Labour and birth

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Labour and birth


What to do if you are in labour

Telephone your Midwife, Maternity Unit or Birthing Suite out of hours anytime about your labour. The midwife will ask you questions about:

  • When  your baby is due;
  • The timing and strength of your contractions; and
  • Whether your membranes have ruptured (waters broken). Please put a pad on if you suspect this so the midwife can check it. It should be clear or slightly pinkish.

What you will need to bring into hospital

For mother
Loose and lightweight clothing for labour
Comfortable day clothes and footwear
Comfortable sleepwear
Nursing bras and pads
Sanitary pads
Medicare Card and Private Health Insurance Card
Hand held record (orange folder)
Energy rich food for labour like bananas, grapes, barley sugar, cheese, yoghurt
Tea, coffee if required between meals
Massage oil with no added scents
Watch or clock
Music in CD or iDOC form for labour
Battery charged 'tea light' candles are permitted only
Camera; and
Mobile phone
(but should not be used in areas where they might interfere with electronic equipment.  If unsure please ask the staff.  Mobile phone use should be restricted in double rooms and turned off overnight).
Maternity Information Booklet
For baby
4 - 6 grow suits, either size 0000 or 000
4 - 6 singlets
4 - 6 light weight wraps
Nappies, pack of 32, newborn size
2 light weight blankets
Socks/mittens
Hat for discharge
Nappy changing gear - face washers, baby wipes, cotton balls
Cloth nappies or hand towels for 'spill' cloth; and
Tin of formula if artificially feeding
If you have a supply of expressed breast milk, remember to bring it with you and take it home on discharge.

Partners need to bring what they may require over 24 - 48 hours including all snacks (meals not provided for partners).

If you have medications that you need to bring, please let your midwife know on arrival.

Do not bring large amounts of money or valuables.  You are responsible for their safe-keeping
(You may be asked to complete a valuables disclaimer when you present to the hospital).

What you will need for your baby at home

At minimum you will require a safe sleep environment for baby (cot or bassinet), approved  rearward  facing car seat and possibly a pram.

Optionally you may like to purchase a baby bath and some type of baby rocker or play mat. Remember the only unsupervised safe sleep environment for baby is their cot/bassinet.

When buying second hand equipment make sure they are safe for baby, with recommended 5 point harness for car seats, prams and high chairs.

For further information on Australian standards

If you are formula feeding your baby, you will need sterilising equipment,  bottles, caps and teats.

Labour and birth

Your birthing preferences

Preparation for your birth is important and some women decide to write down their birthing preferences which allows them the opportunity to share thoughts and special needs with the midwife/doctor and support people. It is important  that you provide your midwife/doctor with a copy of your birth plan prior to your labour to allow an informed  discussion to take place. The midwives will always try to fulfil your wishes provided that it is safe for you and your baby.

Some things to think about during your pregnancy, and possibly discuss with  your midwife and doctor are:

  • Your chosen support team
    (2 people only);
  • Positions for labour and birthing;
  • What you will bring with you to personalise your environment;
  • Your chosen methods of pain relief; and
  • You preferences if there are complications.

Labour has three stages:

Labour is simply the muscles of your uterus contracting to thin and open your cervix (the lower part of the uterine muscle) and to help move baby down further into the pelvis. Oxytocin is your natural hormone that works to allow this to happen.

  • First stage is from  the beginning of regular contractions until the cervix is fully open (10cm);
  • Second  stage is when the cervix is fully open until your baby is born. This is commonly  called the pushing stage, although not all women  feel the urge to push. If you do not feel the urge your body will usually do it involuntarily with contractions anyway. Women  usually feel bowel  pressure and a burning and stinging sensation around their vagina during this stage. This is normal and means your baby will be born soon; and
  • Third  stage is from  the birth of your baby until the birth of the placenta.

How long is labour and how might I feel?

Labour and birth is unique for every woman. This can mean lots of variation in the length of each labour and feelings you may experience.

In the weeks leading up to your labour, it is very normal to experience varying emotions and body changes including increased vaginal discharge, increased Braxton hicks, feelings of anxiousness or excitement and other common discomforts like back or hip pain or the occasional sharp pain within  the cervix region,  as the body and mind prepare for labour.

The early phase of your frst stage is when the contractions are often irregular around 5 to 20 minutes apart lasting 20 to 40 seconds and may range from approximately 8 to 16 hours. During this time your cervix is starting to change, thinning out and dilating to 3-4 cm. You may also notice a mucous plug referred to as a show  (clear or white thick mucous often streaked with blood) or your ‘waters’ break; backache or diarrhoea which  are all normal  signs of early labour. Remember though you do not have to have ruptured membranes to be in labour, this can happen at any stage.

