The delivery

With Central Otago Midwives professionalism and years of experience you are in good hands, also during the time of your baby’s delivery. We consider a good delivery one on which you can reflect positively, whether this was a normal vaginal delivery in primary care setting or a more complicated one in hospital environment. The most important thing is that you and your baby get a good start. You will receive guidance throughout this process. Before it is time to deliver we will have thoroughly screened, informed and prepared you for this special event. This process starts at intake gathering your history and general medical health details and it continues during every single antenatal visit collecting observations and adjusting care on these as necessary. Once you have had an anatomy ultrasound at 18-19 weeks of pregnancy we will start discussing your labor and delivery in more detail. Together we set up a plan. Your central Otago Midwife will take time to listen to your (previous) experiences and needs, fill you in with the appropriate information and discuss your labour and delivery options.

Preparation

Despite you can’t predict how your delivery is going to pan out; you can prepare yourself on what is going to come:

Search for information. Read the pamphlets provided during the

• antenatal visits and look up some books. There is a lot of information on the Internet. Don’t forget to ask your Central Otago Midwife any question that you may have!
• ake some time off in the weeks leading up to your delivery. Wind down and rest.
• o (together with your partner) to antenatal classes.
• iscuss your wishes and any plans you may have with your Central Otago Midwife.
• rrange who you want present for the birth of your child and who you want to look after your family/whanau.
• Pack your bags in time so you safe your partner some last minute stress 
• We always say it is the husband’s task to make sure there is enough patrol in the tank to make it to town!
• ave your car seat organized early and installed in your car.

Stages of labor

A delivery doesn’t usually go like you see in movies. Its progress can be described in several stages and before we discuss pain relief we will take time during the antenatal visits to explain these stages to you.

• Latent phase The cervix is the opening to your uterus and consists of strong connective tissue. Because of this strong tissue your cervix won’t open and this helps you to carry your pregnancy to 9 months. When you go into labor, contractions help to shorten, soften and open the cervix a little (3-4 cm). This is the longest stage of labor and for this you need strong regular contractions that are roughly 6-7 minutes apart. During this stage the contractions are manageable. For this reason it is advised to keep yourself distracted. If you are planning to deliver in Dunedin Hospital this is the best time to travel.
• Active phase The active phase starts from about 4 cm onwards. Most often your body tells you to work with the contractions during this phase e.g. breathing the contractions away. They are more frequent roughly 3-4 minutes apart and last longer. In a first time pregnancy the cervix dilates about 1 cm an hour. Your partner will notice that you are more concentrated with the contractions and that you are less interested in conversation. Whilst monitoring your and your baby’s well being, your midwife will support the two of you finding ways to help you cope with the contractions e.g. positional adjustment, using water and massage. Sometimes extra pain relief is required. If you are planning to deliver in the primary unit in Alexandra this is the time to come in.
• Transitional phase This is the most intense phase of your labor to deal with the contractions. Luckily this is also the shortest stage! The head has descended far enough in the pelvis to be feeling the contractions more in your back. An urge to push is slowly building.
• Pushing stage Finally you can give into that urge to push. You are pushing those contractions away and for that reason a lot of women find this stage a little more pleasant. The end is near, but still can be hard work. Most first time mothers push for about 1 ½ hour. When it is your second or third baby this often goes much quicker. We will continue to monitor the progress and the well being of yourself and your baby. You can count on your Central Otago Midwive’s experience to coach you through this stage and come with suggestions and actions to keep everything progressing well.
• Your baby is born! When your baby is delivered you, your partner or your midwife will place the baby directly on your abdominal/ chest area. We cover you and your baby with a nice warm towel and as long as your baby is doing well won’t intervene. We recommend to leave the cord pulsating until the placenta has separated and is ready to be delivered. During this stage we’ll keep an eye on your blood loss and on how you are feeling. Once the cord has stopped pulsating the cord will be clamped and cut by the person of your choice. During this stage you will see your baby pinking up and becoming more alert. It starts looking around and is picking up your warmth and smell. Your baby will be looking for your nipple and will want to latch on. The warmth of your skin is the ideal place for baby to be in. Your baby’s temperature and sugar levels are well maintained and the first breastfeed will enhance baby’s well being. This nipple stimulation is also very beneficial to you as it helps to release the hormone oxytocin that contracts your uterus, separates the placenta and reduces your bleeding. Sometimes it is necessary to help the uterus contract. This can be when you are at risk for severe bleeding after delivery. In this case an oxytocin injection in the leg can be given. We keep the baby placed with you and when it has had some good time with you and a feed we will check the baby out. A weight will be taken as well as the measurements. Sometimes you can have a vaginal/perineal tear. Your midwife will check for any tears and depending on the extend will suture with good local anesthetic. Usually after a normal vaginal delivery you and your baby stay in the delivery room for up to 2-3 hours. After a shower a clean bed will be waiting for you in one of the postnatal rooms.

