Author Topic: Ratbag's Reality Check - How to have a good birth  (Read 15594 times)

Offline ratbag

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Ratbag's Reality Check - How to have a good birth
« on: Apr 07, 2010, 11:26:31 AM »
All of the advice contained in this thread is meant as a general guide only.  If you have a specific question or worry - especially if you are bleeding or your baby is not moving - then you should contact your healthcare provider

So - you've got pregnant through whichever method suited and worked for you. You've grown a baby and you've waited patiently for labour to start...

Here is my advice to you about what you can do to make it go smoothly... sadly I can't make it painless.

This advice is for all mums, some is more relevant to first timers, some to experienced mums.  Not all women are the same - you may be one of the lucky ones who has a 6hr straightforward first labour, but it will do you no harm to prepare for the long 48hr one instead  :)

Basics....

Don't be too rigid in your planning - have an idea what you'd like but be flexible.  You cannot predict what is going to happen, or how you are going to feel, and neither can the midwife.  So go with the flow.....

I often talk to women about labour being like a storm at sea, with waves of tightenings surging up and down.  If you try to fight it you'll drown - stay calm, allow the wave to take you, let it  wash in and let it wash out again.... The storm may be long but it will pass....


Stay as normal as possible for as long as possible - when the tightenings begin, maybe every ten minutes apart, maybe every five, remember (especially if this is your first) that you are at the start of what may very well be a long journey.  You have to pace yourself. 

If it is daytime be normal - eat as normal, drink as normal, move as normal (or, if you are a bit of a couch potato usually, move a bit more than normal).  Walk the dog, do some housework, dance and sway..., stay well nourished and well hydrated.  If it is nightime go to bed - try to sleep.  Whenever it happens take paracetamol, use a hot water bottle or a wheat bag, try a warm bath.  But essentially - ignore it for as long as you can...  After all, if you stay up all night not eating the first night you won't have the energy to get through the second night....and sadly there is almost always (for first timers) a second night....


Get good support around you - this might be your partner, but it might be your mother or your sister, or your friend or a doula or a combination of all of them. 

For hetrosexual couples it is often assumed that the "dad" will be the significant birth partner - but he is not always the best person - and neither is a lesbian partner.  This is because any birth partner who is scared, or afraid for their loved one, will transmit their fear subliminally to the birthing woman.  I will talk about fear in labour later.

Mums come in two sorts as well - those who trust birth, had reasonable birth experiences themselves, who see their daughter as an equal.  And mums who still treat their daughters as babies, or who have unresolved anxiety regarding their own birth experience.  Obviously the former is preferable....if your mum is the latter suggest she makes your home ready for you and answers the phone to all your friends who are waiting for news.

Instead choose partners who are accepting of labour pain and who are not frightened.  Choose partners who will support you at your most vulnerable, who won't want to talk to the midwife about their own experience (after all its your day not theirs!), and who are thick skinned enough to take the abuse you might throw at them later!

Make sure your partners have enough rest during your early labour - that means if you are in hospital that you let them go home during the night if you are still early.  You call them back at any time but they will get better rest at home than in an upright hospital chair.  If they are not rested and fed they will be no good to you.  Another reason to have more than one if possible...

The midwife - she is doing her job - she may have other women to look after.  This is a sad fact of the modern NHS - it is a national health service not a personal one.  If you want to be guaranteed a personal midwife you will have to pay for one - sad but true.  Make sure you communicate your needs with her, and make sure you understand her plan of care for you.  Remember that the plan is made in collaboration - if there is something you want then tell her.  If you don't understand her rationale for something then ask. 

Remember that your midwife is a person too - she has trained for three years or more specifically for this job.  She is recognised amongst all health professionals as the expert in normal childbirth.  But she is a person - and she doesn't need to be made to feel like a skivvy or threat, she is there to help you and advise you.  If communication between you and your midwife is not working ask for another midwife.  She should not be offended - we cannot get on with everybody we meet in life.



« Last Edit: Apr 16, 2010, 05:45:22 PM by ratbag »

Offline ratbag

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Re: Ratbag's Reality Check - How to have a good birth
« Reply #1 on: Apr 07, 2010, 11:41:33 AM »
Fear in labour

From a physiological perspective (here comes the sciencey bit...) labour is a cauldron of chemicals.  We have oxytocin in our blood stream, when labour starts our uterus begins to make oxytocin receptors, as more oxytocin receptors appear so more oxytocin is made....this causes us to have contractions, which cause the baby to press on the cervix, which causes more oxytocin to be made and so on. So you could think of oxytocin as the accelerator driving the labour car..

