The first thing you’ll see when you walk into the labour ward is a reception desk where a receptionist will greet you and ask for your antenatal notes, so make sure you remember to bring them with you. It’s always a good idea to ring before you turn up, as it helps the midwife in charge of the labour ward plan ahead. You’ll be allocated a midwife from the team on duty to look after you and then shown to a room to get comfortable.
Meeting your midwife
The midwife assigned to your care will want to get to know a bit about you. Depending on how strong and frequently your contractions are coming, she might need to do this pretty speedily! She’ll read through your antenatal notes as it’s important to quickly establish if there have previously been any concerns and then she’ll take a history from you. She’ll want to know things like your due date, when your contractions started, how frequent the contractions are, and if your waters have broken. This is your opportunity to show her your birth plan and talk through any particular requests you might have.
Once you’re settled into the labour ward and have had that initial chat, the midwife needs to do some basic medical checks to establish that there are no concerns over you and your baby. You’ll be asked if she can take your blood pressure and test your urine, in just the same way as your midwife has been doing at your antenatal appointments over the last few months. She’ll also take your temperature and pulse and, assuming that you’re at least 37 weeks, she’ll ask if she can do a vaginal examination as well.
Your vaginal examination gives the midwife lots of essential information; from the position of the baby to how low down in the pelvis he is. It may also be encouraging to hear what progress you’re making. Being told how far your cervix is dilated, for example, can reassure you the contractions aren’t in vain. Usually the midwife will ask you to sit semi-upright on the bed, bend your knees and let them flop open. Assuming that your contractions are strong, regular and your cervix is at least 4cm dilated, she’ll confirm that you’re in labour.
To be honest, you’ll probably know that you’re in labour by how you’re feeling but the examination will give you a ‘baseline’ and might even help you make a decision about pain relief depending on what stage of labour you’re at.
Feeling your bump
Next the midwife will do some external checks to see how your baby’s lying in the womb. She’ll feel your bump and measure from the top of the bump to your pubic bone to give her an idea of the size of your baby and how he’s lying (for example, head down or back to back). If you’re considered low risk, she’ll listen to your baby’s heartbeat using either a pinard (a bit like an ear trumpet) or a hand-held ultrasound machine so that you can hear it too.
Tests over, you might want to talk pain relief. The first method that you’re likely to be offered is a nice warm bath. It doesn’t matter how many centimetres dilated your cervix is, when you feel you want some help, your midwife will run you a bath or offer you the birthing pool, if it’s available. She’ll listen to you and support you throughout your labour and advise you on pain relief depending on what stage you’re at and how well you’re coping. You may also be offered gas and air and/or an epidural or an injection of painkillers. This is a continual process throughout your labour, her watching and listening to how you’re feeling.
Once the midwife has confirmed that you’re in labour, she’ll discuss your birth plan and your options with you. She may take you to the birthing pool if that’s what you’ve chosen. If you’re coping well with the contractions, she might suggest that you have a walk around the labour ward as keeping upright and mobile helps labour to progress normally. If you’re still in the latent phase of labour (very early on), she’ll suggest that you go home and return later when the contractions are stronger and more regular. Some women who live a long distance from the hospital or have previously had a very quick birth may be given the option of staying at the hospital at an antenatal ward for a few hours until labour becomes more established.
Using the loo
Don’t listen to tales of how the midwife will give you an enema to make you open your bowels – it doesn’t happen any more, although it used to be routine many years ago. If you’re feeling uncomfortable as you haven’t been to the loo for a couple of days, she might give you a suppository (tablet into your rectum) but won’t routinely offer this. Your bowels will probably have a natural clearout before labour begins. Your midwife will encourage you to take frequent wees though as a full bladder can slow labour down. Some labour rooms have en suites but many still have separate toilets.
Throughout the first stage of labour your midwife will be listening to your baby’s heartbeat every 15 minutes. That’ll go up to every five minutes during the second stage. If anything causes concern, such as your baby passing meconium (opening his bowels), you’ll be advised to have his heartbeat continually monitored. The midwife will frequently check your blood pressure, temperature and pulse.
Not all babies are delivered by the midwife that you first meet and have those initial checks with. It’s a question of timing – if you’re in labour for a long time, one midwife’s shift can end and another’s can begin.
If that happens, there’s no need to worry. The first midwife will have recorded all your blood pressure and pulse checks, as well as the frequency of your contractions, so that if someone else takes over the care or needs to be involved they can see at a glance the progress that’s already been made.
When you’re in established labour, you’ll be given your own private space to give birth in. Some women choose to get on the bed and adopt various positions but others prefer to stand and lean over the bed, or kneel on the floor. If you’re using a birthing pool, the midwife will ensure the temperature is right. After the birth, your midwife will check you and your baby over to make sure you’re both OK. You’ll be encouraged to cuddle your baby against your skin, and feed him if he shows interest. You’ll be offered a drink and a light meal, such as tea and toast, and will be able to have a shower before being either discharged home, or to a postnatal ward. How long you stay in the maternity unit depends on the sort of birth you’ve had, if there are any concerns about you or your baby and also how much support you’d like.
“I turned up at the labour ward and had to go to a triage (assessment) area so that a midwife could examine me. Once she’d confirmed that I was in labour, she called another midwife to take over my care and accompany me to the delivery room. That was my room right up until the birth, and a couple of hours after it too, then we got transferred to the postnatal ward.”
Krysyna Jasinski, 21, from Corby, mum to Alina, 3 weeks
Anne says: “Some units have a triage area so that women who aren’t in established labour can initially be assessed by a midwife rather than take beds on the labour ward before they need to. They will then be advised what the best action is – for example, to go home or transfer to labour ward.”
“When the midwife examined me, she said I was only 3cm dilated but as I was contracting regularly she suggested that I walked to the hospital canteen rather than go home. An hour later a porter was pushing me back to labour ward in a wheelchair, with a baguette on my lap! Ellie was born 40 minutes later.”
Karen Willon, 30, from Salisbury, mum to Declan, 3, and Ellie, 2 months
Anne says: “The midwife thought it was best not to send Karen home, particularly as it was her second baby, and to stay close to the labour ward. I imagine she hadn’t expected labour to progress quite as quickly as it did, but the length of labour can be unpredictable, particularly when it’s not a first baby. An alternative would be to go the antenatal ward and await events, although most women feel more comfortable going home until labour becomes more established.”
Once it’s been confirmed that you’re staying on the labour ward, your midwife will ask if you want to get changed into different clothing or stay as you are. Many women bring a large T-shirt or nightie to wear for labour, but it’s entirely up to you what you wear.
Food and Drink
As long there are no anticipated problems you’ll be encouraged to eat and drink during your labour. Food and drink on the labour ward might be rather limited so take in a supply of high-energy drinks and snacks.
Shifts vary at maternity units around the country, but the most common shift pattern is that of early morning until early afternoon, afternoon until late evening and then the night shift.
Midwives do frequently have to hand over care to the midwife on the next shift, and women who have a long labour, or are induced, may see several midwives. If the birth of your baby is imminent at the end of a shift, you may find that the midwife caring for you stays on a bit longer to be there for the birth.
Whichever midwife is in charge of you, you can expect to have checks at around the following intervals:
- Baby’s heart rate every 15 mins
- Mum’s pulse every hour
- Blood pressure, temperature every four hours
- Offer vaginal examination every four hours
- Continual assessment of your position and your emotional needs
- Baby’s heart rate every five mins
- Blood pressure and pulse every hour
- Continual assessment of your position and also of your emotional needs