Depending on your medical and obstetric history you will attend either the Midwifery led unit or Delivery suite. Your midwife will have advised you during your antenatal visits, but if you are unsure please contact the hospital on 0151 708 9988. Or attend the Midwifery led unit in the first instance.

 

The Midwifery Led Unit is a delivery / post-natal ward for low risk women who do not require continuous monitoring throughout their labour and can be found on the first floor in the Jeffcoate wing.

 

The majority of care is provided by a dedicated midwife however if you require medical assistance a doctor will attend from the central delivery suite close by. Most forms of pain relief are available. If you request an epidural, this will be provided on the central delivery suite. Additionally alternative therapies such as aromatherapy, hydrotherapy and massage are available on request. A relaxation room is also available for you to use.

 

If you are in good health you will deliver on the MLU unless:

• You have been booked for induction of labour

• Your pregnancy has not reached 37 weeks when you go into labour

• You have gone 10 days past your due date

• You are having twins

• You have had some problems in your pregnancy which mean you will require continuous monitoring in labour

On arrival you and your partner (or other person you have chosen to help you through your labour) will be shown to your room. Security and visiting. Here you can make yourself comfortable, change into hospital gown or nightdress of your own. Choose an old one that is loose and preferably cotton because you will feel hot during labour and won't want something tight. Your midwife will ask you to explain what has been happening so far and will examine you to determine your progress. This will be done by:

• Taking your pulse, temperature, blood pressure and a sample of urine

• Feel your abdomen to check your baby's position and listen to your baby's heart

• Examine you internally to check how much your cervix has opened

Your midwife will repeat these checks at intervals throughout labour to monitor your progress

 

Delivery Suite

 

If you require continuous monitoring throughout your labour you will have your baby on the delivery suite. The unit is situated on the 1st floor of the hospital opposite the maternity wards and the neonatal unit.

Please ring the hospital on 0151 708 9988 and ask to be put through to the delivery suite. To let us know that you are on your way in and don't forget your casenotes.

There is an assessment room which acts as a triage area for women experiencing problems during later pregnancy. Referrals to this area may be made by your G.P. community midwife or you can self refer. You can contact the unit on 0151 708 9988

There are 14 delivery rooms, a pool room, 5 high dependency rooms for the care of women with known medical conditions/ complications and 2 maternity theatres.

A waiting area with a cold drinks machine is available for partners / support person to enable them to remain in the department. Security and visiting.

If a Caesarian Section is required.

 

There are certain cases when it is safer for, either you, your baby or both, for a Caesarean section to be performed. In some cases this is identified prior to the start of labour and the procedure is planned. You will be asked to attend the hospital on a specific day when the obstetrician will perform the procedure in the theatre area of delivery suite. Your baby is delivered by cutting through the abdomen and then into your womb. The cut is usually done horizontally low down just above your “bikini line”. It is performed in most cases under spinal anaesthesia, which allows you to be awake. The obstetrician will talk you through what is happening and will allow you to see and hold your baby as soon as possible after delivery. Your birthing partner can be present and the procedure lasts around 30 to 40 minutes. If a caesarean is required in an emergency then the procedure is the same but the whole process is quicker. It may also be necessary for a general anaesthetic to be performed, but you and your partner will be told of what is happening and why.

 

Home Birth

In the 60's it was quite normal to have your baby at home. Then it was thought that it was safer to have your baby in hospital so home birth went out of fashion. But when the pregnancy is normal and you have planned a home delivery, more recent research hasn't found any difference in the safety of having your baby in hospital or at home.

Although it is often assumed you will have your baby in hospital, the choice is up to you, even if it is your first baby. Women who give birth at home often say they feel more relaxed and in control. However, you won't be able to have an epidural and if there are any complications you may need to be transferred to hospital.

There are some instances when it would be better for you to consider giving birth in hospital e.g. if you suffer from diabetes, high blood pressure or some other medical problem, or you had problems such as heavy bleeding or problems giving birth in a previous pregnancy. Your midwife will be able to talk you through all the available options and give you clear and unbiased advice about what may be the best option for you.

 

3 stages of labour

There are 3 stages of labour.

