Hypnobirthing Course - Prepare for Childbirth

The initiation of labour is not truly understood, there has been many studies done and no-one is truly sure what is the starting of labour, experiments have been done on sheep to try and discover it, but as sheep's hormonal processors are different to us we still don't have all the factors to consider.

What is known is that the initiation of labour is a multifaceted process involving hormonal responses from the mums brain to babies brain and the placenta. The babies seems to have the key role in the initiation of labour.

It is thought from the research carried out that there is an increase in surfactant protein released when the foetus is sufficiently developed to be able to breathe independently, and this may hold the key to the trigger that initiates labour.

It is therefore important to remember that the mother may have little control over when her baby is ready to be birthed and artificial processors made to get labour started could have a negative impact on the foetus if they are not releasing this protein, ready to be born.

Hormonal Factors:

During the Pregnancy process progesterone is high which prevents the uterus from contracting. However towards the end of the pregnancy oestrogen rises relatively to the level of progesterone, the baby also starts to increase levels of oxytocin which could actually be the trigger for the oestrogen rise in the maternal brain. It could be babies way of telling the maternal brain they are ready to be born. This also means there is an increase in the oxytocin receptors on the surface of the uterus. The actual level of oxytocin in the maternal body doesn't increase much more towards the end of pregnancy, however the muscles recognition of its existence and acts upon it has increased significantly.

Prostaglandin production is also increasing during the last few weeks of pregnancy, and this is responsible for softening the cervix, allowing it to become more responsive to the mechanical processors. It also has a softening effect on pelvic ligaments working together with relaxin it enables the pelvis to open and become more effective during labour.

Mechanical Factors:

A the foetus descents into the pelvis towards the end of pregnancy, the presenting part of the baby usually the back of their head, applies pressure to the internal part of the cervix. This pressure when applied evenly creates a reflex reaction that triggers the maternal brain to release increased levels of oxytocin. This in turn triggers contractions of the muscles. As the contractions move the baby own more into the pelvic, the babies head becomes more flexed, this is called foetal axis pressure and allows the baby to descent even lower and apply greater pressure to the cervix, increasing the amount of oxytocin released. This process is called positive feedback mechanism.

This can be a worrying time for Mums Especially first time Mums as they feel like they don't know when Labour is going to happen and they don't know if true labour has started. They might hear stories from friends that they thought they were in labour only to be told by the hospital to go home because they were not in labour yet.

This is because often pre labour is one of the longest parts with signs of labour starting but this can go on for hours even days before true labour has begun.

The definition of active labour is when the pregnant person reaches 4cm dilated, but this can take along time.

Waters Breaking

This is always the version that is seen in tv dramas, but for some mums this is the beginning if labour, However the most common time for membranes to rupture in when the cervix is approx 7 to 10cm dilated later on in labour.

In most cases if the membranes do begin to leak early in labour this is a hind water leak, which is the waters behind babies head which will present in a slow trickle of fluid. Some times mums are confused if they are peeing or is in-fact their waters leaking.

Amniotic fluid doesn't have a scent like urine does so the easiest way to identify if it is urine or amniotic fluid is to smell the fluid and put a pad on their underwear, if the pad continues to be wet is it more likely to be their waters leaking.

The waters should be clear or straw coloured, if there is blood (more than just a little tinge) or brown, green or foul smelling, the mum should contact the doctor or midwife asap.

Sometimes when a baby becomes stressed in the womb they can dirty the water with their first bowel movement meconium which is passed before the baby is birthed. This is what colours the waters a different colour brown or green, or red. If this is the case the baby may have to be birthed quickly to avoid further stress. Babis sometimes also pass meconium if the pregnancy goes beyond 40 weeks, but this does not necessarily mean the baby is distressed but will still require quick action and foetal monitoring.

Bloody Show

When the foetus is concerned the cervix create a small plug called the operculum, which in in place to protect the foetus and womb from external infections, Sometimes labour is noticeable beginning with the discharge of this plug as the cervix softens and begins to dilate. The loss of this mucus usually referred to as "having a show" does not necessarily mean that labour is under way, but it does mean the body is beginning to prepare for labour. The blood that usually represents with it comes from the tiny capillaries inside the cervix being broken. This plug of mucus could be a range of colours from clear to cloudy, yellow or brown pink or red, its more about the consistency that show it is in-fact this plug. Some people notice it when they look in the toilet or wipe. If they have heavily bleeding with it they will need to see the midwife or doctor straight away.

Contractions

For some people the first signs of labour start with contraction, They may have been having Braxton hicks contractions or practise contractions for a few days or even weeks. Although this type of contractions can feel uncomfortable and strong they are irregular with no real pattern to them, but they are a good sign that things are progressing as this is the way the body practises and prepares for birth. These types of contractions may not stop when moving around but may calm down when you slowdown or stop.

Labour contractions usually have a regular pattern and start of gently gradually getting stronger and falling back down again during one contraction. Standing up or moving rocking side to side can increase the strength of the contraction. Labour contractions build up over the course of labour. When they first start they usually last around 30/45 seconds, by the end the contractions will last around 90 seconds, a baby will not be born without this length of contraction, although to mum it might not feel like it is lasting that long.

Some mums might not feel anything right from the first contraction, others might feel it is strong and frequent. There is no real set space between contractions, but some start off ever 20/30 minuets then slowly build up to coming every two minutes, while others might be 3/4 minutes from the beginning to the end.

The first contractions are mildly uncomfortable with the pain being in the lower tummy or back, most mums can still talk and move around through early contractions, as labour progresses, they may need to concentrate more and go inward with each new contraction, breathing can help get mum through it, to focus the mind.

Rupture of Membranes.

Towards the end of pregnancy the chorion which is the outer membrane of the amniotic sac begins to detach from the lower uterine segment as it stretches. This allows for the formation of fore-waters. Which is a bulge in the bag of waters in front of foetuses head. The waters behind the foetuses head are called hind waters. As the baby descents into the pelvis the fore-waters are essentially cut off from the hind waters, by the foetuses head. When the contractions are strong and applying pressure to the hind waters there is not much pressure applied to the forewaters preventing them from rupturing early in labour. This protects the baby and optimises its supply of oxygen through labour.

The physiological timing of membranes to rupture is arounds 8cm dilated. If the membranes do not rupture at all during delivery the baby is born "in the caul" This is considered very lucky in many cultures.

If the membranes do rupture early or there is a hind water leak of fluid, mum might be concerned that the uterus will become dry, however the cells lining the amniotic membranes continue to secrete fluid at the rate of one litre every hour, so the baby is never in a dry environment.

The most significant risk to the fore-waters going prematurely, leaking or rupturing is an intrauterine infection. Avoiding vaginal examinations and keeping away from environments that the maternal immune system is unfamiliar with will reduce the risk.

There is very little research to weather a hind water leak is carries the same risk of infection as a fore-waters leak. What us known is that in same cases the hind water leak appears to heal over eliminating the leak and pregnancy can continue from some time after this.

The best way to know if it is fore waters or hind waters is how it comes out, a slow trickle is a leak from the hind waters, a gush of waters is the fore waters (Which is usually what is seen on tv dramas) But remember this rarely happens this way.

Premature rupture of membranes

Premature rupture of membranes or PROM for short is when the membranes release before labour begins. If this occurs before 37 weeks, it is referred to as premature rupture of membranes.

The membranes may break prematurely on their own for no obvious reasons, however certain factors can increase the risk such as:

Vaginal examinations in pregnancy (including internal scans)

polyhydramnios which is excessive amniotic fluid,

Amniocentesis which is a needle injected into the womb to identify certain abnormalities with the baby

Smoking in pregnancy

Uterine infection.

Vaginal examination

Some studies have shown that vaginal examinations do increase the risk of infection, while others have shown no link. This is discussed further, later in the course around routine procedures during labour.

Polyhydramnios

This is a condition where excess of amniotic fluid exists, this may be caused by maternal illness or abnormalities in the foetus such as kidney problems. This condition is rare as it only presents its self in 1 to 2% of pregnancies. About a quarter of mums with this condition will go into labour prematurely. It is very difficult to diagnoses polyhydramnios accurately as ultrasound only provides an estimate of the fluid within the sack.

Amniocentesis

This is a test used at around 16 weeks of pregnancy to look for chromosomal abnormalities. This procedure is where a needle is inserted through the pregnant abdomen and a small amount of amniotic fluid is extracted. This procedure increases the risk of PROM, by breaking the membranes barrier. The hope is that the incision heals and repairs and pregnancy can continue but it does come with significantly high risks. There is a foetal measuring test performed first to assess if the foetus is high risk and this procedure is offered to investigate further, but it can also be refused if the parent does not want to have it done.

Cigarette Smoking

Smoking in pregnancy increases the risk for the mother and baby. While there is a lot of negative factors to smoking during pregnancy, the proportion of PROM appears to be higher in those who smoke during pregnancy. The reason for this is not fully known yet.

Uterine Infection

This is the most common cause of PROM. Infection enters the uterus and causes the amniotic sac to rupture early.

Once the membranes are broken there is an entrance to the baby for infection. But there are things than can be done to reduce the risk of infection.

Avoiding vaginal examinations during pregnancy, they do not offer much benefit to mother or baby, only for the health care provider to assessment the pregnancy, this is in most cases not needed and increases risk to the mum and baby.

For mum to have good personal hygiene to prevent infection travelling upwards from the vagina to the uterus, for example always wiping front to back after using the toilet so nothing it wiped forward into the vaginal opening.

Avoiding prolonged exposure to unfamiliar environments, in the hospital, mum will be exposes to bacteria that she is not use to and this can increases the risk of infection.

Self monitoring temperature can help identify an infection developing, although sometimes pregnancy can mask an elevated temperature. But if Mum can detect a high temperature she can treat it by taking action earlier to decrease the spread.

Sexual Intercourse

Most publications suggest mum should not have sexual intercourse once the membranes have ruptured but there is evidence to support this. The recommendation seems to come from the evidence of vaginal examinations increasing the risk of infection to the mother and baby. However there is no consideration that mum would be used to the bacteria of her partners penis, while the bacteria presented in hospital environments may be unfamiliar to her.

Bathing in Water

It is also recommended mum should avoid bathing once membranes have ruptured and the prolonged period of time that follows, In some trials done back in 1960, a tampon soaked in iodine was placed in the vagina and the mum placed in water to assess if water enters the vagina, they found that no water entered into the vagina during the bath. Cochrane reviewed 11 trials which included more than 3000 participants which had a mixture of ruptured and intact membranes and found no evidence that emerging in water was a risk.

