Birth & Beyond

• Natural Birth,
• Caesarean Birth,
• Fourth Trimester, and
• Post Partum Care

Natural Birth

Childbirth Preparation Lessons

You may also be interested in taking childbirth preparation classes, which teach coping methods for labour and delivery, and helps guide new parents in the many decisions they will make before and during the birth process.

Packing for Your Hospital Stay

Most women who deliver naturally or by C-section usually need a similar packing bag. Be sure to pack a bag with

• Enough comfortable clothes for your hospital stay
• Pack shirts and tops that have zip or buttoned fronts if you plan to try breastfeeding.
• Look for soft clothes with loose elastic or adjustable waistbands,
• Warm socks, and
• Even some zippered sweatshirts or cardigan sweaters for those cool hospital rooms.
• Include toiletries such as toothpaste, toothbrush, lotion, brush, makeup, and soap.
• Nice-smelling bath soap,
• Your favourite lip gloss,
• Brand new slippers, or
• Extra special hand cream can provide just the pick-me-up you may need while recovering from surgery.

Your Due Date and Labour Day

Labour may start at full term or sometimes preterm.

Your labour may start with irregular contractions that may pick up in duration and intensity, which is when you need to call the labour ward.

You may have

• A gush of fluid (ruptured membranes),
• This sometimes can precede contractions,

Please ring the labour ward and proceed to the hospital.

Your doctor refers you to the hospital for further assessment and management as needed, as there is an increased risk of infection.

Recognising Labour

It is important to recognise the signs of labour so that you will know when you are experiencing the “real thing.”

If this is your first baby, you will most likely experience lightning (the descent of the baby’s head into your pelvis) sooner than women with other children.

Typically, the signs of labour include:

• Uterine contractions,
• Tightening of your stomach, and
• Cramps in your low back.

About two-thirds of women experience these tightening before their waters break. About one-third will notice fluid leaking out first.

If you are unsure about what is happening, call us or the telephone number supplied.

Types of Labour - Preterm Labour

Preterm labour is said to have occurred when you have strong contractions before 37 weeks of your pregnancy, whereas the gestation period normally is 38 to 40 weeks. If born prematurely, a baby will be at risk of complications such as immature lungs, respiratory distress, and problems in digestion as the organ systems would not have developed completely to support survival.

Your doctor will manage this situation with medications that stop labour or prevent infection. Also, medications that accelerate the baby's lung development may be given. You will be advised to take bed rest, usually lying on the left side.

Health Problems of Preterm Labour

The longer the baby is in the mother's womb, the more likely he or she will be healthy. Early preterm babies may have respiratory and digestive problems. They are also at a higher risk of brain and related neurological complications.

Treatment

Treatment is provided in the form of medications. Corticosteroid injections are given to speed the development of your baby's lungs and other organs. A delivery date can be extended by 2 to 7 days with drugs called tocolytics that slow or stop contractions of the uterus. The extra time gained can be used to take corticosteroids or to get to a hospital specialising in preterm care for babies.

Women at Risk

Some women deliver an early premature baby for no apparent reason. However, certain factors may increase a woman's risk of early preterm birth. Some include lifestyle risks (for example, smoking and drinking), a woman is pregnant with multiples, chronic illnesses and a short time between pregnancies.

Prolonged Labour

Most often, during their first pregnancy, some women may go through labour that lasts for too long. Prolonged labour may lead to infection in case the amniotic sac has ruptured. Anti-infective medications may be administered to prevent infection.

Abnormal Presentation

During labour, normally, the baby moves to a head-down position with the back of the head ready to enter the pelvis. Sometimes, the baby may present with buttocks or feet first towards the birth canal. This is called a breech presentation. In some conditions, the placenta may block the cervix (placenta praevia) and cause abnormal presentation.

Abnormal presentation increases the risk of uterus, birth canal, and foetus injuries. A breech presentation may lead to a prolapsed umbilical cord that might cut off the blood supply to the foetus. Your doctor will check the presentation and position of the baby with a physical examination and ultrasound scan. Assisted delivery methods may be adopted in such cases.

