Birth and Beyond

When to Call the Midwife or Go to the Hospital

• Contractions become regular, stronger, and closer together, usually around 3-5 minutes apart, lasting 45-60 seconds.
• Your waters break (even if contractions haven’t started).
• You experience any bleeding beyond a light show.
• Your baby’s movements slow down or change noticeably.
• You feel you need extra support or reassurance.

Pain Relief Options

Natural and Non-Medical Methods:

These can be very effective in the early and active stages.

• Movement and Positioning: Staying upright (walking, swaying, or using a birthing ball) can help your baby move down and ease discomfort.
• Breathing Techniques: Deep, slow breathing can help you stay calm and manage each contraction.
• TENS Machine: This device sends mild electrical pulses through pads placed on your back. It works best when started early in labour.
• Water Therapy: A warm bath or birthing pool can relax muscles and reduce pain.
• Massage and Touch: Light touch or a firm lower back massage can ease tension.
• Hypnobirthing: Techniques like guided meditation and visualization can promote relaxation.

What Happens During the Second Stage?

Full Dilation (10 cm):

• Your cervix is fully open, and it’s time to push your baby down the birth canal.
• This stage can take 20 minutes to 2 hours, depending on whether it’s your first baby and if you’ve had an epidural.

Pushing and Contractions:

• Strong, frequent contractions (lasting 60–90 seconds) will come every 2 to 5 minutes.
• You’ll feel an overwhelming urge to push, like intense pressure in your pelvis or rectum.
• Each push moves your baby further down.

Crowning:

• When your baby’s head reaches the vaginal opening, it will start to “crown”.
• You might feel a burning or stinging sensation (often called the ring of fire) as the perineum stretches.
• Your midwife will guide you to pant (short, quick breaths) rather than push, helping prevent tearing.

Birth of the Baby:

• After the head is born, your baby will rotate, allowing the shoulders to pass through—one at a time.
• Once the shoulders are out, the rest of the body follows quickly, bringing immediate relief from pain.

What Happens Right After Birth?

1. Skin-to-Skin Contact: Your baby will be placed on your chest for warmth, bonding, and to encourage breastfeeding.
2. Cord Clamping and Cutting: The umbilical cord will be clamped and cut—sometimes by your partner, if they wish.
3. Episiotomy or Tears (if needed):

• If the perineum stretches without tearing, no stitches are needed.
• If you have a small tear or an episiotomy (a small cut to help the baby out), it will be stitched with local anesthesia after delivery.

Emotional and Physical Sensations:

• Many women describe feeling an intense emotional high after the birth, alongside overwhelming relief.
• The pain stops immediately, and focus shifts to holding your newborn.

What Happens During the Third Stage?

Delivery of the Placenta:

• After your baby is born, your uterus continues to contract, causing the placenta to detach from the uterine wall.
• You may feel mild contractions, but they’re much less intense than during birth.
• The midwife may ask you to give a small push to help the placenta come out.

Two Ways to Manage the Third Stage:

Active Management (Common in Hospitals):

• You’ll be given an injection of syntocinon or oxytocin into your thigh right after birth.
• This speeds up contractions, helping the placenta detach and reduce the risk of heavy bleeding (postpartum haemorrhage).
• The midwife may gently pull on the cord while supporting your uterus to guide the placenta out.

Physiological (Natural) Management:

• Your body expels the placenta naturally without medication.
• Skin-to-skin contact and breastfeeding can help by stimulating oxytocin, encouraging contractions.
• This approach usually takes longer and might increase the risk of heavier bleeding.

Checking the Placenta:

• Once delivered, the midwife will examine the placenta and membranes to ensure they’re complete.
• If any fragments remain inside the uterus, further medical attention may be needed.

Physical Recovery After Birth

Vaginal Birth Recovery:

• Expect vaginal bleeding (lochia) for 4–6 weeks, starting bright red and gradually fading to pink, brown, and yellow.
• If you had stitches for a tear or episiotomy:
• Keep the area clean with warm water and pat dry.
• Use a peri bottle after urinating.
• Apply cold packs for the first 24 hours to reduce swelling.
• Pain relief like ibuprofen can help.

C-Section Recovery (if applicable):

• Rest is vital. Avoid heavy lifting and stick to light activities.
• Keep the incision clean and dry; watch for signs of infection like redness or swelling.
• Wear loose clothing and a supportive band if it helps.

Afterpains:

• Cramping as the uterus shrinks is common, especially when breastfeeding.
• A warm compress and pain relief can ease discomfort.

Emotional Well-Being

• Baby Blues: Many women feel tearful, anxious, or overwhelmed in the first 2 weeks, due to hormonal changes.
• Postpartum Depression (PPD): If sadness, anxiety, or exhaustion lasts beyond 2 weeks, seek support from your healthcare provider.
• Rest and Self-Care: Sleep when the baby sleeps, accept help, and don’t hesitate to ask for emotional support.

Caring for Your Newborn

• Feeding: Newborns feed every 2–3 hours, whether breastfeeding or formula feeding.
• Sleep: Babies sleep 14–17 hours a day, but only in short bursts (2–4 hours at a time).
• Nappies: Expect at least 6 wet and 3 dirty nappies daily after the first few days.
• Cord Care: Keep the umbilical stump dry and clean until it falls off (usually within 1–2 weeks).

Breastfeeding Tips

Establishing Breastfeeding:

• Feed on demand: Newborns feed every 2–3 hours, about 8–12 times in 24 hours.
• First feeds: Colostrum, the thick yellow milk in the first few days, is rich in nutrients and antibodies.
• Good latch: Ensure the baby takes in both the nipple and part of the areola, not just the nipple.
• Signs of hunger: Rooting (head turning toward breast), sucking on hands, or smacking lips.
• Ensure a good latch to prevent nipple soreness:
• The baby’s mouth should cover more of the areola, not just the nipple.

If nipples get sore:

• Apply lanolin cream after feeds.
• Air-dry nipples and use breast pads if leaking.
• Stay hydrated and eat well to maintain milk supply.

If you’re not breastfeeding:

• Wear a supportive bra, avoid nipple stimulation, and use cold compresses to ease discomfort.

Managing Common Challenges:

• Sore nipples: Use lanolin cream or express a few drops of milk to soothe. Make sure the latch is correct.
• Engorgement: Frequent feeds, warm compresses before feeding, and cold compresses after can relieve swelling.
• Low milk supply: Stay hydrated, eat well, rest, and feed often. Skin-to-skin contact also boosts supply.
• Blocked ducts: Massage the area while feeding, apply warmth, and continue feeding from the affected breast.

Expressing and Storing Milk:

• Freshly expressed milk lasts 4 hours at room temperature, 4 days in the fridge, and 6 months in the freezer.

Pumping Tips & Schedule

To build a stash or relieve engorgement, try this schedule:

• First few weeks: Pump once daily, usually after the morning feed (milk supply is highest).
• Returning to work: Pump every 3 hours while away from your baby.
• Power pumping: To boost supply, pump for 20 min, rest 10 min, pump 10 min, rest 10 min, pump 10 min.

Pumping Tips:

• Relax: Stress can slow milk flow—try deep breathing or looking at a photo of your baby.
• Flange fit: Ensure the breast shield fits properly; a poor fit can reduce output and cause pain.
• Massage: Gentle breast massage before and during pumping helps with let-down.