Care and support during labour

When you meet the midwife, or midwives, who will care for you in labour, they may do some basic checks and preparations.

These might include:

• Assessing your baby's heartbeat - this might be done electronically with an electronic foetal monitor, with a stethoscope, or a Pinard (foetal stethoscope)
• A vaginal examination - to see how far your cervix has dilated, which gives an indication of how far your labour has progressed
• Checking your blood pressure

You'll be asked how often your contractions are coming and how you're coping with them. These same checks, or some of them, may be repeated at intervals throughout labour.

How you're monitored

Electronic foetal monitoring (EFM) - keeps a check on your baby's heart rate, using a transducer held against your abdomen or a small electrode on your baby's scalp. Some foetal monitors allow you to move around, as the signal is sent to the machine via radio waves. A smaller, portable machine called a Doppler uses ultrasound for intermittent monitoring. A small transmitter-receiver is placed on your abdomen to pick up the baby's heartbeat and your contractions.

Continuous EFM allows your carers to see when something might be deviating from the straightforward. Research shows it's less helpful in normal labours and can lead to unnecessary interventions.

Talk about what sort of monitoring you'd like and if you don't want to accept the routines of the maternity unit, say so.

Eating and drinking

You probably won't be hungry once you're in established labour, but earlier on snacks, and later on fluids, will help keep your energy levels up.

What position?

Most women cope best if they're able to adopt different positions during labour. This can include lying or sitting on a bed, but could also mean:

• A supported standing squat (with your partner holding you from behind), which allows your pelvis to open wide
• Leaning against the wall, bed, or a beanbag, which allows for massage
• Rocking on all fours

Episiotomy vs natural tearing

Sometimes, the perineum - the skin between the vagina and the anus - tears as your baby is born. The midwife may ask if she can cut it to widen the opening, either to make the birth easier or to use forceps. This cut is called an episiotomy.

Some experts claim it's better to elect for a controlled cut, while others saying tearing is preferable as it heals quicker.

Whether you're cut or you tear, you may need stitches. You'll be given a local anaesthetic for these.

The stitches dissolve as you heal, but' it's advisable to keep the area clean to avoid infection.

Birth companions

As well as the medical professionals, you can have someone with you as support during labour and birth. Your birth companion can:

• Show encouragement and support with words and gestures
• Help you express what you want to the midwives and doctors
• Suggest different positions, to help you stay comfortable and help you into them
• Offer drinks or snacks
• Cool down your chest and face with a sponge or cloth
• Remind you of breathing or relaxation techniques you've learned
• Massage your back, shoulders and legs
• Time your contractions
• Warm your hands, feet and legs if you get cold
• Put up with you being cross and irritated

Choosing a companion

If you don't have a partner, or not one who's around, or if you or they prefer not to be there, you can have someone else. Alternatively, you could have your partner plus a close friend, a relative, an antenatal teacher or a doula (someone trained in labour support).

The person you choose needs to be someone special. You need to be safe in the knowledge you can say anything to them and comfortable knowing all parts of your body may be on display. They also need to be able to stay calm and unruffled.

Left alone?

When you're in established labour, you should not be left alone without midwifery care for longer than a few minutes at a time.

Sometimes midwifery shortages can mean less than optimum care for some women. If you feel this happened to you, let the hospital's director of midwifery and your local primary care trust (who commission maternity care) know about your experience.