Worried about labour?

Our midwife helps de-stress you before b-day by answering all your questions about labour and birth…

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Try to worry about tearing or stitches

Q. I know that some women poo during labour and it’s really putting me off a water birth. How likely is it to happen in the pool?

A. It’s true that lots of women open their bowels during labour, and you might feel the urge to poo in the second stage as that’s when your baby will be putting more pressure on your rectum.

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But try not to worry, as if you do poo doing during a water birth your midwife will deal with it quickly and discreetly by putting a sieve into the water and removing any debris. In fact, you may not even realise that it’s happened.

Some women will often get diarrhoea before labour starts, so if you do open your bowels in the water it’ll only be a very small amount. The best thing to do is try not to get too tense about it as fear and holding back will just make you feel more uncomfortable, and the only person who’ll notice is your midwife, honestly.

Q. Everything I’ve read says that the water around the baby in the womb is the same colour as urine, so if my waters break how will I know that I haven’t just wet myself?

A. The simple answer is, you might not be sure. The amniotic fluid around your baby
is the same colour as urine and sometimes when women leak a bit of urine (common in pregnancy due to the pressure on the pelvic floor) they’re confused as to whether or not their waters have broken.

The difference is waters tend to trickle, whereas urine is often just a one-off – particularly if you cough, laugh or sneeze. They’re not the same smell either. Amniotic fluid has an aroma of almonds. If you’re in any doubt as to whether your waters have broken, contact your midwife who will ask the right questions to tell if your waters have gone. If she’s still unsure, she can suggest a speculum examination – a bit like a smear test – where she looks inside the vagina and around the cervix to see if there’s amniotic fluid there.

Q. I’d really like to avoid tearing and stitches when I give birth. Is this possible?

A. Unfortunately, you can never guarantee you’ll avoid tearing but there are things you can do to reduce the likelihood.

If you’ve had stitches before, there’s evidence that massaging oil into the perineum (the area between the vagina and the anus) from 34 weeks of pregnancy can reduce the risk of tearing again. On the other hand, if you have an epidural you’re more likely to need a forceps birth, which would involve an episiotomy (cut). To avoid this, try to remain as mobile as possible in labour to encourage contractions.

When it comes to the birth, try to breathe your baby out rather than doing almighty pushes. This helps to control the exit of your baby’s head, reducing the risk of tearing.

If you have a small tear involving skin and not muscle, you might not need stitches, but even if you do, it won’t be as bad as you’re expecting.

Q. I’d really like to have a home birth, but I’m also worried about it. Is it too risky?

A. The evidence is that if you’re considered low-risk, then giving birth in your home is just as safe as in hospital. The Department of Health supports home births for low-risk mums-to-be and recognises that by staying put, labour is more likely to progress normally and less likely to need intervention. So, by opting for a home birth you significantly reduce the risk of ending up with a caesarean section, forceps or excessive bleeding.

Ultimately, the most important thing about choosing where to give birth is that you want to feel as relaxed and in control as you can. For some women that means being in her own home, with her own bath, TV, and as many birth partners as she wants, but for others this means being in hospital with doctors available, in case she needs them. To find out more about home births, log onto www.homebirth.org.uk and also find out if there’s a local support group where you can talk to other mums who’ve been through it.

Q. I’m worried I’ll get so exhausted during labour I won’t be able to carry on. How will I cope?

A. It’s true that some women do experience the feeling of ‘I can’t do it anymore’ and want to give up during labour. It tends to happen during what midwives call the transition stage. This is a time between the first and second stages of labour, close to the birth, and it affects women in different ways.

Some women find that having had strong, regular contractions they suddenly stop. This makes them downhearted as they feel labour’s grinding to a halt. Instead, it should be seen as an opportunity to rest and gather energy, ready for when the contractions return. Whether you experience this stage or not, what’s important is that you’re given support and reassurance at every stage of labour, so make sure you have a good birth partner on hand. And bear this in mind too – if you do get that feeling of ‘I just can’t do it anymore’, chances are you’re really close to meeting your baby.

Q. I’m hoping to just use gas and air for pain relief as I’m scared of needles. Is it effective and how does it make you feel?

A. Officially known as Entonox, gas and air is a mixture of half oxygen and half nitrous oxide, also called laughing gas. Most women say it takes the edge off the pain, making them feel light-headed, while conscious enough to remain in control. A big plus is that you administer it yourself by breathing through a mask or mouthpiece, so you can control how much you have and when. It takes about 30 seconds of breathing the gas for it to kick in so it’s important to start using it as soon as you feel a contraction building. By the time the contraction is at its peak, you’ll receive the full effect.

If you’re scared of needles, gas and air isn’t the only option though. Water is hugely effective pain relief – either a bath or a birthing pool – so you could try this first and then wait until you really feel that you need something else as gas and air could get you through the last bit of labour.

Q. I’m 18 weeks pregnant and am already worried about the birth, as I hate the thought of the indignity. Can I opt for a c-section?

A. Unfortunately, unless you have a medical condition that means you need a c-section, you won’t be offered one on the NHS. You can request one, but as vaginal births tend to be safer, the consultant would have to consider your reasons for doing so.

You can pay to have a c-section privately, but this can cost thousands of pounds. The best plan is to find ways to make you feel more comfortable at the birth, like trying a hypnotherapy class for labour beforehand. If you’re worried about exposing your private parts, get a long nightdress so you can pull it down when you need to. Make sure you state that privacy is important to you in your birth plan too, so your wishes can be accommodated as best they can.

Q: My mum’s labour was two hours but my sister’s was 20! How long does the average labour last?

A: There really isn’t a typical labour. The first one does tend to last longer though, while the position your baby’s in, what pain relief you use and your take on when things actually started will also have an impact.

With your first baby, once you’re in established labour – the onset of strong, regular contractions where your cervix starts to thin, soften and open – the cervix dilates at about 1cm per hour, but it’s still considered normal at half that rate. Once you’re 10cm dilated, the second stage can last around two hours, or longer, particularly if you have an epidural. Keeping upright and mobile so your baby’s head is pressing on your cervix can help your contractions and will also help him on his journey through the birth canal.

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Labour is completely unpredictable, which is what makes it so exciting, so focus your energy on preparing yourself mentally and physically by taking regular, gentle exercise and consider yoga or relaxation classes.

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