Delivery Day: what to expect

It will certainly be a day to remember but the day you give birth might also be one of the most nerve-wracking.

‘Every woman has concerns, especially the first time,’ says Guay Ong of the Royal College of Midwives. ‘But having a baby in hospital is extremely safe and you’ll be surrounded by a team of trained staff all doing their best to help you.’

Having some idea of what happens when you arrive at hospital – perhaps in pain, often in the middle of the night – can also help set your mind at rest. Most units offer advance tours, which can help mums-to-be and their partners familiarise themselves with the labour ward. Understanding what takes place when you get there can also ease the pressure. Here, we’ve put together some information to help take some stress out of your impending big day.

Before the birth

When to go to hospital

‘As rule of thumb, ring the labour ward when your contractions are five minutes apart,’ says Guay. ‘But there’s nothing wrong with calling earlier if you’re anxious.’ The midwife will ask you how you are feeling, when your contractions started and how intense they are, plus how your pregnancy has gone in general. Based on your answers she will then give you some idea of when to set off.

WE SAY When you feel your first contraction, remember there could be hours, even days, before you give birth. Use the time before going to hospital to check you’ve got everything you need in your hospital bag – including your maternity notes.

When you get there

Most women head straight for the labour ward. From there you’ll be sent to an admissions room ‘triage’ – where a midwife will assess how advanced your labour is.

‘Ideally, hospitals try to make sure you have the same midwife right through birth,’ says Mervi Jokinen of the Royal College of Midwives. ‘However, whether this is possible depends on the length of your labour and a midwife’s shift (anything between seven and a half and 12 hours).’ The midwife will check your notes and ask whether you’ve had a ‘show’ – a plug of mucus, often tinged with blood, in your knickers, which is a sign labour has begun. She’ll want to know if your waters have broken, whether contractions have started and how frequent they are. She’ll also check your blood pressure, pulse, temperature and urine. Your midwife might carry out a vaginal examination to find out how many centimetres dilated you are.

WE SAY This is the time to run through your birth plan, including your preferences on pain relief – although do keep an open mind.

You might be sent home…

…if your midwife doesn’t think you’re in ‘established’ labour: at least 3cm dilated. She’ll ask you to come back when your contractions are two to three minutes apart.

WE SAY Be assertive. ‘If you don’t want to go back home, tell your midwife,’ says Guay. ‘Stressed mums-to-be are sometimes allowed to stay.’

After the assessment

If you are in established labour, you’ll be asked to change into the outfit you’d like to give birth in and directed to the labour suite. This is usually a private room.

WE SAY Have something to eat and drink. ‘You need to keep your strength up,’ says Mervi.’ Eat something light, such as a banana.

During labour

A midwife will regularly check your pulse, temperature, blood pressure, urine, cervix and the baby’s position and heart rate. If everything is going according to plan, you’ll be left for your labour to progress.

WE SAY Some labours are as short as four hours, others as long as 40. Have magazines and your iPod with you to pass the time.

Induction

One in four women needs her labour to be started artificially – if, for example, you are more than 10 days overdue. You might be offered a ‘sweep’, a gentle stretch of the cervix, which aids the release of hormones associated with the spontaneous onset of labour. If this fails, the first stage in hospital is to try a vaginal pessary of prostaglandin, an artificial version of the hormone that causes your uterus to contract. If this doesn’t work you’ll be put on a Syntocinon drip, which is an artificial form of the hormone oxytocin. Your baby’s heartbeat will be monitored with a cardiotocograph (CTG) machine throughout labour if you are induced.

WE SAY Be patient. ‘Women who have been induced often expect to have their baby immediately, but this often isn’t the case,’ says Guay. ‘You might need more than one pessary, and induction can often take a day or so.’

If labour slows down

Sometimes contractions slow once you’re in established labour. If that happens to you, your midwife might ask a doctor about augmentation, or speeding things up. This will prevent you becoming exhausted and your baby getting distressed. If your waters haven’t already broken they can be artificially, with a hook – this is known as an amniotomy – or you might be given a Syntocinon drip. Your baby’s heartbeat will be monitored with a CTG machine throughout.

WE SAY Contractions can get very intense after an augmentation. ‘Remember your breathing techniques and talk to your midwife about ways to deal with the pain,’ says Guay.

Pain relief

Entonox (gas and air) is the most popular choice, while others opt for an opiate, such as pethidine, given by injection. A third of women have an epidural: an injection into the spine that blocks feeling from the waist down.

WE SAY Before pain relief, try other options. ‘Walk around, sit on a birthing ball if you have one and ask your birthing partner to massage your back’, says Guay. ‘These techniques might sound simple but they can really help you to relax naturally.’

Forceps and ventouse

If you’re too exhausted to continue pushing, your contractions have slowed down or your baby’s heart rate shows she’s in distress, your midwife might decide on an assisted delivery with either forceps or a ventouse. A ventouse is a vacuum device with a suction cup, which is attached to your baby’s head and helps guide her out. Forceps are surgical tongs that hold the baby’s head, allowing her to be turned or pulled out quickly.

Some women will need an episiotomy: a surgical cut to their perineum (the fleshy ‘bridge’ between your bottom and your vagina) to give the baby extra room.

WE SAY Remember you’re in safe hands. ‘These procedures are usually carried out by an experienced doctor, so the chances of problems are minimal,’ says Mervi.

After the birth

Immediately after delivery, your baby will be patted dry and checked by your midwife, who will place her straight onto your chest for ‘skin to skin’ contact. She’ll check whether you need stitches, then will offer you an injection of Syntometrine, a drug to speed up delivery of the placenta and prevent excessive bleeding. Your baby will also be offered a vitamin K injection to prevent rare cases of bleeding in the days after birth.

WE SAY Some women love immediate skin to skin contact, others prefer their babies to be clean when they hold them for the first time. Let your midwife know your choice.

The postnatal ward

After a vaginal birth you’ll stay in the labour suite for one or two hours, where a midwife will weigh and measure your baby, give you stitches if necessary and take you for a shower. You’ll then be shown to the postnatal ward, which you’ll share with around three other new mums and their babies. If you’ve had a caesarean you’ll be taken to the recovery room until you get some feeling back in your legs, then moved to the postnatal ward.

WE SAY If you have any questions or concerns about what happened during your labour, bring them up with your midwife now. ‘The last thing she wants you to do is go home feeling unsure or unhappy about what you’ve been through,’ says Mervi.

Before you go home

In the hours after birth, midwives will check on you and your baby and help you to breastfeed. Home time varies from hospital to hospital and according to whether you or your baby need any extra care. The average stay for a first-time mum is 48 hours. Before leaving hospital your baby will be checked by a paediatrician or a midwife who’s qualified to carry out a newborn exam.

WE SAY Bring up any concerns you have about the days ahead with the staff now. And remember, a midwife will most probably visit you at home the day after you leave hospital. Good luck!

From first twinge to last push, our online guide covers every stage in more detail at askamum.co.uk/birth/givingbirth