Labour resources

Signs of labour

Hello, my name’s Helen, I’m one of the community midwives. I’m here to talk to you about signs of labour.

It’s important to remember that some of these signs may come at one at a time, some may come together and not all of them may happen before your labour actually starts. There’s no plan, rhyme, or reason to when and how labour starts.

What we are looking at for one sign of labour might be something you’ve heard of called a show. This is a mucus plug that comes from your cervix. It might find it that it’s when you wipe yourself, it might come once into your pants, it might fall down the toilet. It can happen once, it can happen every day for three weeks it’s just a sign that the neck of your womb is starting to soften and the mucus plug that’s in there comes out.

Another sign is you might start to get back ache. You might find to have pains and aches in your tummy, they feel a little bit like period pains. There can be again no pattern necessarily but your tummy goes tight. You might get the back ache, some ladies get pain at the top of the legs. Everybody’s very different in how they feel these pains. It can happen during the day when you’re busy and then relax and stop when you go to sleep.

Another thing that might happen is your waters might break. Now some people’s waters break like you see on the TV shows a great big massive gush in which case there will be no doubt that your waters have broken. What also might happen is the water might break at the back of the baby, so every time the baby moves or you move, there might be a little bit of a trickle of water coming through. Now this water can be clear, it can be straw coloured, it might be green tinged or pink tinged. Any of those, it’s definitely your water.

If it’s coming as a trickle, you might be uncertain if you’ve passed urine. The water from around the baby doesn’t smell like urine at all. If it’s a trickle, you might find if you put a sanitary towel on over an hour, that pad will become quite soaked and quite heavy and that’s one way to think that it is your waters.

We do want to know if your waters go we need to know if you have a show, we don’t need to know. If you’re starting off with contractions, we don’t need to know. One of the things we always want to know is that your baby is moving, at any point if your baby doesn’t move, we would like you to phone the hospital immediately to get some advice from the midwives on your individual situation.

So just to recap, if your waters go, if you have a show, if your contractions are starting, these can all be really good signs of labour. Some people even say that they get a spurge of energy. Some ladies actually get some loose stools, some episodes of diarrhoea the 24 hours before they go into labour but it is different from every person.

Stages of labour

Hi, my name’s Lily McInnes, I’m one of the midwives at North Tees Hospital and I’ll be going through the stages of labour today.

The first stage of your labour is the latent phase, this is described as when your contractions start but are still irregular. These contractions can be quite irregular to begin with, but keep an eye out for them starting to become more strong and more regular in frequency. Your baby should still move the same amount and in the same pattern as it has previously.

During the latent phase, you can contact the hospital as much as you want for any support or advice, but you would most likely be advised to stay at home and take some paracetamol or have a warm bath and keep mobile.

We would class you as in active labour from 4 cm up until 10 cm of dilatation. You would usually find that your contractions have become more regular at this point and are lasting the same amount of time, usually between 40 to 60 seconds and usually 3 and 10 minutes.

We would advise that in this stage that you would still remain upright and in a mobile position for labour and your baby should still remain in the same pattern of movement.

As you get towards 7 to 10 cm, you will experience a transitional phase of labour. This is often when women experience a large sense of panic regarding their labour. You may ask for an epidural or caesarean section, however, do not worry as midwives are aware of this stage and it is usually a sign that you are coming up towards full dilatation.

When you are fully dilated, you may not experience the urge to push straight away. This can be quite normal and may take some time for you to get this feeling. We do advise for you not to push when you are fully dilated until you have that urge. The second stage can last anywhere from an hour to two hours, but sometimes can happen in a couple of minutes.

As your baby’s head is about to deliver, your midwife may ask you to take small breaths, and this is to control the delivery of your baby’s head and try and prevent any tearing.

Once baby has been delivered, baby will be placed up onto your abdomen and stimulated and dried with warm towels.