First Stage

The first stage occurs from the onset of labour until the cervix has opened to 10cm (Approx)

The second stage is the expulsion of the baby through to complete delivery of baby. The Third stage is the expulsion of the placenta. The first stage can be further broken down into several distinct phases. Early first stage, active first stage, transition and the rest phase.

Early First Stage

The cervix begins to soften and prepare for labour. It will begin to efface (thin) and dilate (open). The cervix will open from 0cm to 6cm in this stage. The mucus plug in the cervix may be dislodged "the show" and there may be heavy discharge to light bleeding. The membranes may begin to leak or trickle. There may be mild irregular tightenings. The tightening usually last around 10/40 seconds. If mum is managing to talk through contractions it is more likely she is in early labour.

If the contractions are not lasting 60 seconds or longer and in an irregular pattern it is unlikely they are in active labour.

Babies in posterior position where their back is back to back with mums spine, it can feel like labour is further on than it is. This position means there is more pressure on the mothers bowel so this may mean they feel more pressure that can make mum feel like pushing. The contractions may come very frequently, every 2 to 3 minutes and seem strong, particularly if they are accompanied by back pain. However, they are unlikely to be lasting for 60 seconds or longer if they are still in early labour. Rotational positioning at this stage of labour can be beneficial for those who would like to avoid interventions.

The early phase of labour can occur over several hours, days of weeks. Some Mums find they have periods of regular contractions for some time before labour becomes established while other Mums might have no early signs of labour at all. It is never possible to determine how long this phase will take, nor is the length of this phase any indication of how long established labour will last either.

Active First Stage

The contractions will be stronger and more regular. The cervix is effaced and is opening from 6cm to 10cm. The baby is moving down into the pelvis and into position that will help them to be born. Contractions will at this point be lasting around 45/60 seconds and will gradually become longer and closer together. The peak will seem sharper and more painful. The active phase for a first labour can last from 8 to 16 hours. For those that are having a second or subsequent birth, it may be considerably shorter. If the previous birth was a caesarean, labour might be more like a first labour than a second one.

They are several signs to notice in active labour. As they enter this stage they might experience a sort of mini transition, This can be accompanied by vomiting or waves of nausea, and they may begin to look more focused and withdrawn. From around 5/6 cm they may start to make a noise with each contraction. They may also begin rocking the pelvis and swaying side to side. From around 7cm dilated, they may be more focused and inward and unable to answer questions. Conversations or any external noise particularly during the peak of contraction can be very distracting.

Transition Stage

Transition stage is part of the active stage of Labour. The cervix is now dilated between 8cm and 10cm. Contractions are at their strongest lasting 90 seconds and coming every 2 minutes. The gap between contractions only allows for a quick breathe and a quick sip of water. The peak of every contraction is very wrong and some may feel like double peaks with no break between, It is worth remembering this is due the the muscle tightening to help the uterus up and away so the cervix can open and deliver baby. It is at this stage it is more likely that waters will break on their own. This stage can last anything from a few minutes to an hour or more while some mums may not notice it at all. Transition is usually the most difficult and frightening time during labour, Mum will feel very vulnerable and doubt wether she can get through it. It is usually a good indication of labour progression if Mum is declaring she cant do it, as it in-fact means she is transitioning. It is common for mum to ask for pain relief at this stage or crying out for help. They may begin to feel the urge to push, particularly in this is a second or subsequent baby. Some will feel a bulging feeling in their bottom and sometimes feel like a need to pass a bowel movement, which can happen but a midwife is trained to deal with this so swiftly, mum wouldn't have even noticed they had passed a stool.

Common signs of transition are:

Shaking legs

nauseous and vomiting

cold feet

not wanting to be touched at all

suddenly feeling very cold

hiccuping and burping

helplessness and wanting to give up

anger being bad tempered and aggressive

suddenly removing clothing

not caring about appearance.

Recognising the transition phase is usually straight forward. Together with signs of transition outlined before, you may also notice two distinct physiological changes.

The first occurs in the feet, during the contraction at this stage the mum ay turn her toes up. Mum would need to be in a all fours tummy down type position to be able to see it.

As baby descents into the pelvis and second stage approaches a thin line appears from the crack of the bottom upwards towards the small of the back. This line progressively gets longer til it is around 4 to 6 cm. If you could place your hand on the lower back at this time you might be able to feel the sacrum moving outwards as the baby moves down. If they are on all fours or standing you may be able to see the bulging in the lower back.

Resting Phase

After the very active stage of transition stage, it may appear that labour has stopped for some time. From a medical point of view this is not seen as a stage of labour so it is not widely discussed, but it is commonly seen by midwives and other health professionals. It is believed to b e so mum can get her breathe and catch a rest before the pushing stage. Some Mums don't feel this stage as all and go straight into feeling like they need to push. Other Mums have a very distinct rest phase that can last an hour or more. During this time contractions may space out or even stop altogether. By this stage mum might be feeling exhausted and need to take this opportunity to relax, rest and have something to eat and drink, even empty their bladder if still mobile.

Second stage of Labour

By the second stage the cervix is now fully dilated to 10cm. The contractions start to change as the uterus starts to push the baby down through the birth canal. Contractions last for around 60/90 seconds and maybe about two to five minutes apart. During the contraction the baby moves down and when the contraction ends the baby slips back slightly. This is thought to help the tissue and perineum stretch back and forth, moving further forward with every contraction and movement of baby. As with every contraction the babies head stretches the tissue and perineum, which increases levels of oxytocin to make contractions stronger, this is called the Ferguson's Reflex.

As the baby progresses through the birth canal, it must change shape to fit through the maternal pelvis, this is referred to as the cardinal movements. The baby descents into the pelvis with its head tucked tightly into its chest, called flexion, as the baby's head reaches the pelvic floor, it must rotate to enable the widest diameter of the head, which is front to back to come through the widest part of the pelvic outlet, front to back.

The pelvic floor offers resistance to the head and results in the head turning into optimum position. This is called internal rotation. As the head moves under the public arch, there is no longer resistance from the pelvic floor and extension takes place. now the shoulders are in contact with the pelvic floor, and the babies head rotates to line up with the shoulders this is called external rotation. The babies shoulders are then born one shoulder at a time, and then expulsion takes place as the rest of the babies body is born.

On average the second stage of labour lasts 1/2 hours for first babies and less than an hour with subsequent babies. If the previous birth was a C section and this time the baby is descending down the birth canal this will be like a first time birth.

Often at this point there is a distinct change in the air, from a feeling of birth has taken place but also a scent of birth, a scent of odour, blood, amniotic fluid, vaginal discharge. Weirdly these changes don't seem to take place as much with a medicated pain relief.

The Third Stage of Labour

Once the baby has been born the placenta that has been keeping baby alive and nurtured needs to be born too, they are two choices available when considering how the placenta will be born. The first is active management which involves the use of drugs (usually Vitamin K) to assist in the delivery of the placenta. The second stage is called "physiological management or "expectant management" Which is to wait til the placenta delivers itself usually within an hour or so. This will often depends on if the mum needs stitches or surgery to how quickly the placenta might need to be delivered to get mum into recovery. It is not something that can be planned ahead of time. However it doesn't mean delayed cord clamping needs to take place any earlier than mum wants just because it has been removed from her quicker than she might have liked.

Some parents prefer for babies born to remain attached to the placenta for several days til it falls off naturally, this is called lotus birth.

Indicators of Progress.

There are a few different ways of determining if labour is making steady progress. While cervical dilations is one we have just discussed they are other indicators that show progress and the rate of progress.

Change in the state of the cervix

The position of the cervix changes as labour progresses, before labour it is pointing towards the back of the vagina wall, in what is known as posterior. As the body moves towards the labour the cervix moves to midline position. then finally moves forward to an anterior position which is pointing towards the front vaginal wall.

The condition of the cervix also changes. Before labour it is firm a lot like the tip of your nose, it begins to soften and thin, becoming partially effaced. This stage is when the cervix is considered to be "ripe". If you place your lips together and pout and push your finger against your lips this is similar to how the cervix feels when it is ripe. Once in labour the cervix usually becomes fully effaced, or very thin.

Change in position of the Baby.

As labour progresses baby moves down deeper into the pelvis. the level of decent can be measured during a vaginal examination. During the examination the care giver feels how far above or below the ischial spines the baby's head is lying. Level with the ischial spine would be called-2 station and two cm below the spines would be called +2 station. If the mother is having a second or subsequent baby, the baby may sit very high until the end of the first stage of labour.

Change in Nature of Contractions

Contracts change through out labour, they become longer and stronger and closer together as labour progresses. During early labour, the mum is more likely to talk between contractions and should be able to breath calmly. As they go into active labour and approach transition, they become more focused on each contraction. They maybe making deep groaning noises during contractions, and is likely to be more "inward" between contractions and a lot less talkative. It might be difficult and annoying to mum if there is a lot of noise in the room, and people asking questions.

Visible outward signs of progress

Often birth partners notice signs that midwives don't necessarily recognise.

Such as:

Mums face often becomes flushed around 6cm dilated.

as transition approaches, they may notice mum squeezes her toes during a contraction and there is a slight indent in the middle of the sole. or sometimes mum rises up onto her toes if she is standing up.

As they approach the second stage, a dark line begins to appear on the lower back. The line starts from the crack of the bottom and gradually moves upwards. once actively pushing the line is about 2/4 cm long. This line can also appear if a baby is posterior and is currently moving around the sacrum.

Active management v expectant management

Active management is general hospital routine practise to control the time a woman is in labour. You will find in NHS Antenatal Classes they will talk about it in a positive way that parents wont be in labour more than 12 hours but this is often because if labour is going slowly (which is completely natural) they will aim to speed it up with induction, injection to help placenta detach quicker, immediate cord clamping.

The clinical practice guideline (CPG) for care during childbirth recommended active management of the third stage of labour, which involved the use of oxytocin international units [IU] via intramuscular), followed by early cord clamping, sectioning, and controlled cord traction.

