Coping with Labour

labourHow to cope with your big day – our lowdown on labour

By Radhika Holmstrom

The first thing that you should know about coping with labour is that every single woman’s labour is different. However positive or pessimistic your mindset, your body may have views of its own and you may have a very different experience from the one you anticipated and from that of your friends from ante-natal classes. But there’s a whole raft of different options, from old-school to high-tech, to help you cope on the day. We show you what to expect.

Forward planning

In all honesty, labour is a much less frightening prospect and much easier to cope with when it does arrive, if you prepare for it. Do your reading and join an antenatal class if you can (these are also invaluable for supplying you with friends later down the line).

“What do you want if things don’t start going to plan? Find out and put your preferences on your birth plan,” says doula Mars Lord (mammydoula.co.uk). “If you’re making informed decisions and end up with a medical Caesarean, for instance, you may not be happy but you’ll understand why you got there; and most of the time even if that does happen, you do get a say in how your baby comes into the world.”

“Things can change very quickly in labour and you do make better decisions if you know what the possibilities are. Knowledge can be scary to acquire but it’s definitely the antidote to fear,” adds Francesca Rose, whose play ‘Deborah’s Children’ draws on Rose’s own experience as an antenatal teacher. She suggests thinking of it as a “toolkit of information”, from which you can draw.

What’s going on?

Starting with a quick recap of the physical process: remember that labour has three stages, though they usually take very different amounts of time (see our feature on the three stages of labour).

Stage one is the ‘run-up’ (although it certainly doesn’t feel like it, by the end). Your uterus starts to contract as your cervix opens (dilates) and softens, and the baby starts moving down. This can go on for quite some time and as your cervix opens, contractions escalate till they’re strong and closer together. It hasn’t dilated fully till it’s 10cm wide.

In between stages one and two there’s ‘transition’ – the baby’s head starts to descend but the cervix is still dilating and contractions are extremely strong. Then it’s into second-stage labour, which is the actual work of pushing out the baby, which is moving down the birth canal. This can last a couple of hours, especially if it’s your rst baby and if the professionals become concerned, they may recommend intervention (forceps or ventouse) or a Caesarean section.

Finally, there’s stage three, as you deliver the placenta – often with an injection to get it out quicker.

Pain relief: from low to high tech

The big issue for many of us is just how much is it going to hurt? Not surprisingly, there’s quite a range of options for dealing with the pain of contractions and ‘crowning’ (when the baby’s head emerges, which many describe as a burning sensation) including mental strategies (see hypnobirthing, below) for helping your mind set so that you don’t experience it as pain in the first place.

In the early stages, in particular, a TENS (transcutaneous electrical nerve stimulation) machine or hot pad against your back, a hot bath and/or finding the right position – including walking, if that’s what your body demands – can make a huge difference. None of these should have side-effects. On the other hand, they may not relieve the pain much. Over the past few decades, water births have gone from fringe to mainstream and either labouring or giving birth in water is worth considering (you can do this in conjunction with gas and air). There is some evidence that it’s better to wait till you’re at least 5cm dilated before you get into the pool (some people feel they speed up labour for a while but then slow it down); and they don’t work for everyone but they can make a surprisingly big difference. Some people consider gas and air (Entonox) a definite move to ‘drugs’ but others don’t, not least because this too isn’t guaranteed to work. You breathe in the mix of oxygen and nitrous oxide gas through a mask or mouthpiece, usually as a contraction starts, so that you can breathe out as the pain-reducing effects and the full force of the contraction hit together. It may make you feel a bit sick but it won’t affect the baby.

Pethidine or similar injections also lessen, rather than remove, the pain. These too may make you feel sick or sleepy (this last has its upsides, though, since if it’s at the beginning of your labour a small sleep may be very good for your energy levels!) and if they are given too close to the actual birth they can affect both your ability to push and the baby’s ability to breathe, so the professionals will give the newborn an injection to counter this.

Finally, there are epidurals; unlike all the other options, these are only given by trained anaesthetists as they involve injecting anaesthetic into the spine. Contrary to many rumours, the versions on offer today don’t necessarily knock out your ability to walk or push – and they definitely should stop some or all of the pain. But they can slow down the pushing stage and may leave you with a headache or a sore back.

