Preparation, Birth and Beyond… Transcript
Transcript: [Music]
Welcome to Preparation Birth and Beyond. My name is Olivia and I’m one of the midwives who works in the trust. This session will cover labour and birth, pain relief options, and immediate postnatal care following delivery. We will also discuss what to expect when you and your baby are discharged home. We want you to be as prepared as you can for your labour and birth. And we hope this session provides you with useful information. Any further questions following this session, please ask your community midwife. [music] When it comes to packing your bag for the hospital, there are a few essentials we encourage you to bring. A nighty is always good. It’s easy for access for regular pad changes, more convenient for any vaginal examinations, and also easier to wear if you are needing a catheter bag. You may also want to pack a small dressing gown. Maternity pads. It is normal to bleed following delivery, which can be like a period for a few weeks. Toiletries. Every circumstance is different and people’s hospital stays vary, but we advise to be prepared just in case you have to stay in. Slippers or flip-flops are always good to wear around the wards. Medications, we advise you to bring your own pain relief into hospital for when you’ve had your baby. Paracetamol and ibuprofen are good to take if you are tolerant to these. If you need anything further, we will supply these. Food and drink. We provide meals, but throughout labour, it’s good to stay hydrated. Isotonic sports drinks are good. Snacks in labour are useful, such as fruit, cereal bars, or sweets, such as jelly babies, for a quick energy boost. It’s important for your birth partner to bring their own bag of snacks. Charging cables and toiletries. Also, feel free to bring some music of your choice for during your labour.
For baby, we recommend a hat, some nappies along with cotton wool to change nappies, and a selection of clothing. If you’re planning to formula feed, please bring the pre-made bottles as we don’t have the sterilising equipment for use. Please don’t bring baby’s car seat in until you have been told you are discharged due to lack of storage on the wards.
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We advise you to ring maternity assessment centre if you feel you’re going into labour. The contraction pains would be regular and if they are coming quicker, stronger and longer, we advise you to call. When they become one every 5 minutes lasting around 45 to 60 seconds or you are unable to stay at home due to pain, we would advise you to contact us. We will always want you to notify us if you have any loss from the vagina. This could be your waters breaking or any blood. You do not need to notify us if you have lost your mucus plug or a show. This happens when there is cervical change and is of no concern. Throughout labour, we would want your baby to move in their usual pattern. So, please notify us straight away if your baby’s movements have changed.
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Early labour, known as the latent phase of labour, is your body getting ready for the birth. It can be very stop start. So, don’t be disheartened if you find this.
In this phase, your contractions may be short, mild, irregular, and often uncomfortable or painful, which are not necessarily continuous, but can last for a few days. During this phase, your cervix will soften, efface, and begin to dilate. The cervix has a lot of work to do before labour. Your cervix is a long, thin tube, and it needs to move forward and thin down while also dilating. Timings of early labour differ with everyone. However, this can be the longest part, lasting hours to days. And as long as you and your baby are well, we encourage you to stay at home with your own coping strategies for this part.
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The first stage of labour, often called the active labour phase, is when there are regular painful contractions and there is progressive cervical dilation.
This may be confirmed with a visual assessment or a vaginal examination. Once labour is confirmed, we would transfer you to the labour ward and will provide you with one-to-one care with a midwife and if necessary input from a doctor or if you are having a home birth, this is when the midwife would stay with you continuously. In this phase, we offer vaginal examination every 4 hours to monitor progress.
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There are many options of pain relief we can offer you throughout the labour and these include non-pharmacological and pharmacological options. You can use tablets such as paracetamol and dihydrocodeine which work well in the early stages of labour. You may want to use a TENS machine which can work well in the early stages of labour. There is little evidence of its effectiveness in established labour but no evidence of harm and other forms of pain relief can be used alongside TENS if required. Breathing techniques are a useful way of helping cope with labour pain. Some birthing people may use practices such as hypno birthing.
