A note about birth and planning
Birth is an unpredictable and dynamic process. Sometimes circumstances change and sometimes you change your mind about your initial choices. A birth plan will give me an idea about your ideal birth and also gives us an opportunity to discuss working with your specific cultural, medical or obstetric influences. Be assured that all pain medication options remain available regardless of your choices in the planning stage.
Some women have a very clear idea about the kind of birth they want, others struggle to anticipate what they will want during this new experience. If you have already done a lot of research or have experienced birth before you may wish to skip straight to outlining your preferences.
Some women have a very clear idea about the kind of birth they want, others struggle to anticipate what they will want during this new experience. If you have already done a lot of research or have experienced birth before you may wish to skip straight to outlining your preferences.
Understanding the birth process
It is your responsibility to prepare yourself for labour. Educate yourself with the information provided and make sure your support people prepare themselves as well. Your support people should understand your labour and birth preferences. You all should understand what established labour is and have a plan for dealing with early labour including care of your other children. Labour is a time for your support people to help you. Watch this (animated, non-graphic/child-friendly) "you tube" educational explanation here or this video to learn about the birth process. Read through this pamphlet (which also gives you ideas about how to cope).
Where to give birth
By now you should have an idea about where you would like to give birth. Women who are healthy and are experiencing a normal pregnancy may choose to give birth at home. Research shows that this is actually safer (producing better outcomes and maternal satisfaction) for this group of women. That said, you should give birth in the place you feel safest or on advice from your carers if having any complications.
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Hospital Birth
If planning to go to hospital you can take a virtual tour here. Please remember you will not be able to light candles at a hospital birth due to piped oxygen. The hospital will provide the following items during your stay.
You should pack spare underwear (large enough to fit maternity pads), your medication (such as asthma meds), toiletries and clothing for you and baby to go home in. Dont forget your phone charger! You should bring these items even if you are not planning on staying in hospital after birth. If you have other children (or pets) you need to arrange care for them while you are in hospital. Check the hospital visiting policy during COVID here and read information for your support people here. For information about parking can be found here. |
Home birth
If planning to give birth at home, you will need a few essential items
If you would like to have a water birth you will need to arrange to hire/buy a pool. Either gas hot water or a few big pots are useful to keep the water warm enough for birth. A recommended list of items to have as well as a list of indications to transfer to hospital can be found here. At around 37 weeks I will visit you for an antenatal appointment at your home. We make every effort to have the back midwife attend too. It helps us if we know where we are going in advance and we can also get an idea about where to set up our gear on the day. We can also offer advice on location for birth if you are not sure. We bring equipment with us for birth and are well prepared if any emergencies arise. We have medication and oxygen if needed. If it is thought that an issue is developing throughout your pregnancy or during labour a decision will be made together to birth at or transfer to hospital. |
Support People
The people you choose should be there to provide you physical and emotional support. Rubbing your back, physically supporting you in labouring positions, offering cool cloths, sips of water or snacks and encouraging you when labour gets tough or you need help to focus. It can be better to avoid having people there who are frightened of labour. Calm positive support is most helpful. Birth is not a spectator sport.
It might be worth asking people to refrain from calling/texting you AND your support person during labour. Everyone is very excited about the arrival of your baby but constant phone calls and texts can be a huge distraction and annoyance for labouring women. It also often draws the focus of your support person away from you when you need them.
It might be worth asking people to refrain from calling/texting you AND your support person during labour. Everyone is very excited about the arrival of your baby but constant phone calls and texts can be a huge distraction and annoyance for labouring women. It also often draws the focus of your support person away from you when you need them.
Understanding contractions and active labour
When talking about contractions, we often refer to LENGTH, STRENGTH and FREQUENCY.
LENGTH refers to how long the contractions last. If the contraction starts at 11:00am and finishes at 11:01am, the LENGTH of the contraction was 1 minute.
STRENGTH refers to how strong the contraction is. When talking about STRENGTH we talk about mild, moderate and strong contractions. In established labour, contractions will be too strong for you to talk through them.
FREQUENCY refers to how often the contractions happen. We measure from the beginning of 1 contraction to the beginning of the next contraction.
LENGTH refers to how long the contractions last. If the contraction starts at 11:00am and finishes at 11:01am, the LENGTH of the contraction was 1 minute.
STRENGTH refers to how strong the contraction is. When talking about STRENGTH we talk about mild, moderate and strong contractions. In established labour, contractions will be too strong for you to talk through them.
FREQUENCY refers to how often the contractions happen. We measure from the beginning of 1 contraction to the beginning of the next contraction.
