Notes on labour

I am compiling some notes on labour for one of my best friends since she is giving birth in about two weeks' time *yikes!* and thought I might as well share it with everyone who might be going through the same ordeal soon or in the distant future. She is freaking out (and rightly so :P) but I told her supposedly, knowing what to expect makes labour less scary and painful. I cannot vouch for truth in it but I suppose it is better than treating it like the unknown and panicking when it is happening in earnest :)

I have read a few books and what one lacks, others make up for. However, bear in mind that every individual is different and therefore will go through different pains and emotions and cannot be lumped into one category. The notes here are all general occurrences that are associated with birth and what to normally expect and mostly refer to hospital birth. I also pepper them with some Islamic knowledge where necessary. So, take them as guidelines instead of blow-by-blow instructions, so to speak.

Labour may come as early as the thirty-seventh week as the baby is considered fully-developed (full-term). When your baby is engaged (head is deep in your pelvis), then be prepared for the baby to come at anytime. This usually happens between weeks thirty-six and thirty-eight.

Make sure you have your hospital bags packed for yourself, your support person (aka coach aka birth partner; although I do believe the term ‘partner’ in this sense is used very loosely) and the baby. There is an Excel spreadsheet detailing what you should consider taking at the end of the post for reference.

When you are in labour, you may not notice its early signs. When you do notice them however, then it may occur anytime and you should start conserving energy.

Although there are claims that certain surahs and ayahs will ease labour, these are based on weak or fabricated hadeeths. There are also fabricated and weak hadeeths regarding the virtues of pregnancy such as getting more rewards than a non-pregnant person (please refer to http://islamqa.com/en/ref/121557). Allahu'alem. However, it is always good for a practising Muslim to recite the Quran as it is a form of meditation and spiritual connection. So read the Quran and its meaning as much as possible before and during (this may be a hard ask so you might want to have surahs on your music player playlist if you will be using one) labour which hopefully will aid in calming you down and thus easing labour pains.

Some people experience pre-labour contractions which are also called 'false contractions'. They are usually uncomfortable but bearable and irregular. It is, however, difficult to differentiate between these contractions and the 'latent phase' contractions of the first stage of labour, where the cervix is three to four cm dilated, so you might want to ring up your doctor or hospital for advice.

Signs that labour is ensuing:

1. The protective plug sealing the cervix passes down the vagina that looks like blood-stained mucus (called a bloody show; yes, seriously).
2. When your water breaks, it may be just a trickle or a waterfall rushing out of your vagina. 

If you notice the following, make sure you ring the doctor or hospital right away:

1. There is dark or green stain (meconium - baby's first poo) in the amniotic fluid when your waters break as this may signal foetal distress.
2. You have bright red bleeding which may be a problem with the placenta.
3. You feel or see the umbilical cord in your vagina. This means that the cord has prolapsed, which can cut off oxygen supply to the foetus due to the foetus putting pressure on the cervix entrance, hence, on the cord. If this happens, call or have someone call the ambulance, open the door, kneel down with your bottom in the air and head and shoulders down to ease the pressure.

Real contractions can be recognised when they are regular, get stronger and last longer, come closer together and harder to cope with. 

Time your contractions' (there are apps available for your phone to time contractions. Ahh the wonders of technology) length and frequency and let the doctor or hospital know.

For a primigravida (first-time pregnant woman), this is what to expect:

1. First stage - the cervix dilates to eight to nine cm which takes an average of eight hours.
2. First stage transition - the cervix dilates to ten cm, which takes further three to five hours.
3. Second stage - build up to pushing and the baby is delivered, which takes up about two hours.
4. Third stage - the placenta is delivered, which takes up to an hour if done naturally (about ten minutes if induced with oxytocin).

The average time for labour for a primigravida is about fourteen hours but can range from just a few hours to days.

These are some of the things to expect to be done to you when you get to the hospital:

1. Blood pressure check.
2. Urine sample taken.
3. Temperature and pulse check.
4. Cervical dilation check up your vagina.
5. Electronic monitoring of the baby's heart.

For some people, the first stage of labour is hardly noticeable. I have a friend who rang the hospital when she felt the contractions and was told that she should wait a few more hours before going in. When she went in, they found that her cervix was fully dilated which means her first stage was only felt in the last few hours or lasted a few hours.

If your doctor advises you to spend a few hours of labour at home before rushing to hospital, which in the case of my friend, mentioned earlier, could have meant having the baby in the backseat of a car :P), it is best to time your contractions for about an hour to gauge the length and frequency of the contractions. If they are very close together, then dashing to the hospital is the way to go. Be prepared to go back home though if you have only just begun to dilate but take your hospital bags just in case.

Once you are in the first stage of labour, you might not remember everything that you have read or has been told to you so it might help to have your support person read the notes, remind or do things for you. 

Keep your energy levels up by sucking on sweets, eating jelly, cooked fruit, dry toast or clear soup and keep hydrated by having sips of water or juice fed to you or chewing on ice chips. Eat lightly and avoid fatty, creamy and hard to digest foods. And avoid acidic and spicy foods as well. 

If you opt for any sort of coping strategies, now is a good time to have them implemented, whether a massage, aromatherapy or drugs. You might not notice the urge to pee so it is a good idea to regularly go to the toilet. Make sure to move around to alleviate discomfort and keep hydrated. Try not to expand energy anticipating your next contraction (easier said than done I am sure :P). 

