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

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.

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.