However the labour car may need to be stopped or slowed so our bodies have an evolutionary protective mechanism that can act as a brake in case of danger (ie a sabre toothed tiger or a strange midwife in the vicinity).  This mechanism is adrenaline (and similar chemicals), which is designed to fit into the oxytocin receptor  to stall the labour if it is not safe for the baby to be born.  Evolution would not allow labour to go unchecked if the baby was at risk.  In practical terms this means that if you are scared your labour is going to be longer and harder.  Most women experience a degree of this when they arrive at the hospital and the tightenings become less frequent - this is the adrenaline putting the brake on - strange sights, strange smells, strange noises etc etc.  Most women find that once they acclimatise to the environment they begin to labour again.

It is a sad fact of our society today that women are very unprepared for labour and birth.  They don't have the advantage of living closely with their mother, sisters, and aunties, and seeing them deal with labour, learning how to cope from a very young age, and they have the disadvantage of a media society that portrays birth as dangerous and exciting and quick!  ie waters go, into ambulance, screaming woman, doctor delivers baby with cord around neck blah blah blah... birth is almost never like that but as little girls this is what was instilled in us....

How to reduce fear - accept that despite your education and your ability to knit or mend cars you are essentially an animal.  Your body knew how to make and grow the baby, it knows how to get it out.  Trust that what is happening to you is normal.  Remember that each pain goes away - every single one of them goes away and doesn't come back, think of them as stepping stones to your baby if you like.

Be aware that a small amount of bleeding in labour is normal - especially towards the end.  Be aware that at the very end of labour it becomes hard to hear the baby's heartbeat as it is so deep in your pelvis.  Be aware that labour takes time.

Coping with tightenings/contractions/surges/rushes - pick a spot on the wall and concentrate on that while it is there.  Or count backwards from 100, or pick a nursery rhyme to recite - The Grand Old Duke of York is a good one because he can march his men to the top of the pain and he can march them down again.  Sway your hips from side to side, bend over from the ribs onto a mantelpiece or hospital locker.  Sing.  And when it is gone, breathe out in a big sigh.  Try not to hold your breath.

Remember - every single pain goes away


Offline M&M

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Re: Ratbag's Reality Check - How to have a good birth
« Reply #2 on: Apr 07, 2010, 11:51:55 AM »
This is such a useful thread and a BRILLIANT idea.
TY
M&M

Offline ratbag

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Re: Ratbag's Reality Check - How to have a good birth
« Reply #3 on: Apr 07, 2010, 12:04:14 PM »
The Cervix

Is the entrance to the womb and it has to undergo many changes before the baby can get out. 

During pregnancy it is like a tube and is filled with the operculum - a sticky substance designed to keep germs out.  When cervical changes begin the operculum (or show) can escape.  A good sign that your cervix is changing but not a good sign of imminent labour

It is firm in texture - like the end of your nose, and it has to soften, becoming first like your earlobe, and then like your lips. 

It is long - 2-3cm sometimes, and has to become paperthin - this is called effacement. 

When you are standing up it points backwards, prior to labour it has to move forwards to a more downwards pointing position

It is tightly shut and has to open to 10cm.

In first time mothers these changes tend to happen one at a time - certainly the cervix won't be able to dilate beyond 3-4 cm until all the other changes have happened.

Some women find that they notice these changes happening - they have tightenings that cause the changes - this is called the latent phase of labour.  Other women do not notice the changes at all.  We are all different.  If you are told when someone does an internal that your cervix is 1cm dilated and fully effaced that is good news - effacement and softening is the hardest part of the changes that need to happen, but you are not yet in established labour because the process from firm, long and tightly closed, to soft, thin, stretchy and open can stop and start over many days... once your cervix is about 3-4 cm open your labour will probably continue (as long as your body is not filled wth fear hormones).

As a general rule of thumb - once your cervix is 4cm open it will continue to open (according to the text books) at about 1cm an hour.  However, some women go significantly faster than this (especially if they have laboured before, but even some first time mums), and other women go slower - 1/2 cm an hour is considered acceptable progress, especially if you have an epidural in place.

The cervix is part of a feedback loop that creates contractions - once it is fully dilated there is nothing for the baby's head to press on any more so that feedback loop is interrupted and a lull in tightenings often ensues... once the baby moves into the vagina a new feedback loop is initiated and pains begin again.  Midwives often call this the "rest and be thankful" period as it often follows a difficult and intense period of labour pains that are often called transition - the bit where the last bits of the cerrvix are being dilated.




Offline my sparkle instinct

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Re: Ratbag's Reality Check - How to have a good birth
« Reply #4 on: Apr 07, 2010, 12:17:41 PM »
Of course, it is possible to know all this like the back of your hand and still have a difficult birth for other reasons! Just saying. I knew all this stuff very well (didn't know they aren't supposed to check you though - that was something I learned from Ratbag - thank you) but still had an awful experience. The bit that was up to me though, I did very well. It is good to know all this stuff.

