Delivery Day: What to Expect

We’re so close! Those 9 months can pass so quickly, and before you know it your little boy or girl is ready to come out and meet you. Pregnancy can be life changing and those 9 months can be tough – your body has been through a lot, but you just need to get over this one final stretch and it will all be worth it.

You should discuss your birth plan with your midwife, and you will already know many of the things that will happen on the day you meet your baby. We’ve put together some information and tips on what can happen on delivery day (but keep in mind that this differs for everyone).

Our previous posts in this series look at your:

• First Trimester
• Second Trimester
• Third Trimester

The journey you go on to get to this point can be both exciting and daunting, but whether your feeling anxious or elated, whether you feel ready or not, your bundle of joy is on their way!

How to prepare

Not everything can be prepared for – especially if this is your first child. Of course, the only way to truly know what birth feels like is to experience it, but there are some things you can do to prepare your mind and body for the pain and stress of delivery.

• Keep up gentle exercise throughout your pregnancy. Not only does this help you to maintain your weight, reducing the risk of gestational diabetes and other health issues, but it can prepare your body for labour. Try some labour focused exercises as you approach your due date.
• Both parents can join an antenatal class to learn more about what will happen during and after labour, and don’t forget to ask plenty of questions – don’t be scared, they’ve heard it all, and it’s important for you to feel as prepared and comfortable as possible.
• Massage your perineum (or get your partner to) to reduce the risks of it tearing during childbirth. Use oil, and place one finger inside the vagina and massage in a U shape. Begin this at the start of your second trimester.
• Keep a sanitary towel (not a tampon) handy in case your waters break. This can make it a bit more comfortable and provides a way for your midwife to check the colour of the fluid if needed.
• Plan something to eat during the first stage of labour, as it may last a while and you’ll need the energy later on. Eat bite sized portions of wholegrain carbohydrates such as bananas, dried fruit and nuts, wholegrain biscuits or crackers, wholemeal bread sandwiches, cereal, pasta, etc. Avoid large meals as digestion takes longer during labour and can make you feel nauseous.
• Prepare mentally. Face your fears and find out exactly what will happen during labour rather than hiding from it and building anxiety. Talk to your partner, friends, family, GP and midwife about any questions or concerns that you may have. Practice relaxation techniques and breathing exercises that you can use during labour to help you feel calmer and more in control.
• Decide where you want to give birth. Where is the most comfortable place for you? Around 2% of women in the UK choose to have a home birth which can be more comfortable and straightforward for low risk births (although that can increase the risk of complications for your baby and pain relief options are limited). You can also choose to have your baby at a birth centre or hospital.

Labour

Although it can feel like one long struggle, healthcare professionals see labour in 3 parts, and there are certain things that happen and should be done at each stage. Don’t worry if labour is different for you than your friends – each delivery is individual and the most important thing is keeping mum and baby safe through this journey.

First stage (the latent phase)

• This is normally the longest stage and can last for hours or days.
• Your mucus plug which keeps your cervix closed may appear in your knickers or toilet. This is known as a ‘bloody show’ – it looks a bit like jelly with some blood in it.
• The cervix softens and gradually opens, and you may have irregular contractions.
• Contractions normally start about 20 minutes apart and last for 30-45 seconds.
• Try to distract yourself during this time by meditating, going for a walk, getting ready for the hospital, listening to music, etc.
• You may have loose bowel movements as your body prepares itself for labour.
• Your waters can break at this stage, but they may break in the second stage. Your baby has been developing inside the amniotic sac, and the draining of this if when your waters break. 60% of women go into labour within 24 hours of their waters breaking, and the rest within 48 hours.
• Try to eat and drink something at this stage to give you energy for labour.
• Try breathing exercises, a massage or a warm bath to ease pain.
• If you go to the hospital too early at this stage, you could be sent home until your labour becomes established.
• Contact your midwife if your waters break, your contractions are regular (around 3 every 10 minutes), you need pain relief or are worried.
• Your midwife will monitor your baby, listening to its heart rate every 15 minutes, or using electronic monitoring if there are any concerns or if you’re having an epidural.
• By the end of this stage, your cervix is fully dilated (around 10cm in diameter) and wide enough for your baby to pass through.
• The average time for this stage is 6-12 hours for a first pregnancies, but can be quicker if it’s not your first.