Once the contractions become stronger, more regular and painful you are in a more active part of your labour. This is still a part of the first stage of labour, your cervix is dilating from 4 to 8cm, the contractions are around 3 to 7 minutes apart and lasting up to 60 seconds. This active phase may take around 3-5 hours. Many women present to hospital during this part of labour. During this phase your feelings need all your attention. Remember in between each contraction your body is able to relax and regain focus.

Transition is part of first stage of labour where  your body is working really hard for approximately 1-2 hours.  Contractions may be 2-3 minutes apart lasting 60 to 90 seconds and your cervix dilates to 10 cm. Common feelings include pressure in the bowels,  nausea, irritability or panicky, a heavy vaginal show (thick mucous combined with blood) and spontaneous rupture  of membranes if this has not occurred  earlier. These feelings are a good sign your body is progressing well towards meeting your baby.

Stage two, the pushing phase to the birth of your baby, begins when your cervix is 10cm and fully thinned out, plus the baby has moved  further down  into your pelvis. Pushing for some women  may only take 15 minutes but for other women it could be up to 2 hours. Strong, regular contractions continue during this phase.

Please remember  this is only a guide, each labour is different. For more information please refer to www.raisingchildren.net.au pregnancy information or consider attending one of our antenatal education sessions.

Tear/Episiotomy and Stitches

During your baby’s birth a tear to the vaginal opening (perineum) sometimes happens. The doctor/midwife  will repair the area with stitches within an hour after the birth. Local anaesthetic is used to help numb the area so it doesn’t hurt.

Episiotomy is a cut in the side of the vaginal opening - usually the right side. It is not routinely done but may be necessary depending on the circumstances to assit in the birth of your baby. After the birth the vaginal trauma will be assessed and sutured as required.  Local anaesthetic is used in the area if suturing  is needed.

Both tears and episiotomies usually heal quickly and the stitches will dissolve.

Care of stitches

  • Ensure that you take some pain relief;
  • Stool softeners may be required to decrease pressure on the stitches when opening your bowels;
  • Keep the area clean and dry;
  • Apply ice pack supplied by the hospital every three hours for 20 - 30 minutes in the frst 24 hours, this helps with swelling and pain;
  • If you have problems with wound healing or infection after giving birth talk with your midwife or see your GP; and
  • For women  who  have sustained a 3rd or 4th degree tear to their perineum, a physiotherapist will see you following the birth and you will also have an appointment  to return to the Gynaecology Clinic in about 6 weeks from the birth.

Monitoring your baby during labour

When you come to the hospital in labour there are some routine checks that the midwife or doctor  will usually do.

These may include:

  • Regular check of your blood pressure, temperature and pulse;
  • Check of your baby’s heart rate;
  • Palpation of your abdomen to feel the position of your baby;
  • On admission a monitor  (CTG) may be used to record your baby’s heart rate and your contractions, and in certain circumstances may be required continuously throughout the labour process. In some circumstances when the quality of the external monitoring is poor, internal monitoring  may be required. This involves attachment of a small probe via the vaginal passage and on to your baby’s head; and
  • An ‘internal’ or vaginal examination  will need to be done at regular intervals to check the progress of your labour. This is to feel how open and thin your cervix is and the position of your baby in the pelvis. A vaginal examination  is the only way we are able to accurately determine your progress through labour.

For women  with a high Body Mass Index (BMI) score your labour and birth may be considered at an increased risk. Please discuss this in your  antenatal visits. If your labour  is classifed as higher risk the THS WACS recommends continuous fetal monitoring   and increased observations of the mother be implemented during labour.

How do you know you are in labour

You are unlikely to mistake the signs of labour when the time really comes, but if you’re in any doubt don’t hesitate to contact your Midwife, PAC or Birth Suite and ask for advice. Labour patterns are different for all women. You are likely to be in labour when your contractions are regular (between 3 7 minutes apart) and cause strong period like pain or back ache and last more than 45 seconds.

You time from the start of one contraction to the start of the next contraction and they do need to be strong, regular and painful. Remember normal labour is painful but many women cope well.

You do not have to have ruptured membranes (waters) to be in labour.

Delivery of the Placenta

During the delivery of the placenta and soon after, new mothers are at their greatest risk of abnormal heavy bleeding (known as haemorrhage). With modern medicine the incidence of haemorrhage can be prevented or treated using oxytocin drugs to help the uterus (womb) contract and stop the bleeding, thereby reducing the risk of heavy bleeding.