The third and final stage of labour is the delivery of your placenta. This can be delivered by two methods, either active or physiological.

Active delivery of your placenta is given by an injection of oxytocin into your thigh. This can speed up your delivery of your placenta and also reduce blood loss. This can sometimes take up to 30 minutes to deliver.

However, in physiological delivery of your placenta, no injections are given and we wait naturally until the placenta is delivered. This can sometimes take up to an hour. If you’ve chosen a physiological third stage for your placenta, you can change your mind at any point if you are concerned about bleeding or simply just wanting to speed things up.

Monitoring in labour

Hi, my name is Charlotte and I’m a community midwife working at North Tees and I’m going to talk to you today about what to expect in terms of monitoring in labour.

Once you’ve been admitted into hospital, you will be given a named midwife who will orientate you to the room and she will do certain monitoring for yourself and your baby.

First things first, she’s going to check your essential observations. So, she’s going to do your blood pressure. She’s going to check your temperature and your heart rate. She’s then going to ask you if she can listen into your baby.

So, in low risk laborers you will be listened into using a doptone similar to what the midwives use in your community setting.

When you are in the first stage of labour the midwife will listen in every 15 minutes for approximately 1 minute. When you are in the second stage of labour and ready to have your baby she will listen in every 5 minutes for approximately a minute.

In certain labours if you are classed as high risk you will need to be continuously monitored. To do this, we use a CTG machine which is very similar to this.

You will have two bands placed underneath your back and there will be two probes. The first is to monitor the contractions and to make sure everything is well in your abdomen. That is placed at the top of your bump. The second is to monitor baby’s heart rate and that is placed at the bottom. These will then stay on continuously and you are able to get up and move around off the bed, however, you are limited to the length of the cables available.

An alternative method of monitoring your baby’s heart rate is by the use of a foetal scalp electrode or FSE. This is a small clip which attaches directly to your baby’s scalp through your vagina. It is then attached to the CTG monitor and we can monitor baby’s heart rate much more clearly and much more concisely.

If your waters have broken, the midwives will continuously check the colour of your waters draining, they should be either clear or slightly straw coloured or ever so slightly blood stained. We don’t like red and we don’t like green.

Finally, a midwife’s most important job is to monitor yourself and your emotional well-being. We are here for support. We are here to be your advocates and we are here to guide you through your labour.

Coping in labour

Hi, I’m Sara, I’m a midwife at North Tees and this is Scarlett, student midwife, who’s working under direct supervision with me. Scarlett’s going to talk to you about coping with early labour at home.

It’s really important during the early stages of labour, which is also known as the latent phase, that you remain nice and calm and relaxed at home surrounded by your own home comforts.

There’s various ways to help you keep relaxed at home such as having a hot bath or a warm shower, going for walks and keeping mobile, also using your birthing ball and if you’ve got a TENS machine at home, you can also use that.

It’s really important that you stay well hydrated and you eat little and often.
Sleep as much as you can and rest while you can. Do things that make you happy by reading books, listening to music, or watching your favourite TV show, and if you need to take pain relief, then you’re allowed to take paracetamol, which is one gram every four hours, but not exceeding the daily dose of four grams in a 24-hour period.

The most important thing for you to do is to not panic. It’s really important that you stay nice and calm and relaxed to help your labour progress further.

Birth positions

Hi, I’m Charlotte. I’m one of the specialist midwives at North Tees and Hartlepool NHS Foundation Trust. And this is Steph. She’s one of our students from Teesside University. Under my direct supervision, Steph is going to go through some birth positions today.

It’s important to keep upright and active during labour. This helps the baby to move into correct position and move down into the pelvis. The baby’s head will then push down on the cervix, encouraging it to dilate, which means to open.

It’s important to remember that the coccyx, the bone at the bottom of the spine, is a naturally curved bone. Lying flat on the bed, will create more work and baby will have to move uphill to exit the pelvis. Now, me and Charlotte are going to demonstrate which positions you might want to adopt during your labour. Many people choose to labour on their hands and knees. So, Charlotte, if you’d like to get into position.

The hands and knees position can be helpful if you have pain in your back rather than in your stomach.

Leaning over the bed can also be helpful to ease pain and get baby into a right position. If you get tired during your labour, you can lay on your side. In this position, you can fully relax, open your pelvis, and reduce the pressure on your back from the baby. Using a peanut ball may help you feel more comfortable and help your labour to progress. You can even use a peanut ball when you’ve had an epidural sighted.

When you stand in labour, gravity will help the baby to move down. When standing, many people instinctively rock their hips from side to side or use a circular motion. Using aids such as birthing balls can help you sit upright and help baby’s head descend into the pelvis.

Pain relief

Hi, my name is Lily McInnes, I’m one of the midwives over at North Tees Hospital and I’m going to be talking to you today about the pain relief options for labour.

The first method of pain relief that we would offer is gas and air. This is usually piped from the wall and is a mixture of nitrous oxide and oxygen. We give you a mouthpiece and we will tell you to start breathing in deep breaths from the beginning of your contraction. So, we’ll encourage you to breathe slowly so that it’s in your system for the height of your contraction. As your contraction fades, we will tell you to take some deep breaths of normal air just to ease the dizziness that comes alongside with the gas and air.

One of the benefits of gas and air is that it doesn’t cross your placenta which means there is no effects for baby.

The second form of pain relief that we will offer is an opioid injection into either your thigh or your buttock. This is either called diamorphine or pethadine. We often give this alongside an anti-sickness as it can make you quite nauseous.

This can take usually about 20 minutes to work and last between 2 to 4 hours. Opioid injections do cross the placenta and can make baby quite sleepy. This is why we aim to give it earlier in labour to give you the most pain relief that you need.

The opioid injection diamorphine or pethadine can also be used alongside gas and air.

The final option for pain relief is the epidural. This is a procedure often done by an anaesthetic professional. You can ask for an epidural at any point in your labour and the midwife will facilitate this.

This is a sterile procedure that usually takes anywhere from 30 minutes. We will get you sat on the side of the bed to ensure the area is sterile and cover your back in a sticky drape.

A local anaesthetic is then given into your back. It’s often described as a bee sting. This allows the anaesthetist to pass a small needle into the back to find the epidural space to provide you adequate pain relief in your labour.

You can ask for this to stop at any moment or a break in between contractions. Women’s main worry with epidurals is that the needle is in your back for a long period of time, but don’t worry as this is very quickly removed once the epidural space is found.

Due to your labour becoming more high risk, your baby will be monitored continuously, fluids will be started, and observations will become more frequent. You can change your mind regarding pain relief at any point in your labour. Just ask your midwifery team for any advice.

Induction of labour

Hi, my name is Charlotte. I’m a midwife over at North Tees and I’m here to talk to you about induction of labour.

As you approach term, your midwife in community will offer you a membrane sweep. A membrane sweep is not designed to put you into labour, but if you are on the cusp of starting to labour yourself, a membrane sweep can definitely help.

Your community midwife will ensure that your placenta is in the right location. She will then offer to do an internal examination where she pops two fingers just inside of your vagina and attempts to find your cervix.

Our cervixes are naturally about 3 cm long and very tubular and very tightly closed. As we get towards term, pressure from baby’s head will move your cervix forward, start to soften it, and start to open it.

Your community midwife will try and pop two fingers just inside of your cervix and make a sweeping motion with them. The hope is that this will stir up a lot of hormones and will hopefully push you into labour if your body is ready to do so.

National guidance is now that at 7 days past your due date, you will be offered an induction. Your local trust will invite you in, they will ensure that you are well and baby as well and they will monitor baby.

