CHILD BIRTH

Recognising Labour

It is important to recognise the signs of labour so that you will know when you are experiencing the “real thing.”

If this is your first baby, you will most likely experience lightening (the descent of the baby’s head into your pelvis) sooner than women who have already had other children.

Typically, the signs of labour include

  • Uterine contractions,

  • Tightening of your stomach, and

  • Cramps in your low back.

About two thirds of women experience these tightening before their waters break. About one third will notice fluid leaking out first.

If you are unsure about what is happening, don’t forget that the Mater Mothers’ Private Midwives are available 24 hours a day on 3163 7000 to answer any questions.

Types of Labour

Preterm Labour

Preterm labour is said to have occurred when you have strong contractions before 37 weeks of your pregnancy whereas the gestation period normally is 38 to 40 weeks. A baby, if born prematurely, will be at risk of complications such as immature lungs, respiratory distress, and problems in digestion as the organ systems would not have developed completely to support survival.

Dr Alexander will manage this situation with medications that stop labour or prevent infection. Also, medications that accelerate the baby's lung development may be given. You will be advised to take bed rest, usually lying on the left side.

Health problems of Preterm Labour

The longer the baby is in the mother's womb, the more likely he or she will be healthy. Early preterm babies may have respiratory and digestive problems. They are also at a higher risk of brain and related neurological complications.

Treatment for Preterm Labour

Treatment is provided in the form of medications. Corticosteroid injections are given to speed the development of your baby's lungs and other organs. A delivery date can be extended by 2 to 7 days with drugs called tocolytics that work to slow or stop contractions of the uterus. The extra time gained can be used to take corticosteroids or to get to a hospital specialising in preterm care for babies.

Women at Risk

Some women deliver an early premature baby for no apparent reason. However, certain factors may increase a woman's risk of early preterm birth. Some of them include lifestyle risks (for example: smoking, drinking), a woman pregnant with multiples, chronic illnesses and a short time between pregnancies.

Prolonged labour

Some women most often during their first pregnancy may go through a labour that lasts for too long. Prolonged labour may lead to infection in case the amniotic sac has ruptured. Anti-infective medications may be administered to prevent infection.

Abnormal Presentation

During labour, normally the baby moves to a head-down position with back of the head ready to enter the pelvis. Sometimes, the baby may present with buttocks or feet first towards the birth canal. This is called breech presentation. In some conditions, the placenta may block the cervix (placenta praevia) and cause abnormal presentation.

Abnormal presentation increases the risk of injuries to the uterus or birth canal as well as the foetus. Breech presentation may lead to a prolapsed umbilical cord that might cut off the blood supply to the foetus. Dr Alexander will check the presentation and position of the baby with physical examination and ultrasound scan. Assisted delivery methods may be adopted in such cases.

Premature Rupture of Membranes

Rupture of the membranes that surround the foetus in the uterus may occur prematurely leading to high risk of infection. In these cases, immediate delivery of the foetus will be done.

Umbilical Cord Prolapse

The umbilical cord, which transports oxygen and nutrition to the baby, may slip into the cervix before the baby during labour. The cord may be felt if it protrudes from the vagina. This is an emergency situation as the blood flow to the baby through the umbilical cord may get obstructed. Seek immediate attention of Dr Alexander.

Umbilical Cord Compression

The umbilical cord may get entangled and wrap around the baby several times during pregnancy, but sometimes during labour, the cord may get compressed leading to decreased blood flow to the foetus. This causes abrupt drop in the foetal heart rate. In cases where the foetal heart rate has worsened or there are signs of distress, Dr Alexander may consider a Caesarean section.

Amniotic Fluid Embolism

Amniotic fluid embolism occurs when a little amount of amniotic fluid from the amniotic sac gains entry into your bloodstream during a difficult labour. This fluid may travel up to the lungs and cause constriction of the lung arteries leading to a rapid heart rate, irregular heart rhythm, cardiac arrest and death. Blood clot formation throughout the body is a common complication and requires immediate care.

Child Birth Choice

Dr Alexander respects a woman’s right to choose the method of her delivery. If you wish to aim for a vaginal birth then he will support you fully in this choice. Similarly, if you choose to have an elective Caesarean Section he will also support you your choice.