Evidence from clinical studies demonstrates that active management (administration of oxytocin  drug) of third stage is more effective than natural (physiological) management in reducing the risk of heavy bleeding immediately after birth. For this reason, active management  is considered the best and safest practice around  the world  and is routinely practised in hospitals within Australia.

All THS services have a policy to actively manage third stage with your consent. With consent (obtained during your antenatal visits) you will be given oxytocin with the birth of your baby, a drug similar to the body’s natural hormone,  which causes the uterus to contract and separate the placenta from the uterus soon after the birth of your baby. Following the injection of oxytocin, the umbilical cord is usually clamped within 2-3 minutes and to assist the placenta to be delivered, the midwife or doctor will create tension on the cord whilst also applying gentle pressure on your stomach just above your pubic bone. Side effects such as mild nausea or a temporary increased blood pressure from the oxytocin drug are minimal when considering the risk of haemorrhage is signifcantly reduced.

Please understand  that if you choose  to have a physiological third stage (i.e. no injection of oxytocin  unless heavy bleeding occurs), the THS will respect your decision but recommend that you discuss this at an antenatal visit to ensure your decision is fully informed.

Natural pain in labour

It is normal for women to feel pain in labour and everyone experiences this pain differently. Labour pain can also be seen as functional pain of the body that instinctively guides your body through, with each contraction.

You will feel each contraction reach a peak (like a hill or wave) but then it will recede or lessen and there will be no pain until the next contraction.

Each woman labours differently and how you cope with labour depends upon a lot of different factors. It is important not to compare yourself and how you labour to other women. The most important thing is how you feel.

What you can do for yourself

Research indicates that many women  cope with labour by having a good understanding of the process and feeling well supported. Various hormones and beta-endorphins in your body are superbly designed to help you during labour and birth. To allow your body the best chance possible of labouring effectively and releasing natural pain relief to it’s full potential it is important that you trust your body and try to create a calm, undisturbed environment. Simple and effective ways of helping you include:

  • Understanding what is happening to your  body;  be positive and ask questions if you feel “out of control”;
  • Knowing that you are in a safe environment and the staff will respect your needs and support you;
  • Having a support person with you with whom you feel comfortable and confident;
  • Relaxation and slow breathing that concentrates on the ‘out’ breath;
  • Heat packs (are provided by the hospital, wheat packs or hot water bottles are not allowed in hospital);
  • Choosing to make a noise or be silent;
  • Massage;
  • Moving and varying positions, find the position that is comfortable  for you;
  • Music or an object to help you focus your mind; and
  • Showers/baths.

It is important to have an idea of what you think may work for you when establishing your labour at home. The suggestions provided can be useful at home and in hospital. Remember normal labour is painful but many women do find coping strategies that help them through the pain and reduce the need for medical pain relief options.

Please Note: You cannot bring flammable items such as incense burners  or candles into THS hospitals.

External Cephalic Version (ECV)

In the last few weeks of pregnancy, most babies are head down  in their mother’s uterus and this is the easiest and safest position for birth.

ECV is a procedure performed by an Obstetrician which the THS WACS may be able to offer to turn a baby from a breech (bottom/foot first) to a cephalic (head first) presentation. The obstetrician  will discuss the procedure with you and will need to obtain your consent to perform.

For more information view Breech Presentation at the End of your Pregnancy booklet

Prolonged Pregnancy

Most women will go into labour naturally between 37 and 42 weeks.

If your pregnancy has gone more  than one week overdue it is considered  to be prolonged. Approximately 10% of all pregnancies are prolonged, the majority of these being ‘first time’ expecting mothers. We know from the research that spontaneous labour allows for the best possible outcome  emotionally and physically for the woman, her family and her baby.

However,  we need to balance this with the understanding that closer to the 42 weeks gestation, a very small percentage of prolonged  pregnancies may lead to potential risk to the wellbeing of the baby. The THS policy is that if your pregnancy is normal  but is clearly overdue by 6-8 days AND you wish to have labour induced, the doctor or midwife may, with consent, perform a vaginal examination  to assess the condition of your cervix (neck of the uterus). Induction of labour will not occur at the 41 week consultation, but preparation and planning will however take place for IOL at 40 weeks +10 days. Prior to 40 weeks +10 days the THS WACS support the benefts of spontaneous labour and will only induce women for medical reasons in relation to the mother or baby.

At 41 weeks if on vaginal examination  your cervix  is “ripe” or favourable, you may be offered a stretch and sweep of the cervix and arrangements will be made for induction of labour to be done at a time of around 10+ days overdue.  ‘Ripe’ means that your cervix has opened  and thinned enough to allow an artificial rupture of membranes to be easily performed.  You will be given a date and time to present to the Maternity Unit.

