In Depth or in Distraction > Rainbow Families

Ratbag's Reality Check - How to have a good birth

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ratbag:
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.



ratbag:
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

M&M:
This is such a useful thread and a BRILLIANT idea.
TY

ratbag:
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.



my sparkle instinct:
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.

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