Planning for the birth
Most babies are born vaginally and without assistance. Most babies are born in hospitals and are not born on their expected date.
The following information describes:
During your pregnancy there are opportunities to plan your labour and birth in such a way that lets your carers know your preferences. It is important that birth plans are flexible in case events do not go according to plan.
If you have particular requests for your labour and birth, it is recommended these are:
Ask your doctor/midwife for a birth plan form that you can complete (the Victorian Maternity Record [VMR] contains a useful birth plan template), or a guide to writing a birth plan that you can follow.
It is important to have at least one supportive companion during labour, preferably someone who can stay with you throughout. The right support in labour can make a difference to your labour and how you feel. Research has found that a support person who is present throughout labour reduces the necessity for:
Length of labour has also been found to be reduced to some extent when a support person is present.1
Support is more than just being present. Support should involve physical, emotional and social support and be available throughout your labour. During labour, a midwife will provide your clinical care, and some support. However, if you decide to have your baby in hospital, and depending on the type of care offered at the hospital, change of shifts means the same midwife may not be there for the duration of your labour.
You can choose who you would like to have with you. For example, you may decide to have one or some of these support people present during your labour:
If you are planning to have your other child/children with you during labour, you will need someone in addition to your support, to look after their needs throughout. It is advisable that children attend 'child specific' education classes prior to attending the birth.
During your pregnancy visits, you should discuss when it is best for you to contact your doctor/midwife or hospital. If you are having your baby in a hospital, also discuss when you should come into hospital. The circumstances which will influence the decision(s) include:
It can be difficult to tell when labour has started or becomes established. Your doctor/midwife or hospital staff will advise and assess you to determine whether your labour has established. If it has, some hospitals will recommend you go home to 'await events'.
It is recommended that irrespective of when your baby is due, you contact your hospital or carer if you have any of the following:
In Victoria, the majority of births take place in hospitals. For many women arriving at the hospital, meeting unfamiliar people in an unfamiliar environment can be quite stressful. It is recommended that you ask what you need to bring to hospital and visit the hospital (including birthing suite) prior to admission. Then on admission you may:
There are three stages of labour commonly referred to as:
It is essential to monitor your baby's wellbeing during labour, to ensure all is going well and to initiate appropriate action when necessary.2 During labour, your baby's heart rate will be checked regularly and may involve more than one approach.
If you have had a low risk pregnancy and there are no problems at the onset of labour, your baby's heart will be listened to every 15-30 minutes using a small hand held Doppler ultrasound device or Pinard (fetal stethoscope). This equipment can be used regardless of the position you are in. Your baby's heart will be listened to more frequently during the second stage of labour, up to and after every contraction when you are pushing.
However, continuous electronic fetal monitoring of your baby's heart during labour will be recommended by your doctor/midwife if you develop complications during pregnancy or there are problems arising during your labour.2 This cardiotocograph (CTG) involves two plastic disks (receivers) on your abdomen held in place by two belts. The receivers are attached to a machine, which may limit your movement. These are usually applied when you are sitting, lying down or standing. Some hospitals have machines that allow you to be monitored but still able to move around freely (telemetry).
Electronic fetal monitoring for 20-30 minutes on admission to the birth suite or intermittently during your labour may be recommended by your doctor/midwife when clinically indicated.
It is important for you to choose a position for labour and birth which is most comfortable for you. You will change your position many times during labour. To help prepare for labour, you might practice a number of different positions. Also, if you are having your baby in hospital, check what is available for labour, including baths, showers, birth balls, bean bags and floor mats.
During the first stage of labour, you may find that being on your side or upright (standing, walking, sitting upright, kneeling) compared with lying down in labour, improves the feeling of being 'in control'. In addition, you may find you have more efficient contractions.
During the second stage of labour, being on your back may
You may consider immersion in water to help you relax during labour and as a strategy for pain relief during the first stage of labour. Some hospitals offer the option of water birth although there is insufficient evidence to either support or discourage the practice.1
Your experience and response to pain in labour can be influenced by a number of factors, including the environment in which you give birth, the support you receive, the position of the baby and the method of pain relief used. It is important that you know about the options of pain relief available prior to labour and that your care givers know your preferences.
There are a number of non-medical and medical methods available for you to use in labour. Although some of the non-medical methods have not been subjected to rigorous research, you may find them helpful and these are unlikely to cause harm.
Non-medical methods include:
Medical methods include:
Epidural injections are the most effective pain relief available and are especially useful for women experiencing:
However, epidurals also have some disadvantages for you to consider, including:
During birth the perineum may be injured either by tearing or by cutting the perineum to enlarge the vaginal opening.
If this is your first baby, you may help prevent these types of trauma by massaging the perineum during the weeks prior to the birth.3 However, massaging the perineum during the second stage of labour has not been shown to stretch tissues and therefore does not reduce perineal injury.1
An episiotomy may be needed during the last part of the second stage of labour if:
Episiotomies should be performed only if needed. They should not be 'routine' as they do not reduce the risk of severe perineal injury, urinary stress incontinence, trauma to the baby or improve perineal healing.1
Last updated: 2 September, 2010
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