Preparing for Labour

As your due date gets closer, you will have lots on your mind so it’s a good idea to run through the following actions and make sure everything is ready:

• Have your bag ready for hospital from 36 weeks. Include some treats for yourself, such as your own pillow or cushion, snacks or music
• Consider having more than one person to support you in labour
• Go through your birth plan with your birthing partner, making changes if you wish
• Continue to practice your pelvic floor exercises and some gentle exercises
• Consider protecting your bed with a plastic sheet or wearing a pad in case your waters break

If you have any doubts about whether your labour is starting, give your labour suite a call.

The build up to your due date can be exciting, stressful and tiring. Try and relax as much as you can in the last few weeks of pregnancy – once your baby arrives things will certainly get busier.

Your partner can do many things in the last few weeks to get ready for the birth, such as:

• Keep a list of necessary telephone numbers including the labour suite
• Check the route to hospital, keep change for car park, or keep the number of a taxi company to hand
• Check whether mobile phones are allowed in the hospital (if not, bring money for the phone)
• Make sure camera and phone batteries are charged

Most importantly, birth partners should try and be patient, calm and supportive.

Listen to your partner – she is the one who knows best what she needs.

Braxton Hicks contractions, often called “false labour”, are practice contractions and a sign that your uterus is preparing itself for labour. They are experienced as tightenings, beginning at the top of your uterus and gradually spreading downwards before relaxing. Each tightening or contraction usually last 15-30 seconds but can last up to 2 minutes. In some women they are painless, others find them uncomfortable or a little painful.

Braxton Hicks contractions usually begin around the 20th week of pregnancy. If this is not your first pregnancy, you may feel them earlier than 20 weeks and they may be more intense.

In late pregnancy Braxton Hicks contractions may become more frequent, intense and even painful. These contractions are not strong enough to deliver your baby but they may cause the cervix to efface (thin) and begin dilating in preparation for true labour.

If you find the Braxton Hicks uncomfortable try practising the breathing exercises and any other coping techniques which you have learned for use in labour.

How will I know the difference between Braxton Hicks and labour contractions?

Braxton Hicks contractions are not true labour but it can be difficult to tell the difference between them and true labour pains, particularly premature labour.

For this reason you should familiarise yourself with the signs of true labour.

True labour there is a change in frequency and intensity of contractions Towards the beginning of true labour Braxton Hicks contractions may become more frequent, stronger and even painful.

However, these contractions are normally irregular and usually lessen or go away completely if you walk around or change position. Real labour contractions are regular and get progressively longer and more intense. They are not relieved by a change of position or with activity.

Real labour pains may be in the lower abdomen or in the lower back and abdomen and may spread to the upper thighs.

Episiotomies are not done as a matter of routine, even the thought of an episiotomy can bring tears to your eyes so it’s hardly surprising that most women are keen to avoid tears, cuts and stitches during birth.

Regardless of whether this is your first baby, or you’ve had perineal trauma in previous deliveries and want to avoid it this time round, performing perineal massage during the last few weeks of your pregnancy could be just the solution.

What is perineal massage?
Preparation for delivery begins during pregnancy with the hormones Progesterone and Relaxin softening muscles and ligaments to encourage stretching, and this includes the perineal area. Perineal massage is a technique which, by encouraging blood flow to the area, increases the elasticity of the perineum for birth.

The perineum is the area of skin between your vagina and rectum which can be cut (episiotomy) or can tear during delivery. In 2006 the Cochrane Database reviewed studies on perineal massage that included 2,434 women.

As well as finding that perineal massage reduced the need for stitches, it also found that fewer women needed and episiotomy, and there was a big reduction in the number of women reporting pain 3 months after the birth.

What are the benefits?
Perineal massage has many benefits which all help to reduce trauma during birth.

• It stimulates the blood supply to the perineum and helps speed the healing process after the birth
• It helps prepare you for the feeling of pressure and stretching that comes as your baby’s head is born
• It helps to familiarise you with some of the sensations such as tingling or burning so you are less likely to tense up
• It can help you to relax when you have a vaginal examination

When should it not be used?
Perineal massage should be avoided if you are suffering from active herpes lesions, thrush or any other vaginal infection as massage could spread the infection and worsen the condition.

Are there any dangers?
Perineal massage is very safe for both you and you baby.

How is it done?
You should start perineal massage about 4 to 6 weeks before your due date, and while there are different ways to perform it, they generally all follow the same techniques.

Wash your hands.

1. Find a private, comfortable place and sit or lean back in a comfortable position. Some women lie on their side and bring their hand round the back. Use cushions to support your legs
2. Use an unscented oil, such as sunflower oil or vitamin e oil on your thumbs and around the perineum
3. Place one or two thumbs or fingers, about 1 inch (2-3cms) inside your vagina. Press downwards and to the sides at the same time. Gently and firmly keep stretching until you feel a slight burning or tingling sensation
4. Hold the pressure steady at that point with your thumbs for about 2 minutes until the area becomes a little numb and the tingling sensation stops
5. Keep pressing with your thumbs. Slowly and gently massage back and forth over the lower half of your vagina. Do this for 3-4 minutes
6. As you massage, pull gently outwards (forwards) on the lower part of the vagina with your thumb(s) hooked inside. This helps stretch the skin as the baby’s head will stretch it during birth

Your partner could also perform the massage, as you get closer to your date and it becomes more difficult to reach.

