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BIRTH PLANS
Preferences and Options you are considering for Your Birth and Your Baby:
Birth
- Planned place and type of birth
- Support people present
- Labour aids
- Positioning for labour
- Pain relief
- Who will deliver the baby
- Who will cut the cord
- People present eg students
- Video/camera
- Mirror to watch the delivery
- Delivery of the placenta (Ecbolic injection)
- Do you wish to keep the placenta?
- If Blood Group Rh negative, Anti D Injection?
Baby
- Skin to Skin contact
- Feeding
- Vitamin K
- Metabolic Screening (Guthrie Test)
- BCG immunisation
- Hepatitis B vaccine (if Mother Hep B+)
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Birth: SIGNS AND STAGES
See the video of animation of birth on the resource pages on www.birthresources.org
The YouTube animation shows the cervix shortening (effacement) and opening (dilatation) and how a baby has to rotate to move through the pelvis to be birthed. Though this video shows the mother lying on her back, research has shown it is better to birth in more upright positions such as standing, sitting on a birth stool or kneeling.
Also see the birth animation on http://www.babycenter.com.au/video/pregnancy/labor-and-birth/ There are three signs of labour, which can happen in any order:
- Contractions: become more frequent and often are in a regular pattern, usually painful and do not go away with rest.
- Show: When the cervix (the neck of the womb) opens a plug of mucous, sometimes with a small amount of blood, may be passed. A show may happen during labour or up to 2 weeks before contractions start.
- Rupture of membranes: Usually there is a small gush if your waters break by themselves and the head drops down to act like a plug, and you will continue to leak small amounts of sweet smelling clear fluid. In 15% of labours waters break before labour. Let your LMC know if the fluid is green in colour as this is from the baby doing a bowel motion/poo (meconium) which is a sign of being distressed.
First stage of labour (early, established and transition phases)
Early/latent Labour
How you may feel:
Unsure is this labour?
Restless
Physical changes:
Contractions begin then become more regular (10-30mins apart)
Start off feeling like period cramps then get stronger, like a tight rubber band getting pulled around your abdomen.
Some people feel it in their back also.
Cervix is thinning (effacing) and starting to open (dilatation)
Established labour
How you may feel:
Hot and sweaty
Find it hard to get comfortable
Want to move around
Need reassurance and support
Physical changes:
Contractions are stronger more painful and closer together (5mins apart)
Your body will be working hard, like climbing up a mountain with a heavy backpack (in this case a heavy frontpack!). Try to use visualisation eg
Think of the wonderful view you get from the top of a mountain.
Think of the contractions as waves on the ocean.
Think of your wonderful baby you will see at the end of this.
Cervix is opening more 3-4cm+
Transition
How you may feel:
You may feel you are rowing up stream and not getting anywhere.
This is time when you become fed up and annoyed.
Do not want to do this any more!!
Very verbal or quiet
Feel can not cope, as there is little time to relax between the contractions
Need reassurance and support
Physical changes:
Contractions more painful and last longer (60 seconds)
Your body may shake; legs cramp and you may have waves of nausea.
Second Stage of Labour
The pushing stage
How you may feel:
Urge to push and feeling of pressure in your bottom.
Some people find pushing feels productive.
Find it hard work, are tired and want to rest but unable to.
Realization that you will soon see your baby
Physical Changes:
Cervix is fully dilated (10cm)
Push with contractions
Lots of pressure in your bottom,
like you are constipated and need to go to the toilet!
Stretching/burning feeling as the baby's head pushes on the perineum just before the head is born
Birth
How you may feel:
Amazed at this beautiful baby
Deep emotions
Relief that the baby is out
Feel happy on a natural high
Exhausted as if you have just run a marathon
Want to touch, hold and feed your baby
A Birthday party, your babies Birth Day!
Third Stage
The Placenta
Physical Changes:
Placenta separates causing bleeding
Uterus Contractions to slow down bleeding
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BREATHING IN LABOUR
Some people will say that you need to learn to breath for labour and others will say that you find on the day the best way to breath and learning techniques before hand will only confuse you.
