For many of us, when we are pregnant and preparing for the birth of our baby, we are aiming for a ‘normal’ labour, we want as natural and as straightforward an experience as possible. But with an unplanned caesarean rate of 14.8%, an assisted delivery rate of 12.5% (Birthchoice) and a growing epidural rate of 30% – what affects how labour flows and how we manage our contractions
As a mother of three and an antenatal teacher with 12 years experience, I passionately believe that good antenatal classes are an important part of pregnancy – to inform, provide practical information and skills, to support and to reassure. There is a lot to be said for knowing about and trusting the birth process – of believing we can do it and this does go a long way to deal with anxiety and fear but this is only part of the story, so what can affect how labour flows and our need for pain relief and interventions?
If your baby is back to back/posterior you may experience a longer labour with a continuous back ache – this can be harder to manage than the contractions, which will provide us with a pause in-between. The back pain will ease when your baby is in a better position – to ease the backache and to encourage your baby to move, move around and lean forward to get the weight of your baby away from your spine.
Babies can sometimes turn into a posterior position during labour, which could affect how you dilate, how your baby moves through the pelvis as well as how you feel and manage your contractions.
Spinning Babies provides a wealth of information
Patterns of contractions…
Labour can sometimes be tough – it can last longer than you thought and the contractions can be more powerful or closer together than you expected, which can cause you to feel overwhelmed with fear and anxiety and you will need some good support to keep going and to stay positive.
Remembering why your contractions need to be so powerful – to bring us your baby – can enable you to stay positive and focused. Walk around, move, lean in to someone, breathe through your contractions, use gas & air, use water. If you are distressed and tired, you may need an epidural to help you continue positively.
Where you labour…
The environment in which you labour can have a huge effect because it needs to make you feel safe and relaxed, it needs to be somewhere you can allow your body to relax, let go and do what it needs to do to dilate and birth your baby.
For some women this will be at home, for some it will be to stay at home for as long as possible before moving into hospital and others will want to get to hospital as soon as they can. If you are going into hospital you may need to nest, to make the room yours – making it comfortable and a workable space for you to move, relax, feel safe and birth in. Bringing in familiar and comfortable items such as a birth ball, a blanket and a pillow can make a huge difference. As can listening to music – especially if it is music you relax to.
The positions you use need to feel comfortable and right for you – if you are on the bed and it doesn’t feel right move around the bed or get off it and, if you have an epidural, move around on the bed.
The people around you – birth partners and midwives…
In order for you to feel safe, secure and relaxed you need the people around you to be confident, calm, relaxed and respectful of your needs. Chances are, you will need to be listened to, to be supported when you need it, to be left alone when you need that too, to enable you to listen to your body, to do what feels right – you may need some love and some nurturing.
If you feel scared, uneasy, unsure what to do, under pressure or rushed – chances are you will be tense and producing adrenaline, you may feel more pain and your contractions may slow.
So, as part of your birth preparations, it can be useful to think about where you want to give birth and who you want to be with you – a birth doula can be an ideal additional birth partner to provide continued support and, for some women giving birth at home, they want an independent midwife.
And it’s worth remembering that when you go into hospital, you probably won’t know your midwife so you may need to communicate if you need more/less support from her – she’s not a mind-reader so it is easier if you tell her what you need.
Not knowing what’s going on…
Information about how your body dilates and what it needs to help that process is powerful – it underpins why your body is contracting, why your body needs you to move and get into different positions and why your breathing can keep you calm and give you more control.
It is also useful to remember that there is no right length of labour – it will be what it will be, it is unique to you, this is your birth.
If induction gives your body a little nudge to labour, then labour could be like any other spontaneous labour but if your body and babies are not ready for labour, it can be a tougher battle – with the synthetic oxytocin, contractions can be strong and closer together which can be hard to manage if you haven’t experienced a build up of contractions. There can be the pressure of time limits and closer monitoring, which can make you feel disconnected to your instincts and what your body is trying to do.
You can help yourself by staying upright, moving around and listening to your body. Focusing on your breathing can help you connect and, if you need more support, you may need to ask for it! Trying to stay calm and focusing on each contraction rather than feeling under pressure to dilate can also be beneficial.
Having an epidural…
Epidurals can provide much needed relief for some labouring women and it can work brilliantly but it can also affect your contractions – so synthetic oxytocin could be used – and it can affect the birth of your baby as a caesarean or an assisted delivery with ventouse or forceps may be needed.
If you have an epidural, it is just as important to have gravity on your side. Rather than lying back on the bed in a semi-recumbent position, it can be helpful to have the back of the upright, so you are sitting up, or lying flat on your left side so you can rest and encourage your baby to get into or to stay in a good position for birth.
Epidurals can be managed so that when you are fully dilated, it can be beneficial to you and your baby to hold off pushing (assuming you can’t feel the urge to push) to allow you to conserve energy and to allow your baby to move down through the pelvis. The theory is that your body will move our baby down through the pelvis so we will start to push when your baby is closer to being born.
