Leaflet resources
Cannula care
This leaflet will cover everything you need to know if you have a cannula sited during labour.
Home birth
Everything you need to know when considering a home birth.
Induction of labour
If you require an induction of labour then this leaflet contains all the information you need.
Monitoring your baby’s heartbeat in labour
This leaflet will cover how your baby’s heartbeat will be monitored during labour and birth.
Pain relief in labour
Everything you need to know about your pain relief options during labour and birth.
Permanent contraception – sterilisation during caesarean section
Your options for permanent contraception if you’re having a caesarean section.
Reducing the risks of blood clots in hospital
Advice on how to reduce the risk of blood clots if you’re admitted to hospital.
Reducing the risk of infection – what you can do to help
Advice on how to reduce the risk of infection if you’re admitted to hospital.
Refusal of blood transfusion
Your options explained if you refuse a blood transfusion.
Water birth
This leaflet will cover everything you need to know if you’re considering having a water birth.
Useful websites
NHS Labour and Birth
How to tell if you’re in labour and what happens during labour and birth.
NHS Caesarean birth
Caesarean section overview.
National Childbirth Trust
What really happens during labour and what can you expect and prepare for. Read about each stage here.
Pelvic Partnership
A useful website should you require support and information about pelvic girdle pain (PGP) during your pregnancy and beyond.
Useful videos
NHS: What positions are best for giving birth
Advice about which positions are best to adopt in each stage of pregnancy.
Video transcript
There are various positions that you can adopt during the first stage of labour. Upright positions are best because they relieve the pressure from your back, they help you to cope better with the pain, they align your baby in the right position, they help to open up the pelvis and also gravity helps a baby to move through the pelvis.
The props which can be used to support various positions and labour things such as surfaces, beanbags, birthing stools, birthing chairs, a pool with water or your partner supporting you. We have various positions in which you can give birth but again it’s finding the position that’s most comfortable for you.
The positions that you can adopt are squatting, kneeling on all fours that could be on a bed, or could be on a mat on the floor, could be on a birthing stool or birthing chair or also in a pool.
Your partner can assist you by practicing the positions with you during pregnancy so that when you do go into labour it’s easier for you to get into these positions and you may have an idea of what’s more comfortable for you.
Certain drugs and also if your baby’s being monitored electronically may alter the position that you can adopt in labour, but the midwife will be there to assist you into a comfortable position, which will be best for you and your baby at the time.
NHS: What is involved in an assisted birth
Advice around what to expect if you require an assisted birth (forceps or ventouse).
Video transcript
One in eight babies will need help to be delivered vaginally. The doctor or the midwife may decide that you need an assisted vaginal birth if you’re very tired, if the baby is distressed, or the baby is not progressing.
The doctor or midwife can define if you need an assisted birth by examining you to see if your cervix is fully dilated. The two instruments that are most likely to be used are of forceps with a curve at the end and the curve is just to protect the baby’s head during the delivery.
Or you can have a ventouse delivery, which is a pump and a suction cup attached to the end that’s place at the top and the back of the baby’s head and that helps us to deliver the baby.
An episiotomy is a cut that is given to the perineum and this is just a cut at a 90 degree angle which gives more room for the baby to come out and to apply any instruments.
You can’t always avoid having an assisted birth, but there are things that you can do to reduce your risk, things such as being upright during labour, avoiding the use of epidurals, having the support of a partner throughout labour, and not pushing too early.
NHS: What are the first things that will happen once my baby is born?
Advice about what to expect in the first few minutes after birth.
Video transcript
Immediately after your baby is born, you’ll notice your baby may be very wet and covered in some really thick creamy substance known as vernix. Newborn babies aren’t washed immediately because we want them to keep their temperatures up and stay nice and warm with their mum.
Your midwife will deliver the baby on to your chest. This is know as skin-on-skin. It’s the best place for your baby to be because it helps your baby adapt to life outside the womb and this also helps the baby get ready for its first feed.
If you have a caesarean section, you will still be encouraged to have your baby skin-on-skin. The midwife will offer you an injection to help deliver the afterbirth, or the placenta as it’s commonly known.
The umbilical cord will be clamped and cut. You might want to consider who’s going to cut the cord – sometimes your partner will want to do this. Your baby will need to be examined. They may need a little bit of extra help just to start breathing.
