Labour

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

Birthing preferences

• Preparing for birth is important.
• You may wish to write down your birthing preferences.
• This allows you to share your thoughts and special needs with you midwife, doctor and support people.
• It is important to provide your midwife and doctor with a copy of your birth plan prior to your labour.
• Your midwife will always try to fulfil your wishes provided that it is safe for you and your baby.

Things to consider in your birth plan

Three stages of labour

1. From the beginning of regular contractions until the cervix is fully open (10cm)

Visit the Raising Children website for more information about what to expect during each stage of labour.

Vaginal tears, episiotomies, and stitches

Vaginal tear

• During your baby’s birth, a tear to the vaginal opening sometimes happens.
• Your doctor or midwife will repair the area with stitches within an hour after the birth.
• Local anaesthetic is used so it doesn’t hurt.

Episiotomy

• Episiotomy is a cut in the side of the vaginal opening (usually the right side).
• It may be necessary depending on the circumstances to assist in the birth of your baby.
• After the birth the vaginal trauma will be assessed and sutured as required. 
• Local anaesthetic is used if needed.
• If you have a 3rd or 4th degree tear, a physiotherapist will see you following the birth. You will also visit the Gynaecology Clinic about 6 weeks after birth.

Care of stitches

• Tears and episiotomies usually heal quickly, and the stitches will dissolve.
• 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 the hospital ice pack every three hours for 20-30 minutes in the first 24 hours.
• If you have problems with wound healing or infection, speak to your midwife or doctor.

Monitoring your baby during labour

We do routine checks when you are in labour. These may include:

If you have a high Body Mass Index (BMI), we may also do continuous foetal monitoring during labour.

How do you know you are in labour?

• Labour patterns are different for all women.
• You are likely to be in labour when your contractions are regular (between 3-7 minutes apart).
• They 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.
• Contractions 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 and after the placenta delivery, you are at higher risk of abnormal heavy bleeding (known as haemorrhage).
• Haemorrhage can be prevented or treated using oxytocin drugs to help the uterus (womb) contract.
• This can help stop the bleeding and reduce the risk of heavy bleeding.
• Administering oxytocin during the third stage of labour is considered the best and safest practice.
• With consent (obtained during your antenatal visits) you will be given oxytocin with the birth of your baby.
• Following the injection of oxytocin, the umbilical cord is usually clamped within 2-3 minutes.
• Your midwife or doctor will create tension on the cord and applying gentle pressure on your stomach.
• Side effects (mild nausea or a temporary increased blood pressure) from the oxytocin drug are minimal.
• If you choose not to have oxytocin (unless heavy bleeding occurs), we will respect your decision.
• It is important to discuss this at an antenatal visit.

Natural pain in labour

It is normal to feel pain in labour. You will feel each contraction reach a peak, then recede or lessen. There will be no pain until the next contraction. Simple and effective ways of helping you through contractions include:

You cannot bring flammable items such as incense burners or candles into our hospitals.

Moving your baby to the right position for birth

• In the last few weeks of pregnancy, most babies are head down in your uterus.
• This is the easiest and safest position for birth.
• External Cephalic Version is a procedure performed by your obstetrician to turn your baby from a breech (bottom/foot first) to a cephalic (head-first) position.
• The obstetrician will discuss the procedure with you and will need to obtain your consent to perform.
• For more information, download the 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.
• A small number of prolonged pregnancies may lead to potential risk to the wellbeing of the baby.
• If your pregnancy is normal but overdue by 6-8 days and you wish to have labour induced, the doctor or midwife may, with your consent, perform a vaginal examination to assess the condition of your cervix (neck of the uterus).
• Induction of labour preparation and planning will take place at 40 weeks +10 days.
• Prior to 40 weeks +10 days we only induce women for specific medical reasons.

Induction of your labour

Sometimes labour needs to be started artificially. This is called ‘induction of labour’. This is only done if the health of the mother and baby is of concern. Some reasons for having an induction may be:

When induction of labour is considered

• At 41 weeks, you may be offered a ‘stretch and sweep’ of the cervix to see if your cervix is ‘ripe’.
• This means that your cervix has opened and thinned to easily allow artificial rupture of membranes.
• If your cervix is ripe, we will induce labour around 10+ days overdue. 
• If your cervix is not ripe, you will be admitted to hospital the evening prior (9+ days overdue). 
• If you are 10-12 days overdue and do not wish to be induced, we recommend foetal heart monitoring three times a week.
• We also perform an ultrasound scan to measure the amount of amniotic fluid around the baby.
• If any tests suggest a medical reason to deliver your baby, we will explain it to you for an informed decision.

Learn all about what happens during induction of labour on the Raising Children website.

Assisted births

• In some births, assistance may be required to allow your baby to be born vaginally.
• This may be through a suction cup (ventouse) or obstetric forceps.
• It will depend on the circumstances of your labour and your individual needs.

Ventouse (suction cup)

• This may be used to assist in the birth of your baby if labour is not progressing with pushing.
• This may be due you or your baby showing signs of fatigue.
• The cup is made of plastic and has a hand pump.
• It is carefully positioned and placed onto your baby’s head.
• The suction is applied for gentle traction when you are pushing.
• Your baby will have a swelling on the head immediately after birth.
• This 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.
• Sometimes an episiotomy is performed but is not always necessary.

Forceps

• Forceps are special instruments placed around your baby’s head inside the vagina.
• They 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 if we are concerned about your baby’s well-being. 
• An episiotomy may be required to assist the birth of your baby’s head.

Next birth after caesarean section (NBAC)

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, so we will monitor you 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.

Benefits of a successful NBAC

Benefits of a successful NBAC include:

When is a NBAC not advisable?

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 risk of rupture or tear during labour.
• Uterine rupture is a rare but serious complication for the mother and unborn infant.
• To reduce the risk, 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 improving your chance of a successful NBAC

Factors reducing your chance of a successful NBAC