A Comprehensive Guide to Labour and Birth: Signs, Stages, and Preparation, Study notes of Public Health

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Your Guide to

Labour and Birth

2016

2 In this handout, you will learn the answers to common questions women have about labour and birth:

1. What needs to be done to get ready? .......................................................... 3 2. What is labour? .......................................................................................... 5 3. What are the signs of labour? ..................................................................... 6 4. How do you time your contractions? .......................................................... 8 5. When should you go to your place of birth? ............................................... 9 6. What are the four stages of labour? .......................................................... 10 7. What can help you stay comfortable during labour? .................................. 11 8. What are some comfortable positions for labour? ....................................... 13 9. What medical procedures are sometimes used during labour and birth? .... 14 10. What can you expect right after birth? .................................................... 16 11. Who are your important contacts? .......................................................... 17

Labour is different

for each woman.

It is normal to feel

excited, happy,

sad, nervous, and

afraid all at once!

q^ Health card q^ Pen and paper q^ Underwear q^ Nursing bra or good support bra q^ Toiletries (toothbrush, hairbrush,

lip balm, hairdryer etc.)

q^ Sanitary pads q^ Nightgown, slippers and robe q^ Loose fitting clothes for the

trip home

q^ Plastic hospital registration

card, if you have one

q Money for vending machines,

hospital cafeteria or hospital

parking

q^ Phone numbers for friends

and family

q^ Camera q^ Cell phone and charger q^ Very light reading q^ Your favorite music What to Pack Before Going to the Hospital/Birthing Centre For Your Baby’s Trip Home For your partner or support person For You q^ Approved car seat q^ Undershirt q Diapers and wipes q^ Sleeper q^ Socks or booties q^ Hat q^ Sweater q^ Thin blanket q^ Warm blanket

(for winter)

q^ Pajamas or comfortable clothes q^ Toiletries q^ Money q^ Cell phone and charger q^ Book and music 4

Uterus Internal os External os Uterus Uterus Un-effaced cervix Effaced cervix Dilated cervix

2. What is labour? Labour is the work your uterus does to help the baby come out. For many hours, your uterus will tighten (contract), rest, and then tighten (contract) again. This makes the opening of the uterus (cervix) get thinner (efface) and open (dilate). The Thinning and Opening of the Cervix A contraction occurs when the uterus gets tight, rests, and then gets tight again. You will feel many contractions when you are in labour. The “pain of childbirth” comes mainly from the contractions. When your cervix opens to 10 cm, your contractions and your pushing will move the baby down the birth canal (vagina) and out into the world. Labour and birth is a natural and important process for your body. Your hormones are preparing your body and your baby for the transition from the womb to the outside world. Trust the process. For more information, see Pathway to a Healthy Birth at www.nationalpartnership. org/research-library/maternal-health/pathway-to-a-healthy-birth-booklet.pdf Efface Your cervix gets thinner (effaces) before it opens (dilates). Dilate Your cervix will open (dilate) to about 10 cm (4 inches) before your baby comes out. 5

(4) Bag of Water Breaks Your baby is inside a bag of water (amniotic sac) in your uterus. When the baby is ready to be born it is normal for the bag of water to break. This may happen before labour starts, early in labour or when the baby is almost ready to be born. When it happens, you may have a little or a lot of water leaking from your vagina. Sometimes women do not know whether this is water from their uterus or urine. If you are not sure, call your health care provider. When your bag of water breaks:

• Write down the time that your bag of water broke.
• Look at the colour of the water (it should be clear).
• Notice if there is a smell (it should not smell).
• Do not use a tampon – use a pad in your underwear or towel if needed.
• Call your health care provider or hospital for instructions. (5) Contractions Late in your pregnancy you may have contractions (uterus tightens, rests, and tightens again) that are very strong. They may come and go for hours or days and then stop. These contractions are helping your womb (uterus) get ready for birth and are called pre-labour or Braxton-Hicks contractions. The chart below will help you know when you are really in labour. Pre-labour contractions Do not get stronger. Do not become regular. Go away with walking. Feel strongest in front. There is no bloody show. Tend to go away with rest. Get stronger. Become regular and closer together. Get stronger when you walk. May begin in back and move to front. Bloody show is usually present. True labour contractions 7

How far apart the contractions are How long the contractions last. Strength Duration intervals between the contractions How far apart the contractions are How long the contractions last.

