Birth Expectations Part 2 Analgesia labour and birth

Birth Expectations Part 2 – Analgesia, labour and birth Role of the birth partner 3 stages of labour Positions for labour Monitoring your baby during labour Breathing techniques during labour Pain relief during labour Vaginal tears, episiotomy and sutures

Role of the birth partner Be flexible er h t r po Sup sically phy Listen to her Be co nf encou ident, rag motiv e & ate y& n a p m o Offer c raction t s i d e l t gen Pra ctic al s upp ort Emotional support B ep e ar ed Be er h for Pr re the B ad e an vo ca te

3 Stages of labour 1 st stage of labour Regular contractions, which will encourage the cervix to thin and dilate open to 10 cm dilated. Your waters may go during this stage. 2 nd stage of labour Now your cervix has reached 10 cm dilated, your baby will be making its way down through your birth canal. You may feel the urge to push during this stage, and your contractions will be strong and regular 3 rd stage of labour The placenta will detach from the wall of the uterus and be expelled by the vagina. You may feel the urge to push again during this stage.

1 st stage of labour Before labour you cervix starts around 2 cm in length, hard to touch and closed. During active labour your cervix has shortened in length and started to dilate Second stage, your cervix has completely thinned out and dilated to 10 cm

2 nd stage of labour • Can take up to 3 hours • You will still have regular contractions • Push down into your bottom with your contractions • Blow out candles as the head crowns • In most cases baby is delivered straight onto your chest

3 rd stage of labour Every minute of your pregnancy, 1 pint of blood is pumping into the uterus, exchanging nutrients with the placenta. The placenta can weigh up to 2 pounds The blood of the baby and the mother both pass through the placenta, but NEVER mix Multi functional organ, Lungs – supplies oxygen Kidneys – Filters out waste Gastrointestinal – Delivers nutrients Immune system – delivers antibodies

Positions for labour Standing, supported by a birth partner Laying on your left side Sitting back to front on a chair Supported squatting Sitting on a birth ball Sitting up, wide legs Walking up and down stairs Sitting on a birthing stool Kneeling, supported by a birth ball or bean bag Kneeling

Monitoring your baby during labour Pinard • • Used intermittently Less reliable with a higher BMI Not audible to those in the room More like a vibration than a sound Doppler • CTG machine • • • Continuous throughout labour Required with and epidural Restricts mobilisation Cannot be used in the pool Reviewed every hour by another professional • • Audible to those in the room Non invasive The probe is waterproof so can be used in the pool

Pain relief during labour

Water birth Positives • Increase sense of control • No side effects • Encourages you to relax during labour • Easily manoeuvre into comfortable positions in the water • Safe for you and the baby • Entonox can be used in the pool Negatives • Cost of pool hire if having a home birth • Not available to high risk pregnancies

TENS machine Positives • Reduces the amount of pain signals sent to the brain • Increases endorphins • No side effects • Works instantly • Your in control • No harmful effects to baby Negatives • Not proven to be effective during the active stage of labour • You need to buy / hire your own • Cannot be used in the pool

Entonox Negatives Positives • Acts quickly • Nausea • Encourage you to use good breathing techniques in labour • Dry mouth • Lack of concentration • Sickness • Light headedness • Sleepy • • Wears off quickly No harmful side effects to you or baby

Epidural Negatives Positives • • Most women will experience complete pain relief Patient controlled administration • Can only be administered by an anaesthetist on delivery suite • Continuous fetal monitoring will be required throughout your labour and delivery • Fluids will be in place to counteract the drop in blood pressure caused by the epidural • Will be in situ until after the delivery • Can easily be topped up by an anaesthetist • Can prolong the 2 nd stage of labour • Encourage you to relax during your contractions as they wont feel as painful • Increase the chance of instrumental delivery being required • A urinary catheter will be required throughout labour

Pethidine Positives • Administered via an injection into either your upper arm, thigh or buttocks • Effects will last 2 – 4 hours • Effects can be felt as soon as 20 minutes post injection • Can help you to relax during the contractions Negatives • Associated with nausea, vomiting & drowsiness • Pethidine is an opiate drug and can cross the placenta to baby • Not administered towards the end of the 1 st stage of labour or in the 2 nd stage of labour

Vaginal Tears Tear to the perineal skin, through the muscle and into the anal sphincter Requires suturing in theatre by a doctor Tear to the perineal skin Doesn’t normally require suturing 1 st Degree Tear 2 nd Degree Tear 3 rd Degree Tear 4 th Degree Tear through the perineal skin and into the muscle Requires suturing by a midwife in the room Less than 2% of women nationally experience this degree of tear Tear through the perineal skin, muscle and the anal sphincter and into the rectum Requires suturing in theatre by a doctor Less than 2 % of women nationally experience this degree of tear

Episiotomy and sutures Coventry Community Office – 02476 967 424 (Available Monday – Friday 9 am – 5 pm) Rugby Community Office – 01788 663 184 (Available Monday – Friday 9 am – 5 pm)

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