There should be very little time where you and your baby will need to be separated. Unless your baby’s born at home, your baby will need to be uniquely identified to you. This is done with two white name bands – normally put one on an ankle and one on a wrist. Your midwife will also advise you about giving your baby vitamin k.
This is an injection, a very small injection, given to your baby to help prevent a bleeding disorder. You may need some stitches after the birth of your baby. This is done whilst you’re still in the delivery room, still having a cuddle with your baby to distract you. Your baby will need to be checked by a paediatrician or specially trained midwife. This newborn check is important to make sure your baby is fit and well.
NHS: How will I know I am in labour
Advice about what to expect and how to recognise the signs of labour.
Video transcript
There are many different signs that you’ll have before you actually go into labour. You can start having contractions, these may start off as crumbs or period like pains in your back then they become more intense. The frequency will start to come every two to three minutes.
You may also have a show, you can also have backache and have your waters breaking, these are all signs so I will tell you not worry.
The bloody show just means that you’re getting ready to go into labour. It’s a sticky plug of mucus so once it’s sticky and it has blood which could be either red or brown, quite normal.
When your waters break, you could put a pad on and I advise you to call your midwife and she will advise you to come into hospital just to check that the colour is normal, that you are well and that the baby is well.
You may also be discharged back home if you are not only but because the process can take up to 6 to 12 hours.
Other symptoms that you may be in labour are nausea, vomiting, diarrhoea. These are all signs that things are progressing well and you’re going into the right direction.
Trust Video: What to pack in your hospital bag
Community Midwife Helen helps break down what to pack in your hospital bag in preparation for the birth of your baby.
What to pack in your hospital bag
Hello my name is Helen Green, I’m a community midwife. I’m here today to talk to you about some things you might want to pack in your hospital bag ready for labour.
Most ladies start to prepare and pack this bag at about 36 weeks pregnant. We don’t need you to bring a whole suitcase full, you’re not staying in hospital for two weeks. Hopefully it’s only a short stay for a couple of days.
You will be needing a wash bag, and again a short stay would be fine. Very simple, basic things you would normally bring.
Some deodorant, Some shampoos, Some body washes and toothpaste, toothbrush, hairbrush and a bobble.
You might want some makeup wipes, and you might want some makeup. Lip balm of some sort is also very handy, as is a small face cloth, a flannel, that would be very useful if you need to mop your brow in labor.
Having some a small wash bag, is all that you really need, for the one day, possibly two days you might be staying in.
We’ll need some other things for you when you’re in labor. You will need something cool and loose to wear, whether you choose to wear your own clothes, whether you choose a loose cotton nighty, a large t-shirt. It’s entirely up to you and the hospital can provide loose cotton gowns if that would suit you better.
We would want you to bring in some bras, primarily for afterwards. Considering breastfeeding bras – you might want a breastfeeding bra such as the type that has a clip in – so that you’ll be able to breastfeed with a bit more ease, once you’ve had your baby.
You’re also going to need some other underwear. A lot of ladies choose to bring disposable pants of some kind. You will probably need about four or five pairs of disposable pants or some other underwear. Some pants that are comfortable and that fit you.
You might find it comfortable to have something like a spray to put some water in, to cool yourself down. Delivery suite can be a very warm, hot place to be spending time in. Again just using your cold flannel might suffice for yourself. It might also be advisable that your partner packs a cool t-shirt to change into if he’s going to be with you for a little bit of time, and you might also want a change of clothes or a toothbrush for afterwards.
We’re wanting you to bring some things in to prepare for your baby, an obvious one is some nappies, perhaps one small pack of first size nappies would suit you, and we would like you to just have some cotton wool for using to clean the babies bum with.
Whether you to use balls or pack cotton pads is entirely up to you. Baby will also need some clothes to wear and we advise to bring the little vests. You may want to bring two or three sizes of the short sleeved vests and then of the little baby grows, again two or three outfits or sizes.
You may want a special outfit for baby to go home in and blankets such as a cellular blanket or a bit more of a blanket for baby to go in. We would like you to have cardigans, to help keep baby warm, because when baby’s a newborn they’re often quite cold initially. And we want to keep them nice and cozy warm, to help keep the temperature and for that reason we ask you to bring a small woolen hat for when baby’s born.
If you don’t have a woolen hat the hospital can provide one.
