NHS Forth Valley

No matter how much you prepare, it is hard to know how you will actually feel when you are in labour, so it is a good idea to think about your options beforehand.

Labour pain is very subjective, meaning that each woman will experience and cope with pain differently from the next woman. Labour pain and contractions/surges will also change in sensation, frequency and duration, so you may consider trying a variety of different methods of pain relief to help you work with or through your labour.

How labour works

There are a lot of hormones that influence labour, but the main ones are:

Oxytocin is the hormone that causes the uterus to contract during labour. It is also known as the “love hormone”, which is released when we feel good and safe with partners, friends or family. Your body will be producing this hormone during labour.
Endorphin (Beta endorphin) is the hormone that is released in times of pain or when we feel very intense sensations and is a natural equivalent of painkilling drugs. This hormone will help you feel less discomfort during your labour.
Adrenaline (Catecholamines), the fight or flight hormones, are released when survival mode is needed is situations of danger or stress. This hormone may interfere with oxytocin during your labour and also after birth.

Why is this important?

Sometimes during labour, you may encounter situations that can make you feel stress or out of control, which could interfere with your labour. This can happen when you move from your home to the hospital. You move from a place that makes you feel safe to a place that is unknown to you. It also may happen if you are experiencing pain and are not able to cope with it. Knowing this, you and your birth companion and the maternity staff can use techniques to make your surroundings feel safer and to assist you in coping with labour.

How contractions work

Contractions are regular tightening of the womb, which usually begins gently, builds up to a peak, and then tails off. These open your cervix and move your baby down the birth canal. The different sensations and levels of pain are different for each person. Some may feel some cramping, some may feel the abdomen tight, some may feel pressure, or some may feel all of those. If the sensations are very intense, they may make you experience fear or stress, which will make your body release adrenaline, and this can make your muscles more tense (including the uterus).

This tension can make those sensations more intense and will lead to the cycle starting again.

Breathing & Relaxing Techniques

Breathing and relaxation techniques help you cope with pain and keep you calm and relaxed.

Pain often feels worse when you’re tense and anxious. When you’re relaxed, your body releases its own hormone-like pain relievers called endorphins.

Keep calm and get labour going

To keep oxytocin flowing and to stop adrenaline from appearing it is particularly important to remain calm. This sound easier said than done, however there are many techniques that can be used to help you relax and to remain in control. It is important that you become familiar with these techniques before labour, so when the time comes, it will be easy for you to remember.

As described in the clips, things like changing the language and using positive affirmations can be extremely helpful to keep a positive mind and prevent the fear cycle from happening. There are also things you can bring with you to change the environment and set up the room (think about how relaxed you feel in a spa). You can discuss those things with your midwife as part of your birth plan to ensure that all that you bring is safe to use (for example it would be dangerous to use flames in a hospital, but you can bring some battery powered candles).

Coping with contractions. It is important that you concentrate on your breathing, keeping it slow and relaxed, focusing on breathing out. You can use the clip above to learn the breathing and practice. It is helpful that while you do the breathing, you also practice relaxing your face, and your shoulders as you breath out.

You can also watch this clip to learn more about some other techniques that will help you with your labour.

Hypnobirthing & Self Hypnosis For Childbirth

Many women find Hypnobirthing and/or self hypnosis very beneficial.

Hypnobirthing and/or Self-hypnosis can help you relax, improve sleep, reduce anxiety and help during childbirth.

5 Top Tips To Relax And De-stress

Take a few moments each day to practice taking yourself into a deeply relaxed state – just focus on 5 slow breathes, relax your shoulders, your hands, your arms, your back.
Create a relaxing, private place in your mind, maybe a beach, garden, childhood hideout – practice going there in your mind a few times a day e.g. when you have a few moments at work, waiting for the kettle to boil, or relaxing in the bath – feel, see and hear things as if you are actually there.
Indulge yourself by fantasising about your perfect birth – allow yourself to go over it in great detail from beginning to end. Do this daily in the last few weeks of birth.
Keep focusing on what you do want rather than what you do not want – the brain can not compute the negative – e.g. DON’T think of a pink elephant! See what I mean?
Protect yourself from negative images about birth – when someone jumps in to tell you about their horror story – stop them politely and ask them about the good bits they remember

Early labour (The latent phase)

The latent phase of labour is when your cervix becomes softer and thinner and goes from being closed to being 4 cm open (dilated). Usually starts with irregular contractions, this means that they are not frequent, and they can last from a few seconds to one minute. As you progress into labour, those contractions will become more frequent and more regular (your birth companion can time them, so you can focus on your breathing and your relaxation techniques). Sometimes you may have a period of frequent contractions and then they slow down or stop. Remember all the techniques that can promote the oxytocin to flow or take that time to rest and replenish.

