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PARENTING

PARENTING

My Labour Choices
By Anastasia Alcock

Nowadays your labour and delivery can be tailor-made. You can choose:
 

  • Where you give birth – at home or in a hospital

  • Whether you go private and chose your consultant obstetrician

  • How you give birth – either vaginal delivery or caesarean section

  • Whether you have pain relief

  • What type of pain relief – be it natural methods or medical methods

  • When you give birth – if you choose to have a caesarean section there can be some flexibility in the date that you have your operation

Some women have very strong views and opinions as to the type of delivery that they want. These ideas can be based on previous experience from their own deliveries, experiences from others, or media and social pressure. Your own personality plays a big role in the decision process, too. 
 

Here are some facts that might help you through the maze of choices that are available.  Remember, there is no right or wrong way to have a baby! You have to do what feels right to you. The ultimate goal is to have a healthy mum and baby: how you get there is a journey.
 

Vaginal or caesarean delivery?
 

Vaginal delivery
 

Many women feel that this is the obvious choice for them. It is the ’natural’ way to give birth and can be done with the minimal medical intervention and allow you to be up and functioning quickly after the delivery.
 

Here is a list of things to consider when making your decision:
 

  • Limited medical intervention – your delivery can be without medical intervention in a midwife-led unit or at home

  • Choice of types of pain relief - natural or medical (gas and air, pethidine or epidural)

  • No operation

  • Risk of perineal tears/ episiotomies – 80% of women tear from a vaginal delivery. Only 2.4% of these are major tears that have risks related to incontinence

  • Risk of short term incontinence – also for caesarean section

  • Risk of short term sexual dysfunction – also for caesarean section

  • Quick recovery – you are able to stand up and care for your baby almost immediately and you can leave hospital within hours

  • Earlier skin-to-skin contact with your baby

  • Earlier opportunity to breastfeed and hence to start the hormonal process of milk production

  • Easier to cope with the initial few days as you are not recovering from surgery

Caesarean Section
 

Many women choose this as their preferred option. This can be for a variety of reasons: maybe you do not want to experience the pain of labour or maybe you do not want a vaginal delivery and this is the only other option. Perhaps you feel that this is the safest option for yourself and your baby, maybe you need the assurance of a specific delivery date or maybe you have experienced something or heard stories about vaginal deliveries that have put you off that option. 
 

Quite often, there is no choice in the matter. By that I mean there are some situations that will require you to have a caesarean section either for your health or your baby’s. It is important to remember that labour is not something that you can predict. You need to be ready for all eventualities, including a caesarean section.
 

Below is a list of things to consider when deciding whether to choose a caesarean section:
 

  • Scheduling the birth

  • Avoidance of labour pain

  • Avoidance of labour fears – losing control, not coping, not doing it ’right’, your own safety and the safety of the baby

  • Abdominal surgery – risks from anaesthetic, DVT, infection, bladder or bowel damage, bleeding and blood loss

  • Reduced risk of post-traumatic stress disorder – normally associated with a very traumatic and stressful delivery, often caused by vaginal deliveries with many complications

  • Risk of accidental surgical cuts to your baby during the operation

  • Risk of scarring to your womb and therefore problems with future pregnancies and deliveries. It may mean that your next delivery will need to be a caesarean section

  • Risk of post-operative infection of your womb, abdominal scar or bladder from the catheter

  • Increased risk of initial breathing problems for your new baby, a ‘mucusy’ baby

  • Slower milk production within the early days

Home or hospital delivery?

I think that most of us feel that the birth process may be too medicated and perhaps staying away from hospitals could be a good thing. There are, however, a few things that need to be carefully considered before you decide on a home birth. Remember, not every pregnancy is appropriate for a home delivery. One must also consider the existing statistics. Recently, a large-scale study looking at 65,000 births across the UK was carried out. Here are two key figures:
 

  • 48% of first-time pregnancies delivered at home end up in hospital due to complications for either the baby or the mum. This can be very distressing and worrying, especially if the hospital is a long distance from home

  • 20% of women who have already had a baby needed medical care and had to go into hospital during a home delivery

Home delivery

Many women want to explore the idea of a home delivery and see if it is right for them. It can be a wonderful experience to deliver in your home with your family around and without the noise and rush of the hospital. If you are at home you will have a midwife with you to help you through the delivery. There will be no other health professionals present so you will benefit from a much more private labour and delivery. You will also be free from medical intervention, which is often the main reason many choose to deliver at home.
 

