Childbirth

Childbirth, also called labour, is the act or process of giving birth. Every birth is different and unique even from one pregnancy to the next.  Australia is one of the safest countries to have a baby due to the high standards of staff training and quality of facilities available.

At Eve Care we are acutely aware of the privilege and responsibility of sharing this very special day with women and their partners.  There is something about a new life coming into the world that is unrivalled by any other human experience.

We work with women to make the birth special and safe for them, their partners and their babies and create an environment in which they feel safe, cared for and heard.  It is impossible to predict exactly how everything will unfold so if you gain as much knowledge as possible and work out your preferences in advance it may reduce the uncertainty. 

The process of normal childbirth/labour is categorized into 3 Stages:

First Stage

This stage commences with the beginning of tightenings/contractions and the cervix (neck of the womb opening until it is fully dilated (open). This stage is usually the longest part of the labour and is further divided into early labour and active labour.

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  Early labour: In early labour, the cervix is softening, getting shorter and opens up slowly.  Women may experience a “show” which is the mucus plug coming out mixed with blood. The duration of early labour is unpredictable and can take longer than 12 hours and is usually longer for first delivery and shorter for subsequent deliveries.
• Active labour: During active labour, the cervix dilates more rapidly, and the contractions stronger, closer together and lasting longer. The transition phase is considered as the last part of active labour when the baby starts to move down into the vagina till it hits the pelvic floor and causes an urge to push.

Second Stage 

The second stage is when a woman starts pushing till the baby is born.  It again lasts longer with first than with subsequent births.  At the end when the head starts to emerge or crown, you will usually be asked to stop pushing to allow the head to be born slowly so that there is a smaller chance of a tear.  After the baby’s head emerges the rest of the baby’s body is delivered soon afterwards.

Third Stage

This starts from the birth of the baby till the placenta is delivered.   We will usually give you an injection to speed up this process and to prevent bleeding. Once the placenta is delivered we will massage your uterus to minimise bleeding.

How to recognise labour

A woman is in labour when she has regular painful uterine tightenings/contractions and the cervix is changing (ripening or opening).  There are a number of ways in which it can start.  Unfortunately, we are still unable to predict exactly when labour will start and it can be difficult even for seasoned professionals to be certain if what a woman is experiencing is early labour, let alone for a first time mum!  Often the best thing to do is for a woman to call us (Eve Care or the hospital) to discuss her symptoms if she is not sure.

Antenatal classes

We recommend that women and their partners attend antenatal classes as they provide an excellent education that has been shown to prepare them for birth and to dispel unnecessary fears and anxieties. 

Birth plans

When thinking about a baby’s birth, things to consider are:

• Mode of delivery i.e vaginal or caesarean section
• Pain relief
• Support person/people
• Special requests/preferences
• Specific concerns and anxieties, most will be addressed  before birth during your surgery visits
• What to take to the hospital
• When  to go to the hospital, where to go, who to call

Originally written birth plans were introduced at a time when women had no say in what happened at the birth of their children.  At a time when partners were not even allowed to be present doctors and midwives made all the decisions.  It played an important role as women were fighting for the freedom of choice that exists today.

A birth plan is not essential and it can never replace ongoing communication between women and their caregivers as it cannot take account of every possible scenario.  It can help to make her wishes clear to her caregivers and we find that we can accommodate most requests relatively easily.  A birth plan that is too prescriptive or inflexible may increase anxiety as childbirth is a dynamic process and when things do not go according to the pre-prepared plan women can feel out of control.  We keep women informed throughout, explain our findings and assessment of the labour every time things change and will always discuss any concerns we have with you. That is one of the main benefits of having a private delivery is that you can choose and get to know your doctor while you are pregnant.  (At Eve Care we encourage women to also meet the other doctors on the on-call roster in case your chosen doctor is not available, even though this is an uncommon experience.) If you do decide to draw up a birth plan, make sure you discuss it with your doctor or one of our midwives.

Electronic Fetal Monitoring(EFM)

EFM is done by tracking the baby’s heart rate on a monitor. (Also known as a cardiotocograph or CTG).  By looking at the heart rate, variability (short term variation in heart rate), accelerations(transient increase in heart rate), and decelerations (transient decrease in the heart rate) we can tell if the baby is getting enough oxygen.  CTGs are not always easy to interpret so doctors can look at the CTG remotely on their phones or computers if the midwives have concerns. 

Induction of Labour

Induction of labour is where childbirth is brought on before it starts naturally.  It can be done for medical reasons for instance when a pregnancy goes more than one week past the due date if the baby has growth restriction when the mother has preeclampsia or diabetes.  Women can also request to have an induction of labour at or after 39 weeks.  This is called a social or maternal choice induction.

To do an induction your doctor has to artificially rupture your membranes/break your water and we then start an Oxytocin infusion.  Oxytocin is the same hormone that the body naturally produces during normal labour/childbirth.  If the cervix (neck of the womb) is not yet open enough to break the waters, we either use medications (eg  Prostaglandin gel or tape, Misoprostol tape) or a balloon catheter.  The baby has to be electronically monitored during an induction.

We know from studies that inductions do not increase the risk of caesarean section and reduce the risk of the caesarean section if it is done in women who are more than 41 weeks.

Group B Streptococcus (GBS)

GBS is a bacteria that can live as a commensal in the human bowel and the vagina.  It can cause disease in adults such as urinary tract infections and even serious infections but this is very rare and usually easily treatable with antibiotics.  A newborn baby, on the other hand, has very little resistance against GBS and can get very sick very quickly.  To protect them from GBS we do rectal and vaginal swabs at around 36 weeks on all women who plan to have a vaginal delivery.  All women who test positive are given antibiotics in labour or after their membranes have ruptured. Penicillin is the antibiotic of choice and if allergic we usually give Clindamycin.

Doulas

Unless you do not have any other support person available, we discourage you from spending money on a doula.  During the birth, there will be a midwife with you at all times to support you and your doctor (or if not another Eve Care doctor) will be available during the labour and present during the birth.  Midwives are trained and experienced professionals and chose their profession because they have a passion for helping and supporting women during the labour and birth process.  In our experience doulas are variable in their skill level and ability to support women.  Because you do not need to be a  registered health professional to be a doula, practically anyone can put their hand up and frankly some have no idea what they are doing.  They claim to advocate for women but may make the communication with a woman and her partner difficult because we have to explain to the doula what is happening and then wait for her to explain it to you.  If they are not conveying the correct message or give women incorrectly and sometimes contrary medical advice, it creates confusion and anxiety.   If you have concerns that your opinion or wishes will not be honoured during birth, please discuss it with your doctor.  Taking your support person to antenatal classes with you will empower them and relieve your anxiety because you know they will be there with you.