Your Care and Support During Labour

When you meet the midwife or midwives who are to care for you in labour, they may do some basic checks and preparations.

09:13 09 June 2009

You'll be looked after physically by health professionals when you're in labour, but most women choose to have someone close to them to offer encouragement and emotional support. This article also appears on www.bbc.co.uk/parenting/having_a_baby

Looking after you in the final hours

A lot of the care you get is routine and, like antenatal care (see our feature Antenatal care), aimed at spotting anything unusual, so major problems can be averted.

When you meet the midwife or midwives who are to care for you in labour, they may do some basic checks and preparations.

These might include:

• listening to your baby's heartbeat " this might be done electronically with an electronic fetal monitor, or with a stethoscope, or with a Pinard (fetal stethoscope)
• a vaginal examination, to see how far your cervix has dilated, giving an indication of how far your labour has progressed
• checking your blood pressure.

You'll be asked how often your contractions are coming, and how you are coping with them. These checks may be repeated at intervals throughout your labour.

Monitoring " how it's done

Electronic fetal monitoring (EFM) " keeps a check on your baby's heart rate. Ultrasound waves transmit the heart rate to a machine, via a transducer held against your abdomen, or from a small electrode, clipped onto your baby's scalp. The heart rate appears on the machine, and a paper record of this and your contractions can be printed out. Some fetal monitors allow you to move around, as the signal from the heart rate is sent to the machine via radio waves. A smaller, portable machine called a doppler uses ultrasound for intermittent monitoring. A small transmitter-receiver is placed on your abdomen to pick up the heart and your contractions.

Continuous EFM " is useful if there is a problem, as it allows your carers to see when something might be becoming more serious. Research shows it's less helpful in normal labours, and can lead to unnecessary interventions. Interpreting the monitor is not always cut-and-dried " even the experts differ about what might signify a problem. Talk about what sort of monitoring you would like and if you don't want to fall in with the policy of the maternity unit " which may not be evidence-based " then say so.

Eating and drinking during labour

"...the last thing on your mind will be food..."

You probably won't be hungry when you're in established labour " the last thing on your mind will be food " but earlier on, snacks will help keep your energy levels up for later. Try to drink something all the way through. Some units may have a rule that you shouldn't eat anything at all, but this only makes sense if you know you may need a caesarean with a general anaesthetic (anaesthetic has risks if the stomach is full).

What position for labour?

Most women cope best if they are able to adopt different positions during labour. This might include lying or sitting on a bed, but it could also mean: a supported standing squat, which allows your pelvis to open wide. If your partner's strong enough, he can hold you from behind, under your arms. Practice ahead, so you can see if this is possible and comfortable leaning against the wall, bed, or a beanbag or floor cushions. This allows massage from your partner which can be very helpful, especially if you are having a 'backache' labour, where the pain affects your back rocking on all fours.

Or any other position that helps you... you may find you need the freedom to move from one to the other as labour progresses.

In stitches?

Sometimes, the perineum " the skin between the vagina and the anus " tears while stretching as your baby is born. The midwife may ask if she can cut it to widen the opening. You will also be cut if forceps are required to assist in the birth of your baby. A cut here is called an episiotomy. There are two schools of thought on episiotomy versus tearing. Some experts claim it's better to elect for an episiotomy as it's a controlled cut, while others saying tearing is preferable as the healing time is quicker.

The three types of episiotomy are:

The midline episiotomy is best avoided because of the risk of the the cut running into your anus.

Either way, if you have a large tear or an episiotomy, you will need to be stitched after the birth. You'll have a local anaesthetic for this.The stitches dissolve by themselves as you heal, but it's advisable to bathe as much as possible to avoid infection once you have been stitched. If you notice a strong smell in the stitched area, notify your doctor or midwife immediately.

Hello baby!

Immediately after the birth, your baby may look a little bit different from how you imagined him when you were pregnant. He may have vernix on his skin, which is an oily cream substance, and he may have a bit of your blood on his head and body. His head may temporarily be slightly mis-shapens " this is because the soft bones of the skull move a little as he's born.

What birth companions can do:

• show encouragement and support with words and gestures
• help you express what you want to midwives and doctors
• suggest different ways of positioning you, to stay comfortable offer drinks or snacks
• cool down your chest and face with a sponge or cloth
• remind you of breathing or relaxation techniques you've learned
• massage your back, shoulders, legs
• time the contractions, so you'll be able to tell how it's coming along
• warm your hands, feet and legs if you get cold
• put up with you being cross and irritated and the whole damn thing!

Take a look at our feature Dads: birth for more information.

Who else is with you during labour?

It's often assumed you will have your partner with you in labour, but it doesn't have to be that way.

If you don't have a partner, or not one that's around, or if you or they prefer it that way, you can have someone else. Or you could have your partner plus another " a close friend, a relative, an antenatal teacher or a doula (someone trained in labour support).

Whoever you choose needs to be special

You need to be comfortable that you can say anything to them, and be comfortable knowing all parts of your body may be on display! They also need to be able to stay calm and unruffled.

"I don't remember much about when things got difficult, but I'm told I got pretty nasty!"

"I found it great to have my sister with me " she just kept holding my hand, speaking softly to me, and it was wonderful to share the moment of birth with someone who loved my baby almost like I do."