Getting into water can be a good option to help pain during labour, but be mindful we wouldn’t be able to use the CTG monitor in the pool and you are limited to other options of pain relief if in the pool.
So, please speak to the midwife caring for you during labour if you would like to consider getting in the birthing pool. Entonox is also known as gas and air that you inhale usually at the start of a contraction. The effect is short lasting and in between contractions you will breathe normal room air and the side effect should wear off quickly. The Entonox can make some people feel slightly dizzy and sometimes nauseous. Another option to help with the pain is an opiate drug such as morphine. This is usually given by injection into the top of your leg or your buttock. Again, this can cause nausea and vomiting. So to help this, we administer it with an anti-sickness drug. Morphine can help make you feel relaxed. Although it will not take the pain of the peak of the contraction away, it should help reduce the pain. In between contractions, it can make a person feel sleepy and its effect usually lasts around 2 to 4 hours. Opiates do
cross the placenta, so baby can also become sleepy.
We monitor this closely, but the midwife may not recommend morphine if upon examination you are close to delivering your baby. You can also opt for an epidural during the active stages of labour. An epidural is performed by an anaesthetist and it involves a needle used to insert a fine plastic tube called a catheter into the back near the nerves that carry pain messages to the brain.
The needle is then removed leaving just the catheter in the back.
Pain relief medication is given via the catheter and is run on a pump.
So it’s continuous and doesn’t run out until we switch it off. When working effectively, the epidural can remove pain, but also can provide a person to feel numb from the top of
the bump to their feet. Once the pump has been switched off, a person returns to have normal
feeling in a few hours. The main side effects of an epidural are is causing low blood pressure
and headaches, but the anaesthetist will go through all the risk with you prior to the procedure.
Please be mindful that you will be required to sit in an upright position for
at least 20 minutes during insertion. If you do opt for an epidural, we would recommend a urinary catheter, so we can ensure you are emptying your bladder, avoiding retention.
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It is important we monitor your baby’s well-being during labour. We can either monitor your baby continuously or intermittently and this would be decided at the time of labour following a discussion with your midwife. However, ultimately it is your choice which option you would like. Intermittent monitoring involves auscultating your baby’s heart rate every 15 minutes during the active stages of labour using a handheld sonicaid. We would listen following a contraction to assess how baby is coping with these. Auscultation using a sonicaid is recommended in patients with a low-risk labour and allows you to be mobile and active during labour. Continuous monitoring involves monitoring your baby’s heart rate using a CTG machine.
You will be placed on a CTG machine which monitors your baby’s heartbeat and your contractions continuously.
We recommend this type of monitoring in high-risk labours such as people who’ve been induced, have high blood pressure, or any concerns arising at the onset of labour. Please feel free to discuss options with your community midwife. And as always, we can recommend a way to monitor your baby’s well-being, but we encourage you to make an informed choice.
Although continuous monitoring can limit mobility, we still encourage movement and will support an active labour where we can. We always have some wireless CTGs in the hospital if you wish to be mobile. These are subject to availability at the time. At the time the midwife is caring for you and she becomes concerned and needs assistance quickly, she may press the emergency buzzer. This is loud and we are aware it can cause some anxieties. So please don’t panic. It is a way of us getting more hands to help and quickly.
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The second stage of labour starts when you are fully dilated, which is when your cervix has opened up to 10 cm, which means no cervix can be felt on examination. This is usually confirmed with a vaginal examination from your midwife. However, your body may start to involuntary push and you may experience a feeling of pressure. In some cases, we usually allow your body up to an hour of time to allow baby to descend before we commence active pushing.
As your baby’s head is crowning, your midwife will tell you to stop pushing and use that pain and pressure to breathe gently instead. This is to allow baby’s head to deliver slowly to reduce your risk of trauma to the vaginal and anal muscles. Your midwife will apply some pressure to your perineum at the same time which also contributes to reducing your risk of tearing.
