Labour and Birth

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:

• Have previously experienced preterm labour
• Are having more than one baby (multiple births)
• Have a short period between pregnancies (less than 6 months between birth of baby and beginning of next pregnancy)
• Are smokers
• Have high blood pressure (related to preexisting health conditions or stress)
• Are underweight
• Are not getting enough healthy food
• Have a vaginal or bladder infection
• Have had a previous loss

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 they are at risk 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 are between the 20th and 37th week of your pregnancy, and you experience any of the symptoms listed above, go to the hospital right away. If you can't get to the hospital right away, call the birthing unit for information.

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?

• Eating Well with Canada's Food Guide 
• If you smoke, find support with quitting or reducing the amount you smoke
• Have an alcohol-free pregnancy 
• Gain a healthy amount of weight in pregnancy 
  
• Reduce stress and get enough sleep 
• Start prenatal care early in pregnancy
• Learn about the signs of preterm labour and what to do if it happens

Labour is not easier with a low birth weight baby. If you are worried or need help, speak with your health care provider.

You may become excited or irritable as your due date gets closer. Continue to practice the comfort measures with your labour support person. Here are some 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 (preferably your left side) 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 starts. 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 practice relaxation and breathing techniques daily
• Take a daily walk (unless your health care provider has advised to limit your physical activity)
• Rest as much as you can

Things you can do as a partner

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

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 manage 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 different methods to help deal with pain. Practice the different methods together before the baby is born. Learn how to help her relax and breathe in pattern.

Your birth plan can include:

• Who you want to share the baby's birth with:
  • your partner
  • other support people - friend/family
  • a doula - a professional support person
• How you wish to manage your labour pain (non pharmaceutical and pharmaceutical options).
• Your labour and birth preferences:
  • To have your partner/labour support person with you for any necessary procedures
  • To be able to move around/walk during labour
  • To have pictures or video of the labour and birth
  • Your desired positions for birthing
  • Having dim lights and/or quiet room

  • Seeing your baby being born

  • Helping deliver your baby

  • Having early skin-to-skin contact with your baby for as long as possible

  • Donating your baby's cord blood to Canadian Blood Services' Cord Blood Bank

  • Having some family time once baby is born

  • Receiving support with breastfeeding within first 30 minutes after baby's birth

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 manage pain in labour. You can try:

• relaxation and breathing techniques
• massage (hand, foot and back)
• different labouring positions
• 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
• using a focal point
• visualization - painting a picture in your mind of a soothing place and focusing on it
• double hip squeeze
• TENS

When those techniques no longer work, you also have the choice to use pain medications. If you have any questions, speak to your health care provider about what options will be available.

Pharmaceutical pain management options:

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

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.