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Positions for Labour & Birth

There are few instances in labour where you will be unable to move freely to find the position which is most comfortable for you. The only glaring exception to this would be if you were using an epidural for pain relief. The fact that you will feel less pain when using upright positions for labour is one of the strongest reasons for encouraging you to remain upright and mobile during this time. Another is that as animals we have evolved to give birth in as safe a way as possible to ensure survival of our species. As humans we have been socialised to fear birth and accept its medicalisation.

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Skin to Skin Contact

There are numerous reasons why skin to skin contact immediately after your baby’s birth should be the norm and not provided merely at your request. Midwives should be using this as their default method and not after a discussion on the subject. The only logical reasons why skin to skin contact wouldn’t be carried out immediately are;

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Vitamin k

The Department of Health recommend that all babies are given a vitamin K supplement at birth and this comes in two forms: A one off injection into your baby’s muscle or a course of oral medication given at birth and then subsequent doses up to one month depending on which method of feeding you are using. We all need vitamin K to help our blood clot and most of this is taken in by our diet or produced in our gut by bacteria. As babies are yet to establish feeding their guts are totally sterile and will have no bacteria so are born with very low levels of vitamin K in their bodies. This puts them at risk of bleeding problems especially if they have an assisted birth, caesarean section, are premature or have liver problems.

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Cord Clamping

Would you prefer to wait a few minutes to allow your baby to receive more of his blood from the placenta or would you prefer his cord to be clamped straightaway. If you wish your baby to have some of the benefits of a physiological third but wish to have active management you can opt for ‘delayed cord clamping’. This involves placing your baby on your abdomen and then waiting one to three minutes before the cord is clamped and you are given drugs to contract your uterus. If you prefer to have your baby on your chest, because the blood flow has to work against gravity, it should be left slightly longer, up to five minutes. A review of research on this subject found that there was no significant difference between the groups having delayed and immediate cord clamping on the rate of severe blood loss. Furthermore, a Swedish randomised controlled trial in 2011 found that using delayed cord clamping reduced levels of babies with anaemia, or low iron count. It was also found to reduce the risk of babies suffering from iron deficiency at four months of age.

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The Placenta

Your placenta and membranes are around one third the weight of your baby but made entirely of soft tissue. The placenta itself is usually round in shape and anything from one to two centimetres thick. It has the ‘maternal side’ where it was embedded into the wall of your uterus and the ‘foetal side’ which contains the membranes, blood vessels and his umbilical cord. The side which embedded into your uterus did so within one week of conception and small blood vessels, called ‘arterioles’ spread out from your blood supply to feed this newly forming placenta.

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Assisted Birth (Forceps & Ventouse)

Sometimes, and it is usually dependent on the shape of your pelvis, no matter what you do it may be necessary to perform an assisted birth. It may also be that your baby is showing signs of distress and it may be safer for you and him to have an assisted birth than prolong your labour to achieve a normal birth. At this point in your labour your baby’s head is usually too low in your pelvis to make a caesarean section the safest option. Also, a caesarean section at full dilatation carries a higher risk of infection and bleeding than the first stage of your labour. A caesarean section for you carries the greatest risk than other methods.

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Once you are on labour ward the atmosphere may change and you may find it more challenging to question situations that you are unsure or unhappy about. You are your partners advocate so make sure that your midwife understands your partner’s birth plan and any other wishes for the birth. There may also be occasions where your midwife or obstetrician discusses possible intervention that may be needed, for example the hormone drip. As this point you may feel overwhelmed with responsibility.

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Monitoring your Baby’s Heartbeat in Labour

Your midwife will have listened to your baby’s hear rate initially and as you enter the active phase of your labour she will do this more frequently. If you have been well in your pregnancy with no underlying medical conditions and your baby is growing normally, you should be classed as a ‘low risk’ pregnancy. Occasionally, some women for one reason or another be it a problem with their baby, a medical condition or one that presents itself in labour may be classed as ‘high risk’.

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Vaginal Birth After Caesarean (VBAC)

The reasons for needing a caesarean section will vary, however they are more likely to occur during labour for women in their first pregnancy. This may be due to a number of things such as ‘foetal distress’ where there are concerns over your baby, or ‘dystocia of labour’ where your labour stalls completely. For others, caesarean sections will be planned during pregnancy. Whatever the reason for your caesarean section it is safe in most cases to plan for a vaginal birth with your next pregnancy and your consultant obstetrician or consultant midwife will be able to discuss this with you further. If you gave birth by caesarean section previously then your chance of having a vaginal birth this time is seventy to ninety percent. If you have had a vaginal birth previously as well as a caesarean section then your chance increases to ninety percent.

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