Dreamer with a day job

Ready Or Not

I’d really like to start getting other parents involved in my blog right from the off – largely so that I can get to know some of my (hopefully) regular readers, but also because I would love to hear other people’s opinions on certain topics. And I know that no group of people have stronger opinions than mums!

To that end, I’d like to share with you an interesting subject I am busy researching at work at the moment – the latent phase of labour. This is basically the extremely frustrating period of time when you are just about ready to pop but are not yet considered to be in ‘active labour’. I realise at this point that I have just alienated anyone who is either entirely disinterested or has no experience of this, but stick with it; you might learn something.

I find myself at a bit of a disadvantage when it comes to this part of the whole childbirth process as I had a controlled early induction in hospital so missed out on the exciting waters-breaking-in-Tesco part (which I’m sure doesn’t actually happen very often but sounds very dramatic – “clean up, aisle 3!”). I’ll have to imagine the next bit – you may have some very vivid memories of it.

Picture this: your due date approaches, you’re waddling around the house like Danny DeVito in Batman Returns, and you’ve had the ‘show’ (and I don’t mean going to see Mamma Mia). You may or may not have had an embarrassing supermarket incident at this point – more likely you may have had a bit of a leak of your waters, or maybe nothing at all. Either way, you’re contracting with frustrating irregularity and you know something is happening down there but you’re a long way off yet.hospital

24 hours later, your contractions are getting stronger, you’ve had three baths, and bouncing on your birthing ball like an excitable child on a Space Hopper is no longer helping. You’ve attempted various relaxation exercises – deep breathing, gentle massage, an irritating CD of whale noises – but over-the-counter painkillers and your hired TENS machine aren’t doing the trick anymore and you’re sure that your baby’s arrival must be imminent. Maybe you won’t even make it to the hospital. You imagine your other half weaving wildly through traffic before being stopped by police, to whom your hysterical partner yells “she’s in labour!”, and you screech up to the maternity unit doors with a lights and sirens escort. Your actual journey to the hospital is less dramatic but you are glad to be in capable hands, who will surely have your little one delivered within the hour.

“You’re about 1-2 centimetres dilated. Go back home and try to have a rest.”

Is there any sentence more disheartening for a mother-to-be to hear than this? You’ve arrived at the maternity unit, hospital bag in hand, doubled over at the admissions desk and after a bit of poking and prodding, some midwife tells you that you’re nowhere near. You’re in considerable pain, if it’s your first baby you’ll undoubtedly be fairly scared, and after a day or so without proper sleep you’re already feeling exhausted. The last thing you want is to be turned away at the door when you really feel like you need some help. But it doesn’t have to be this way.

laborI am looking into how effective antenatal education can be at preparing women for the latent phase, and the importance of good telephone triage (when women are assessed by a midwife over the phone) to encourage women at this early stage to stay at home for as long as possible, and to recognise when they really should come in. There is good evidence to show that the further along in labour a woman is when she arrives at hospital, the more likely she is to have a ‘normal’ birth with fewer interventions. If she is well prepared for the onset of labour through having plenty of information beforehand, and has the benefit of a supportive birth partner, she is likely to be more relaxed and will cope much better than women who panic and feel that they don’t know what is happening. On the part of midwives, they should not underestimate the positive effect of their advice and reassurance over the phone when a woman most needs it.

I would love to get some feedback on your experiences of this early stage of labour. Did you feel prepared when you had your first baby? Do you think women should be turned away when they come into hospital, regardless of how far dilated they are? And do you think you should get your shopping for free if your waters break at the till? I’d at least expect a voucher or something.

4 thoughts on “Ready Or Not”

  • I think I skipped this phase altogether with both of mine. Kiran was a 3 hour labour from first contraction to him being born – I arrived at the hospital fully dilated, he was almost born in the car :p

  • Thanks for your reply Rachel – I think you’re illustrating the sometimes extreme difference between baby no.1 and no.2 (although it sounds like you were pretty quick with both)! This was an interesting point raised by one of my mum friends on Facebook, as she knew mums who had almost given birth in the car park or in the hospital corridor with their second baby. She suggests that second time (or more) mums should never be sent home once they present at hospital as things can progress so much more quickly with a second baby. A valid point to consider.

    I received a reply from a mum on Twitter who had two home births and had been well prepared with hypnobirthing to keep her relaxed and in control. The mad dash to the hospital was never necessary. It’s great that she had the confidence and knowledge to do this – the ideal is that all women should feel so prepared but is too often not the case.

    A couple of responses I got from antenatal practitioners typically focused on the positive effects of good antenatal education. They mentioned the key benefits of empowering women and encouraging them to trust their instincts in labour, and also that being well prepared can make for a better birth experience – even making the latent phase enjoyable! Seems to be that the mental preparation women receive is the key to everything.

    • yes my 1st labour was pretty quick too, though quite different. I arrived at the hospital at 9am for my routine weekly checkup and the doctor wouldn’t let me go home as I was 3cm dilated and contracting (although I felt nothing). I was very unimpressed as I’d heard stories of people walking round at 3cm for ages and was convinced I’d be hanging around for days with nothing happening.

      They let me check into my room and do my own thing for the rest of the morning but eventually they made me stay in the delivery suite as things were progressing but I was still not feeling contractions any stronger than mild period cramps(I was even less impressed with this)

      Fast forward to about 8pm, my waters broke, *real* contractions suddenly kicked in with less than a minute inbetween them and Maya was born at 11pm.

      I also used hypnobirthing which certainly helped me stay calm the second time round when I knew what was coming but it’s hard to feel in control when there is no slow build up in contractions. As 2nd births are usually faster, my doctor advised me to come in when the contractions were 10 minutes apart but as soon as they started they were 1 minute apart and progressed from period style cramps to full blown contractions within half an hour! I laugh now that when I woke up i was planning on going back to bed but thought i’d better time them just in case!

      I do find this whole area fascinating, particularly the difference between countries. I think the uk has one of the best systems in the world although there are obviously many problems related to underfunding etc.

      What exactly do you do at work? I’m curious 🙂

      • Good question! I work for NHS Clinical Networks (North of England). The role of the network teams is basically to improve service quality and thereby improve outcomes for patients across (initially at least) four key healthcare areas – cancer; cardiovascular diseases; dementia, neurological conditions and mental health; and maternity and child health, which is my area of work.

        Overarching these condition areas are such themes as living with long term conditions, patient experience, patient safety, primary care and early diagnosis, and so on. The Clinical Network acts as a hub, if you will, for programmes of improvement, and we encourage collaborative working across different hospital trusts in the region, for example, to share best practice and ways of working.

        Because I only started here a month or so ago I have been doing a lot of background research work for projects that are just starting out – the latent phase being one area of focus. Getting patient perspectives is obviously an important consideration in any potential change of procedure, which is why I find everyone’s personal experiences so interesting!

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