4. How do you time your contractions? By learning how to time your contractions, you will know when you are in true labour. Time your contractions when the contractions come closer together and/or the contractions get stronger or when your water breaks. It is also helpful to time for at least 3 contractions in a row to see what the pattern is. Write down:

• When each contraction begins and ends.
• How far apart the contractions are.
• How long each contraction lasts.
• How strong the contractions feel. Start Time Stop Time Length of Contraction Frequency of Contractions Use a clock or watch with a second hand. To find out how long the contraction lasts, start timing from the beginning of the contraction to the end of the same contraction. To find out how far apart contractions are, time the beginning of one contraction to the beginning of the NEXT contraction. Labour Record 8

6. What are the four stages of labour? Labour can be divided in four stages: Stage 1: Labour Your contractions will slowly get stronger. They will happen more often and last longer. By the end of this stage your cervix will be thinner (effaced) and will open (dilate) to 10 cm. Your baby will move down into your pelvis. Stage 2: Birth of Baby You will have more contractions. They will be very strong. You will feel the need to push. Your baby will be born. Stage 3: Release of Placenta Not long after your baby is born, you will feel some mild contractions again. You will then be able to push out the placenta. This is usually a quick process. If the placenta does not come on its own, your health care provider may need to remove it for you. Stage 4: Recovery During this stage you will be resting after labour and birth. You will be spending time with your baby. Skin-to-skin contact with your baby will help you bond with your baby and will keep your baby warm. It will help your baby find your breast and latch on to your nipple. This is a good time to start breastfeeding. 10

7. What can help you stay comfortable during your labour? Here are some tips that you and your partner can use to help you learn to relax. This may make labour more comfortable and will help the baby move down into the birth canal. I think this graphic really illustrated poor posture. would it not be better to have it so that the back is flattened. Could we have a graphic of a women sitting on a couch so we get away from the idea that she is confined to bed Ask your support person to massage different parts of your body. If your lower back hurts, ask your support person to apply steady pressure on your lower back. Learn breathing techniques such as how to:

• Breathe slowly and rhythmically in through the nose and out through the mouth.
• Take light (shallow) breaths in and out of your mouth.
• Take short quick breaths in and out of your mouth. You can learn the breathing techniques in prenatal classes or ask someone to show you. Practicing your breathing techniques alone or with your coach will help you to prevent hyperventilating. Try to find something to look at or think about during your contractions. 11

8. What are some comfortable positions for labour? Try some of these positions to find the ones you like. It is important to change positions during labour. Doing so will help you to stay comfortable and will help your baby move down. 13

9. What medical procedures are sometimes used during labour and birth? There are several medical procedures that your health care provider may use. Sometimes, babies need some help to be born. During your prenatal visits talk about what medical procedures your health care provider may use during labour and birth. This will help you to be aware of the risks and benefits, for you and your baby, of each procedure as well as the alternatives so you can make an informed decision during labour. When in labour, choose the method(s) that works best for you and your baby. Induction Labour may need to be started for you because the baby is overdue, for special health reasons or because the bag of water breaks but there are no contractions. This can be done with special medication (oxytocin). If your bag of water is not broken, your health care provider may suggest breaking it for you before starting the medication. Augmentation Breaking your water and/or the use of oxytocin can help if your labour is slow to progress. Anus Middle Cut Baby’s Head Side Cut Pain Medication