Second stage

• This stage begins when the cervix is completely open and ends with the birth of your baby.
• Contractions are longer, closer together and more intense.
• Your waters may break at this stage, but if they don’t, your midwife may break them for you.
• This is the time to find a comfortable position to give birth in (but try them out before you go into labour). Standing, squatting or using a birth seat creates a more natural position and allows more oxygen to get to your baby. Lying or semi-sitting can make it easier for your midwife to access the abdomen and monitor the foetal heart rate. Kneeling takes the weight off the tailbone, etc.
• As your baby gets closer to the entrance of your vagina you may feel the urge to push (which feels a bit like needing to poo).
• This pushing stage can last up to 3 hours for first time mothers, and 2 hours if you’ve had children before.
• When your baby is almost ready to come out, your midwife will ask you to do some short breaths – this pushes the head out slowly and gives your perineum time to stretch. If you have any large tears, they will be stitched up after your baby is born and you’ll be given a local anaesthetic injection.
• Once your baby’s head is out, its body normally comes out in the next one or two contractions.

Third stage

• After your baby’s born, your placenta will come out.
• You can do this through active management where you will get an injection of oxytocin to make your womb contract, your midwife will wait 1-5 minutes to cut the umbilical cord (as long as there are no problems with it), then they will pull the cord which pulls the placenta out through your vagina.
• You can also choose physiological management, where this stage happens naturally. The cord is cut after around 2-4 minutes (once it stops pulsing) and you will push the placenta out. You can hold your baby while you wait for the cord to be cut. It can take anywhere from 10 minutes to an hour for the placenta to come out, but you can spend this time saying hello to your baby.
• If you opt for physiological management but there is heavy bleeding, you may need to switch to active management.
• This is a magical time – you finally get to meet your baby! All of that hard work has paid off and although you’ll be feeling exhausted, this is a moment you’ll cherish and remember for the rest of your life.

Pain relief

Natural techniques

• Help your body to get your baby into place by using upright positions: squat, sit (on a chair, bed or birth ball), stand, walk or even slow dance to naturally help your baby get into your pelvis and help you to feel more comfortable.
• A neck or foot rub can ease a tense body and take your mind off contractions. Get your partner to press on your tailbone or lightly massage your shoulders and run their fingers up and down your back.
• Try a hot water bottle or heating pad on your lower back or belly, or a cold pack on your back to ease the pain a little bit.
• Don’t worry about making noise. Sighs and moans can help release tension in your body.
• A transcutaneous electrical nerve stimulation (TENS) machine uses sticky pads attached to your back and sends small electrical impulses to stimulate endorphin production. Endorphins act as natural painkillers, and mum can control the intensity of the impulses coming from the machine. This is a way of getting some pain relief without medication, as well as some feelings of control.
• Have a bath or shower – the warm water can help you feel relaxed.
• Water births can be used to make you feel more relaxed and the contractions less painful. The temperature should be kept below 37ºC at all times and you may be asked to get out of there are any issues.

Epidural

• This is the most effective form of pain relief in childbirth.
• It’s an injection in your back given by an anaesthetist (so can’t be given at home).
• It creates numbness and allows for pain relief drugs to be given (normally local anaesthetic and opioid).
• For most women, it provides complete pain relief.
• Some women avoid them due to their side effects, such as low blood pressure, increased likelihood of needing forceps or vacuum assistance, increased risk of your baby having abnormal foetal heart tones, itchy skin, nausea, headaches nerve damage, etc.
• You may find it difficult to wee and might need to have a catheter fitted.
• It’s not always 100% effective – 1 in 8 women who have an epidural require further methods of pain relief.

Injectable opioids

• Drugs injected into your muscle or through an IV.
• They can help you relax and can be administered by a midwife.
• Normally used for women who can’t have or do not want an epidural.
• They can make you feel nauseous or drowsy and, once injected, last for a few hours and can’t be stopped.
• They can have an effect on your baby – they can be slower to breathe at birth and may stay sleepy for a few days after, making it more difficult to start breastfeeding.

Gas and air (Entonox)

• You will breathe an odourless gas made up of half oxygen and half nitrous oxide through a mouthpiece.
• It’s fast acting, and the effects wear off quickly after you stop breathing it in.
• It can be used in hospitals, at home and in birthing pools.
• It can make you feel nauseous, dry mouthed or light headed.

Caesarean delivery

Around 1 in 4 pregnant women in the UK have a caesarean section. It’s is where your baby is delivered through a cut made just below your bikini line, which is only done if it’s the safest option for you and your baby. You are awake but the lower part of your body is numbed. You should always prepare for the possibility of a c-section in your birth plan. It may be recommended by your doctor (planned/elective) or may occur at short notice as an emergency.

