You should get a few things ready at least two weeks before your due date.
The following techniques can help you to be more relaxed in labour, and this can help you to cope with the pain.
2. Intramuscular injections of pain- relieving drugs
How it works
A drip will run fluid into a vein in your arm.
While you lie on your side or sit up in a curled position, an anaesthetist will clean your back with antiseptic and numb a small area with some local anaesthetic.
A very small tube will be placed into your back near the nerves that carry pain from the uterus.
Drugs (usually a mixture of local anaesthetic and opioid) are then administered through this tube. It takes about 20 minutes to get the epidural set up and then another 10–15 minutes for it to work.
After it has been set up, the epidural can be ‘topped up’ by an anaesthetist or you may be given a machine, which will let you top up the epidural yourself.
Your contractions and the baby’s heart will need to be continuously monitored by a NST machine. This means having a belt round your abdomen and possibly a clip attached to your baby’s head.
Some women want to avoid the above methods of pain relief and choose acupuncture, aromatherapy, homeopathy, hypnosis, massage and reflexology. Most of these techniques do not provide very effective pain relief.
What Happens In Labour?
There are four stages of labour. In the first stage the cervix gradually opens up (dilates). In the second stage, the baby is pushed down the vagina and is born. In the third stage the placenta comes away from the wall of the uterus and is also pushed out of the vagina. Fourth stage is the stage of observation for 1 hour after the delivery.
The first stage of labour – The dilation of the cervix and effacement (softening) of the cervix
The cervix needs to open to about 10cm for a baby to pass through. This is called ‘fully dilated’. Contractions at the start of labour help to soften the cervix so that it gradually opens. Sometimes the process of softening can take many hours before what midwives refer to as ‘established labour’. This is when your cervix has dilated to at least 4cm.
Fetal heart monitoring
Your baby’s heart will be monitored throughout labour. There are different ways of monitoring the baby’s heartbeat.
Speeding up labour
In early labour, you can have liquids and maybe a light snack. You can walk around until you are comfortable. As the contractions start getting more frequent and stronger, deep breathing and relaxation technquies are helpful.
The second stage of labour – the baby’s birth
This stage begins when the cervix is fully dilated, and lasts until the birth of your baby.
When your cervix is fully dilated, you can start to push when you feel you need to during contractions:
Once your baby’s head is born, most of the hard work is over. With one more gentle push the body is born quite quickly and easily.The cord is clamped and cut, and the baby is handed over to the paediatrician.
The third stage of labour – the placenta
After your baby is born, the uterus can contract to push out the placenta.
An injection contains a drug called oxytocin will be added to your drip or given intramuscularly in your thigh, which makes the uterus contract and helps to prevent the heavy bleeding which some women experience.
Let your baby breastfeed as soon after birth as possible.
1 hour of observation of the mother’s vitals( pulse, blood pressure) and vaginal bleeding after delivery
It is the deliberate cut given on the perineum during second stage of labour when the head is about to deliver in order to avoid vaginal tears. It is not essential in all women but those delivering for the 1st time may need it, big babies, and premature deliveries.
Once the placenta has delivered, the vagina is cleaned and the episiotiomy cut is sutured and stitched back completely with absorbable (dissolving) stitches. These stitches do not need to be removed later. The stitches do not require dressing. It is left open. It has to be kept clean and dry. The stitches will heal in 8 to 10 days. If the stitches are very painful, report to your doctor.
After a normal delivery
Induction of labour
Labour can be induced if you have crossed your expected date of delivery and not gone into labour, or there is any sort of risk to you or your baby’s health – for example, if you have high blood pressure or if your baby is failing to grow and thrive. Induction is always planned in advance, so you will be able to talk over the benefits and disadvantages with your doctor and find out why they recommend your labour is induced.
Contractions are usually started by inserting a gel or tablet into the vagina or sometimes an oral tablet can also be given. Induction of labour may take a while (24 hours to 48 hours), particularly if the mouth of the uterus (the cervix) needs to be softened. Sometimes a hormone drip is needed to speed up the labour. Once labour starts it should proceed normally, but it can sometimes take 24–48 hours to get you into labour.
Assisted birth (forceps or ventouse delivery)
About one in eight women have an assisted birth, where forceps or a ventouse are used to help the baby out of the vagina. This can be because:
Your baby is distressed your baby is in an awkward
Position you are too exhausted.
Both ventouse and forceps are safe and are used only when necessary for you and your baby.
As the baby is being born, a cut (episiotomy) may be needed to enlarge the vaginal opening. Any tear or cut will be repaired with stitches
A ventouse (vacuum extractor) is an instrument that has a soft or hard plastic or metal cup, which is attached to your baby’s head by a tube that is fitted to a suction device. The cup fits firmly onto your baby’s head and, with a contraction and your pushing, the obstetrician or midwife gently pulls to help deliver your baby.
The suction cup (ventouse) can leave a small mark on your baby’s head called a chignon, however it will disappear after delivery. It may also cause a bruise on your baby’s head called a cephalhaematoma. A ventouse is less likely to cause vaginal tearing than forceps.
Forceps are smooth metal instruments that look like large spoons or tongs. They are curved to fit around the baby’s head. The forceps are carefully positioned around your baby’s head and joined together at the handles. With a contraction and your pushing, an obstetrician gently pulls to help deliver your baby.
Forceps can leave small marks on your baby’s face. These will disappear quite quickly.
You may sometimes be fitted with a urinary catheter (a small tube that fits into your bladder) for up to 24 hours after instrumental delivery
There are situations where the safest option for you or your baby is to have a caesarean section. As a caesarean section involves major surgery, it will only be performed where there is a real clinical need for this type of delivery.
Your baby is delivered by cutting through your abdomen and then into your uterus. The cut is made across your abdomen, just below your bikini line. The scar is usually hidden in your pubic hair.
Most caesarean sections are performed under spinal anaesthesia (injection in your back which makes everything from your umbilicus downwards numb but you are awake). It minimises risk and means that you are awake for the delivery of your baby. A general anaesthesia is required only in very few conditions.
If you have an epidural or spinal anaesthesia, you will not feel pain– just some tugging and pulling as your baby is delivered. A screen will be put up so that you cannot see what is being done. The doctors will talk to you and let you know what is happening.
Urgent (emergency) caesareans
Urgent (emergency) caesarean sections are necessary when complications develop and delivery needs to be quick. This may be before or during labour.
This maybe needed in certain conditions like fetal distress (baby’s heart beats are dropping), abruption (placenta suddenly gets prematurely separated), and prolonged 2nd stage of labour.
Planned (elective) caesareans
A caesarean is ‘elective’ if it is planned in advance. This usually happens because your doctor or midwife thinks that labour will be dangerous for you or your baby. Some of these conditions are placenta praveia (placenta is low), big baby, breech, twins if the 1st baby is not cephalic (head down), severe growth restriction in the baby (IUGR), severe PIH (very high blood pressure).
In case of a planned caesarean section,
Once a caesarean always a caesarean?
If you have your first baby by caesarean section, this does not necessarily mean that any future baby will have to be delivered in this way. Vaginal birth after a previous caesarean can and does happen. This will depend on your own particular circumstances.
After normal delivery /caesarean section after 7 days and then after 11/2 months.