What it is

There are two kinds of electronic monitors, external and internal. An external monitor can be used early in labour and is sometimes used during pregnancy to check the baby’s well-being. The internal monitor is slightly more accurate. You will have belts strapped around your body and a tiny electrode will be clipped on to the baby’s head. Your contractions and the baby’s heartbeat are recorded on a printout (partogram). There is also a video screen that records the contractions and heartbeats as visible waves, punctuated by flashing lights.

During a contraction blood flow to the placenta is reduced for a few seconds, and your baby`s heart rate will dip. This is quite normal and the heart rate returns to baseline when the contraction passes. If the return to base­line is delayed, your baby may be distressed and action can be taken early to protect his well-being. The latest type of EFM, known as telemetry, uses radio waves and allows you to walk around because the baby’s monitor is attached to a transmitter strapped to your thigh. The older equipment confines you to a bed or chair.

How it is done

Your waters bag are broken when the cervix is about 5-6 cm {2-TA in) dilated and the electrode is applied to your baby’s head. In addition to the baby’s monitor, which picks up his heartbeat, a second monitor is placed between your baby and the uterine wall to measure the pressure and contractions

It may also be necessary if you have previously had a Caesarean. This was once thought essential, because it was feared that the scar of the previous Caesarean section would open up during labor. But experience has shown that this does not happen with the horizontal or “bikini” cut, which is now usually employed. Doctors often suggest that you try a normal vaginal delivery, known as a “trial of labor”. However, remember that it is your uterus that is on trial, not you, so don’t feel you have failed if you end up having a Caesarean.

Non-emergency Caesareans are often carried out under an epidural anesthetic. This has several advantages over a general anesthetic: it is safer for your baby; you have no post-operative nausea or vomiting; and because you are conscious, you can hold your baby as soon as he is born. In addition, it is usually possible for your partner to be with you during the operation, just as he would be if you were having a vaginal delivery.

When you have a Caesarean, you may feel disappoint­ed or even cheated that you did not have a vaginal delivery. Such feelings are perfectly natural, and the best thing you can do is talk about them with your partner. It will probably help if he can describe the birth to you in detail — this will help you to visualize and accept it.

It also helps, of course, to prepare yourself in advance for this type of birth. With your partner present, find out from the obstetrician what the operation entails, the procedures that will be used, and whether your partner is allowed to be present. Ask if you can see a video so you will know what is going to happen to you. If at all possible, talk to other women who have had Caesarean sections. They will not only provide you with useful information but with emotional and moral support.

Caesarean with an epidural

Caesareans are now rarely performed under a full anesthetic but you are given an epidural anesthetic, which numbs the lower part of your body. It also means that you can be conscious throughout the operation, your partner can be with you, and because it is very quick, within 5-10 minutes of the incisions being made the baby is delivered and you are able to hold your new son or daughter.

Emergency Caesarean Section

This is often needed when something goes wrong during labor, such as a prolapsed umbilical cord or hemorrhage from placenta praevia, or if there is evidence of fetal distress. Emergency Caesarean sections may be carried out under an epidural and the hospital may not allow your partner to be present at the operation.

After a Caesarean Section

As is the case with any major surgery, it takes time to recover from a Caesarean, but even so you will be encouraged to get up and walk around a few hours afterwards to stimulate your circulation. You will be given painkillers if you need them, and the dressings will be removed after three or four days. Your internal stitches will be made with absorbable sutures, which will dissolve away naturally, and your external stitches will be removed within about a week.

Positions
Walking around, leaning against your partner or the wall, and rocking your pelvis will probably feel much more comfortable than lying on your back in bed. There are also certain positions that you will find more comfortable than others, because these will relieve the pressure on your back.

Massage
This is a wonderful way of getting reassurance from your partner while relieving discomfort, whether you’re lying, standing or squatting. It can be particularly relieving if you have backache during labour, which most women do, or if you suffer from a backache labour.