If on examination at your 41 week consultation your cervix is not favourable or “unripe” and your labour needs to be induced you may still be offered a stretch and sweep but arrangements will be made for your admission to hospital for the evening prior to commencement of your labour at 9+ days overdue.  This is to allow procedures to be put in place that encourage cervical ripening. After any of these procedures a monitoring trace (CTG) will be taken of baby’s heart rate.

If you are 10-12  days overdue and do not wish to be induced, we recommend the following:

  • Fetal heart monitoring  three times a week; and
  • An ultrasound  scan to measure the amount of amniotic fluid around the baby.

If any tests suggest a medical reason to deliver your baby it will be fully explained to you so an informed decision can be made.

Induction of labour

Sometimes labour needs to be started artifcially. This is called induction  (IOL).

This is only done if the health of the mother and baby is of concern.

Some reasons for having an induction may be:

  • Being overdue (usually 10 days);
  • Having a medical problem,  eg. high blood pressure, diabetes, bleeding; and
  • Baby is stressed or not growing well.

IOL may progress differently to spontaneous labour. These changes can include:

  • Preparing the cervix for labour may take some time, even a few days, to be effective. For this reason the decision for caesarean birth may occur if mother  or baby are not well enough for IOL.
  • Once the waters are broken labour may take some time to begin or may not establish.
  • There  is a slightly higher risk that your baby may show  signs of distress and require  an assisted birth  or caesarean section to be born safely.
  • Intermittent monitoring whilst preparing the cervix and then continuous electronic monitoring  (CTG)  of baby is required once in established labour to ensure your baby is coping well with the changing environment.
  • You may require pain relief to help you manage labour.

There are other reasons why labour may need to be induced, and your doctor or midwife will explain these to you so you can participate in the decision.

There are several methods used to induce or begin a labour. The choice of this depends on a medical assessment by the doctor or midwife.

Induction of labour often needs to be carried out in two phases. The first phase is called cervical ripening, where the cervix (neck of the uterus) is encouraged  to soften, shorten and open slowly to prepare for labour.

This is called effacement of the cervix.

Cervical ripening can be encouraged by placing a hormone  called prostaglandin near the cervix during an internal examination, given in the form of a slow release pessary or a gel to help soften the cervix. The prostaglandin pessary is left in place for 12 hours; the prostaglandin gel is absorbed slowly into the area and may require 2-3 doses over a day or two before induction is possible.

Another way to encourage cervical ripening is by placing pressure on the cervix. A thin rubber  tube called a balloon catheter is inserted through the cervix. The catheter has two balloons at the tip that can be filled with water. When inflated these balloons put pressure on the cervix stretching it and encouraging it to release natural prostaglandin which leads to softening and shortening.

Cervical ripening methods may take several days to be fully effective, and in some cases more than one method  is used. The second phase occurs after the cervix has softened and is the labour phase.

Labour may have commenced with the use of the prostaglandin hormone  which may bring on contractions or by breaking the forewaters (artifcial rupture of membranes or ARM) which typically occurs the following morning once the cervix is ripe.

If you do not begin to have strong, regular contractions (3-4 contractions in 10 minutes,  lasting 45-60 seconds), an oxytocin infusion (hormone drip) will be started to encourage contractions to begin. The oxytocin infusion often needs to continue throughout labour and birth to allow for the contractions to continue.

What will happen when I arrive at the hospital?

Present to Maternity Unit, bringing your bags with you.

You will initially be admitted into a shared room  until labour has begun. This means that your partner will not be able to stay with you overnight. When labour is establishing and you are moved to a birthing room your partner/ support people will be able to remain with you until your baby is born.

If labour begins to establish during the night, we will contact your support person and ask them  to return to the hospital.

An intravenous cannula (IV) may be placed into your hand or arm and a blood test will be taken to check your haemoglobin (iron) levels, this is part of routine care for women  having an induction of labour to ensure safe care is provided.

When  medical staff are available, the prostaglandin or balloon procedure will take place, and your baby’s heart rate will be monitored for a short time to make sure you are both well.

You will need to remain in hospital, but are encouraged to walk around to assist labour to begin. Even though you are experiencing an induction of labour remember  an active labour has been shown to improve time frames and reduce pain levels and further intervention. Your cervix will be re-assessed later depending on which method of induction has been chosen. If your cervix has not changed enough to allow your waters to be broken, more gel or another balloon may be required.

Your midwife will check on you and your baby regularly over this time.

