Labour and Delivery

Labour

Labour is defined as regular coordinated contractions that cause your cervix to dilate.

When to Contact the Hospital

When you have contractions which become stronger and more regular – every 10 minutes, then you should phone Norwest Hospital Birth Unit (Tel: 02 888 28591) or the San Hospital Labour Ward (Tel: 02 947 9561). Contractions initially are often felt as low abdominal cramps similar to period pains, perhaps with backache.

Some women (about 10%) experience rupture of their membranes before the onset of labour. This can occur quite dramatically or as a small leak. If you suspect your membranes have ruptured you should phone Norwest Birth Unit or the San Labour Ward.

Labour is usually heralded by mucous streaked with blood from the vagina which is called a “show”. If this happens you should phone the San Labour Ward or Norwest Birth Unit.

If you have bleeding more than usual then please phone Norwest Birth Unit or the San Labour Ward immediately.

Your Care in Labour

san labour wardYou can do a virtual tour of Norwest and the San Hospital including the Birth Unit /Labour Ward in the photo gallery of our Facebook site.

When you arrive in labour a midwife on duty will be assigned to you to support you and your baby while you are in labour.

This midwife will advise me of your admission. your progress in labour, the wellbeing of you and your baby and of any significant developments as appropriate. There is no need for you to contact me directly when you go into labour.

Your assigned midwife will advise me about developments in your labour and when I am needed.  I will  attend as soon as possible if there is there is any significant problem in labour. I will attend when your delivery is imminent. If possible I will attend while you are in labour, even when there are no problems.

Unfortunately while it is  not possible for me to be with you during all of your labour, I am personally responsible for your care and the wellbeing of you and your baby. The midwife looking after you is highly skilled and experienced. She is a trained registered nurse with extra training in midwifery. As well she will be keeping me informed. So don’t worry!

Birthing Positions

I plan to keep your delivery as natural as possible.

If all is progressing well you can adopt whatever labour and birthing positions you find more preferable. I do not have strict views about birthing position. You will find some positions are more effective for pushing in second stage than others.

As well the use of drapes will be kept to a minimum.

Your baby will be delivered on to your abdomen when possible with consideration of your birthing position. Also this may not be possible if there is concern about your baby’s wellbeing at birth or there is an unusually short umbilical cord.

Pain Relief in Labour

Norwest Labour ward_thumbYou choose.

All popular modern methods of pain relief are available in labour. These include the gas (Nitrous Oxide and Oxygen mix), Pethidine injection and an epidural block. A booklet on epidurals is available.

You should wait until you are in labour before deciding your preference. You do not know how you will cope with the pain of labour or how your labour will progress. Keep an open mind. While an epidural usually gives good pain relief it can slow down your progress in labour and can make it harder for you to push your baby out. On the other hand an epidural gives you much more control at delivery and so can reduce the chances of perineal trauma with a normal delivery. If you want to use a TENS machine I have no objections. Some patients find calm birth classes, meditation therapy, self-hypnosis, relaxation techniques or accupuncture helpful.

See also Am I more likely to have a Caesarean section if I have an epidural for my labour? in the blog section

 

Fetal Monitoring in Labour

There will be an initial electronic fetal heart tracing at the onset of labour to assess your baby’s wellbeing. This is a routine hospital procedure.

This monitoring can be discontinued and there will be intermittent monitoring of the fetal heart in labour as long as there is normal progress in an uncomplicated labour.

If you have a high risk pregnancy, if there are concerns about your baby’s wellbeing, if you have had a previous Caesarean section, if you have an epidural for pain relief in labour or if there other significant complications then there will be indications for continuous electronic fetal heart rate monitoring. Even if continuous fetal monitoring is necessary, where possible we encourage you to be ambulatory and as active as possible in your labour.

 

Induction of Labour

Sometimes there are very good reasons why your labour should be induced. These can include concerns about the risks of you going significantly overdue, concerns about your baby’s or your wellbeing, concerns about your baby’s size being to big for your birth canal, etc.

Some inductions are done for social  – your request. This can be requested because of your husband/partner’s travel, your parents arriving from overseas, religious reasons, you are ‘fed up’ and uncomfortable with being pregnant. I will arrange for you to have a social induction if you request as long as you are more than 37 weeks pregnant and the risk of a “failed induction” is minimal. Your suitabilityto be induced is assessd by a pelvic digital examination. If the pelvic examination findings are such that you are not ready then an attempt at induction is likely to fail and will result in a Caesarean section after hours of trying to get you into labour.

Induction can be with:

  • ARM (artificial rupture of membranes) only – if your cervix is very favourable.
  • ARM and Syntocinon hormone drip – if your cervix is favourable.
  • Prostin gel ripening followed by an ARM and Syntocinon drip – if you cervix is inducible but not favourable for induction. Sometimes you may labour on the Prostin gel and so nothing more is needed.

