No book, no training course, no YouTube movie can really prepare you for having a baby. What they can do is provide you with knowledge to empower you to make decisions that help you as you enter the realms of parenthood. Birth and the following few days are hard….. It is labour for a reason. It is a fabulous life-changing experience viewed upon by mums and dads in different so many different ways.
Here are some realities and things the books don’t tell you.
Before your baby arrives
Is it time yet?
The books will give you few scenarios.
You might lose a plug of mucus and then contractions will start slowly and become progressively more intense until it is time to go the hospital. But how intense should they be before you go…..? Being British, when you can no longer focus on making a cup of tea, it’s time to go.
Your waters will break, and not long after, your contractions will begin in force and you need to get yourself to the hospital pretty quick.
The reality is that there are all kinds of ways that you labour can begin.
You could be like Sarah whose uterus played tricks on her a few times before the real deal (Three ‘false alarm’ hospital visits).
Sometimes labour will begin with back pain and it can be quite intense and you might not realise that it is labour. It is caused by your baby lying with its back against your back. Going on all fours as Amy did after many hours in labour relieved the pressure, turned her baby around and very quickly afterwards she delivered.
There are also surprises… Claire was totally expecting a long drawn-out labour, only to make a mad dash down the motorway to the hospital, just making it into the delivery room.
Or Tricia whose waters broke in the supermarket (She received a gift voucher from the Supermarket!).
Your waters might not break at all and you could deliver your baby in the membranes (this is called ‘en caul’ or ‘veiled’ birth and is supposed to be lucky for the infant. But mostly your waters will be broken beforehand with an instrument that looks like a knitting needle (it doesn’t hurt you or the baby).
There are so many scenarios - so be open, be prepared and don’t be afraid to ask.
It’s going to hurt?
Well I’m not going to tell you it will be pain-free, because that would be a lie, but there are many ways to help you find the right level that you can cope with. Techniques such as hypnobirthing can provide you with visualisation tools and coping strategies that you can do with or without your partner.
You learn these during your pregnancy and practice them so when the time comes you can really ‘tune out’, relax and let your body do the work it needs to do. (See below for hypnobirthing in Switzerland).
Pain relief is available whenever you need it. Work with the midwife or care provider to decide on the right one for you.
The positives to pain relief are that it makes you more comfortable and able to cope, but there are also negatives with some of them.
Opioids such as pethidine, or morphine can make you feel ‘out of it’ and they can also pass through to your baby, making him/her sleepy for the first 24 hours, which may influence the ability to breastfeed. It also means you would not be able to move around or go into the water.
Epidural are a fabulous way to have a pain free labour and delivery. Some lower dose epidurals mean that you can still feel pressure and some pain, BUT evidence indicates that you are more likely to need an instrumental delivery such as forceps or ventouse (a vacuum cap on baby’s head) or even a cesaerean section. Your labour could also be much longer and you are much more immobile. You might also need a catheter (to drain your bladder), and you will have a drip in your arm/hand.
Talk to your midwife and ask her to explain the advantages and disadvantages of all pain relief that is on offer.
I might have a poo!
Every birthing mother’s nightmare. But as a midwife, we really do not care. Some mothers do, some don’t but you will not realise either way. If your bowel is really full, it can prevent the head from coming down the vagina and so something to help empty the bowel beforehand may be necessary.
Baby’s out – What’s next
The hardest part is over, but there is still much to know and do.
Delivery of the Placenta
This is the afterbirth and you need to deliver that too and is known as the third stage of labour. There are two ways to do this
Physiological
Active Management
Physiological: allows the placenta to come out mainly by pushing, gravity and contractions. The cord is clamped and cut once it has stopped pulsing or when the placenta has come out. It can take up to one hour (but shouldn’t take more) and there are ways to help it on its way including skin to skin with your baby (see below) and breastfeeding. If baby won’t latch, nipple stimulation is useful to give a surge of oxytocin, which then helps contract the uterus and expel the placenta.
Physiological third stage is generally only recommended if you’re at low risk of heavy blood loss.
You can change to active management at any time if needed.
Active Management: Involves injection of a drug called syntocinon or ergometrine in your thigh soon after your baby’s born. It speeds up the delivery of the placenta (usually within 30 minutes after birth). The cord is cut within 5 minutes of delivery and your midwife or doctor will place a hand and apply pressure around the symphysis pubis area (this is known as fundal pressure) at the same time gently pulling the placenta out by the umbilical cord. Active management lowers the risk of heavy blood loss, but the injection might make you feel sick or vomit, and can increase your risk of high blood pressure.