If you feel intense back pains, the baby's head is probably pressing against the pelvis. You might be able to relieve the pain by doing the following:

1. Walk around, crouch, squat, get on all fours or lie on your left side in a foetal position if you cannot move to ease the pressure on your back.
2. Use a hot water bottle or ice pack or alternate between them.
3. Use a tennis ball for a massage (one of things listed as what to pack).
4. Your support person might be able to counter the pressure, which might give some relief, and also some bruises, but well worth it.
5. Drugs.

Labour positions are up to you. You may want to squat, get down on all fours, stand up or even sit. All those are okay but you should not lie flat on your back because that would interfere with blood circulation. If you have to lie down, make sure it is on your left side as this puts less pressure on major blood vessels.

Slow breathing might help during the first stage of labour. Breathe in slowly through your nose and breathe out calmly through your mouth as the contraction begins.

Light breathing should be done when contractions become stronger and more frequent. Use your upper body (instead of your abdomen) to breathe. Take light and short breaths.

The second part of the first stage (first stage transition) is often more challenging, when contractions are more painful and last longer (a minute to a minute and a half) and they come closer together. You may feel extreme temperatures, nausea or even vomit. You may also start feeling like screaming at your partner for putting you in this position. Your cervix is fully dilated at the end of this stage. You may feel like pushing before you are fully dilated but have your support person remind you to pant instead. 

Some get a latent phase before the second stage of labour before the body tells them to push the baby out. Contractions will be just as long but will be a few minutes apart. In spite of what the movies show you, using a big push while holding your breath is not recommended. Instead, use shorter pushes with each contraction, making it easier for the pelvic floor to relax and let the baby out. It might take longer but it will put less stress on you and the baby. A poo might also be pushed out, which is entirely normal and nothing to be ashamed of, not that you will be in any state to be embarrassed about anything. Grunt and moan as much as you want. Doing so might expand more energy but if it makes you feel better...

Now here comes the part every woman dreads. The baby's head will be pushing against the perineum, and this is called crowning. You will feel a great urge to push but you will be advised to stop pushing at this stage. Instead, you will have to relax your pelvic floor in order to prevent tearing or an episiotomy (a cut made on the perineum and the posterior vaginal wall). 

You will want to increase your breathing now. Use shallow breaths involving only your mouth. Take care not to hyperventilate by breathing out too much. Breathe lightly in and out through your mouth and gradually speed up your breathing. Short breaths or pants will help the baby to be delivered slowly and will put less pressure on the perineum.  Remind your support person to remind you (every day leading up to the labour if you can if you are scared stiff of anything splitting down there, which I am while typing this) to do this so that there is less chance of badly tearing up the perineum.

Forceps delivery may be employed if in the second stage of labour there are poor contractions or foetal or maternal distress. The forceps will grasp the baby's head and guide it out without injuring either the baby or the mother. 

Another instrument that might be used is the vacuum extractor. It works in a similar fashion to the forceps by attaching to the baby's head via suction. Don't worry, the baby's skull is made up of many unconnected bones which over the months will join together thus making the shape normal over time :)

An episiotomy may be done if there is a chance of tearing towards the anus. Kegel exercise done routinely might help prevent the need for this (plus other benefits including better healing post partum (after birth), better sex and preventing incontinence). 

After the head comes out (this supposedly is the hardest part), then the baby rotates and the shoulders will slide out along with the rest of the baby :)

Pics of a cute baby for motivation lol (taken from

http://25.media.tumblr.com/tumblr_lbr2fhOsGx1qzfb93o1_500.jpg)

If you are holding the baby right now, you might not even be aware of the placental delivery. Ideally, you will want to put the wee babe straight on your breast (you can do the gushing afterwards :)). This will aid the delivery of the placenta and get the baby used to your breasts and stimulate the production of milk. Uterine contraction will continue to detach the placenta and remnants of the amniotic sac. The contractions will also seal off the point of placental detachment so no bleeding will occur from that site. The placenta will be checked to make sure that it has been fully ejected and nothing grisly is left inside the uterus. They will proceed to check on your well-being, making sure there is no haemmorhage.

Then, the baby's reflex and other observations will be done. The umbilical cord will be clamped and if need be, the perineum will be sewn up. Some books refer to this as the fourth stage.

The first thing a baby should hear is the adhan and so have the father recite it in the baby's right ear.

For further information on what to do after the baby is born based on Islamic sunnah, please refer to this link http://www.islam-qa.com/en/ref/7889.

Here are the links for this post in PDF form and an Excel spreadsheet for the hospital packing lists which you can modify to suit your own needs:

1. Labour notes 
2. Hospital packing lists
3. Hospital packing lists (PDF)

If there is any questions regarding the post or the links, please feel free to contact me at horrendezvous@hotmail.com. 

To those who have gone through this, I salute you. To those who will be going through this soon, all the best and Godspeed! Ta ra~ 

References:

A Blessed Pregnancy by Sherin binti Kunhibava

Conception, Pregnancy and Birth by Dr. Miriam Stoppard

Islam QA – www.islamqa.com

Pregnancy Week-by-week by Dr. Jane MacDougall

The Practical Encyclopedia of Pregnancy and Babycare by Alison Mackonochie

Up the Duff by Kaz Cooke

What to Expect When You're Expecting by Heidi Murkoff, Arlene Eisenberg and Sandee Hathaway

Years of Reproductive Biology Studies by Me