 

The first stage

Contractions at the start of labour helps the cervix to soften it will then gradually open to about 10cms. This process can take many hours until you are in established labour when the cervix is about 3cms. If this is your first labour, the start of established labour through to full dilation can take between 6 and 12 hours. You can be up and about if you wish, you may even take a shower if it will help you relax. You can drink sips of water but will be asked not to eat. (In case you need a general anaesthetic later) as your contractions get stronger and more painful you can put into practice your breathing and relaxation exercises you learnt antenatally. You partner or friend can help by doing them with you and by rubbing your back to relieve the pain.

 

The second stage

This stage begins as the cervix is fully dilated and lasts until your baby is delivered. Your body will tell you when to push, its important to listen to your midwife who will help you. Find a comfortable position, which will make labour, easier for you. You may chose to lie on your back propped up with pillows, stand, sit, kneel or squat, kneel on all fours or lie on your side. You can start to push each time you have a contraction. Take 2 deep breaths and the contraction starts and push down. Give several pushes until the contraction stops. Try to rest between each contraction, this stage is hard work but your midwife will help you all the time telling you what to do and encouraging you. The length of this stage is variable but may last a couple of hours. As your babies head moves into the vaginal opening you can put your hand down to feel it. When about half your baby's head can be seen your midwife will tell you to stop pushing. This is so your baby's head can be delivered slowly and give your skin and muscles of your perineum (area between your vagina and back passage) time to stretch without tearing. Sometimes they won't stretch enough and may tear. If this is the case the midwife with stitch the area following the birth.

Once you baby's head is born most of the hard work is over. With one of more gentle push your baby is born and the midwife will lift your baby straight onto you. The cord will be clamped and cut and your baby will be dried to prevent him from becoming cold. Sometimes some mucus has to be cleared out of your baby's nose and mouth.

Usually you will be given an injection in your thigh, as your baby is delivered, to aid the delivery of the placenta.

The third stage

After your baby is born more contractions will push out the placenta. This stage takes up to 30 minutes.
After the birth if any tear has occurred you may require stitches. This is done using a local anaesthetic unless you have had an epidural during labour for pain relief. Your baby will be examined, weighed and measured. Your baby will be tagged for security reasons and given a band with your name and number for identification. You will be left to freshen up and given time alone with your partner and new baby. If you have chosen to breastfeed you can let your baby suckle. You will be offered something to eat and drink and given time to spread the news to family and friends. Once comfortable you will be either allowed home (after about 6 hours), transferred to Jeffcoate ward or the Maternity ward 2.

Birthing Pool

The calming, soothing properties of water have long been recognised. For many years midwives have encouraged women to use water during pregnancy and labour in order to gain these beneficial effects.

 

In direct response to consumer and midwifery demand Liverpool Women's NHS Foundation Trust Trust incorporated facilities for the use of water during labour and/or delivery into plans for the new hospital which opened in 1995. With continuing commitment to waterbirth the Trust encourage ongoing training for midwives and plan to introduce waterbirth facilities into the midwifery-led unit in the near future.

 

Current facilities include antenatal aquanatal classes in the community, and for labour - a deep bath for use in early labour and a birthing pool for use during established labour and delivery if wished.

 

Commonly Asked Questions

Do I have to "book" the pool if I want to use it during labour?

No. If you are interested in using waterbirth facilities discuss your wishes with your midwife during an antenatal clinic visit - either in hospital or your GPs surgery. She will complete a referral form which will be forwarded to the waterbirth midwives. You may also be referred on admission in labour.

 

Can I view the pool before going into labour?

Certainly - either by joining one of the hospital tours (contact parentcraft co-ordinator) or one of the waterbirth midwives via the hospital switchboard.

 

When can I use the pool?

• You should be generally fit and healthy having had an uncomplicated, singleton pregnancy.

• Labour should occur spontaneously between 37 - 42 weeks of pregnancy.

• Your labour should be well established (cervix dilated at least 4 - 5 cm) before entering the pool. Before this time it is advisable to use a small bath.

• Both you and your baby's condition should remain within normal limits.

Can my partner get into the pool with me?

Yes. There is enough space in the pool to accommodate two people comfortably. However, we do suggest that perhaps the wearing of a bath suit or shorts may spare some blushes!!

