Preparing

Preparing for the birth

Your pregnancy is nearing its end. The nursery is ready, the house is tidy. Now it is just a matter of waiting for your baby to arrive. You enjoy the baby’s intimate movements, but you are also curious: when will the birth start? You notice every little cramp in your body.

Good preparation is half the work. Reading up is important, but a birth preparation course can also be very valuable.

Pain during labour is a natural phenomenon. Everyone experiences this pain differently, and it often helps if you can relax as much as possible. What actually hurts? And what can you do yourself to cope with it? Here you will find an explanation and lots of tips for reducing labour pain.

What is labour pain?

Pain during labour mainly comes from the contractions. The womb is a muscle that tightens during a contraction. It feels like a cramp: the pain builds up, lasts for a while and then fades again. The womb then relaxes for a few minutes until the next contraction. The contractions and the pressure of the baby’s head open the cervix. After that, the contractions together with the urge to push bring about the birth. The pain during a contraction can come from:

• Pressure on the tissues of the cervix and the vagina.
• The stretching of these tissues.
• Pressure on the pelvis.
• Tension in the ligaments that attach the womb to the pelvis.
• Lactic acid building up in the muscles of the womb, abdomen and back.

My body knows what to do.

Labour pain does not mean that something is wrong or that you are in danger, as pain from an illness or an accident would. The pain fits with what your body is doing to make the birth of your baby possible. At the same time your body produces substances that help against the pain: endorphins.

What is the role of oxytocin and endorphins?

During labour, the hormone oxytocin causes your contractions. As the amount of oxytocin increases, you get more contractions, which become more painful. Together with the oxytocin, the pain signals from the contractions cause endorphins to be released in your brain. Endorphins are messenger substances. They suppress pain and increase your resilience and motivation. You feel less tired and can focus better on a goal, such as coping with the contractions.

Why does relaxation help against pain?

When you feel relaxed and safe, your body is best able to produce oxytocin and endorphins. If you feel very tense or anxious, you produce stress hormones instead. These stress hormones can slow down the production of oxytocin and endorphins. They also make your muscles tense.

You do not need to be relaxed all the time during labour. But you can find out what helps you relax best, and what you need to calm down when you feel tension. You can already think about this during your pregnancy.

Natural pain relief: the power of your body

During labour your body produces endorphins, its own natural painkillers. We encourage you to support these natural processes:

• Distraction and staying active: In the early stage, look for distraction. Keep moving and focus on other activities.
• Good positions: As contractions become stronger, a comfortable position helps ease the pain and helps labour progress.
• Warmth: A warm bath or shower relaxes your muscles and can make contractions considerably more bearable.
• Massage: A lower back massage by your partner can give a lot of relief, especially with back labour.

Additional pain relief

When natural methods do not give enough relief, safe and effective options are available:

TENS machine

• How it works: Four pads on your back give small electrical pulses. These block pain signals to your brain, so you feel less pain.
• Safety: Completely safe for both you and your baby.
• Availability: Can be used at home as well as in hospital, and is often covered by health insurers.

Pain relief with medication

When the need for pain relief is great, options with medication are available in hospital. Below are the pros and cons of two common methods: remifentanil and the epidural.

Remifentanil (through a drip)

Remifentanil is a morphine-like painkiller given through a drip. You can request an extra dose yourself with a push button.

Advantages:

• Works quickly: The pain relief takes effect fast.
• Self-regulation: You can control the amount of pain relief to some extent yourself.
• Short-acting: The drug is broken down quickly, which is good for mother and baby after the birth.
• No effect on mobility: In principle you can change position.

Disadvantages:

• Intensive monitoring: Requires constant monitoring of your blood pressure and oxygen levels and continuous monitoring of the baby’s heartbeat (CTG). This means you are cared for in hospital by a hospital midwife or gynaecologist.
• Side effects for the mother: Can cause drowsiness, nausea, itching and shallower breathing (which may require extra oxygen).
• Side effects for the baby: After the birth the baby may be drowsier and have more difficulty breathing or finding the breast, although this is temporary.
• Peaks and troughs: Despite continuous administration and self-regulation, there can be moments when the pain relief works less well.

