Ten really important things about birth that noone tells you

1.             Having the continuous reassuring presence in labour of another woman, who has had a positive experience of birth herself (your mum, sister, friend, midwife, doula), seriously increases your chance of having a straightforward vaginal birth.  The government recommends all women be told this.

2.             Birth is an involuntary bodily function controlled by the autonomic nervous system, which also controls your breathing, digestion, going to the loo and other automatic functions over which you have very little control, except to stop or slow it down.  Labour will be easier, quicker and less painful if you feel safe and in control enough to let go and let it happen, letting the hormones flow and the muscles work. 

3.             When you go into labour you should stop thinking about what you have learnt and simply tune in to your instincts and do what your body tells you to do. Tune out from the world.

4.             Planning a home birth triples your chance of avoiding a caesarean, or assisted birth and also improves outcomes for mother and baby across the board, inc. length of labour and amount of pain. Everyone should at least consider this option.  After all, by planning for a home birth you are maximising your options – you can still go into hospital at any time.

5.             Cocoon yourself in labour to let the birth hormones flow freely.  You need to feel secure and in control enough to let go and let it happen. Fear makes your uterine muscles contract and labour more painful; fear releases adrenaline which slows down or stops the flow of the birth hormones. Let your birth partners be your advocates and protectors – let them deal with any hassles.  Be a queen.

6.             The uterus is a muscle and so you need to apply what you know about how muscles work best – be relaxed, breathe steadily, keep hydrated and fed.  Labour can be physically demanding.

7.             ‘Breathing through contractions’ is simply breathing out through your mouth in a rhythm.  By concentrating on your out breath, you keep your breathing steady (not holding your breath, nor breathing too fast), you get oxygen to your muscles and your baby, you will be more relaxed, and it gives you something to focus on, all of which reduces the pain.

8.             In a midwife group in London almost 80% of women (not having operative deliveries) had no form of artificial pain relief.  You can reduce pain of contractions by having good support, relaxing your body (go saggy with the pain), using distraction and positive thoughts, being upright and mobile, breathing steadily, looking after your muscle, using water, massage, and making the most of the interval between contractions (pacing yourself).  Women who think they will be able to cope report less pain than women who think labour will be unbearable.

9.             Pharmacological methods of pain relief use either muscle relaxants, mind-altering drugs, or interrupters of nerve messages.  By using the methods above to relax your muscles, change your perception of the pain, or to interrupt the pain messages, you can go longer without these, or work with them to make them move effective.

10.          It is not just important to have the baby’s head down, your birth will be smoother if the baby’s back is towards your front.  In late pregnancy there are things you can do to move the baby round; in labour, keep upright and leaning forward, moving (walking, marching, whatever your body tells you) and be prepared for a longer labour.

REMEMBER: It is your body, your baby, your birth. It is the law of this land that everything is your decision.  Health professionals can only recommend an action.  This applies to everything from where you give birth to having any treatment, including being induced.

Myth 1: Big babies are harder to birth than small babies - False

Back on the computer - children still sleeping so I get a chance. Baby has been moving a lot and giving me insomnia!

As I said in my last post - women can have a difficult time with a small baby, and others, an easier time with a large baby. A woman can have a long difficult labour with a 6/7 lb baby and then has a straightforward birth with a 9-10lb baby. This happened to my cousin who, after a long, difficult first birth to an average sized baby, gave birth to a 10.5 lb baby at home in the pool without a tear or even gas and air. Why does this happen?

The main factors are the position of the baby and the position of the woman. Birth tends to be longer, more difficult, and more painful if the baby has its back towards its mother's back (sometimes called: back to back, posterior, or OP). Most babies will turn in labour - but it can take time. It is more common in first time babies - though not known why - possibly because of tighter tummy muscles or more time spent lying or tipped back on settee, in car, or in office chair compared to second time more time spent on hands and knees and leaning forward positions (search 'optimal foetal positioning' for more info). Other positions that can mean longer or more difficult births are where the baby's head is not tucked in (more common with OP babies), where there is a hand or arm up by the head, or baby's head coming down at an angle (asynclitic).

The position of the mother makes a difference too (especially to birth where the baby is not in the ideal position). Moving about, walking, rocking your hips, being upright or leaning forward all help the baby and your body to do what it needs to do. The uterus tips forward in labour. Gravity helps the baby move down. Rocking and walking helps the baby move down and to move into the best position. It also making labour less painful as your body does not need to work harder, and because often pain in labour is there to get us to move and get into positions that help labour, we do it because it eases the pain and that is what our body wants us to do. I have heard of women doing strange movements, moving legs, or getting into positions instinctively - to relieve the pain - and that happens to be just what her body needed so it could birth the baby. Being in the warmth and support of water can help too.

Lying on your back or semi seated lengthens labour but also it reduces the size of the pelvis dramatically. Women's tailbones (cocix -sp?) are hinged (unlike men's)to enable them to move back in labour. The ligaments between the pelvic bones are softened in labour to allow them to move apart to make more room. Lying on a bed stops all this happening. Lying down also means your body has to work harder. The uterus is tipped forward as I said - but in a lying position that means tipped up. The action of the first stage of labour is to shorten and move the muscle fibres up towards the fundus (pulling the cervix open) - again, if you are lying down this is against gravity. The baby is not putting pressure on the cervix so it dilates slower, and possibly leaving a lip because of uneven pressure. The baby also has to move uphill and you will be pushing up hill.

Another effect of lying down is that it is more painful, which may cause you to want an epidural, or an epidural is the cause of you lying down. Epidurals relax all the muscles from waist down. This includes the pelvic floor. This may sound like a good thing but it is not. When the baby's head touches the pelvic floor muscles the pressure and firmness prompts it to turn its head to manoeuvre through the pelvic outlet. With an epidural the muscles are floppy and they do not support the head to move, which is why epidurals are associated with a greater need for forceps or ventouse assisted births. This is particulary significant with large babies.

Being relaxed, feeling supported and able to follow your instincts all help you to birth your baby - whatever the size. A wise obstetrican I met (whose wife had 3 home births) said it is counterproductive to talk about big babies as the best way for the baby to be born is vaginally and that is more likely to happen if the woman is not fearful.

There are two concerns that relate to big babies that are worth noting - but they do not contradict what has been said above.
Firstly - a big baby can be a result of diabetes. If the mother has had diabetes that can cause the baby to have more trouble stabilising its blood sugars once it is born. Women who have diabetes prior to pregnancy will receive additional care. There is some debate whether gestational diabetes (ie caused by pregnancy) exists and of the reliability of diagnosis and the value of diagnosis (ie how does it affect outcomes.) The concerns regarding gestational diabetes are two fold: the baby's control of its blood sugar when born, and difficulties of a big baby at birth (see above and below). It is worth noting that more than half of 'macrasomic' babies (over 4kg) are born to women who do not have diabetes.

More in part two - shoulder distocia.