Offline Evelet

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Re: Ratbag's Reality Check - How to have a good birth
« Reply #5 on: Apr 07, 2010, 01:15:01 PM »
This is a good thread. Maybe it could be made a sticky?


Offline Lust for Life

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Re: Ratbag's Reality Check - How to have a good birth
« Reply #6 on: Apr 07, 2010, 02:10:35 PM »
This is a good thread. Maybe it could be made a sticky?

a mucal plug? ;D

Offline ali

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Re: Ratbag's Reality Check - How to have a good birth
« Reply #7 on: Apr 07, 2010, 02:15:52 PM »
[

a mucal plug? ;D
[/quote]
meconium 8)

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Re: Ratbag's Reality Check - How to have a good birth
« Reply #8 on: Apr 07, 2010, 02:57:10 PM »
Thanks for the Thread RB  :)

Offline ratbag

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Re: Ratbag's Reality Check - How to have a good birth
« Reply #9 on: Apr 07, 2010, 05:27:14 PM »
Pushing the baby out

Once the baby is in the birth canal you may start to get an urge to push.  Just like the latent stage of labour though, many midwives think that the second stage of labour has a latent phase too.... Your cervix is fully dilated and the second stage countdown starts... but actually the baby needs to descend onto the muscles of the pelvic floor - when a reflex, known as Ferguson's reflex, or the fetal ejection reflex begins and you begin to push spontaneously.

Pushing a baby out is exactly like having the biggest poo of your life - there is no getting away from it, unless you relax in the same way you do to open your bowels your baby will take a long time to come out.  Many women don't want to push because they feel they are going to have a poo.  Maybe they are and maybe they aren't - more of that later.

When you push you should push down into your bottom, not in your throat.  You should push wiith your bottom relaxed, not with it tense - this stops the baby moving down.  You can make a noise by all means, but screaming is unproductive. 

If you can't push - or if you feel you can't push, try putting your hands into a big fist shape and blow hard into them.  Feel how your intra-abdominal pressure changes the forces upon your pelvic floor - that is the movement that you need.

Try not to push too early - your cervix might not be fully dilated, or the baby may still need to rotate, or it may still be too high.  You might have a vague urge - but really its best to resist that urge as long as you can.  If you can resist it its probably too soon....

When the head is actually crowning it burns - try pulling your mouth open as wide as it will go to get an idea of what that stinging burning feels like.  As a midwife, sitting outside a labour room, I can tell when a baby is about to be born as the noise women make at this stage is universal...

Poo

When your baby is in your vagina it acts like a snow plough. 

Your rectum is next to your vagina, if it has a poo in it the baby's head will push the poo out ahead of it...

No getting away from it.

Lots of women are embarrassed by it - there is no need.  It is a good sign of progress...  We'll pick it up and put it in a bin, or cover it with an inco sheet, or sieve it out of the pool, whatever is most appropriate at the time.  Sometimes it is smelly - can't be helped...

In the old days women were given enemas to prevent pooing in labour - but actually its harder to clean up the product of an enema than a formed poo. 

There is some evidence to suggest that babies are born facing the rectum to allow them to pick up faecal matter from their mother in order that their gut can be colonised with friendly bacteria and vitamin k.

So, poo is good... try not to fret about it.


Offline Lust for Life

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Re: Ratbag's Reality Check - How to have a good birth
« Reply #10 on: Apr 07, 2010, 05:53:20 PM »
this thread is excellent, although it does kind of remind me of that time I read an excellent book on how to conceive....whilst 7 and a half months pregnant ;D

Offline Hayjay

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Re: Ratbag's Reality Check - How to have a good birth
« Reply #11 on: Apr 07, 2010, 05:57:59 PM »
Thanks Ratbag

< fan of sensible stuff  ;D ;D
Having a child is surely the most beautifully irrational act that two people in love can commit.

Offline my sparkle instinct

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Re: Ratbag's Reality Check - How to have a good birth
« Reply #12 on: Apr 07, 2010, 07:07:27 PM »
It is important to note that until you are in labour ward you will not just have one midwife - I had around five who looked after me at different times. They also don't always tell each other everything so you will probably find you have to repeat things over and over again, even when they are written down.

Offline rosypie

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Re: Ratbag's Reality Check - How to have a good birth
« Reply #13 on: Apr 07, 2010, 08:11:27 PM »
^and i never saw the same midwife twice when i was pregnant first time.
I ate my way out. I love caramel.

Offline ali

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Re: Ratbag's Reality Check - How to have a good birth
« Reply #14 on: Apr 07, 2010, 08:36:20 PM »
I saw the same midwife while I was pregnant. Throughout labour 1st baby I had one midwife and 2nd baby I had 2 as it went on a bit 8)
We had to repeat ourselves but at least it gave DP something to do :P