Labour and Delivery

When you are booked in for obstetric care with Yinka Akinfenwa, he will in almost all cases be available to be with you in labour, should you need any assistance during the birth of your baby. The midwives on the delivery suite will also be there to support you.

Prelabour : What to expect

Before true labour begins (i.e. your cervix begins to dilate) it’s common to have runs of contractions, perhaps over a few hours. Some women feel them for a few days before labour begins. As your body prepares for labour, there are a few things you can do:

Try to relax as much as possible. Even though you may feel excited, or nervous, or both, relaxation is important. The aim is to minimize anxiety and tiredness!

Carry on as normal but try to conserve your energy. You may want to use aromatherapy, movement or acupressure techniques you have learnt, or visit an acupuncturist or massage specialist. Your partner may be a great help, and enjoy being involved, by giving you a gentle massage. Eat small portions of healthy, non-processed food, if you feel like it, or boost your energy levels with honey, fruit juice or small snacks.

Who to contact and when
Stay at home in the early stages of labour but do contact the delivery suite; you’ll be able to tell a midwife what is happening. She’ll keep Yinka informed about events as they unfold. Yinka will provide you with all the contact details.

What to bring to hospital
Night gown or T-shirt, dressing gown, toiletries and atomizer water spray, energy bars/drinks, phone numbers, photographic equipment and most importantly your pregnancy records.
 
Start of labour: What to expect

True labour begins as your cervix dilates. This may bring on much more intense contractions. As the birthing hormones run through your body, you will experience many new sensations – and with the rise in the hormone prostaglandin, you may have frequent bowel movements. You may have a ‘show’: a jelly-like discharge that shows the cervix’s mucous plug has come away; it may be brown or stained with blood. For some women, labour begins with the breaking of waters, although this can happen before labour begins, or during labour.
 
Self-help and Integrated holistic care
As your labour progresses, it’s useful to keep comfortable and relaxed in whatever way works for you; your partner or birth supporter may play an important role here, helping you to feel supported and safe, as you ride through the contractions. Keeping your energy up with energy bars or drinks is also useful.

Moving around and choosing comfortable positions to relieve pain and enable your body to get the benefit of gravity will help. Sitting upright on a birthing ball encourages descent of the baby though the birth canal. Kneeling and resting on a bean bag, simply walking, or swaying from side to side can all help.

Having a warm (not hot) bath, or using a birthing pool helps many women both to relax and progress well, and can provide significant relief from pain. Holistic alternative remedies such as aromatherapy oils and massage, especially over the sacrum and lower back, can help. It’s useful to plan or practice methods during pregnancy, so that you and your birth partner feel prepared on the day.

Normal labour: obstetric assessment and care

When you arrive at hospital the midwife or Yinka will assess your condition. They can tell a lot through what you tell them and by the way you are behaving, and through a physical examination.
The cornerstone of labour care is the careful assessment of;
  1. Mother’s wellbeing
  2. Baby’s wellbeing
  3. Progress of the birth process.
The normal sequeunce of events on your arrival is as follows:
  1. Confirmation that labour has begun
  2. Identify/rule out potential problems
    • Maternal distress
    • Maternal high blood pressure
    • Maternal nutrition
    • Fetal distress
    • Fetal abnormal presentation
    • Placental or cord complications
    • Amniotic membranes:  Waters broken or not?
      • What colour is the amniotic fluid?
      • How long have they been broken?
      • What is the risk of infection?
  3. Baseline assessment
Part of the routine assessment that will be carried out by midwives include
  • Maternal vital signs (pulse, blood pressure and temperature)
  • An obstetric examination of the abdomen to assess the baby is appropriately grown,
  • Checking the lie of the baby is suitable (e.g. not breech) and checking the level of the presenting part in relation to the pelvis.
  • Checking and recording a baseline fetal heart rate to assess the wellbeing of the baby
  • Checking the frequency, strength and duration of the contractions
  • Vaginal examination
A vaginal examination is vital to assess the progress of labour and is carried out every 2-4 hours or if it is deemed necessary.  The progress of labour is determined in relation to a baseline established on admission and not the length of time that there have been contractions.
During the examination the following are checked;

Presenting part:      Head, breech (bottom), shoulder, cord
Cervix for:               Length, thickness, pliability, closeness and application to presenting part
Fetal head for:        ‘Station’, position, flexion, caput (top of head)
Amniotic fluid:         Volume and colour (meconium or blood)
 
Latent phase: this is the early part of labour where the rate of dilatation is relatively slow. Obstetric management is mainly one of offering support. In the latent phase, simple pain relief measures tend to be sufficient, e.g. use of water (in the bath or pool), a TENS machine, acupuncture or acupressure or simple pain killers.

Active phase: this is what is described as established labour. Cervical dilatation is quicker in this phase and the contractions become regular and more intense. Typically the rate of cervical dilatation in this phase is at least 1cm/hour. In mothers who have had previous vaginal births the progress may be even quicker.

Second stage of labour: This is the stage in which the baby is born. The cervix becomes fully dilated (10cm) and the presenting part of the baby descends through the birth canal. You may not at first need to push during this phase; there is often a passive phase when the baby’s descent is powered by the strength of the uterine contractions. The active part of the second stage is the phase during which you will be actively pushing, or bearing down, for your baby’s birth. Midwives often play an important role during this time; they may guide you through breathing, pushing and relaxing.

Abnormal progress

The progress of labour can be charted with a partogram; this is a graphical representation of the cervical dilatation and will reveal where progress is slow in comparison to the acceptable or optimal range of timings.
The cause of abnormal progress in labour is typically down to one of three things:
  1. the “passage” (obstructions to the birth passage, for instance due to an abnormal pelvic shape, fibroids or a small pelvis);
  2. the “passenger” (for instance the baby’s size is causing a problem);
  3. the “powers” (uterine contractions are not strong enough, or too infrequent).  
If progress is abnormal, Yinka will consider the probable underlying cause and the available options for assisting progress. An oxytocin infusion may be recommended; this helps to increase the power of contractions and can improve progress.
 
Operative deliveries

Assisted delivery may be required for one or more of 3 main reasons:
  1. Fetal distress
  2. Arrest of the progress in labour
  3. Maternal compromise
Depending on the stage of labour the options available include
  • Caesarean section
  • Instrumental delivery
Instrumental deliveries include ventouse (vacuum extraction) or obstetric forceps. These are both designed to safely deliver the baby and each has advantages and disadvantages. The optimal instrument to use depends on the situation; the two are not interchangeable.
Caesarean section
If a caesarean section is necessary Yinka will explain the reasons for this decision. You will be asked to sign a consent form, and then Yinka will carry out the operation. A consultant anaesthetist will explain the anaesthetic procedure. Your midwife will remain with you and continue to provide support to both you and your partner and also prepare to receive your baby. A paediatrician will be asked to attend to ensure your baby is well at birth.
 
After birth

After birth Yinka is keen to encourage skin-to-skin contact between mother and baby at the earliest possible opportunity. The benefits of this simple and beautiful contact are many, including calming baby and mum and assisting early bonding. You can rest with and hold your baby, feeding if you like, even while you are delivering the placenta and being checked over following the birth.
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