Drugs in labour and birth
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Alison Ross
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Registered Midwife, DipHe, BSc (Hons) Was a midwife at Kingston Hospital and Specialist Midwife in Perinatal Mental Health.
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Birth and Labour

Where should I have my baby?

There are various options you can choose from for having your baby. The usual ones include a hospital maternity unit, a midwife-led birth unit or your home. Further variations include water birthing, hypnobirthing, natural and active birthing. There are advantages and disadvantages to each of these which are discussed here.
In Short
Assuming you are having a normal pregnancy and look set for a normal birth, you can choose whatever feels the most comfortable for you to give birth.

However, if you are in the high-risk category, it’s likely you’ll be advised to go for the hospital option so that help is at hand immediately in an emergency.

Make your choice an informed one

You will be asked to make a choice of where you have your baby quite early on in your pregnancy. Rest assured that you can change your mind later if you want to – just discuss it with the relevant teams. You may even have to change your mind – for example if you have chosen a home birth, but your pregnancy becomes more complicated. Your choice may also vary between areas. For example, some areas might not be well equipped for supporting home births.

The usual range of choices includes:

  • Hospital.
  • Home.
  • Midwife-led birthing unit (MLBU).
Is a hospital/ midwife-led birth safer than a home birth?

For most people, safety is the most important consideration. For a first baby, it is slightly safer to give birth in a hospital than at home. However, there’s no reason why a first-time mother cannot aim for a home birth if she is ‘low risk.’ For a second or subsequent baby, assuming the first birth was normal, a home birth is as safe as a hospital or midwife-led birth unit birth.

If you decide on a home birth, make sure you discuss what happens if you need to be transferred to hospital during labour.

If you have a medical condition or need additional medical support, then probably you will be advised to give birth in a hospital. There you will have instant access to any extra help you may need.

In a report from NICE (the National Institute for Health and Care Excellence in the UK) released in December 2014, the guidelines on birth location were changed.

Professor Mark Baker, NICE’s clinical practice director, said:
Most women are healthy and have straightforward pregnancies and births. Over the years, evidence has emerged which shows that, for this group of women, giving birth in a midwife-led unit instead of a traditional labour ward is a safe option. Research also shows that a home birth is generally safer than a hospital for pregnant women at low risk of complications who have given birth before.

Home birth

Around 1 in 50 women in the UK give birth at home. If you make this choice, you will be supported by a midwife throughout, and she will make arrangements for you to be transferred to hospital if anything goes wrong.

The advantages of a home birth include:

  • You don’t have to move once labour starts.
  • You are in familiar and comfortable surroundings which will have a positive effect on your labour.
  • You are more likely to know your midwife.
  • You are less likely to have an intervention such as forceps or ventouse

The disadvantages of a home birth include:

  • You will need to be transferred to hospital if anything serious goes wrong.
Midwife-led birthing unit

A midwife-led birthing unit may be independent or part of a maternity hospital. They are generally more cosy and comfortable than a hospital.

The advantages of a midwife-led birthing unit include:

  • More comfortable surroundings than a hospital.
  • More immediate access to expert help if needed.
  • You are more likely to have a midwife you know which will help you cope better with your labour.

The disadvantages of a midwife-led birthing unit include:

  • You may still need to transfer to the delivery unit if something serious goes wrong or if the labour is not progressing.
  • There might not be as many pain relief options available – for example, an epidural.
Hospital Birth

Most women in the UK – over 90% – give birth in a hospital.

The advantages of a hospital include:

  • Having immediate access to teams of experts if something goes wrong.
  • Having access to all methods of pain relief if needed.
  • Having immediate access to special care baby units if there are any problems with your newborn baby.

The disadvantages of a hospital birth include:

  • You may not know the midwife.
  • You may find your labour is managed more than you would want
  • You may be moved quickly after the birth.
FAQ about birth:
What is a natural birth?

A natural birth generally describes a vaginal delivery where the woman labours with support from her midwife and birth partner, doesn’t have any pain relief and there is no medical assistance during the actual delivery. A natural birth can take place in water, squatting, kneeling on all fours or even on a bed. After the birth, the baby is passed straight to the mother and placed on her chest. If the birth is in a pool the mother may bring her baby out of the water herself.

