Your birth at North Mid

Birth Options Clinic

At North Middlesex Hospital you are in control of all decisions about your labour and birth. Midwives and doctors have a duty to discuss all care recommendations, so you are fully informed of the risks and benefits. Once you have this this information, you decide what is right for you.

North Middlesex run twice-weekly Birth Options clinics with the Consultant Midwives. These clinics are perfect for you should you wish for a birth that may not be recommended to you. For example, if you have a medical complication but would like to consider homebirth or birth centre birth. Please discuss this with your midwife and ask for a referral to the Birth Options clinic

Maternal Choice Caesarean Section

You may wish to consider a planned caesarean rather than giving birth vaginally. Even if there are no medical indications but you would like to choose a planned caesarean section this is an option for you. Please discuss this with your midwife and ask for a referral to the Birth Options clinic. At this appointment the Consultant Midwife will discuss all the risks and benefits and discuss what is important to you. If, following this appointment you would like to go ahead with a planned caesarean section, you will see an obstetrician to complete the paperwork, and the caesarean will be booked. Please see the information on ‘Planned Caesarean’.

Whatever your choices and wishes for your birth, the Consultant Midwives will discuss all the risks and benefits, and the decision is yours, and yours alone. As the Royal College of Midwives state: ‘Your body, your baby’.

Place of birth

We have three settings in which you can choose to give birth: homebirth, birth centre and the labour ward. There is more information about these option on the ‘Your Birth at North Mid’ section.

Your midwife will discuss with you which setting is right for you. If you are experiencing a straightforward pregnancy and you are fit and well, a midwifery led homebirth or midwife led birth centre birth will be recommended to you. This is because you are more likely to have uncomplicated birth and it is safe for your baby. Women often feel very positive about their births in these settings. Equally, if you don’t have any complications but would prefer to birth on the Labour Ward, this option is there for you.

If you are experiencing any complications in your pregnancy, the midwives and obstetricians may recommend you give birth on the Labour Ward, as you and your baby can be more closely monitored here. The labour ward has a team of dedicated midwives and doctors to support you and has a beautiful pool room with waterproof monitoring.

All women who are well and do not develop pregnancy or medical complications are safe to choose home birth. This includes first babies.

There is a high rate of normal birth for women who choose to give birth at home. 

Advantages of home birth

• Birth in a familiar and comfortable environment.
• Keeps the birth process as normal as possible.
• Women who give birth at home report needing less drugs for pain relief.
• Less disruption to family life.
• Reduced risk of hospital acquired infection.

Disadvantages of home birth

• You may have to transfer to hospital if there are certain complications.
• You will need to transfer to hospital if you decide you would like an epidural.
• The need to transfer to hospital means it will take longer to get emergency treatment.
• The transfer rate to hospital for first time mothers is approximately 30% although it is less for mothers who have had a baby before (Birth Place Study 2011).
• There is a slight increased risk of complications for first time mothers and their babies compared with mothers who are giving birth for the second time at home. However, birth is generally safe and overall risks are low (Birth Place Study 2011).

Who will be present at home birth?

Our community midwives will provide all your care, one midwife will be with you during labour, two midwives will be present at the birth.

What pain relief methods can I use at home?

• Water (you can have a home water birth but you will need to hire or buy your own birthing pool).
• TENS machine (hired or bought).
• Complimentary therapies.
• Entonox (gas and air) is provided by the midwife.
• Injectable pain relief can be arranged with your GP.
• Birthing aids such as mats and birthing balls (bought, hired or arranged with your midwife).

The Birth Centre provides support during labour in a relaxed and homely environment designed specially to support normal, active birth. This birthing centre is aimed at women who:

• Have a low risk pregnancy and anticipate a low risk labour and birth e.g. no previous medical or obstetric problems
• Do not want to have an epidural in labour.
• Wish to use therapies such as water, massage, music, low lighting and upright / mobile positioning to enhance the safe natural progression of labour and easing pain. 

Pain relief methods you may wish to use on the Birth Centre

• Breathing / relaxation techniques.
• Mobilisation.
• Hydrotherapy
• TENS machine (a method of pain relief involving the use of a mild electrical current)
• Hypnotherapy will be supported
• Entonox (gas and air)
• Injectable pain relief.

If you require/wish to have a epidural during your labour, you will need to be transferred to the labour ward when a room, midwife and anaesthetist are available.

If there are any complications during your pregnancy or labour, we offer consultant-led care on our our labour ward. 

This means your care is provided by a multi-disciplinary team made up of medical, obstetric, midwifery, neonatal and anaesthetic experts. 

We have a consultant on our labour ward 24/7 in case of any emergencies.

Our facilities

All of our labour rooms are en suite and we have one birthing pool room. We encourage women to be as mobile as possible during labour and there are lots of birthing balls, bean bags and birthing mats available to facilitate an active labour. We also have two specialist obstetric theatre and 4 recovery beds on the ward for both elective (planned) and emergency care on  labour ward.

