Labour and Birth

Labour and Birth 

 

Preterm labour

What is preterm labour?

A normal or "term" pregnancy lasts 37-42 weeks. In labour, there are contractions of the uterus. This causes the cervix to open. Preterm labour is labour that starts before 37 weeks of pregnancy.

Who is at risk for preterm labour?

Preterm labour can happen in any pregnancy, even if you are healthy. Medical experts do not know all the causes of preterm labour. It is very important for pregnant women and their partners to know how to tell if they are in preterm labour. They should also learn what to do if it happens. Women who may be at higher risk of having preterm labour are those who:

  • Are having their first baby
  • Have had a baby born too soon before
  • Are having more than one baby, (multiple births)
  • Are smokers
  • Are underweight
  • Are not getting enough healthy food
  • Have a lot of stress in their life
  • Have a vaginal or bladder infection
  • Have had a previous abortion

What are the risks for my baby?

Preterm labour may lead to your baby being born too soon. The earlier your baby is born, the more at risk they are for long-term health problems. Some babies who are born very early may not be strong enough to live.

What are the signs of preterm labour?

These signs may be new or different from what you have already been feeling. Here are important signs to watch for:

  • A sudden gush or a constant slow leak of fluid from the vagina
  • Bleeding from the vagina
  • Contractions of the uterus or a change in what you normally feel
  • Low dull back ache
  • Pelvic pressure (feeling full or heavy "down below")
  • Increase in discharge from the vagina

You may just feel that "something is not right".

What to do if you have signs of preterm labour?

If you have any of the above signs after the 20th week and before the 37th week of pregnancy, go to the hospital right away. If you can't get to the hospital right away, call the birthing unit for information.

Low Birth Weight

What is low birth weight (LBW)?

Low birth weight (LBW) is when a baby weighs less than 2500 gm (5 1/2 lbs) at birth. A baby's birth weight is one measure used to assess their health at birth. A healthy birth weight is important. It helps a child fully develop. Babies born with a low birth weight are at higher risk for long term health problems. Those who are very small may need special care.

What are the reasons for LBW?

There are two main reasons why a baby may be born with a low birth weight.

  • Preterm birth. This is when a baby is born before 37 weeks of pregnancy.
  • Fetal growth restriction. This means that a baby does not grow as well as they should before they are born. Some of the reasons this may happen are problems with the placenta, mother's health or birth defects.

What are the risk factors for having a LBW baby?

Some women are at higher risk of having a low birth weight baby. Some of these risk factors are:

  • preterm birth
  • having more than one baby (multiple births)
  • smoking
  • drinking alcohol
  • using street drugs
  • not gaining enough weight during pregnancy
  • mother's age
  • poor nutrition in pregnancy

What will help reduce the risk of LBW?

Labour is not easier with a low birth weight baby. If you are worried or need help, talk to someone you trust.

Last weeks of pregnancy

You may become excited or irritable as your due date gets closer. Continue to practise the comfort measures with your labour support person. Here are some other tips you may find helpful in the last few weeks of pregnancy.

Rest

Try to get at least 8 hours of sleep each night. Also try to take afternoon naps if possible. Your rest might be interrupted by tightening of the uterus or the need to pee more often because of the pressure on your bladder.

Position in bed

Using lots of pillows will help you to get comfortable. Try side lying with a pillow under your stomach and one between your knees. When getting out of bed, roll to one side and push yourself up with your arms.

Protect your mattress

In the last few weeks , you should protect your mattress in case your waters break. One idea is to use a large plastic garbage bag. Cut off the bottom and up one side. Put the garbage bag between the bottom sheet and the mattress.

Meals

You may find it easier to eat small meals more often as you stomach is more cramped. To prevent heartburn, stay away from spicy and greasy food. Follow Canada's Food Guide to be sure you are getting the healthy foods you and your baby need.

Breast care

Wear a good supportive bra for comfort. If your breasts are very heavy, you can wear a light bra for sleeping.