A common myth is that if you are induced your labour will be more painful. There is no credible evidence to support this view. Another challenge that undermines this assertion is there is so much variation in “natural” labour.  Also it is sometimes said you onset of labour will be quicker if you are induced. Again this is not so unless you are mismanaged or have an unexpected response to the induction prcess. What induction does need is careful assessment of the cervix, etc to decide the best option and careful management.  This is the case for my patients. If the assessment and induction are done by staff who are training or inexperienced or in the public sector then there is likely to be more problems.

See also Induction of Labour in the Questions and Answer section

Syntocinon Augmentation of Labour

This is sometimes necessary because your contactions are suboptimal in strength or frequency or both for you to progress in labour.  The midwife assigned to you can detemine whether you labour is progessing well by internal examinations. If there is lack of progess then she will advise me and we will discuss options which include augmentation. This lack of progess in labour can be a consequence of it being a ‘tight fit’ and the Syntocinon drip can overcome this and increase your chances of having a normal vaginal delivery.

In about 10%  of cases there is spontaneous rupture of membranes (SROM) before you are in labour. If labour does not start after a reasonable time and if you are at least 36 weeks pregnant whne this happens then a Syntocinon drip is indicated to start labour. It is safer for your baby than leavung you for a long time with the risk of ascending infection and umbilical cord prolapse.

See also Rupture of Membranes  in the Questions and Answer section

Delivery

My goal is for you to have a spontaneous normal vaginal delivery.

I will work with you in labour to optimise your chances of achieving this. Sometimes is happens easily and sometimes to achieve this requires very careful management that I can provide you because of my considerable experience and expertise as an obstetrician and having managed the labour and delivery of thousands of women before you.

Your Perineum

I prefer you to have an intact perineum. Failing that my prefernec is a small tear.

We me as your obstetrician it is unlikely that you will need an episiotomy if you have a normal delivery or a vacuum delivery. An episiotomy may be required occasionally to avoid a very large tear. If you need a forceps delivery you will need an episiotomy to avoid a large tear.

See also  Perineal Tearing at Delivery in the Questions and Answer section

Operative Vaginal Delivery

This may be necessary because of developments in second stage such as lack of progress in spite of maternal effort or if there is fetal distress.

I am highly skilled in both the use of the vacuum suction cap and forceps. Many obstetricians do not have this range of skills.

See also Vacuum and Forceps in the Questions and Answer section

Your husband/partner

Your husband/partner is encouraged to stay with you during labour and during the delivery (including operative vaginal delivery and Caesarean section with regional anaesthetic). He is usually your best support person.1025275_612421685449643_820994739_o

He is encouraged to participate in the delivery of his baby unless there is a contraindication, e.g. an urgent vaginal delivery for foetal distress or a Caesarean section. At the very least this will be by him to cut the umbilical cord. I will also invite him to deliver your baby’s body, as long as all is progressing well.

Photos

Make sure your husband/partner brings the camera and that the battery is fully charged! He will also be the photographer on the day, though the midwife is usually keen to help. I allow videos to be taken also.

Other Support People in Labour

This should not be a problem as long as there are not too many!  Your request should be discussed with me and the Labour Ward / Birth Unit staff prior to the day you are admitted for your delivery.

Communication

This is your big day! It is the birth of your baby! We want it to be as pleasant an experience as possible.

Good communication is an essential part of this. I will explain as well as I can and in non-technical terms everything that is happening and your labour management options. The midwife will endeavour to do the same.

If you don’t understand something that is happening or are concerned about something that is happening then please let us know so the matter can be discussed and worked through.

Birth Plan

A formal bith plan is not necessary.

The birth plan concept is far more relevant for pregnant women going through the public system to have their baby where there is no personalised care and where their the staff looking after them in the labour are strangers, who often have their own bias as to how you should be managed, irrespective of your thoughts.

I focus on personalised individual pregnancy care and during the course of the pregnancy. I suggest you ask me questions, advise me of expectatations and plans at your antenatal visits with me so we can work through them.

I can make relevant notes. That means when you are admitted in labour we are both ‘on the same page’ with consideration of you expectations and wishes. It is very easy for me to bring the midwifery staff ‘up to pace’ with what we have discussed.

See also Birth plan – Do I need one? in the Questions and Answer section

 

What is most important?

I believe that mother and baby wellbeing are the most important considerations and should not be compromised.

I want you to have a successful outcome for yourself and your baby with the minimum intervention necessary and for you and your husband/partner to have a memorable and joyful experience. After all childbirth is one of the most important and exciting times of your life!

See also Labour and Delivery in the Questions and Answer section