Delivery SuitEs at Mater Mothers’ Hospital

Dr Alexander has chosen to deliver babies at the Mater Mothers’ Private Hospital because he feels that the Mater Mothers’ offer a safe environment for both Mother and Baby.

If all is going well then you should be able to experience labour the way you wish.

You can have a very “low-tech” birth if you wish, knowing that all the best equipment, services and staff are immediately available,

if required. Mater Mothers’ hospitals have operating theatres close by, Anaesthetists on standby and Paediatrician available.

Mater Mothers’ Hospital is considered a tertiary hospital and therefore has a Level 3 (the highest level) Intensive Care Nursery, if required.

Childbirth Pain

One of the things you may be most concerned with is the amount of pain you may experience during labour.

Childbirth is different for all women, and no one can predict how much pain you will have.

During the labour process, your midwife or Dr Alexander will ask you if you need pain relief, and will help you decide what option is the best for you.

Your options may include

  • A local or intravenous analgesic (pain relieving drug),

  • An epidural (injection which blocks pain in the lower part of your body),

  • Spinal anaesthesia (used when the delivery will require forceps), or

  • A Pudendal block (numbs the vulva, vagina and anus during the second stage of labour and during delivery).

After your due date has Passed

Your due date is an estimate of the date of delivery and determined based on the date of your last period. Your physician uses this date to assess the progress of your pregnancy and baby's growth in the womb.

The due date may be confirmed or updated after ultrasound is performed between 18 and 20 weeks of pregnancy. Usually the due date is 40 weeks after the first day of your last period with most babies arriving between 37 and 41 weeks.

A post-term pregnancy is described as lasting 42 weeks or more.

Risks related to Post-Term Pregnancy

When a pregnancy exceeds 42 weeks, there is a small risk of the baby being stillborn.

The causes for such deaths have not been established with certainty but probable reasons include reduced efficiency of placenta (tissue that provides nourishment to the foetus) and a decrease in amniotic fluid levels. Other risks to the baby include meconium aspiration, neonatal acidemia, low Apgar scores, macrosomia (excess birth weight) which can lead to birth injury.

Tests associated with post-term pregnancies

The health of a baby not born by the due date is determined with the help of a few tests. The expecting mother herself can do certain tests, such as a ‘kick count’. This test is a record of how often the mother feels the baby moving.

Other tests such as electronic foetal monitoring involve measuring foetal heart rate and strength of uterine contractions by placing instruments under belts wrapped around the mother's abdomen.

Inducing labour

Most hospitals suggest inducing labour (causing a pregnant woman's cervix to open and to prepare for vaginal birth) at maximum 40 weeks plus 10 days

Prostaglandins (naturally occurring fatty acids) and/or special devices are used to soften and dilate the cervix, following that rupturing the amniotic sac to release the fluid, and an intravenous Syntocinon hormone is then used to initiate and maintain the contractions of the uterus.

 

C-Section (Caesarean Section)

Preparing for Surgery

You would have discussed with Dr Alexander the date and time of the procedure.

Dr Alexander will discuss with you any special preparations if needed depending on the course of your pregnancy.

You will also be reminded to refrain from eating or drinking for eight before your surgery.

Checking into the Hospital

Present to the Mater Mothers Hospital 5th floor reception desk the morning of your surgery, usually two hours before the operation time.

Once you’ve arrived at the hospital, you’ll

  • Check in, admitted and be shown to your room,

  • Change into a hospital gown

Once in your ready you will be

  • Assessed by the midwife including physical assessment (checking vital signs and reviewing your medical history),

  • The hairline 3 cm above pubic bone might be shaved down.

The C-Section Procedure

When the time comes, a nurse will bring you and your partner to the operating complex.

You will meet your

  • Midwife

  • Paediatrician, and

  • Anaesthetist

The Anaesthetist will discuss your options for anaesthesia.

After an anaesthetic is administered, you will

  • Lie down on an operating table and

  • a catheter will be inserted to drain urine during your C-section and until you can attend to your own bathroom needs.

Dr Alexander or attending nurse will then set up a curtain above your chest to separate you from your surgical team (giving you both some privacy during your operation).

Your arms may be secured to keep you from accidentally reaching into the sterile surgical area.