 

What forms of pain relief can I use?

It is thought that the environment of water, and indeed the pool room itself will help you to relax and thus alter your perception of pain. When in the pool you can use "gas and air". We also encourage use of aromatherapy in combination with hydrotherapy. Oils such as lavender help to promote relaxation. Should you find that you require further pain relief then this can be provided out of the water.

 

Can my baby be delivered in the pool?

Providing your labour progresses normally you may deliver your baby in the water should you wish to do so.

 

Can my partner still cut the cord if I use the pool?

 

Yes, no problem.

 

What if I need to leave the pool?

The buoyancy water provides will help you to change position effortlessly during labour. This will also help you, along with assistance of your midwife, to get out of the pool should the need arise.

 

Any further questions?

Contact a waterbirth midwife via the hospital switchboard 0151 708 9988.

Aromatherapy

Pregnancy and Childbirth Aromatherapy may be used occasionally during the second and third trimester of pregnancy to alleviate fear and anxiety, to aid relaxation and encourage a positive attutide. It may help to relieve aches and pains in the back, pelvis, legs and hands, and may be useful for other common discomforts of pregnancy. It may aid pain relief and relaxation during labour. During the post natal period, it may be useful for healing, relief from anxiety, encouraging a positive attitude and confidence, promoting relaxation and relief from tiredness.

 

Pain Relief in Labour

We hope that if you know what to expect you will not find labour alarming, and that, with good pain relief, the birth of your baby can be comfortable and enjoyable.

What will labour feel like?

Towards the end of your pregnancy you may notice your uterus tightening from time to time. When labour starts these tightenings become regular and much stronger. This causes pain which at first feels like strong period pain but usually gets stronger as labour progresses. The amount of pain varies. Your first labour is usually the longest and hardest. Sometimes it is necessary to start labour artificially or to stimulate it if progress is slow, and this may make it more painful. Over 90% of women find they need some sort of pain relief.

 

Preparing for labour

It is helpful to attend antenatal classes run by midwives who know about Liverpool Women’s Hospital. They teach you about pregnancy and labour and caring for your baby. They will tell you what to expect when you go into hospital, what procedures may be needed and the reasons for them. Understanding what may happen during labour will make you feel less anxious, help you to relax and cope better. During pregnancy, physiotherapists can teach you breathing exercises, relaxation and good posture to help your back. At the antenatal classes you can also learn about the types of pain relief that are in use. Ask to see an anaesthetist if you want further advice about certain types of pain relief and whether they may be suitable for you. Anaesthetists are doctors who provide epidurals, and who can also advise you about other types of pain relief

 

What methods of pain relief are available?

There are several ways of helping you cope with pain. It is difficult for you to know beforehand what sort of pain relief will be best for you. The midwife who is with you in labour is the best person to advise you. Here are some of the facts about the main methods of pain relief you may be offered.

• Simple Methods

  • Mild pain in early labour can often be managed by simple methods.

  • A supportive companion is invaluable.

  • Relaxation is important and moving around sometimes helps.

  • A warm bath and gentle back rubbing by a supportive partner can help you relax and take some of the pain away.

  • Aromatherapy can be helpful in labour and is available at this hospital. Certain aromatherapy oils are contraindicated in pregnancy. Please consult a qualified aromatherapist before using them.

  •  

• Transcutaneous Electrical Nerve Stimulation (TENS)

  • A gentle electrical current is passed through four flat pads stuck to your back.

  • This creates a tingling feeling.

  • You can control the strength of the current yourself.

  • It can be helpful at the beginning of labour, particularly for backache.

  • If you hire one you can start it at home.

  • The hospital may have a few sets that can be lent out. It has no harmful effects on the baby.

  • It is unusual for this to be the only method of pain relief you would need but it can help you through early labour.

  •  

• Entonox (50% nitrous oxide and oxygen, sometimes known as gas)

  • You breathe this through a mask or mouthpiece.

  • It is simple and quick to act.

  • It sometimes makes you feel light-headed or a little sick.

  • It does not harm your baby.

  • It does not take the pain away completely but it helps.

