Labour and birth On this page: Signs of labour Stages of labour Pain relief options When extra help is needed Caesarean Section Twins or more Vaginal Birth After Caesarean (VBAC) Meeting your baby Your recovery Signs of labour There are several signs that labour might be starting, including: contractions or tightenings a “show”, when the plug of mucus from your cervix (entrance to your womb, or uterus) comes away backache an urge to go to the toilet, which is caused by your baby’s head pressing on your bowel your waters breaking (rupture of membranes) The early (latent) stage of labour can take some time. Call your midwife or the maternity advice line on 0300 422 5541 if: your waters break you’re bleeding your baby is moving less than usual you’re less than 37 weeks pregnant and think you might be in labour Stages of labour Labour happens in three clear stages: First stage: when contractions gradually open up the cervix, which is the neck of your womb (uterus).The first stage of labour can include a period of early labour, often referred to as the latent phase of labour. This is followed by active labour, and the transitional phase. Second stage: when you push your baby out into the world. Third stage: when you deliver the placenta. Read more about the stages of labour here. Monitoring your baby in labour Your midwife will monitor you and your baby throughout labour to make sure you’re both coping well. This will include using a small handheld device to listen to your baby’s heart every 15 minutes. You’ll be free to move around as much as you want. Your midwife may suggest electronic monitoring if there are any concerns about you or your baby, or you choose to have an epidural. Electronic monitoring involves strapping two plastic pads to your bump, and possibly a clip attached to the baby’s head (a foetal scalp monitor). These are attached to a monitor that shows your baby’s heartbeat and your contractions. You can ask to be monitored electronically even if there are no concerns. Having electronic monitoring can sometimes restrict how much you can move around. If you have electronic monitoring with pads on your bump because there are concerns about your baby’s heartbeat, you can take the monitor off if your baby’s heartbeat turns out to be fine. A foetal scalp monitor will usually only be removed just as your baby is born, not before. Pain relief options Labour can be painful – it can help to learn about all the ways you can relieve the pain. You can discuss your options for pain relief with your community midwife. You may wish to write them in your birth plan, but remember you need to keep an open mind. You may find you want more pain relief than you’d planned, or the midwife caring for you in labour may suggest more effective pain relief to help you. Read more about the different options for managing your pain in labour here Alternative therapies in labour Some women may choose alternative treatments such as acupuncture, homeopathy, hypnosis, massage and reflexology. Most of these techniques aren’t proven to provide effective pain relief. If you’d like to use any of these methods, it’s important to discuss them with your midwife or doctor and let the hospital know beforehand. Most hospitals don’t offer them for pain relief during labour. If you want to try any of these techniques, make sure the practitioner is properly trained and experienced. Use of Essential Oils We were among the first in the country to use aromatherapy techniques to help women before, during and after labour. This is available at all of our birth facilities. Your midwife will be able to tell you more about this unique service, but for more information read the Use of Essential Oils and Massage to help with your labour patient leaflet. Hypnobirthing Hypnobirthing can help you work with your body, releasing the fears and worries of birth and replacing it with calmness and confidence. Hypnobirthing is safe, you will always be aware of what is happening to you, it doesn’t mean you will be in a trance or a sleep, but you will be totally relaxed, be able to chat to everyone and be fully in control. Please speak to your midwife for further information. Birthing Pools Being in water during your labour can help you relax and make the contractions seem less painful. Ask if you can have a bath or use a birth pool. The water will be kept at a comfortable temperature, but not above 37.5C, and your temperature will be monitored. All of our birth units at Gloucester, Cheltenham and Stroud have birthing pools. There is also a pool room on the Delivery Suite where we can accommodate a waterbirth for those women for whom it is considered safe to labour and/or give birth in water. The National Childbirth Trust has information on using water during labour and birth. When extra help is needed Sometimes labour can be slower than expected or during the birth you or your baby may need some extra help. If there are concerns for the wellbeing of you or your baby during labour or birth you will be offered medical intervention. Your consent will be required before any treatment is given, therefore any treatment will be explained so that you can make an informed choice. Breaking your waters Labour can sometimes be slower than expected. This can happen if your contractions aren’t coming often enough or aren’t strong enough, or if your baby is in an awkward position. If this is the case, or if your baby is not coping very well with the stress of the labour, your doctor or midwife may talk to you about breaking your waters. Breaking the membrane that contains the fluid around your baby (your waters) is often enough to make contractions stronger and more regular. This is also known as artificial rupture of the membranes (ARM). Your midwife or doctor can do this by making a small break in the membrane using a very tiny hook (amnihook) during a vaginal examination. This may make your contractions feel stronger and more painful, so your midwife will discuss pain relief with you. Assisted birth There are some instances when you may need help with the birth of your baby. This may be for one of the following reasons: Your baby is not moving out of the birth canal as would normally be expected There are concerns about your baby’s wellbeing during birth You are unable to, or have been advised not to, push during birth The purpose of an assisted vaginal birth is to mimic a normal (spontaneous) birth with minimum risk to you and your baby. A doctor will use specially designed instruments (ventouse or forceps) to help your baby to be born during the last part of labour. Read more about forceps or ventouse delivery here. Emergency caesarean birth In certain instances an assisted birth with forceps