Spurt of energy

You may have a spurt of energy a couple of days before labour star ts. Try to save up this energy for labour and birth.

Your body

" Engagement" or "lightening" is when the baby drops into the pelvis. You may have tightening of the uterus more often and more vaginal discharge. You will have to pee more often and may find it hard to find a comfortable sleeping position. You may also have low backache.

Things you can do

  • Pack a bag for the hospital
  • Continue to practise relaxation and breathing techniques daily
  • Take a daily walk (unless your health care provider has limited your activity)
  • Rest as much as you can

Things you can do as a partner

  • Help with the house cleaning
  • Practise the relaxation and breathing techniques
  • Encourage her to rest
  • Provide distractions
Birth plan

Giving birth is one of life's most special events. It is important that you and your baby feel welcomed and loved.

  • Think about who you would like to have with you at the baby's birth. When choosing, think about your safety, comfort and the kind of support you want.
  • Use a birth plan to write down what is important for you and your labour support person or partner.
  • Talk about your choices with your health care provider.
  • Bring your birth plan to the hospital with you so the staff will know what you would like during your labour.

It is a good idea for you and your labour support person to get ready for labour and birth. Every birth is different and not all women will need or want the same things. Your birth plan will let people helping you know what you want to do to help with your pain in labour. It should be flexible as not all the tools are available at each hospital. Keep an open mind and know that things may not happen as you planned.

The role of the labour support person is to give the mother love and support. This will help make her feel safe and confident. Prepare yourself for a very active role. Talk to each other about what you think the birth will be like. Learn about what happens during labour and birth as well as the tools to help deal with pain. Practise the different tools together before the baby is born. Learn how to help her relax and breathe in pattern.

Your birth plan can include:

I want to share the baby's birth with:

  • my partner
  • other support people - friend/family
  • a doula - a professional support person

Tools to help deal with pain in labour

  • different labour positions (link to positions in labour)
  • movement - walking, pelvic rock
  • birthing ball
  • keeping bladder and gut empty
  • counter pressure - putting pressure on lower back
  • hot packs
  • cold packs/compresses
  • using water - bath, whirlpool, shower
  • massage - hand, foot, back
  • using a focal point
  • visualization - painting a picture in your mind of a soothing place and focusing on it
  • double hip squeeze

Other choices

  • To have my partner/labour support person with me for any procedures I need
  • To be able to move around/walk
  • To have pictures or video done
  • Positions for birth
  • Dim lights, quiet room

Other choices for helping with labour pain

  • TENS
  • narcotics (a kind of pain medicine)
  • nitrous oxide
  • epidural
  • walking epidural

When my baby is born, I would like to:

  • See my baby being born

  • Help deliver my baby

  • Have early skin-to-skin contact with my baby for as long as possible

  • Donate my baby's cord blood to Canadian Blood Services' Cord Blood Bank

  • Have pictures or video tape taken

  • Have some family time once our baby is born

  • Get some help with breastfeeding within first 30 min after baby's birth

  • Wait until we are ready to leave the birthing room before the nurse puts the antibiotic ointment in my baby's eyes

Pain in labour

There are many reasons for pain in labour such as the stretching of the cervix. The pressure the baby puts on your organs as baby moves down the birth canal is another cause. Most women have pain during contractions. Each woman's experience of pain during labour is unique to her. Other factors that may have an effect on how you feel pain during labour are:

  • your past experiences of pain
  • the support you get from those around you
  • fear
  • anxiety
  • tension

There are many things you can do to help deal with pain in labour. You can try relaxation and breathing techniques, massage and different labour positions. Comfort measures have helped many women deal with pain during labour. When those techniques no longer work then you have the choice to use pain medications. If you have any questions, talk to your health care provider.

Stages of labour
The beginning of labour

Lightening

This usually occurs 2 to 4 weeks before labour starts in first time mothers. The top of the uterus falls 3 fingers below the bottom of the breastbone as the baby drops into the pelvis. This will make breathing easier but you will need to run to the washroom more often as there will be more pressure on your bladder.