Premature Rupture of Membranes

Rupture of the membranes surrounding the foetus in the uterus may occur prematurely, leading to a high risk of infection. In these cases, immediate delivery of the foetus will be done.

Umbilical Cord Prolapse

The umbilical cord, which transports oxygen and nutrition to the baby, may slip into the cervix before the baby during labour. The cord may be felt if it protrudes from the vagina. This is an emergency as the blood flow to the baby through the umbilical cord may get obstructed. Seek the immediate attention of Your doctor.

Umbilical Cord Compression

The umbilical cord may get entangled and wrap around the baby several times during pregnancy. Still, during labour, the cord may get compressed, leading to decreased fetal blood flow. This causes an abrupt drop in the foetal heart rate. In cases where the foetal heart rate has worsened, or there are signs of distress, Your doctor may consider a Caesarean section.

Amniotic Fluid Embolism

An amniotic fluid embolism occurs when a small amount of amniotic fluid from the sac enters your bloodstream during difficult labour. This fluid may travel up to the lungs and cause constriction of the lung arteries leading to a rapid heart rate, irregular heart rhythm, cardiac arrest and death. Blood clot formation throughout the body is a common complication and requires immediate care.

Caesarean Birth

Preparing For Surgery

You would have discussed with Your doctor the date and time of the procedure. Your doctor will discuss any special preparations if needed depending on the course of your pregnancy. You will also be reminded to refrain from eating or drinking for eight before surgery.

Checking Into The Hospital

Present to the Hospital's reception desk the morning of your surgery, usually two hours before the operation time. 

Once you’ve arrived at the hospital, you’ll check in and be shown to your room, where you’ll change into a hospital gown. Once in your room, you will be admitted and assessed by the midwife, including a physical assessment (which includes checking vital signs and reviewing your medical history), the hairline 3 cm above the pubic bone might be shaved down. 

The Operation

When the time comes, a nurse will bring you and your partner to the operating complex. You will meet with an anesthetist to discuss your anesthesia options and meet the midwife and Paediatrician.

• Your partner is allowed to sit at your side during your operation. He will be given hospital scrubs to wear during your surgery. 
• During the operation, your partner will be prohibited from videotaping. However, still, photos are allowed.
• After an anesthetic is administered, you will lie on an operating table, and a catheter will be inserted to drain urine during your C-section until you can attend to your bathroom needs. 
• Your doctor or attending nurse will set up a curtain above your chest to separate you from your surgical team (giving you both privacy during your operation). 
• Your arms may be secured to avoid accidentally reaching the sterile surgical area. If you have regional anesthesia ( epidural or spinal ), the method generally preferred by doctors and hospitals, you’ll be awake during the operation. 
• You won’t feel pain, but if you’ve had an epidural, you will probably feel pressure and pulling throughout the procedure. 
• You should be able to talk to your partner and your doctor during the procedure.

Post-Op: Moments After Surgery

Once your baby is born, the paediatrician will examine him or her in the same operating room, which takes 5-10 minutes. The baby is then brought into your arms until the procedure is finished. You will then be moved to a post-op recovery room, where you’ll be closely monitored, usually for the next hour.

A lot of what you’ll experience is based on the type of anesthesia. Women who’ve had general anesthesia will feel more groggy and sleepy. While those who had a spinal or epidural may be experiencing “the shakes.”

This uncontrollable shivering is harmless and is caused by a combination of the birth process and the medications you receive in your spinal or epidural. If you received morphine through your spinal or epidural towards the end of the surgery, you might also have an all-over itchy feeling—a common side effect. Some medicines will help control the itching should it become unbearable.

You’ll be moved to your hospital room if all is going well.

Nurses will closely monitor you. Throughout your first day after delivery, you can expect checks of your vital signs, your incision, and your vaginal discharge. Your nurse will check the amount of urine you’re passing and use a stethoscope to listen for bowel sounds. Your nurse will also assess your pain and help with pain management.