If you have regional anaesthesia (epidural or spinal), the method generally preferred by doctors and hospitals, you’ll be awake during the operation.

You won’t feel pain, but if you’ve had an epidural, you will probably feel pressure and pulling throughout the procedure.

Your Partner During C-Section

Your partner is allowed to sit at your side during your operation; he will be given hospital scrubs to wear during your surgery. You should be able to talk to your partner and Dr Alexander during the procedure

During the operation, your partner will be prohibited from videotaping, however still photos are allowed.

Moments after your C-Section Delivery

Once your baby is born, the paediatrician in the same operating room will examine him or her and that takes 5-10 minutes.

The baby then is brought to your arms until the procedure is finished. You will then be moved to a post-op recovery room where you’ll be closely monitored, usually for the next one hours.

A lot of what you’ll experience is based on the type of anaesthesia. Women who’ve had general anaesthesia will feel more groggy and sleepy.

While those who had a spinal or epidural, may be experiencing “the shakes.” This uncontrollable shivering is harmless and is caused by a combination of the birth process and the medications you received in your spinal or epidural.

If you received morphine through your spinal or epidural towards the end of surgery, you may also have an all-over itchy feeling—a common side effect. There are medicines that will help control the itching, should it become unbearable.

If all is going well, you’ll be moved to your hospital room.

Your First Day After Caesarean Section

Nurses will still closely monitor you. Throughout your first day after delivery, you can expect checks of your vital signs, your incision, and your vaginal discharge.

Your nurse will check the amount of urine you’re passing and will use a stethoscope to listen for bowel sounds. Your nurse will also assess your pain and help with pain management.

You can have water after 4 hours, and if you feel well and nauseous will be allowed to have free fluids after 6 hours, and diet as tolerated the day after.

The bladder catheter will stay for at least 12 hours, that is usually removed the second morning after the procedure and you will have what we call Trial Of Void.

The nurse will measure the volume of urine that is left in the bladder after you urinate. That practice was put in place to insure the proper functioning of the bladder after spinal or epidural anaesthesia.

Breastfeeding After a Caesarean Section

If you had a Caesarean due to a complicated pregnancy or delivery, or if you or your newborn is ill, it may take longer to begin nursing,

If you and baby are both feeling well, you may have started nursing in the recovery room. Expect to need help with breastfeeding, especially at first.

Your hospital’s lactation nurse can help you. Always remember that there are many techniques and many opinions. Do not get confused, you might need to try all and settle on one that suits best your baby and yourself.

Your Second Day After Caesarean Section On Your Feet

You’ll probably be free of the catheter on your second day after delivery. And if you are feeling well enough, you’ll begin eating and drinking again.

Around this time, your nurse may also help you take those first post-op steps and will help you have a shower, you will also be visited by a physiotherapist who will teach you a few bracing techniques, and exercises.

Dr Alexander will come to check on you the second day, you will also be able to to discuss any concerns you may have. The paediatrician will also come to check on the baby.

Your Recovery After C-Section

Pain control usually, oral medicine, is ordered for you by Dr Alexander and the Anaesthetist. Some are given regularly and some as required.

Take your pain relief, and keep on top of it. Use your hospital stay to recover,

Having a pillow on hand can help tremendously during these days after surgery. Press it gently against your belly to help soften pain when walking or sneezing, and tuck it behind your back to help you feel more comfortable when sitting.

Risks With Caesarean Section Delivery

Though planned Caesareans aren’t foolproof, it can be reassuring to know that, for the most part, you have the ability to prepare for one of the most exciting events in your life.

Armed with knowledge, many mothers find that delivering via C-section is less stressful than they expected. With a good birth plan and open communication between Dr Alexander and your birthing team, you’ll be able to fully enjoy the birth of your child.

Your New Baby after Caesarean Section

Your stay post procedure is also a time to get to know your baby and gain confidence in preparation to discharge home.

Going Home After C-Section

You will be going home from the hospital on Day 5 if all is good. The first week or two you are home don’t push yourself.

You can also ease your recovery by continuing to be gently active and remembering not to lift anything heavier than your newborn.

Try to have sleep whenever you can, you and your partner should take “shifts”, when you feel tired frustrated and “nothing working” take a break and have couple of hours sleep. With each day that goes by in the first two weeks, you typically feel a little better.”