Written by Caroline Meyer
You have probably heard tales of the perfect births that you feel you could never live up to. You will probably have heard some horror stories where everything went wrong. When it comes to labour and delivery, especially the first time around it can seem quite scary and you may become quite anxious. Knowing what to expect and reducing the unknowns as much as possible can make you feel calmer and less stressed when preparing for the big day. We answer a few common questions to help you on the way.
How likely is it that you would need a Caesarean section? First time mums that are not carrying multiple babies and who go into spontaneous labour on have around a 15% risk of needing a C-section. The risk is higher for multiples, premature babies or when labour is induced. This can be as high as a 1 in 3 chance of needing a C-section under these circumstances on average. If you have a doula, your chances of a C-section are reduced by 40%. Doulas are able to help you change positions, offer back massages for the pain and generally support you throughout the delivery. They will be there through the entire birth and this seems to improve the chances of a natural vaginal birth. They are experienced and can advocate for you from a position of knowledge. You can actually hire a doula to assist throughout your pregnancy, which helps when it comes to the birth as you will feel comfortable with the person. If you doctor wants to schedule a Caesarean, you are within your rights to ask if it is possible to try for a normal labour and delivery first as long as there is no increased risk of harm to you or your baby. Even during delivery, when a C-section is offered, there may be other alternatives to try such as changing position or allowing the labour to continue a little longer before a C-section becomes the only alternative. If a C-section becomes necessary during labour, a consent form can be signed and the procedure can be done almost immediately and be over within an hour or so.
How painful is it going to be? A lot depends on your pain threshold, but yes, labour does hurt. There are medications that can be offered to make it less painful but even if you choose not to use these, the worst part is over quickly and you have the reward of your new little addition to the family. Labour pain is not for nothing. It helps us move and change position in order to progress the birth. Most women handle the early stages of delivery fairly easily and pain is akin to backache or period pains and is for the most part bearable. The transition period usually lasts from 1 to 3 hours and this is when the going can get a little rough. This is followed by actively pushing, which is usually over quite quick. Then there is the euphoria afterwards when your baby is in the world and the pain is already fading from your mind. If you have major concerns about handling the pain, you can speak to your doctor about a pain management plan during labour that can include medications such as an epidural to help you through it. There are also alternatives such as using a TENS unit for pain. It has also been found that practising Yoga during your pregnancy helps reduce pain through breathing exercises, relaxation techniques and being able to move your body to reduce some of the discomfort. You can attend birthing classes during the last trimester as well as a way to gain knowledge and prepare you for labour and birth. They also teach breathing techniques, position changes and other ways of reducing the pain or being able to tolerate it better.
What if the baby gets stuck? How big baby is or if you have wide hips doesn’t seem to have as much of an impact on the progression of labour as you would think. Quite often, its baby lying in an awkward position or the head being titled in a strange way. If this happens and baby is passing through the birth canal the way he should, a C-section will be done. There are ways to reduce the risk of baby being in an awkward position and not moving down the canal properly. Stay upright and mobile as much as possible during the labour. If you have a birthing ball, you can try swivelling on the ball or use it to make back and forth and side-to-side rocking motions. You can also rotate your pelvis while standing (have your partner there to support you while you do this) and practise hip circles similar to a belly-dancer move. Swaying side to side and rotating your body helps make more room for the baby to move into position and down the birth canal. If your delivery is not progressing the way it should and baby is close to crowning, your doctor may use alternate methods such as vacuum extraction or forceps to help bring baby out. If baby is further up and these methods are not possible, a Caesarean will be recommended. If you are concerned, speak to your doctor before delivery so you are aware of what these procedures entail.
What if I have to be cut or I tear during delivery? Episiotomy (a cut in the perineum) is usually done to prevent serious tearing and is done in around 12% of natural births. Smaller tears may happen during the birth. You doctor will put in stitches after the birth. These heal naturally in a few weeks after birth. To avoid tearing, you can try perineum stretching exercises during pregnancy. During labour you can try upright positions or lying on your side when giving birth to reduce the risk of tears. Some places will have squat bars that can be used during birth so that you can remain upright. Even if you have had an epidural it is possible to use these. You can ask for a warm compress to be placed on the perineum before birth to help the area become more elastic and able to stretch better without tearing. After a tear in this area, it may tingle and itch a bit while it heals and the area could feel a bit tight. Oestrogen cream may be prescribed to help the area heal faster. You can sit in a bath daily to help make it feel less tight and itchy. By 6 weeks the wound should be completely healed. If you have any concerns during the healing process you need to speak to your doctor especially if it is extremely painful, inflamed or not healing normally.
What if I don’t get to the hospital on time? In general, especially in first labours, it takes quite some time from the start of contractions to the actual labour. Most moms get to the hospital long before they need to and may even be sent home. Generally, the rule of thumb is to call your doctor or midwife when your water breaks or the contractions are around 5 minutes apart. Being at the hospital is more stressful than home and can actually cause the labour to take a lot longer. If you go through at the 5-minute contraction mark you are unlikely to give birth in the car. If due to unforeseen circumstances you can’t get there on time and baby is born somewhere outside of the hospital, cut the cord, swaddle baby in something warm and clean the mouth and nostrils for ease of breathing. Make your way to the hospital as quick as you can. Baby is more than likely to be just fine.
What if my labour lasts for days? Early labour can last for days but contractions are very mild, widely spaced and the discomfort level is quite low. Active labour, when the cervix begins to dilate and the contractions are closer together and more intense does not usually last for more than 8 hours. Once your water breaks your doctor is unlikely to allow your labour to continue for more than 24 hours without intervention. Stay active and relax as much as you can during early labour. The intense part will go quicker and be over before you know it.