We would also advise that you might want a little bib to have for your baby, for when feeding. If you’re going to choose to formula feed your baby, you would have to bring the formula in the ready-made packs. This is the packs that come with the teat, obviously we support you however you feed your baby and give you lots of breastfeeding support. But if you’re choosing, to bottle feed you need to bring a newborn starter pack with you.
You may want to bring some muslin wipes instead of a bib, that’s absolutely fine.
For breastfeeding, you’re probably going to want to have some breast pads. You can have the disposable ones, like these, or some reusable ones. And it may be that you want some small samples of nipple cream. Speak to your midwife for some advice.
Your sanitary towels are also very important, some not necessarily whichever make you get, but make sure the super grows open night time, at least one big pack, that you’re bringing in with you.
If you’re needing any more than this your family and friends can bring you things in, and we would advise you not to bring your car seat in until your baby is ready to go home.
Trust Video: Signs of labour
Community Midwife Rebecca breaks down the signs to look out for to know when you may have gone into labour.
Signs of labour
Hello, my name is Rebecca Allison. I’m one of the community midwives here at North Tees and Hartlepool and i’m here today to talk to you about the signs of labour.
So labour can start after 37 weeks of pregnancy, or that’s when you’re classed as full term. It can actually come before then, but that’s not what we’re here to talk about today.
If you do feel like you’ve gone into labour before 37 weeks, you must ring the hospital immediately for advice.
But full term pregnancy is classed after 37 weeks of pregnancy and there are no real predictable signs of labour – everyone is different. And some people will get some symptoms, and some people will get all of the symptoms.
What I would say, is quite a lot of ladies get what we call the nesting instinct, and that’s where you tend to go on a bit of a crazy and cleaning spree at home, and feel like you need to get everything ready for your baby’s arrival. Quite often in the few days leading up to labor, you can have some sickness and diarrhea, which can be normal.
Also lots of ladies get what we call a show and that’s the passing of the mucus plug from your cervix and it can be quite sticky, snotty, bloodstained in color. And that’s just the opening of your cervix and the mucous blood coming away helping your body to get ready for the labor process.
It’s all very normal, a show can sometimes just happen once, but also it can happen several times as the cervix starts to move up and stretch open.
Also your waters can sometimes go and you don’t have to be in labor for your waters to break. But if you do feel like your waters have gone and it may be a gush of fluid, or a trickle of fluid, either way you must ring the hospital and for advice. Because they will want you to come in and check you and baby over, to make sure everything is okay.
Sometimes your waters break before labour, other times they don’t break until you’re actively advanced in your labour, which we’ll cover in another session.
And finally, the most predictable sign of labour is contractions. So if you’ve heard of braxton-hicks contractions they’re when your uterus tightens and softens off, and this can happen really from any time in the third trimester.
This is just pretend contractions, your body getting ready for labour. When you have full blown contractions, it’s generally tightening across your tummy and that’s your uterine muscles all contracting together.
But sometimes people will experience back ache, or pain in their thighs, and the pains can come and go, and come and go for quite a few days. And that is normal. And then it will start to become more frequent, and that’s the most predictable sign of labour.
Trust Video: The stages of labour explained
Community Midwife Rebecca explains the different stages of labour.
Stages of labour
Hi everyone, I’m now here in this session to talk to you about the stages of labour. What I would say, is you don’t need to get too hung up about the different names of the stages of labour.
You don’t really need to know the different names and the stages of labor. But it’s good to have an understanding of the process of what’s happening in labour, and what’s happening to your body, and why you are feeling different things at different times.
So the first part of labour, is what we refer to as the latent phase of labour, or what you may well have heard of it with being referred to as slow labour. When you hear stories about so-and-so being in labor for several days, and it’s your body starting with contractions, that stop and start, and stop and start and this is the first part of labour.
And within latent phase, quite often the pains are irregular, and you might get a strong pain and then a not so strong pain.
And as I’ve said, it can go on for a long time and at this point, the contractions aren’t necessarily in a regular pattern. Now at this point you may have had a show, which would be normal and just to use the props that we’ve got. The latent phase of labor, in labour we’re talking about your cervix opening up, and your cervix starts off shut. But within the latent phase of labor, it’s starting to gradually open up, and also your cervix starts off very thick, and it started to be pulled up. So what it’s doing, is the contractions pulling up the cervix, and they’re opening up the cervix.