or ventouse may not be possible and your baby may need to be delivered relatively quickly. In this instance you will be offered what is known as an emergency caesarean section. In reality, very few caesarean sections are performed due to the immediate threat to the life of you or your baby, and in most cases, if a caesarean section is necessary, you will have plenty of time to discuss this with the doctor looking after you and your partner will be able to come into the operating theatre with you. Most caesarean sections are performed under what is called a Spinal anaesthetic. If a caesarean section has to be done immediately and you have to be put to sleep for the procedure, your partner will be asked to wait in the recovery room where you and your baby can be taken as soon as the operation is finished. Read more about caesarean section birth here. Planned Caesarean birth A caesarean may be recommended as a planned (elective) procedure or done in an emergency if it’s thought a vaginal birth is too risky. Some women choose to have a caesarean for non-medical reasons. If you ask your midwife or doctor for a caesarean when there aren’t medical reasons, they will explain the overall benefits and risks of a caesarean compared with a vaginal birth. Read more about caesarean section birth here . Twins or More It’s important to understand your birth options if you are expecting more than one baby. Twins and triplets are more likely to be born early and need special care after birth than single babies. It’s a good idea to discuss your birth options with your midwife or consultant early on in your pregnancy. You’ll normally be advised to give birth in a hospital as there’s a higher chance of complications with twins. Read more about giving birth to twins here. Vaginal birth after caesarean (VBAC) Many women who have had a caesarean section go on to safely have a vaginal birth in a future pregnancy. Your obstetrician will meet with you during your pregnancy to discuss your individual circumstances and advise you on whether VBAC is suitable for you. For more information about your options following a previous caesarean section click here. Find out more about vaginal birth after caesarean in this film, featuring a mum talking about her experience of going through it, and local midwife Jo. Meeting your baby It’s a good idea to also know what to expect straight after your baby is born. Your baby can be lifted onto you as soon as they’re born and before the cord is cut so you can be close to each other straight away. Your baby is then dried and covered with a towel to stop them getting cold. You can continue to hold and cuddle your baby. Your baby may have some of your blood on their skin and perhaps vernix, the greasy white substance that protects your baby’s skin in the womb. If you prefer, you can ask the midwife to dry your baby and wrap them in a blanket before your cuddle. Delayed cord clamping After your baby has been born the umbilical cord, which links your placenta to the baby, continues to pulsate and transfer blood and oxygen and stem cells to your baby until baby has transitioned to life outside the uterus and becomes stable. Your midwife will normally wait until the cord has stopped pulsating and becomes white before clamping the cord. This is called delayed cord clamping and you can read more about it on the Tommy’s website here. Skin to Skin Skin to skin contact at birth can be beneficial for you and your baby in many ways, including the following: Calms and relaxes both mother and baby Regulates the baby’s heart rate and breathing, helping them to better adapt to life outside the womb Stimulates digestion and an interest in feeding Regulates temperature Enables colonisation of the baby’s skin with the mother’s friendly bacteria, thus providing protection against infection Stimulates the release of hormones to support breastfeeding and mothering. Read more about skin-to-skin contact. Your baby’s first checks Sometimes, babies need a little bit of help to get their breathing established. Mucus may need to be cleared out of your baby’s nose and mouth. Your baby may even be taken to another part of the room to have some oxygen. They’ll be brought back to you as soon as possible. Once you are ready, your baby will be examined by a midwife or paediatrician, then weighed and given a band with your name on. An electronic tagging system is used for all babies. Within the Women’s Centre a small tag is secured using a baby identity label on your baby’s feet. Taking a baby near to one of the ward exits will cause an alarm to sound. The tag will be checked and removed by a member of staff just prior to your discharge. What is an Apgar Score? At one minute after birth, and again at five minutes after birth, your midwife will assess your baby’s wellbeing. Your baby is given a score between zero and two, for five basic observations (skin colour, heart rate, response to stimulus, breathing and muscle tone) which are then added up to give the Apgar score. This is a quick way to assess whether your baby needs any immediate help and to record your baby’s early wellbeing in the notes. Keeping your baby warm It is important to keep your baby warm. Babies can’t control their body temperature as effectively as we can. Babies also don’t have as much insulating body fat, especially sick or premature babies. Keeping your baby warm helps them stay healthy and comfortable, and enables them to conserve energy that they need for feeding and adjusting to life outside the womb. Vitamin K for your baby Within the first hour or so of your baby’s birth, you’ll be offered an injection of vitamin K for your baby. This helps prevent a rare bleeding disorder called haemorrhagic disease of the newborn. Your midwife should have discussed the injection with you while you were pregnant. If you’d prefer for your baby not to have an injection, they can have vitamin K by mouth instead, but they’ll need further doses. Read more about vitamin K for babies here. Link to local patient information leaflet Your recovery Recovering from giving birth vaginally can take anything from a few days up to a few months. Many women feel back to normal around 6-8 weeks after the birth. You can find advice about stitches, piles, bleeding and other physical changes after birth, plus tips to help you make a healthy recovery, on the NHS website here. Recovering from a caesarean may take longer. You may be in hospital for a few days after a caesarean section, and may need to take things easy for several weeks. Read more about recovering from a caesarean section here. For more information about your recovery in the days and weeks after you give birth, head to the You and Your Baby page here.