Our aim is to start your induction in a timely manner. The Maternity Unit is a busy workplace with unexpected admissions and fluctuations in the number of women presenting in spontaneous labour. Unfortunately sometimes we may need to delay or postpone your induction to ensure all our women  are cared for in a safe environment.  If you have any questions or concerns please contact the clinic or Maternity Unit.

If you have any questions or concerns after admission, please ask your  midwife  or doctor.

Assisted births

In some births assistance may be required to allow your baby to be born vaginally. Whether  you have a Ventouse or obstetric forceps depends on the circumstances of your labour and the individual needs of the labouring woman.

Ventouse (suction cup)

This may be used to assist in the birth of your baby if labour is not progressing with pushing. Reasons may include that the mother  is too exhausted to push effectively, or if your  baby is showing signs of fatigue and needs to be born quickly. The cup is made of plastic and has a hand pump. It is carefully positioned by the doctor  and placed onto your baby’s head; the suction is applied, which allows for gentle traction when the mother  is pushing. Your baby will have a swelling on the head immediately after birth which will begin to reduce over the following 24 hours.

Sometimes there  is bruising on the head which will recede within about 10 days following the birth. An episiotomy is not always necessary with a birth assisted with a Ventouse however the decision to use episiotomy to assist the birth is decided following evaluation of each individual woman.

Forceps

Forceps are special instruments placed around your baby’s head inside the vagina to help guide your baby out during the pushing or second stage. They are used if there is delay in the second stage, your baby is in a difficult position, or there are concerns for your baby’s well-being.  An episiotomy (small cut) in the perineum may be required to assist the birth of your baby’s head.

Next birth after caesarean section (NBAC)

For many women it is safe practice to have a vaginal birth  after having had a previous caesarean birth. It is important you discuss your options and wishes with your doctor or midwife as this information does not cover all the known facts about NBAC or all rare but possible complications that can occur as a result of NBAC. Everyone  has different circumstances and personal requirements that need to be considered.

Many women  who have had a caesarean section can have a vaginal birth in subsequent pregnancies. There  is a small risk of problems with previous caesarean scars and you will therefore be monitored closely. Your doctor and/or midwife will discuss which conditions or precautions are necessary for you.

In some cases a repeat caesarean section will be recommended for certain medical or obstetric reasons.

It is important that you discuss all your options with your health care team. Write down any questions you have and your doctor/ midwife will be pleased to answer them.

What does the research say?

Caesarean section is a common operation with reported rates varying across the world. Australia’s reported rate is 23%  of all births.

Women considering their birthing options should understand that, overall the chances of a successful planned NBAC are 60-80% (R ANZCOG, 2010) and 90% for those who have had a subsequent normal vaginal delivery following a caesarean section (R ANZCOG, 2007).

Benefits of a successful NBAC include:

  • reduced blood loss;
  • less likelihood of infection;
  • shorter recovery time and hospital stay;
  • reduced chance of readmission after giving birth;
  • less need  for strong pain relief medications;
  • reduced risk of complications in future pregnancies;
  • less risk of the baby having breathing problems and being admitted into the nursery;
  • reduced complications associated with major abdominal surgery;
  • improved  chance of early physical contact with baby and initiating breast feeding;
  • enhanced ability to care for baby more effectively after delivery;
  • some women experience a high level of satisfaction after a vaginal birth;  and
  • reduced risk of future placental problems from repeat caesarean section.

When all the risks of labour are considered NBAC results in fewer complications for most women than routine, repeat caesarean sections.

When is a NBAC not advisable?

  • After a previous vertical/classical caesarean section birth where the uterine incision has involved the upper segment of the uterus.
  • After some uterine surgery.
  • After a previous uterine tear or rupture.
  • Because of a maternal or fetal reason for an elective caesarean section.
  • If the baby remains in a breech presentation.
  • If you have a multiple pregnancy, even if you have had a previous successful NBAC.
  • Two or more previous caesarean deliveries.

Risks associated with NBAC

A previous caesarean section leaves a scar on your uterus. This scar is a potentially weakened  area that has a small associated risk of rupture or tear during labour because of the forceful contractions.

The reported risk of uterine rupture  is 1 per 200 births. This is a rare but serious complication for the mother and unborn infant. To reduce the risk of a tear or rupture, spontaneous labour  is preferred but labour may need to be induced for some women.

A repeat caesarean section may be required if labour does not progress.

Factors which improve your chance of a successful NBAC include:

  • waiting at least 18 months after a caesarean section before becoming pregnant again;
  • no complications such as medical problems;
  • healthy weight range Body Mass Index (BMI) of less than 30 and eating low GI foods;
  • going into labour naturally before 41 completed weeks of pregnancy with baby lying head down in an anterior position;
  • baby’s estimated weight  less than 4000 grams; and
  • continuity of midwifery care.