The next stage of Labour, is the first stage of labor, and that’s when you’re four centimeters dilated or in active labor. Now on this dilatation chart, four centimeters dilated isn’t all the way until here, when when the cervix is approximately opened up about four centimeters. But to get to this stage can take a long time, and this is why we stress the importance of staying at home for as long as you possibly can, because getting to here you can really take a couple of days in some cases.
Once you’re past four centimeters dilated, usually then that’s when you’re having regular contractions, and they would be coming every few minutes and should have been coming every few minutes, lasting at least 30-40 seconds. Sometimes up to a minute. And really the need to have been coming regular like that for about two hours, before things are really starting to happen and your cervix is starting to open at a more regular pace.
In the first stage of labour it moves from being an irregular pattern into a more regular pattern of contractions. And when you speak to the midwives for advice over the phone, they’ll ask you about the pattern of the contractions and guide you and whether think you’re the right stage of labour to come into hospital.
During this stage of labour, it becomes harder to cope as well, so just be mindful of that. If you feel like you’re able to breathe through, you’re possibly not in established labour, but on the first stages of labor. But as the pain increases in strength, that’s a sign that things are starting to happen.
Now your body has the contractions which then helps the cervix to dilate all the way through these different phases of the cervix, until you get to be 10 centimeters. So here for example, is 6 centimeters, here is 8 centimeters, and when you are fully dilated that’s when all of the cervix has disappeared and there’s there’s nothing holding your baby back.
To get from 4 centimeters all the way to 10 centimeters dilated actually takes on average of about 12 hours, so it’s a really long time. It’s a really long time for you and your birth partner to be in the hospital environment, and that’s another reason why it’s such a good idea to stay at home if you’re calling for as long as you can.
When you are in labour, the midwives know how far dilated you are by doing a vaginal examination, with your consent. And that’s where we put two fingers into your vagina, to find the cervix and we can feel how open the cervix is, how thin the cervix, but also – I don’t know if you can see, but these funny little lines and triangles to mimic the markings on your baby’s head – and this helps us to define the position of your baby.
During the labour process, what happens, if you imagine this is your pelvis in labour, and your baby, along with the contractions, is getting its head pushed down, and its body push down more and more and more, through the pelvis.
And the contractions each time pushing, pushing, pushing, and then also pulling, pulling, pulling, up your cervix and open up your cervix to enable your baby to pass through the pelvis and to be born.
Now what is quite tricky, what you don’t really need to get your head round, but helps us to understand what’s happening in the labor. Is when your baby descends into the pelvis, it has to rotate, and then rotate again, in order to descend through the different dimensions within the pelvis. So when the midwives are examining you, as well as feeling how open are how dilated your cervix, they’re also feeling the position of the baby, by feeling baby’s head vaginally and baby’s body abdominally.
When they feel your tummy, it helps them understand better how the labour is progressing, so that’s why we do that.
Now towards the end we get to the third stage of labour, which is detailed in the next video.
Trust video: Labour – third stage
Community Midwife Rebecca explains the third stage of labour, known as the afterbirth.
Labour: Third stage
Hi everyone, we’re now going to talk about the third stage of labour, or this is actually the delivery of your placenta, which is sometimes known as the after birth.
So once your baby is being delivered and you’re giving your baby a nice cuddle and skin to skin contact, your body is doing amazing things and your uterus is actually having little contractions now, in order to contract your uterus down and make it small and we need to then deliver your placenta.
So once the uterus is contracted enough and your placenta starts to separate from the line of the uterus, it’s ready to be delivered. Naturally, This can take about 30 minutes, sometimes a little bit longer. There is a slight increased amount of blood loss when it happens naturally. Or we can offer you an injection, normally given at the top of your leg once your baby’s born. Which is a synthetic hormone of oxytocin and brings on quite a big contraction to help separate that placenta quicker and help contract your uterus just to help control the bleeding.
We call this an active stage of labor, so active third stage of labour. Whereas if you choose for your placenta to come away naturally, it’s called a physiological third stage of labor.
The midwives looking after you will ask you what you’re wanting to do, so they know and they can plan for the birth. The active stage of labour normally takes about 10 minutes, by the time the placenta and the uterus is contracted and present separated. But once the placenta is separated from your body, the midwives will have clamped the umbilical cord and by this stage they will have also have clamped baby’s belly button.
