When you have suffered the loss of your baby, you may find thoughts of a vaginal birth really difficult but it is usually recommended for a variety of reasons, including a quicker physical recovery, and a quicker discharge home from hospital. There is also usually less risk for your health and, although this may feel very far from your mind, for further pregnancies, should you choose to have another child. During your labour, you will be supported throughout the process of labour by the multi-disciplinary team-midwives, obstetricians and anaesthetists.
Labour is the physical process of giving birth by the process of uterine action (contractions). If you are being induced, your waters will normally be manually broken for you. This is done by the midwife by carrying out a vaginal exam and using an ‘amni-hook’ to break the waters. This should be no more painful than the exam and entonox (gas and air) can be used if you find this procedure uncomfortable.
There are three stages of labour. The first stage consists of a latent period, where contractions may be irregular, mild to moderate and gradually becomes established or active labour when contractions become strong and regular. If this is not your first labour, this process may happen quicker since your uterus is muscular, it remembers the process from previous experience. A midwife will usually assess the progress of labour by carrying out an internal vaginal examination to determine the dilation (opening) of the cervix. Your cervix starts out closed and gradually dilates (opens) with each contraction. When you are 4cm dilated you are considered to be in established labour and should have one to one midwife care to support you and help you with decisions in relation to pain relief. Your waters may break at any point if you have naturally gone into labour.
Your midwife will usually recommend staying upright and active to promote a shorter first stage of labour. You could use a birthing ball to sit on, squat, lean on your partner for support, kneel on the bed for example. Use of water immersion for pain relief is very effective and you may find a shower or bath offers welcome relief. You may use (gas and air which is freely available and is effective. An epidural will be available to you, but in some cases, it may not be appropriate (for example, if you have an infection or issue with blood clotting).
Just before the second stage of labour, there is a ‘transition’ period. During this period, a lot of women feel like they lose control and may often request an epidural at this point. Women often feel nauseated and may vomit. The second stage is from full dilation to the birth of the baby. When you reach full dilation, you will feel an involuntary urge to push and naturally bear down. Communication with your midwife is important so that you remain in control and focussed. A slow delivery of the head is encouraged to minimise perineal tearing and your midwife will guide you through this.
Delivering your baby when you know he or she has died is likely to be heartbreaking, and some parents find it very distressing. You may choose whether you (and your partner) would like to see your baby immediately or not. Whether or not you want to hold your baby immediately, or if you prefer to delay this for a little while, to recover from your labour first, your wishes will be respected. You will be supported to hold and spend time with your baby if that is what you would like to do.
You will also find this pamphlet, prepared by SANDS, helpful as you prepare to for labour and delivery after your baby has died.