TENS
(Trans-cutaneous Electrical Nerve Stimulation) Pain impulses conducted by nerves are blocked by an electric current, which also stimulates the production of endorphins. A battery-powered stimulator is connected by wires to electrodes that are placed on either side of the spine. You then use a handset to regulate the amount of stimulation and thus pain relief that you receive.

Visualizing
Creating images in your mind can be a very effective way of calming fear and reducing pain. As your contraction begins, imagine something that you find particularly soothing, for example, warm, bright sunshine. Contractions in the first stage are opening the cervix and you may find it helpful to think of the image of a bud of your favorite flower opening slowly, petal by petal. Thoughts of waves are also very comforting, the flow of the waves matching each contraction as it increases in intensity, peaks and dies away.

Water
Lying in warm water can be very relaxing and soothing because the water renders you virtually weightless and this brings relief between contractions. For these reasons, birthing pools are used by some mothers under supervision.

Sounds
You can help to diffuse the pain and anxiety of your labour by vocalizing in the way you feel is most helpful. Sighing, moaning, groaning and grunting are all ways of releasing tension, and you shouldn’t be inhibited, or worry about disturbing others.

Many women find that listening to music is very effective. Your birth assistant can play different pieces on a cassette recorder depending on how you are feeling.

Hypnosis
This isn’t something that you should try on a whim, since you need to respond to hypnosis very easily. Women who can go into a deep trance have been able to have a forceps delivery, stitches or Caesarean without feeling pain. A period of practice sessions is advisable, so that both you and your hypnotist are completely familiar with what you have to do during the birth.

Acupuncture
You should only opt for this method if you have already found that it can relieve pain in other situations. In addition, your acupuncturist must be familiar with labour and delivery. This may not stop you feeling any pain at all, but it will certainly reduce it, and also helps prevent nausea.

While consulting your notes, the midwife will ask you questions about your labours progress — whether your waters have broken and how often your contractions are coming.

You will be asked to undress and put on a hospital gown or your own T-shirt or nightdress.

You will then be examined; the midwife will palpate your abdomen to feel the baby’s position; she will listen to the fetal heartbeat, take your blood pressure, pulse and temperature and give you an internal examination to see how jar your cervix has dilated.

You will be asked to give a urine sample to test for the presence of protein and sugar.

You 11 be asked when you last had a bowel movement and it may be suggested that you have an enema or a suppository (although this is no longer routine in many hospital).

You then have a shower or bath and are shown to the first stage labour room. If you have any questions or you want to make your feelings known to the staff, now is the time to remind them of your birth plan.

Every woman’s experience of labour is unique, and the time span can’t be predicted. However, an average labour lasts about 12—14 hours for first-time mothers, and about seven hours for subsequent labours. If your first labour lasts longer than 12 hours, or in subsequent labours nine hours, your obstetrician may intervene.

The first stage of labour can be regarded as having three separate phases. The early, or latent, phase is the longest, lasting about eight hours for first babies, during which the cervix is softening and you will feel contractions occurring with increasing frequency and length. Try to conserve your energy during this time.

The next, active phase when the cervix is dilating, is shorter, lasting from three to five hours, and this is when your contractions become more painful, and you may want pain relief. The final phase of dilatation (sometimes called transitional) is the shortest and most intense, usually lasting under an hour, and comes just before you begin to push.

Your Cervix Dilates

The normally tough cervix must be stretched thin and opened wide before your baby`s head can pass through. The contractions of the first stage of labour achieve this.

Before labour

Your cervix is normally thick and closed, but has been softened by hormones during pregnancy.

Early (Latent) phase

Your cervix begins to thin (efface) before it can stretch and dilate.

Active dilatation

When your cervix is about 5cm (2in) wide, it is halfway to full dilatation and delivery.

End of the first stage

Your cervix is fully dilated when it is about 10cm (4in) wide. Now the head can descend.

- you have to work harder pushing the baby uphill;

- pain may be greater in this position than in a vertical one;

- the tissues of the birth canal may be slow to open and be stimulated by the descending baby, thus possibly prolonging labour;

- there is a greater need for an episiotomy;

- there may be an increased chance of a forceps delivery;

- it inhibits spontaneous delivery of the placenta;

- there is a greater possibility of lower back strain.