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Latent or Early Labour
During this stage you will likely experience irregular or erratic tightenings. Your cervix is becoming thinner (effacing) rather than dilating. Sometimes this stage can last 24-48 hours and it is best spent at home. If you present to hospital with a low risk pregnancy, before 4-6cms dilated you will generally be sent home to await established (active) labour. Try to stay patient – your baby will come soon enough. Read “Working with Labour” for ideas on how to deal with latent labour. You might find it helpful to print out the “Working with Labour” handout Some women will have a period of time in early labour where they feel the contractions are regular and very close together. This usually lasts for around 30-40 minutes and then they go back to the irregular contractions. The muscles of the uterus are beginning to become co-ordinated and are figuring out how to work together. This is why it is important to have strategies for coping and wait before calling your midwife. Resting is the most important thing to do in this stage of labour. This can be a good time to use your TENS machine if you have hired or bought one. |
Established Labour
This is the time where you will have to find your own ways of being with your pain. This stage of labour is when the cervix opens from 6 to 10cms dilated. Lean on your support crew to love, nurture and support you but be prepared to accept the pain in this process. Know that your amazing body grew this baby and it can birth this baby too. Babies take their time to arrive and in a low risk pregnancy, if you are planning a hospital birth, there is no need to rush there. Once labour establishes there are usually many more hours before baby is actually born. Signs of this stage
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Waters breaking
If your water breaks it is best to put a pad on, note the time and the colour of the fluid. It is most common for your waters to break in labour, however they can break before you go into labour. There is no need to go to the hospital if your waters break and they are the normal colour – clear, straw coloured or tinged with light pink.
If your waters break before labour starts and your baby is not born within 18 hours, there is a protocol for intravenous antibiotics once labour starts, and induction at 24 hours if labour does not establish. If you do not wish to have antibiotics or an induction you will need to go to the hospital for monitoring and discuss your desires with the on call obstetrician. (please see Group B Streptococcus pamphlet for more information).
Green or brown waters can mean baby has passed his/her first bowel motion which can be a sign baby isn’t coping with labour or has been distressed. It is important we monitor your baby’s heart rate so you will need to call us immediately. If you are planning a home birth, green or brown waters is an indication for transferring to hospital. Continuous monitoring of baby's heart (via a CTG) is advised.
If your waters break before labour starts and your baby is not born within 18 hours, there is a protocol for intravenous antibiotics once labour starts, and induction at 24 hours if labour does not establish. If you do not wish to have antibiotics or an induction you will need to go to the hospital for monitoring and discuss your desires with the on call obstetrician. (please see Group B Streptococcus pamphlet for more information).
Green or brown waters can mean baby has passed his/her first bowel motion which can be a sign baby isn’t coping with labour or has been distressed. It is important we monitor your baby’s heart rate so you will need to call us immediately. If you are planning a home birth, green or brown waters is an indication for transferring to hospital. Continuous monitoring of baby's heart (via a CTG) is advised.
Keeping labour normal and natural ways of coping
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Once labour is established it is important to stay as relaxed as possible and allow your body to do the work of labour. Move and vocalize as you need to. Try to relax your pelvic floor as much as you can (keeping your facial muscles relaxed helps). Dimmed lights and privacy are beneficial to the labour process.
As the LMC midwife I will be focussed on ensuring you are medically well. My main role is to encourage the normal process of labour and to identify if your labour requires medical intervention. Your support people are there to provide support and encouragement, offer drinks, massage and physical assistance to move in labour. I will be with you to provide reassurance and answer questions. The positions opposite can be useful in labour, your support people should be able to assist you in trying any that might help. They should also help you to focus on keeping your breathing long and regular and your muscles loose and relaxed throughout contractions. Use the “working with labour” information to give them ideas on how to help you. It can be useful to print this out to give your supports in labour. |
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Managing labour pain
There are many ways to deal with labour. Read the pamphlet to help decide which you prefer to try and which you might prefer to avoid. Water is a well known tool, as is epidural. Many women also find acupuncture/acupressure very effective. If you wish to have pain medication in labour you must request it, it is not our practice to suggest it. Use of available options is entirely your choice and they remain available even if it is not part of your original plan.
Transition
As you approach 10cms dilated you may start to feel restless and a bit overwhelmed. If you are not already at the hospital now is a good time to think about heading there. The contractions are very intense and it is really important that your support people encourage you to stay focused. This is the time many woman feel they have no more strength left or that they “can’t do it.” This is a normal and common feeling, rest assured your hormones will provide you with the energy you need.