But in addition to pain relief, there are other ways to cope with labour too.

Before it all starts

As you get past week 34, it’s time to practise breathing and positions as even first babies can turn up early.

“Prepare for what you want and who you want with you in the birth place. Look after yourself and nurture yourself, eat well and relax,” says Jane Munro of the Royal College of Midwives. “Alongside that, revisit all your preparations about the birth plan. Think about the place of birth, wherever that is; about the things you want to take in with you; the decisions you’ve made about birth positions and music; and so on. Go through it again with your partner.” Check the routes to hospital including parking – and pack your hospital bag.

Getting started

It’s often not entirely clear when labour has started. “Most people feel something but real life is often very different from TV,” says Lord. “Trust your body and listen to it.” You may feel the contractions anywhere from your legs to your back and may want to do anything from lie down to pace up and down.

Assuming you’re planning a hospital birth, you still don’t have to go in till you’re ready. But if you feel you’d be safer and more comfortable there, do set off – though if your cervix still hasn’t opened very far you may have a long wait. At this stage, breathing and positions can help a lot; in addition to any pain relief that you use.

Another big help in coping can be your birth partner – as long as they realise that they’re in a supporting role! If you find that you’d rather they left you alone, that’s par for the course. “Even your gorgeous caring partner, who’s doing everything they can to help, can start getting on your nerves,” Lord says. If the professionals make suggestions you don’t understand or don’t like, ask them to explain too. This really is one time when it’s all about you.

Getting out

The ‘transition’ stage is the hardest to cope with and from now on, you may well nd that best tactic is to turn to the people who get women through having babies every day. It doesn’t mean you’ve somehow given up – it means that everyone is getting on with their job, with you doing the most important job of all. “It’s not unusual to feel out of control at this stage, and look towards the experienced professionals for hope and support rather than anyone else. You can bene t from a stronger line in encouragement and the staff expect it,” Rose recommends. “There’s nothing wrong with relinquishing control and letting them help you over that last little bit when the uterus is really gearing up.” With their help, hold on from pushing till they say it’s OK. If you push before your cervix is open you may make it swell up, or even tear. When you do push, being as upright as possible will help – and keep breathing! “Relax and allow your sphincter muscles to open. Trust that your body will open and your baby will come out,” says Lord.

Of course, it may not go smoothly. “Not all women have a perfect birth. We have doctors for those times,” Lord points out. Your coping strategy here is to be informed. Remember, a good birth doesn’t have to be the birth you’d ideally have wanted.

Looking back

The last thing to remember is that there are different ways to cope with your labour and birth retrospectively. If there’s anything that you want to talk over afterwards – whether that’s how the actual birth went in itself or how your health professionals handled you – do please make an appointment with your team. And finally, good luck!

 

You and your birth partner – who you gonna call?

The pros and cons of different birth partners – and how to choose.

When asked who is going to be our birth partner, many of us answer automatically “oh, my partner” – and often that’s the right choice. After all, if you’re going to be embarking on parenthood together, surely you should both be welcoming your new baby into the world. Just bear in mind, though, that you do have other options – and indeed, you may want your partner to be there but not doing the ‘birth partner’ work. If you’re very close to your own mother, she may be a brilliant choice to help you through what is a very primal as well as a very personal moment. She has experience of birth herself and knows you very well. You might also want a close friend, especially one who’s given birth herself. It doesn’t have to be a woman, either – more than one woman’s asked her father to be a birth partner, however odd that sounds!

Finally, don’t forget doulas; part of their role is to be with a labouring woman through birth. And because that’s their job, most have seen many a birth and can deal with whatever the event throws at them.

Ultimately, it’s up to you. This is your birth, and you have the right to request the support that you need, from whoever you feel is the best person to provide it.

hypnobirthingHypnobirthing

Hynobirthing is a mix of self-hypnosis and breathing techniques which aims to put you back in control of your own birthing experience. It may help you feel less pain, too, as the techniques focus on reducing the stress and anxiety which ramps pain up. To nd a Hypnobirthing specialist near you, or for more information, go to the Resources page on our website

We have lots of great features to read on our website on the logistics and psychological impact of your birth.

See this piece on how you feel about birth and if you have any worrries And for lots more on labour and birth go

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