Q&A with The Honest Midwife: Pregnancy and Birth Anxiety

Early labour can be slow-going and will often stop and start so you might feel confused about whether you are really in labour. Initially, labour can feel very similar to period pains. You may notice a show – jelly-like vaginal discharge, which may be pink in colour or streaked with blood - when you go to the toilet. This is the mucus plug which has been sealing the entrance to your cervix and it coming away is a sign that your baby is coming soon. However, it doesn’t always mean labour is imminent and you may still have a few days before you go into labour.

Another sign your labour has started is that your waters may break – this can be a sudden gush of fluid or a slow trickle. If you suspect your waters have broken, contact your midwife for advice. It is likely you will be asked to go into the hospital so it can be confirmed if your waters have broken or not. If your labour has started, you will experience contractions-  rhythmic tightenings of the uterus, which will come and go. These can feel very intense as they build to a peak and then die away. If what you are experiencing are Braxton Hicks, they will usually die off whereas genuine contractions will become more intense and closer together.

The best way to navigate your time at home is to think of all the things you like to do to relax in everyday life.  Baking a cake, reading a book, walking your dog, watching a film… Spending time doing these things is far more productive than counting your contractions. However, if this is not your first baby and you had a particularly quick labour with your other children, being a little more mindful of how “think and fast” they are coming is not a bad idea.

For those having their first baby, most fears centre around not knowing what to expect. It is not uncommon to wonder if you will cope, whether the birth will go to plan and most importantly, whether you and your baby will be ok. These are completely natural fears and the best way to deal with it is to learn what you can about giving birth beforehand, write a clear birth plan so everyone at the hospital or midwife-led unit knows your wishes and communicate with your midwife during your labour so they can fully support you. Trust your body and listen to it, sometimes medical interventions will be necessary but in many cases, your body will simply know what to do if you relax and go with the flow. Making sure you have a birth partner you can trust will also help ease some of your fears during the birth itself. Giving birth does not always happen in the way you expect or want but the health professionals looking after you and your baby will always consult you on any recommendations and will act in your best interests to keep you both safe. For those who have given birth before, fears often stem from past experiences. If you remember finding the contractions hard to cope with or something happened during the birth which was not part of the plan, this can make you worry history might repeat itself.  Second and subsequent births do tend to be quicker and more straightforward than first births but do speak to your midwife or consultant if you have fears which relate to any previous experiences.

I’m not going to sugarcoat it, the vast majority of women do find labour and birth painful. However, how well someone copes with contractions and how they manage it really does vary from person to person. Some people find they manage well using natural methods like breathing techniques, a TENS machine or hypnobirthing, while others will want something much stronger to manage. There is no right or wrong way to give birth and no one will give you a medal for coping without any pain medication. Talk through the different pain options available to you with your midwife and see how you go. If you give birth in hospital, you will have a wider choice of pain relief, including an epidural, a type of anaesthetic which can take away the pain completely. Other options include Entonox, usually referred to as gas and air, or powerful painkillers administered by injection like pethidine or diamorphine. If you give birth at home or in a midwife-led unit, you will not be able to have an epidural and your other pain relief options may be limited. All pain relief comes with some potential side effects so discuss it with your midwife so you can make an informed choice.  These are all covered with The Honest Midwife’s classes!

Gas and air (Entonox) is a combination of oxygen and nitrous oxide gas, which you can breathe in while you are experiencing a contraction. You will be given a mouthpiece (or sometimes a mask) and you control when you breathe it in. Your midwife will talk you through how to use it but you will be advised to breathe in the gas and air using deep, slow breaths when you can feel a contraction coming on and then take a break in between contractions. Gas and air can make you feel giddy and light-headed but it wears off very quickly. It will not completely take the pain away but many women find it reduces it enough that they are able to cope.

Pain relief injections of pethidine or diamorphine are often used to help labouring women relax so they can rest. They are more powerful than gas and air and may be offered if you are struggling to with just Entonox or if you are becoming very tired during a long labour. The injection will be administered by your midwife or a doctor and it will be put into your thigh or bottom. It will take around 20 minutes for the pain relief to kick in. Pethidine and diamorphine can make your baby a little drowsy if they are given close to your baby being born. This can cause baby to be a little slow to feed so you will not be offered these injections if your midwife feels you are close to delivering your baby. If your baby is sleepy, this is usually short-lived and shouldn’t impact your breastfeeding endeavours. If you want an epidural, have a drip put into your arm and an anaesthetist will use a needle to put a very thin tube into your back. A mixture of opioids and local anaesthetic will be administered through the tube to numb the nerves which carry pain messages from your uterus to your brain. It can take a while for an epidural to be set up and start working and an anaesthetist must be available so if you plan to ask for one, do not wait until you are in a late stage of labour. Your epidural can be topped up to make sure it is effective and you may need your midwife to tell you when to push and you may not be able to feel your contractions. An epidural does increase the risk of needing a ventouse or forceps-assisted delivery. You will also need to be continuously monitored however, you should still be able to move into different positions on the bed or, in some cases, use a birthing ball.

Writing a birth plan encourages you to think about all the options available and gives you some idea of things you may want to understand better. Birth plans make it easier for those caring for you during your labour to know your what your preferences are. However, it is impossible to guarantee you will be able to follow your birth plan to the letter. Emergencies do happen and it is important to view your birth plan as a wish list or an ideal scenario and not to become too upset if things happen differently to how you imagined they would. You can also change your mind at any point about how you give birth. So for example, if you thought you wanted to give birth with no pain relief but then found it difficult to manage, you can still ask your midwife what options are available. My suggestion would be that your birth plan is a way of getting to understand all the different possibilities rather than deciding way before the big day what you do and don’t want.  That way you will never look back and say your birth didn’t go according to your plan because your mindset was open to what ever was needed at the time.

You might well do but you probably won’t even notice! The pushing stage of labour involves a lot of bearing down and you will be told to push through your bottom. This means if there is anything in your bowels, it is quite likely to come out. But please don’t worry about it – your midwife has seen it all before and will just discreetly move any poop without even mentioning it. It really is nothing to be embarrassed about but just a natural part of a vaginal delivery. Making sure you go to the toilet before you reach the second stage of labour can help reduce the chance of this happening but believe me when I say no one working on the maternity unit will bat an eyelid if it does happen.