There are so many things to think about when it comes to giving birth. Whether you’re into hypnobirthing and fancy a natural labour or are more of a bring-on-the-drugs kind of mama, it doesn’t matter. Birth is a unique experience. Think about what kind of things would make a difference to you and it can help you plan towards the birth experience you want.
Deciding where to give birth
One of the biggest decisions is where you want to be giving birth. Find out what options are available near you and visit them to get a feel for the place. See where you would be most comfortable being during labour.
Midwife led unit
Midwife led units or birthing centres are run entirely by midwives. One of the advantages of choosing them is that you will usually be looked after in labour by a midwife who you already got to know during your pregnancy. Usually you can stay in the same room throughout your labour. There are often sofas and bean bags. The lighting and decor is designed to create a calm and tranquil atmosphere that is more like a hotel than a hospital. Being in a homely environment should allow you to focus on your body and your baby. The more relaxed you are in labour, the better your experience giving birth usually is, so this environment can make a difference. Pain relief is offered by gas and air and, sometimes pethidine. Many units also have water pools that you can use.
Midwife led units are not set up to offer epidurals, c-sections or any medical interventions. If your labour is not progressing well, or if there is a medical emergency then you would have to transfer to a hospital. So this is also worth keeping in mind when making a decision.
This is the most common choice for women giving birth and the safest place in terms of medical care.
You may feel more comfortable giving birth in hospital, where you know that if there is any need for medical intervention, you are in the right place for swift action. You will be looked after by a midwife during labour. You can also feel safer knowing that obstetricians are on hand if you need any extra help or care. As well as having access to gas and air and pethidine, you can choose to have an epidural to help you cope with labour pains. Some hospitals offer water pools and rooms for active birthing, with lowered beds, sofas and lower lighting. Ask what is available at your local hospital. It’s worth remembering that these rooms are not always available if the maternity ward is very busy. When going to hospital to give birth, you can take in some home comforts to help make your hospital room feel more relaxed. Some ideas are to bring your own pillow, photos for your table and a playlist of your favourite music.
Take a tour
You should be offered a tour of your local maternity ward and delivery rooms as part of your antenatal care. It is worth going along for a visit, wherever you plan to give birth. That way if you end up in hospital for any reason, you are more familiar with the setting and know what to expect.
You may choose to have your baby at home.
Remaining in the comfort of your own home can help you feel relaxed, which is beneficial to a positive birth. Research shows that when women are at home they feel freer to move around in labour. They are more likely to be relaxed and less likely to need medical intervention. There is also a reduced risk of infection for both mum and baby compared to being in hospital. National Institutes of Clinical Excellence (NICE) guidelines in 2014, advise that home births are a safe option for women with straightforward pregnancies who have already had one baby. If you want to give birth at home you can talk to your midwife and she/he will explain how to organise this and be able to talk through what to expect.
For women with low risk pregnancies expecting their first child, NICE advise that with home births there is a ‘small increase in risk to the baby’. The NCT website reviewed the advice and explains:
There may be around four extra adverse outcomes in every 1000 planned home births compared with ones planned in obstetric units.
Every mum-to-be must also be aware that if there are any complications or you need any extra care during your labour then you will be transferred to hospital. The Birthplace Study revealed that:
nearly half of all first-time mums planning a home birth end up giving birth on the labour ward, while around one in ten women who have given birth before are transferred.
Being moved to a hospital in the middle of labour, aside from being inconvenient, can mean that medical treatment is delayed until you reach the hospital. This delay can pose risks to you and to baby and should be considered when deciding which venue is best for you when giving birth.
Deciding on pain relief and your birth experience
There are many things to consider when deciding what kind of pain relief you might choose during labour and what kind of things might help you through the contractions.
Help in early labour at home
Antenatal classes are a great opportunity to talk through and explore all the options for pain relief during labour. Many mums say that a TENS machine helps with the pain of early contractions. You can buy these, otherwise many hospitals and local birthing groups hire them out too. A TENS is a small, battery operated device that uses a mild electrical current to give pain relief. You stick small pads to your skin (usually on the lower back) and when you turn a dial you will feel small electrical currents that feel like a tingling sensation. These can reduce the pain signals going to the brain and can also stimulate endorphins, which are your body’s natural pain killers.
Another labour aid that many mums love is a birthing ball. This is like a large yoga ball and you can sit on it and bounce gently to ease pressure. It can help you find a good upright position, which is more comfortable for you. As well as sitting on your ball, you can lean on it with your arms from a kneeling position on the floor.
