Having a baby is such a unique and special time. Bringing a new life into the world comes with huge excitement and some trepidation. Wading your way through all the information to find the important stuff is almost a full time job – but I’ve trimmed away all the fluff and the stuff that’s nice to know, to make sure you have the things you need to know about having a baby. Anyone can tell you how many babygros you should have in your hospital bag, but here’s the good stuff that you need in your back pocket.
1. The type of maternity care that you choose affects your chances of having a C-section.
There are a number of maternity-care options available to women having a baby in Ireland, including consultant-led care, midwife-led care, and home birth. Depending on where you live in the country, it’s possible to avail of these services either publicly, privately, or, in the case of consultant-led care, semi-privately. Before choosing the kind of maternity care that’s right for you, it’s important to be aware that the decision you make can affect your chances of having a C-section. Research published by the Health Research Board last year showed the chance of a woman having an elective Caesarean delivery increases by 22 percent for women with private medical insurance when compared with those without private medical coverage. Additionally, it found that women attending a private consultant alone were over 70 percent more likely to have elective or planned Caesarean sections when compared to those receiving combined care from a GP and any other health professional.
2. Where you have your baby also has an impact on your chances of having a C-section.
The hospital where you have your baby is also a factor in your chances of having a C-section. Data released by the HSE shows a huge variance in C-section rates around the country, with a rate of 38 percent in 2011 in St Luke’s Hospital in Kilkenny and a rate of just 19.1 percent in Sligo General Hospital, with all the other units ranging somewhere in between.
3. Midwife-led care is available to first-time mums, depending on where they live in Ireland.
Many people believe that they must be under consultant-led care when having their first baby. In fact, midwife-led care is an excellent option for first-time mums who are low risk. This is where you attend a clinic led by a team of midwives, either in a hospital or in an adjoining midwife-led unit. You see midwives for your antenatal appointments and they attend you during labour and in the postnatal period. Some midwife-led services have the option of an early discharge home after you have your baby, and a midwife will come visit you in your home for seven to ten days after the birth. An important element of midwife-led care is that it does have a focus on natural birth. Having an epidural when in labour is absolutely an option, but you’ll be transferred to consultant-led care if you’d like to have one. Midwife-led care will focus on other labour-management tools first.
Access to midwife-led care is dependent on where you live, so it’s worth looking into your options before you get pregnant – it is a very popular option and clinics fill up fast. It’s also possible for first-time mothers to have a home birth, either with a hospital-based scheme or with a self-employed community midwife. You can find more information about home birth at the Home Birth Association’s website, www.homebirth.ie
4. Having an epidural can increase the length of your labour by up to two hours.
Epidurals can be a great option for women if they choose it, especially if they have had a long labour and are very tired. But as with all medication, it’s worth being aware of both the benefits and the risks in advance of making the decision on the big day. One thing to bear in mind is the result of a new study published this year which found that the second stage of labour – the pushing stage – can be up to two hours longer when an epidural is used.
5. Your chances of having an episiotomy are dependent on where you have your baby.
Figures released by the HSE earlier this year show that your chances of having an episiotomy – a surgical cut with a scissors to your perineum during labour – vary significantly from maternity unit to maternity unit. For example, the National Maternity Hospital in Dublin has an episiotomy rate of 27.2 percent whereas Wexford General Hospital has an episiotomy rate of 10.3 percent. If you would prefer to avoid an episiotomy, it is worth including this in your birth preferences. Another great option if you’re a first-time mum is to practice perineal massage – see number 6 below for more information.
6. Perineal massage will increase your chances of avoiding an episiotomy.
Not the lovely relaxing kind of massage that you’d like to think it is, perineal massage is definitely worth your time anyway, particularly if you’re a first-time mum. Studies have shown that massaging your perineum a minimum of twice a week from your 35th week of pregnancy will decrease your chances of having an episiotomy and ongoing perineal pain. The research doesn’t support the same effects for mothers who have already had a baby – but if it ain’t broke…! Perineal massage is best performed with a lubricating and softening oil such as sweet almond oil or an organic olive oil, for example. Buy a big bottle and use generously!