Have you started your perineal massage? If not or you have any questions, please speak to your community midwife.
At the time of delivery, we will ask for another midwife to support us routinely. So, you may hear the call bell go off in the room.
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Following the birth of your baby, you will enter the third stage of labour where you will deliver your placenta. You will be given a choice of whether you want to birth your placenta physiologically, meaning with no intervention. If you choose this option, then we
would allow your placenta to come naturally. However, if this has not happened within an hour, we would recommend intervention to help the placenta deliver. This would be initially with an injection that helps contract the uterus and expel the placenta.
While your placenta is still in, there is an increased risk of bleeding.
Therefore, we would not recommend waiting any longer than 1 hour. Active management of the third stage involves the injection just discussed. This would be given straight away following the delivery of your baby. This would be administered into either your thigh or upper arm. This method may be advised if you are at higher risk of bleeding following delivery. Your midwife will discuss these options during your labour so you can make an informed choice prior to delivery.
Please note, there may be a change in circumstances and in an emergency we may need to intervene
and administer drugs to help contract the uterus and actively help deliver the placenta.
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It may be recommended in some cases to have an assisted delivery which can include a ventouse delivery or you may recognise it as the suction cup or a forcep delivery. In these cases, it’s suggested by an obstetrician if you are fully dilated and have been actively pushing in most cases over an hour and your baby has not yet delivered. This could mean your baby needs some assistance with their position or we have concerns around your baby’s heart rate. If an assisted delivery is performed, then it is very likely an episiotomy will also be done prior to the procedure. This is a cut made to the vaginal muscle to create space and reduce the risk of a larger tear affecting the anal muscles. Assisted deliveries can occur either in the labour room or you may need to be transferred to theatre where your birthing partner will be able to join you. There is also always a chance an emergency section may be required. This mode of delivery would be suggested if we believed you were unwell, your baby’s well-being was compromised or the labour was not progressing as we’d expect. This would be suggested as the safest option at the time. You would be transferred to theatre and ensured adequate pain relief is provided. In some cases, you may be offered an elective caesarean section where the operation is planned.
For some people, this is offered as the safest option opposed to natural birth.
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Towards the back end of your pregnancy, usually around your due date, you may be offered a membrane sweep by either your community midwife or by a midwife or doctor at the hospital if you haven’t gone into spontaneous labour.
Membrane sweeps are offered prior to an induction of labour as it can encourage labour to
start spontaneously or reduce the need for prostaglandins during the process. Your community midwife will talk to you about membrane sweeps and you will be able to make an informed choice as to whether you want one or in some cases you may be offered more than one.
You may be offered induction of labour for several reasons whether that be a concern about you or your baby or that your pregnancy has gone beyond your due date.
This may take place either on the antenatal ward or sometimes the delivery suite if your pregnancy is deemed as higher risk. On occasions, we may offer an outpatient induction of labour where you can spend the early stages of your of your induction at home.
Your midwife will discuss all these options when you arrive at the hospital on the morning of your induction.
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Firstly, you will be offered a vaginal examination to assess your cervix.
If your cervix has already started to soften and dilate, then it may be that we can artificially break your waters. This can be known as an ARM. If this is the case, then you will be transferred directly to delivery suite. Please be aware that due to acuity, then it may take a while for this to happen. Once on delivery suite, you will be provided with one to one care. You will have a cannula inserted into your hand or arm so that we can commence an oxytocin infusion. This hormone drip will be started at a low rate and increased accordingly until you are having good, strong, and regular contractions.
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In this case, you would be offered intervention which aims to soften and ripen the cervix with the aim to get you to the stage where we can break your waters.
