Your Birth OptionsMidwifery Led Care

Information leaflet for women and their families

Maternity Department

Date of publication: July 2014 Review date: July 2017

Ref: XYZ 1234/567

© North Middlesex University Hospital NHS Trust www.northmid.nhs.uk

Birth Centre & HomebirthMidwife Led Care

Philosophy of care

We believe.....

Pregnancy and birth are normal yet extraordinary life processes.

That women should be educated and empowered to embrace a strong sense of self, to trust their bodies, to plan their pregnancies and births, in order to be able to make informed choices

Women believe birth is normal and prefer to avoid unnecessary interventions

Respect, trust and open communication is promoted and results in the best possible maternity care for women

Midwives facilitate active, natural birth with minimal intervention through the provision of physical, emotional and social support

Midwifery is an art and a science - Our Midwives combine traditional skills with relevant, evidence-based knowledge to ensure you are always at the centre of our care

Pregnancy and birth transform the lives of women and their families.

How we are born matters.

Having a baby is one of the most significant and life changing experiences of a woman and her family’s life. We plan to do everything we can to make your birth a positive experience.

We recognise pregnancy and childbirth not simply as clinical events but as a time when not only major physical changes take place but also psychological ones and your lifestyle is transformed. This is different for everyone so we see it as vital that our care centres on your unique, individual needs.

We will work in partnership with you to provide care in a flexible safe and wholly supportive way. We will actively encourage you to make informed choices throughout your pregnancy and childbirth. To help you we will provide objective and evidence based information which empowers you to make decisions

We encourage and inspire you to take responsibility for, and control of your own health and birth. It is our hope that the care we will give you supports you and you family to confidently welcome a new baby into your lives

Homebirth

All women who are well and do not develop pregnancy or medical complications are safe to choose home birth. This includes first babies.

There is a high rate of normal birth for women who choose to give birth at home.

Advantages of home birth

Birth in a familiar and comfortable environment. Keeps the birth process as normal as possible. Women who give birth at home report needing less drugs for pain relief. Less disruption to family life. Reduced risk of hospital acquired infection.

Disadvantages of home birth

You may have to transfer to hospital if there are certain complications. You will need to transfer to hospital if you decide you would like an epidural. The need to transfer to hospital means it will take longer to get emergency

treatment. The transfer rate to hospital for first time mothers is approximately 30%

although it is less for mothers who have had a baby before (Birth Place Study 2011).

There is a slight increased risk of complications for first time mothers and their babies compared with mothers who are giving birth for the second time at home. However, birth is generally safe and overall risks are low (Birth Place Study 2011).

Who will be present at home birth?

Our community midwives will provide all your care, one midwife will be with you during labour, two midwives will be present at the birth.

What pain relief methods can I use at home?

Water (you can have a home water birth but you will need to hire or buy your own birthing pool).

TENS machine (hired or bought). Complimentary therapies. Entonox (gas and air) is provided by the midwife. Inject able pain relief can be arranged with your GP. Birthing aids such as mats and birthing balls (bought, hired or arranged with

your midwife).

Birth Centre

Who can use the Birth Centre?

The Birth Centre provides support during labour in a relaxed and homely environment designed specially to support normal, active birth. This birthing centre is aimed at women who:

Have a low risk pregnancy and anticipate a low risk labour and birth e.g. no previous medical or obstetric problems

Do not want to have an epidural in labour. Wish to use therapies such as water, massage, music, low lighting and

upright / mobile positioning to enhance the safe natural progression of labour and easing pain.

Pain Relief Methods you may wish to use on the Birth Centre.

Breathing / relaxation techniques.

Mobilisation.

Hydrotherapy

TENS machine

Hypnotherapy will be supported

Entonox (gas and air)

Meptid injection.

If you require/wish to have a epidural during your labour, you will need to be transferred to the labour ward when a room, midwife and anaesthetist are available.

The Latent Phase of Labour

The latent phase is the first part of your labour. Some women will have backache and cramps or have bouts of contractions that may last a few hours and then stop and start up again the next day. This is perfectly normal.

The duration of the latent phase of labour can be variable. It may last for 24hrs or more and can be exhausting for you. It helps if you can stay as relaxed as possible during this part of your labour and remain at home in comfortable surroundings as long as you can.