Slow Deliveries

What is considered to be the normal length of labor varies from hospital to hospital— and it is the marrying of what is right for you with what is normal for the hospital that causes problems. Procedures that are more likely to be used when the medical staff wishes to hurry you include:

- rupturing the membranes (if still intact), or setting up a Syntocinon drip to speed up contractions.

- use of an episiotomy and forceps.

The unkindest cut?

An episiotomy is an incision that helps deliver a baby`s head; it isn’t always needed if the head is delivered slowly.

The mid-line cut

To perform this the doctor have to cut straight down into the perineum, between the vagina and anus.

The medio-lateral cut

A local anaesthetic in your perineum, known as a pudendal block, is usually necessary beforehand.

If you have already had an epidural for your labour, you will probably not need any further anaesthetic, unless it has worn off, in which case it may be topped up.

Episiotomy

This is a surgical cut to enlarge the vaginal oudet at delivery, and is the most commonly performed operation in the West. Episiotomies are employed in order to avoid tears, which have ragged edges and are difficult to stitch together and were believed to heal less well. This is not the case. Tears can be avoided if a woman is encour­aged to stop pushing while the head is being born, and is allowed to let her uterus ease out the head gradually rather than quickly. When the head delivers too fast, an episio­tomy may be done because the perineum is thought to be under stress. If you wish to avoid an episiotomy, have it noted that you don’t want one unless absolutely necessary.

Regional anaesthetics

These remove sensation from part of your body by blocking the transmission of pain from nerve fibres. Caudal anaesthesia is administered by an injection into your spinal area around the sacrum, and numbs your vagina and perineum. This may be used for short-term relief if the birth involves a vacuum extraction or forceps delivery.

To administer a pudendal block, anaesthesia is injected straight into your vagina near the pelvic region, blocking the pudendal nerve. This numbs the lower part of your vagina, and may be used if you have an episiotomy.

The most widely used form of this type of anaesthesia is the epidural block. Most mothers who have a Caesarean have an epidural instead of a general anaesthetic, which allows them to stay awake throughout the birth.

Anaesthetic is syringed into the catheter, which is then sealed, although it can be topped up at any time if necessary. You need to let your attendants know in advance that you wish to have an epidural because it must be given by a skilled anaesthetist, and it usually takes 10-20 minutes to be set up. The anaesthetic will take effect within a few minutes.

Inhalation analgesic

This is a gas that you administer yourself using a face mask, and consists of Entonox (gas and oxygen). You inhale deeply as the contraction starts, and carry on until the contraction peaks or you have had enough. You then put the mask aside and breathe normally. Gas works by numbing the pain centre in the brain, and can make you feel as though you’re floating. You may be able to practise this in an antenatal class.

Narcotics

Now considered rather old-fashioned, the most commonly used is pethidine, which is derived from morphine, and is given by injection in the thigh or buttock in varying dosages during the first stage of labour. It dulls the sensation of pain by acting on the nerve cells in the brain and spine. If you choose this, it is probably wise to ask for a small dose to see how you are affected. It will take about 20 minutes to work.

How drugs affect your baby

Most drugs will cross the placenta to affect your baby once they are in your bloodstream. Those used in epidural anaesthesia cannot enter your baby’s blood.

Drowsiness

A large dose of sedatives or tranquillizers may affect his ability to suckle, and to respond to you immediately after he is born.

Breathing and sucking

If you take pethidine late in your labour it could affect your baby at birth because narcotics can depress your baby’s breathing and make sucking inefficient.

Epidural anaesthetic

After an injection of local anaesthetic in your back (to numb it), the anaesthetist will insert a fine, hollow needle into the epidural space — the region around the spinal cord — and the anaesthetic is injected through this.

The kind of pain you’ll experience during contractions can vary. It may feel like a thick band being squeezed around your abdomen as the uterus hardens and tightens for several seconds before relaxing. Some women compare it to severe menstrual cramps, others experience backache, but there may be a combination of sensations as the contraction peaks and then subsides.