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Pain management

Every woman when pregnant wonders how she will cope with giving birth. It doesn’t matter if it is your first pregnancy or perhaps your third baby. Every pregnancy and baby can be experienced differently and with that comes a natural amount of doubt. How bad will it be? What if I can’t handle it? Giving birth hurts. There is no denying, it is a simple fact. But every birth is different and so is every woman. Some women handle pain better then others. And for some who thought they have a low pain threshold are surprised by their capabilities. There is no way of predicting. But don’t worry too much: there are several ways to relieve the contractions and dealing with the labor. There is medical pain relief and there is natural pain relief whether you are in a maternity home or in larger hospital environment.

A few facts about contractions and pain:

• Your body naturally produces painkillers The pain caused by contractions is special. You only feel it when laboring and giving birth. It tells you about the impending labor and birth. You now know to look for a safe and quiet place where you feel emotionally comfortable being. It tells you to look for help. Your body will respond to this by making endorphins, these are produced to ease your pain.
• Contractions come in waves A contraction is a uterine muscle tightening. You can compare these with waves washing ashore; they build in strength and as the are at their highest point ease off. Between the contractions your uterus releases and you have a break.
• The pain isn’t always as bad Labor has different stages. The first stage is called the latent phase. This is the longest and most manageable stage of labor. In the beginning the contractions are not so painful and there is space in between them. Then the time between the contractions becomes closer. They become more intense and cause more discomfort. You are working hard with it. This is called the active stage of labor and doesn’t last as long as the latent phase. Finally, you feel that an urge to push is building and these are pushing contractions that are part of the transitional stage. This is the most intens phase but the shortest phase of labor. Your body then tells you to push and you feel good doing this as you are pushing away these strong surges.

A few tips to help you through labor naturally:

• Find distraction At the start of your labor don’t focus on the contractions as they are usually very bearable at this stage. Keep going with whatever you were doing or find distraction. Watch TV, listen to music or when you would like to deliver in Dunedin Hospital… travel.
• Listen to your body and adjust with a position that is comfortable to you When you get into the active stage the contractions become stronger. It can become more difficult to relax. Position yourself in whatever way you feel more comfortable; find that position in which you can relax. E.g. You may sit yourself on a swiss ball and during a contraction rock your hips. Or lean on a table or chair. With contractions located in your back it may feel good to take the gravity off your back and place yourself on your hands and knees. Some women find walking around pleasant or stepping the contractions away. Try not to tens up keep calm and breath slowly. When you hold your breath you tens up and pain can be felt more intensely.
• Try to keep yourself warm and comfy Placing warmth on a sore area helps to relieve. Ensure the temperature in the room is pleasant and dress comfortably. You can use hotties on your back or abdomen. You can use water. The pool is there to help you relax and cope with the labor as well as using the stream of the shower.
• Think positive Feel confident that you can deal with this. Count the contractions down: this contraction has been dealt with, brings me closer to giving birth and wont return. You are getting closer to the end. Towards the final stage it will become harder and you will doubt yourself again. We will encourage you and help you through it.
• Concentrate on your breathing Keep calm, breath in slowly counting to four.
• Use your support crew (partner, whanau, midwife) Some women like it when someone pushes their two fists on the lower back or massages. Try it out and inform people whether you like it or not so much. Some people like to be left alone.
• Birth TENS machines In our small practice we have the TENS machine available to our clients only. From experience we can say TENS has really worked for many. The pads of a TENS machine are placed on your lower back. You operate the TENS machine yourself and this gives you a sense of control and also distraction. When experiencing a contraction you press ‘boost’ and with that a strong pulse is released. It feels like someone who is pushing strongly on your lower back. This releases endorphins in the spine and it helps you to cope with contractions for longer. It has no harmful affects on you or your baby, but you can’t use it in combination with water. We supple the machines for free. The pads can’t be re-used and therefor you can purchase the pads on: www.babycaretens.com