7. You can only have a water birth in one Irish hospital
The Coombe maternity hospital in Dublin is the only maternity unit in Ireland that facilitates delivering your baby into water. However, some other maternity units do have a birth pool that you can labour in, but you must leave the pool for the pushing stage of labour. Labouring in water has been shown to be a very effective way of coping with your labour and has been proven to significantly reduce the need for pain medication. As well as The Coombe, Cork University Maternity Hospital and the midwife-led units in Our Lady of Lourdes Hospital in Drogheda and Cavan General Hospital all have birth pools. Waterford Regional Hospital has plans to open a birth pool soon. Many of the other units have deep baths that you can labour in; or even a hot shower will be a great comfort.
Another way to have a water birth in Ireland is to have a home birth with a self-employed community midwife (SECM). Not all SECMs offer this service, so it’s worth checking with the midwife first.
8. Your chances of having an induction are dependent on where you have your baby.
Maternity hospitals around the country have different policies for inducing a pregnant woman when she is considered “overdue”. We often hear that a full pregnancy is 40 weeks, but in fact a full-term pregnancy can be anywhere between 37 and 42 weeks, depending on the woman and her baby. Some units have a policy to induce women when they are 10 days over 40 weeks, some have a 12-day policy, and others will not induce until 14 days past that point. It’s worth bearing in mind that even if a hospital has a policy in place for inducing at 40 +10 days, your baby may not be ready to be born at that point. Remember that you are the main decision-maker in you and your baby’s care. If you would prefer to go into labour naturally, then this is worth discussing with your healthcare provider. A good way of figuring out if an induction will be successful for you is to ask your caregiver what your Bishop Score is. A Bishop Score is a method of assessing how ready your cervix is for labour. If you score 3 or lower, an induction is more likely to fail and require a C-section. However a score of 8 or higher indicates that an induction will be quite successful.
You can read more about induction of labour and Bishop Score here in the UK NICE Guidelines.
9. It doesn’t matter if your baby is breech at your anomaly scan.
Women are often told that their baby is breech when they have an ultrasound scan in the middle of their pregnancy. This is where your baby is bum down towards your cervix rather than head down. Don’t worry! At that stage in your pregnancy, your baby is still swimming around there with plenty of room and might change positions often. If your baby is in breech position at 37 weeks, your healthcare provider will probably discuss your treatment and birth options with you, but until then it’s not worth stressing about. Acupuncture, swimming, reflexology, and positioning such as those available on www.spinningbabies.com are thought to help. Hypnotherapy is also a great technique to use and listening to the Breech Turn track from your GentleBirth Complete Boxset at around the 34-35 week mark, is a great idea. I know it worked for me! The good news is that 96 percent of babies are head down at term, and I like those odds!
10. Don’t mind the horror stories.
Everyone is only dying to tell you about a six-day bloodfest of a giant-baby labour. Don’t mind them. Seriously. Someone else’s experience is not yours. Switch off the One Born Every Minute and stick your finger in your ears when the horror stories come out. As someone smart once said, taking all that on board is the equivalent of watching plane crashes before boarding a flight. Close your eyes and picture you and your baby working together for the calm birth that you want. And keep watching that scene over and over again.
11. Being prepared is the best gift you can give yourself and your baby.
It wouldn’t be unusual to hear the expression “you’re better off not knowing what’s going to happen” when people talk about having a baby. They are well-meaning, of course, but the opposite couldn’t be more true. The greatest gift you can give yourself and your baby is the gift of preparation. While we’re trotting out the clichés, you wouldn’t arrive at the start line of a marathon without putting in some serious training in advance, would you? Research the kind of birth that you would like, look into your options, know what the policies are in your local maternity unit, go to an independent antenatal class like my GentleBirth weekend workshops (upcoming dates here), join some online forums or Facebook groups, write down your birth preferences and read, read, read – the informative kind, not the scary kind. Learning new information and having to make decisions for the first time when you are in labour is not an easy thing to do. Know your stuff, and then put it into practice!
Good luck – it’s going to be awesome!© Sylda Dwyer, AlphaBirth 2014. Unauthorised use and/or duplication of this material without express and written permission from the owner is strictly prohibited. An older version of this article first appeared on www.parent.ie. Research and information is current from July 2014.