You control the amount of gas you use, but timing is important. You should start breathing the gas as soon as you feel a contraction coming on so that get the full effect when the contraction is at its strongest. You should not use it between contractions or for long periods as this can make you feel dizzy. Also breathing very hard is not very good for your baby.

• Diamorphine

  • A pain relieving injection usually given by midwives

  • It makes you drowsy, relaxed and more comfortable.

  • It can make you feel sick, but this effect can be reduced by another injection.

  • It can sometimes make your baby drowsy when delivered. An antidote can be given to the baby for this if necessary, and the baby looked after on the neonatal unit for a few hours.

  • It delays stomach emptying which might be a hazard if a general anaesthetic is needed. You should also not eat or use the birthing pool if you have had diamorphine.

  • It does not take the pain away completely.

  • Some mothers find it helps them relax, while others find it less effective.

  • Up to two doses can be given by midwives.
    

• Pethidine

  • This is an alternative to diamorphine also given by injection.

  • It acts in a similar way.

  • It may be less effective than diamorphine.

  • It has the same advantages and disadvantages.
    

• Epidurals

  • Given into a very small tube in your back

  • Most complicated method, performed by an anaesthetist

  • Little effect on you baby

  • Small risk of headache

  • Most effective method of pain relief.

  • Who should have an epidural ?

  
  Most people can have an epidural, but certain complications of pregnancy and bleeding disorders may make it unsuitable. If you have a complicated or long labour the obstetrician may recommend one and you may find you need one. In such circumstances it will benefit you and your baby.

   

  What does it involve ?

  
  You will first need a drip, that is fluid running into a vein. This is often necessary in labour for other reasons. You will be asked to curl up on your side or sit bending forwards. Your back will be sprayed with a cold antiseptic lotion and a little injection of local anaesthetic given into the skin, so putting in the epidural should not hurt. A small plastic tube is put into your back near the nerves carrying pain from your uterus. Care is needed to avoid puncturing the bag of fluid that surrounds the spinal cord, as this may give you a headache afterwards. It is therefore important to keep still while the anaesthetist is putting in the epidural, but after the tube is in place you will be free to move.

  
  Once the tube is in place, pain relieving drugs can be given as often as necessary, or continuously by a pump. While the epidural is taking effect, the midwife will check your blood pressure regularly. The anaesthetist and the midwife will also check that the epidural is working properly. It can take up to twenty minutes before it is fully effective. Occasionally it does not work very well at first, and some adjustment is needed

   

  What are the effects ?

  
  Nowadays it is usually possible to provide pain relief without numbness or heavy legs, in other words a ‘mobile epidural’. This is the sort of epidural that is most likely to be offered to you at Liverpool Women’s Hospital although we do not actually recommend walking about when the epidural is in progress.

   

• An epidural should not make you feel drowsy or sick

• Occasionally it drops your blood pressure, which is why you have the drip.

• It sometimes makes you shivery, but this usually stops quite soon.

• It may prolong the second stage of labour and reduce the urge to bear down but with time the uterus should push the baby out. You are more likely to have a normal delivery than any other type of delivery.

• It removes much of the stress of labour, and this is good for the baby.

• In this country as a whole, there is about a one in hundred chance of your getting a bad headache after an epidural. If you develop a headache afterwards, it can be treated.

• Backache is common during pregnancy and often continues afterwards when you are looking after your baby. There is now good evidence that epidurals do not cause long-term backache, though you may feel local tenderness for a day or two afterwards.

• About one in 10,000 mothers gets a feeling of tingling or pins and needles down one leg after having a baby. Such problems are more likely to result from childbirth itself than from an epidural.

• Other more serious problems happen even more rarely.

   

  What if you need an operation ?

  
  If you need any operation such as caesarean section or forceps delivery, you should not need a general anaesthetic, as the epidural can usually be used instead. This is safer for you and the baby.

   

  What about spinals ?

  
  Epidurals are rather slow to act, particularly in late labour. If the pain killing drugs are put directly into the bag of fluid surrounding the nerves in your back they work much faster. This is called a spinal. In some hospitals spinals, or a combination of spinals and epidurals are used for pain relief in labour and spinal anaesthesia is often used for caesarean section.