Individual response

You may prefer not to use certain drugs during your labour as they can dim your awareness of what is happening; however, it is very difficult to know the level of pain you can manage without relief, particularly if this is your first baby. Some women are surprised by the overpowering intensity their contractions, others may find their pain worsen through fear and anxiety.

Analgesia, such as epidural anaesthesia can offer complete relief of pain, while gas and oxygen and narcotics help reduce pain to bearable levels. Many opt for no drugs in the early part of the first stage, then have gas and oxygen towards transition. Don`t be self-critical if you do need drugs for pain relief it isn’t a sign of cowardice. Remember, labour isn`t a test, and drugs may even be essential to deliver your baby.

If you wish to have full participation in your baby’s birth without dimming your consciousness of the physical and emotional sensations, there are alternatives to drugs for pain relief.

A clear choice

Find out as much as possible about the types of pain relief that will be available. Have a discussion with your doctor, midwife and hospital attendants, and then outline your choices in your birth plan. Be prepared for your plan to change if any complications arise.

How drugs affect you

Apart from offering pain relief, drugs can affect your experience of childbirth in other ways. Make sure you opt for the type that will help enhance, rather than detract from, the pleasure of your baby’s birth.

Drowsiness

This is a common side-effect of gas and oxygen, tranquillizers and narcotics. Some women enjoy the sensation of drifting, but sometimes this can make mothers feel they lack control A few women have become so lightheaded they were unaware of what was happening around them, and gave birth without realizing it had happened.

Dizziness

Pethidine and other narcotics can sometimes induce a feeling of confusion, or disorientation, and some mothers have even had hallucinations.

Nausea

The sensation of nausea is usually slight with gas and oxygen, but is quite common after using pethidine and other narcotics, and a few mothers may suffer attacks of vomiting.

Your state of mind can have a major effect on the intensity of pain experienced in labour. So if the use of drugs will make you less anxious and more relaxed, there is no point in depriving yourself since excessive tension can affect the uterus, increase your perception of pain, and lengthen labour.

UNDERSTANDING YOUR ROLE

Like many partners, you may be nervous or worry about feeling squeamish, or being inadequate at offering sufficient support. You can help combat this by prepar­ing yourself in advance. It s important that you know as much as possible so that you can effectively help the mother meet the physical and emotional demands of labour. At the antenatal classes there will be demonstra­tions to describe the onset of labour and the effect of contractions, and you will be taught techniques for helping her relax.

If it’s going to be a hospital birth, visit the labour and delivery rooms with her and introduce yourself to her hospital attendants so you wont feel like an outside when the time comes. If the birth is to be at home, find out what will be expected of you.

HOW TO HELP DURING LABOUR

You may have a very active role throughout the labour and birth, but sometimes your presence is all the mother needs. Make sure you are familiar with her birth plan and any alternative version. You need to be aware of her wishes in order to speak on her behalf during labour if necessary.

Use your intuition

You need to judge the situation, observing your partner’s moods and fitting in. Alternatively, she may need a great deal of verbal or physical encour­agement, or to be distracted by music or talking.

Provide emotional support

Stay as intimate as possible using loving words, and keep your movements slow, quiet and steady. Always be positive: offer praise, never criticism. If she wants to hear your voice, constantly tell her how well she is doing (how far dilated), suggest how she can relax herself, tell her what other people such as the midwife are doing to help her, and what will soon happen.

Also, help her to see how much she has achieved already – its easy for her to be overwhelmed by how far she thinks she has to go. Massage and stroke her slowly, but if she just wants to hold your hand, you can offer encouragement by using facial expressions and lots of eye contact.

Combat fatigue

Before labour, remind her to rest as much as possible, particularly if she seems to spend a lot of energy cleaning during the “nesting” period. If she has a long, tiring labour, try to help her relax between contractions to conserve her energy for the second stage. If she’s not feeling nauseous, provide her with as much refreshment as she wants (see also p. 32). She will probably find that having her face wiped is very soothing.