**The NICE Guidelines currently say 2022: **

Active and physiological management of the third stage

1.14.6Explain to the woman antenatally about what to expect with each package of care for managing the third stage of labour and the benefits and risks associated with each. [2014]

1.14.7Explain to the woman that active management:

• shortens the third stage compared with physiological management

• is associated with nausea and vomiting in about 100 in 1,000 women

• is associated with an approximate risk of 13 in 1,000 of a haemorrhage of more than 1 litre

• is associated with an approximate risk of 14 in 1,000 of a blood transfusion. [2014]

1.14.8Explain to the woman that physiological management:

• is associated with nausea and vomiting in about 50 in 1,000 women

• is associated with an approximate risk of 29 in 1,000 of a haemorrhage of more than 1 litre

• is associated with an approximate risk of 40 in 1,000 of a blood transfusion. [2014]

1.14.9Discuss again with the woman at the initial assessment in labour (see section 1.4) about the different options for managing the third stage and ways of supporting her during delivery of the placenta, and ask if she has any preferences. [2014]

1.14.10Advise the woman to have active management of the third stage, because it is associated with a lower risk of a postpartum haemorrhage and/or blood transfusion. [2014]

1.14.11If a woman at low risk of postpartum haemorrhage requests physiological management of the third stage, support her in her choice. [2014]

1.14.12Document in the records the decision that is agreed with the woman about management of the third stage. [2014]

1.14.13For active management, administer 10 IU of oxytocin by intramuscular injection with the birth of the anterior shoulder or immediately after the birth of the baby and before the cord is clamped and cut. Use oxytocin as it is associated with fewer side effects than oxytocin plus ergometrine. [2014]

1.14.14After administering oxytocin, clamp and cut the cord.

• Do not clamp the cord earlier than 1 minute from the birth of the baby unless there is concern about the integrity of the cord or the baby has a heart rate below 60 beats/minute that is not getting faster.

• Clamp the cord before 5 minutes in order to perform controlled cord traction as part of active management.

• If the woman requests that the cord is clamped and cut later than 5 minutes, support her in her choice. [2014]

1.14.15After cutting the cord, use controlled cord traction. [2014]

1.14.16Perform controlled cord traction as part of active management only after administration of oxytocin and signs of separation of the placenta. [2014]

1.14.17Record the timing of cord clamping in both active and physiological management. [2014]

1.14.18Advise a change from physiological management to active management if either of the following occur:

• haemorrhage

• the placenta is not delivered within 1 hour of the birth of the baby. [2014]

1.14.19Offer a change from physiological management to active management if the woman wants to shorten the third stage. [2014]

1.14.20Do not use either umbilical oxytocin infusion or prostaglandin routinely in the third stage of labour. [2014]

The NICE Guidelines change from time to time, so check out the link below for the yearly updates:

https://www.nice.org.uk/guidance/cg190/chapter/Recommendations#third-stage-of-labour

**Expectant or Physiological Management **

Expectant management consists of waiting for the body to birth and labour naturally and trigger the elimination of the placenta naturally. It would be ideal for a midwife to monitor the process. When the natural birth process is expected to labour and birth in its own time.

Advantages of expectant management:

• Torrent of oxytocin that raises the woman's mood, and acts as a natural pain reliever, which builds up naturally.

• Birthing experience. Self-confidence in the body itself, in its ability to carry out the process. There are studies in which 70-80% of women would choose expectant management if given the option.

• Avoid risks associated with active management. The process is not forced

• . Avoid possible damage to the uterus (synechiae, damage to the endometrium, tears, infections...) that may cause secondary infertility. The process in the hospital can be very traumatic due to the lack of support.

• Privacy. The woman is no longer a patient by removing the process from the hospital environment. She can benefit from the support of her family and her closest environment.

• Give time to detect possible issues and find a resolve.

Where the different types of management come in

If Mum plans to have a hospital birth, that is more likely to be active management, but it ultimately depends on that hospital and NHS trust and what their policy is.

If Mum plans to have a home birth this is more likely to be expectant management, and allow her to birth her own way, in her own time.

Birth Centres are usually in the expectant management area but it again depends on their policy.

It can often fall onto how busy the hospital is, how many beds they have, how many members of staff they have, and it is ultimately down to a manager which the parents are unlikely to ever meet.

Thats why it is especially important for parents who do want to go into hospital or even a C section to let the hospital know they have studied hypnobirthing and would like a birth as close to that as possible, as the hospital will be well aware of the procedures and calming techniques these parents want. In hospital they might not be happy to change their policy but they might be willing to adapt and bend somewhat.

Induction of labour

Induction of labour is the use of medical methods to get the delivery to begin, that is, for the uterus to contract.

Induction of labour is recommended when something about the health of the baby or woman is causing concern and delivery has not started spontaneously.

According to the Ministry of Health, induction is an acceptable and recommended practice when indicated. Inducing labour can avoid unfavourable outcomes for the mother or baby and an unnecessary cesarean section and its possible consequences.

However induction of labour also comes with its own set of complications, such as decrease in endorphins the natural pain relievers, and oxytocin needed to bond with baby on arrival into the world.

Stages of labour

First, it is essential to clarify how labour develops. It has three stages, and induction is only done when the woman is not yet in the first stage.

Here are the stages of labour:

• First stage: the woman has regular contractions every 3 to 5 minutes for more than 1 hour. Contractions are usually painful and last around 50 to 60 seconds. It is divided into two phases:

• Latency Phase: Gradual change of the cervix. It can reach up to 6 cm of dilation.

• Active Phase: Rapid change of the cervix. It starts after 4 to 6 cm of dilation and goes until full dilation or 10 cm when the cervix disappears completely, and the uterus and vagina become the birth canal.

• Second stage: from full dilation to birth. This is when the baby's head descends through the birth canal. It is divided into two phases:

• Passive Phase: from full dilation to involuntary pulling (when the woman feels the urge to push, such as the urge to have a bowel movement);

• Active Pushing Phase: from the beginning of the pushing until the baby is born.

• The third stage: is from the baby's birth to the delivery of the placenta, called delivery.

Why do labour induction?

The Ministry of Health recommends that labour induction be performed after the 41st week of pregnancy, with the woman's agreement.

Other reasons to perform labour induction are oligohydramnios, a decrease in amniotic fluid, a ruptured sac without the woman has gone into labour, hypertension during pregnancy, or some other condition in which waiting for spontaneous delivery brings associated risks.

Whatever the reason, the woman must be informed, clarified, and agree to the procedure.

How is labour induction done?

Before the induction is performed, the ideal is to try some methods of preparing the cervix, which will help to make it softer and a little dilated to facilitate the dilation that will happen when the contractions get rhythmic.

There are pharmacological and non-pharmacological ways to perform this preparation. Among the non-pharmacological methods are the detachment of membranes (which can be complemented with some acupuncture points) and the use of an intracervical balloon. The pharmacological process consists of the use of prostaglandins vaginally.

Illustration of the use of intracervical balloon

Although a little uncomfortable, membrane detachment is a safe and effective method, as it promotes the release of prostaglandin. This hormone helps to mature the cervix and sometimes ends up triggering contractions. It consists of a touch exam and a massage on the cervix, which takes off the part of the bag that is in contact with the cervix.

The intracervical balloon involves inserting a catheter with a balloon filled with water or serum at the tip into the cervical canal, which softens and dilates it, preparing the ground for the action of contractions. The intention is for the cervical balloon to massage the cervix until it opens and the balloon comes out, leaving the path prepared.

Vaginal prostaglandins are the pharmacological alternative for the preparation of the cervix, and they are available in tablet or ribbon form. They are used with the patient already hospitalised and can often trigger contractions (in addition to preparing the cervix, which is the desired function). They are contraindicated for women with a previous cesarean section because they increase the risk of uterine rupture.

How labour is further induced - NHS England

If you're being induced, you'll go into the hospital maternity unit.

Contractions can be started by inserting a tablet (pessary) or gel into the vagina.

Induction of labour may take a while, particularly if the cervix (the neck of the uterus) needs to be softened with pessaries or gels.

If you have a vaginal tablet or gel, you may be allowed to go home while you wait for it to work.

You should contact your midwife or obstetrician if:

• your contractions begin

• you have not had any contractions after 6 hours

If you've had no contractions after 6 hours, you may be offered another tablet or gel.

If you have a controlled-release pessary inserted into your vagina, it can take 24 hours to work. If you are not having contractions after 24 hours, you may be offered another dose.

Sometimes a hormone drip is needed to speed up the labour. Once labour starts, it should proceed normally, but it can sometimes take 24 to 48 hours to get you into labour.

Towards the end of pregnancy, a hormone called oxytocin stimulates the uterine muscles and causes contractions that begin the process of labor. Pitocin® is a synthetic version of oxytocin, and doctors use this IV medication for labor induction. This drug helps imitate natural labor and birth by causing the uterus to contract.

But bear in mind this is still a synthetic drug that can have negative effect for mum and baby, such as fetal distress, mums inability to cope with the strong pains.

Expectant due date myth

How do you figure out estimated due date

Almost everyone—including doctors, midwives, and online due date calculators—uses Naegele’s rule to figure out an estimated due date (EDD).

Naegele’s rule assumes that you had a 28-day menstrual cycle, and that you ovulated exactly on the 14th day of your cycle (Note: some health care providers will adjust your due date for longer or shorter menstrual cycles).

To calculate your EDD according to Naegele’s rule, you add 7 days to the first day of your last period, and then count forward 9 months (or count backwards 3 months). This is equal to counting forward 280 days from the date of your last period.

For example, if your last menstrual period was on April 4 you would add seven days (April 11) and subtract 3 months = an estimated due date of January 11.

Another way to look at it is to say that your EDD is 40 weeks after the first day of your last period.

In cases where the date of conception is known precisely, such as with in vitro fertilization or fertility tracking where people know their ovulation day, the EDD is calculated by adding 266 days to the date of conception (or subtracting 7 days and adding 9 months). This increases the accuracy of the EDD because it no longer assumes a Day 14 ovulation based on the first day of the last menstrual period.

But where did Naegele’s rule come from

In 1744, a professor from the Netherlands named Hermann Boerhaave explained how to calculate an estimated due date. Based on the records of 100 pregnant women, Boerhaave figured out the estimated due date by adding 7 days to the last period, and then adding nine months (Baskett & Nagele, 2000).

However, Boerhaave never explained whether you should add 7 days to the first day of the last period, or to the last day of the last period.

In 1812, a professor from Germany named Carl Naegele quoted Professor Boerhaave, and added some of his own thoughts. (This is how Naegele’s rule got its name!) However, Naegele, like Boerhaave, did not say when you should start counting—from the beginning of the last period, or the last day of the last period.

His text can be interpreted one of two ways: either you add 7 days to the first day of the last period, or you add 7 days to the last day of the last period.

As the 1800s went on, different doctors interpreted Naegele’s rule in different ways. Most added 7 days to the last day of the last period.

However, by the 1900s, for some unknown reason, American textbooks adopted a form of Naegele’s rule that added 7 days to the first day of the last period (Baskett & Nagele, 2000).

And so this brings us to today, where almost all doctors use a form of Naegele’s rule that adds 7 days to the first day of your last period, and then counts forward 9 months—a rule that is not based on any current evidence, and may not have even been intended by Naegele.

How do we talk to our students about estimated due date.

