Arm yourself with the facts so you're prepared for how your baby will be delivered into the world - whether it goes to plan or not.
Contractions - what to expect
Contractions soften the cervix, which gradually opens to about 10cm wide, enough to let the baby out and called 'fully dilated'. It may take several hours before 'established labour' (when the cervix is 3cm or more and you'll be transferred to the delivery ward). From this point, if it's your first baby, you should expect full dilation to take between six and 12 hours, but this can vary. You may have been told that contractions feel like period pain, but the intensity of the pain is normally many times stronger (although every woman's labour and pain threshold is different). This makes sense when you consider that during a period, your cervix opens just a fraction of a centimetre!
If you're induced you may find that your contractions come on a lot stronger than if you go into labour naturally and they start gently and build up, but this is completely normal. Visualisation, breathing techniques and positive thinking can help make the contractions bearable. Remind yourself during the worst pain that the contraction won't last much longer. Your birth partner can also help by offering encouraging words, back rubs, drinks and perhaps by playing relaxing music.
It's important to learn about all pain relief options well before you're due so they don't have to be explained to you when you are too exhausted, distressed, or preoccupied to absorb vital information. Remember that all pain relief options have their pros and cons, and it's your choice. Here are the most common methods:
- TENS machine - Transcutaneous electrical nerve stimulation which triggers the body's natural painkillers by delivering small electrical pulses to the body via electrodes placed on the skin;
- Gas and air (Entonox) - a mixture of oxygen and nitrous oxide breathed through a mouthpiece that will help take the edge off your contractions;
- Pethidine/diamorphine - strong pain-relieving drugs which are injected;
- Epidural - local anaesthetic that provides total pain relief and is injected into the space between the woman's vertebrae;
- Spinal block - this is very similar and as effective as an epidural, but works faster. The downside is that it cannot be 'topped up'.
Many hospitals now have birth pools as water is believed to ease labour pain and give your baby a gentler welcome into the world. Hospitals normally only have one or two, so when you arrive at the hospital tell someone as soon as possible that you would like to use one. Provided that you've had an uncomplicated pregnancy and labour is progressing naturally, you should be able to go ahead with a planned water birth at hospital, a birth centre, or at home.
Cuts and tears
An episiotomy - where a cut is made in the skin and muscle between the vagina and the anus - is sometimes necessary after a phase of pushing has not delivered your baby. A local anaesthetic is usually administered to numb the birth canal (not necessary if you've had an epidural) so you shouldn't feel any pain. Intervention such as an episiotomy is less likely during water births, but is still possible. Sometimes the birth canal can tear slightly during birth - it will either be allowed to heal naturally or repaired afterwards. Stitches will be carried out by your midwife or a doctor immediately after birth (the anaesthetic will still be in effect) and dissolve a few days after you return home, so do not need to be removed.
Forceps and ventouse (assisted delivery)
If the baby is becoming distressed or in an awkward position, the contractions aren't strong enough or you're exhausted, forceps - or vacuum suction - sometimes called 'ventouse', can be used to provide gentle but controlled pulling. Almost always, an episiotomy is needed to widen the birth canal and then either the doctor places the forceps around the baby's head or, with vacuum delivery, a shallow cap is fitted to the baby's head by suction. You can help by pushing when the obstetrician and midwife tell you - just a few more pushes should get the baby out. Either method can leave red marks or swelling on your baby's head, but these will soon fade.
Caesarean section (C-section)
Contrary to popular belief, a C-section is not for women who are 'too posh to push', but major surgery that's only performed where there's a real clinical need. It's either 'elective' (planned in advance if normal delivery is judged to be dangerous) or 'emergency' (if complications develop). Usually C-sections are done under epidural - you won't feel pain, just tugging sensations. A screen will shield your view but the doctor will talk you through the process. The baby is delivered by cutting through the abdomen and into the womb and surgery usually takes 30-40 minutes. The cut is usually made below the bikini line and is hidden when your pubic hair grows back. You'll need extra help when you return home and shouldn't lift anything heavy or drive a car for six weeks.
Written by Liz Nicholls
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