Factors which reduce your chance of a successful NBAC can include:

  • induction of labour;
  • being overweight ie BMI of more than 35;
  • no previous vaginal birth or labour;
  • previous caesarean section for failure to progress; and
  • large baby (over 4000 grams).

Labour

  • Phone the hospital to discuss when  to come in if: you are experiencing regular painful contractions;
  • your membranes (waters) have broken;
  • you are bleeding; and/or
  • you have constant pain.

On admission, it is advisable that an intra- venous cannula (IV) be inserted into your arm in case of bleeding due to possible scar problems.

It is advisable to monitor the baby’s heart rate continuously by the cardio-toco graph (CTG) machine once you are in established labour as fetal heart rate issues will often precede potential scar problems. To remain active in labour, you can request telemetry CTG monitoring which enables you to walk around without being attached to the machine.

The progress of your labour will be monitored  closely, your doctor or midwife will assess the strength and timing of contractions along with fetal wellbeing.

Birth by caesarean

A caesarean  is usually performed under spinal or epidural anaesthetic so that you are able to be awake for the birth of your baby.

You do not watch your own operation as a screen is placed over your chest. A general anaesthetic  is not a common  choice but may sometimes be necessary.

A caesarean birth may be elective/planned or it may be an emergency/unplanned. There are many reasons why women have a caesarean birth, and these may include:

  • Problems with mother – e.g. small pelvis, high blood pressure, bleeding, no progress in labour; and
  • Problems with baby – e.g. wrong position, breech, too big or too small or distressed baby.

Preparation for a caesarean birth

If the plan is for you to have an elective or planned cesarean section you will be given an admission time & date with your Doctors appointment, where the operation  will be discussed & a consent obtained. You will also be given instructions for blood tests & when to fast prior to your operation, as well  as exercise advice & what activities are limited after your operation.  You may also be asked to have a pre-admission clinic appointment  to see an anesthetist.

For emergency caesarean births you will be prepared on the Maternity Unit and transported to theatre from there.

Skin to skin contact  is advised as soon as possible after birth.

  • However you feed your baby skin to skin will be encouraged for at least one hour, even if baby feeds early.
  • Following  a caesarean, if both mother and baby are well, baby will be placed on the mother’s chest whilst on the theatre table.
  • If the above is not possible, your baby will have skin to skin within 10 minutes of arrival in the recovery room.
  • If you have a general anaesthetic skin to skin will be within  10 minutes of being able to respond to baby.

Expectations

  • For planned/elective caesarean, do not eat for 12 hours prior to admission
  • The abdomen and pubic hair may be clipped.
  • A urinary catheter will be inserted into your bladder to keep it empty.
  • A dose of antacid or citrate preparation is given to neutralise stomach acid.
  • You may be in the operating theatre for more than an hour.
  • Your support person/partner may come into the operating theatre with you unless you are having a general anaesthetic.
  • You may take still photos of your baby at birth, but THS hospital policy does not allow videoing of procedures.
  • Your hospital stay will be 2-3 days post birth  as required.
  •  

You will only be separated from your baby if;

  • You need a more prolonged stay in the recovery room;
  • You require  a general anaesthetic; Baby needs to go to the Special Care Nursery (SCN); and
  • If your baby is well but you require attention, then your partner or support  person is encouraged to have contact and bond with your baby, on the Maternity Unit.

You and your baby after a caesarean birth

Whilst still in the operating theatre, your baby will be checked to ensure he/she is well. Your birth partner and you will be able to cuddle your baby. We will assist you to begin skin to skin contact with your baby as soon as possible after the birth. If you have chosen to breastfeed you should begin feeding as soon as your  baby is showing signs of wanting to do so.

If your baby is premature, has medical reasons or is having problems with breathing, he/she may need to go to the Special Care Nursery (SCN) for observation. If this is the case, staff will take you and your partner to see your baby as soon as possible. You will need to express breastmilk if your baby is unable to feed from the breast, starting as soon as you can after birth.

After the operation

Pain relief

It is important in the first 2 days after the operation to ensure you have adequate and regular pain relief so that you can move around freely. Support your wound by applying firm pressure with the help of a rolled towel or a small pillow. Your need for pain relief should decrease with each day.

The Anaesthetic Service will visit you on the day after your caesarean birth to discuss your pain relief. You are usually confined to bed for 12-24 hours after the birth. When confined to bed there  is a risk that you can develop  clots in your legs (deep vein thrombosis). A drug is given  as a small injection into the fatty tissue just under the skin, to help prevent deep vein thrombosis.

