| More and more women today feel that birth should not be a high-tech affair unless there are definite indications for it. Hospitals are notoriously unrelaxed, noisy, insensitive places in which to give birth, but they have their merits. The author saw a young mother in her second pregnancy nearly die because the womb inverted as the placenta was delivered; this is very rare and could not possibly have been foreseen, but the mother would certainly have died if she had been at home.
The ideal solution would be to make hospitals homelier and more responsive to real need. In special birthing units mothers could be attended by their own midwife, give birth in the way which suits them rather than the hospital, and have members of their family present at the birth if they wish. Emergency medical help would be available within minutes.
If complications are expected, it is best to have the baby in hospital. If you have strong views on specific procedures or specific drugs, approach your consultant at some point during the antenatal period - do this privately if you cannot get to see him or her on the NHS - and make your wishes clear. This is also the time to ask if there would be any objection to your using homeopathic remedies; these will not interfere with any drugs you may be given.
First stage of labour
In the last week or so of pregnancy the baby's head slides down into the pelvis - this relieves pressure on the diaphragm and stomach but increases pressure on the bladder and rectum - and the whole vulval area becomes moister. You will probably have felt twinges of pain (see False Pains) in the last few weeks of pregnancy, but as labour approaches these will become more insistent, more frequent, and more regular; you may also feel trembly and chilly. Now is the time to telephone your medical doctor or the hospital. A sure sign that labour has started is the 'show', a discharge of blood and fluid as the protective plug of tissue in the cervix is shed. At the same time or shortly afterwards the membranes around the baby may rupture, resulting in a trickle or sudden flood of fluid, the 'waters'. As labour proceeds, your pulse will become harder and faster, and your mouth may feel dry; restlessness, nausea, and sometimes vomiting are quite common, especially at transition, where things may come to a halt before second stage begins.
During this first stage of labour the cervix or neck of the uterus opens and is pulled upwards so that uterus, cervix, and vagina form a single tube or 'birth canal'. Once in hospital you will be given a vaginal examination to assess how close you are to giving birth, and possibly an enema to empty your bowels; the old-fashioned habit of shaving the pubic hair is not necessary to prevent infection. This first stage of labour usually lasts about 12 hours in a first pregnancy and 6 hours in a second, but there are no hard and fast rules; sometimes the first stage takes up to 24 hours, sometimes a few minutes.
Second stage of labour
This usually lasts an hour or so in first pregnancies, and about half an hour the second or third time around. Contractions become stronger and you feel the urge to push; push with the contractions and rest between them. If your bowels feel as if they are going to open, this is because the baby's head is pushing against your rectum; don't let this stop you from pushing. As the head comes down the birth canal and is ready to escape from the pelvis, go into panting respiration. The midwife or other helper will control the head so that it slips through the vagina without stretching it too much or causing splitting. If there is a fear that the vagina will be badly tom, you may need an episiotomy (an incision in the skin of the vagina under local anaesthetic). However with good control and gentle massage of the vaginal skin an episiotomy is often not necessary, though in some cases it is to the advantage of mother and baby; this is something you should discuss with the midwife or consultant beforehand.
Once the head emerges, the shoulders and body soon follow. The baby can then be delivered on to your tummy. Breathing is started by clearing the baby's airways of mucus and tipping his or her head down. The cord need not be clamped and cut until it has stopped pulsating, unless it is round the baby's neck.
Third stage of labour
This takes another 30 minutes or so, and is marked by an increase in bleeding, as the placenta or 'afterbirth' is delivered. The midwife usually pulls gently on the cord while pushing gently on the womb. You may be given an injection of Syntometrine (derived from the same source as the homeopathic remedy Secale) to make the womb contract and prevent excessive bleeding. This is a good time to bond with the baby, have a quiet cuddle and offer the breast.