Epidural (epidural anaesthesia)

The epidural is an effective method in which an anaesthetic is given continuously between the vertebrae, taking away almost all of the pain of the contractions.

Advantages:

• Most effective pain relief: In most cases it takes away all the pain of the contractions.
• Long-lasting effect: Gives continuous pain relief for the duration of the labour.
• Rest and recovery: Gives the woman in labour the chance to rest and regain strength.

Disadvantages:

• Intensive monitoring: Requires continuous monitoring of your blood pressure and of the baby’s heartbeat (CTG). Here too, the birth is supervised by a hospital midwife or gynaecologist.
• Less mobility: Your legs feel heavy and numb, so you are confined to bed.
• Effect on the pushing stage: Can reduce the urge to push, which can make the pushing stage longer or increase the need for a ventouse (vacuum) delivery.
• Side effects for the mother:
  • A drop in blood pressure: can lead to dizziness or nausea.
  • Fever: a raised body temperature is more common.
  • Less bladder control: a catheter is often needed.
  • Headache: in rare cases a severe headache after the birth.
  • Itching and nausea: these also occur.
• Rare complications: Very rare, but serious complications such as nerve damage or an infection are possible.

Feel free to talk to us about which form of pain relief best suits your situation and wishes. We will inform and support you in making a well-considered choice.

Birth positions

During labour it is good to change position regularly. This can make it easier for the baby to descend, for the cervix to open and for you to push. Different positions are possible; we are happy to help you find the option that suits you best.

Different positions

• Giving birth on the bed: comfort and familiarity
  The most traditional way, but no less special! On the bed you can take up different positions: on your back, on your side, or on your hands and knees. Your partner can easily support you. The midwife guides you step by step. It is a familiar setting in which to concentrate fully on the contractions and pushing.
  Please note: pushing on your back reduces the space in your pelvis and makes pushing harder. We therefore advise giving birth on the bed on your side or on your hands and knees.
• Giving birth on a birthing stool: the power of gravity
  Would you like to use gravity to your advantage? The birthing stool could be for you! In this sitting position the baby can descend more quickly. You have more freedom to move. Your partner sits behind you for support. The midwife coaches you. Some women like a mirror to see the progress, which can be motivating.
• Water birth: relaxing in warm water
  Warm water can work wonders during labour! It is relaxing, helps relieve pain and can speed up dilation. For the baby it is a gentle transition from the warm womb to the warm water. You can even catch your own baby and lay it straight on your chest!
  Hiring a birthing pool in Zoetermeer. Would you like a water birth at home? Then you hire a birthing pool yourself, from a company of your choice. One example is bevallingsbaden.nl. How far ahead you need to book depends on the company, so check this in good time. Discuss it with your midwife during a check-up. Together we will look at whether your home is suitable: think of the space, the floor and enough hot water. Giving birth at HagaZiekenhuis Zoetermeer? There you can use a birthing pool without booking in advance, for € 90.

Important to know: your birth plan can always change! Sometimes a position does not feel right after all, or complications arise that mean a referral to the gynaecologist is needed. We discuss all options and think along with you flexibly.

Would you like to know more about the different birth positions or how best to prepare? Take a look at the website deverloskundige.nl (in Dutch).

Where would you like to give birth?

During your pregnancy it is also important to think about where you want to give birth.

Giving birth at home

If you are healthy and your pregnancy is going well, you can choose to give birth at home. You often feel more relaxed in your own surroundings, which can speed up labour. The place where you can relax best will make for the best birth.

Outpatient birth in hospital

You can also choose to give birth at the HagaZiekenhuis Zoetermeer. In this video you get a short tour of their delivery rooms. If you give birth in hospital as an outpatient (poliklinisch), we can care for you. If you give birth in hospital without a medical reason (outpatient), you usually pay a personal contribution. The amount differs per health insurer and hospital: check your policy or ask your insurer.

Medium-risk birth

Sometimes it is necessary to give birth in hospital because of your medical history or how your previous birth(s) went. You then have a medical indication for a hospital birth, but you can still give birth with us. An example is if you lost too much blood at your previous birth.

We look forward to accompanying you on this special journey!