When should I go to hospital in labour?

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At the sight of your feet become obscured by the burgeoning of your blossoming belly, you’re likely to be feeling more than a little excited at the prospect of baby’s arrival.

But before you pop open the bubbly, there’s still the actual birth hurdle to negotiate. And on that note, if you have waded through a stack of pregnancy and birthing books and are still a little apprehensive about many aspects of your impending labour, wouldn’t it be ideal to have access to a simple set of facts about what you can expect on the big day? Well, here they are!

How will I know when I am actually in labour?

If you are somewhere near the late third trimester of your pregnancy, you are probably waiting for a sign to tell you that labour has begun. The truth of the matter is that labour is different for every person. And while some women develop very obvious signs to indicate that their labour has commenced, others may have a more subtle experience.

An early indicator of a pending labour may involve a change in the appearance of your belly. This occurs as your bub moves down from under your ribcage and settles in the pelvis in preparation for delivery. This sign is called ‘lightening’ as it is associated with a release of pressure on your diaphragm, and provides you with a sense of breathing a little easier.

As labour commences, you may experience a trickle, gush or flood (in true Hollywood style) of clear or pink-tinged fluid from your nether parts. This spontaneous rupture of membranes (or ‘breaking of your waters’) occurs when the amniotic sac surrounding your baby ruptures. Some women are concerned that they may confuse their waters breaking with a ‘wee’ accident, as urinary incontinence can occur during late pregnancy. However, bear in mind that amniotic fluid will not smell like urine. If you do notice an odour, as a safe measure it is best to mention this to your caregiver.

Labour contractions are a further sign to inform you that your baby is on her way. Although these may start off as vague low back or period-type pains, as labour contractions develop, they will occur at regular but increasingly shorter intervals, and become more intense and longer as they progress. Additionally, the thick mucus plug that sealed off your cervix throughout your pregnancy will come loose. At this time, you may notice the appearance of a blood-stained blob-like or stringy vaginal discharge. This is called the ‘show’ – however, despite its name, this sign may be missed if it is passed when you are on the toilet.

When should I go to the hospital?

This is a common concern for just about every imminent mum. On the one hand you want to get the timing right so that you can receive the care and assistance you require; but on the other hand, you don’t want to arrive at the hospital prematurely only to be advised to promptly return home. As a general rule, if you feel that labour has commenced, it is best to call your doctor, midwife or hospital contact number for guidance.

During your pregnancy, your doctor or midwife will have advised you about who to call and when. This is the time to use that information! Bear in mind that there will likely be some nervous excitement in your household at the prospect of a pending labour. To prevent a frantic, fumbling search for important numbers, it may be helpful to attach these to all telephones in your house right now. If at any time you have concerns about your health or your baby’s wellbeing, it is best to bypass time taken on the telephone in favour of going straight to the hospital for assessment.

Who will be with me during labour?

An essential issue to consider now is who you would like standing by your side (apart from your obstetrician and/or midwife) as you undertake one of the most wonderfully significant experiences of your life. You have several choices available to you, including your partner, a family member, best friend, and labour coach or doula. When you think about it, your labour support person (or people) requirea few crucial qualities.

Firstly, they need to be able to provide you with support and comfort during this exciting and very exhausting time. They also require loads of energy and stamina to keep you encouraged and clearly focused during the long haul. A good, strong hand to withstand regular, tight clenching is an absolute must, and it is also essential your supporters understand your birth preferences so that your choices and needs are respected throughout. It is helpful to discuss your birthing intentions with your ‘team’ prior to the big day.

'''What does an internal exam involve, and what does it show?'

''' During labour, the cervix opens or dilates in preparation for your baby’s debut in the world. In order to assess how your labour is progressing, your doctor will monitor your cervical dilation by performing an internal vaginal examination or ‘internal exam’. This is usually done after a contraction finishes (and when you give the go-ahead!). It involves your caregiver inserting 2 gloved fingers into your vagina to examine your cervix. Dilation is measured in centimetres – from 1 to 10cm. A fully open cervix is 10cm dilated. Apart from measuring cervical dilation, an internal exam also provides important information about whether the cervix is soft and stretchy (or ‘ripe’), how thin (or ‘effaced’) the cervix feels, and whether the baby’s head is lying in a favourable position for delivery.

How will I control the pain during labour?

While labour is generally a painful process, it may help to remember that ‘pain is gain’, and with each contraction and push, your baby is one step closer to being born. Simple comfort measures such as breathing techniques, lower back massage or water therapy (with a bath or shower) may help minimise the pain. Your support person plays a vital role in encouraging and comforting you through this time, and it is helpful if he or she has good massage hands.

In addition, there are several medical pain relief choices (such as gas, an injection or epidural) to help with pain control during labour. While some women are concerned that they may miss the boat for pain relief if they wait too long, bear in mind that there are a variety of medication options available, depending on your stage of labour. Although you do not need to make final decisions about pain medication now, it is advisable to discuss this topic with your caregiver so that she can assist you in achieving your birthing wishes throughout each stage.

What will I be doing after my baby is delivered?

After your little one is born, and before you pack up shop for the day, your next task will be to deliver the placenta, which has served as your baby’s life-support system for all those months. The birthing of the placenta is helped by ongoing contractions which help to detach the placenta from your uterus and expel it through your vagina. Once passed,the placenta and attached membranes will be carefully examined to ensure that nothing has been left behind. Bear in mind that, as essential as delivering the placenta is, you will most likely be less focused on this stage of labour, as your eyes will no doubt be unwaveringly trained on your new baby.

What will happen to my baby after birth?

Once your baby has arrived you will have the opportunity for a skin-to-skin, love-at-first-sight meeting. Be prepared: she will be quite wet, red and messy upon arrival. The umbilical cord will be clamped in two places and then cut. This important task may be performed by your partner, if he is willing! As the cord contains no nerves (similar to your hair and nails), this is a painless procedure for you and your baby. However, it’s helpful to pre-warn your partner that the cord is often thicker and tougher than expected (it has been likened to cutting meat gristle).

While you and your newborn are falling in love, she will be wrapped in a warm blanket and observed by your caregiver to make sure she continues to be well. At one and five minutes after birth, an Apgar evaluation will be done to assess your baby’s breathing, heart rate, muscle tone, reflexes and colour. She will be briefly whisked away to have her weight, length and head circumference measured too. Very shortly after birth, you may attempt your first breastfeed with your new baby. Although you are likely to feel exhausted at this time, don’t forget to give yourself a few claps of praise – you have done so well!