3.0 - Labour and Birth

Sources

1. Guide to Childbirth by Wong Boh Boi
2. The New Contented Little Baby Book by Gina Ford
3. Your Baby’s First Year by American Academy of Pediatrics
4. Take It From A New Mom: 18 Tips to Make Delivery Easier by iVillage.com

(3.0) Before Labor

1. Braxton-Hicks Contractions: Periodically, bouts of hardening and tightening of the uterus occur in the last few months of pregnancy. These are painless. But they may become intense and frequent when you are nearing full term. They cease when you lie down to rest after walking or standing. The tightening gradually relaxes and is often known as ‘false labor’. Be careful if every movement you make triggers off contractions. Inform doctor so he can monitor you closely to exclude a sensitive uterus, which may bring on premature labor. However, if you feel your contractions getting closer together, more intense and longer in duration, you can officially consider yourself in labor. Go straight to hospital.
2. Lightening or Engagement: It takes place when the presenting part passes through the pelvic brim. This causes the baby to gradually drop lower into the pelvis. The abdomen sticks out more prominently and is lower, relieving pressure on the mother’s diaphragm, making breathing easier now. However, lightening can also cause more discomfort through frequent urination and lower backache. (pg 58-59)

(3.1) True Signs of Labor

1. The Show: As the cervix dilates and stretches, the opening becomes wider, causing the mucous plug to slip out, together with a brownish or blood-tinged, jelly-like substance.  It signals the onset of labor. Take note the time the show occurred.
2. Contractions: As your labor progresses, the contractions become stronger, longer and more frequent. It feels like bad menstrual cramps. Some women feel the pain very low under the tummy, while others feel the pain in the back, especially when the baby is in a posterior position. In between contractions, there is no pain. This results in the progressive effacement of the cervix of the os. Take note when the contractions began and its regularity.
3. Rupture of Water Membrane: You notice either a slow trickle or a sudden gush of water from your vagina. When it burst, put on a sanitary towel and go straight to the hospital. Take note the time the water bag burst. (pg 59)

(3.2) Induction of Labor

1. The main reasons for the induction of labor are post-maturity or overdue, the placenta’s inadequacy to support baby, or other medical reasons.
2. Besides maternal request, reasons to induce labor include medical indications like: reduced fetal movement, medical maternal problems like hypertension, minor cardiac and renal problems, gestational diabetes, Rh (Rhesus) incompatibility, poor obstetric history and unstable lie of the fetus.
3. Induction can be done in 3 ways – Prostaglandin Pessary, Oxytocin-induced Labor and Artificial Rupture of the Membrane. (pg 60-61)

(3.3) Presentation of the Baby

1. The most common is that of the head, cephalic or vertex presentation which accounts for 93% of all presentations.
2. In the primigravida, most babies engage or have the vertex pass through the brim of the pelvis by 36-38 weeks of gestation. Studies shown that 80% of all these engagements go into labor 2 weeks later.
3. For the multigravida, engagement of the vertex does not take place until the woman goes into labor.
4. Breech Presentation: The incidence is about 3-4% of presentation. About 57% breech presentations are spontaneous versions occurring around 32 weeks gestation. Around 34 weeks, some doctors may help the mother by trying to turn the baby around. External cephalic version, done under a scan, is a procedure that can only be performed by a doctor. Large and persistent breech presentation of the fetus may be delivered by a caesarean section. If the doctor is sure that there is plenty of room in the pelvis, he will try to deliver vaginally.
5. Other Presentations: Oblique, brow and shoulder presentations, where the fetus is usually delivered by C-section. (pg 61-62)

(3.4) Leaving to Hospital

1. As your due date approaches, plan your route from your home to the hospital. Take note of peak hour traffic, the journey distance, as well as alternative routes to take.
2. Other factors to consider include roping in your close relative, mother or best friend should your husband be away during this crucial stage, and making alternative arrangements for transportation should your assigned driver be unavailable.

(3.5) Length of Stay

1. For normal delivery, your estimated stay in the hospital should be 2-3 days.
2. If you have a C-section, you should be prepared to stay 3-4 days.
3. It is advisable to stay longer so that you can learn how to take care of your baby and establish breastfeeding. (pg 64)