There is such a huge debate surrounding estimate due dates, and the thing to encourage mums to remember is it is only an estimate. only 4% of babies are born on their due date, and 68% born 41+4.

Therefore even if the health care team are pressuring mum to think about a sweep or induction of labour, it is her choice to refuse interventions at all, or until she is 42 weeks pregnant, and only then if she decided to change her mind.

Electronic Fetal Monitoring (EFM)

Electronic monitoring involves strapping two plastic pads to your bump. These are attached to a monitor that shows the baby's heartbeat and mums contractions. A lot of hospital units now have wireless monitors. These are often waterproof so are suitable if mum is having a water birth.

You don’t need electronic monitoring if labour is going well, although you can ask for it if you want to.

The midwife or doctor will suggest EFM if:

• having an epidural

• have an oxytocin drip to speed up labour

• if there is baby poo (meconium) in the womb

• have high blood pressure, a high pulse rate or develop a temperature

• start bleeding in labour

• there is a delay in labour

• there are concerns about baby's heartbeat.

It is Mums choice whether to have EFM or not. If she are advised to have it, the midwife will explain why it’s needed and what it may show.

If Mum is having a home birth, she would have to be transferred to hospital. Once electronic monitoring is started, the midwife will:

• stay with mum at all times

• ask mum how she is feeling

• ask mum about baby’s movements

• check the monitor regularly

• carry out any other tests that are needed.

Mum should also be kept fully informed about what is happening at every stage of electronic fetal monitoring.

If the doctor or midwife starts because they are concerned about the baby's heartbeat but it is found to be normal, the monitor should be taken off after 20 minutes.

Fetal scalp stimulation

If the EFM shows that there may be a problem, the midwife may suggest that mum has a fetal scalp stimulation. This is a vaginal examination in which the healthcare professional will rub baby’s head with their finger. This may make your baby’s heartbeat speed up, which is a reassuring sign.

Planned C section

Over the past 40 years, the cesarean delivery rate has increased from about 1 in 20 deliveries to 1 in 3 deliveries. This trend has caused concern among specialists that cesarean sections are being performed more often than necessary.

Because of the risks of C-sections, the American College of Obstetricians and Gynecologists recommends that planned C-sections generally be done for medical reasons only.

As of March 2021 NICE Guidelines in the UK states that all mothers who choose to have a C Section are allowed to do so at will.

Check out this link below to find the guidelines:

Physiology of Labour Pain

Action of Uterine Muscles

The Uterus is made up of 3 layers of muscles. Longitudinal muscles over the whole uterus, circular muscles predominantly around the cervix, and oblique muscles. During the whole of pregnancy the circular muscles are contracted, keeping the cervix closed. During labour, these circular muscles must relax and allow the longitudinal muscles to contract effectively. It is the contractions of the longitudinal muscles that enable the cervix to open and the baby to move down through the birth canal.

Muscles can do one of two actions - contract, which is to shorten, or relax which is to lengthen. They tend to work in pairs, as one muscles contracts the other relaxes. Thinking about muscles in the arms, if you stretch your arm out the muscle in your forearm contracts, while the muscle in your upper arm relaxes. You experience pain when two muscles are both trying to work together at the same time. A bit like cramps in the muscles is the two muscles contracting at the same time.

Our body has two nervous systems, the peripheral nervous system, and the central nervous system. The central nervous system is made up of brain and spinal cord and is responsible for transmitting nerve messages or impulses through the spine to the brain to be interpreted. The peripheral nervous system includes autonomic nervous system which can be further broken down into the parasympathetic and sympathetic nervous divisions. The Parasympathetic division is most active when we are in non stressful situations. It is responsible for keeping our body energy low and managing digestions and elimination of faeces and urine. The Sympathetic devision is also referred to as the fight or flight system. When we are in danger, excited, or sexually aroused, our sympathetic system is at its most active. Through out this course you will hear us talking about this system because it plays a huge part in the fear mums have surrounding birth. It is the parasympathetic system that controls the hormonal responses in labour.

Pain during labour and birth have several different sources. These include functional, physiological and emotional sources.

Functional pain includes the pain that results from dilation of the cervix, pressure on the internal organs and rectum, physical procedures such as vaginal examinations, and the contractions themselves. As the uterus contracts strongly, it is temporarily deprived of oxygen, resulting in tissue ischemia, which increases the pain experienced.

Physiological pain is the result of abnormal events or events that are deviations from normal. An example would be the extreme back pain that can occur with posterior labour, where the baby is lying against mothers spine or pain from a uterine rupture.

Emotional sources of pain include fear, tension, and anxiety that a mum may have when she thinks about her birth, a sense of isolation or lack of support. These can all intensify pain or reduce tolerance of pain.

Gas and air (Entonox) for labour

This is a mixture of oxygen and nitrous oxide gas. Gas and air will not remove all the pain, but it can help reduce it and make it more bearable. It's easy to use and you control it yourself.

You breathe in the gas and air through a mask or mouthpiece, which you hold yourself. The gas takes about 15-20 seconds to work, so you breathe it in just as a contraction begins. It works best if you take slow, deep breaths.

Side effects

• there are no harmful side effects for you or the baby

• it can make you feel lightheaded, sick, sleepy or unable to concentrate, but if this happens you can stop using it

If gas and air does not give you enough pain relief, you can ask for a painkilling injection as well.

Injected pain relief

Drugs to facilitate childbirth

The drug still commonly used in childbirth is pethidine, an opiate. It dulls the sensation of pain in the brain, causes a sense of serenity, and makes you a little tired. Pethidine is injected into the muscles of the thigh or buttocks or given as an infusion through a vein in the arm. The effect usually occurs after about 20 minutes, in the case of venous administration after a few minutes, and lasts between 2 and 4 hours.

** Pethidine**

Pethidine's popularity has waned due to its number of adverse side effects. The expulsion phase can make it more complicated if the results have not worn off when you need to push. It can also have a robust depressing effect on your consciousness, make you listless, or even affect birth memory.

What are the possible side effects of taking pethidine?

All medicines, including pethidine, can have side effects.

Like all opioid medicines, pethidine can cause life-threatening or fatal breathing difficulties. The the risk of these is higher:

• when you are first taking pethidine

• after a dosage increase

• if you are older

• if you have an existing lung problem

The side effects of pethidine increase with repeated dosing and so the medicine is not often used to treat pain.

Repeated dosing, especially in people with poor kidney function, can also lead to neural (nerve) conditions such as tremors, twitches and seizures.

Other side effects include:

• lightheadedness

• sedation

• dizziness

• sweating

• hallucinations

• constipation

• nausea and vomiting

Disorientation, loss of control, and confusion have also been observed. In addition, pethidine occasionally causes nausea and vomiting, but this can be treated with an antiemetic (an anti-vomiting medicine) given at the same time.

In newborns, especially premature babies, pethidine can affect breathing for up to three hours after delivery because it is passed from the placenta to the baby through the umbilical cord. An antidote (naloxone) must then be given to the newborn immediately after birth. Pethidine can also cause drowsiness in the child in the first few days after delivery, making breastfeeding difficult.

Patient-controlled analgesia (PCA), in which the drug Remifentanil (Ultiva) is injected via a dosing pump by the woman giving birth according to her individual needs, has been increasingly used.

https://www.healthdirect.gov.au/pethidine

Tramadol, an opioid, is also used during childbirth for severe pain. Tramadol does not affect the uterus's ability to contract before or during delivery. In newborns, it can lead to changes in the respiratory rate that is usually not clinically relevant. It is administered as an injection into a vein, in the form of drops to be taken or as a suppository.

Antispasmodic drugs (spasmolytics) have also proven themselves in obstetrics, e.g., Buscopan (scopolamine butyl bromide). They are usually administered as suppositories; Buscopan can also be administered as an infusion in the expulsion phase.

Sedatives such as benzodiazepines (e.g., Valium) or barbiturates can restrict breathing, especially in children, and are only used in exceptional cases and with careful observation.

Epidural pain relief

Epidural anesthesia (PDA) and pain relievers to relieve labour pains

During pregnancy, many women think about how to deal with the pain of childbirth. Some prefer not to take medication. For others, it's comforting to know that there are effective ways to relieve the pain. Many then choose epidural anesthesia (PDA).

It can often help a woman deal with the pain if she receives personal encouragement and support from her partner, a friend, or other loved ones during the birth. The pain can also be made more bearable with non-drug measures such as walking around, conscious breathing, warmth, or relaxation exercises.

There are usually several alternatives available to an expectant mother. The so-called epidural anesthesia (PDA) is the most effective local anesthetic, also called the "backpack sprayer." It is the most common form of pain relief medication during childbirth.

What is epidural anesthesia?

A PDA is an anesthetic technique in which the transmission of pain signals from the spinal cord to the brain is specifically prevented. In the peridural space, a little dose of anesthesia is injected. The peridural space is a fluid-filled area that surrounds the spinal cord. Nerves (spinal nerves) that carry pain signals from the body to the brain enter the spinal cord at specific points. The drug numbs the spinal nerves, blocking pain transmission. It cannot be used in women who have, for example, an allergy to narcotics or a disorder of blood clotting.

Since a single injection is often not sufficient for the entire birth, acatheter placed and fastened on the back, this fine plastic tube is inserted into the peridural space advanced. If necessary, additional anesthetics and painkillers can be injected into the catheter. Doctors often do this by hand, or at the catheter, a small pump is connected, continuously delivering small amounts.

During the epidural, a woman also gets another cannula in a vein in her arm, to which a drip can be connected. This is also a safety measure: It can happen that the blood pressure suddenly drops during an epidural. An appropriate antidote can then be given very quickly via the cannula.

To avoid injecting too much anesthetic at once, the dose is usually increased gradually. Typically, the pain-relieving effect becomes noticeable after 10 to 20 minutes. Sometimes, the doctors need a little time to hit the right spot on the back with the injection needle or fail.

How well does the PDA work?

Epidurals are very effective and are almost always better at relieving pain than other medications. Most women feel little or no pain with an epidural. It is estimated that one in 100 women needs additional painkillers in addition to the epidural. For comparison, about 28 out of 100 women who have had other methods of pain relief from the beginning need additional or repeated pain medication during delivery.

Side effects of epidurals

Epidurals are usually safe, but there are risks of certain side effects and complications. Although rare, risks and complications that apply to all types of epidural procedures include:

• Having low blood pressure, which can make you feel lightheaded.

• Experiencing a severe headache caused by spinal fluid leakage. Less than 1% of people experience this side effect.

• Getting an infection from the epidural procedure, such as an epidural abscess, discitis, osteomyelitis or meningitis.

