Tuesday, 20 August 2013

In labour - seven things I know now.

One of my favourite bloggers - Chantelle at fatmumslim is going to be having a baby soon, and she is not looking forward to the labour. Reading her post reminded me that I've been neglecting you. I'm sorry. Summer holidays, family stuff, and a touch of the blues have got in the way, but I'm in the middle of a series, so I'll be needing to continue.

As you'll recall, I've had three children, and survived the baby and toddler years. Add to that a background in maternal stuff, and I don't just have my stories to draw on... And I promise I'll not regale you with stories. No. I've already told you things I know now about pregnancy, and going into labour. Now here are some things I know now about labour itself.

Seven Things I Know Now About Labour

1 Keep calm and carry on snoozing.

All animals have their babies when they feel as calm as possible. A cat might hide out in an airing cupboard (do people still have those?), but for humans we generally find it's at night when things kick off. This can mean that labour proper will see you up in the wee small hours, so get all the sleep and general rest you can, to make sure you've got plenty of reserves. Personally, I find hospitals stressful places, so try to avoid them, which worked great for me. On the one time I did go into hospital before everything was really kicking off, getting there made everything stop. That happens a lot. It's tempting to stay put, but doing so will just make it more likely you'll end up with some sort of intervention. Your best bet is to have a chat with a friendly midwife and head home to get some rest. You'll be up again soon.

2. Make sure you've got a good team

There has been a whole lot of research done into what helps women get birth experiences they feel content about, and do you know what comes out top? It's trusting the people you're with. A woman in labour has got to feel safe, so being with people you trust is really important.

Part of that is your birthing partner. Choose the person who will be best for you. It might be your partner, your mum, or a trusted friend. You might want to look into getting a doula. You know who you want. More people can be around, but if you're going to hospital check their policy - you might need to work something out. If you do need to go into theatre you'll only be allowed one person - it's busy in there!

The other part of having a good team is trusting your midwife (please note, this is UK based, but wherever you are, you need to trust your medical personnel). It is difficult to do this if you don't know her, and if she doesn't have time to build rapport with you. Ask your antenatal midwife who'll be looking after you for the birth. Some areas are better at continuity of care than others.

Lots of women worry about something going wrong, and ending up with a caesarian. Trusting your midwife will help avoid interventions, but it will also help you feel better about interventions you do have.

Personally I am a massive fan of home births. I went for home births for two of my births. Not only was I somewhere I felt safe, but I had my own midwife for the whole shebang. The baby got her own midwife too (as midwives consume a lot of tea and toast, you need to stock up on these for a home birth). Midwives are amazingly good at keeping your carpets clean, and they come with inco sheets.

If you are having a home birth, but you decide you want to go to hospital after all, your midwife comes too, so you get to keep your own midwife, which is great.

When I had my last baby, I had to emergency transfer into hospital for a caesarian. This is not my happiest memory, but I had two incredible midwives with me. We all talked through the situation, and I knew the transfer was the right thing to do. They came with me, and looked after me in the ambulance (with my fantastic, and only slightly terrified husband), and came into the hospital with me. They helped me remove my nail varnish, and got me into a gown. They couldn't come into theatre, so they introduced me to my surgeon. Told me she was good. They introduced me to the theatre nurses, and I felt like a really good team were helping me.

You need a good relationship with the midwife. Give her chocolate and just keep talking with her. It takes a really special kind of person to become a midwife.

3 You've got to dilate 10 centimetres!

You might get told in your ante-natal class that dilation of the cervix takes about one hour per centimetre. This is what they told me, anyway, and I suppose it may be broadly  true that it takes about 10 hours to get to the magic 10 centimetres (in case you are wondering, this is measured by midwives digits - one finger equals one centimetre... It's just a little bit All Creatures Great and Small), but I have never met anyone who progressed like that. A lot of people discover they're a centimetre or two dilated without realising it, and then it takes ages to get up to 5. Between 5 and 10 centimetres, most people seem to get stuck somewhere for a while, and then suddenly they're nearly at 10, and they have the joy of transition.

You thought those were contractions? The Weirdness of Transition

You're beginning to think you're getting the hang of this baby-birthing thing. You've got your breathing down. You've deemed your tens machine useless and your husband is happily electrocuting himself with it. And then... You get cold. You get shaky. Your contractions change from being like really bad period pains to being like your body is changing into an alien who is a totally different shape pains. You know, like a werewolf changing? You have a moment of clarity in which you think that actually, this is a really bad idea, maybe you should just go to the pub instead... Or climb in a wardrobe (I did this), or hide in the toilet (a friend did this). You are in transition. The midwives are wise to you, and they can cope with it. They are rather fabulous aren't they? The good news is that whatever your opinion at this time, you are about to have a baby!

5 Most births are 'normal' births

I'm not quite sure what is normal about it, but most births involve a woman getting a baby out of her vagina without surgical help.  You're more likely to need some help for your first birth, maybe because your body hasn't done it before, but also because you haven't done it before, and it's really weird - your birth will go best if you're relaxed and it's hard to relax when you're turning into a werewolf.  However, there is no-one dishing out brownie points for birthing.  It is perfectly OK to have the birth you and your baby need to have.  The prize at the end is the same for nearly everybody.  A healthy mother and baby.

6 There's a lot more caesareans these days

Partly this is because medical staff are less used to delivering more complicated vaginal births, so they will advise a caesarian more readily.  The good news is that because the doctors have had more practice, caesareans are much better than they used to be. 

Planned caesareans tend to have better recovery time than emergency sections, so it might be the thing to go for if it looks like you'll need one. That said, a caesarian is major abdominal surgery, and you will need time you're unlikely to have to recover. 

I never wanted to have a section, until I knew I needed one. Follow your heart, talk to your midwife, and make sure you've got the best birthing partner for you. Honest, dad won't mind, so long as you feel safe.

Having a caesarian is no less authentic a birth experience than a vaginal birth.  However, the shock on your body may cause your milk to be delayed a bit, so you'll need extra support for breastfeeding. 

7 Caesareans are not the only thing they can do.

You've been pushing and pushing and your midwife is worried that you're exhausted, and that the baby's distressed. They're thinking about writing 'failure to progress' on your notes (which is a horrible thing to call it, but it's not a judgement on your maternal character). You are tired, hormonal, and feeling rubbish. At this point, they may suggest a ventouse - this is like a plunger they suck onto the baby's head, then they pull while you push. This is good as it does work sometimes, but baby's aren't very keen, so if it fails you'll probably need a section. Alternatively you could go for forceps, which is a similar idea, but like salad servers they fix round baby's head after 'widening' the vaginal  opening with an episiotomy. I've had both. I had a horrible experience of the forceps, mainly because of the episiotomy. However, lots of people have them. If you do have one, contact the NCT about special cushions to sit on after.

Recovering from caesarians gets a lot of attention, but an episiotomy, or a tear, can be really debilitating too.  I couldn't sit down properly for months.  Talk to your midwife and health visitor about your recovery - don't be brave, get the help you need.  You need to be on top form to deal with motherhood.  On which, more next time.  Your baby's birth will not last forever.

So go on, women of the world... what was your labour like?  What was funny?  What was scary?  What was crazy?  What would you tell your sister if she was about to do it?

This is one of a series of posts on all things bumps and babies.  Here are a number of things I now know about: