Your midwife will make an appointment with you when you are around 34 weeks pregnant to discuss labour and birth and create a personal birth plan that becomes part of your hospital notes.
The birth plan gives the midwife that looks after you in labour an understanding of any wishes you and your partner may have regarding your labour care.
You may have attended antenatal classes or have had a baby before and these may inform your ideas of what you would like in labour. Birth plans are personal to each woman and their partner taking into account their individual needs.
It is very important that birth plans are flexible to accommodate for changes in circumstances. These can arise if you develop complications in later in pregnancy or labour that require additional intervention, or if particular facilities such as birthing pools are not available at the time required.
The midwife caring for you will endeavour to support your preferences as fully as possible whilst providing care that is safe for you and your baby.
Reference: National Health Service, 2013 How to make a birth plan
Options – choosing where and how to give birth:
Hospital or Home
There are advantages and disadvantages to a home or hospital birth. You and your partner need to consider these for each option.
You may feel safer and more comfortable having your baby in hospital, especially if it is your first child.
In the Salisbury area about 2,400 mothers a year choose to have their baby in the maternity unit at Salisbury District Hospital.
Our newly refurbished (summer 2013) Labour ward has ten ensuite rooms (including two pool rooms and an Obstetric Theatre).
You will be looked after by experienced midwives and have access to a range of types of analgesia (see Pain Relief).
If your labour deviates from the normal, there will be a Senior Doctor available at all times and a Consultant Obstetrician on call out of Hours. Experienced paediatricians are available within the hospital, 24 hours a day and the newly extended and refurbished Neonatal Unit is situated close to the Labour Ward.
Depending on the type of delivery and whether or not this is your first child, you may go home directly from the Labour Ward or you may go to the Postnatal ward to take some time to recover.
The Midwives and Maternity Care Assistants on the Postnatal Ward will check both you and your baby. They will also introduce you to the basic care of your baby (or give reminders) as necessary e.g.help with breast feeding, bathing and nappy changing.
When you go home you will still receive support from the Community Midwives for postnatal checks.
Talk to your Community Midwife, she will be happy to discuss the possibilities of Home Birth with you.
You should consider:
- The distance that you live from the hospital should a transfer in become necessary
- In familiar surroundings you may be more relaxed and able to cope with the pain
- You are likely to be looked after by a midwife that you know
- The limited analgesia options available at home
- If there is an older sibling, childcare may be easier with a home birth but a backup plan will be needed in case a transfer into hospital is needed.
- You will not need to be separated from your partner after the birth
There may be factors that would reduce the suitability of a home birth.
Certain diseases which you have already had or an illness you develop during pregnancy or other factors may mean that you will be advised to have your delivery in hospital e.g. if you are expecting twins, if you have high blood pressure, high BMI or factors related to previous births.
Wherever you decide to give birth, you can change your mind at any stage of the pregnancy (subject to medical limitations on home birth).
Further advice on where to give birth can be obtained from:
We have two rooms with birthing pools. Some mothers choose to use a pool in the early part of establishing labour (see below in “Pain Relief”).
Although many women choose to get out of the pool to deliver or have alternative pain relief, some women feel comfortable and choose to deliver in the pool. We need to be able to listen to the baby’s heart whilst the mother is in the pool. For this we have waterproof sonicaids which can be used without disturbing the mother.
Sometimes however, either due to the position of the baby or the position the mother has adopted, it may be difficult to hear the fetal heart and we have to ask the mother to change position, stand up or even leave the pool briefly so that we can hear the fetal heart rate clearly.
Some fathers want to get into the pool with the mother to be more involved with the birth. This can be really helpful and some mothers find it a great comfort. (Fathers – please bring a pair of trunks if this is in your plan.) Please note, this is not for all dads. They can be just as supporting from dry land. Also the pools are not so large that having two people in the pool may restrict the mother’s ability to move freely. It will be up to the mother where she finds her partner most helpful.
Our priority is always a good birth experience for the parents resulting in a healthy child. Sometimes where that experience happens may change from your first choice. We would only ask you to get out of the pool if we were not happy with the well-being of the mother and/or baby.
Elective Caesarean Section
There are some cases when it will be recommended for you to have a planned caesarean section.
You will be given a date and time to come in and (unless there are exceptional circumstances) your baby will be delivered by caesarean section (LSCS) that day. Salisbury Maternity Unit has an obstetric theatre which is open 24 hours a day. Before your elective Caesarean Section you'll be advised not to eat from midnight and not to drink anything after 6:00am. You will be given an antacid tablet to be taken at 6:00am.
Common reasons for Elective Caesarean Section include:
- Baby presenting by the breech
- Previous LSCS
- Maternal illness
- Fetal problems
- Placenta praevia
A decision on an elective caesarean will follow investigations and tests in the Antenatal Clinic, by the Consultant Obstetrician and in discussion with the parents.
Relevant factors in choosing where to have your baby
Your Community Midwife will be discussing these with you.
If your midwife is concerned that your pregnancy is deviating from the norm, she may refer you to the Antenatal Clinic at the hospital to be reviewed by a Consultant Obstetrician. The obstetrician will assess you and carry out any relevant tests or scans.
There are many considerations when deciding on the most appropriate mode and place of delivery, including:
- Parity i.e. first, second or more babies
- Gestation – length of pregnancy
- Presentation of baby
- Maternal age
- Maternal BMI
- Maternal health e.g. diabetes, infectious conditions, anaemia, vascular problems etc.
- Previous obstetric history
- Previous perineal trauma
The discussion and choice will always be focused on providing a good birth experience resulting in a safe birth.
Pain Relief (inc Aromatherapy):
Stimulates the body’s own natural pain relievers called endorphins. It works by blocking the pain signals from the uterus to the brain.
Many women find it useful in the first stage of labour and it may reduce the need for drugs however it can be used in conjunction with other pain relief options TENS machines are available to hire from the maternity unit for £25 plus a £20 refundable deposit.
Helps to create a calming and relaxing atmosphere, may aid contractions and can help to ease nausea and sickness. It also enhances mood to create an uplifting feeling. This can be used in a birthing pool, through an aroma stream or added to oil for a relaxing massage.
Our maternity unit has two birthing pools that are available to use if the rooms are free, please enquire when you ring up in labour.
Water can be relaxing; you feel weightless in the water and can move around with ease. The water is kept at body temperature and gas and air is available to use in the pools.
Pools are also available to hire for home births.
Gas and Air
It is a mixture of oxygen and nitrous oxide (laughing gas), it is breathed in through a mouth piece and you are in control of how much you breathe in. This is available for both home birth and hospital birth.
It does not take the pain away but takes the edge off and makes the contractions more bearable.
Pethidine is an opioid and is available in the form of an injection for pain relief and this is used by a small number of women to help them to relax during labour.
Diamorphine is similar to Pethidine as it is from the opioid family and is given by injection, its effects can last longer than Pethidine and it has fewer side effects.
An epidural is a drug that is inserted into the epidural space of the lower back near the nerves. It offers complete pain relief. It can be useful for women who are having long labours or who are very anxious.