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1 Birth Table of content s; Birth.2 Induction of labour...2 Assisted delivery..5 Caesarean section.5 Following the birth.7 1

2 Birth Where will I give birth to my baby and by what means? Every birthing experience is different. Most women in Ireland give birth in hospital, and, while not always necessary, you will have access to pain relief and technological facilities such as fetal heart rate monitoring if required. You also have expert care, rest and time to recover after birth. While complications are not common, some women do require some form of assistance during labour and birth such as; 1. When your baby is overdue. Your expected due date has past but you are still waiting your labour and birth or your baby. There are some methods you can try to stimulate labour naturally and if these are unsuccessful, you may need to come into hospital for induction, which normally happens around days past your due date. Here is some information on natural stimulation and formal induction. Natural methods; Nipple Stimulation from 39 weeks, gentle rub your nipples between your thumb and forefinger, one breast at a time for 5-10 minutes, up to 4 times each day. This stimulates the release of oxytocin, which helps your womb contract. Making love releases a hormone called prostaglandin that helps ripen (prepare) your cervix for labour. If you have a low-lying placenta penetrative sex should be avoided as it may cause bleeding. Clitoral stimulation may encourage contractions and could kick start your labour if it needs a boost. A gentle walk gravity pushes your baby s head against the cervix A long warm (not hot) bath. A hot curry is thought to stimulate the smooth muscle of the bowel and the womb. A fresh pineapple contains an enzyme believed to stimulate contractions. (Practice based knowledge). 2

3 Artificial Methods Sweeping your Membranes involves your midwife or doctor inserting a finger into your cervix and in a sweeping motion separating the cervix from your membranes. This procedure can be performed from 40 weeks onward. It is uncomfortable, some women find it painful and it can cause some bleeding. It is more effective when you are overdue. There is no increased risk of infection with this procedure. Sweeping your membranes if effective will stimulate labour. The process of induction of labour can take some time, for some women it can take hours before they are in established labour. The steps involved the induction process is the use of prostaglandin gel, artificial rupture of your membranes and the syntocinon infusion. You may need one or more of these methods to induce your labour; each step will be discussed with your prior to each examination. Your midwife will be available to answer any questions you have regarding your induction. Step One. Prostaglandin gel is administered on the labour ward. You will be monitored closely during this procedure. Your baby s heartbeat will be monitored continually (CTG) for approx 20 minutes before prostaglandin gel is given, you will then rest on the labour ward for 30 minutes followed by a 30 minute CTG, after which you will return to the ward to await events. Prostaglandin gel is inserted into the birth canal behind your cervix. The gel itself can make you feel uncomfortable and your may experience prostin pains that are similar to contractions. Your midwife will ask you keep walking as much as possible to use the effects of gravity and activity. You should not leave the maternity unit during this time and should not have a bath for a couple of hours post-gel. Prostaglandin gel can be repeated after 6 hours if labour has not already started. A maximum of 3 doses of prostaglandin may be given. 3

4 Step Two Artificial Rupture or your Membranes If the process of effacement (thinning) and dilation (opening) of your cervix has started, and you consent the doctor will break your waters. But if your cervix is not opened sufficiently he/she can repeat the prostaglandin gel. When your waters are broken your midwife and doctor will discuss your options. If your waters are clear and your baby s heartbeat is satisfactory you may be encouraged to walk around for a couple of hours until your next examination or until you are having regular contractions. Step Three Syntocinon infusion a concentrated form of the hormone oxytocin, used to stimulate your contractions through a drip in your arm. Your baby s heartbeat will be monitored continually by the electronic fetal heart monitor. Your mobility will be restricted because of the monitoring but you may be able to move from the bed to sit on a chair or on the birthing ball or stand up if you wish to change positions. If your waters break and you don t start having contractions you may need a Syntocinon infusion to stimulate your contractions. For some women, labour may slow down and a Syntocinon infusion may be used to restart your labour or boost the effectiveness of your You ve contractions. given birth what happens next? When to come in for your induction of labour? Most women will have gone into labour naturally by days over their due date, if that s not you, then you will have a induction of labour. This will have been discussed with you in the antenatal clinic and you will be given a date for when to come in. First time mothers will come in the night before their induction date at around 8pm. Second and subsequent mothers will come in, on the morning of their induction at around 7.30am. 4