Either way breathing is an important part of body function, and many people use breathing techniques to help them, for example when playing the trumpet, singing, yoga and swimming.
Breathing happens automatically. It would be tiring if you had to keep reminding yourself to breath. But you do have control over your breathing and can use this to help yourself. For example slowing it down and concentrating on your breathing when you are feeling stressed can help calm yourself. When someone is hyperventilating, telling them to concentrate on their breathing and slow it down will help them to relax and gain more control. You should avoid holding your breath for long periods as this can make you feel faint. This is why you may hear people saying, "remember to breath".
Janet Balaskas Book New Active Birth has a section on breathing in which she talks about how breathing can help you tune in with your body rhythms. Also about the importance of breathing deeply to fully expand our lungs so your body cells can receive the maximum benefit of oxygen, which is needed for their function.
She talks about deep breathing in through your nose and out through your mouth.
The Pink Kit has information about techniques to help with birth, visit www.birthingbetter.com. They talk about breathing effectively to reduce tension by breathing in deeply and slowly through your nose, to fully expand your lungs, then relaxing and letting go of tension with the breath out.
They also teach techniques to direct the breath to an area for eg to the area of discomfort.
The Auckland Home Birth Association "A guide to healthy pregnancy and childbirth" talks about keeping your breathing regular (in a pattern). Then in transition when labour becomes more intense using shallow rapid breathing if needed.
The New Zealand Pregnancy Book by Sue Pallon talks about breathing in through your nose feeling your chest expand, then slowly breathing out through your mouth with lips just slightly open. Taking one long slow breath at the start and end of each contraction as a starting and finishing breath.
Panting is when you breath in and out quickly and is used to stop people pushing at the end of labour as the baby's head is being delivered to give time for the perineum (skin between vagina and anus) to stretch. This can help reduce tears in some cases.
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HOMEBIRTH
Homebirth is a birth service that is available to people in Aotearoa New Zealand. Other choices are birth centres and hospitals.
Homebirth is a free service as is all antenatal, pregnancy and postnatal care up to six weeks by a public lead maternity carer (LMC).
Homebirth is an option to any woman without complications in their pregnancy or labour. If complications arise then it is recommended that they would need to go to Hospital.
Not all Midwives and Doctors will provide the service of attending a Homebirth so it is important to find out which Midwives do, and to be happy with your choice of LMC as you will be working in partnership with them.
The midwives who do conduct homebirths will bring with them equipment needed to assist in the delivery or any complications.
The midwife may have a TENS machine to help with pain relief. If not these can be hired from some chemists or via the physiotherapy department.
The midwife may also carry Entonox gas.
The birthing woman or couple will often be asked to provide the following: - Washing up bowl
- Towels
- Sanitary towels
- Torch/spot light
- Container to put the placenta in
- Hot water bottle or heater to warm baby clothes and towels
- A warm room for when the baby is born, and running water is helpful (cold and hot)
- A working phone, though most midwives carry a mobile phone so emergency services can be contacted if needed.
- Arranged care of any other children they have in the house, and prepared them for the delivery.
- Decide where in the house the delivery will take place and be prepared (eg plastic sheets) and any items needed to assist in the comfort of the labouring woman (eg pillows, drinks and snacks).
The New Zealand Home Birth Association estimates that around 75% of pregnant woman could safely give birth at home.
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LABOUR AIDS
It is a good to work with your body during labour. One of the ways you can do this is to try to remain in an upright position, thus gravity will help the contractions push the baby into the birth canal. Think about the things that help you cope when you are feeling stressed or uncomfortable and use these during your labour. Eg music, warm baths, massages, dim the lights, and heat packs Partners will find it hard to see the person who they love in pain, but by being there you are helping. Remember there will be an end to the labour and the pain of the contractions do not harm the labouring woman. In between the contractions you will be able to rest, as you will feel tired. Think about what the contractions are doing, they do have a purpose. The human body is the most amazing thing, we have to have trust in its ability and remember woman have been giving birth for 1000?s of years. Also think about your beautiful baby you are going to see at the end. Labour often starts with period like cramping pains and these become stronger and closer together. As they get stronger you will have to stop what you are doing during a contraction and be in a supported position. You will have to concentrate on breathing through the strong contractions. You do this by focusing on your breath; you may find it helpful to breathe in through your nose and slowly out through your mouth. Think about relaxing yourself as you do this. Some woman find it helpful blowing out through pursed lips.