People on the ward

You will be cared for by a midwife throughout your time on labour ward. We are a training hospital and you may be asked if a student midwife or medical student could be present to observe and take part in your care under supervision and with your permission. Many women feedback to us that they really benefited from having a student participate in their care. You will always be asked permission for a student to be present, and it is not a problem if you decline this offer.

You can have whoever you would like to support you in labour; your partner, a relative or a close friend. Doulas and natural therapists such as acupuncturists are welcomed onto the units and we encourage you to discuss your birth plan with your midwife.

Options available to you

Women who are known to have a high risk medical problem or obstetric history or a known problem with their current pregnancy or baby are recommended to give birth in a consultant led unit, although low risk women may choose to give birth here too. Please also discuss your options with your midwife or doctor.

The latent phase of labour

The latent phase is the first part of your labour. Some women will have backache and cramps or have bouts of contractions that may last a few hours and then stop and start up again the next day. This is perfectly normal.

The duration of the latent phase of labour can be variable. It may last for 24hrs or more and can be exhausting for you. It helps if you can stay as relaxed as possible during this part of your labour and remain at home in comfortable surroundings as long as you can.

Remember that every woman’s labour is different and sometimes it can take a long time.

Your contractions may feel uncomfortable but they may not be regular. They may be sharp but short lasting. They may stop and start, last for 30 – 40 seconds and may continue for several hours.

The neck of the womb (the cervix) has been long and closed during your pregnancy.

These contractions help to soften the neck of the womb and prepare your body for active labour.

As the contractions become closer together, longer and stronger, the neck of the womb will also begin to shorten and then open up. Once the cervix is 4cm dilated and the contractions are regular (every three minutes or so) and lasting for at least a minute, then labour has become active.

How can I help myself

There are many ways of helping yourself to cope through these first hours of the latent phase of labour.

It is important to try and remain relaxed.

• Keep your breathing deep, steady and slow during a contraction. This will prevent you from using extra energy. Once the contraction is wearing off, close your eyes and allow your body to rest before the next one.
• Take a warm bath or shower, at regular intervals. You will find the warmth of the water soothing and relaxing.
• You may want to call your birthing partner for added support during this time.  It may be useful if your partner massages your back to reduce, backache, helps you to relax, and supports you in any alternative positions that you may adopt. Your birthing partner can also make other family members aware of the latent phase of labour and encourage them to support you rather than raise concerns unnecessarily at this stage.
• Try to remain active without exhausting yourself during this time. Take a walk out with your partner, stopping if you need to during a contraction. Remaining upright will assist gravity and help your baby to descend into the pelvis. Rocking your pelvis and swaying your hips can also assist you. If you have access to a birthing ball, use it regularly as this too can alleviate any discomfort.
• Ensure that you maintain your energy levels by eating small, light meals containing carbohydrates such as bread, pasta. The use of high energy drinks will also add to your energy requirements and keep you hydrated.
• It is safe to take simple pain killers, such as Paracetamol if you are not allergic. You can take two tablets / 1gm, every 4-6hrs. Do not take more than 8 tablets within a 24hr period.
• Some women who have hired a TENS machine put it on during the latent phase.

When should I go into hospital?

If you have tried all of the above suggestions and your contractions are now regular and painful, you may want to ring triage (0208 887 3682) or the Birth Centre (0208 887 3820 or 0208 887 4230). The midwife will advise you depending on the information that you give.

If you come into hospital then take your bag with you. However, if labour has not yet established you may be asked to return home. This decision will be based on the findings of a thorough examination.   Hospitals are not always the best environment for women who are in the latent phase of labour.

Travelling to hospital

We strongly advise to you plan how you are getting to hospital when you are in labour in advance. Whether that be with a friend, minicab or your own car. Parking is available in front of the maternity unit and the entrance is off of the north circular (A406). Please note ambulances are only to be used in an emergency.

What you may like to bring in with you:

• Personal toiletries, towels for your use and Sanitary Pads – thick ones!
• Sieve and mirror for pool use (You must bring these with you if you intend to use the pool)
• Disposable knickers for yourself
• Loose and comfortable clothing for you to labour in with some flip-flops/slippers
• Food and drink for your support people
• Music
• If your partner stays with you, appropriate sleep wear must be worn at all times ( long pyjamas or tracksuit bottoms).
• Extra pillows.
• Snacks & energy drinks.

For your baby - disposable nappies, clothing (e.g. vests, baby grows, jacket, booties, hat), baby blanket. Please ensure any clothing has been washed in a mild soap to rid the fabric of manufacturing chemicals.

When can I go home after the birth?