Moving – getting out of bed

For most women it is quite safe to be out of bed the day after their caesarean birth. Circulation and deep breathing exercises are important to do regularly while resting in bed, until you are moving freely around the ward. These exercises and walking on the ward are encouraged to help prevent post-operative chest infection and deep vein thrombosis (DVT). When you return from theatre you may have pressure devices on your legs called SCUDS and special stockings called TEDS. This helps with the circulation until you are able to ambulate freely.

When getting out of bed for the first time ensure  a staff member is present. Whilst you may feel normal when in bed you may find your legs are weak or you become dizzy the first time you try to stand. You may also find the wound pain increases.

It is safer to be accompanied until you are sure any risk of falling has been assessed.

Wound

The incision will be located below your bikini line. The type of wound dressing used changes from time to time. Often the wound will be covered with a clear dressing that should remain intact for 7-10 days.

You can remove it yourself in the shower. Generally you do not need to have your stitches removed.  Sometimes staples are used which need to be removed, this can be done by the Extended Midwife Service (EMS) or by your GP.

If there  is any redness or discharge from your wound notify midwifery/medical staff or when you get home see your family doctor.

Vaginal discharge

There will be some bleeding after the operation and this usually decreases over the next few days. If it increases tell your doctor or midwife.  See page 41 for further information.

Intravenous cannula (drip) and urinary catheter

  • You will be encouraged to sip fluids soon after the operation and eat a light meal when you feel ready. Once you are able to tolerate fluids the intravenous drip is usually removed.
  • The day after your operation the urinary catheter is usually removed.

This enables you to move freely, get up, shower and care for your baby.

Some people find difficulty with passing urine following removal of the catheter, the midwife caring for you will instruct you on how to measure the amount passed the first few  times.  Passing urine  may also sting, if this happens tell the midwife, who can give you some medication to help neutralise the urine acidity. If stinging continues a specimen may be sent to pathology to rule out an infection.

Returning to normal activities

Help at home is necessary over the first few weeks caring for your baby.

Initially you should only lift things around the weight of your baby but increase this activity  as you feel able.

Ensure you do not put yourself or your baby at risk by taking on too much too soon. Be aware that it will take time to heal and stay safe.

Check with your insurance company before you begin to drive – some may not cover you in the first 6 weeks post operatively.

Will a caesarean birth be necessary in the future?

If a woman has had a lower  uterine segment caesarean birth and there is not a recurrence of the problem that led to the first caesarean, then she may be able to have a vaginal birth next time. Factors such as the size and position of your baby can affect whether your next baby is born vaginally or by caesarean. Discuss this with your doctor/midwife.

Caesarean birth  is a safe method for the birth of your baby but it is a major operation, and therefore the decision to have a caesarean is made  carefully.

If further information is required  please request the RANZCOG leafet on Caesarean Section or Vaginal Birth After Caesarean Section.

Medical pain relief options

Everyone manages labour differently and there are many pain relief options available to assist you.

TENS Machine (Transcutaneous Electrical Nerve Stimulation)

The TENS machine is a small, hand-held, battery operated unit, with wires and self-adhesive pads attached. The pads are placed on 4 points on your back. These pads produce  an electrical pulse with a tingling sensation, that helps block the sensation of pain interpreted by the brain which occurs with contractions. It can work well for pain during any phase of labour, but it seems to work best for back pain.

Labour TENS machines can be hired privately through local medical companies and online. Operating instructions come with the machines.

For further information or hire call the Better Life Company on 6234 5144 or visit them at 83 Brisbane Street Hobart. Alternatively search Australian companies online for TENS hire.

Water Injections

It has been suggested that injections of small amounts of sterile water into, or just under, the skin of the lower back might be able to relieve some types of labour pain, especially the pain felt in the back. There are no known side effects for mother or baby.

Nitrous Oxide (Gas)

This is a mixture of nitrous oxide and oxygen sometimes  called ‘laughing gas’. It is a very safe option for pain relief in labour. Some women fnd the gas helps by taking the “edge” off the pain of the contraction, others fnd it is a good focal point  to help slow down breathing during contractions. The midwife will instruct you on how to use it during labour. You may experience nausea, light headedness and a dry mouth for a short time. There are no after effects for you or your baby. This is a great option if wanting minimal intervention.

Narcotic Pain Relief

Narcotic medication given as a single dose injection either under the skin, into a muscle or via an intravenous cannula. It helps take the edge off contraction pains through a sedative effect but will not take all the pain away. Further doses can be given after around 2 hours. This medication does cross the placenta to the baby. It can make you and your baby sleepy, and this may reduce respiratory effort in your baby if given close to birth. Research indicates that these drugs when given in labour can reduce your baby’s sucking reflex, which may affect initiation of breastfeeding in the first 12 to 48 hours. After this time your baby will become less sleepy and breastfeeding should improve. Morphine is more rapidly eliminated than Pethidine so the effects to baby may resolve quicker. Please note  these side effects are not seen in all babies whose mums have had narcotics during labour.