They will then insert what is called a cervical ripening balloon. This is done by using a foley’s catheter. It is very soft and very stretchy, that goes inside your cervix and is then inflated with 30mls of water. It forms a large water balloon on the end.

This is then left to hang from your vagina and is often taped to your inner thigh. The pressure from the balloon then adds pressure to your cervix which hopefully will increase dilatation.

You will then be given a time to go back into hospital to have this balloon removed. Hopefully, while you are at home, the pressure from the balloon will help to dilate your cervix so much that the catheter just falls out naturally itself. If this does occur, then you would ring your chosen trust and go back in earlier.

Once your catheter has been removed, the next stage of induction is to break your waters. We do this with an Amnihook. It is a small plastic hook with a tiny little spike on the end.

This is then popped inside your vagina. It shouldn’t be painful for you and it shouldn’t be painful for baby. We then use it to nick your bag of membranes around baby and release the water from there.

Following that, you will be left alone for a couple of hours for your contractions to start naturally.

The final stage of induction is when we pop a canula into the back of your hand and we start an oxytocin drip. This will be turned up very very slowly in little increments until you are contracting regularly and the doctors are happy with your progress.

So you can opt to decline induction at term plus 7. We would recommend that you have a discussion with your midwife and a consultant if you are registered with one so that further plans can be put into place.

We will not break your waters until there is a midwife available to do so as after we break your waters you will get one to one care from a midwife on delivery suite. This therefore may delay your induction ever so slightly until the situation on delivery suite ensures that we have one-to-one care available.

Assisted deliveries

Hello, my name’s Helen. I’m one of the community midwives. I’m here to tell you a little bit about assisted delivery today.

Assisted deliveries are generally a term that we use to cover forceps and ventouse deliveries.

Most babies will come with the mother. Some babies need a little bit of a hand. This can be because the mum’s tired, because the baby’s tired, and at any point you will get a full explanation for the midwife looking after you as to what’s happening, why it’s happening.

Both assisted deliveries are performed by your doctor who’s fully experienced who will also explain and make sure you understand what’s happening, why it’s happening, and most importantly to gain your consent in what is needed to happen.

We would for a forceps delivery or ventouse you nearly always will have some local anaesthetic injected into your perineum to make it numb unless you have an epidural in place.

When we are doing the ventouse delivery or suction cup delivery, that is a small little cup that’s suctioned onto the back of the baby’s head and in essence makes it have a handle. When you are contracting and pushing, the doctor will then gently put some pressure on that cup and pull along with your pushes which will help the baby to be delivered as needed.

Sometimes you will need a little cut in that area that has previously been numbed.

Some babies then after they’ve had a suction cup, a ventouse delivery can have a small little bump on the back of the head. Sometimes they do end up with a little bit of bruising under there. This generally fades within a day or two.

A ventouse or a forceps delivery is safe way to deliver the baby and it is certainly safer and has less recovery time for you and baby both than a caesarean would.
A forceps delivery is where there is some instruments put upon round the baby’s head. Now there’s one instrument goes in first and then another one and they lock together to create a handle around baby’s head. This can enable the doctor perhaps to change the position slightly of baby to help to deliver it.

Again like the ventouse as you push the doctor pulls you are still delivering your baby.

Once the baby’s head is out they will unlock the forceps and remove them out and deliver that baby. Sometimes babies who have a forceps have a small mark along their face. Sometimes they get a little cut, but often it’s just a red mark along the face where the edges of the forceps have been. This will again fade within a few days. Sometimes there’s even a little sore spot on the skin.

We’re very careful the doctors that when they are putting the forceps on that they’re fully explaining what they are doing to you and why. And afterwards they will do a full debrief with you to explain what happened in full for you.

So just to go over once again some of the side effects after having a forceps or ventouse are that the baby might have a small bruise on the back of its head or a swelling which will go down. Babies might have a mark on the face where the forceps has been. There might be small cuts under the skin just where the pressure has been but there will be healing really really quickly and wouldn’t even need a plaster. Sometimes if there’s been pressure on the baby’s face in a forceps, there can be a small numbing of the baby’s nerves, but the doctors will do the best to try to avoid that happening.

