Sunday, January 27, 2013

5 top tips for pregnant women about to have their baby

I was asked the other day by some pregnant women to write a post about labour and birth. So here's my top 5 tips for women who are about to have a baby.

My default position is that every pregnant woman should have a known midwife who provides care throughout pregnancy and birth, and home birth for low-risk women. However, not every woman can have, or chooses, either. These tips are for women who have chosen to have a hospital birth, and in particular do not have their own midwife. 

1. Do not agree to have your labour induced the minute you reach 40 weeks pregnancy
There's no doubt that every day over 40 weeks of pregnancy seems like the longest day of your life. This problem is accentuated by all the modern tests we have that emphasize pregnancy dates. Gone are the days when women think about having their babies in terms of.... the phase of the moon.... month... or even season. These days we talk about giving birth down to the last day, hour, minute...

The reality is pregnancy varies considerably from woman to woman, and term pregnancy is defined up to 42 weeks gestation. There is evidence to show that mortality increases after 42 weeks pregnancy, however, the number of deaths are few, and each mother and baby's risks should be reviewed individually. My experience has been that when you try to induce labour before the mother's body is ready, the induction process is much longer and painful for the mother, with increased risks of medical intervention at a later stage.  This is what we call the "cascade of intervention", which is so often started by unnecessary induction of labour,

It goes without saying that if you have risk factors such as high blood pressure or your baby is showing signs of ill health, then you must follow the advice of your doctor. However, if you are fit and healthy, and have a low risk pregnancy, then resist pressure to have your labour induced. Focus on keeping active, yet relaxed, and spend your time preparing your body and mind for life as a new mum.

2. Stay at home as long as you can before you go into labour
The longer you stay in an environment where you feel relaxed and in control of what's happening to you, the better the outcome for you.  The longer you are in hospital, the greater risk you run of being submitted to unnecessary medical interventions. This can be a little tricky, especially when you are expecting your first baby because you don't know what to expect. I find it is often the dads/partners that get nervous and want to take their wife into hospital as soon as they can, so it is helpful to have someone with you at home who can support you. The best thing, if you can arrange it, is to get a midwife to come and check your progress at home, and make sure you do not go into hospital until you are in established labour.

3.  Have an advocate with you when you are in labour
By this, I mean, have someone with you who will ensure you have your wishes adhered to, that you are treated with respect, and that your right to informed choice is maintained at all times.  I don't think that husbands/partners can always do this because they can become very emotionally involved. So I think you should take a third person who is not so closely related to you. This person may be a friend or family member, or even an employed doula. This person must recognise that there are times when the best laid plans can turn to custard and medical intervention is required, but at the same time, be able to stand up for you against pressure for treatment, or attitudes that are inappropriate, and that everything is fully explained to you at all times.

4. Wait as long as you can before you have an epidural, if that is your choice of pain relief
I have mixed feelings about epidurals. On the one hand, when epidurals are well managed they can relieve severe pain, and assist mum to have a quiet, controlled birth which is a joy to behold. But in my experience, these births are few and far between.

Epidural interfere with the physiology of labour and birth, make labour longer, increase the risk of needing powerful drugs to increase contractions, prevent women from being able to push and increase the risk of a forceps delivery - with the accompanying risk of damage to mum and baby. Epidural also increase the risk of cesarean section for baby distress, which is thought to be caused because epidural increase maternal body temperature.

Bottem line: if you can manage your pain without an epidural, then do so. However, if you decide to have an epidural, leave it as long as you can before you have it because you will increase your chances of having a normal birth. 

5. Do not agree to continuous baby heart monitoring with a CTG machine unless your doctor or midwife can provide strong evidence that your baby is at risk
Many hospitals insist that women have a CTG baby heart monitoring trace when they first go into hospital, and even that they have continuous monitoring throughout labour. However, for low risk women, this medical intervention has been shown to have no impact on birth outcomes, and indeed, increases a woman's risk of procedures such as cesarean section.

If you are not sure what goes on in your hospital, check out their policies and guidelines for labour and birth while you are still pregnant. The more homework you do before you go into labour, the better prepared you will be.

What are your top tips for a pregnant women to think about before she has her baby?

If you want to read more details with links to research evidence, have a look at this article: What to reject when you're expecting. 10 procedures to think twice about during your pregnancy. The other blog that presents excellent evidence-based information about birth is: Science and Sensibility. And if you're a dad, may I recommend this blog: Beer and Bubs. As a midwife, some of the places I go for evidence-based information about labour and birth are:

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Shari said...

Thanks for the blog post - I really enjoyed it. It supports a lot of feedback I've had from female family members ... especially about waiting as long as possible to have an epidural if I need one. I'm glad to see that these tips are backed by a medical professional. Shari from

Sarah Stewart said...

Thanks for the feedback, Shari. Let me know how things go when you have your baby :)