Remember that every woman’s labour is different and sometimes it can take a long time.

Your contractions may feel uncomfortable but they may not be regular. They may be sharp but short lasting. They may stop and start, last for 30 – 40 seconds and may continue for several hours.

The neck of the womb (the cervix) has been long and closed during your pregnancy.

These contractions help to soften the neck of the womb and prepare your body for active labour.

As the contractions become closer together, longer and stronger, the neck of the womb will also begin to shorten and then open up. Once the cervix is 4cm dilated and the contractions are regular (every three minutes or so) and lasting for at least a minute, then labour has become active.

How can I help myself?

There are many ways of helping yourself to cope through these first hours of the latent phase of labour.

It is important to try and remain relaxed.

Keep your breathing deep, steady and slow during a contraction. This will prevent you from using extra energy. Once the contraction is wearing off, close your eyes and allow your body to rest before the next one.

Take a warm bath or shower, at regular intervals. You will find the warmth of the water soothing and relaxing.

You may want to call your birthing partner for added support during this time. It may be useful if your partner massages your back to reduce, backache, helps you to relax, and supports you in any alternative positions that you may adopt. Your birthing partner can also make other family members aware of the latent phase of labour and encourage them to support you rather than raise concerns unnecessarily at this stage.

Try to remain active without exhausting yourself during this time. Take a walk out with your partner, stopping if you need to during a contraction. Remaining upright will assist gravity and help your baby to descend into the pelvis. Rocking your pelvis and swaying your hips can also assist you. If you have

access to a birthing ball, use it regularly as this too can alleviate any discomfort.

Ensure that you maintain your energy levels by eating small, light meals containing carbohydrates such as bread, pasta. The use of high energy drinks will also add to your energy requirements and keep you hydrated.

It is safe to take simple pain killers, such as Paracetamol if you are not allergic. You can take two tablets / 1gm, every 4-6hrs. Do not take more than 8 tablets within a 24hr period.

Some women who have hired a TENS machine put it on during the latent phase.

When should I go into hospital?

If you have tried all of the above suggestions and your contractions are now regular and painful, you may want to ring triage or the Birth centre. The midwife will advise you depending on the information that you give.

If you come into hospital then take your bag with you. However, if labour has not yet established you may be asked to return home. This decision will be based on the findings of a thorough examination. Hospitals are not always the best environment for women who are in the latent phase of labour.

When and how do you call the Birth Centre or Triage

You should contact the Birth Centre (0208 887 3820) when you think you are going into labour, your waters have broken or you are having any blood loss or reduced baby movements. Sometimes the midwives are unable to answer the phone because they are caring for women if this is the case please call Triage (0208 887 3682)

Travelling to Hospital

We strongly advise to you plan how you are getting to hospital when you are in labour in advance. Whether that be with a friend, minicab or your own car. Parking is available in front of the maternity unit and the entrance is off of the north circular (A406). Please note ambulances are only to be used in an emergency.

What you may like to bring in with you:

Personal toiletries, towels for your use and Sanitary Pads – thick ones! Sieve and mirror for pool use (You must bring these with you if you intend to

use the pool) Disposable knickers for yourself

Loose and comfortable clothing for you to labour in with some flip-flops/slippers

Food and drink for your support people Music If your partner stays with you, appropriate sleep wear must be worn at all

times ( long pyjamas or tracksuit bottoms). Extra pillows. Snacks & energy drinks. For your baby - disposable nappies, clothing (e.g. vests, baby grows, jacket,

booties, hat), baby blanket. Please ensure any clothing has been washed in a mild soap to rid the fabric of manufacturing chemicals.

Am I allowed visitors?

We allow visitors into the birth room to support you in labour and after the birth.  To reduce the risk of infections, we do not encourage children under the age of 16 unless they are your own children and usually only after you have given birth.  We encourage you to be sensible about the amount of visitors you receive following the birth. This is a very special time which should be used for getting to know your baby and establishing feeding.

What are the benefits of an active birth?

Numerous studies indicate that the benefits of Active Birth are:

The natural rhythm and continuity of birth are not disrupted Uterine contractions are stronger, more regular and frequent Dilation of the cervix is more efficient More complete relaxation between contractions First and second stages of labour are shorter (some studies show up to 40%

shorter) Greater comfort, less stress and pain and so less need for pain relief Less fetal distress and improved condition of the newborn Women feel that they are fully participating, in control and more often

experience giving birth as a positive, empowering experience

Waterbirths

We are experienced in water births and enjoy providing care for women who choose this option. Many of our women choose to use one of our pools to labour and give birth in, around 70% However, some women choose to labour in water but want to get out to give birth. Whatever you choose to do we will be there to support you.

Using water enables you to move freely and adopt any position you feel like, aided by the buoyancy of the water. It is a marvellous relief for aching backs or for women who feel their contractions in their back. Our women have told us that they feel very safe and comforted by being in a cosy, warm, egg-shaped pool!

Feeling safe and relaxed means that the body then produces its own natural pain-relieving hormones called endorphins and thus the body is able to get on with producing other hormones which are vital to the process of labour and birth. The production of these hormones can be interrupted by fear, unnecessary interference with a labouring woman, bright lights or loud noise, in short, anything which makes the woman feel uncomfortable or unsafe. For this reason we are quiet and respectful at births, providing support and guidance as gently as possible. Having said that, we also have had clients who were very happy to have the TV on or play loud music during their labour and they gave birth just fine!

The baby is born underwater and gently brought to the surface either by you, your partner or the midwife. It is a very gentle way to be born and babies born this way rarely seem to cry at first and soon open their eyes to see what they can of their mother.

Birthing Balls

We also recommend birth balls which are useful both during pregnancy and during labour. They are very helpful for backache of pregnancy, providing gentle exercise and aiding mobility whilst you sit on one and gently rock or make small circular movements. They are very comfortable to sit on, providing support, but also with some “give” to the pelvis.

Another way to use one is to lean over it (bump permitting, of course!) almost hugging it and rocking back and forth. Women have said that they find this rhythmic movement comforting and a relief for an aching back, either in pregnancy or during labour.

If your partner is on a chair, they can hold the ball in place whilst you lean over it, head towards your partner, so that they can also massage your shoulders and back.

Leaning over the ball this way is also an excellent position for giving birth in, should you so choose. Many women, left to follow their instincts, will give birth on all-fours, either in water or on dry land. This position enables the pelvis to open to the widest diameters possible thus allowing the birth to proceed well.

Birthing stool

The birthing stool has been used for millennia. Birthing chairs took the place of labouring mothers sitting on birth attendant’s laps, as it was the previous practice. The birthing chair can be traced to Egypt in the year 1450 B.C.E. Pictured on the walls of The Birth House at Luxor, Egypt, is an Egyptian queen giving birth on a stool.

We are very lucky in our birth centre to have the 21st century “BMW” of birthing stools made by Fibromed.

It is designed to help you maintain a physiological upright posture during childbirth. The birthing chair is intended to provide you with balance and support while giving birth in a squatting position supported by your birthing partner.

Delivery of the Placenta

There are two ways in which you can choose to deliver your placenta. The first is by the physiological method. Once the baby is born, the midwife will wait until the cord stops pulsating before clamping and cutting. You will then wait for a contraction and deliver the placenta by yourself. It can take up to one hour to deliver and you may have a slightly higher risk of bleeding. The other method is for you to be given an injection after the delivery of the baby, the midwife then waits for signs the placenta is ready to be delivered and will then proceed to deliver it. This can take around ten minutes. You may feel shivery or vomit after the injection but these side effects are quite rare. Your midwife will ask you which method you prefer.

Reducing the risk of Perineal Trauma

After the delivery of your placenta, the midwife will check to see if you have any tears and if you require stitches. The midwives are able to suture you on the Birth centre using local anesthetic which should provide adequate pain relief. However if you have a deep or extended tear you may have to transfer to the labour ward for suturing by a doctor, and an epidural may be necessary for pain relief. If you wish to reduce the risk of tearing, then perineal massage has been shown to be extremely effective in your first pregnancy. It must be started from 36 weeks and should be done every day. Please discuss this with your midwife if you have any questions about this

When can I go home after the birth?

Most women choose (and are encouraged) to go home within 6 -12 hours of their baby’s birth, unless there is reason to remain in hospital. If you need to stay for a

longer period of time either for medical reasons or by choice you will be transferred to the postnatal ward in order to allow the birth rooms to be used by other women. We will discharge you to the care of the community midwife who will continue your care when you go home.