If you are a fan of warm baths then the idea of a water birth may appeal to you. You can hire birthing pools if you are planning a home birth. Many hospital and birthing centres also have some available for mums to be to use when giving birth. The warm water of the pool helps relax both your body and mind. Just as a hot bath soothes aching muscles, the warm water can help ease the pain of contractions. The buoyant effect of the water can make it easier to move around in labour too and find a position that feels the most comfortable for you.
There are some instances where you cannot use a birthing pool. If your baby is premature (if you go into labour before 37 weeks), if you have diabetes, epilepsy or high blood pressure it’s not allowed. It’s also not advised if you have a history of complications during pregnancy or previous labours, such as heavy bleeding during pregnancy and after birth. If you are overweight or have mobility issues, which may make it hard for you to get out of the pool quickly if needs be, then a water birth is not recommended. If the idea of a water birth appeals to you, talk to your midwife about whether it would be right for you and what options are available.
Many mums swear by the power of hypnobirthing to help them get through labour and giving birth. Hypnobirthing techniques are taught in classes, which usually take place over 5-8 sessions. They teach women ways to stay calm and in control during labour. You will be taught to think about labour and birth with different, more empowering language. For example you can call contractions birth breathing. The classes teach you about different positions for labour, relaxation techniques to use and breathing techniques to help you cope. Your birthing partner will play a key role, supporting you and reminding you of all the techniques you have learnt as you labour. Hypnobirthing isn’t pain relief per se but the techniques you learn can help you perceive pain as less intense. It can help you feel more in control when giving birth and prevent you from getting scared or anxious.
Bring on the drugs
Warm water and relaxation techniques might not feel like they will be enough for you. You may already know that you don’t cope well with pain and would prefer to know that the option of more help is available should you need it. Depending on where you give birth you could be offered a sliding scale of pain relief ranging from gas and air, pethidine and an epidural. An epidural will numb you from contraction pain completely. There is no shame at all in wanting pain relief during labour. If you have a headache you don’t beat yourself up for taking a paracetamol so don’t feel any guilt for wanting some drugs to take away the labour pains. Find the best way of giving birth for you.
Some mums to be will have a planned caesarean section. These can be agreed in advance for all sorts of reasons. These include your baby being in breech position, if you have a low lying placenta, if you are carrying twins or more, if you have a medical condition such as diabetes. If you have preeclampsia it can also make it dangerous to delay giving birth. You may have had a previous traumatic birth experience or are very scared of childbirth, in which case you can also ask for a caesarean. Your midwife will talk to you about your options and whether this is the right choice for you.
You may plan for a natural birth but sometimes labour doesn’t go smoothly and it can mean that you need an emergency caesarean. It can feel scary to you find yourself in a position where sudden decisions are being made to medically intervene. Some mums may also feel disappointed when this happens. Remember that the only important thing is for your baby to be delivered healthy and for you to be well. Whichever way the birth goes.
There may be complications during labour that mean your baby has to be delivered quickly. Sometimes this will mean that you will be assisted in delivery with the use of forceps or a ventouse. Both of these are ways that an obstetrician will help deliver your baby as you push. Forceps are a bit like big salad servers. They are metal implements which gently fit over your baby’s head and help pull him out. Ventouse caps use gentle suction to help your baby move through the birth canal.
Every delivery is different and some women and babies will need more help than others. Talk with your midwife about the different types of medical interventions beforehand. That way you will know what to expect in an emergency and it can help you feel less panicked if they are needed.
The best laid plans of mums-to-be…
It’s good to make a birth plan so that you can think about your options for labour and childbirth and feel prepared for what’s to come. Remember though that it’s just a guide. It’s not a schedule to stick to or a test you have to pass. Birth is unpredictable and you never know how labour will go. Any number of things might happen that mean you have to abandon your birth plan and go with a different option.
Many mums feel a huge sense of disappointment if their birth doesn’t go to plan and feel as if they have somehow failed the first test of motherhood. If you planned and hoped for a natural birth at home and end up having an assisted birth in hospital or an emergency c-section, it can be hard to come to terms with. You can feel a real sense of loss for the birth you had planned. Letting go of the guilt is the first step to healing. Giving birth is an unpredictable journey that often strays from its course. As you approach your due date it is worth keep this in mind. Recognise that you have done all you can to plan your ideal birth experience but that, if things change, it’s ok. The most important thing of all is that your baby is delivered safely and that you are looked after and safe too. You have done a phenomenal job nurturing and carrying your baby. You are about to do the incredible task of bringing baby into this world. However it happens, you are amazing.