Show

Mucus builds up at the opening of your cervix during pregnancy. When the cervix starts to get soft and open, this plug of mucus falls out. It may have some blood in it as the pressure of the baby can cause some tiny blood vessels in the cervix to break. It happens a few days or even a few weeks before labour starts. It is not painful.

Rupture of the membranes ("breaking of the waters")

This can feel like a sudden gush or slow trickle of fluid. The amniotic fluid is colourless and odourless. Your bag of water can break early or late in labour. In the last few weeks it is a good idea to carry some pads and a towel in your purse or car in preparation. If you think or know your bag of water has broken, call your health care provider or hospital and follow their instructions.

Contractions

A contraction is when your uterus squeezes and then relaxes. Contractions push the baby down and out of the mother's body.

True labour contractions:

  • Are girdle-like across the lower back and lower abdomen. They can feel like the cramps you have with your period.
  • Get stronger, last longer and come closer together as time passes.
  • Don't go away with mild activity.
  • Cause the cervix to open (dilate) and soften (effacement).

False labour contractions:

  • Are felt in lower abdomen and groin.
  • Don't get stronger, longer or closer together - they stay about the same. They have no pattern.
  • Will lessen with walking or changing positions.
  • Don't cause the cervix to open.

True versus false labour:

  • If you have been active, try to rest or sit down. True contractions will not go away. False labour will get weaker.
  • If you have been sitting or resting, try walking. True labour will increase with activity. False labour will start to go away.
  • Have a warm bath. Warmth increases true contractions. False contractions will fade away.

If you are not sure if you are having true contractions, call the birthing unit at your hospital.

Remember

Contractions, "breaking of the waters" or a change in vaginal discharge that happen before 37 weeks could be preterm labour. Go to the hospital right away if you are in preterm labour.

What you can do in the beginning of labour:

  • Eat
  • Call your health care provider if you have any concerns
  • Continue your normal activities
  • Go to the hospital:

    • When your bag of water breaks
    • When the contractions are 5 minutes apart
    • As per information from your health care provider
  • Use a pad, not a tampon, if your bag of water breaks
Early first stage (latent stage)

What's happening to your body?

  • Cervix effaces (thins) and starts to open to 3 to 4 cm .
  • Contractions are often irregular - 5 to 30 minutes apart and last 20 to 30 seconds.
  • Contractions will get longer, stronger and closer together lasting 40 to 60 seconds.
  • This is the longest stage of labour.

What can you do?

  • Start slow rhythmic breathing during contractions as necessary 
  • Massage your stomach and use pelvic rocking
  • Empty bladder every hour
  • Eat/drink easily available carbohydrates such as toast, popsicles, applesauce, jell-o and plain pasta to keep your energy up.
  • Drink enough liquids
  • Relax between contractions
  • Stay upright as much as possible

What can you do as a partner?

  • Give her attention and encouragement
  • Time and record contractions
  • Help her relax - use touch relaxation
  • Help her with breathing if needed
  • Encourage walking
  • Remind her to empty her bladder
  • Distract her
First stage (active phase)

What's happening to your body?

  • Cervix thins and opens from 5 to 8 cm 
  • Contractions are 2 to 3 minutes apart. They are lasting 40 to 60 seconds.
  • Contractions are more powerful- the pain will be more frequent, stronger and last longer
  • May have back labour which can feel like mild to severe backache
  • This is a shorter stage than the first one

What can you do?

  • Use a slow breathing pattern as long as it works; switch to faster breathing as needed 
  • Use a focal point
  • Use effleurage (light massage)
  • Continue pelvic rocking between contractions
  • Change position frequently
  • Rest between contractions
  • Continue to empty bladder every hour
  • Try comfort measures listed in your birth plan

What can you do as a partner?

  • Give her massages
  • Use a cool cloth on her face
  • Give her ice chips to suck on
  • Remind her to change positions and empty her bladder
  • Encourage her to relax
Late first stage (Transition)

What's happening to your body?

