Q: We don’t have a car so we’re planning to get a cab home from the hospital. Do we still have to have a car seat for the taxi and if so how do we know which one will fit?
A: The law states that all babies and children must be secure when travelling in cars, and there is a lot of advice and information on car seat and travel safety available from The Royal Society for the Prevention of Accidents (see www.rospa.com ). Rospa highlights that child seats can be used in taxis and private hire vehicles in the same way as in any other car, and that some drivers or companies have child seats available. You would need to check with the taxi firm in advance. You can use your own seat, but you must make sure that you know how it works and how to make sure it is secure. Some companies are willing to hire out car seats and it may be useful to check with your local maternity unit whether they have that service available. If you are borrowing a seat from a friend, you need to reassure yourself that it meets the safety standards recommended and that any seat involved in an accident has been thoroughly checked for damage. If you are in any doubt, then don’t use it – and never travel with your baby just in your arms.
Q: Several pregnant friends have had difficulty getting into the birthing units of their choice, as they seem to get booked up quickly. I’m currently trying to get pregnant, so how early do I need to be looking at my options and where do I find information?
A: Birth centres provide an alternative setting for healthy women anticipating a normal birth, enabling them to make their own birth decisions. They can be free-standing or sited within a hospital, and are run by midwives. Research has shown they have benefits for women and midwives, including shorter labours, higher normal birth rates, fewer interventions, less use of drugs for pain relief and greater satisfaction with the birth experience.
You need to think about what types of birth experience you would like, and then you could discuss this with your midwife early in your pregnancy. If the birth unit is booked up, you may want to consider having your baby at home, or look at what facilities are available in the maternity unit.
There are a number of websites that provide further information about birth centres (such as www.birthchoice.com , www.drfoster.co.uk , www.nct.org.uk and www.rcm.org.uk ), but it’s best to speak to your midwife about what is available, while recommendations from friends may also be helpful. Be aware that information from websites may not be monitored.
Q: Is there any differences between the various makes of TENS machines? What is it important to look out for?
A: Many women find TENS (transcutaneous electrical nerve stimulation) useful in helping with the pain of labour. Some women use TENS on its own, while others use it in conjunction with gas and air, or pain killing drugs.
TENS machines generally consist of 4 pads (electrodes) which are placed on either side of the lower back, and a gentle electrical stimulus is passed through the pads. It is thought to work by blocking the pain sensation pathways and encouraging the release of the body’s natural painkillers, endorphins.
It is best to apply the pads in early labour, as it can take up to 40 minutes to encourage the release of endorphins. Most TENS units have a variable frequency, which means that the intensity of the sensation can be gradually increased as needed. Using TENS in early labour can enable the woman to stay at home longer, where she may also feel more relaxed. TENS can also be used while walking about, and being mobile may shorten the length of the labour.
There are a variety of TENS units on the market and they are all very similar. A unit that enables you to alter the frequency of the current is useful, and it is essential that the machine meets British and European safety standards. Many hospital and antenatal clinics have TENS units to borrow, and some companies will hire out the machines at minimal cost. Your midwife will be able to advise you on what is available in your area.
Q: I live in a very rural and remote area and it takes up to an hour to get to our nearest hospital. Ambulance crews have found it hard to reach our house in the past and I am worried about being stuck without any professional help when I go into labour. Could I be induced at an appropriate time to ensure I’m in the hospital for the birth?
A: There are a number of things you can do in preparation for labour – you need to discuss the options with your midwife and doctor. Labour usually starts gradually, with the contractions coming about 10 to 15 minutes apart; babies are rarely born so fast that you would not be able to reach the hospital in an hour – and this is especially true for first babies.
Once you think labour is starting you can call the hospital and advise them that you are on your way. Alternatively, you could ask your midwife to come to the house so she can assess the progress of labour and if necessary, travel in the ambulance with you for additional reassurance. If you need to rely on an ambulance to take you o hospital, you will need to discuss with them in advance about where you live and how to find your house. This information can be made available to all the emergency crews.
It may be possible to consider inducing labour when you get close to term. However, you need to consider the disadvantages of an induced labour where there are no medical indications. It may take a few days for labour to start following induction of the body is not favourable. In addition, the contractions tend to be strong from the start, and his can make the labour more painful.