Labour and pain is different for everybody and is different every time even if you have laboured and birthed before. So, let’s make a start:

• Antenatal Education
  Some NHS Trusts run Antenatal Education/Birth Preparation Classes. These may be run over several weeks (same day same time), or a full weekend day and are usually open to yourself plus a birth partner. Unfortunately, due to staffing, financial pressures and space many Trusts have now decided not to provide their own classes but may be able to signpost you to alternative private providers. Increasingly there has been a trend towards online, virtual and on-demand downloadable classes as many women and partners find being able to join either scheduled classes from home or being able to watch on-demand classes suits their lifestyles more. Our own on-demand classes have 7.5 hours of evidence-based information about your pregnancy, labour, birth and becoming a new parent and are presented by Registered Midwives, a Consultant Obstetrician and a Consultant Anaesthetist and covers everything from aches and pains, breathing techniques, caring for baby, c-section, pain relief and emergency scenarios.

• Positions for Birth
  This can and does relate to both you and to baby.
  Your baby can be in any number of different positions and your Midwife will be skilfully trained to identify their position both by palpating your abdomen and, if applicable from a vaginal examination. If there is any uncertainty about your baby’s position (if we do not think they are head down) at term you may be referred for an Ultrasound Scan to determine if they are in an optimal position for labour and birth or may need further planning.
  For you position can be incredibly important. Antenatally adopting a good posture (position) when walking, seated or in bed can impact hugely on your day to day wellbeing supporting your musculoskeletal system and taking the stress off your bones, muscles and ligaments which in turn can hugely reduce pain and discomfort. But as labour starts your position become increasingly important as it can help to reduce pain, help to get baby into the optimal position themselves and ultimately can help labour progress smoothly and in a timely fashion.
  Consider what positions make you feel most comfortable, the position of your baby is likely to dictate some of this (even if you are unaware of their position you will automatically adopt a position that accommodates baby’s). In early labour whilst still at home think about the things you have available to you; a bed, a dining chair, a bath, a wall, the loo or a gym ball and think how you can use them by leaning over them, squatting or for counter pressure to help open your pelvis and relieve discomfort of cramping and irregular tightenings.

• Perineal Massage
  Probably one of the most important things you can do to help to prepare your body for birth is to massage your perineum (that delicate area of skin between your vagina and anus). Using a suitable oil most pregnant women are advised to massage their perineum 3-5 times a week for between 3 and 5 minutes from 35 weeks of pregnancy. This adds hydration and elasticity into the skin enabling it to stretch and reduce the risk of a serious (3rd or 4th degree tear). It also helps you to become more familiar with your own body and gives you the confidence to understand the birth process.

• What you cannot change about labour and birth

Although there are many things you can prepare yourself for physically and mentally we have to let you know that there other things you simply cannot do anything about – and that is your genes (this is where you get to blame your own parents)!

Let’s look at pain for starters; as Midwives we have medications that we can prescribe and give you to reduce the pain and discomfort you may be experiencing, however, what we cannot predict is who will feel a lot of pain and who will breeze through labour without even breaking a sweat and this may be attributed to your nerve fibres; micro conductors that have a huge influence of your perception of pain. There are two types of nerve fibres, thick ones and thin ones. Thick ones conduct pain sensations very quickly and in bulk so you may experience much higher more intense levels of pain than someone with thin fibres where only small amounts of pain can be transmitted at a time.
The other significant thing you absolutely cannot change is the shape of your pelvis – something you have probably never given even a passing thought to before. Basically, there are 4 types of pelvic shape; Gynecoid, Android, Anthropoid and Platypelloid although it’s fair to say we will all have a variation of the above rather than being 100% one or the other!

In simple terms:
Gynecoid is what we think of as a typically female pelvic shape
Android is a more male shape. Babies tend to present as OP (back to back) which can make labour longer and can cause more intense lower back pain

Anthropoid is a shape associated with tall, slim women who often birth babies easily

Platypelloid is a flatter shape which no matter how optimal a position your baby is in will usually result in a c-section as insufficient space for baby to progress through the pelvis to be birthed vaginally.

• Pain Relief

As Midwives we know that one of your major concerns is pain during labour and birth. Having already explained why some women feel pain more than others and how using changes of position can help you cope we will explore other pain relief options that you could consider:
TENS (Transcutaneous Electrical Nerve Stimulation) Machine uses micro electrical impulses via handheld device controlled by you that literally interfere with the transmission of pain sensations along nerve fibres. TENS is a great starting point for using at home and in early labour but can’t be used by anyone in water. There are no known side-effects and are easy to use. You can hire or buy them locally and can be used postnatally for any lower back pain.
Water is a hugely underrated form of pain relief and a bath is one of the best things you can do in the early stage of labour when you might be experiencing back pain, abdominal cramps or just feeling tired and a bit unsettled. The buoyancy of the water can reduce the sensation of pain and discomfort and the warmth of the water can soothe your tired, stressed muscles helping you to relax. Birth partners Top Tip – run the bath anyway even if your partner says not to bother, chances are she will definitely give it a try if you do, if she really doesn’t enjoy it he can always get back out.
Massage is a wonderful way to help relax you when you are stressed and tense. It can help to distract you from early period type cramping and when used during labour in the lower back acts as the counter pressure most women find hugely beneficial as baby’s head descends through the pelvis putting enormous strain on the sacrum. Did you know that a 20 minute back, neck and shoulder massage releases a 9 minute boost of Oxytocin -the hormone of love that helps to promote contractions and progress labour.
Tablets – Paracetamol is an over the counter cost-effective pain relief medication with very few known side effects (always read the safety leaflet) and is perfectly safe, when taken as per dosage instructions, to take during pregnancy. An ideal first-line medication your Midwife will advise that you take some in early labour to help you to stay at home for longer. If you chose to birth in the hospital, there are other oral medications we can offer you including Codeine which is a stronger opioid prescription-only medication.
Entonox (Nitrous Oxide), more commonly referred to as Gas & Air is a mixture of Nitrogen and Oxygen which is inhaled through a tube and is entirely controlled by you. You can use this when you are in hospital and classed as being in established labour. Start to deep breathe it in as soon as you feel the contraction starting and keep breathing in and back out into the tube until the contraction has finished. Many women describe the feeling of Entonox as a few gin and tonics into a good night out, but for some they dislike the feeling enough to not want to use it further. Once your contraction has ended it is important to take some deep breaths of fresh air to help the effects wear off. Some of the side effects are feeling tired or loss of control, nausea and vomiting and a temporary deep voice (I was convinced Barry White was in the room turned out it was just me talking!).
Epidural/Spinal Anaesthetic are administered by an Anaesthetist and numb the area from the top of your bump to your legs. An epidural can be done in the birth room and which can be topped up as required, whereas a spinal is a denser more immediate block, usually used for a c-section.

• Exit Checklist
  Have you sorted other children or the dog out?
  Have you blown out candles/turned out lights?
  Have you got fuel in your car?
  Have you got your notes for the hospital?
  Have you locked the door?
  You can print one off from our website and stick somewhere that you’ll see it every day and keep ticking jobs off as they are done – this relieves anxiety on both you and your partner because you know you are good to go!

Remember though these are only our tips you might have been passed others and you’ll find what works for you.