Newborn physical examination and Hearing screening

We offer every baby a full physical examination by an appropriately trained midwife or neonatal doctor either before you go home or in the community

We also offer early hearing screening.  The hearing screening team work 09.00-17.00hrs. If you give birth to your baby and go home outside of these hours, we will arrange an outpatient’s appointment in the community.

Feeding your baby

We will support you in your choice on how to feed your baby. We actively encourage skin-to-skin contact after the birth of your baby. This is important regardless of how you choose to feed your baby, as it helps facilitate that transition from birth to life.

We will give you any support and assistance you need with breastfeeding. Should you choose to bottle-feed your baby, then please be aware that we don’t provide milk (in accordance with hospital policy), so you will need to bring your own. If you need further advice on how to feed your baby, then please discuss this with your midwife.

Vitamin K

Vitamin K is a substance that is produced in the body to help blood clot. When a baby is born, it has a very low store, which is used up quickly within the first few days of life. Some babies (this is very rare) may be more vulnerable to bleeding and unable to clot their blood. Vitamin K helps to prevent this. There are no apparent side effects, although, there was some link to childhood cancers many years ago, this has not been confirmed with furthermore extensive research. Therefore, we still offer vitamin K to all newborns. It can either be given orally (three doses over four weeks) or by injection. Your midwife will ask you which one you would prefer, she will be happy to discuss it with you should you have any questions.

And Finally…What our women say about us

“You have all made the birth of my third child one of the most exciting and moving experiences of my life”

“My midwives were a fantastic support throughout my labour…calm, knowledgeable and positive I couldn’t have got through it without them. Their team effort allowed me to have the natural birth I so wanted despite the complications my son’s position brought to bear. Thank you all!”

“I felt strong… all my feelings were listened to. I’ll be back!”

“My midwives what can I say? Calm, kind and professional, they made me feel special”

“Simply wonderful”

“Thank you for all your advice and care during and after the wonderful birth experience of our beautiful daughter. I am still in shock to have given birth in the pool in three and a half hours!”

“What can I say? Thank you! Thank you! Thank you!...I never knew being in labour could be fun!!I know it must have been extremely tiring and stressful for you but you were wonderfully cool and professional. I felt safe, loved and listened to…”

Where can I discuss all of my birth options further?

All North Central London Maternity Units are very happy to provide further detail on each of the birth choice options available to you on an individual basis. Please discuss this with your midwife or obstetrician.

Occasionally, demands on the service may mean that all birth options are not readily available. Your midwife will be able to provide information about this.

If you feel unhappy with the choices you are offered or recommended, it is important to discuss this with your midwife or obstetrician.

You can also ask to be put in contact with a local supervisor of midwives.

The role of supervisors of midwives is to support women, keep them safe and to be available to discuss any aspects of your maternity care with you.

Supervisors also support the midwife in the care he/she gives you.

It may be helpful to read a leaflet called Support for parents: how supervision and supervisors of midwives can help you. This can be found on the website of the Nursing and Midwifery Council.

http://www.nmc-uk.ort/Publications/Information-for-the-public/

For more information about the role of supervisors of midwives, please visit www.londonlsa.org.uk or the Nursing and Midwifery Council website www.nmc-uk.org/aArticle.aspx?ArticleID=2098

How to contact a supervisor of midwives

If you would like to speak to a supervisor of midwives, there number is on the front of your hand held maternity notes

Further information

NHS Choices Pregnancy and Baby Guide:http://www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-and-baby-care.aspx#close

The National Childbirth Trust (NCT): http://www.nct.org.uk

Help in choosing where to have your baby: http://www.birthchoiceuk.com/

AIMS – Association of Improvement in Maternity Services. Help if you are having problems getting the maternity care you would like:http://www.aims.org.uk/

Information about finding an independent midwife:http://www.independentmidwives.org.uk/

Doula UK - the non-profit organisation for Doulas: http://doula.org.uk/

References

Birth Place Study 2011 www.npeu.org.uk

Information about you

All NHS staff have a legal duty to keep information about you confidential. This means that your personal information must be used fairly and lawfully.

You have a right to access the information held about you. You can find out about what information we have about you by writing to:

Data Protection Officer

North Middlesex University Hospital NHS Trust

IT Department

Sterling Way

London N18 1QX