Baby check
Immediately after birth the midwife or doctor will check to see that your baby is all right, although a more thorough check will be done later. The baby's facial features will be checked for Down's syndrome, genitals inspected for doubtful sex, and fingers and toes counted; the back will be checked for signs of spina bifida (hairy patches or missing skin at the base of the spine), and the navel for signs of diaphragmatic hernia; the anus will be examined to make sure that it is open; a finger will be put in the baby's mouth to check for cleft palate; hips and feet will be checked for congenital dislocation or club foot.
After the birth
Once the baby has been settled, you will be washed or asked to take a shower. Bathing your vaginal area with Arnica solution (10 drops of mother tincture to 0.25 litre [½ pint] warm water) will take away some of the soreness and promote healing. After that you should be allowed to sleep, or at least be very quiet and tranquil. At this time well-meaning visitors and telephone calls can be very exhausting.
You will probably not feel very hungry for a day or two. Thin vegetable soup is good on the first day, with salads and fruit on the second, and a return to your normal diet on the third. Tea, coffee, chamomile tea, and wine are best avoided. The most important nutrients in the weeks after birth are iron (to make up for lost blood), protein (to aid healing), and calcium (if you are breast-feeding). To get back into shape, cut down on starchy foods.
A mixture of blood, fluid, and mucus are discharged from the womb in the days immediately following delivery. After pains are common at this time, and tend to be worse if labour has been relatively easy. It is quite normal to feel very weary and stiff. Some women also find themselves perspiring at lot. Within 12-15 days the womb returns to its normal size. After an episiotomy or a tear, the vulva and vagina will take several weeks to heal.
Periods usually restart 6-8 weeks after delivery, but may not reappear for several months, especially if you are breastfeeding. If you are worried, see your medical doctor.
Breast-feeding
Breast milk contains, in ideal proportions, everything your baby needs - not only carbohydrates, proteins, fats, vitamins, and minerals, but also antibodies against many infections, including those which cause diarrhoea. In Western countries breastfeeding tends to prevent obesity; in many developing countries it prevents the opposite marasmus or wasting diseases. There is mounting evidence too that breastfeeding for the first 4-6 months helps to prevent allergy- formation, especially if there is a family history of allergy. Cot deaths, constipation, intestinal obstruction, hypocalcaemic convulsions and tooth decay also occur less frequently in breast-fed babies than in bottle-fed. Child abuse is also less common, probably because of the strong emotional bond which grows out of the physical contact between mother and baby. From the mother's point of view the breast is much cheaper than the bottle and always handy. Lactation also helps to balance her hormone secretions. There is some evidence that silicon leaking from mothers with breast implants could cause digestive problems in babies. Check with your medical doctor or obstetrician.
Bottled milk contains additives such as pH adjusters, anti-oxidants, carageen, hydroxypropyl starch, emulsifiers, and thickening agents. Though some constituents - zinc for example - are in the same proportion as those found in breast milk, they are less well absorbed. Try to breast-feed in the first 24 hours if you can, because this is the most sensitive time for your baby. Your milk will be very watery to begin with, but rich in protective antibodies. As your baby sucks on the pigmented area around the nipple messages go to your pituitary gland telling it to produce oxytocin, a hormone which stimulates the glands in your breasts to produce milk. Proper milk comes in on the second or third day, at which time you may experience sudden chills or notice that blood and fluid loss becomes scantier.
Feed on demand if you can, otherwise your milk production may drop or cease altogether. Breast-feeding is not a reliable means of contraception though, even if you are feeding on demand, so if you need contraception, see your medical doctor. Combined oral contraceptives should be avoided as they interfere with the volume and composition of breast milk.
If you cannot breast-feed, don't feel guilty or despairing about it, but have a really good try first. Not everyone takes to breast-feeding like a duck to water. There is a knack to it, so don't be afraid to ask your nurse or midwife what to do or contact the La Leche League. If the bottle turns out to be best, you can always kick your partner out of bed in the middle of the night to feed junior! |
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