You can have water after 4 hours, and if you feel well and not nauseous, you will be allowed to have free fluids after six hours and diet as tolerated the day after. The bladder catheter will stay for at least 12 hours, which is usually removed the second morning after the procedure, and you will have what we call a Trial of Void. The nurse will measure the volume of urine left in the bladder after urinating. That practice was put in place to ensure the proper functioning of the bladder after spinal or epidural anaesthesia.

Breastfeeding

If you had a Caesarean due to a complicated pregnancy or delivery, or if you or your newborn are ill, it may take longer to begin nursing. Still, if you and the baby are both feeling well, you may have started nursing in the recovery room. Expect to need help with breastfeeding, especially at first. Your hospital’s lactation nurse can help you. Always remember that there are many techniques and many opinions. Please do not get confused. You might need to try all and settle on one that suits best your baby and yourself.

On Your Feet: Day Two

You’ll probably be free of the catheter on your second day after delivery. And if you are feeling well enough, you’ll begin eating and drinking again.

Around this time, your nurse may also help you take those first post-op steps and will help you have a shower. You will also be visited by a physiotherapist who will teach you a few bracing techniques and exercises. 

Your doctor will check on you the second day and discuss your concerns with him, if any. The paediatrician will also come to check on the baby.

Pain control, usually oral medicine, is ordered for you by Your doctor and the Anaesthetist. Some are given regularly, and some as required. Take your pain relief, and keep on top of it. Use the time you spend in the hospital to recover, get to know your baby, and gain confidence in preparing for discharge home.

You will return from the hospital on Day 5 if all is good. If you are home the first week or two, don’t push yourself.

You can also ease your recovery by remaining gently active and remembering not to lift anything heavier than your newborn.

Having a pillow on hand can help tremendously during these days after surgery. Press it gently against your belly to help soften pain when walking or sneezing, and tuck it behind your back to help you feel more comfortable sitting. Try to sleep whenever you can. You and your partner should take “shifts”. When you feel tired, frustrated and “nothing working”, take a break and sleep for a couple of hours. You typically feel a little better with each day that goes by in the first two weeks.”

Your Postpartum Checkup: Six To Eight Weeks Later

Most women will be on track by weeks 3-4; You’ll have your final postpartum checkup with Your doctor. Take that opportunity to discuss your concerns and clarify various issues as the need arises. Discussion regarding contraception and pap smear will also be done.

You should have stopped bleeding by six weeks, been pain-free, and returned to normal life. You will have some numbness still typically above the scar as the superficial nerves that were cut will regenerate not before six months.

Emotional Rescue

It’s not uncommon for some women who deliver via Cesarean, especially the unplanned ones, to feel guilty about the procedure, even those with planned operations—discussing the issue with Your doctor and explaining why the unplanned emergency C-Sections tend to alleviate those feelings. 

The most important thing you should remember is that you and your baby are healthy.

Though planned Cesareans aren’t foolproof, it can be reassuring to know that, for the most part, you can prepare for one of the most exciting events in your life. Armed with knowledge, many mothers find that delivering via C-section is less stressful than they expected. With a good birth plan and open communication between your doctor and your birthing team, you can fully enjoy your child's birth.

Fourth Trimester

The fourth trimester of pregnancy is an important period for both mother and baby. It begins when the baby is born and continues for the next three months. 

It is a transition and adjustment period when the mother learns more about her infant.

The baby’s physical and neurological systems are rapidly maturing during this period. During this time, the mother's body changes as she recovers from childbirth and adjusts to her new role as a parent.

Post Partum Care

Postpartum care is the term for the medical care that is provided to the mother after delivery.

Mothers need proper care during this period to ensure optimal health. Postpartum care includes:

• monitoring the mother's vital signs, 
• providing physical assessments such as checking for perineal tears, and
• providing psychological and emotional support.

After childbirth, mothers need to get adequate rest, nutrition, and exercise to promote healing and recovery. Postnatal care will align with the care arrangements you have made with your hospital. 



Your local doctor may not provide postnatal care home visits if you decide to go home early, but the hospital midwives can provide this.