Q: I went overdue with my first and second babies, and had to be induced. I’ve since heard from friends that midwives can do membrane sweeps to encourage labour along. Is this only available in some parts of the country, or should I have asked for it?
A: There are a number of reasons why labour needs to be started artificially, but the most common is going past your due date. Most women will go in to labour naturally within two weeks either side of their due date.
However, if the pregnancy goes beyond two weeks, the baby may not receive as many nutrients, as the placenta becomes less efficient. This is the reason why your doctor might suggest induction: approximately 20% of women will have their labour started. The National Institute for Health and Clinical Excellence (NICE) is looking into the procedures for induction of labour. One of the recommendations is likely to be that all women are offered a membrane sweep at around 41 weeks. This involves a vaginal examination, and the midwife will then try to ‘strip’ the membranes. This will hopefully lead to an increased production of prostaglandin, the natural hormone that helps to establish labour.
The procedure should not be painful, but some women do have a small amount of ‘spotting’ afterwards. This is normal, and some women experience some period-like pains before their labour starts. It does not work for all women, but the evidence suggests that membrane sweeps will reduce the need for drugs to start labour for many. If you discuss it with your midwife, she will be able to give you more information about it.
Q: My husband, mum, and 2 sisters want to be in the delivery room for the birth of my first baby in a month’s time. Will a hospital allow this?
A: Having your first baby is an exciting time and it is nice that you have the support of your family. Labour can be quite tiring and may last several hours. Women who are calm and not distracted in labour tend to have effective contractions which help the birthing process. When there is a lot of activity, noise and excitement, and the woman is worrying about what is happening around her, labour may be longer as contractions would be less efficient.
While some women feel reassured at having their mother or sister near, birthing you baby is not necessarily an event to be watched over by the family. Many maternity units have a guideline of only one other person attending. One reason for this is that hospitals do not have large delivery rooms. Another concern about too many people is a potential increased risk of infection. It is important to think about what you want and who will give you the best support.
If pregnancy is straightforward and considered by the midwife or doctor to be low risk, you might want to think about having your baby at home – then you could decide who is with you. Bear in mind that while it is nice to have family near, giving birth is an intimate experience, which many women choose to share with their partners.
Q: There’s a male midwife on the staff of my local hospital and I’m not sure I’d feel comfortable giving birth with a man I don’t know assisting. Can I request a female midwife instead?
A: There are increasing numbers of men entering the midwifery profession and they receive the same training as female midwives, and will be able to offer safe and sensitive care and support.
However, if you are uncomfortable with a male midwife, talk to your own midwife before you go into labour, and also record your preference on your birth plan. Labour is exciting and sometimes challenging time and it is important that you feel comfortable and safe with the midwife providing your care. It is not unusual for women to make requests about the care they receive in labour – some women prefer not to be attended by male doctors or medical students. Your care will not be compromised. However, it is important to be aware that sometimes, possibly due to staffing levels or emergencies, it may not always be possible to grant your request.
Q: My husband is really squeamish and isn’t keen on being at the birth of our baby. I feel I need him there for support – and also to witness what I’m going through! Should I insist he attends?
A: Having partners at the birth is a fairly new phenomenon: 30 years ago this was considered the domain of women. That said, many couples are comforted by and enjoy this shared experience. However, some men find watching someone they love in pain very distressing and this can be made worse by fears of fainting or being unwell. It is not a good idea to ‘insist’ that he is there, but you should talk to your midwife and try to identify a plan that suits you both.
Your husband can offer you support during the first stage of labour, and if he feels squeamish later, you could call on a friend or relative to stay with you during the birth (knowing that your husband is close by). Many dads have concerns about not being able to ‘cope’ with the birth, although when the time comes they are keen to stay and support their partner. Your husband doesn’t have to see the baby being delivered: he can concentrate on talking to you and offering reassurance. If he feels under pressure he may not be able to give you the support you need, and you may spend more time worrying about him than yourself.
Q: I’m keen to give birth at home, but I am concerned should anything go wrong. What equipment would a midwife use to monitor my baby, and for resuscitation?
A: Women who choose home births describe the experience positively. They tend to feel more relaxed and in control. The midwife will have discussed the risks associated with labour and delivery with you, and it is important to advise the midwife if you know of factors that may affect you, such as previous difficult birth. All women are monitored in pregnancy, and if yours is low-risk, the potential problems for home birth are few.
But unexpected problems can arise, at home or in hospital. Your midwife will have been trained in emergency procedures for both you and your baby. Most midwives attending home births will have oxygen and suction apparatus, which may be used if the baby is slow to breathe. Once you start labour, the midwife will assess your progress at home, and as you approach the second stage, may call in an additional midwife. The midwife will have advised the local maternity unit of the home birth, so urgent help will be available. In an emergency, the midwife will stay with you and the paramedic crew have other emergency equipment.