Always remember perineal massage is not for everyone.

Sweeping the membranes is a safe way of increasing your chance of going into labour yourself and reducing the risk of your labour requiring to be induced.

You do not have to have the procedure done, it is your choice.

How does it happen?
Sweeping the membranes increases the level of naturally occurring hormones, called prostoglandins, around the cervix (neck of the womb). These hormones cause your cervix to soften and dilate.

How is sweeping the membranes performed?
Membrane sweeping is carried out during a vaginal examination and involves placing a finger inside your cervix and making a circular sweeping movement to separate the membranes from the cervix.

When can it be performed?
Sweeping the membranes can be performed in the week your baby is due.

Who does it?
Your doctor can carry out sweeping of the membranes during your routine antenatal clinic appointment.

He will discuss the procedure with you prior to your expected date of delivery.

Is it painful?
Some women can experience some discomfort, however the majority of women do not find it painful.

Is it dangerous?
Sweeping of the membranes is not associated with any increased risk of infection to either you or your baby, however there are some situations when the procedure cannot be carried out, for example when:

• Your babies head is too high
• The cervix is closed or too far back
• The afterbirth is lying low

What will happen after my membranes have been swept?
Most women will experience some irregular contractions, which may become uncomfortable. Some mothers may experience some slight vaginal bleeding, or notice the presence of some show (plug of mucous passed vaginally). This is quite normal and not necessarily a sign that labour has started.

You should however contact your Hospital if you have any signs of labour e.g.

• If contractions become regular and are increasing in frequency
• If you have any fluid draining vaginally (ruptured membranes)

How does massage help relieve pain?
Massage stimulates the body to release endorphins which are natural painkilling and mood-lifting substances. Endorphins are responsible for the “feelgood” factor — the “high” you feel after a vigorous game of squash, or a good laugh with your friends during your coffee-break. In labour, massage is important because it brings you close to the person who is caring for you, be this your midwife or your birth partner. The touch of someone who loves you and wants to help you is very empowering when you’re coping with contractions and are perhaps tired and frightened.

Are massage oils a good idea?
Using oil makes massage easier to carry out and more pleasant to receive. However, you have to be careful which oil you choose for labour. Don’t buy an essential oil without consulting a properly accredited aromatherapist. Essential oils are extremely powerful substances and can interfere with contractions if used wrongly. Some aromatherapists prefer just to use a base oil for labour. Base oils include sweet almond and grapeseed. Don’t use sweet almond if you have a nut allergy or are worried about nut allergies. Just as good is grapeseed and even olive oil which is particularly well absorbed by the skin.

Shoulder massage
It’s important for labouring women to keep their shoulders relaxed. Relaxed shoulders assist rhythmic breathing and rhythmic breathing maximises the oxygen available to both you and your baby. Massage is very helpful for keeping the shoulders and breathing relaxed.

Your birth companion should place his hands on your shoulders and lean lightly on them. This will help you drop your shoulders if they are already hunched because you have become stressed. Next he can stroke down from your shoulders to your elbows, maintaining a rhythmical action and applying firm pressure. Tell him whether the massage is helping you and how he could make it better.

He could also try resting his hands on top of your shoulders and using his thumbs to massage in small firm circles behind your shoulder blades. Tell him if he is pressing too hard or not hard enough, or if he is massaging too quickly. It’s important for him to avoid frantic massage as this serves only to speed up your breathing when the aim is to slow it down!

Back massage
Many women feel contractions strongly in their lower back, so back massage is very useful. In early labour, your partner can use the flat of his hand to stroke down the side of your spine, from shoulder to bottom. He then uses the other hand to stroke down the other side of your spine, maintaining a rhythmical movement, with one hand constantly in contact with you. These long, slow
strokes are very soothing. Make sure that he is massaging you using the whole of his hand and not just the heel. His fingers need to be in contact with your body as he tries to respond to the tensions he finds there.

In advanced labour, your birth companion can use the heel of his hand to massage firmly over the base of your spine. He will need to apply quite a lot of pressure to counteract strong contractions. Or he can use his thumbs to make circles over the dimples in your bottom. Tell him what you find most helpful.

Foot Massage
Many people who say that they can’t tolerate having their feet touched nonetheless enjoy firm, rhythmical foot massage. The massage does need to be firm, however, or it will be unbearably ticklish. If you find yourself sitting down or in bed for long periods of your labour, foot massage is ideal. Your partner can simply stroke your feet firmly from ankle to toes, or make circles with his thumbs all over the soles of your feet. You may find that your feet become very cold in labour, and a foot massage will help to warm them up.

Hand Massage
If you have had an epidural and are lying in bed, shoulder or back massage is difficult. And if you can’t feel your feet, there’s no point in your partner offering you a foot massage. In these circumstances, hand massage is very soothing. Your birth companion can simply stroke each hand in turn, first on the back, then on the palm, sweeping firmly down from your wrist to your fingertips. He can make small circles all over your palm, and gently pull each finger in turn to release the tension. This is a lovely way of being close to each other and making your labour special.

Not all women like massage
If your birth companion is keen to massage you in labour, he may be very disappointed if you don’t like it. However, some women simply cannot bear to be touched when they are having contractions. The contractions are so strong that even the slightest extra stimulus is more than they can cope with. Other women find massage so helpful that they want their partners to keep rubbing their backs for hours on end! Birth companions need to be aware of these different reactions and respond accordingly.