  • Cervix opens from 8 to 10 cm 
  • Very strong contractions lasting 60 to 90 seconds
  • These contractions peak quickly and come 1 to 2 minutes apart with possibly more than one peak
  • Nausea and/or vomiting
  • Increase show
  • Membranes may break if it hasn't happened before now

What can you do?

  • This stage is the hardest but the shortest one 
  • Take one contraction at a time
  • Do light massage on your stomach and inner thigh
  • You may want to wear socks, and cover up in a warm blanket
  • Pant-blow breathing on 3:1 ratio may help
  • Relax between contractions
  • If contraction gets strong quickly, switch to pant-breathing right away
  • Don't hold your breath
  • Don't push until cervix is opened all the way

What can you do as a partner?

  • Don't leave her
  • Tell her that labour is almost over and baby is coming
  • Breathe with her
  • Wipe her forehead with a wet cloth
  • Stay calm and positive
  • Rub her back or put pressure on it
  • Help her relax between contractions
  • Call the nurse if she says she feels the need to push
Second stage

What's happening to your body?

  • Cervix is completely open 
  • Contractions may stop for a period of time
  • Baby is pushed through birth canal. Can see top of baby's head at opening of vagina.
  • Contractions last about 60 to 75 seconds and come every 3 to 5 minutes
  • Contractions may feel less strong than in the transition period
  • Rarely, but when necessary, health care provider will do an episiotomy. A small cut done to make the opening of the birth canal bigger.
  • Delivery of baby's head, then shoulders followed by the rest of baby
  • Baby is born

What can you do?

  • Wait until health care provider says you can push. You may have to wait until you feel the need to push, that your cervix is fully opened and your baby is in the right position.
  • Wait for the contractions to start again before starting to push
  • Get into a comfortable pushing position
  • Push only when you feel the contractions
  • Relax the muscles of the perineum
  • Relax between contractions
  • Pant or blow as the head is delivered

What can you do as a partner?

  • Help her get into a position for pushing
  • Count to help her when she is pushing during contractions
  • Remind her to pant or blow as head is delivered
  • Remind her to relax
  • Remind her to keep her eyes open to see baby's birth
Third stage

What's happening to your body?

  • Delivery of the placenta 
  • A few contractions are usually needed to deliver the placenta
  • Oxytocin given to control any bleeding
  • Mother is covered with warm blankets

What can you do?

  • Push with contractions when told to for delivery of the placenta 
  • Get to know your baby - hold and soothe them
  • Breastfeed your baby

What can you do as a partner?

  • Share in the joy of your new baby
  • Help mother put baby skin-to-skin. If she can't, you can hold baby skin-to-skin on your chest
Fourth stage (bonding and recovery)

What's happening to your body?

Mother

  • Repair of episiotomy or tear as necessary 

Baby

  • Your baby has a head to toe exam 
  • Baby gets weighed. Baby, mother and partner get name tags.
  • Nurse puts antibiotic ointment in baby's eyes and gives an injection of vitamin K in baby's thigh

What can you do?

  • Undress, touch, breastfeed and talk to baby 
  • Make eye contact with baby
  • Start breastfeeding as soon as possible
  • Can ask to wait until they leave the birthing room before the nurse puts the antibiotic ointment in baby's eyes
  • Eat and drink

What can you do as a partner?

  • Share some bonding time with your baby and partner
  • Continue skin-to-skin
  • Help your partner start breastfeeding
  • Take pictures
  • Share the news - make phone calls
Positions for labour

Using different labour positions is a way to help decrease pain in labour. Here are some positions to try:

Walking, standing, and leaning:

  • Helps stimulate contractions .
  • Uses gravity to help baby 's descent.

Kneeling:

  • Helps decrease back pain .
  • Helps baby turn to a better position: occiput anterior (OA).
  • Helps with hemorrhoids.

Sitting:

  • Uses gravity to help baby 's descent.
  • Gives you the chance to rest between contractions.

Squatting:

  • Uses gravity to help baby 's descent.
  • Opens pelvis to make more room.

 

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