They usually ask birth partners if they want to cut the cord to separate baby from the placenta and this actually also helps with the natural separation of the placenta.
So the midwives, they’re the ones that do the work you don’t need to worry about this and the delivery of your placenta is not like the delivery of the baby it’s just squidgy. There’s no bones involved. So the midwives usually will take hold of the umbilical cord and then they pull on your placenta.
They’ll ask you if you want to look at it if you want to, but not many people do and this is the delivery of the placenta and the membranes, which is the bag of waters that the baby is being protected inside of you for nine months.
So they then get rid of the placenta, which we do check later. But at this point then the midwives will press on your tummy and just to make sure that uterus is nice and contracted.
At this stage, it’s normal for ladies to bleed so expect to bleed a little bit, we’re used to that we manage that okay. And that’s what the body’s naturally doing. And once we’re happy that your uterus is contracted, the midwives will then ask you if it’s okay if we can check just to see if there’s been any tears or any trauma inside you.
They may need to put their finger into your back passage, into your bum hole, or into the vagina just to inspect and make sure everything’s okay. But at this point you’re going to have baby in your arms and you won’t care what they’re doing.
Trust video: Tears and cuts
Community Midwife Rebecca, discusses tears and cuts and allays any fears.
Tears and cuts
Hi everyone in this session we’re just going to talk for a few moments about tears or cuts.
When I speak to my ladies ante-natally, this is one of the biggest fears that I find and people are frightened that they’re going to need to be cut in labor.
What I would say when I was a midwife on the labour ward for over 10 years, I can count on probably two hands the amount of ladies I had to do an episiotomy on.
An episiotomy is the formal name for a cut, and that’s where we make an incision to create a bit more space for the baby to be born.
When your baby is being born, the midwives will often try to control the rate at which your baby is born, to try to eliminate any tears or extended tears that you may need.
They will only need to do a cut in a real emergency situation, if they feel like the baby’s head’s a little bit stuck, or if they feel that we need to deliver baby quickly.
Unfortunately, if you do need a forceps delivery or a ventouse delivery, the likelihood is that the obstetrician delivering your baby will perform an episiotomy and that’s in order to be able to deliver your baby safely. To be able to put the instruments inside of you in a safe manner. If we do an episiotomy, we will give you local anaesthetic first like when you go to the dentist and get filling, just to help numb everywhere so you won’t feel the cut.
In terms of tears it is very common for ladies to tear when they’ve had a baby, but this is natural and that part of your body is full of vessels and it’s very vascular and it heals really well after you’ve had your baby. It does tend to be a little bit more common in first-time moms, rather than second or third time mums, but it can happen in any labour.
Once your baby is born and the midwives will inspect the area to see if you have torn and any tears or cuts they will recommend that we stitch them up afterwards in order to just bring everything back together and help with the healing process. It’s such an important part of your body it’s really important that we get it right.
You’ll be stitched straight after you’ve had your baby, if you do have a water birth we may leave you about an hour before we do the the stitch, but you tend to have your baby in cuddles anywhere, or maybe breastfeeding your baby. So you’re usually quite happy to let the midwives get on with what they’re doing, and your legs will be put into a lithotomy position so we can see what we’re doing. And you will be given more local anaesthetic, or you can use your gas and air if you want to. The stitches that the midwives use are dissolvable and don’t need to be removed and they tend to come away after about a week to 10 days, but your midwives postnatally will give you advice and guidance on that.
Trust video: Back pain in labour
Community Midwife Rebecca discusses back pain during the labour process.
Back pain in labour
Hi everyone. We’re now going to talk about back pain and labour.
Towards the later stages of your pregnancy and in labor back pain is really common, so i’m sorry if you’re experiencing back pain, but your baby is pressing really low into the pelvis and you can imagine this is your spine, and this is your sacrum, and the baby’s head is putting a lot of pressure on this lower part of your back. Pushing it out and consequently you can get quite a lot of lower back pain during the labour process.
You can hire or purchase tens machines, which is trans-electronic nerve stimulation, you place the patches of the tens machine in this area, and that’s just above the sacrum. That’s to try to help counteract the pain receptors going up and down your spine to your brain, and that can help with backache.
