Physiotherapy
The preparation for labour leaflet uses the pneumonic of ‘preparation’ and discusses everything from pregnancy hormones to getting your hospital bag ready. It also highlights the early signs of labour, including when to stay at home and when to ring the hospital.
Pregnancy hormones
In the last few weeks of pregnancy, your hormones are pre preparing your pelvis for labour by softening the ligaments at the front of your pelvis and in the lower back region.
Be mindful of this whilst doing daily tasks, avoiding extra stress and strain on your back and pelvis by doing light duties only and changing your posture regularly. Start to use the gym ball as an alternative to sitting on the sofa and gently massage the lower back muscles as they may start to ache.
Ready?
Your hospital bag for labour should be packed and ready from about 36 weeks. Involve your birthing partner in this process, so that they know what is in the bag. Remember nappies, cottonwool or water-wipes, newborn (0-3mth) vests and babygrows as well as muslin cloths and scratch mittens. (Remember pre-made milk cartons and bottles if not breast feeding) Changes of clothes for yourself, toiletries, breast pads, nipple cream, sanitary pads and plenty of spare underwear. Other top tips : hair bobble, lip balm, handheld fan, energy bars and juice cartons. (Look on-line NHS for more extensive lists).
Early signs
As labour approaches you may experience loose stools, as baby positions deeper into the pelvis putting pressure on the bowels, as well as high levels of hormones.
You may also notice a mucus plug discharge, called the ‘show’ and this is a thick whitish colour or may have a pink tinge from spots of blood, but it is not necessary to inform the hospital of the ‘show’ unless it is a bleed (or a greenish colour discharge) then phone the advice line.
Otherwise early signs of labour may be felt as waves of discomfort in your lower back or tummy area, similar to that of ‘period’ type discomfort or pain.
Plan to stay at home
During the early stages of labour, the best place to be, is at home.
Make sure you have paracetamol pain relief at home (and can progress to Co-codamol) but record your dosage intake, especially noting the paracetamol content.
Other alternative pain relief options at home include:
- A warm bath – maximum 37°
- Gentle heat pack
- Back massage
- Aromatherapy
- Deepfreeze gel
- Gym ball
Sitting and gently rocking the pelvis, or standing with the ball behind your back against a wall, or leaning over it on a table.
AND - Possibly a TENS machine
A form of pain relief to be hired from 37 weeks from the physio department
It is important to stay calm and create a relaxing environment, for example; dim lights and soothing music.
Active labour
Time the length of your contractions (discomfort or pain) and the gap of time between your contractions. You will notice the contractions becoming stronger and longer (30 to 40 seconds) and the gap between them becoming shorter.
Try stay active during this first stage of labour by walking or adopting upright and forward positions, for example; sitting on a ball and resting forward onto a table, or kneeling on the floor or sofa and resting forward.
Keep breathing through the discomfort or pain and make sure you don’t hold your breath. Listen to relaxing music and take slow deep breaths, concentrating on expanding your ribcage and tuning out or ignoring the pain, by remaining calm and staying positive.
Ring the hospital
If you are high dependency please ring the advice line as advised by your consultant or midwife.
If you are low dependency it is a good time to phone the advice-line when your contractions are about 5 minutes apart, to discuss whether it is advisable for you to come into hospital or stay at home a bit longer (until you are experiencing 3 contractions in a 10 minute period).
Arriving at hospital
After phoning the advice-line and being advised to come into hospital, bring your hand-held antenatal notes with you, and arrive through the Maternity, women and children’s entrance. Head towards the Maternity Assessment Unit (MAU).
After an internal examination, monitoring your contractions, as well as baby’s heart rate, it will be decided if you are in ‘established first stage of labour’ and whether you are still ‘low’ or ‘high’ dependency for labour, and then taken round to the appropriate labour ward.
When you are in your labour room, it is important that you and your birthing partner ‘settle in’ and make it feel homely and comfortable.
Feel free to dim the lights, use battery candles, run yourself a bath and play soothing music on your phone. Ask for a birthing ball, beanbag and possibly a birthing stool, and the midwife will assist you in re-arranging the pillows and bed height to allow you to find comfortable active birthing positions.
The midwife will be popping in periodically to monitor you and baby, as well as offer different forms of pain relief, but if you feel your ‘waters’ break at any point, please let the midwife know.
Transition
As your cervix is dilating and your body is preparing for the second stage of labour, you may feel slightly irritable, during this transition phase, as you experience a deep stretching sensation in your pelvic floor and a pressure towards your back passage (like you need to open your bowels).
If you start to have these sensations and an ‘urge to push’ please alert a midwife and she will examine you and determine if you are fully dilated to 10 centimetres and ready for the second stage of labour.
In tune with midwife
During this important second stage of labour, the midwife will stay with you and guide you through step by step, to help you push baby out. It is better to be in a more upright position during the pushing stage, as this will allow gravity to help both you and baby. Try remain calm and breathe slowly and deeply.
The midwife will guide you to use a long breath out, to push or bear down and work with your uterus during contractions, so listen carefully and stay tuned to your midwife’s instructions.
The painful contractions will only last for about a minute long, then they will cease and relax, until the next one. Each contraction is bringing you closer to meeting your baby, so focus on that and stay positive.
As the head starts to crown, you may feel a burning or stinging sensation, which is your body’s signal to push slowly and gently, as your midwife guides you through delivering your baby.
Only the placenta left
Once your baby is born, the third stage of labour is to deliver the placenta. The midwife will usually wait a minute for baby to receive all the nutrients and blood from the placenta, then when it stops pulsating, the midwife will clamp and cut the cord.
The placenta can be ‘actively managed’ by having an injection to speed up this stage and reduce bleeding or it can be an ‘unaided’ delivery whereby your body does this process naturally.
You may be asked to help push the placenta out or the midwife may press on your tummy to draw it out, although the placenta is soft and will deliver without discomfort.
New bonding
The best part is when you get to hold and cuddle your newborn baby and enjoy ‘skin to skin’ bonding time.
This precious time of mum and baby being wrapped up together, helps to regulate baby’s heartbeat, temperature and breathing. It also encourages the baby’s natural urge to feed (breast or bottle) and helps you release hormones related to breast-feeding and to emotionally bond with your baby.
It is also possible for your birthing partner to experience ‘skin to skin’ bonding time as well.
Patient experience
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.
To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.
T: 01642 835964
E: [email protected]