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MASSAGE
I am not trained in massage. this is a guide from my experience from looking after women in labour.
- Massage helps relieve muscle tension.
- It is helpful to practise massage techniques before labour. You can also give your partner/support person a massage and show them how you like it done.
- During labour some women love stroking massage using the flat of your hand or pressure over areas that are uncomfortable eg pressing firmly over lower back tension spots (you can use a rolling pin to do this also), others will not want anyone to touch them at all. You have to communicate how and where you like the massage, "harder, softer, lower, higher, stop, don't stop"
- To avoid skin irritation use talcum powder, pregnancy massage oil or a good vegetable oil. Having soft music or aromatherapy may help relax you also.
- The labouring woman should try to stay in an upright position during the massage and try to think about her breathing, slow breaths in through your nose and out your mouth.
- Start the massage with the neck and shoulders, work down the back using long rhythmic stroking movements and small circles. Avoid pressing over the spinal column, as this will be uncomfortable.
See the videos on accupressure points on the resource page on www.birthresources.org
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PREPARATION
You may have your EDD (estimated date of delivery) circled on the calendar but it is only an estimate and less than 5% of babies are actually born on this day! Babies do come early, so be ready in advance. Think about putting down a plastic covering or towels over your bed mattress and car seat in case your waters break while sleeping or driving.
If planning a hospital birth you may want to bring: - Snack food and drinks for the labouring woman eg muesli bars, bottled water. Also food for the support people.
- Labour causes you to get dry lips, chap stick is helpful.
- Heat packs are good for back pain. With heat pack/wheat bags remember to have a glass of water in microwave as they are a fire risk and do not add oil to the heat/wheat pack.
- Massage oil, lavender scented oil is relaxing.
- Calming music and a player.
- Hair tie if you have long hair.
- Remember to have film in the camera.
- Money/ph cards, have a list of phone numbers of who to call after the birth. Most people will ask you the sex of the baby, time of birth and weight (kgs and pounds).
- Bring pen and paper to write these kinds of things down.
- Cell phones aren't allowed to be used inside some hospitals, as may interfere with some equipment.
- Comfortable cool clothes eg a sarong, big T-shirt.
- You will still look pregnant for about a week after having baby, so also have clothes which will fit afterwards.
- Bring in old knickers as you will bleed (like a heavy period) and have to wear pads. Tampons are not recommended as increase the risk of infection and your midwife will want to know what your blood loss is like. If you have a caesarean section you will want large granny knickers so that the elastic doesn't sit over your scar!
- Sandals/slippers as feet swell. Your feet get cold during labour so bring warm socks.
- Have your Antenatal record with you. Also remember to take this with you are going away when pregnant so if you need to go to another hospital they will know about your pregnancy checks.
- Leave valuables/rings at home if going to the Hospital may get lost or stolen.
- Maternity bras, at about day 3 your breasts will become large and heavy with the milk supply increase and engorgement of fluid. Some woman leak breast milk and need to use breast pads.
- Postnatally a tri pillow is handy for breast feeding.
- Most hospitals don't provide clothes for the baby so bring in 2-3 sets of clothes. This may include singlet, stretch and grow, woollen jersey and hat, socks, mittens and booties (ones with ribbon ties don't tend to stay on).
- Ask your midwife if the hospital supplies nappies. Babies will need 6-8 changes per day.
- You will legally need an approved infant car seat to take baby home in. Know how the car seat works before putting baby in it. Have baby warmly wrapped with a blanket around them when going outside.
See the information on the what you need, and mothers diary on the survival guide pages of BabyWebNZ.
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