Help her cope with pain

It’s hard to see someone you care about in pain, but try not to reveal your anxiety because she may become discouraged. On the other hand, don’t discredit her suffering. Don’t let her feel embarrassed about expressing her discomfort – encourage her to be as uninhibited as possible. Try not to be upset if she becomes critical or aggressive – this often happens when the pain is very intense.

Assist with breathing

You will probably have practiced this during antenatal classes, but allow her to follow her own rhythm. If she seems to lose control, slowly guide her through the pattern until she can carry on alone. Be prepared to adapt – very few people follow exactly what they practiced at antenatal classes.

Admission to hospital

Once you’ve arrived in hospital you may be offered a wheelchair to transport you from the hospital entrance to the labour ward. If your labour is well advanced, you’ll welcome a wheelchair, but if not, you should be allowed to walk if you wish.

You may have outlined in your birth plan how you wish your labour to go, and once youve met your midwife or doctor, this is the time to make sure they have a copy that you can look over with them. They will also make some checks and will ask you questions about your labour.

If you aren’t happy with any procedure, if equipment, lights, and needles frighten you, or if you are upset by a staff member, act at the time. Your birth assistant can voice your feelings if you aren’t feeling strong enough.

Examinations

Your baby’s heart will be regularly moni­tored by fetoscope, sonicaid or an electronic fetal monitor (see opposite). You will probably have an internal examination every two to four hours during the first stage to check the dilatation of your cervix.

Each time you have an internal examination, ask how you are progressing. It is very comforting to know how far your cervix has dilated between examinations. If your personal birth assistant is asked to leave during an internal examination, say that you would prefer him or her to stay. If you’re asked a question while you are having a contraction, concentrate on your relaxation techniques and answer when the contraction is over.

Pain relief

After the admission procedures, you will be visited by the anaesthetist if you have opted for some form of medical pain relief. If you are having epidural anaesthesia, the procedure will be set up now. This usually takes 10-20 minutes. The anaesthetist may then leave you with your birth assistant and midwife, but will return later to check and top up the anaesthetic. Pethidine, and gas and oxygen are always available.

Monitoring labour

Contractions are recorded by an external monitor strapped to your abdomen. An internal monitor is attached to your baby`s presenting part, usually the head, by piercing his skin. It provides an electrical contact that picks up his heartbeat. Some babies` heads will be bruised or have a rash where the electrode was attached.

Forceps look like large sugar tongs and are designed so that they will fit snugly over the sides of the baby’s head, covering the ears. They are rather like a cage and protect the head from any pressure within the birth canal.

The decision to use forceps is a medical one. Forceps are only applied when the first stage is complete, the cervix is fully dilated and the head is in the birth canal

Why it is done

Forceps are used when the baby`s head has descended into the mothers pelvis but fails to descend further; when the baby is presenting in a posterior position; in a breech delivery (see opposite); when the uterus fails to maintain contractions; and when the mother lacks the strength to push out her baby. Nowadays, nearly all premature babies are delivered by forceps to protect their delicate skulls from being compressed in the birth canal.

How it is done

You will be asked to lie on your back and your legs will be put up in stirrups. A local anaesthetic will be injected into your perineum, and an episiotomy performed. Then the forceps will be inserted into your vagina one at a time. A few gentle pulls on the forceps, 30-40 seconds at a time, will bring your baby`s head out. The rest of his body will be delivered as usual

Episiotomy Wound

The pain from an episiotomy wound gets worse before it gets better. The wound is positioned where fluid can accumulate in the cut edges. These then swell, with the result that the stitches become tighter and bite into the sore skin around the wound

if you are bruised or if the stitches are really painful, it will help to sit on an inflatable rubber ring (some hospitals have these). Good hygiene is vitally important while the wound is healing, so make sure that it is kept clean. Most stitches will dissolve after five or six days.

Warm baths and showers are soothing and encourage the healing process, as do pelvic floor exercises. You may also find that ice packs or local anaesthetic creams are helpful There are special perineal pads that fit between your sanitary towel and the wound. Your doctor or midwife will advise you about these.

Don’t use antiseptics or perfumed bubble liquid in your bath water because they can cause irritation. After bathing if you can, dry the area with a hairdryer instead of a towel, which can be painful.

Urine, which is strongly acid, will make the raw skin sting Standing up to urinate may help. You could also try pouring warm water over yourself as you’re urinating to dilute the acid and reduce the sting.

Fatigue

Getting enough rest and sleep is essential if you are to combat the inevitable fatigue of the first weeks of caring for your newborn baby.

Try to rest whenever you can, especially during the first week or so when you will still be recovering from the exhaustion of labour. Avoid climbing stairs and heavy lifting as much as possible, and get your partner or someone else to help you with the baby and the general housework. Take advantage of your baby`s daytime naps to rest or nap yourself, and try not to waste these valuable chances for rest by using them to catch up on the ever-present chores.

Make sure that you get enough sleep. At night, go to bed half an hour or so before you plan on going to sleep, and unwind slowly. Try sipping a warm, milky drink, listening to music, watching television, or doing a little light reading to relax you physically and mentally before you sleep.

If you are breastfeeding express milk into bottles so that your partner can share the night­time feeding duties just as he would if you are bottle-feeding.

A healthy diet is an essential part of combating fatigue, but don’t eat too much late at night because digesting it might interfere with your normal sleep pattern.

Breech Birth

If your baby is in a breech position (buttocks down), and your obstetrician decides that he can be delivered safely without a Caesarean section, he will be born vaginally. The breech birth should not be thought of as an abnormal birth — it is better to think of it as a variation of normal, because four out of every hundred babies are born in the breech position and most of them do so i smoothly and are healthy.

In most breech births, the buttocks are delivered first, then the legs. In some births the feet descend ahead of the buttocks. The body slips out next. Before the head is delivered, you will almost certainly have to have an episiotomy because the head is the widest part and your baby`s bottom will not have stretched your birth canal sufficiently for his head to pass through it without some pressure being applied.

Once the baby`s body is born, his weight pulls the head down. His body is then lifted upwards by the midwife, and one more push is usually enough to deliver him. Forceps may be used to protect the baby`s head (see column, opposite).

It is now fairly common practice for you to be given an epidural if you are having a breech birth. This is so that if you need a Caesarean section it can be done quickly and simply without further anesthesia, and you will be able to hold your baby as soon as he is born.

Clean your breasts and nipples daily with cotton wool and baby lotion or water, but avoid using soap because it strips away the natural oils that protect the skin from drying and cracking, and it can aggravate a sore or cracked nipple. Always treat your breasts with care – don t rub them dry for example, but very gently pat them dry instead.

There is no need to wash your nipples before or after each feed but, before you fasten or put on your bra after feeding, let your nipples dry in the air, and always wash your hands before handling your breasts in order to prevent infection.

Engorgement

About three or four days after you have given birth, your breasts will fill with milk. They will become larger and heavier, and feel tender and warm when you touch them. If they overfill, the condition is known as engorgement. This usually only lasts a day or two, but it can be uncomfortable and may recur.

To ease engorged breasts, take off milk either by expressing manually or by feeding your baby (you may have to express a little milk first so that he can latch on). In addition, you may find that it helps to bathe them with warm water or cover them with warm towels, or to stroke them gently but firmly towards the nipple.

Engorgement can recur at any time while breastfeed­ing, particularly if your breasts are never’ properly emptied or if your baby misses a feed.

Blocked ducts

A blocked milk duct may occur in the early weeks of breastfeeding. It may result from engorgement, from a bra that is too tight, or from dried secretions on the nipple tip. Your breast will feel tender and lumpy and there may be a reddening of the skin.

To clear a blocked duct, start feeds with the affected breast and gently massage it just above the sore area while feeding to ease the milk gently towards the nipple. If the blockage will not clear, don’t offer that breast to your baby and consult your doctor immediately because it could become infected.

Sore nipples

When you begin breastfeeding, your nipples may feel slightly tender or very sore for the first minute or so of suckling. This tenderness is quite normal, and it usually disappears after a few days. Prolonged sore nipples, however, can turn what should be a pleasure into something of an ordeal. Take care when latching on and taking your baby off your breasts, to prevent these problems from arising. This is also essential if the nipples are to heal after they have become sore or cracked.

Cracked nipples

If a sore nipple becomes cracked, you may need to keep the baby off that breast for up to 72 hours and express milk from the breast to avoid engorge­ment. Cracked nipples can be very painful, and they can lead to breast infection (mastitis).

Certain procedures historically associated with childbirth are being re-evaluated. Some have been found to be unnecessary, others unjustified. However, most of today`s obstetricians believe that they can guarantee that childbirth is a safer and happier experience for a mother and her baby with the help of modern technology.

By drawing your attention to the arguments con­cerning some standard medical practices, this will help you to question them assertively with your medical and nursing attendants. More often than not, your wishes will be complied with, especially if you have written a birth plan in advance, but occasionally you will be told that to continue with a particular option will put you or your baby at serious risk — for instance, if your baby is showing signs of distress and you fight to continue with a totally natural childbirth. Be prepared to adapt your ideas.

Shaving

Nowadays, shaving is unnecessary unless you are having a Caesarean section. Any chance of infection can be eliminated by wiping the vulva with gauze and simply spraying with an antiseptic.

Nil by mouth

Many modern obstetric units have aban­doned the old custom of nil by mouth but some hospitals may still practice it. There is no medical nor scientific rationale for starving a woman during labour. In fact, quite the opposite: the hard work of labour uses up much energy, which causes sweating, and a woman must replace the fluids that she has lost.

Before epidurals became commonplace for Caesarean sections, if a general anaesthetic became necessary it could not be given to a woman who had eaten recently as she might have inhaled vomit. But, even so, there is no reason why every woman should still suffer simply because a small number need surgical intervention.

Moving to a delivery room

In some hospitals a woman still has to undergo the physical and emotional upheaval of leaving the room in which she had so far laboured in order to have her baby in a delivery room. Ideally, labour should proceed smoothly in peaceful surroundings, and as long as a room is equipped with good lighting, oxygen in some form, and a suction apparatus to clear out the babys air passages, if necessary, I can see no reason why a woman in normal labour should be forced to move to a delivery room. Many progressive hospitals now have more congenial all-in-one labour and birthing rooms and, if possible, you should choose a hospital with these.

Induction

Starting off labour artificially is not a new idea, but it only became an easy procedure in the latter half of the twentieth century. Labour is usually induced for medical reasons such as pre-eclampsia, high blood pressure or post-maturity, when induction can save the lives of mothers and babies.

An induced labour may involve the use of a Syntocinon drip, which will restrict your movements. Such a labour can be shorter and sharper and probably will increase your need for heavy-duty painkillers.

Amniotomy

This is when the membranes (the bag of waters) surrounding the baby are artificially ruptured. It may be carried out in a high-tech birth, and if so, is usually done early in labour for three reasons. The first is so that electronic fetal monitoring equipment can be set in place; the second is to check if the amniotic fluid contains meconium (this is the baby’s first bowel movement and its presence may indicate fetal distress); the third is that once they are ruptured, the baby’s head can press down hard on the cervix, helping dilatation of the cervix and speeding up the first stage.

Women at high risk, and those women with an existing condition such as diabetes or having a Rhesus negative blood group, are carefully monitored so that the baby’s welfare is never in jeopardy.

You will attend an antenatal clinic at either the hospital where you will have your baby or at your doctor’s surgery. Most of the women attend once a month or so up until 7 months of pregnancy, every two weeks up to 9 months of pregnancy, and then once a week for the last month.

You will need to attend mo/e frequently if any complications develop, such as your expecting more than one baby, if you have a pre-existing medical condition, or if you are at risk.

Attending an antenatal clinic in a hospital can be intimidating and frustrating: there may be a large number of staff coming and going, and you may be kept waiting for some time. Many women describe it as a cattle market. Negative feelings can be made much worse by the discontinuity of care — it’s quite possible to see different nurses and doctors at every visit. Much of this can be avoided if you opt for shared care, a GP unit, or the “domino” system where you mainly see your doctor or your midwife for check-ups, with occasional visits to the hospital antenatal clinic.

When you go, try to make the best of your time at the antenatal clinic by taking along something to read or to do, and some food and drink just in case the food trolley doesn’t come by while you are there. Take a friend or your partner with you for company and moral support.

Ideally, your partner should attend at least one antenatal clinic with you so that he is familiar with what you go through and can sympathize. He can also have his questions answered and, most importantly, give you moral support. If you already have young children, arrange for them to be looked after if at all possible because they can be quite a handful in a confined space with little to interest them.

On your first visit to the antenatal clinic, you will be asked various questions on the following subjects:

- Your personal details and circumstances including age, marital status, next of kin and religion.

- Childhood illnesses or serious illnesses you have had.

- Serious illnesses that run in your family or in your partners family

- Whether there are twins in your family

- What symptoms of pregnancy you have, and the state of your general health.

- Details of previous births, pregnancies or problems in conceiving.

- Whether you are taking any prescription medication or whether you suffer from any allergies.

- your menstrual history — when you started, how long your average cycle is, how many days you bleed, and the date of your last menstrual period (IMP).

- From the above information, your estimated delivery date (EDD) will be calculated.

However anxious and overwhelmed you are, you must stay calm and reassure her – she needs to feel confident and relaxed. Encourage her to take up any positions in which she feels most comfortable and to eat and drink if she feels like it. Speak quietly and keep any onlookers at bay.

Between contractions

Turn up the heating in the room if at all possible. Wash your hands thoroughly in soap and water, and then fetch several clean bath towels and place them conveniently to hand. Fold one and put it on the bed or floor so that you have something soft on which the baby can be laid.

Then fill several bowls with hand-warm water, and collect as many clean hand towels, face flannels or tea-towels as you have; immerse these in the water and use as wipes for mother and baby during and after delivery.

The birth

Your partner will know when the baby is coming because she will feel a stinging or burning sensation as the baby stretches her vagina. After washing your hands thoroughly again, look to see if you can see the top of the baby’s head in the vaginal outlet. Remind your partner to pant or blow, so that her vagina and perineum have time to thin and stretch, which may enable her to avoid tearing.

The baby’s head will probably be born in one contraction and the rest of his body in the contraction afterwards. When the head is born, wipe each of the baby’s eyes from inside to outside with separate pieces of moist linen, and then feel round his neck to see if the cord is present. If it is, crook your little finger underneath it and pull it very gently over the head, or lift it so that the body can be born through the loop.

Do not cut the cord because it may go into a spasm and deprive your baby of oxygen. If the membranes (called the caul) are still present over the baby’s face, you must gently tear this off so that the baby can breathe.

Delivery of the Placenta

If the placenta is delivered before an attendant arrives:

Never pull on the cord or cut the cord.

After the placenta comes out, massage the mother’s abdomen firmly, with a deep circular motion, gently pushing downwards 5-7cm (2-3in) below the navel. This is important to make sure the uterus contracts and stays hard after the birth without hemorrhaging.

Its normal for a couple of cups of blood to be delivered when the placenta comes out.

Getting the mother to nurse her baby immediately will help contract the uterus and minimize blood loss.

AFTER THE BIRTH

Be careful to hold the baby firmly as he is born, because he will be slippery with blood, mucus and a waxy substance called vernix caseosa. Once he is born, he will probably give a couple of gasps, a cry, and then start to cry properly If he doesn’t cry immediately, place him across your partner’s thigh or abdomen, with his head lower than his feet, and then gently rub his back. This helps any mucus drain away and usually causes a change in blood pressure, which will bring about his first breath. Talk to him lovingly.