Massage as well, as i’ve mentioned earlier, in this part of your back is also really helpful and really effective in easing that pain. And within North Tees hospital, they also offer water blisters, which go into the same place where the tens machine patches would go and it has a similar sort of principle in terms of counteracting that pain up to the brain.
What happens is two midwives have injections, and it is purely water, and it’s ampules of water that are injected into four areas onto the back and they’re popping up on your back like little blisters, almost like a bee sting.
Now when they are administered they do hurt a lot and it is normal for ladies to almost scream out in pain, when they get the blisters, but what we know from lots of ladies that we look after, is that they’re so effective in getting rid of that backache, and it’s like magic how quickly that backache is eased.
Trust video: Pain relief
Community Midwife Rebecca discusses your options when it comes to pain relief during labour.
Pain relief
Hey everyone. In this session we’re going to talk about pain relief and we’re going to talk about natural methods of pain relief that you can adopt yourself easily at home.
We’ll also talk about pharmacological forms and relief that you may wish to choose if you go into hospital. Now when you are in labor, in the early stages are a blur, but it’s really important that you have good coping mechanisms, to help you to relax and help you cope from those early stages. Because they can take several hours, if not several days in those early stages of labour.
Try to keep your mind occupied, try to keep eating little snacks because you need the energy on board for when you get into active labor. Keep drinking because that helps as well and maybe go for a little walk, read a magazine, watch a bit of telly. Try not to get too hung up about the timing of your contractions, when they’re coming how frequently could come in, because at this stage it will just start to irritate you a little bit.
Just be mindful of the fact, that okay, i’m getting them and starting to get a little bit more stronger and a little bit more frequent.
We also said that having a bath or a shower often helps, heat or a hot water bottle which you can administer yourself at home. Place the water well above your bump, just helps you to relax and helps you cope. So distractions at this stage, is really helpful, things like a comedy on TV, or use of music also helps.
When you are in labor, if you relax through your contractions, it really helps you to cope. When you get your contraction, it starts off really mild and it gets stronger and stronger and stronger and it comes to a peak. Then it starts to really take your breath away, but then that pain starts to go off and it fades away and it’s a little bit like wave. It comes and it goes and the frequency of these contractions as the labour progresses becomes more frequent.
So the good thing about contractions, is that you know that they go. When you get them, they’re not pleasant but they always go. So by using breathing techniques and breathing through your contractions, it really helps with coping with your contractions. And when I say breathing techniques, it’s just long, slow, relaxed breathing.
The more tense you are in labor, and it’s our reaction when we’re in pain to tense up like I am, that builds up adrenaline and it makes the pain feel worse. So if you stay calm, relaxed, think relaxed shoulders, relaxed face, relaxed body, by listening to your music or your distraction therapy, and focusing on your breathing. If you
breathe it out, that contraction will eventually ease off.
All of these things you can do at home and you can get through the early stages of labour really quite effectively by using these techniques. In terms of alternative therapies, if you wish to look into this further you may wish to – you may wish to look into aromatherapy as a means of relaxation – and this isn’t something that the midwives can administer, but you yourself or your birth partner can do that.
For example lavender – might help you to relax or bergamot you could use for energy. Also massage sometimes – some ladies love massages in labour – other ladies don’t like massage in labour and can’t stand being touched.
You’ll find what’s right for you, but your birth partners can gently massage you and that can sometimes help particularly in your lower back area where your sacrum is, because your baby’s pushing against that part of your spine, so by rubbing this area that can help a lot with pain as well.
There are also other techniques that people will adopt, for example, the use of hypnobirthing and this might be something that you wish to do, which again is just a form of like a deep state of relaxation, to help you calm breathe through your contractions.
If you feel that this is not helping and you need something stronger, which often ladies do, then we would offer you paracetamol and certainly this is something what you could take at home and often in hospital the midwives will offer you codine or dihydracodine, which does work quite effectively with the paracetamol combined together and just helps to take the edge off.
Then you would also be offered entoknox or gas and air in labour. And although this is not connected into the walls, it’s very clever because the entoknox actually comes out of the walls in the hospital, or if you wanted to be in the bath for example, we have mobile gas and air, so you can have that wherever you want.
And in enable you to walk around here and there, but what the gas and air does, is it doesn’t take away the pain completely, it just helps you cope with your breathing. It helps take the edge off the pain and as those contractions are starting to build up and get stronger and stronger, that’s when you would start taking your entoknox, so it’s long slow deep breaths.