This early labour can last a few hours or can last several days, so it is very important for you to keep relaxed. You can think of labour like a marathon, so this early labour would be the time to warm up and focus. During this period, you may find it helpful to:

Mobilise. Move around and stay active. Go for walks, or walk around your house and keep busy, as it will distract you. Try to be as upright as you can and if sitting down or using a birthing ball, lean forward, as those positions encourage baby to be in a good position for labour (link to spinning babies).
Rest. It is also important to rest, especially if your contractions start at night. Resting on your sides will encourage baby to be in a good position for labour and it can be more comfortable for you.
Eat and drink. Have plenty of fluids and have small and regular snacks (like toast, fruit). Some people may not feel very hungry or feel sick, in which case you can take some honey or some small fruits, to keep your body fuelled.
Practice. You can put into practice your deep breathing and you can use some of the techniques explained in the clip such as massages, warm baths or showers, heat packs or TENS machine.
It would be useful to have your hospital bags packed in advance, so your journey to the hospital is as calm as possible.

Call maternity triage

When you have no risks or problems with yourself, your pregnancy or your baby, the maternity team will advise you to stay at home as long as possible. Your obstetrician or midwife will let you know if it is preferable that you attend as soon as contractions start. If you are in doubt, you can call maternity triage for further advice.

There are times where you may wish to contact the maternity unit for additional support or advice, for example:

Bleeding – fresh red and more than 2 tablespoons
If you feel your baby’s movements have reduced or changed
If your waters have broken
If your contractions become longer, stronger and more regular (3 contractions in 10 Minutes lasting around 60 seconds)
You are worried about anything

Maternity Triage – 01324 567098 – always available for advice.

Active labour (First stage)

First stage of labour happens when your cervix dilates from 4cm to 10cm and/or you have regular contractions every 2-3 minutes. Remember to use all your techniques, and to bring with you the things that make you safe and focus to have around the room (positive affirmations, fairy lights, your own comfortable clothes…)

The midwife will stay with you during labour and she will offer support and she will monitor your safety and the safety of your baby. She will:

Read your birth plan and discuss it with you or your birth companion. She can also help to set up the room or assist you with techniques that you find helpful (massages, coaching).
Listen to your baby´s heart with a doppler every fifteen minutes if low risk, and with EFM (Electronic fetal monitoring), which is the device that we put on your abdomen to monitor your baby´s heart and your contractions held by belts. In labour ward rooms you may be offered EFM by telemetry, which allows you to mobilise freely through the room and are safe to use in the pool.
Monitor your contractions by gently placing her hand in your abdomen to assess the frequency and the strength of your contractions
Measure your pulse every hour, and your temperature and blood pressure every four hours. Those checks may happen more frequently if there is any particular concern. She will also encourage you to empty your bladder every couple of hours or as you feel you need to.
Offer vaginal examinations

It is important that you are as mobile as possible during labour, and avoid lying on your back. You could be walking and standing, sitting on a birthing ball or on all fours. You may find it helpful to rock your hips as well.

The midwife will assist you and offer different aids, such as:

Kaya Birthing Stool, which can be used for sitting, squatting, for support when standing, rocking and can be used in the pool or shower.
Peanut Balls, which give a more controlled, multi directional movement, therefore providing more stability for you in labour. This ball sits comfortably between your legs and can be used in a variety of positions. It is designed to maximise the space within the birth canal supporting your baby’s journey into the best position for birth. It is particularly helpful when lying on your side or with an epidural.
Birthing Ball, which allows gentle rocking and movement in the pelvis. Helps with labour, assisting you into better positioning for birth whilst providing support.
CUB Chair, which allows you to adopt and maintain positions that are not only the most comfortable but physically the most helpful for you and your baby during labour. This will be available in the low risk unit or AMU.

Ready for your baby (Second stage)

The second stage starts when your cervix is fully open (dilated) and ends when baby is born. There is usually a need to push, although you may not feel it immediately. You may not feel the urge to push if having an epidural, in which case the midwife will coach and support you with this stage. There can be a period where your contractions seem to be less frequent when reaching this stage, giving you some time to rest before pushing.

Between the first and second stage of labour there is often a period called “transition”, in which you may feel impatient, tired and irritable. This can be a natural reaction to baby being close. It will be important at that moment for you to focus and for the birth companion and the midwife to support you and remind you of the techniques that help you relax.

Your midwife will also assist you during this stage, encouraging you to find the best position. You might need to change positions often during this stage. It would be helpful to avoid lying on your back as much as possible, to have some aid from gravity and to have more space in your pelvis.

You will see the midwife bring a big machine (baby resuscitaire) into the room just as she prepares the room for the birth. This is only used in the case of baby needing help with the transition to outside of your womb. The midwife will also call another midwife in to provide an extra pair of hands at the time of birth.