Labour is unpredictable. Women who have never had a vaginal delivery before may not to know what to expect. Women who have had previously had a vaginal delivery might expect a replica of their previous labour. The truth is; labour is unpredictable. Each woman experiences labour differently and each baby's birth is unique.
That being said, women are often quite keen to come up with a birth plan. In my NHS Trust, there is a space in the handheld records for women to write their thoughts on their labour. It is quite vague, but prompts women to consider some of the things that they will have some control over. Here is a look at some of the things in labour which women might like to think about beforehand.
Who will be there?
Women will no doubt have planned whom they will have as a birth partner. Quite often, this will be their partner who is generally the baby's father. But some times, this will not be the case, whether for cultural/religious reasons, or because there is no father or for any other list of reasons. It is important that the woman choose someone who is going to be there to support her, not just someone who wants to be there so they are the first to see the new baby. Women should also consider who will go with her if she were to go to theatre. It will only normally be one of her birthing partners.
In addition to the birth partner, women may also wish to consider if they will have a student present. This will usually be a student midwife, but could be a student nurse or a medical student. And although I have never seen it, I presume it could also be a paramedic student, as paramedics sometimes end up delivering babies. Some women I have spoken to are under the impression that if they give consent for students to be present, there will be a long line of them at the end of the bed, just staring. This is not the case. There will only be one student present (although a medical student did come in for the actual delivery of one of the deliveries I did; she met the woman beforehand, and she was happy for this). Quite often, the student will only have one woman in labour, whereas the midwife may have more than one. This means that the woman will receive constant emotional support from the student whilst the midwife may have to pop in and out to look after more than one woman. The student may or may not be hands on with the delivery. A brand new student may just be there to observe and will do very little else other than chat to the woman and her birth partners, whereas a more senior student may provide most of the care, under supervision of the midwife. Regardless, though, the midwife and the student will seek consent before each procedure, such as vaginal examinations. Even if the woman consents to a student being present, she can decline for the student to also examine her.
Where will the birth take place?
There is no reason why a first time mother cannot give birth at home. A recent study (called the Birth Place Study) has found that low risk women who have babies at home are at a lower risk of a negative outcome, with the exception of first time mums, who have a slightly increased risk, although this is not statistically significant.
At home, women often feel more relaxed and as a consequence, there is better release of the hormone oxycontin - this is the hormone that causes the contractions. There is less risk of interventions and the woman can guarantee that the midwife will only have one woman to look after. There will also be a second midwife called for the actual delivery.
Women planning a home birth or a delivery in a birthing unit or midwife led unit, however, must be aware that there are certain times when transfer to hospital will be advised. Women should be prepared for this outcome, and should listen to t he advice of the midwife.
Will the baby be placed skin to skin?
Skin to skin, where the baby is placed, unwrapped, next to the woman's skin is great for bonding. It helps initiate breastfeeding for those women who are planning to do so, and helps the new born baby control their breathing, oxygen levels, temperature and heart rate. It is recommended that the mum and baby should be left like this, undisturbed, for up to an hour. However, some women do not like the idea of this, as the baby may be covered in some blood, vernix and liquor, and prefer for the baby to be dried down and wrapped up before being given to the woman.
How will the placenta be delivered?
Women can either chose to have an active or a physiological third stage of labour. The third stage of labour is the delivery of the placenta and control of any bleeding. There are two options; firstly, the woman may have an injection of syntometrine or syntocinon. This causes a large contraction and the placenta detaches from the uterus and is delivered with the help of the midwife. The other option is to allow it to happen naturally. The cord is left, attached to the baby an dis not touched by anyone. The woman's body will cause contractions to deliver the placenta. This may take as little as five minutes or as long as an hour. The midwife will observe for any bleeding, and may recommend the injection if there are signs of bleeding.
Will the baby have Vitamin K?
Vitamin K is essential for clotting. Research has shown that some new born babies are deficient in Vitamin K, putting them at risk of bleeding. This is known as Vitamin K Deficiency Bleeding, or Haemorrhagic Disease of the Newborn. Consequently, all parents are asked if they would like their baby to have Vitamin K. This can either be given as an injection shortly after delivery, or by mouth. The injection is given once. The medication by mouth has to be repeated on day 5 and, for breastfed babies, on day 28 also.
The research, however, is old, and was done with women having poor access to Vitamin K rich food. There are no recent research studies in to new borns and Vitamin K.
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