5 2. Assisted delivery If you have been pushing for a long time or your baby is in distress, your midwife and doctor may discuss using one of the following methods to deliver your baby safely: Ventouse; A metal cup (connected to a vacuum pump) is attached to the baby s head. During contractions while you are pushing, the obstetrician gently guides the baby out and assists with the delivery. Forceps; Metal forceps are placed either side of the baby s head, and while you are pushing the obstetrician gently guides the baby out and assists with the delivery. Some women may experience slight tearing of the perineum area during childbirth. Your midwife or doctor will stitch any tears directly after the birth. Perineal massage can often help to reduce tearing to the perineal area during delivery, below is a guide on how to do perineal massage. 3. Having a Caesarean Section A vaginal delivery is the most common way to give birth. However, a caesarean section may be advised in certain circumstances. A caesarean section is when the baby is delivered through an incision (cut) in the abdomen (tummy). Caesarean section rates in Ireland are about 20% to 25%, currently in Cavan/Monaghan General Hospital this figure was 30.9% for Caesarean section may be planned in advance (elective caesarean section) or be performed at short notice, particularly if there are complications in labour (emergency caesarean section). Reasons for caesarean section include: Placenta praevia (when the placenta is low-lying in the womb and covering part of the womb entrance). Baby is not in the head down position (breech). Labour fails to progress normally. When a vaginal (normal) birth could put you or your unborn baby at risk. What are the risks of having a caesarean section? The following information is given to help you understand the potential complications that may arise from a caesarean section. Vaginal birth is safer than a caesarean section, whether planned (elective) or carried out as an emergency. The main risks to you when having a caesarean section include: Infection of the wound: antibiotics are routinely given at the time of the caesarean section to try to prevent this. Haemorrhage (Bleeding): which may require a blood transfusion in less than 1% of cases. 5

6 Thrombosis (blood clot) in your legs: blood clots can be dangerous if part of the clot breaks off and lodges in the lungs. To avoid this complication heparin injections and/or special anti-embolic stockings may be required before and for some days after surgery. Damage to the bladder: during the surgery there is a small risk of damage to the bladder (1 in 100 cases) or to the ureter (1 in 500 cases) and even more rarely damage to the bowel (1 in 1000 cases). This is more likely if the procedure is complicated e.g. if there has been previous surgery or massive haemorrhage during the surgery. Scar Numbness: After surgery, the patient may develop numbness around the scar. Smokers: women who smoke or who are overweight are more at risk of developing a chest infection and all other complications. Removal of the womb: Very rarely a hysterectomy (removal of womb) is necessary (1:1000 caesarean section). Death: Death is an extremely rare complication and occurs secondary to the complications of surgery, in particular, thrombosis or haemorrhage (in less than 1 in 5000 cases). Getting back to normal In general it will take about six weeks for all your tissues to heal completely. Before this time, the basic activities of life, such as caring for your new baby and looking after yourself, can resume within 12-24hrs. However, you may not be able to do some activities straight away, such as driving a car, exercise, carrying heavy things and having sex. You should only start to do these things when you feel able to do so - ask your midwife for advice if you are unsure. If you drive, check your insurance cover to see if there are any restrictions about driving after a caesarean - some companies require your GP to certify you fit to drive. After your section really listen to your body and rest as much as you can while doing gentle exercise as much as possible. Denise Future Pregnancies If you have had a delivery by caesarean section, it does not necessarily mean you will have to have a caesarean again in the future, you have a 68-72% chance of having a vaginal birth following a caesarean. You can discuss all future pregnancy options with your Obstetrician, who should take account of: Your preferences The overall risks and benefits of a caesarean section If the caesarean was carried out for a health reason that will not change in your next pregnancy, it is likely that a caesarean section will be necessary for each birth. If you want to have a vaginal birth, your healthcare team should support your decision. 6

7 Following the Birth You ve given birth what happens next? Along with the excitement there are certain procedures you may find common to all deliveries: o As your baby is being born you may get an injection of syntometrine into your leg, this will help your womb to contract, deliver the placenta (afterbirth) and control bleeding, it may make you feel nauseous and/or vomit. o If you have an intervention free labour you can request a physiological third stage where the placenta is allowed to separate naturally without any stimulation, this may take longer and you may initially have more blood loss. o Your midwife will discuss your choices with you and obtain your consent before giving you this or any other medication. o When your baby is born, the baby is delivered straight up onto your abdomen, to commence skin-to-skin contact, the cord is clamped and cut (by Dad if he wishes) o The baby is dried. o We encourage skin to skin contact to promote bonding, so snuggle your baby close to your chest, this is a great way to meet your baby, check out his/her toes and fingers, and see who he/she looks like! It also helps regulate their temperature and breathing and is very calming for them, after all this is where they have come from. o This is an ideal time to start breast-feeding. o Identity bracelets are put on - one on his/her ankle the other on his/her wrist, these bracelets match the one on your wrist and should stay on while you are in hospital. Your midwife will have checked the bracelets with you and your partner during your labour and/or before putting them on your baby. If the bracelets become loose during your stay or if you notice one has come off inform your midwife and she will replace it. A baby tagging security system is also in operation, all newborn babies are fitted with an electronic tagging alarm (on their ankle) and this will remain active until it is removed prior to discharge. o After skin-to-skin with your baby, your baby will be weighed. o You will be asked if you wish your baby to be given an injection of Vitamin K - this helps stimulate the liver to produce clotting factors in your baby s blood, preventing Haemorrhagic Disease of the newborn - a rare but serious bleeding disorder. Babies are deficient in Vitamin K at birth. o Before leaving labour ward baby will be dressed. 7

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