Suturing
Sometimes, the skin between your vagina and your back passage, does not stretch quite enough and you can have a tear and occasionally, if the doctor or midwife feels it is necessary, you may have a small cut (episiotomy). If you have an instrumental delivery, the doctor will normally do this, but you will have local anaesthetic and will not feel it. You can discuss an episiotomy with your care provider during labour.
During the suturing procedure you will have a local anaesthetic and ask to hold your little one in skin to skin so you will be so occupied, looking and wondering at your amazing new arrival, you won’t even realise what is going on.
Skin to Skin
This is the fun part, the time to get to know your baby. Ask to be left holding your baby for at least an hour. Your baby does not need to be weighed straight away, does not need drying with a rough towel or wrapping in a warm blanket – you are your baby’s blanket. Your body is amazing and your temperature will increase by a few degrees to help keep your baby warm. Let your new little one, snuggle into the breast, and do not force him/her to take the nipple. Watch and see what he/she does. Let your new baby lick and smell and taste you even if you feel you are dirty and sweaty. This time is vital and the sweat and whatever else is on your breasts is really good for him/her as it helps prime your baby’s gut, build your baby’s immune system and set the path for his/her future by priming the microbiome. You can read more about that HERE.
Blood Loss
You may stand up the morning after delivery and dump copious amounts of blood onto the floor – this is ok. You have lain for a few hours and then stood up and the pool of blood in your vagina just flows. Blood loss for the first 24 hours can be pretty heavy and can also contain small clots. If there is a clot larger than a chf5 coin, then let the staff know. The nice sexy lingerie that you have at home will have to wait a while and bring on the ‘granny pants’ and thick pads. As the days go by, the size of pads will decrease, as will the size of the knickers and you’ll soon be back in that sexy lingerie again.
Every time you breastfeed, you may find your blood loss increases, due to the release of oxytocin - which brings me onto…….
After-Pains
These are like mini contractions and can be quite alarming. It is your uterus going back into shape. The surge of oxytocin that you get when you breastfeed also affects the uterus helping it to go back to its almost original shape.
Peeing and Pooing
The reality is that it can sting to pee and if you’ve had stitches…. Holy moly, it can really hurt to poo. It is important to relax. Sit on the toilet and move your pelvis back and forward. Do not strain……. Think of the pelvic floor. (oh and that’s another topic altogether)…. If you cannot go for a couple of days, firstly that is ok, you have probably not really eaten much but if you are worried, then ask your doctor for a light laxative to help you on your way.
Sitting down
If you have had stitches and sometimes even if you don’t, sitting down can be quite uncomfortable. Well……. you have had a lot going on down there and produced a huge watermelon from your vagina, so a little discomfort is inevitable. Ice packs can help as can a cushion, shaped like a ring (a breastfeeding cushion folded right, can also work, just change the cover each time, before breastfeeding). You can also take paracetamol if it is really uncomfortable. For those who have a cesarean section, sitting can be uncomfortable due to the situation of the wound. For breastfeeding, a laid back position can really help, or side-lying. Ask your midwife or lactation consultant to show you some different positions.
Overwhelming Love
This is what all parents expect to feel when they see their new baby for the first time and some do, but many don’t. It is normal. Your body has just run a marathon, you’re exhausted, you hurt and ache and then you are expecting to feel elation. Do not be hard on yourself, be real. Hold your baby close. Look, touch feel him/her and just enjoy the warmth on your body, the closeness and the energy. The feelings may come in the next few days, or not at all. This does not make you a bad mother, it is reality. Being a mum is hard work and you do love your baby and would do anything to protect him/her and that is part of this overwhelming love.
Post-natal Blues/depression
Around four or five days after the birth, there is a change in hormone balance and obviously a change in your lifestyle, add the tiredness from giving birth and sleeping less, so feeling really down and crying is normal and ok. Be kind to yourself, and ask others to help. Sometimes these feelings do not go away and recognising that you are not feeling ‘right’ is the first step to getting better. Tell someone how you feel and take that first step. (I feel a whole blog developing for this topic)
Pregnancy, labour and childbirth is unpredictable, mysterious and magical and nothing can really prepare you. Go in with an open mind, ask questions, don’t be afraid and know that you can do it.
Every new baby that comes into the world comes out from a woman’s wonderful body. A body that deserves nurturing and looking after, a body that is amazing and adaptable and sexy all in one.
Good luck to you all – you’ve got this
X Janet
Hypnobirthing in Switzerland:
Switzerland: HypnoBirthing course in English | Zürich, Zug, St. Gallen
These are recommendations from people I know:
Zug: Open Hand Birthing
Geneva: expatmidwifegeneva.com