You may have to have a c-section because:

• Your baby is in the breech position (feet first) and can’t be turned around.
• You have preeclampsia (high blood pressure).
• You have a chronic condition such as kidney disease, diabetes or heart disease.
• You are obese and this is causing complications.
• You have problems with your placenta such as a low lying placenta.
• You’ve have previous caesareans.
• You have an infection such as HIV or active genital herpes, and a c-section can prevent them from being transferred to the baby.
• Your baby isn’t getting enough nutrients and oxygen.
• Your labour isn’t progressing
• You have vaginal bleeding
• You’re expecting more than 2 babies.

Although this may be safer in some situations, it does carry some risks and will result in a longer recovery time. Some risks include infections, excessive bleeding that may lead to womb removal, heart attack and problems with pregnancies in the future. It also increases the risk of your baby being admitted to a neonatal unit and/or having breathing problems.

Other complications

Unfortunately, not all pregnancies go smoothly so it’s important to be prepared for complications that may occur.

• Prolonged labour happens in around 8% of births. If it happens in the first stage, it doesn’t normally lead to complications but if it happens in the second stage then intervention may be needed. It’s caused by things such as slow cervical dilations, a small pelvis, a large baby, stress, etc.
• Perinatal asphyxia is a brief period where the baby doesn’t breathe. The medical team will work to get them breathing again, but it can lead to brain damage and mechanical breathing or medication may be needed.
• Placenta previa is where the placenta covers the opening of the cervix and often leads to a c-section.
• Foetal distress can be a number of things, and it affects around 1 in 4 labours. It's normally where your baby’s heart rate and oxygen levels show signs of distress. This can be helped by increasing your fluid levels, lying on your left side, using forceps or, in extreme cases, having an emergency c-section.
• Postpartum haemorrhage is excessive bleeding from the vagina after birth which can lead to a longer stay in the hospital.
• Meconium aspiration happens when the baby inhales meconium (a black, tar-like substance), and can lead to them going into intensive care with breathing problems.
• Nuchal cord affects around 10-29% of births. It’s where the umbilical cord is wrapped around the baby’s neck, but it isn’t always serious as they don’t breathe through using their mouth and lungs until the umbilical cord is cut. Often, midwives won’t even mention it and will simply unwrap the cord as the baby is crowning.

These all sound very scary, but you need to remember that you have medical professionals around you who are used to dealing with these complications and will do their very best to help keep you and your baby safe. It’s important to understand the conditions, but to also remember that you’re in safe, experienced hands.

Tips for partners

The above may seem like a lot for somebody to go through, and we haven’t even covered every eventuality! Pregnancy and labour can be an exhausting and stressful time, but it can also bring couples closer together.

Although many things will be in the hands of mum, her midwife, doctors, etc., there are a few things that partners can do to help make this time a little bit more comfortable:

• Learn as much as you can about your partner’s pregnancy and what’s happening to them – go along to antenatal classes and help them make the birth plan to show them that you’re on this journey with them.
• Talk to her and listen to how she feels. Communication is key, especially if she’s having worries.
• As you approach your due date, make sure you can be contacted at all times and have a plan to get to the hospital for when she goes into labour.
• During labour, praise, encourage and reassure. Help with breathing exercises and massages, the TENS machine, and using a birthing pool.
• Make sure she keeps hydrated and is eating enough.
• Keep an open mind – things can change quickly during labour and complications can occur. This may be difficult but try to stay calm to help your partner through this time.
• Be prepared to make decisions on behalf of your partner – if your partner is unable to communicate due to pain, you might have to do it for her.
• If she wishes to know, describe what’s happening while she’s giving birth. This isn’t a job for the faint hearted!
• Be prepared to care for your baby, partner, home, etc. while she recovers.

We hope this has helped you to understand some of the things that can happen on your delivery day. Remember, all births are different and it’s important to communicate and work with your midwife to make sure mum and baby are both safe and happy.

If you’re heading towards this day, don’t forget to check out our pregnancy blog posts, and if your little one is already here, we have plenty of posts on your baby’s sleep, health and well-being to help you on your parenting journey.

Whatever stage of your pregnancy you’re at, we wish you all the best with your delivery day!

Let us know in the comments below if you have any tips on making labour a little bit more comfortable.