Birth of your baby - pushing
After sometime relaxing into contractions you will generally feel a sensation of fullness or pressure in your bottom. Breathe through these contractions and focus on relaxing between contractions too, to allow your baby to descend into the birth canal. Your body will tell you when it is time to push; you will feel an overwhelming urge to bear down. Then it is time to give ALL your energy to pushing your baby out. Initially it will feel as though you are pressing your baby out through your bottom. This is exactly as it should feel – don’t resist your body. As your baby’s head presses against your perineum you will get a burning, stretching sensation. We will apply heat (warm cloths) to the area to give some relief and help assist the tissues to stretch. As your baby’s head emerges I will encourage you to be more gentle with your pushing efforts and ease baby out to minimize any tearing that may occur. Your support people will need to be quiet at that point so you can hear directions.
Skin to skin
Once baby is born the best place for them is directly on your skin. This helps regulate baby’s breathing, heart rate and temperature. We encourage as much time as possible in skin to skin contact with your baby in the first few weeks and a minimum of one hour immediately from birth. If you or baby need extra help and this skin to skin time is interrupted we will make sure you have skin to skin as soon as possible.
During this first hour of skin to skin baby will usually attempt to breastfeed, this can also encourage the birth of the placenta.
During this first hour of skin to skin baby will usually attempt to breastfeed, this can also encourage the birth of the placenta.
Birth of baby's placenta (whenua)
We encourage allowing your body to birth the placenta in the normal physiological way unless there are factors that necessitate the use of medications (including use of epidural and other interventions, or a medical/obstetric history requiring it). The cord is usually cut once it has stopped pulsing and baby has had time to transition to life outside the womb. After the placenta is born we inspected it to ensure it is complete and then you are able to keep it/take it home if you wish or leave it for hospital disposal. Read more here.
When things dont go to plan
Sometimes labour/birth deviates from what is considered normal. Our job is to encourage it back on track. If your contractions space out or if progress is slower than expected we might suggest ARM (releasing the waters around baby) and/or IV fluids for hydration. If we become concerned about the well-being of yourself or your baby we may want to involve another midwife or the Obstetric/Paediatric Team. Possible interventions include; augmentation (syntocinon drip to increase contractions), episiotomy (cutting the vaginal opening), ventouse (suction cup on baby’s head to assist birth), forceps (tong-like instruments around baby’s head if vntouse is not suitable/successful), caesarean section (surgical birth). We strive to avoid these interventions when possible and will always seek your consent if they are advised. In most cases you will be aware in advance of possible interventions and have time to discuss your options and ask questions. Most of these interventions will need to take place at a hospital.
If your labour is very long (or happens soon after another birth I have attended I may need to call on another midwife for help. Most times with this support I can stay until your baby is born. The supporting midwife will then take over care, helping with feeding and doing baby's first checks. Complicated births may need to be managed by hospital staff. The safety of you and your baby is the most important factor in making these decisions.
If your labour is very long (or happens soon after another birth I have attended I may need to call on another midwife for help. Most times with this support I can stay until your baby is born. The supporting midwife will then take over care, helping with feeding and doing baby's first checks. Complicated births may need to be managed by hospital staff. The safety of you and your baby is the most important factor in making these decisions.
The immediate postnatal period (just after the birth)
After birth we need to check if any stitches are required around your vaginal area. It is best to apply these as soon as possible. If the tear is extensive or complex we may need another person to assess and/or repair it. Local anaesthetic is used for applying stitches. Then we can help you to get baby on the breast. Baby may feed for a long while (up to an hour) and that is a good time to have a snack yourself and get to know your baby a bit more. You may be very hungry after giving birth. The hospital can provide toast and a cup of tea/milo but tasty snacks from home are usually preferred. Sending a support person for snacks is common. Once baby has fed we can do the first checks and you can get up to the shower and toilet. It is very important that you pass urine so that your uterus can contract well and your bleeding does not become too heavy. If you have given birth in hospital and all is well, you are then able to discharge home. If you prefer, you may stay at the hospital. You might want to book in to have postnatal care at Helensville Birthing Centre. Partners are welcome to stay there and they provide great support. I will need to sign a booking form so ask for one at your birth planning appointment or fill in this one. If there have been any concerns during or after your birth, we may request that you stay in hospital or transfer there for monitoring of you or baby.
Vitamin K & BCG for baby
You will be asked if you would like your baby to have vitamin K. Read this pamphlet to help you decide. It is strongly recommended.
BCG is a vaccine for tuberculosis, it is an option for at risk babies. We will discuss if your baby is at risk at your appointment. This pamphlet will explain more. FOR BCG QUERIES CALL 0800 367 224 Monday to Friday 8.30am - 5pm
BCG is a vaccine for tuberculosis, it is an option for at risk babies. We will discuss if your baby is at risk at your appointment. This pamphlet will explain more. FOR BCG QUERIES CALL 0800 367 224 Monday to Friday 8.30am - 5pm