People that have had a forceps often do have a really big cut, if not a tear, that will need suturing after. You potentially have got your legs up in stirrups while these are happening. That’s the most likely way to happen and that can be uncomfortable if you haven’t got an epidural, but they’ll make sure that your legs are brought down as soon as possible.

As we will always discuss these side effects with you in person individually before we undertake any procedures. Sometimes after having a forceps or ventouse your higher chance of having a blood clot in your leg or your lungs partly because you’ve been laid in an uncomfortable position for a little while. To prevent this we may give you some special stockings which can prevent clots that you may need to wear for a few days after giving birth. You also may need injections to help these blood clots forming. And again the staff will explain individually to you as that is needed.

Caesarean section (C section)

Hi, my name is Charlotte and I’m a community midwife over at North Tees and I’m going to talk to you today about caesarean sections.

A caesarean section is an operation where we deliver your baby through your abdomen rather than vaginally.

There are different categories of caesarean section all ranging in their seriousness.

The first category of caesarean sections is an elective caesarean. An elective caesarean is done prior to labour on a date and a time to suit yourself and the hospital that you’re delivering at.

An elective caesarean is done for multiple reasons, for example, perhaps you have a breech baby or a twin pregnancy, you might have a medical condition that would suggest a caesarean would be best or you’ve had a caesarean before or perhaps you and your consultant have decided that a caesarean birth would be most appropriate for yourself.

The other three categories of caesarean section are classed as emergency caesareans purely because they’re not planned.

They range in their severity depending on what is happening in your labour at that point in time.

This could be that you’ve gone through the induction process and we’ve gone as far as we possibly can and your labour is not progressing, so, the only other option left is that a caesarean birth would be recommended or that it is emergency and that you and your baby are potentially in danger.

When it comes to a caesarean section, we will always try to keep you awake. Therefore, the anaesthetist will give you a spinal anaesthetic into your back which will numb your lower half completely.

In certain situations, we may have to put you to sleep which would be a general anaesthetic. If you have any concerns or any worries in regards to caesarean sections, please don’t hesitate to speak to your community midwife or your hospital.

Delayed cord clamping

Hi, I’m Charlotte. I’m one of the specialist midwives from North and Hartlepool NHS Foundation Trust and this is Emma, one of our students from Teesside University. Today, she’ll be under my direct supervision talking to you about delayed cord clamping.

Your umbilical cord connects your baby to your placenta. In the minutes after your baby is born, it continues to work, transferring blood, oxygen, and stem cells to your baby.

Evidence suggests that delaying cutting the cord allows for extra blood to be transferred from the placenta to your baby. This is called delay cord clamping and is recommended for all babies.

Delay core clamping allows for additional iron to be transferred to your baby and is essential for brain development.

Once your baby is born, they’ll be dried, assessed, and placed into skin-to-skin. If all is well, there will be a delay in cutting the cord.

You can choose to wait for a couple of minutes or until the cord is completely white, which would show that there is no longer any blood flow to the baby. You also have the option of waiting until the placenta is completely delivered before cutting and clamping the cord.

If you’re having a caesarean birth, doctors can still facilitate delayed cord clamping. However, it will not be in the traditional way, including skin-to-skin. Once the cord is clamped and cut, the baby can then be placed into skin-to-skin contact.

Perineal tears

Hi, I’m Sar, I’m a midwife and this is Scarlett she’s a student midwife working under direct supervision and she’s going to talk to you about perineal tears and episiotomies.

So, perineal trauma can happen to anyone. It’s really common for first-time mums who are given birth to tear during delivery.

A midwife will try her hardest to help and avoid a woman from tearing during childbirth,  she will ask you to stop pushing and to breathe and pant very slowly while the baby’s head is emerging from the vagina. In order for her to do this, it gives the muscles around the vagina and the skin to stretch for baby’s head to be delivered.

After delivery, a midwife with your consent will ask to inspect the vagina and areas around the vagina to see if you have had any trauma following delivery.
The first form of trauma is a first-degree tear and these usually don’t require any sutures and it may just have grazes along the vaginal wall. These may be sore when going to the toilet.

The next degree of a tear is a second degree and usually these do require a few sutures, again it can be sore when going to the toilet or opening your bowels.
Sutures are done in the room by a midwife with your consent, a numbing agent is given via an injection to the area to help with pain and these stitches dissolve within two to three weeks.

Third and fourth degree tears are more rarer, they will be inspected by a doctor and will need to be repaired in theatre under a spinal anaesthetic for adequate pain relief. You will need to stay in hospital as an inpatient until you’ve had a poo just to make sure everything is healed nicely.

All sutures will dissolve within two to three weeks. If you have any concerns, you must inform your midwife or GP.

Massaging the perineum in the last few weeks of pregnancy can help reduce the chance of you needing an episiotomy for the delivery of your baby. You insert two fingers to the bottom of the vagina and massage gently in a downward sweeping action to help soften and stretch the skin ready for the delivery of your baby. The type and frequency of the perineal massage depends on how comfortable you are at 37 weeks gestation.

An episiotomy is a cut that’s made in between the vagina and the anus. It can be done by a doctor or a midwife in the room along with the woman’s consent after an informed decision’s been made.

It is done to allow for baby’s head to be delivered more easily as it makes the vaginal opening more wider and it also prevents severe tears from happening. Episiotomies are not routinely done in the UK. However, if a decision has been made for an episiotomy to be done for the delivery of your baby along with a woman’s consent, it is usually for various reasons.

If baby is showing signs of fetal distress, you are having a breach delivery and need to make the vagina wider. If mum has serious health conditions or an instrumental delivery such as forceps or ventouse. If the decision for an episiotomy has been made, a numbing agent can be given to you before and which will cover you for the repair afterwards as well. If you already have an epidural on board, then this can be topped up to give you adequate pain relief.
If you have any concerns with your episiotomy or your sutures in the healing process, please highlight this with your midwife.

Alternative methods to pain relief

Hello, my name’s Lucy Barclay and I’m a community midwife at North Tees.

Today I’m briefly going to talk about some alternative methods of pain relief that’s available to you and your baby in labour.

It’s important to talk to your healthcare provider before choosing these options to make sure it’s safe for you and the baby.

The first option that I’m going to talk about is a TENS machine. Now, this TENS machine works by providing electrical nerve stimulation to your spine. You place two pads on your lower back and then when you experience a contraction you press the monitor which is attached to these pads and it provides a stimulative electrical impulse which distracts from the contraction pains. People can use this all the way up until the baby is born.

Another alternative option for pain relief is essential oils which you can place in a diffuser and some women like to use clary sage for this as it can help boost hormones and promote oxytocin which can relax you in labour.

Massage is another alternative to assist with pain relief and you can get your birthing partner involved in this. You can do this at home or in the hospital, lower back massages can really assist in descent of the baby as well as encouraging you to be mobile in labour and it can boost that oxytocin hormone and get you nice and relaxed.

A newer technique of pain relief is a birthing comb and this is a type of acupuncture pain relief and it works by holding the birthing comb in the palm of your hand and pressing it down when you experience a pain. This type of acupuncture can distract you and help you breathe through contractions.

And finally, a fourth option of pain relief is the water blisters, and these work by injecting some sterile water into your lower back. This can be especially useful if you’re experiencing a lot of back pain. If your baby’s more towards your spine in labour, the sterile water actually puts pressure on your nerves, which distracts you from experiencing any pain and can help you be more mobile in labour if you’re struggling with your back.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.