These are strong pain relievers given by injection.  At all times prior to the administration of these narcotics or any other drugs, the midwife or doctor will need to assess the progress of your labour. They take between 5 to 30 minutes to work depending on the way the drug is given.

Epidural Anaesthesia

Epidural  Anaesthesia is an effective means of pain relief and involves the injection of local anaesthetic and other pain relieving medication into the epidural space. This is the only pain relief that has the ability to take the pain of labour away almost completely.

You will always have an intravenous infusion inserted, a monitoring machine (CTG) to measure baby’s heart rate and to measure your contractions. A urinary bladder catheter  is always needed.

Only  a specialist doctor called an anaesthetist can give an epidural anaesthetic. You will be given a local anaesthetic into the skin of your back before the epidural is inserted. After this you should only feel a dull pushing sensation on your back. A thin flexible plastic catheter  is inserted into the epidural space and this will stay taped in place until after the birth when it will be removed.

Anaesthetic drugs are given continuously through this catheter via a pump to provide pain relief through the labour, pushing and any suturing that may be required. There is also an option to have  Patient Controlled Epidural Analgesia (PCEA) where  you are given a smaller continual does but can push a button  to provide extra pain relief as needed. Management and care are the same for standard epidurals and PCEA.

If you have an epidural for pain relief in labour it will be turned off once any suturing has occurred  after the birth of your placenta. Generally it will take 1-2 hours to feel full sensation and strength in your legs again. When  you stand for the first time after having an epidural removed  please ensure you are not at risk of falling by having a staff member with you to assess the situation.

Advantages of Epidural Anaesthesia

  • It can allow you to rest during a long or painful labour.
  • It is the only form of pain relief that causes little or no drowsiness to you or your baby.
  • If a forceps, caesarean birth or other intervention  is needed to deliver your baby, a stronger epidural may be used to help to relieve the pain of these procedures.

An epidural does not necessarily lead to an increased risk of a caesarean birth. However there is a slightly higher chance of a ventouse/forceps birth as the urge to push may not be felt.

Anaesthetic and pain-relieving procedures are typically reliable and safe but do have some risks. Despite the high standards of medical practice, complications can occur.

Possible complications of Epidural Anaesthesia

  • Your blood pressure may fall and this may affect your baby. To prevent this, an intravenous drip line is inserted beforehand so fluid and medications can be given quickly.
  • Walking around is not possible due to heaviness and numbness in the legs but you can usually move freely in the bed.
  • Irregular or ineffective pain relief can sometimes occur if the anaesthetic agent does not spread evenly. A top-up may be necessary or a re-positioning or replacement of the epidural may occur.
  • A leak of spinal fluid can cause a severe headache. A number  of leaks heal on their own while others may require a further epidural injection. The risk of this is about one in one hundred.
  • Local tenderness and bruising can occur around the site of the epidural but usually resolves within  7-10 days.
  • Shivering, nausea and vomiting may occur but this frequently occurs in a normal  labour  as well.
  • Intense itching with some types of medication can sometimes occur.
  • Rarely, an allergic reaction to an anaesthetic agent may occur.
  • Occasionally, the anaesthetic service is unavailable or delayed because the anaesthetist may be tending to other urgent responsibilities.

Rare complications of Epidural Anaesthesia

  • The site of the epidural may become infected and you will require antibiotics. Very rarely this may lead to meningitis or an epidural abscess.
  • The local anaesthetic may be accidentally injected into a blood vessel causing dizziness, a metallic taste in the mouth, and in extreme cases, convulsions and significant heart problems.
  • Temporary  damage to spinal nerves outside the spinal column may occur. Virtually all of these cases recover within a few weeks or months.
  • Permanent but rare damage may occur ranging from nerve damage to paralysis in one in 20,000 to 200,000 women undergoing an epidural anaesthetic depending on the severity and type of the damage.

Unexpected outcomes of pregnancy

If unexpected complications occur with your pregnancy, the hospital has staff and services available to support and assist you. Any concerns can be discussed with the midwives and doctors.

Loss and grief are not usually associated with pregnancy, but not all pregnancies progress smoothly. Unfortunately, miscarriages do occur, as do stillbirths, and some babies are diagnosed with medical problems. We are able to call on resources in the hospital and community that can support you during your time of need.

Contacts: