Water

Woman in birthing pool holding new born baby while her partner and their other children look at the baby

Using water (either in a bath or birthing pool) is known to be an effective method of providing pain relief and aiding relaxation. If your pregnancy and labour have been straight-forward, using a birthing pool may be particularly suitable for you. The water will be kept at around body temperature and you can get in and out as you wish during labour. Many women also opt to give birth to their baby in the pool, which is a safe option if all is well with you and your baby during labour. If you are planning a homebirth, you can hire a birthing pool. Discuss this with your midwife if you want to know more about having a water birth at home or in your maternity unit.

Water birth explained

14th August 201815th June 2021

Gas and air (Entonox)

Close up of woman breathing in gas and air from mouthpiece

This is a mixture of oxygen and nitrous oxide gas, and is breathed in through a mouthpiece which you have control of yourself. It can be used throughout established labour and can reduce the amount of discomfort you feel from the contractions. If you are planning a homebirth, a midwife can bring a cylinder of entonox to your home for you to use. Entonox is available in all midwifery-led and obstetric units. Short term use in labour causes no harmful side effects and you can often stay mobile whilst using it. It can also be used in the birthing pool. Entonox can make some women feel light-headed, sleepy or nauseous – if this happens you can stop using it and the effects will subside.

Gas and air (entonox)

14th August 201815th June 2021

TENS (transcutaneous electrical nerve stimulation)

This small machine is attached to your back using sticky electrode pads, and it sends mild and painless electrical pulses through your body, disrupting the nerves that transmit pain. It may also boost your body’s natural pain-killing endorphin production. TENS is most effective in early labour. TENS machines can be hired or purchased online, or in some larger retailers. Make sure the machine you get is designed specifically for labour as there are many different types.

TENS machines More on TENS machines

14th August 201820th October 2022

Complementary therapies

Close up of hands performing foot massage on a pair of bare feet

This includes aromatherapy, acupuncture, homeopathy, reflexology and massage. Ask your midwife what your chosen maternity unit offers or search for a local practitioner online. Certain techniques should not be used during pregnancy or birth, so always consult a qualified practitioner with experience of treating pregnant women before trying a complementary therapy.

Complementary therapies in labour

14th August 201814th June 2021

Self-hypnosis/Deep relaxation techniques

Heavily pregnant woman sits in cross legged yoga pose

There are certain breathing and self-hypnosis techniques which many women find beneficial when experiencing labour. The techniques must be learnt and practised, and are taught by a qualified practitioner. You can ask your midwife about this, or simply search online for local services/practitioners.

Hypnobirth class 1 essentials from HypnobirthMidwivesUK

What is hypnobirthing?

14th August 201825th August 2021

Coping in early labour

Heavily pregnant woman lies back in a bubble bath

The early labour (or latent) phase is usually spent at home, and there are plenty of things you can try to ease any discomfort you have whilst also encouraging labour to progress well. These simple techniques can also help throughout labour:

having a warm bath or shower
sleeping/resting in between contractions
eating and drinking, little and often
staying calm and relaxed and focusing on deep, slow breathing
distraction techniques such as cooking or watching TV
massage from your birthing partner, particularly on the lower back and/or shoulders
trying different positions or going for a gentle walk.

Contact my maternity unit

Pain management First stage of labour: signs, coping and when to go to hospital

14th August 201829th February 2024

Coping strategies and pain relief in labour

Close up of heavily pregnant woman leaning forwards with her birth partner standing behind her and touching her waist

As labour progresses, there are plenty of options available to help you manage the sensation of the contractions as they get stronger and more intense.

Coping in early labour Self-hypnosis/Deep relaxation techniques Complementary therapies TENS (transcutaneous electrical nerve stimulation) Gas and air (Entonox) Water Opioids (pethidine/diamorphine/meptid) Epidural

Pain relief in labour Pain relief information in English and other languages

14th August 201821st June 2022

What happens if my baby is born prematurely?

Mother in hospital armchair holds premature baby to her chest

Babies born before 34 weeks are likely to need extra help with breathing, feeding and keeping warm, and would therefore be transferred to the neonatal unit for care. This care is provided by a highly skilled neonatal team. Your baby may need to be in an incubator, however once they are stable you should be able to hold them and have skin-to-skin contact. A delay in clamping the umbilical cord for up to one minute after birth is recommended for most preterm babies, unless there is urgent need to pass the baby to the care of the baby doctor (paediatrician). There are other reasons that might mean delayed cord clamping is not possible. These are:

you have monochorionic twins (identical twins that share a placenta)
trauma to the cord, such as a snapped cord
you have HIV with a high viral load
the baby is not breathing or has a very low heart rate
you need to be resuscitated.

Colostrum and breast milk are very beneficial for babies that are born early. Most hospitals will encourage you to express colostrum from your breasts, either by hand or with a pump, so that this can be given to your premature baby within the first six hours of birth. If your baby is too small to feed itself you can express your breast milk and this will be given to your baby via a tube. The neonatal team will support you with expressing your milk. Once your baby/babies can breathe on their own, feed via the breast or bottle and have gained weight, you will be able to take them home. This can often take several weeks if your baby was born extremely preterm. You will be supported by the maternity team whilst you and your baby remain in the maternity unit. There are also many organisations that provide support to parents of preterm babies.

Reducing cerebral palsy in pre-term babies

Premature babies Integrated Family Delivered Neonatal Care app

14th August 201825th August 2021

What happens if I go into preterm labour?

Adult hand touches the tiny hand of preterm baby

If you think you are showing signs of premature labour you should contact your nearest maternity unit as soon as possible. You will be seen by a midwife or doctor who will ask you questions about your general health, the symptoms you are having, including any pain or bleeding, and if you think your waters have broken. Your assessment will include:

checking your temperature, pulse, blood pressure and urine
examining your abdomen for any contractions or pains
checking baby’s heartbeat, by listening with a handheld device if baby is less than 26 weeks or using an electronic monitor
taking a blood sample to check for signs of infection
doing an ultrasound scan to check your baby’s wellbeing and position
doing a speculum (vaginal) examination to find out if the cervix is opening (dilating) and the presence of any fluid. This may feel uncomfortable but is done quickly
using a special swab test which can predict the risk of going into premature labour.

If there is no suspicion of preterm labour, your tests are negative and you and your baby are well, then you will be discharged home. If some or all of your tests suggest you may be at risk of preterm labour and birth, you will be advised to be admitted to the hospital. You may be offered some or all of the following:

a course of two corticosteroids injections usually 24–48 hours apart to help with your baby’s lung development and reduce the risk of respiratory problems when baby is born
a course of antibiotics if your waters have broken or if you are in active labour, to decrease the risk of infection
A medication (through a patch or tablets) to try to stop or slow down labour, if your waters have not broken, in order to give enough time to administer the 2 doses of corticosteroids
Magnesium sulphate, a medication administered through a drip. This would be considered if you are between 23+6 and 32 weeks of gestation and likely to give birth within the next 24 hours. This treatment provides protection to the baby’s brain (neuroprotection), reducing the chance of complications for your baby, in particular cerebral palsy. If you or your baby require emergency delivery however, delivery will not be delayed in order to administer the medication.

The neonatal team (baby doctors) will inform you about the care plan for your baby if born prematurely. You and your partner may be offered the opportunity to visit the neonatal unit. If you are extremely preterm, you may need to be transferred to a hospital that is better equipped to care for your baby. Confirmed preterm labour does not mean you will need to birth your baby by caesarean section. The risks and benefits of caesarean birth versus vaginal birth will be discussed with you. Factors to be considered will include the gestational age of the baby, how well they are, their position in your womb and if you have had a previous birth or surgery to your womb.

Portal: What happens if I go into preterm labour?

What to expect in preterm labour Signs of preterm labour

14th August 201820th October 2022

Causes of preterm birth

Smiling parents and touch their preterm baby through a porthole of an incubator

A baby may be born prematurely as a result of preterm labour or because an earlier birth is recommended, due to complications that may have arisen during the pregnancy (affecting the mother or the baby). In many cases, it is not clear why labour starts early, however factors known to increase the risk of preterm labour include the following;

premature rupture of the membranes (your waters breaking early)
some infections, such as urinary tract infection, or chorioamnionitis which effects the membranes and amniotic fluid protecting the baby
multiple pregnancy (the average twin pregnancy is 37 weeks in length, and the average triplet pregnancy is 33 weeks in length)
previous preterm delivery
having a placenta that is ‘low-lying’ (meaning it either partially or completely covers the cervix) or having a placental abruption (meaning the placenta starts to separate from the wall of the womb)
maternal medical conditions, including diabetes or conditions linked to inflammation (eg. Crohn’s disease)
being a smoker, drinking alcohol or using illegal substances
low Body Mass Index (having a weight that is considered to be low for your height)
biopsies or LLETZ treatments to remove abnormal cervical cells
undergoing subfertility treatment
having a weak (short) cervix that might open during pregnancy
polyhydramnios (excessive amniotic fluid)
intrahepatic cholestasis of pregnancy (a pregnancy condition affecting your liver)
abnormalities of the shape of the womb
previous late miscarriage (after 14 weeks) or having vaginal bleeding after 14 weeks in this pregnancy
having previously had a baby by caesarean section at full dilatation of the cervix.

Sometimes, you may develop a complication during your pregnancy and your healthcare professional may recommend preterm delivery. Examples of conditions that may require preterm delivery include:

moderate to severe pre-eclampsia (a pregnancy condition causing high blood pressure which can also affect some of your internal organs)
poorly controlled diabetes
intrauterine growth restriction (when your baby’s growth slows down or stops)
if your waters break early and you are developing an infection
other medical complications of pregnancy.

Women who are considered to be at risk of starting labour prematurely may be offered treatment to maintain the pregnancy for as long as is safely possible.

Can premature labour and birth be prevented?

Sometimes preterm labour can be predicted especially if there is a history of preterm birth or your cervix is found to be short during a routine scan appointment or you are being seen in a preterm birth clinic because of previous surgery to your cervix. If your cervix is found to be short, you may be offered special medication, or a cervical stitch to reduce your risk of early birth.

Causes of preterm birth