If your labour is slow, your doctor may recommend acceleration to get things moving. You should be given a clear explanation of why this is proposed. To start with your waters will be broken (if this has not already happened) during a vaginal examination. This is often enough to get things moving. If not, you may be offered a drip containing a hormone which will encourage contractions. If you have a drip, the hormone will be fed into a vein in your arm.
The second stage
The baby’s birth
This stage begins when the cervix is fully dilated and lasts until the birth of the baby. Your body will tell you to push. Listen to your midwife who will guide you.
Position
Find the position that you prefer and which will make labour easier for you. You might want to remain in bed with your back propped up with pillows, or stand, sit, kneel or squat (squatting will take practice if you are not used to it). If you are very tired, you might be more comfortable lying on your side rather than your back. This is also a better position for your baby.
If you’ve suffered from backache in labour, kneeling on all fours might be helpful. It’s up to you. Try out some of these positions at antenatal classes or at home to find out which are the most comfortable for you. Ask the midwife to help you.
Pushing
You can now start to push each time you have a contraction. Your body will probably tell you how. If not, take two deep breaths as the contractions start and push down. Take another breath when you need to. Give several pushes until the contraction ends. As you push, try to let yourself ‘open up’ below. After each contraction, rest and get up strength for the next one. This stage is hard work but your midwife will help you all the time, telling you what to do and encouraging you. Your companion can also give you lots of support. Ask your midwife to tell you what is happening. This stage may take an hour or more, so it helps to know how you’re doing.
The birth
As the baby’s head moves into the vaginal opening you can put your hand down to feel it, or look at it in a mirror. When about half the head can be seen, the midwife will tell you to stop pushing, to push very gently, or to puff a couple of quick short breaths blowing out through your mouth. This is so that your baby’s head can be born slowly, giving the skin and muscles of the perineum (the area between your vagina and back passage) time to stretch without tearing.
Sometimes the skin of the perineum won’t stretch enough and may tear. Or there may be an urgency to hurry the birth because the baby is getting short of oxygen. The midwife or doctor will then ask your permission to give you a local anaesthetic and cut the skin to make the opening bigger. This is called an episiotomy. Afterwards the cut or tear is stitched up again and heals.
Once your baby’s head is born, most of the hard work is over. With one more gentle push the body is born quite quickly and easily. You can ask to have the baby lifted straight on to you before the cord is cut, so that you can feel and be close to each other immediately. Then the cord is clamped and cut, the baby is dried to prevent him or her from becoming cold, and you’ll be able to hold and cuddle your baby properly. Your baby may be quite messy, with some of your blood and perhaps some of the white, greasy vernix which acts as a protection in the womb still on the skin. If you prefer, you can ask the midwife to wipe your baby and wrap him or her in a blanket before your cuddle.
Sometimes some mucus has to be cleared out of a baby’s nose and mouth or some oxygen given to get breathing underway. Your baby won’t be kept away from you any longer than necessary.
The third stage
The placenta
After your baby is born, more contractions will push out the placenta. This stage can take between 20 minutes and an hour but your midwife will usually give you an injection in your thigh, just as the baby is born, which will speed it up.
The injection contains a drug called Syntometrine or Syntocinon which makes the womb contract and so helps prevent the heavy bleeding which some women may experience without it. You may prefer not to have the injection at first, but to wait and see if it is necessary. You should discuss this in advance with your midwife and make a note on your birth plan.
Information provided by Health Promotion England
