How will I know when I am in Labour?

The classic signs that you are in labour include:

• A 'show' is the release of the mucus plug, which seals the cervix or opening of your womb. It is usually a jelly-like substance which can be streaked with blood. A 'show' can occur a few days before labour starts properly or it can be a few hours or anything in between.
• Contractions may start off as period-type pains which can occur in your stomach, back or thighs. You can experience irregular pains for a whole day before the pains take on any type of pattern. As your labour progresses you will notice your pains increase steadily, reach a peak and then decrease, followed by a pain free phase. You should time the length of your contractions and the time between contractions. Labour is usually established when your contractions last for more than 40 seconds, occur every five to seven minutes over an hour and are beginning to become painful.
• For a small percentage of women the first sign of labour is when the waters break. When this happens some women will experience a gush of warm clear fluid, others just notice a gentle trickle. At this time you should contact your midwife or hospital.

When should I call the midwife or go to hospital?

• If you are feeling anxious or worried you should call the hospital to speak to a midwife. They will discuss your contractions with you and ask you how long it will take you to get to hospital. Based on the information you give them they will advise you when best to go to hospital.
• If your waters break and the fluid is a brown/yellow/green colour you should go to the hospital immediately as your baby may have passed it's first bowel movement and your labour will need careful monitoring.

Please explain the different types of pain relief for Labour

There are plenty of different pain-relief choices available to help you cope with labour and you should inform yourself about each one. Have a discussion with your midwife or at your antenatal class.
Gas and Air (Entonox)
A mixture of two gases (nitrous oxide and oxygen), inhaled through a mouthpiece or mask which works to take the edge off your contractions. It is the most widely used drug for helping women to cope with labour and has no known harmful side effects for you or your baby. It can make you a little nauseous and light-headed and can make voices sound like echoes.
Pethidine
Pethidine is a pain-relieving drug (from the 'opiates' group), which is injected into the buttock or thigh to relax the muscles. Takes effect within 15-20 minutes and can be topped up. Can make you nauceous but an injection to counteract this is usually given at the same time. Can make you and your baby drowsy.
Epidural
A strong local anesthetic is injected into the small of your back by an anesthetist. It takes about 15 minutes to insert and 15-20 minutes to become effective and numb the area between your waist and knees. Having an epidural means you will not be able to get out of bed during labour or for up to six hours after your baby is born. An epidural increases the likelihood of you having to have a forceps or vacuum (ventouse) delivery. You will also have to have a drip inserted in your arm to minimise the drop in blood pressure an epidural can cause.
TENS machine
Transcutaneous Electrical Nerve Stimulation (TENS) releases mild, painless electrical pulses, which you control, to stimulate your body's natural painkillers (endorphins) and help block pain impulses from reaching your brain. It is recommended that TENS is started early in your labour to be most beneficial. TENS machines are available for rent or to buy in Ireland.
Aromatherapy
can also be used to help manage pain-relief in labour but you must seek advise from a certified aromatherapist as some oils are not suitable for use during pregnancy and labour.

What is a Birthplan?

The concept of a birthplan was first introduced by Sheila Kitzinger, an advocate of natural childbirth, in the 1970's. A birthplan is a very personal document and can be a very effective communication tool between you and the midwife delivering your baby.

Basically, a birthplan is a list of all the things you might like to happen during your labour and delivery of your baby. Some things in this plan may include

• the position(s) you would like to adopt for labour and delivery. Women are now advised to be as active as possible during labour and to adopt whichever position is best suited to them for delivering their baby. You may wish to experiment with different types of positions during your labour.
• You could also include in your plan what type of pain-relief you'd like to use during labour.
• If you feel strongly against having an assisted delivery you should include this in your plan.
• You may like to have your baby placed on your chest immediately after birth as skin-to-skin contact has been proven to promote bonding and to aid breastfeeding.
• Also, if you wish to breastfeed your baby you should state this in your plan as the best time to start breastfeeding is 30 minutes to an hour after your baby is born.

These are just some of the things you may wish to include in your birthplan but each one will be a unique plan for the mother involved.

Why use a Birthplan?

Basically, a birthplan will allow you to effectively convey to your midwife your hopes and wishes for your labour and delivery. If your are having your baby in hospital you may not have met your midwife beforehand and your birthplan will help you to communicate your wishes clearly to her/him.
Devising a birthplan during your pregnancy will enable you to consider all aspects that will affect your labour, for example, pain-relief, types of delivery, your individual wishes, your partner's wishes and any other issues relevant to you.

The most important aspect of writing a birthplan is that it will help you to think about what you want for your labour and delivery and it will give you an opportunity to find out about the choices and options available to you. Your birthplan will help keep you involved in any decision making during your labour and delivery and you will feel more in control.

A birthplan is a very useful communication tool but you must remain open-minded and flexible during labour because sometimes things do not go exactly to plan and you must accept any decisions made for the safety of you and your baby, even if it's not what you'd hoped for.