• Having a negative reaction to the medications, such as hot flashes or a rash.

• Experiencing bleeding if a blood vessel is accidentally damaged during the injection, which could cause a hematoma or a blood clot to form.

• Having damage to the nerves at the injection site.

• Temporarily losing control of your bladder and bowels. You might need a catheter (a small tube) in your bladder to help you pee.

Disadvantages and risks that apply to epidural analgesia for labor and delivery specifically include:

• You might lose feeling in your legs for a few hours.

• It might slow down the second stage of labor.

• You might not be able to push and need help to give birth. Your provider may need to use forceps or a vacuum to help deliver your baby.

• Your baby will need to be closely monitored during your labor.

Risks and complications that apply to epidural steroid injections specifically include:

• Experiencing a temporary increase in pain.

• If your provider uses fluoroscopy or a CT scan for imaging guidance, there will be minimal low-level radiation exposure due to the X-rays.

• If you have diabetes, a steroid injection will likely cause high blood sugar (hyperglycemia). This could last for several hours or even days.

Optimal Birth Positions

Breathing and position during labour and delivery

Labour pains come in waves, and the ability to manage pain usually depends on getting into the body's rhythm and "riding" the waves of pain by regulating breathing and body position during contractions.

It all sounds very "New Age," but it's surprisingly intuitive and effective - and most midwives, doctors, and recommending this are common . After all, it's something we've done since the dawn of time.

Moving the body through a series of positions to help mum cope with each contraction can be an effective way to manage pain.

Lying on the back during labour is perhaps the most painful position and actually stems from henry the eight, as it is believed he wanted to watch his wives giving birth, and to this day it is considered the best position for medical interventions to assist with the birth, not what is best for the birthing person.

Walking, standing in a way that leverages gravity to help the baby descend through the pelvis, and taking postures that take the weight off the back are all well-documented ways of speeding up labour and managing discomfort.

Upright positions that fully support the woman in labour may involve the need to lean on the partner or to receive other physical support from the partner, pillows, ottomans, or other furniture - inflatable fitness balls can also be helpful.

Pelvic rocking, bent knees, squatting, or crouching on all fours can be effective pain-relieving exercises.

The positions of childbirth

There is not an ideal position for everyone. Each one should be free, once labour has begun, to put herself in the way that is most comfortable for her, allowing her to relieve the pain of contractions and facilitate the descent of the baby along the vaginal canal. Because every woman is different, but above all every birth is different.

Let's see the advantages and disadvantages of the various positions in which it is possible to face the moment of the baby's birth. It is understood that each must be free to make her choice and to change position as often as she wants, while the healthcare staff should not ever obstruct this sacred right of hers!

The supine position

• Benefits

Obstetricians and gynecologists prefer the prone position because it allows you to constantly monitor the situation and intervene, if necessary, with any maneuvers. It also will enable mothers to rest between contractions.

Crouched position

• Benefits

The squatting position favours the relaxation of the pelvic muscles, the opening of the vaginal canal, and the baby's descent using the force of gravity.

To be more effective and more comfortable, it is good that the mother places her feet well on the ground (even with the heel!) And clings with her arms to a chair, to the bed, or to her partner, who should always be next to her to provide all physical and psychological support.

Kneeling position

• Benefits

The position on all fours does not tire the legs because the knees are resting on the ground or a pillow, while the arms are supported on the bed or a chair. The ball to lean on with all components and the head turned on its side is very comfortable. Alternatively, a chair with a cushion is also acceptable. Also, in this position, you can relax your back better. The pelvis has greater freedom of movement, allowing the woman to find the place that best supports the baby's thrusts and relieves the pains.

Standing position

• Benefits

In the standing position, with the arms around the partner's neck or supported by the partner's armpits, the woman bends her knees and keeps the baby's pressure: it is undoubtedly one of the positions that make the most of the force of gravity and favours the descent of the baby, In the pauses between one contraction and the next, the woman has the opportunity to move a few steps if she feels like it.

Lateral position

• Benefits

In the lateral position, lying on the bed on her side, with the external leg bent towards the chest and the arms clinging to the headboard to provide further force in the thrusts: it is a reasonably comfortable position, which allows mum to relax between a contraction and the 'other. The belly does not compress the veins, and there is no overload on the back; between the knees, a pillow and a pad are placed.

Please see below and in the resources area the Positions sheet to share with your students, and you can practise them in class as a fun activity.

Choosing the environment.

The first step to experiencing a relaxed birth is to find a suitable birth environment and plan where the child will be born. There is no evidence that it is safest for all babies to be taken in a clinic and under the supervision of many doctors. Some studies show that in an environment that isn't cluttered with technical and medical devices, mothers and babies require fewer interventions - at the same time, the likelihood that they will survive the birth physically and mentally healthy increases.

Therefore, each family should consider whether a clinic is a suitable place for them. They may prefer a birth center or home birth instead.

If they wish to give birth in a hospital or are forced to due to medical reasons, they can make the delivery room as comfortable as possible by pushing the bed against the wall to make room formats, birthing balls, stools, and pillows. Wear clothes for as long as possible (loose top and stretchy sweatpants are ideal).

Also, they can bring some additional pillows from home. rompers or cuddly toys for the child if they want, and ask the midwife to put them where you can see them. To ensure privacy, ask that anyone entering the room knocks first.

Women should give birth to their children in an environment similar to where they were conceived. In other words: in a place with an intimate atmosphere that is cozy and pleasantly lit.

Birth partners role

In the past, Midwives and Doctors were the only ones present during childbirth. Now, the father/Partner is almost always participating. Their role is to support their partner; every mom needs someone she can trust in this sensitive and memorable moment.

But what should the Father/Other Parent of the child do during childbirth?

Firstly, they can ensure that her wishes are respected during delivery. In addition, they can help her relax and remind her to control her breathing. When the contractions become too intense, she can squeeze their hand quite tightly.

Here are some steps for the Father/Other Parent to be included in the birth of the child:

1 - Write the birth plan in advance

As the woman will give birth, she is responsible for the main choices, such as where the delivery will take, who will be present, which position she prefers to be in, etc. However, the other parent must be present to help the partner make decisions and be on top of everything that will happen at the time. Thus, they will be better prepared to ensure that the mother's choices are respected. It might even be that they decide the other parents role, and activities during the birth at this time.

**2 - Familiarise with what will happen **

Before the birth, the woman and her partner can tour the hospital facilities where the delivery will take place. Prenatal classes also help the couple to be prepared. Like the one you will be running so always encourage the other parent or birth partners to come along with the Mum to gain all the information they need to know too. informed is always the best position to be in.

3 - Support the partner

The other parent has essential practical functions, but one of their most prominent roles is an emotional one: simply being present, being calm, and encouraging his partner through every step of the sweet and scary process of becoming a mother.

4. Make the birth announcement

Some couples choose to notify about the child's birth only after a few days when the baby is already at home. But most still prefer to post a photo or send a message to friends right after giving birth. This is an activity for the other parent. They can also organise the schedule of visits during the stay in the maternity ward.

Here is some examples of what role the Birth Partner can play.

• Know What to Expect During Labor

• Help Time Her Contractions

• Be an Active Participant, bring water, food, comfort measures.

• Know What She Wants and Be Her Advocate

• Be Flexible and Be Prepared.

• Massage and Stroke Mums Skin

• If at home can fill and empty the birth pool (if they are using one)

• Positive words of encouragement

• Help move into birth positions

• Hold her through contractions as a counter action

• Cut the cord if they chose to.

Delayed cord clamping

What is delayed cord clamping?

Delayed cord clamping is the increase in time between the birth of the newborn and the clamping of the umbilical cord. The custom of cutting the umbilical cord immediately after delivery has existed for 50 to 60 years. However, some suspect that it is not suitable for the baby missing much blood and other benefits. The World Health Organization (WHO) suggests that DCC is safe for preterm infants, provided they do not require breathing assistance. The cord attached to the baby and mother can significantly interfere with resuscitation efforts.

Is delayed umbilical cord clamping common?

The potential benefits of delayed line locking have attracted more attention in recent years. Despite the risk to infants and mothers, it should be practiced in healthy infants and mothers without complications.

How Long Should You Delay Line Clamping?

The circumstances of both mother and child influence the timing of umbilical cord clamping. When cord separation is delayed rather than clamped immediately, an infant receives 30% greater fetal-placental blood volume. "The best timing for cord clamping for all infants, regardless of gestational age or fetal weight, is when perfusion in the cord has ended and the chord is flat and pulseless (about 3 minutes or more after birth," according to the World Health Organization.

Benefits of delayed line clamping

Before birth, the baby and the placenta share the bloodstream. The baby receives oxygen and nutrients from the placenta and umbilical cord. The functions of the baby's lungs, liver, intestines and kidneys are taken over by the placenta. So, the baby's organs need a little blood flow.

Therefore, the placenta carries a significant part of the baby's blood volume. The blood in the placenta is the baby's blood. The placenta supplies the newborn with oxygen and nourishment after birth and returns blood to the mother.

This mandatory part of the birth process is called placenta transfusion. The placenta transfusion provides the baby with red blood cells, stem cells, immune cells and blood volume.

DCC offers several advantages. Here are some:

1. Neuroscientific benefit

Extra minutes tied to the umbilical cord at birth can slightly boost the child's development a few years later. Children with DCC have slightly higher social and fine motor skills than ICC children.

2. Reduced risk of anaemia

Breastfed infants need iron supplemented as breast milk is low in iron to prevent anaemia. Infants need iron for rapid brain growth and development. One study found that DCC increases iron availability at birth and haemoglobin concentration at two months. A 2-minute delay in line clamping could help prevent the result of iron deficiency before the age of six months.

3. Increased blood volume or smoother cardiopulmonary transition

About a third of the blood volume is in the placenta for preterm and preterm infants. This amount of blood is required to suffocate the fetal lungs, kidneys, and liver at birth. With a 2–3-minute delay in clamping their cords, babies have appropriate iron stores and a smoother cardiopulmonary transition. Greater platelets, essential for good blood coagulation, are another potential benefit of increased blood volume.

4. Elevated levels of stem cells

Stem cells play a role in developing the immune system, respiratory system, cardiovascular system, and central nervous system, among other strategies. It also repairs the brain damage the baby suffered during a difficult birth. Delayed cord cuts lead to an infusion of stem cells.

5. Better outcomes for preterm babies

Premature babies with DCC tend to have better blood pressure immediately after birth and require less medication to maintain blood pressure. They also require fewer blood transfusions and minor bleeding in the brain. It reduces the risk of critical intestinal injury - necrotizing enterocolitis.