When you push, moving around on the bed to maximise the space in your pelvis – it is possible with some help – and getting gravity on your side can make you feel better connected to your body and to help you push to birth your baby.
How your baby handles the labour and birth…
The unknown element of labour and birth can be how your baby copes with the contractions – thankfully, most babies are healthy and birth beautifully given the time they sometimes need. If your baby doesn’t cope well with the contractions – maybe due to induction or lying down on the bed for too long or because they are just not handling the contractions or their journey down the birth canal – they may need to be birthed by caesarean or with ventouse/forceps.
Slow your breathing down to stay as calm as possible
If you feel overwhelmed in this way, chances are you are tense, you could be in pain and your contractions may not be working as efficiently to help you dilate, slowing your labour down.
This is where good support, information and being able to be open about how you are feeling is so beneficial. Using your breathing to slow your heartbeat will help you think, it will stop your body producing adrenaline, it will enable you to communicate and listen to your body and your instincts so you can get your head back in the right place to labour and you can feel able and back in control again.
Tips from mothers
- Someone gave us advice that my husband should not be afraid to ask questions to the midwives, as he would be the one seeing, hearing, worrying, enjoying the birth while I was drugged up… if we did not understand anything just ask… Sometimes when we are in the professionals hands we think “they know best” so we keep quiet with our thoughts and questions…but it was his baby and wife. We had the most amazing midwives delivering the baby and not only did they keep the hubby informed they gave him lots of cuppas also
- Being at home, using a TENS then water later on. Probably only person ever to say this, but having a birth ‘plan’ was fantastic. It helped me to focus, weigh up options in advance and meant the fantastic midwives knew exactly how I wanted to be supported. But that’s me – I do like a good list.
- I found it helpful to believe my body could do it. Your classes /reading books & ignoring people’s horror stories aided this. A midwife & husband who genuinely also believe you can do it are invaluable especially around 4-5 centimetres when those first big powerful contractions hit & you realise you’ve never been in real pain!
- Pain wise the birthing pool, low lighting and gas & air kept me calm and focused
- Birth plan. Helios homeopathy birthing kit. Fantastic antenatal teacher in London. Reflexology. Husband with good strong arm to massage lower back. Stubborn belief in the power of the uterus!
- I think that every little thing we hear, see and do since we get pregnant affects how we labour! If you hear something that sticks in your mind it might pop out during labouring and make you fearful.
- Being at home as long as possible kept me calm enough to deal with it, up to 5cm no pain relief… Then an epidural helped with the rest.
- A good supportive network during birth (well informed partner, good midwives) were all essential for me. And being informed yet flexible when it came to my choices helped me relax, personally I think good antenatal classes were vital for me as it gave me the confidence and support I needed to birth at home whist not being fearful of other interventions if they were to be needed.
- Being at home made for an amazing experience especially with hands off midwives it’s the only ‘shortish’ labour I’ve had.
- What didn’t work was being adamant about not having an epidural, what did work was having the epidural!
- Hypnotherapy, tens machine and pool helped me – although pool knocked my contractions off at the end. Knowing that I needed to stay calm and stop my adrenaline to help my contractions and believing that I was doing what I was designed for. Ended in a drug free text book birth and I was over the moon
- So glad we did your fab class as we were prepared but it all went out the window. Tens machine did help though and swearing A LOT
- Reading up about baby positioning, being at home, controlling my breathing and having a fab partner and midwives helped for numbers 2 & 3.
- Both for my labour & emergency c-section and for my prep for planned c-section the key things that made a positive difference were: my husband being there; having lots & lots of information to help me know what was happening & to make decisions; breathing to control pain, anxiety, flashbacks etc; having a sense of trust in those caring for me (by feeling understood and that they would try to make it as positive an experience as possible). Little things like choosing music, clothes for the baby etc helped in the run up to both births, but were pretty immaterial during labour & c-sections in the end.
- My birth plan went out of the window from the minute my waters broke so I wasn’t ‘allowed’ the water birth I had hoped/longer for. I was extremely disappointed but with it being my 1st baby I went on the advice of the professionals. Contractions were much more painful than I envisaged and next time I will take more control on breathing but I found the pushing stage really empowering and with the support of a fantastic husband and amazing midwifes and supportive classes delivered by your good self I was able to deliver a beautiful healthy baby with limited pain relief. You have to trust in your body and the people around you, I used a tens machine throughout the labour and they really helped.
- Having a medical condition, I was limited to how I was going to labour – I wanted to be in a bath/water birth but wasn’t allowed, however because both my husband and I are a bit older from having the first two children, I did sort of get the labour/birth I wanted for my 3rd baby, but that was down to the midwives! Through all three labours I have had fantastic midwives who have talked/been very supportive and felt like they were in my corner helping rather than against me! My husband was also a very good support who would make sure I was ok! My breathing helped with my pain but it took until having my second baby to realise how to ‘breathe’ through the pain!
A specialist in pregnancy, birth and early parenting