Choose an antenatal class

You wouldn’t dream of running a marathon without training first. The same is true for childbirth – you need to be prepared mentally and physically. Knowing what can happen during labour and delivery – and your options for pain relief – can alleviate your fears and boost your confidence. “Knowledge is power,” says nurse and childbirth educator Sheri Bayles.

Your first step should be to sign up for an antenatal class. Many women skip these because they’re planning to use pain medication or have watched TV shows about birth. But antenatal classes are worthwhile, even if you anticipate using medication.
What if an anaesthetist is not available for an epidural? Having strategies for coping with labour pain is very important. A class can also open your mind to possibilities you may not have considered. “Many women can deliver without drugs if they’re prepared,” says Dr Laura Riley, author of You & Your Baby: Pregnancy. Also, “the instructor can help you sort out all the other information you’ve received,” says Dr Judith Lothian.

Choose an antenatal class
It is important to consider the educator’s philosophy about childbirth. There’s no right or wrong way to have a baby, so choose someone who will support you no matter what you want. Ask these questions before you sign up:
1. What are your qualifications: midwife, doula, childbirth educator?
2. How long have you been teaching?
3. What do you cover in class?
4. What is your basic philosophy about childbirth?
5. How do you feel about medication and induction?
6. How would you deal with a hospital’s
protocols if they don’t match your own?
7. How many couples are in your class? You’ll get more personal attention in a small class.
8.What is the time commitment?
9. Are you a lactation consultant?
10. How much does the course cost?

Create a birth plan

Your next step is to create a birth plan, which will help you think through what you want – or don’t want – during your delivery. Many antenatal classes will help you do this. Keep in mind the term is a bit misleading because birth is unpredictable. Call it a wish list – a tool to share the things that matter to you with your care provider.

For instance, you might mention that you want to walk around during early labour, use a doula for support or have your husband announce the baby’s sex. It’s best to keep it short (no more than a page) and write it before your sixth month because that’s when you should discuss it with your doctor or midwife.

Your pain-relief options

As you think about your birth plan, you’ll need to decide whether you want medication, plan to avoid it or see how things go. These are the most common methods.

Short-acting medications, such as morphine and pethidine, are given in early labour (up to four or five centimetres dilated).
Pros: can take the edge off the pain so you’re able to take a nap (for perhaps an hour or two).
Cons: may not offer adequate pain relief, and the medication can slow the baby’s breathing.

An epidural block delivers medication through a catheter to an area outside the spinal cord.
Pros: provides pain relief in the abdomen yet usually allows enough sensation so you can push. The baby is not affected and, because the medication is given continuously, the dose can be adjusted, allowing you to move around or push when necessary. Research shows an epidural doesn’t slow labour.
Cons: risks include fever, which requires antibiotic treatment; decreased blood pressure; blood clots; and, rarely, a severe headache that lasts for several days.

A spinal block involves injecting medication into the sac that surrounds the spinal cord; it can be given before a C-section or if a vaginal delivery is expected within two hours.
Pros: takes effect immediately and provides pain relief from the chest down for up to two hours.
Cons: you can’t walk during labour and you may be too numb to push. The medication can also cause nausea, low blood pressure and, in rare cases, a severe headache.

Or perhaps you’ll want to try nondrug options such as slow, controlled breathing, which distracts from the pain of contractions; or the TENS machine; or etonox, gas and air. Other options include acupuncture and water birth.

Expect the unexpected

Whether you’re hoping for a natural delivery or all the pain relief you can get, childbirth is often full of surprises. Today, in the private sector, two in three births is via C-section, so it pays to be aware of common labour and
delivery complications like these, some of which may lead to one.

The baby doesn’t tolerate labour well
This happens in about four per cent of deliveries, perhaps because the placenta isn’t functioning correctly or there’s decreased blood flow to the uterus and the baby’s heart rate drops during each contraction. He may not be getting enough oxygen and needs to be delivered quickly.

The doctor needs to use instruments
If the baby is in distress or you’re too tired to push, your doctor or midwife may deliver the baby via a vacuum extractor or forceps. The baby is not usually harmed, but forceps may cause severe perineal tearing.

The umbilical cord is wrapped around the baby’s neck, hands or arms This occurs in about 30 per cent of deliveries. It doesn’t usually cause problems but can sometimes deprive the baby of oxygen.

Shoulder dystocia has occurred
This means the baby’s head is delivered, but one of his shoulders is stuck behind the mother’s pubic bone. It occurs in less than one per cent of births, although it’s more common among women with gestational diabetes.