When the natural ways to help you cope with labor are not sufficient for you, you can receive support with medical pain relief options. Depending on the setting in which you are giving birth there are the following options:

• Gas or Entenox This is a mixture of nitrous oxide gas and oxygen, which you breathe through a mouthpiece. It is commonly used in normal vaginal deliveries to help women through their labour. Entenox only takes the edge of the pain, not the complete pain. There are no known side affects to baby, as this does not cross the placenta. It works very quickly and you are in control of using it. You can still easily move around and even use it when going into the pool. The disadvantage is that the gas can make you feel sick and give a feeling of light-headedness. It is advised to keep yourself hydrated as using the gas can dry your mouth.
• Pethidine injection Pethidine is administered by means on an injection in your thigh. Pethidine is morphine derivate and works within 30 minutes. Like Entenox it only takes the edge of a pain away, it numbs the pain. It can make you feel sleepy and some women may even fall asleep. This can be pleasant if you are not able to relax yourself at the start of your labor. This medication does cross the placenta and therefor does have possible side affects on your baby. The durations of its effectiveness is about 2-4 hours and for this reason it is not given when you are in well established labor as it is more likely that baby will experience the side affects once it is born e.g. difficulty breathing, drowsiness and struggling to latch onto the breast. Another disadvantage is that you are less aware of the birth due to drowsy and sleepy state you might experience.
• Epidural analgesia This is an injection with a combination of analgesic medicines in the lower back. An epidural takes away the pain in the lower part of your body, and with that the pain experienced with contractions. The anesthesiologist inserts a needle in your lower back under regional anesthesia. You have to arch your back and lie or sit still. Through the needle a thin flexible catheter is inserted. When this is positioned in the correct place the needle is removed by the catheter will remain. Through this catheter the analgesic medications are administered during labor and delivery. There are a few advantages and disadvantages to this way of pain relief. Advantages include no experience of pain during contractions (95%), no harmful effects on the baby, no side affects like sleepiness or drowsiness and with that you will be fully aware of the birth. There are also disadvantages to the use of an epidural. It can delay your labor and delivery process. Sometimes the contractions need to be enforced with medications. When you are fully dilated and it is time to push, the baby’s head pushes on the sacral area with which you feel a natural urge to push. This sensation with an epidural is affected and with that delivering the baby can take longer. This increases the chance of needing assistance delivering the baby instrumentally. After delivery you can’t mobilize for a period of time and are bed ridden, as there is not enough sensation in your legs to support yourself. Due to the loss of sensation you are also not aware when it is time to empty your bladder and therefor with an epidural you will also be given a urinary catheter.

What to bring to hospital

• We recommend packing your bag timely and keeping your car filled with patrol so that you can drive in once to hospital when necessary. Clothing for your baby 2-3 sets. A wrap, hats and booties.
• Comfortable clothing for yourself during delivery and after to go home in. Your nightgown and slippers. Nursing bras
• Warm socks for yourself
• Nibbles and water bottle
• Toiletries for yourself and your partner. A few maternity pads for travel. Both hospitals provide maternity pads whilst staying.
• A few nappies and wipes for baby when travelling. Both hospitals provide nappies when staying.
• Formula and bottles when you intend to formula feed
• Nipple cream
• Photo camera
• Chargers
• Car seat
• Maternity notes
• A few coins for car parking.