Risks of immediate cable pinching

ICC affects the mother as well as the child. The following is a list of dangers to be aware of:

• ICC disrupts normal physiology, anatomy and the birth process - it splits the baby from the still functioning placenta and stops blood circulation.

• This leads to lower iron stores in the baby, which negatively affects the development of neurons.

• Early pinching increases the risk of bleeding and retention of the placenta by enriching the placenta with the baby's blood. This makes uterine contraction more complex, leading to difficulty expelling the placenta.

The first skin to skin

The first inclination that this practice could be revolutionary evolved in South America in the 1970s. Two physicians in Bogotá, Colombia, didn’t have enough incubators to care for all the premature babies in their hospital. So, they placed these tiny naked babies directly on their mothers’ bodies with both mother and baby covered by an exterior wrap, allowing the mom’s body heat to warm the baby. The babies thrived. The doctors named their technique the kangaroo mother method. The kangaroo mother method also includes breastfeeding instruction and support as well as earlier discharges. Later, this term was shortened to kangaroo care and has been associated primarily with the skin-to-skin aspect.

Researchers say a baby in skin-to-skin contact with the mother stimulates a specific part of the newborn’s brain. The baby is stimulated to move to mom’s breast, attach and begin feeding. This first step – getting sustenance – encourages physical development. A second step also happens. The baby will open his or her eyes and first gaze upon mother. This encourages emotional and social development. Numerous other research studies have revealed scores of additional benefits. Briefly, here are some of them:

For baby:

• Better able to absorb and digest nutrients

• Better body temperature maintenance

• Cries less often

• Demonstrate improved weight gain

• Experience more stable heartbeat and breathing

• Higher blood oxygen levels

• Long-term benefits, such as improved brain development and function as well as parental attachment

• More successful at breastfeeding immediately after birth

• Spend increased time in the very important deep sleep and quiet alert states

• Thermoregulation

• Stronger immune systems

For mother:

• Experience more positive breastfeeding

• Improved breast milk production

• Likely to have reduced postpartum bleeding and lower risk of postpartum depression

Massage during labour

The discomfort of contractions throughout the body is usually accompanied by lower back pain in most women in labour. Massage with some unscented massage oil can provide a lot of relief. Check out our sheet and video on the massage moves that can help during labour and could be performed by a birth partner or doula.

Warm compresses during labour

A warm compress made from a towel soaked in boiling water and then wrung out can be used to relieve pain in the stomach and lower back (or both). Bean bags (fabric bags filled with grains/beans and heated in a microwave) or heated gel packs are also effective.

Hot showers during labour

A hot shower, with the jet of water directed at the lumbar area of

the back, can bring relief during contractions. Delivering a baby is a messy activity; you often lose amniotic fluid everywhere and sweat, so you usually have a general feeling of well-being after spending some time in the shower. In most hospital labour rooms, it is possible to equip the battery with a chair with a plastic cushion to rest on for some time.

Birth tubs / pools

Many women who choose home births rent a small portable pool or sizeable deep tub that can be filled with hot water; many delivery rooms and most birth centers are equipped with large tubs or baths. If you have enjoyed swimming in the latter part of your pregnancy, you will know how magical it feels. It can be much easier to manage contractions in hot water, and often you get some relief from back pain. Parents would need to speak to caregiver if they would like to deliver their baby in the water; it can be an excellent option for childbirth if the caregiver feels comfortable and there are no complications in the pregnancy. But it can also be down to supply in a hospital setting, and if the birth is straight forward.

**Cool Compress **

Often as labour progresses the mum can become very warm and need cooling down. This can be done with a cool compress applied to the forehead to help mum cool down quicker, it might need refreshing every so often by the birth partner.

Vocalisation in labour

Singing has always represented an important, fundamental dimension of human life in a transversal way at a geographical, historical, and cultural level. For many centuries, singing (not intended as songs and musical instruments) has been a form of communication (even sacred) and reflection. It is linked to the voice experience that develops from early childhood.

Singing is therefore deeply linked to breathing and, for this reason, capable of producing beneficial and relaxing effects on the whole organism, both from a physical and psychological point of view. For this reason, many cultures, especially the oriental ones, still practice and live this sound dimension to accompany the most critical phases of life, including pregnancy and birth.

The so-called Carnatic song fits precisely in this wake. Only an excessively medicalised vision of childbirth typical of the Western world has led to silence (in all senses) in this bodily, psychological, and intimate dimension.

Carnatic chant is a discipline that involves the whole body, not just the voice, and first of all, it involves stretching and relaxation exercises to work on the pelvis and the spine. The authentic Carnatic chant begins only after this initial preparatory phase, which is characterised by the emission of the same sounds but using different vowels.

Depending on the vowel pronounced during singing, there is a different breathing and a greater or lesser opening of the mouth and the escape of air, ensuring those benefits on the body and mind typical of this discipline. An essential element of the Carnatic chant is silence, which accompanies both the beginning and the end of the vocalisations and represents a separate reality of living and immersing oneself in and not the mere interruption of the song.

Vocalisation is the use of sounds in labour. Some woman groan, yell, or moan while others might hhmm or sing or chant. Making noise released some of the tension, and encourages effective breathing. The pitch of the noise is usually low and deep in the body.

For example if you were to burn yourself on something hot, you initial reaction might to be cry out, or shout. Another example would be tennis players when they grunt when they serve, or weight lifters who are usually vocal when exertion. Some mothers might use positive talk such as i can or yes instead of i cant or no. While the mother is making noises she is likely to be deep breathing.

Others might find it uncomfortable when mum is making a lot of noise, so they may even discourage her from making the noise.

While making noise is normal in labour, so is silence. Some mums find other ways to vocalise such as singing or chanting.

When the Mum is able to relax and tune into her instincts the noises will flow naturally so we can let her know about the noises in class, but can encourage her to get comfortable making noise and follow her own instinct.

Breathing Patterns

Proper breathing techniques during childbirth

Even deep breathing relieves the labour pains of the woman giving birth. At the same time, the baby is sufficiently supplied with oxygen in the stomach. Even if birth preparation courses are initially ridiculed by many parents-to-be as "Help courses," they are essential for mother and child. To make birth more accessible for you and your baby, there are certain aspects of the different phases of delivery that you should consider when breathing. We present these to you below.

While mum will always be breathing probably without thinking about it, she could try using different breathing patterns and techniques to help deal with the pain and intensity of contractions.

This may include:

• Deep breathing at the beginning of labour

• Focusing on the out breath

• Finding a rhythm to breathing, e.g. Ste, breathe, sweep, breathe.

• "Hoo-Hoo-Ha" type patterns when in transition

• Tiny breaths, as if she is trying to make a candle flicker, in transition

• Panting

• Blowing a balloon up to release pelvis floor

Slow and focused breathing can help with relaxation and reduce tension and fear. It also leads to increased endorphins. breathing goes hand in hand with relaxation and movement. As long as Mum breathes at a level that feels comfortable, it will continue to have some effect. The level of effectiveness depends on the mothers feelings, the level at which she is relaxing, and the amount of pain she is experiencing. This technique can be used throughout labour, regardless of the stage.

Breathing can assist any type of birth to help keep mum calm and relaxed and provide good oxygen levels to her baby.

Breathing techniques also allow mum to feel more in control of her birth. The mother can remain more clear headed and able to communicate.

The negative side of breathing techniques is that they may not be effective enough in the stronger part of labour. Some mothers feel breathing techniques don't work for them as they can be confusing and hard to remember.

It is become more popular to educate mum to breath in her own deep relaxed way rather than following a set pattern.

It is also beneficially to mum if the birth partner can remind mum to breathe deeply through out labour.

Download our suggest breathing techniques for deep relaxation. To the right of the screen.

Basic rules of breathing during childbirth and labour

Even if it is difficult during the painful contractions:

1. Mum should always try to breathe in calmly and evenly through her nose.

2. Exhale through the slightly open mouth.

3. If possible, being careful not to press her lips together.

With an open mouth, the cervix can also open more easily. To supply your baby with sufficient oxygen, never holding her breath during birth, except during the expulsion phase, where mum might feel she needs to if she wants to push.

Mum Doesn't need to be afraid of "forgetting" to breathe correctly during childbirth: Many women live intuitively and quickly apply what they have learned in the preparation course. They will also receive reliable instructions from the midwife on breathing during birth and birth partners can also assist in reminding mum.

Here is some breathing exercises to teach your Mums to be:

The opening phase: deep breathing into the abdomen

Contractions come and go in waves during the opening phase and last about 1 to 1.5 minutes. Initially, the distances were still relatively long. Over time, the intervals between contractions become shorter. Regular breathing is the be-all and end-all in this phase: At the beginning of the squeeze, take a deep breath, breathe deeply into the stomach and let the air out slowly through the open mouth. Some women find it helpful to say long tones like "ooooh" or "aaaah" as they exhale. Tip: Exhale three times as long as you inhaled. If the mouth gets dry from breathing, drink some water between contractions.

The short transition phase follows the opening stage. Panting, which was previously recommended, is now discouraged because women can hyperventilate through this breathing.

The expulsion phase: Don't forget to breathe!

The cervix is ​​fully dilated during the expulsion phase, and the baby is pushed down towards the pelvis. Now the contractions are starting, and mum can finally go yourself actively so that the baby will soon see the light of day. In this phase, many women who give birth often make a grave mistake: To be able to build up more pressure, they hold their breath. On the other hand, if they continue to breathe evenly, the contractions are supported. When the contraction has subsided, breathe in and out profoundly again to briefly recover from the exertion. This even breathing also prevents mum from hyperventilating and getting short of breath.

Even if the pain is particularly great at this stage and mums feels she wants to push to speed up the birth: If the midwife asks mum to stop trying, she must listen to the instructions. This allows the perineum to slowly stretch without suddenly tearing when the baby's head wants to go outside.

Shortness of breath: Back to a regular rhythm

During childbirth, mum can tense up or even panic. Breathing then becomes irregular and accelerates, so shortness of breath and even hyperventilation can occur. The consequences can be dizziness, blurred vision and poor heart sounds in the child. For this state to return to normal quickly, mum should concentrate entirely on calm and deep breathing. The midwife and partner can help her get back into your rhythm.

The afterbirth phase: Breath calmly and deeply.

The afterbirth phase begins when mum is finally holding her baby in her arms. This phase is marked by separating the placenta from the uterine wall. Even when the worst of the pain is over, the uterus contractions can range from very uncomfortable to painful and can last for a few hours.

To alleviate this pain somewhat, it is advisable to breathe calmly and deeply from the opening phase: you breathe in deeply through the nose and out through the mouth for a long time.