There are a few things that you need to think about before deciding to have a home delivery:
 

  • Have you had a normal pregnancy? Most women who have suffered complications during their pregnancy will not be fit for a home delivery

  • Do you have a medical condition? If you do, you may well need the support of the medical team for your delivery, so a home birth would not be right for you

  • Have you had a previous vaginal delivery without any complications? If yes, you are a very good candidate to have a home delivery 

At present the rate of home deliveries in the UK is about 2.4%. It is worth noting that 1 in 5 deliveries that begin at home end up in hospital. This figure is much greater if this is your first delivery, with 48% ending up in hospital. 
 

How do you start to organise your delivery at home? Sometimes it is possible through your maternity hospital if the midwives have a home delivery team. Otherwise you may need to look for an independent midwife. A good place to start is www.independentmidwives.org.uk or your hospital midwives may know of independent midwives in your local area.
 

There is a lot of equipment that you will need for a home delivery. Below is a list to get you started. Many people would like a birthing pool. These can be borrowed, hired or bought very easily. Your home delivery midwife will be able to help you.
 

Equipment needed for a home delivery;
 

  • Your midwife will provide you with a birth pack consisting of drugs and equipment that may be needed during your labour

  • Plastic sheeting to protect your home

  • Old towels/sheets to cover the plastic sheeting

  • Warm blankets for you

  • Desk light so your midwife can see if you have any tears and for examining your baby

  • Clean, warm towels for your new baby

  • Portable heater to keep your baby warm

  • The contents of your hospital bag

If you are not suitable for a home delivery or you feel that the risk of not going into hospital is too high, or perhaps you live too far from your local maternity unit, you may still be able to have a medical-free delivery. Many maternity units have ’Home from Home’ midwife-lead units, allowing you to come into the hospital to a unit that is much more relaxed and calm than the busy maternity unit. There are only midwives in these units, but if any problems occur they are able to call for a doctor who will be able to attend quickly. These centres are ideal for first time deliveries provided your pregnancy has been normal and no complications for delivery are foreseen. 
 

Hospital delivery
 

In most large hospitals there are choices as to where you can deliver your baby. There is always a delivery suite that will be led by doctors, however midwives oversee and care for each patient. The doctors often do not need to intervene unless the midwives notice a problem. These are often very clinical and practical areas and you will always be given your own room. You will have the full range of natural and medical pain relief on offer to you should you need it.
 

As previously mentioned, there will often be a ’Home from Home’ unit which is midwife-led and a much calmer and a less clinical area. These units are often close to the main delivery suite so if a doctor is needed the midwives can contact one easily. You will not be able to have an epidural in a centre such as this, but other forms of natural and medical pain relief will be available.
 

The third option is a midwife-led unit that is not attached to a delivery suite. These are often in a countryside setting and are solely for uncomplicated pregnancies. Here you have the support of the midwives, but should anything go wrong and a doctor be needed you will need to go by ambulance to the nearest maternity centre.
 

Even within the hospital setting, there are still choices that you can make to suit yourself. Remember, pregnancy and birth are unique and personal things. You must look at all the options and choose which is right for you. If you have time to visit the birth centres around you then be sure to do so – it can really help to see the space and to talk to the teams.

 

 

About the Author
Dr. Anastasia Alcock
Founder
The Prenatal Classroom

Mother-of-two Anastasia Alcock holds a Diploma in Obstetrics and Gynaecology from Imperial College School of Medicine in London. She has worked as a paediatrician in hospitals including Guy’s and St Thomas’ Hospital, London, The Royal Brompton Hospital, London and the John Radcliffe Hospital, Oxford and has significant experience in delivery and newborn care.

Most expectant mums have a multitude of questions as they prepare for their new arrival. Who better to ask for advice and support than an experienced doctor who is also a mum and who above all has the time to listen to your concerns and worries?

Anastasia launched The Prenatal Classroom to offer group and private lessons for expectant parents to teach them the knowledge they need to approach parenthood with confidence.

The course was put together based on Anastasia’s medical knowledge, her own experiences as a mother the psychological wellbeing of pregnant women and with additional input from experts in nutrition, breastfeeding and baby care.

Classes are held in West London and Oxford. They are relaxed and informal but have a clear format and come with the guarantee that the same doctor will teach all your classes.



T: 07940 589 021
FB: www.facebook.com/ThePrenatalClassroom
E: anastasia@theprenatalclassroom.com
W: www.theprenatalclassroom.com
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