• Intravenous Infusion (IV) may be used to give you fluids, medication, or pain medication through your arm.
• An Epidural may be used to give you pain medication through your lower back. An epidural anesthetic numbs the lower part of your body. Fetal Monitoring
• During labour, your baby’s heart rate will be checked.
• Your health care provider will use a hand-held stethoscope called a Doppler.
• A machine called a “fetal monitor” may be used to listen to the baby’s heartbeat.
• Monitoring also includes recording and measuring the contractions. Anus Middle Cut Baby’s Head Side Cut 14

10. What can you expect right after the birth? Right after the birth of your baby, place him skin-to-skin. Skin-to-skin means your baby is wearing just a diaper (and maybe a hat) and his bare skin is against your bare chest and tummy. Your baby will be wiped dry and a blanket will keep you both warm. Even if your baby isn’t ready to breastfeed right away, it is good for him to stay skin-to-skin without interruption for at least one to two hours, or until he is ready to feed. Being skin-to-skin will help your baby:

• Be calmer.
• Breathe better.
• Have normal blood sugar.
• Stay warm. Holding your baby skin-to-skin also promotes:
• Better milk flow and production.
• Bonding (the process of developing an emotional connection to your baby). Skin-to-skin contact at any time has benefits for both you and your baby. Fathers, partners, and support persons can also hold baby skin-to-skin. Skin-to-skin cuddling and breastfeeding also help if your baby has to have a blood test or other painful procedure. Your baby will have an exam by a doctor – to assess her overall health (called Apgar score). Other interventions will be:
• Vitamin K injection in her thigh.
• Antibiotic eye ointment.
• Heel-stick blood test to check for a variety of disorders (called newborn screening test).
• Hearing screening test. You will have an exam by a doctor. The health care team will make sure that you’re doing well and to answer your questions. Interventions can be:
• Check that the placenta is delivered.
• Check your uterus by pressing lightly on your stomach.
• Check your vaginal bleeding.
• If you had an episiotomy or tear, or if you had a caesarean birth, you will have stiches. 16

11. Who are your important contacts? My Personal Help My Health Care Providers Emergency (Fire / Police / Ambulance): 911 Telehealth Ontario 24/7: Free medical advice 1-866-797-0000 or www.ontario.ca/page/get-medical-advice-telehealth-ontario Your local public health unit: To find out about programs and services close to your home offered by your public health unit 1-800-267-8097 or www.health.gov.on.ca/en/common/ system/services/phu/locations.aspx Motherisk: The helpline offers information and counseling on alcohol and substance use 1-877-FAS-INFO (1-877-327-4636) or www.motherisk.org EatRight Ontario: Speak with a Registered Dietitian for free 1-877-510-5102 or visit www.eatrightontario.ca Bilingual Online Ontario Breastfeeding Services: Search for breastfeeding services near you www.ontariobreastfeeds.ca Name and Title (partner, family, friends, neighbours, peer support, community drop-ins, blogs, etc.) Name and Title (doctor, midwife, nurse, nurse practitioner, lactation consultant/clinics, dietician, doula/ labour support person, etc.) Contact Information (phone numbers, emails, web links, and addresses) Contact Information (office number, cell numbers, emails, web links, addresses) 17

This document has been prepared with funds provided by the Government of Ontario. The information herein reflects the views of the authors and does not necessarily reflect the views of the Government of Ontario. The resources and programs cited throughout this guide are not necessarily endorsed by the Best Start Resource Centre or the Government of Ontario. Some Resources to Know More About Getting Ready for Baby My Breastfeeding Guide Find information and answers to questions you may have as an expectant parent or as a new parent www.beststart.org/resources/breastfeeding/BSRC_My_Breastfeeding_Guide_EN.pdf Sleep Well, Sleep Safe This booklet is for parents of infants from 0-12 months and for all who care for infants www.beststart.org/resources/hlthy_chld_dev/pdf/BSRC_Sleep_Well_resource_FNL_LR.pdf What to Expect in the First Three Months – Information for New Parents This handout will provide you with important information on what to expect in the first three months after your baby is born www.beststart.org/resources/hlthy_chld_dev/K82-E-hospitalhandout.pdf

We would like to

thank the parents

and the experts

who provided input

on this guide.

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