Movement

Labour can be stimulated by walking and movement. As gravity helps baby to push against the cervix which can release hormones needed to start labour.

In the final days of pregnancy mum can take long walks and keep moving around to help the body move into labour naturally in the best way.

Movement also increases blood flow which in turn also increases oxygen to mum and to the baby.

During labour

Once labour has started mum needs to keep moving around to be able to manager her pain, and allowing baby to move down the birth canal and into the optimal position. Gravity will ultimately always work best in the upright or leaning forward position.

This is often referred to as "Active birth" which just means moving around during labour.

The benefits of movement is that mum feels more in control of her labour, gravity helps the baby decent and shorten labour, Movement can also help with back pain and getting baby in to optimal position. Keeping mum upright also increased oxygen to baby, and reduces the possibility of foetal distress.

Mums birth partner can assist with different moves and positions if mum is stood up.

The importance of movement

During labour, the baby's head adapts to the diameters of the mother's pelvis by riding her skull bones. The female pelvis is also modified to facilitate the descent of the baby. When there is freedom of movement, mom and baby adapt to each other to reduce this passage through the birth canal and welcome this child.

This process happens naturally millions of years ago without us being fully aware of these biomechanics. Each position that the mother chooses during childbirth generates changes in the diameters of her pelvis. However, before, for different reasons that we will not talk about today, our mothers were not allowed to move.

Unfortunately, until a few years ago, women could not move freely during their labour or choose the position to give birth. Lying on their backs limited their possibility, which increased the sensation of pain.

Today that has changed! Much necessary research indicates that walking and adopting upright positions (such as walking, sitting, rocking, all fours) during the first stage of labour reduces the length of delivery and the need for an epidural and minimises the chance that the birth will end in cesarean section, it is indisputable that women can, and should, choose how to move during labour.

Why is it important to move during labour?

• The positions that the mother chooses naturally relieve the pain of contractions

• The movement helps the progress of labour

• The rocking performed by the pregnant woman facilitates the baby's passage through the pelvis.

• Shortens the duration of labour.

• Reduces the need for interventions

• Reduces the request for epidural analgesia

• Minimises the possibility that the birth ends in cesarean section.

If women are kept in a supine position during labour, this position may impede labour progress and reduce placental blood flow." For this reason, movement is still significant even if mum choose to have an epidural analgesia. Movement can still be done, with help and support and a small dose of epidural.

What is the ideal position for labour?

There is no ideal position for labour; each mother must find what movement and what measure of comfort allows her to relax her body. These discomforts will serve as a guide to choosing the correct position. A pregnant woman moving freely will adopt the postures that produce the slightest pressure on her pelvic socket.

Scientific evidence shows us the importance of preparation for comprehensive childbirth, where you can find out about the process you will experience, to give confidence and gradually incorporate tools such as movement and breathing. This is important to break the circle called: fear – tension – pain.

A mother who keeps moving during pregnancy and practices different relaxation methods will go through the most comfortable pregnancy. She will also feel more confident in herself to move freely during labour. If she finds relief and rest positions during pregnancy, she will surely try to find the same in delivery.

Position during labour and delivery

Labour pains come in waves, and the ability to manage pain usually depends on getting into the body's rhythm and "riding" the waves of pain by regulating breathing and body position during contractions.

It all sounds very "New Age," but it's surprisingly intuitive and effective - and most midwives, doctors, and recommending this are common . After all, it's something we've done since the dawn of time.

Moving the body through a series of positions to help mum cope with each contraction can be an effective way to manage pain.

Lying on the back during labour is perhaps the most painful position and actually stems from henry the eight, as it is believed he wanted to watch his wives giving birth, and to this day it is considered the best position for medical interventions to assist with the birth, not what is best for the birthing person.

Walking, standing in a way that leverages gravity to help the baby descend through the pelvis, and taking postures that take the weight off the back are all well-documented ways of speeding up labour and managing discomfort.

Upright positions that fully support the woman in labour may involve the need to lean on the partner or to receive other physical support from the partner, pillows, ottomans, or other furniture - inflatable fitness balls can also be helpful.

Pelvic rocking, bent knees, squatting, or crouching on all fours can be effective pain-relieving exercises.

The positions of childbirth

There is not an ideal position for everyone. Each one should be free, once labour has begun, to put herself in the way that is most comfortable for her, allowing her to relieve the pain of contractions and facilitate the descent of the baby along the vaginal canal. Because every woman is different, but above all every birth is different.

Let's see the advantages and disadvantages of the various positions in which it is possible to face the moment of the baby's birth. It is understood that each must be free to make her choice and to change position as often as she wants, while the healthcare staff should not ever obstruct this sacred right of hers!

The supine position

• Benefits

Obstetricians and gynecologists prefer the prone position because it allows you to constantly monitor the situation and intervene, if necessary, with any maneuvers. It also will enable mothers to rest between contractions.

Crouched position

• Benefits

The squatting position favours the relaxation of the pelvic muscles, the opening of the vaginal canal, and the baby's descent using the force of gravity.

To be more effective and more comfortable, it is good that the mother places her feet well on the ground (even with the heel!) And clings with her arms to a chair, to the bed, or to her partner, who should always be next to her to provide all physical and psychological support.

Kneeling position

• Benefits

The position on all fours does not tire the legs because the knees are resting on the ground or a pillow, while the arms are supported on the bed or a chair. The ball to lean on with all components and the head turned on its side is very comfortable. Alternatively, a chair with a cushion is also acceptable. Also, in this position, you can relax your back better. The pelvis has greater freedom of movement, allowing the woman to find the place that best supports the baby's thrusts and relieves the pains.

Standing position

• Benefits

In the standing position, with the arms around the partner's neck or supported by the partner's armpits, the woman bends her knees and keeps the baby's pressure: it is undoubtedly one of the positions that make the most of the force of gravity and favours the descent of the baby, In the pauses between one contraction and the next, the woman has the opportunity to move a few steps if she feels like it.

Lateral position

• Benefits

In the lateral position, lying on the bed on her side, with the external leg bent towards the chest and the arms clinging to the headboard to provide further force in the thrusts: it is a reasonably comfortable position, which allows mum to relax between a contraction and the 'other. The belly does not compress the veins, and there is no overload on the back; between the knees, a pillow and a pad are placed.

Positive language effect

The harmonious law of attraction

This law explains that what we think and what we say produces specific energy according to our experience and our experience. This energy comes back to us like a boomerang.

An example: a mother-to-be who constantly hears those contractions are painful and who is convinced of this will feel these contractions as painful.

Every thought or word you will send into the universe will come back to you as you formulate it. Words can hurt and can hurt. The more transparent the thought of the word, the stronger the psychological imprint will be.

That's why I suggest that you ask parents to focus only on positive words, words around birth, beautiful birth images, on gentle birth videos to create conditioning and positive energy around the delivery of the baby.

Indeed, the language used by the people around Mum (caregivers, friends, etc.) will stress her out or, on the contrary, calm her down. It is wise to ask friends who have had a traumatic birth experience to tell their stories after gaving birth.

The law of repetition

The more people tell you that giving birth hurts, the harder you believe it. Conversely, use a positive vocabulary if you want to get rid of certain words with a negative energy composition. Repeat this vocabulary. Maintain it in your everyday life. they can ask their care provider to use the same vocabulary as them. Repeat it. The more they repeat it, the more the emotions will change, and the words will then be loaded with positive connotations around the birth.

Language to prepare for childbirth

What if we were talking about (uterine) waves? How about choosing your own words to explain the feeling during these waves: tingling? A squeeze? a tug?

The baby passes through the birth path or passage. Let's talk about crowning, receiving the baby, breathing down…

Allow your learners to change the words to something that feel comfortable to them.

waves, sensation, tightening are all very popular choices.

Music in labour

Why music is so nice during childbirth

Music has a lot of influence on the limbic system of the nervous system. This system regulates emotions, memories, and feelings of fear. Listening to music that makes you happy can provide strength and reassurance to the senses and nervous system during labour. Music can also distract from sounds that you don't want to hear; for example, in the hospital, in this way, women in labour can better control pain and anxiety. This gives positive hormones such as oxytocin-the chance to do their job, leading to a smoother delivery.

Kind of music

Every woman has her preferences when it comes to music during childbirth. One likes meditation, lounge, or classical music, and the other wants an uplifting beat, such as workout music or even rock.

On Spotify, you can find more than 90,000 playlists for childbirth inspiration.

But, of course, Mum. can also find her favourite birthing music. Choosing songs that remind her of good moments in her life or give her a feeling-good feeling. Especially pieces with a solid instrumental focus can help, or songs with vocals in a language unknown to her. You can also play songs that you have already played to the baby during pregnancy because research shows that babies recognise this music, giving them a familiar feeling during birth.

Which I personally think is a really cute thing to do, as it reminds mum of the pending parenthood about to arrive, and helps baby feel relaxed and comfortable.

Guided meditation in labour

Pregnant women can practice one of eight main types of meditation. Below is the examples that you can explain to your students for them to do their own research if they want to personalise their mediative state.

They are as follows:

1. Vipassana Meditation:

This technique assists in becoming more aware of your current state and focusing their attention within, allowing them to understand better how they feel on the inside and out. "Seeing things as they are" is the correct definition of the term.

2. Sound meditation or mantra:

In this technique, one focuses on a particular prayer, sound, or phrase, such as "Om." Chanting Omkara creates vibrations in the body that aim to balance the body's energy centres (chakras) You can also try singing other words like "So-ham," "yam," or "ham."

Did you know that our thoughts and words have power as well? When you say or think about something, it has an impact on your nervous system as well as your personality. Having your mantra, often known as positive affirmations, is a fantastic idea.

Then, create your mantra, such as 'Breath in for the baby; this is a strong mom's breath,' which permeates your self-awareness and allows you to truly absorb the powerful meaning of the words that can help during pregnancy or difficult labour.

3. Breath awareness or deep breath meditation:

This focuses on breathing and observes its pattern. It relieves muscle tension, lowers heart rate, and helps you to fall asleep. You may also feel the rhythmic breathing by placing a hand on the bump.

Place feet shoulder-width apart and lie down. Close your mouth and take slow, deep breaths via your nose. As air enters your lungs and diaphragm, your stomach rises. Exhale through the nose after a second of holding the position. You can alter your sleeping position to the side, with a pillow between your legs, starting in the second trimester or when you start to feel uncomfortable lying on your back.

4. Conceptual meditation (guided meditation):

This involves displaying an object. IA blue sky, sea waves, a crystal, a flower, a stone, a leaf, or your growing baby could all be examples. Learn to focus on image-stimulated stillness and meditate and stay focused.