(3.6) In the Delivery Suite

1. Relaxation: Relaxation increases the level of endorphins, which can help to ease the pain naturally. Fear and tension can increase pain perception. They are many types of relaxation techniques: Breathing with contractions; Focusing on baby; Visualization techniques; Meditation; Massage 
2. It is advisable to avoid holding your breath for longer than 5 seconds, as it will alter the blood gases in your placenta and may compromise fetal circulation. 
3. First Stage, Early Labor (Contractions are 10 minutes apart, last 30-45 seconds each): When your contractions are regular but relatively gentle to start with, you can use Slow Coastal Breathing to help you stay calm and relax – Sit propped up and cup your hands over your abdomen. Breathe in through your nose and hold for 3 seconds before you breathe out through your mouth, with your lips gently parted, let your shoulders sag and relax your body. Ideal Position: During the first stage, positions which best help the progression of labour are upright and walking about or kneeling during contractions, resting between them. This will help the intensity, strength, frequency and regularity of her contractions. You can imagine how much easier it is for the uterus and baby to work with the forces of gravity, rather than lie down and work against them. Lying down may slow labour and contractions may become more ineffective than being upright. 
4. First Stage, Active Labor (Contractions are 3-5 minutes apart, last 40-60 seconds each) (Dilates 4-7cm): Your contractions are now stronger, longer and closer together. They hit a peak during which it is hard to relax. You now need to change your breathing technique. Pattern-spaced Light Breathing – Sit propped up and support your body. Take a slow coastal breath as soon as you feel the contraction starting. Let out the breath and then switch to saying ‘He, he, hoo’ (Blow, blow, blow). Continue with ‘He, he, hoo’ for 3 breaths and repeat this as many times as you need through the peak of contraction until you feel it going away. Request for other pain relief or Epidural Analgesia – self-administered (PCEA) or continuous via a syringe pump or top up by the nurse. 
5. Transition (Contractions are 2-3 minutes apart, last 90 seconds each) (Dilates 8-10cm): Do not push the baby out prematurely. Use pant-pant-blow breathing. Avoid holding your breath for longer than 5 seconds, as it will alter the blood gases in your placenta and may compromise fetal circulation.  
6. Second Stage (Contractions are 3-5 minutes apart, last 60-90 seconds each):Midwife will position you and get your husband to help you get ready to push the baby out. Do not hold your breath for more than 5 seconds if you feel the urge to do so. During crowning, doctor will ask you to pant awhile to check your perineum and position of the umbilical cord. Ideal Position: Positions which best help the progression of labour are standing or kneeling with the upper body leaning forward during contractions. Towards the end of the second stage, supported squatting provides the greatest increase of pressure in the pelvic cavity and seems to be the most effective position during contractions. If the second stage is very quick, kneeling on all fours may be preferred. 
7. Third Stage, Delivery of the Placenta: You may be given an injection to speed up the birth of your placenta and control the bleeding to prevent postpartum hemorrhage. While baby is being given his own ID tag, checked and weighed. 
8. Begin breastfeeding within first hour of birth. (pg 66-75) 
9. Tips from moms:  

• Take lots of photos
• Surround yourself with lots of support: The nurse I had for the night of delivery was so-so. I wish I had spoken up about this and asked for more help. Thankfully, my doctor came in at the right time and was the best cheerleader -- she got my spirits back up.
• Speak up or have your partner talk for you: Prepare your partner to be as helpful as possible when you're in the delivery room. This could mean he needs to be assertive in asking for what you need physically -- like insisting that you be permitted to drink fluids if you need them. It could mean that he needs to tell bossy obstetricians to lay off. As a general rule, the husband should know in advance what his wife's needs and preferences are, so that he can demand them when his wife is not in a position to do so herself. Bottom line: He shouldn’t just take a passive role -- he should evaluate what's going on and intervene if he thinks it's necessary.
• Let your body take over: The pain of childbirth is all natural, meaning it's not like you were in a car accident and lost your arm. That type of pain would be scary and have the element of unknown. But labor is completely different. It's your body doing what it’s supposed to do when it is supposed to do it. Whenever I thought of this, I tried to relax and let my body take over. You really do dilate faster when you relax more, so don't fight it by clenching and tensing up.
• Be flexible: Babies don't read birth plans. It is great to have a wish list but don't get so caught up in your labor and birth going a certain way that you feel like a failure if it doesn't.
• Pack your fave soap: Bring really good-smelling soap to the hospital. By the time I was able to take a shower, I felt disgusting but was so grateful to have something wonderful-smelling to wash with. I was still sore, but I did feel clean for at least a little while!
• Bring your own pads: I wish someone would have told me to pack my own pads for the hospital stay -- the ones they gave me were big enough for a horse! My son was a preemie who stayed in the nursery, so walking down there to see him with a boat between my legs looked really weird.
• Enjoy your hospital stay: Enjoy the rest and pampering during your stay in the hospital. I loved being served my meals, having the nurses constantly check in on me, and getting up to take a shower or soak in the hot tub only to return to a freshly made bed.
• Thank extra-helpful staffers: Consider taking a thank-you card with you to the hospital to be addressed to an especially helpful and caring staff member (like a nurse). You’ll be so grateful to those who really help you during this time, and it will be nice to have some way of expressing your appreciation.