Most women choose (and are encouraged) to go home within 6 -12 hours of their baby’s birth, unless there is reason to remain in hospital. If you need to stay for a longer period of time either for medical reasons or by choice you will be transferred to the postnatal ward in order to allow the birth rooms to be used by other women. We will discharge you to the care of the community midwife who will continue your care when you go home.

Active birth

Numerous studies indicate that the benefits of Active Birth are:

• The natural rhythm and continuity of birth are not disrupted
• Uterine contractions are stronger, more regular and frequent
• Dilation of the cervix is more efficient
• More complete relaxation between contractions
• First and second stages of labour are shorter (some studies show up to 40% shorter)
• Greater comfort, less stress and pain and so less need for pain relief
• Less fetal distress and improved condition of the newborn

Women feel that they are fully participating, in control and more often experience giving birth as a positive, empowering experience

Waterbirth

We are experienced in water births and enjoy providing care for women who choose this option. Many of our women choose to use one of our pools to labour and give birth in, around 70% However, some women choose to labour in water but want to get out to give birth. Whatever you choose to do we will be there to support you.

Using water enables you to move freely and adopt any position you feel like, aided by the buoyancy of the water. It is a marvellous relief for aching backs or for women who feel their contractions in their back. Our women have told us that they feel very safe and comforted by being in a cosy, warm, egg-shaped pool!

Feeling safe and relaxed means that the body then produces its own natural pain-relieving hormones called endorphins and thus the body is able to get on with producing other hormones which are vital to the process of labour and birth. The production of these hormones can be interrupted by fear, unnecessary interference with a labouring woman, bright lights or loud noise, in short, anything which makes the woman feel uncomfortable or unsafe. For this reason we are quiet and respectful at births, providing support and guidance as gently as possible. Having said that, we also have had clients who were very happy to have the TV on or play loud music during their labour and they  gave birth just fine!

The baby is born underwater and gently brought to the surface either by you, your partner or the midwife. It is a very gentle way to be born and babies born this way rarely seem to cry at first and soon open their eyes to see what they can of their mother.

Birthing balls

We also recommend birth balls which are useful both during pregnancy and during labour. They are very helpful for backache of pregnancy, providing gentle exercise and aiding mobility whilst you sit on one and gently rock or make small circular movements. They are very comfortable to sit on, providing support, but also with some “give” to the pelvis.

Another way to use one is to lean over it (bump permitting, of course!) almost hugging it and rocking back and forth. Women have said that they find this rhythmic movement comforting and a relief for an aching back, either in pregnancy or during labour.

If your partner is on a chair, they can hold the ball in place whilst you lean over it, head towards your partner, so that they can also massage your shoulders and back.

Leaning over the ball this way is also an excellent position for giving birth in, should you so choose. Many women, left to follow their instincts, will give birth on all-fours, either in water or on dry land. This position enables the pelvis to open to the widest diameters possible thus allowing the birth to proceed well.

Birthing stool

The birthing stool has been used for millennia. Birthing chairs took the place of labouring mothers sitting on birth attendant’s laps, as it was the previous practice. The birthing chair can be traced to Egypt in the year 1450 B.C.E. Pictured on the walls of The Birth House at Luxor, Egypt, is an Egyptian queen giving birth on a stool.

We are very lucky in our birth centre to have the 21^st century “BMW” of birthing stools made by Fibromed.

It is designed to help you maintain a physiological upright posture during childbirth. The birthing chair is intended to provide you with balance and support while  giving birth in a squatting position supported by your birthing partner.

Delivery of the Placenta

There are two ways in which you can choose to deliver your placenta. The first is by the physiological method. Once the baby is born, the midwife will wait until the cord stops pulsating before clamping and cutting. You will then wait for a contraction and deliver the placenta by yourself. It can take up to one hour to deliver and you may have a slightly higher risk of bleeding. The other method is for you to be given an injection after the delivery of the baby, the midwife then waits for signs the placenta is ready to be delivered and will then proceed to deliver it. This can take around ten minutes. You may feel shivery or vomit after the injection but these side effects are quite rare. Your midwife will ask you which method you prefer.

Reducing the risk of Perineal Trauma

After the delivery of your placenta, the midwife will check to see if you have any tears and if you require stitches. The midwives are able to suture you on the Birth centre using local anesthetic which should provide adequate pain relief.  However if you have a deep or extended tear you may have to transfer to the labour ward for suturing by a doctor, and an epidural may be necessary for pain relief.  If you wish to reduce the risk of tearing, then perineal massage has been shown to be extremely effective in your first pregnancy. It must be started from 36 weeks and should be done every day. Please discuss this with your midwife if you have any questions about this. 

 

 

You may be offered or recommended an induction of labour. This is where we artificially start the labour, rather than waiting for the labour to start on its own (spontaneous labour).