The cord will not be cut for several minutes until it has stopped pulsating to maximizes the blood that is passed through the placenta to the baby. You will not have a managed third stage either. Instead, the placenta will be expelled naturally by contractions whilst the mother cuddles or breastfeeds her baby. After a natural birth, the mum and baby are generally left in quiet and low lights.

A woman can feel very disappointed and like a failure, if they wanted to have a natural delivery but needed help. Remember that the ultimate goal of any decisions around labour and birth is your safety and that of your baby, so don’t be hard on yourself. There are lots of chance factors during labour and every birth is a unique event.

What is a water birth?

Water can play a wonderful role in birth, whether during labour or for the birth itself. Most midwife-led units and labour wards offer water birth as a birth option. Being in warm, deep water allows women to get in lots of comfortable positions to both cope with contractions during labour and deliver their baby. It is considered that a water birth makes the transition from the warm, watery environment of the womb to the outside world more gentle for your baby. Babies can be safely born underwater without the risk of drowning as they receive their oxygen via the umbilical cord until they take their first breath of air. Due to the ‘dive reflex,’ a baby does not take its breath of air until its face comes into contact with air, an amazing instinct to witness. Midwives have reported that babies born in water are calmer and cry less than other babies.

If you have a low-risk pregnancy, your antenatal team should support you in wanting to use a birthing pool. During a water birth, you can only have gas and air for pain relief – you can’t have pethidine or an epidural. However, provided you are in a labour ward if you are struggling to cope you can ask to come out of the water and have pain relief. You may also prefer to spend some of your labour in water but not necessarily be there for the birth or all the time.

What is active birthing?

Active birthing seeks to use gravity and your body movements to help birth your baby. The angle of the birth canal means that when you are lying down your baby you effectively have to push your baby ‘uphill’ to deliver her. By being in a more upright position gravity helps your baby move down through the birth canal. You can have an active birth in a pool too. Good positions for active birth include:

  • Standing and swaying your hips.
  • Sitting on a birthing ball.
  • Sitting on a chair facing backwards, so you can hold the back of the chair and bear down.
  • Kneeling on all fours.
  • Crouching, holding onto something or on a small birthing stool.
  • Lying on your side

Active birth is a very woman-centered approach to birth, which empowers and encourages t women to get in touch with their own bodies and to keep active during labour. It works with a woman’s body and mind to bring their babies safely and gently into the world using the natural positions, and the techniques teach pregnant women to think and respond to labour with a positive mindset. Relaxation and visualisation techniques help cope with the contractions.

How can my birth partner help?

Your birth partner can work with you during an active birth to help you get into comfortable and effective positions. You might find it helps to stand with your arms over your birth partner’s shoulders, or if you are sitting on a birthing ball or chair you birth partner can massage your back to help ease any back pain.

How do hypnobirthing and hypnotherapy work?

Hypnobirthing, sometimes known as the Mongan method is a deep relaxation technique in which you take yourself into a state of hypnosis during labour (or your birth partner can hypnotise you). The theory is that anxiety and stress slow down and disrupt the natural process of labour. Indeed, it is well-documented that labour can completely stop in both animals and labouring women during high stress.

There is also evidence that our pain perception is affected by anxiety levels – anxious people feel more pain from the same stimulus than relaxed people. When you are able to relax and breathe your way through contractions the muscles in your womb and cervix respond accordingly and this helps speed up your labour. If you are interested in using hypnobirthing, it should be part of your birth plan. You will need to attend a special course with your birth partner speak and learn the hypnosis techniques before you go into labour.

Hypnotherapy is used before the birth in the antenatal period to embed positive messages and feelings about the birth into your brain. The idea is that when you go into labour you will respond to the birthing process more calmly and embrace it. If you would like to try antenatal hypnotherapy you will need to find a therapist who specialises in antenatal hypnotherapy and book in several sessions before your baby is due.

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DISCLAIMER
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.