For example, visualise the blue sky and how the clouds pass by. Quiet images can create peace and silence within you. Similarly, you can also imagine a pebble and focus on its colour, texture, and shape to increase your focus and awareness.

5. Walking meditation:

Help calm your restless mind. Choose a place to walk and focus on your breathing and its rhythm. This is also effective for labour, which allows you to focus on delivery while keeping you mobile and active

6. Deep belly meditation:

Gently cradle the baby by placing your hands on the expanding bump. In the palms of your hands, you can sense a warming sensation. Inhale and exhale slowly. If any thoughts arise in your mind, let them pass. Practice for about five minutes each day and increase the duration each week.

7. Meditation of the "third eye":

The "third eye" is the space between the brows on the forehead. The pineal gland, which regulates wake-sleep rhythms and is light sensitive, is located behind this location. A neurotransmitter produced by the pineal gland is serotonin, which alters the energy levels responsible for feelings of happiness and well-being. When you're anxious or working, close your eyes and focus on the third eye—these aids in the relaxation of the muscles surrounding your brow.

8. Progressive muscle relaxation:

Mastering this technique takes time. On the other hand, progressive muscle relaxation will help as your pregnancy progresses and getting a good night's sleep becomes increasingly challenging.

Lie on the floor or bed. Try to squeeze your muscles and let them relax slowly. Focus on one muscle group at a time and keep alternating left and right sides. You can also start by reaching and releasing your hand, followed by a forearm, shoulder, face, chest, stomach, legs, and feet

Meditation may seem safe without much practice or supervision, but you can reap the maximum benefits by following a few guidelines.

Here is our example of Guided Meditation, you can have fun creating your own, or you can purchase a book to read a guided meditation out to your students.

It is a great way at the end of a session to allow parents to relax and absorb the information you have taught them.

Addressing fears and concerns

How to deal with anxiety and fear of childbirth

The final weeks of birth bring many fears for mothers; see tips to face this moment with more wisdom and tranquility, without anxiety and fear of childbirth.

The dictionary has at least two definitions for anxiety: (1) "physical and psychic suffering; affliction, agony, anguish, anxiety, nervousness; and (2) "emotional state facing an uncertain and dangerous future, in which an individual feels important and helpless." After nine months of carrying a baby in the womb, there is nothing more natural than for mothers – especially first-time ones – to take this feeling in the last moments of pregnancy.

Anxiety and fear of childbirth

Let's start by talking about the last weeks of pregnancy, which naturally lead to the fear of bringing the baby to the world.

First of all, it's normal for the parents to be afraid of this moment and what it means. It is about a change in the lives of women and the family. In addition, it also represents a complete change in the couple's life, with the arrival of a baby awaited with great affection over the last nine months. Although this fear is normal, it is possible to reduce it.

Choose a trusted professional – The first step is to find a trusted Midwife, Doula or Doctor. Many women find it challenging to find a professional they fully trust. In this sense, the best tip is to take advantage of the beginning of pregnancy to establish criteria and select a person who understands the concerns and will respect them until the final moments of pregnancy. This might be you! If you are their antenatal and Hynobirthig instructor they might come to you for a lot of questions and ongoing support. Especially if they are going down a more natural birth route. As long as you remain within your professional perimeters you can encourage and support and make a huge difference to the families who use your services.

Here are some examples to share with the families you work with about how to control their fears during this time.

Do the prenatal follow-up properly – The best way for mum to feel safe is to know the pregnancy situation. There is no better way to do this than following prenatal care properly with the professional in charge of the mums care.

If the nine months have passed uneventfully, the possibility of a natural birth increases. On the other hand, if there are restrictions for health reasons (hypertension or heart disease) or related to the positioning of the baby, the placenta, among others, discussing with the professional the criteria for a possible cesarean gives more peace of mind - especially if the mother prefers standard delivery or natural.

Know the deliveries – Make the decisions according to interest as a pregnant woman. Childbirth is a feminine moment, and the mother needs to be calm and comfortable with her decision, whether natural, normal, or cesarean. Trying to follow her instincts and desires without falling under pressure from family members, doctors, or society. This can lead to feelings of empowerment and confidence in her own ability.

Plan - During pregnancy, in addition to the body, the house is being prepared for the arrival of this new little person, with the purchase of a crib, dresser, room adjustment, and contemporary paintings, among many other details that were thought of.

In the same way, leaving the bag taken to the maternity hospital ready, which will give a feeling of security, as the moment approaches and off to the hospital/maternity hospital for this long-awaited moment.

Try to inform them self – Looking for books that help you fully understand pregnancy and the first days with baby. If they are a visual person, Several Youtube channels and social networks approach the subject from the most varied perspectives.

Look for relevant sources and, in case of doubts, do not hesitate to solve them with your medical support who will always be the most suitable person for this, and again you might be the person the families come to, to answer all their questions.

Give the head a break - It's not easy to take the mind off the anxiety of childbirth in the last days of pregnancy, but it's an excellent time to find a TV series, great reading, a hobby, or just hanging out with their partner and trying to clear the head of worries.

Special care in the last few days

The last days of pregnancy also require special attention to some details that have already been followed. As the body is relatively altered, women need to take extra care in their daily lives to ease the anxiety and fear of childbirth.

Class Exercise

As an exercise in the class you can you can get each parent to write down their fears and concerns about the birth or postnatally. If they write down their own, then swap paper and discuss their answers, it helps to open up communication to each other and be honest about worries, and quite often they end up reassuring each other.

B.R.A.I.N

When in doubt over a decision in labour wether expected or not, a good idea is to think about using your brain.

BRAIN stands for:

Benefits

What are the benefits of making this decision? What will happen or be achieved?

Risks

What are the risks associated with this decision? so you can weight up if the risks are small or significant, that might prevent you from taking the step recommended.

Alternatives

Are there alternatives? If so, what are they? This is super useful as often in a hospital setting they are not forth coming with alternatives unless asked, they often fall under routine procedures or drug administration and don't vary from the routine procedures unless asked or insisted.

Intuition

What does my gut say? We are blessed with mothers instinct in childbirth and often can be led b y our gut instruct to make the right decision, and we can change our mind if we are led to do so.

Nothing

What if I do nothing or wait it out? This again is down to choice of doing nothing is still doing something it is choosing to do nothing.

When to use the BRAIN Acronym?

In most cases, they will be able to speak with the care provider before informed consent or informed refusal on a matter. By exploring the benefits, risks, alternatives, as well listening to their intuition, they are exercising their ability to think through the options. This will help the Mum and Partner make the best choice(s) for their situation whether that looks like doing nothing at all, waiting it out, or moving forward.

Furthermore, it highlights evidence-based information versus the opinions + advice of others. After all, the parents are in charge of making the decisions for birth and have the right to know all of the options!

Quite often with medical practitioners are dealing with this every day so they only mention on a need to know basis unless you ask questions, and it often makes their job easier if the parents are well informed and know the questions to ask.

The Environment to give Birth

Candles

Candles have the ability to give our brain a visual example of being present in the moment, giving us something to solely focus on to tune our brain into the present and giving your body time to stop and relax. Candles can be great for aromas to so invest in a nice aromatherapy candle can add to the experience. This are perfect to use around the bath, turning the main bathroom light off and creating your own little sanctuary.

Music

Music can soothe our soul, I am sure you already have favourite music and music you like to listen to in your car maybe, or your favourite radio station , but I am talking more about relaxation music, which might take you a little while to get use to, it might feel a bit fluffy to start with but it really will trigger your brain into deep relaxation. It could also help with settling your baby. This could be incorporated into your every day life, when you are in the house or car you can play some relaxing music and it will help you and baby feel calm.

Here are our top picks for relaxation music. They are on Spotify which you can download for free with adverts playing between songs or you can pay a small fee to get the add free version which i recommend as Music can be incorporated in every day life, wherever whenever.

Aromatherapy

Aromatherapy is widely used to treat a lot of body aliments and mental issues. it can treat you emotionally, mentally, spiritually. It is based on the theory of Aroma can trigger your brain to feel a certain way. This is such a good and easy one to incorporate into your every day life. Here are a few examples of how you can use aromatherapy oils.

. a few drops in the bath

. a few drops in a room defuser

. a few drops on a Aromatherapy bracelet to inhale regularly

. a few drops on your pillow just before bed.

. diluted in a room spray

. diluted in a massage oil such as coconut oil (my favourite)

plus so many more ways I am sure you can use your imagination with this one.

Please Note - Essential oils are not to be used neat onto the skin.

Exercise

Lets face it exercise might not be the fore front of your priorities with a young baby but it is a good way to help your body calm down. When we exercise we release endorphins which are feel good hormones. This can help both our physically body stretch and warm our muscles but also help our self mentally. This could be as simple of walking with the pram for 30 mins a day while baby sleeps, going to a buggy fitness class to join other like minded Mums, attending a baby yoga class to incorporate some gentle body movement. There are also so many videos online with tips and techniques you can use in your own home if you don’t feel like going out one day.

Here are a few videos that we have found useful.

Breathing Exercises

This one is a simple yet effective one. This can be done anytime anywhere. Deep breathing exercises give your body permission to relax and stop and focus for a second. This one is effective as babies pick up on how their care givers are feeling so if you are calm and relaxed so will your baby. Conscious breathing exercises are the quickest way to relax , calm down and slow. This is also a great way to start if you are feeling overwhelmed and frustrated, this is the start for a few minuets then you can calm down enough to decide how to move forward.

People in the room

We must remember that as part of the environment for birth this also included people in the room, so mum is only going to want people in the room , or birth partners that she is completely comfortable with, now the best way to assess this is to think of who she wouldn't mind pooing in front of!

It sounds a little crazy at first but if you feel comfortable pooing in front of those people you will feel complete comfortable birthing in front of them if not they are not an idea match for the birth room.

Informed Consent

This is a huge part of labour and birth that the woman must always feel like she is in control of her body and in control of her decisions and options. No one can touch your body without your consent, so for example if mum doesn't want vaginal examinations that is her choice, if she doesn't want continuous ' monitoring that is her consent.

In this role you might hear it often pregnant ladies told what they are "allowed to do" when it is their body and their birth they are allowed to do as they choose even if it is against the medical advise.

The best example to think of this, is if the mum needs a blood transfusion but for religious reasons is now allowed, there is a chance she might die but she is well within her human rights to refuse. This is an extreme example but it helps you to understand the control and consent mum has over her body even if others don't agree or advise against it. It is often hospitals policy which doesn't always work for everyone.

If if the pregnant person needs medical assistance for medical conditions they still have the right to accept or decline something to happen. This is when the BRAIN acronym can be used to assess the situation and work out what is best for the individual.