There are several reasons why we may offer you an induction, such as concerns that the baby is small or not growing well in the womb, if you have diabetes, or if your pregnancy has gone 12 days beyond your due date. The doctors and midwives will discuss the reasons why the induction is recommended. They will also discuss the risks and benefits of this option with you. You may choose to decline the recommendation and your decision will be respected with alternative plans put in place.

The induction process usually involves being admitted to hospital and your birth partner can stay with you for the whole process. When you first arrive, the midwife will carry out a full check and will then discuss the plan going forward.

There are several steps to the induction process:

1. Cervical ripening. The neck of the womb (cervix) may not be ready for you to go into labour. This needs to happen at the beginning of the induction process. It can be done in several different ways: some that are inserted into the cervix or with a hormonal  pessary that goes inside the vagina, next to the cervix. Your midwife or doctor can discuss this in more depth with you. Some women need several rounds of this process to open the cervix enough that we can break the waters. Be prepared that it’s sometimes a long process. 
2. Artificial rupture of membranes (ARM). Once the cervix has opened a little, the next stage of the induction is where we break the waters. This sometimes starts contractions. If it does not, the next step is the hormone drip.
3. Syntocinon infusion. The next stage of induction is with medicine that goes into the vein called syntocinon. This drug mimics natural oxytocin and will start the contractions.

Some women find the induction process painful and uncomfortable. We can offer you pain relief to support you. You may wish to opt for an epidural, just let your midwife know.

We may also be able to offer you an ‘outpatient induction’ where you could go home in the early stages of the induction. Discuss this with you midwife or doctor. 

Planned caesarean birth

The decision for planned caesarean birth will be made with you and the obstetric and midwifery team.

You may wish to consider a planned caesarean rather than giving birth vaginally. Even if there are no medical indications but you would like to choose a planned caesarean section this is an option for you. Please discuss this with your midwife and ask for a referral to the Birth Options clinic. For more information about this see the Birth Options section.

Your planned caesarean section

You will be seen two days before the operation for routine pre-operative blood tests and swabs.

You will be asked to take some medication on taken the night before and on the morning of your operation.

You should not eat any food after midnight but may drink water until 6am on the morning of your operation. On the day of your caesarean, you will normally arrive at your maternity unit early in the morning.

You will usually have a spinal anaesthetic or combined spinal epidural which causes the body to go numb from the abdomen to the feet. In the operating theatre, your chosen birth partner can accompany you and can stay by your side, unless circumstance change and you need a general anaesthetic. A catheter will be inserted into your bladder, and this will normally be removed the following day. Once the operation starts, the baby is normally born within 10 minutes, and all being well you can have skinto-skin contact in the operating theatre.

After the surgery you will spend a few hours in a recovery area, and a nurse or midwife will check your observations regularly. You can start feeding and bonding with your baby during this time. Your anaesthetic will wear off after a few hours. You will normally stay on a postnatal ward for one to three nights and you will be given regular pain relief. You will be helped to become mobile soon after the caesarean. You may require blood thinning injections to prevent blood clots.

North Middlesex Maternity Department understands the importance of having the right support for women during their pregnancy journey.  We are reviewing this on a regular basis, and we are now able to support / welcome two consistent birth partners with you into our Labour Ward, Birth Centre, Induction of Labour. On the Maternity Ward we have now advanced to 24hr visiting for one designated birth partner.

This can be a member of your family, a friend, a doula, Birth Companion or an independent midwife. All birth partners must follow these rules and any other instructions from staff, at all times:

• Birth partners will be given a wrist band which they must always wear. Any damage to the band may delay access. Do not swap the band with another person.
• Birth Partners must practice good hand hygiene and wash hands/use gel; when entering the hospital, when entering or leaving the rooms and when using the toilets:
  • On the Labour Ward all birth partners must use the toilet labelled ‘visitors’ only.
  • On the Birth Centre your birth partners can use the ensuite toilet.
  • On the Maternity Ward you must use the toilet labelled Relatives, these are in the room/bay and are clearly signposted
• If you are moved to theatre, your birth partner can go with you. If birth partners are unable to attend theatre (for example if the procedure involves a general anaesthetic) they will be supported to wait in the labour wardroom or recovery area.
• On the Maternity Ward a designated support partner can stay 24hrs they should stay in the room/ behind the curtains as the corridors can become busy. We are encouraging new mothers to ask people to wait until they leave hospital to visit to give them time to bond with their babies and receive the necessary support for caring for themselves and their baby.
• Please wear suitable clothing on the maternity ward and be mindful of the other women on the ward. If you are staying overnight, stay with mum if you need to leave, please be patient as we do not have door service overnight and the staff are often very busy.
• Be aware that we have toilet facilities only for visitors on the Maternity Ward. Unfortunately, at this time the Ward cannot provide food for relatives however we do have tea and coffee facilities that you can help yourself to during your time on the ward.