Exciting, frightening, wonderful and shocking. These are all of the words that spring to mind when we think about labour and the impending birth of our child. You may have read everything you can get your hands on about labour and birth and feel totally prepared; you may have not wanted to read anything, preferring to just see what happens. You may be hoping for a drug free, candle-lit water birth with Norah Jones singing in the background of the labour suite, but you may end up with a shot of penthdine in your backside and an emergency ceasarean section. Scotmum member, Libby said that she "didn't really have a birth plan and had a very open mind to any intervention needed. I had low platelets so many decisions were out of my control. I had emergency section under general anaesthetic". It is clearly best to be as prepared and flexible as possible since Mother Nature will not always read and stick to your precious birth plan. The best plan is to expect the unexpected. So, what are your labour and birthing options? What kind of birth can you choose? What drugs are available and what happens if you need a bit of help to get the little one out safely?
Where can I have my baby?
The first thing that you need to get clear in your mind is whether you are able or would like to have your baby in your own home, or in a hospital. 1.5% of all births in 2007 were homebirths with the highest rates seen in Argyll and Bute and the Highlands and Islands. If you choose to give birth at home, you will have the services of a professional midwife and/or a doula for the duration of your labour. There are clear advantages to this arrangement in that you may feel more relaxed in your familiar surroundings and will not have to travel to a hospital and stay in a maternity ward once you have given birth. Some health professionals may discourage you from opting for a home birth if it is your first child or you have had some health complications or issues throughout your pregnancy. You will usually only be able to use gas and air in your own home as opposed to the plethora of drugs available in a hospital and you should also be prepared to make your way to a hospital if your labour is not progressing well and you require medical assistance.
The majority of women give birth in their local hospital. You are required to book into a hospital during the first trimester of your pregnancy, however, you should be prepared to travel to an alternative hospital should your original option be full to capacity. Many women opt for a hospital birth because they will have access to immediate pain relief and medical intervention if required. You may also be able to use a birthing pool in the labour suite if one is available (you are unlikely to be able to reserve one, however) and can take along music to listen to.
Once you have given birth you will be taken to a maternity ward where you will stay with your baby until you both have recovered sufficiently from the birth. There are facilities for you to have a shower on your ward and you will be sharing them with up to four other women. Remember that if you have had an epidural you will not be able to stand up, let alone shower or go to the loo for some time whilst the effects wear off. Be aware, also, that the first time you stand up post-birth, you may find that there is a 'gush' of fluid. This surprises most women and can be quite embarassing if it happens suring visiting time, or any other time for that matter! I thought I would add that nugget in so that you can prepare yourself as I wish someone had told me.
What pain relief is available?
TENS machine
TENS stands for Transcutaneous Electrical Nerve Stimulator (TENS machine). TENS machines deliver small electrical pulses to the body via electrodes placed on the skin. This is thought to help ease pain. The machines can be hired from various on line companies or your local chemist. You can use this small machine in the early stages of labour and place the electrodes on your back to help you get through the early contractions. Opinion is divided as to the effectiveness of TENS machines among women since the pain relief the machines offer will vary from person to person.
Gas and Air
Commonly known as laughing gas, this mixture of oxygen and nitrous oxide serves to take the edge off the pain of contractions in early labour. It is available for use at home and in hospitals. A woman in labour is encouraged to suck the gas from a tube when she can feel a contraction beginning. The gas may make women feel very light headed and sometimes nauseous and can only be used for a short period of time.
Diamorphine
Diamorphine and other pain killing drugs such as pethadine and meptazinol are administered with an injection into the muscle of the thigh or buttock. The drugs can sometimes be given into the bloodstream directly for a faster effect. The dose given broadly depends upon body weight. Side effects of these drugs can be drowsiness, nausea and vomitting. They can slow breathing down if you have too much. If given close to the birth of the baby, they can slow down the baby's breathing and make him or her sleepy.
Epidural
A fine needle is placed in the region of the nerves and a single injection of painkiller is made. The fine tube is then placed in the same region so that 'top ups' can be injected. The 'top ups' are a combination of two types of painkiller. The local anaesthetic is weaker than a standard epidural and it is less likely that your legs will feel heavy. Effective pain relief is achieved by the use of a second pain killer in the mixture used for 'top-ups'. In order for the epidural to be effective it must be administered early enough to be able to take effect. The normal dosage of the painkillers used will not make the baby sleepy or slow to breathe at birth as some of the other strong pain relief injections used in labour may do. The epidural may be used in normal births and caesarean sections.
What happens if I need an assisted delivery?
Forceps & Ventouse
Should your baby require a little bit of help to enter the world, forceps may be necessary. It is probably best not to look at them if you are told by your midwife or doctor that they will be used to assist delivery given that they resemble very large metal salad servers. The purpose of the forceps is to cup your baby's head and ease it through the final part of the birth canal. It may be the case that your baby's head will be quite mishapen and red/bruised following the use of forceps, however, such marks soon vanish. Often, you will require an episiotomy which is a surgical cut in the perineum, the muscular area between the vagina and the back passage. This will be stiched following the birth, although you may feel some discomfort as this heals.
The ventouse is very much like a vacuum and attatches to your baby's head to ease delivery. Many doctors prefer to use the ventouse rather than the forceps since it is less painful for you, an episiotomy and tearing of the perineum is less likely.
Caesarean Section
The overall rate of caesarean section in Scotland has risen from 5% in 1970 to 19.7% in 1999. Therefore, approximately 1 in 5 Scottish women have their babies through a section. Babies born by caesarean come out through incisions in your uterus and abdomen. You may be able to opt for a caesarean after discussing your options with your midwife or you may end up with an emergency caesarean if your labour does not progress well. An epidural is most commonly used, however general anaesthetic is sometimes administered in which case the mother is not awake during the birth. A woman that has had a caesarean section is advised not to undertake any heavy lifting or even driving for about 6 weeks post-birth. A caesarean is major abdominal surgery and women should make sure that they give themselves sufficient time to recuperate.
One thing that you should remember if you are approaching the birth of your child is that however uncomfortable & painful labour may be, you soon forget. The bliss of holding your newborn helps to melt away any pain and disappointment regarding the actual birth. Even if your labour is a hideous experience, the fact that you have become a mother will superseed any bad memories. The best advice that I have gleaned from friends and family is to just go with the flow. I did not have a pleasant labour and did not physically recover for some months after my daughter's birth. Once I had gotten over my experience I was able to exchange 'labour stories' with my friends. There is little else that will bring you closer to a friend that a shared labour experience.