Long and slow. And as that contraction gets to the peak and you can start to feel it tailing off, that’s when you come off your gas.
It can make you feel a little bit giddy, or a little bit drunk, and sometimes ladies say they feel it makes them a bit sickly, or their mouths try it first. But do bear with it, because I do think it becomes your best friend during labour and you never really want to let it go.
In terms of the dry lips, maybe bring some lip balm with you. Or keep drinking plenty of water, to help and the sickness feeling tends to wear off. The other useful thing with gas and air, is it can be used alongside other forms of pain relief. Gas and air doesn’t actually affect your baby, its respiratory, so you breathe it in and you breathe it out. While the other forms of pain relief that you may need if the pain has become particularly strong, for example, maybe an opiate based medication, such as pethidine or diamorphine, these are really strong drugs and provides a very effective form of relief in labour.
It’s an injection, so with a needle and the midwives will draw up the medication, two midwives will check the medication and it’s usually given either into your leg or into the back of your bum.
Now diamorphine can make you sleepy, or any opiate injection can make sleepy, and it can also make you feel sick. So because of the sickness, we tend to give you an anti-sickness drug at the same time to help prevent that. It usually takes about 20 minutes to kick in, but after that 20 minutes, the sleepiness or that very relaxed state really helps you cope.
And an opiate injection is very good if you’re about six to seven centimeters dilated and it just helps you cope through that later stages of labour, before you’re ready to start pushing your baby.
It can make your baby a little bit sleepy as well, because it passes into your bloodstream. So because of that, if we can avoid it and try not to give you an injection too close to when you push your baby. One, because we need you have the energy to be aware to push your baby out. But also we don’t want your baby to be to sleepy when your baby’s born.
Please be assured though, that if you need the pain relief, nobody will deprive you of anything if it’s requested and needed, we will give you it.
One of the final methods of preparing that we do offer you is the most effective form of pain relief and that’s an epidural. Again this is one of the biggest fears that I find when I talk to my ladies ante-natally and a lot of people say ‘I don’t want an epidural’ – my advice would be not to have anything set in stone in terms of your birth plan. Just go with the flow, be guided by the staff and how you’re feeling, and I always say to my ladies don’t be a martyr.
If you feel like you need the pain relief and you’re not coping, an epidural is a really useful form of pain relief in labour. Particularly if your baby’s not quite being in the right position, and you’ve been in labour for a long time, and you’re really exhausted, it’s amazing.
An epidural is the only form of pain relief that takes away all of the pain and with all of the other forms you generally have a little bit of pain with it and are aware of your contractions. With the epidural, if it’s working effectively, it blocks the pain receptors that are going up your back, to your brain. And the epidural preforms a complete block of pain. The negatives of the epidural are it potentially can drop your blood pressure, so because of that we counteract that by putting a needle in the back of your hand with fluids open, that helps us to control your blood pressure if we need to.
You would also need to be continuously monitored in labour because of this reason. So that would mean that you would need to be attached to the CTG monitors where we put the balance around your tummy to monitor baby’s heartbeat. So we know that baby’s doing okay.
We need an anesthetist to be able to administer an epidural – there’s always an on call 24-hours a day anaesthetist for the labour ward. If however there is an emergency caesarean section going on at the same time, the anesthetist will be with that lady and you would then have to wai for your epidural until they were free.
There are some very low risks associated with an epidural to do with back pain and longer term back pain and headaches.
But if we were to give you an epidural, the anaesthetist would talk you through those potential side effects with you before you decided to have an epidural.
On occasion, the epidural doesn’t work, and isnt entirely 100% percent effective and it sometimes fails, with pockets of pain. And if that was the case, the midwives will be continuously monitoring you and how effective the epidural is. They would call back the anesthetist to come and recite the epidural to make it work for you. An epidural won’t affect your baby in anyway. But what we do know is that sometimes it’s hard for you to push your baby out because you’re not necessarily feeling the contractions.
And what happens with the epidural, it’s a needle that goes into your back when the anaesthetist administers it, but then they’ve got very thin tubing and they pull the needle out and that tube is then tipped all the way up the back and there’s a little port here where we administer the drugs.
It’s a continuous dose of drug’s to keep that nice level of pain relief, but you have a little button and you can keep pressing the button if you’re feeling any additional pain when you’ve got your contractions. The good news is is that you can’t overdose on the epidural, because there’s a pump that has a lock out to it so you can administer too much.
In terms of pushing out your baby, rather than pushing the button the midwives quite often at that stage will encourage you to not push the button, because if you can’t feel the contractions a little bit so you are guided in when to push your baby.
And towards the later stages of your pregnancy and in labour, back pain is really common so I’m sorry if your experience back pain.
But your bad baby is pressing really low into the pelvis, and you can imagine this is your spine and this is your sacrum and the baby’s head is putting a lot of pressure on this lower part of your back, pushing it out and consequently you can get quite a lot of in lower back ache during the labour process.
You can hire or purchase tens machines, which is trans-electronic nerve stimulation, you place the patches of the tens machine in this area, and that’s just above the sacrum. That’s to try to help counteract the pain receptors going up and down your spine to your brain, and that can help with backache.
Massage as well, as i’ve mentioned earlier, in this part of your back is also really helpful and really effective in easing that pain. And within North Tees hospital, they also offer water blisters, which go into the same place where the tens machine patches would go and it has a similar sort of principle in terms of counteracting that pain up to the brain.
What happens is two midwives have injections, and it is purely water, and it’s ampules of water that are injected into four areas onto the back and they’re popping up on your back like little blisters, almost like a bee sting.
Now when they are administered they do hurt a lot and it is normal for ladies to almost scream out in pain, when they get the blisters, but what we know from lots of ladies that we look after, is that they’re so effective in getting rid of that backache, and it’s like magic how quickly that backache is eased.
Trust Video: Labour positions – Upright
Community Midwife Rebecca and Gayle demonstrate the upright position during labour.
Labour Positions: Upright
Hi everyone, we’re now here in this session on the labour ward and we’ve got the lovely Gayle Smith who’s one of our midwives.
She is going to help us demonstrate positions in labour. So when you are in an upright position rather, than being laid on the bed. It really helps with the descent of your baby and it helps if you can open up your pelvis. So if you’ve got some things like a birthing bottle at home, or an exercise ball, which is just as good.
It’s really helpful to, as Gayle is demonstrating, when you sit in this position, by opening up your pelvis, it also helps to get your baby to turn around. So they can flex their head and help press on your cervix more effectively to bring on better contractions.
If you don’t have an exercise ball at home, or you don’t find this position comfortable there’s lots of other positions that you can try. So we’ve got in a hospital, things like birthing stools and you can see it is exactly the same position as a toilet seat. Which is really helpful by helping you to open up your pelvis, but providing support and also helping if you’ve got back ache, because it’s a really good supportive position. And these sorts of positions are really good because then your birth partner can come around behind you and rub your back and massage your back if you want to.
Trust video: Labour positions – Upright 2
Community Midwife Rebecca and Gayle demonstrate an alternative upright position during labour.
Labour Positions: Upright 2
So here Gayle is demonstrating another really useful position, and she’s managing to remain upright, yet she’s able to rest, and if she wanted to she could have a pillow under her head.
She’s able to relax through the labour, and through the contractions, while it’s maintaining that beautiful position, where she’s opening up her pelvis and helping baby to descend quicker.
Trust video: Labour positions – Left lateral
Community Midwife Rebecca and Gayle demonstrate the left lateral position during labour.
Labour Positions: Left lateral
Here Gayle’s demonstrating another position, which ladies will often adopt in labour.
Particularly towards the later stages of the labour and this we call the left lateral. It’s really important that mums lay on the left-hand side, but this is a beautiful position for helping to get your baby to descend down through the pelvis.
Now here we’ve got a delivery bed that’s adapted into this position. and these move so they can adapt to each mum and each mum’s size, But also this could just as easily be demonstrated if the birth partner was also holding up the leg, providing that extra element of support.
Trust video: Labour positions – All fours
Community Midwife Rebecca and Gayle demonstrate the all fours position during labour.
Labour positions: All fours
Now Gayle’s in an alternative position and we call this all fours. Which you can easily do at home, leaned over a puffy or onto your sofa, if you’ve got your knees on the floor at home.
But in hospital if you’re feeling that you’re not able to walk around and stay upright, as well because you’re feeling like the leg is progressing and you need a rest. The all fours position is really helpful, because again, you’re able to maintain that upright position but able to rest as well.