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.

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.