There are two methods we can use. The differences and benefits of each method will be discussed with
you at the time. One option is dilapan which is an osmotic cervical dilator and does not involve any medication. This can be beneficial in reducing hyper stimulation where it it can cause too many contractions. Propess is the other method used in Leeds. It is a prostaglandin agent which sits behind the cervix and again the benefits of having this method would
be discussed at the time. Any of the discussed methods of induction will require close fetal monitoring.
and this can vary depending on which method is used. Please also note that if you require either dilapan or propess, this will happen on the antenatal ward and it can take 2 to 3 days.
Your midwife will support you with pain relief throughout the whole process.
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When your baby is born, if there are no immediate concerns, the best place for your baby is with
you in skin-to-skin. Your midwife will have this conversation with you during labour
and check this is what you want to happen. We do encourage skin-to-skin as it is linked to many benefits such as regulating your baby’s temperature, breathing, and heart rate. It also helps increase your oxytocin levels, a hormone which helps you to bond with your baby
and improve breastfeeding initiation.
Again, if there are no immediate concerns, we will delay cutting the cord. If there are any concerns that your baby needs assistance with their
breathing, we will take your baby and place them on the resuscitaire, where we can provide support and any intervention if required.
We have resuscitaires in all labour rooms so you will not be separated from your baby.
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So once your baby is born, we will offer a vaginal and rectal examination.
This is to assess for any tears or trauma following the birth. We categorise any tears based on how deep they are.
Some tears are minor and can be repaired by a midwife in the room straight away.
However, if the tear is more complex or we may suggest you go to theatre so it can be repaired by your doctor in a more controlled environment. We will always explain what we are doing. Ensure that you are comfortable and have adequate pain relief for any repairs.
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For your baby, we will carry out immediate checks to ensure your baby is well and it may be that we need to provide your baby with some resuscitation. In the room you’ll see a piece of equipment called a resuscitaire. This is there as a precaution and will enable us to assist your baby if they need a little help with their breathing once born. We will also undertake a top to
toe check of your baby to look for any visible abnormalities and we’ll weigh your baby.
We will offer vitamin K for your baby that will help your baby’s blood to clot.
This can be given as an injection into the thigh or orally depending on your preference and consent.
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Once you’re home, the following day you will get a home visit from a midwife. We like to see you on the first day home, day three if you’re breastfeeding, day five, and also around day 14 for your discharge appointment. We tailor these appointments to you so we can offer more input if required. Community midwives are there to ensure you are physically and mentally well.
We will frequently review your vaginal bleeding and any vaginal tear repairs or caesarian section wounds to ensure the sutures are not infected. We will also check you are opening your bowels as normal and passing urine with no problems. Following assessment, you may be discharged home with some medication to reduce your risk of developing a blood clot.
So, the midwife will check and provide some support if necessary. Your mental health is important following delivery and we encourage you to speak to your midwife if you are feeling low in mood or struggling in any way. During home visits following discharge, the community midwife will also be reviewing your baby’s well-being, ensuring they are alert with good colour and tone and a normal breathing pattern. They will check closely for jaundice, which is a yellow tinge to the skin or eyes. They will also offer feeding support and ensure your baby is feeding well and has adequate wet and dirty nappies for their age. We have maternity support workers who can provide breastfeeding support in community and offer a tailored approach to care. We will offer to weigh your baby on day five.
Babies are breastfed will also be reviewed at day three and weighed to ensure the weight loss is within normal limits. We expect
all babies to lose weight but after birth, but we want to make sure the weight loss is within normal limits. When your baby is 5 days old,
we offer newborn screening tests to all babies. This is offered as part of the national
screening program. This is a heel prick blood test and we collect four drops of blood
onto a piece of card. We are checking for a number of metabolic disorders. Your midwife will explain this test and on the day and ensure informed consent prior to taking. If by 2 weeks
old you and your baby are both well, then you will be discharged from midwifery services
and your GP and health visitor will take care of you both moving forwards.
Please contact maternity assessment centre with any urgent concerns or any signs of labour.
For any non-urgent calls, then please call the community triage line which is open Monday to Friday.
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