Dr Rahul Sen | Specialist care for birth and beyond | Sydney, Australia

Rooms : Edgecliff 02 9363 9474
Macquarie Street 02 9221 2600

Preparing for Labour and Birth

Birth in most cases occurs between 37 and 41 weeks of pregnancy.

Here are a few suggestions to prepare your mind and body for labour from Michele Simpson:

Mind Preparation

Connecting your mind with your baby may help both the baby and your body to release the hormones that will initiate labour. Talking to your baby, being aware of baby’s movements and imagining what life with your baby will be like as you go through your day to day activities eg: shopping, driving, may help you to connect and prepare you better for the reality of being a mum.  Yoga, relaxation, hypnobirthing sessions, meditation, visualization and prenatal classes may also help.

Body Preparation

Helping your baby to adopt a head-down, anterior (back facing the front) position will optimize your chances of having a normal labour and birth. Leaning forward over the kitchen bench and rocking your pelvis for a few minutes several times each day in the last few weeks of pregnancy may help. Avoid leaning back in lounge chairs, instead adopting a leaning forward position when sitting may also help. Remember not to sleep on your back as it may decrease the blood flow that you and your baby receive. It is best to lie on either side to sleep, and not flat on your back.

Therapies such as Chiropractic, Osteopathy, Homeopathy, Reflexology, Acupressure & Acupuncture are believed by some to be beneficial though again research into actual benefits are inconclusive.

Perineal Massage

RAH-Drawings-PerinealMassagePerineal massage has been used in different countries and cultures throughout much of human history. It is a method of preparing the outlet of the birth passage, particularly the perineum, for the stretching and pressure sensations during the birth of your baby.

The aim is to avoid trauma to that area – either a tear or an episiotomy (a cut made in the perineum to enlarge the outlet). It has been shown that women experiencing their first vaginal birth, who practise perineal massage from 34 weeks onwards, have a lower risk of serious tearing or episiotomy.

Massage can be done internally or externally before your baby is born by you or your partner depending on how comfortable you both are with the procedure.  To aid relaxation prior to the massage, a warm bath or warm small towels placed on the perineum before starting the massage can help to relax the area.  A low-irritant oil or cream e.g. vitamin E, or olive oil can be used as a lubricant if desired.  Perineal massage can be performed from 34 weeks onward, just 3 times per week for about 5-8 minutes per day.  You will notice that the stretchiness and flexibility of your perineum will increase.

First wash your hands, then obtain a mirror and prop yourself up with pillows. Look at your perineum with the aid of the mirror and become familiar with the whole area involved.

If you use a lubricant, put it on your thumbs and place your thumbs three to four centimetres inside your vagina and press the inside of the perineum toward the rectum and to the sides. You will feel a slight tingling or burning as you gently press down and stretch the opening.

Maintain this stretching and pressure for about one minute. The area will become a little numb. Work the lubricant in, slowly and gently, maintaining the pressure and pulling the perineum forward a little; this is what your baby’s head will do as it is being born. The massage can be in one direction at a time i.e. from side to side, or the fingers can be swept in the opposite direction. Try different ways until you find which is more comfortable for you. This massage should not be painful.

If your partner does this massage, the perineum and sides are pressed by using his two index fingers. He massages with his index fingers inside and his thumbs outside. This is a very intimate and private area and sensitivity within the relationship with your partner is essential.

Perineal massage will make you more aware of this area and will assist you to relax and open up for your baby’s birth. During the bearing down stage of labour it is common to tense and try to hold back. Women who have consistently done perineal massage do not report the extremes of stinging and burning that often accompany the birth of the baby’s head. It is hoped that because the stinging and uncomfortable burning sensations are reduced, you will be able to relax more and allow your baby’s head to slip over an intact perineum. Be prepared to have a slow, controlled birthing of your baby’s head. Pant/blow to overcome pushing sensations as the head emerges.

Pelvic floor exercises should be practised daily throughout pregnancy. This practice will help you to be able to consciously relax the muscles of the pelvic floor, which is exactly what you will do to assist in the birth of your baby. Pelvic floor exercises after birth will help you to re-tone your stretched muscles and tissues.

Please note:

  • You can massage over previous episiotomy scars.
  • It is advisable not to use perineal massage if you have any lesions or active herpes during this stage of pregnancy.

Epi-No

The Epi-No device is a device for perineal stretching.  It is a relatively new invention (15 years) and the evidence supporting its use is still somewhat conflicting.  It may, however, reduce the likelihood of having a major perineal tear.  It costs around $280, and can be purchased from the hospital Foyer Pharmacy, and can be used as an alternative or in addition to perineal massage.

Ripening of the Cervix

(things to do if you are 37 weeks or more)

Nipple Stimulation:

Oxytocin, a hormone that initiates labour, is released when nipples are stimulated and breasts are expressed. Roll one nipple at a time between finger and thumb alternating positions of fingers as breasts may be tender.  You may want to express your breasts (squeeze breasts in a pumping action for 10 minutes at a time as often as you like at least 3 times per day (ask us to show you how).  You may notice some colostrum (milk) coming out.  In many cases, expressing at the end of pregnancy can increase the amount of breast milk you will have for your baby (only to be done after 36 weeks).

Membrane sweeping & stretching:

This should only be done by a midwife or doctor and involves a vaginal examination, stretching of the cervix, and separation of the membranes from the cervix.  It is generally very safe, when there are no complications.  Often the procedure can cause discomfort and bleeding (a “show”) and sometimes, irregular contractions.  It may however help you to go into spontaneous labour earlier than otherwise.

Acupuncture:

Regular acupuncture sessions have been shown to decrease stress and increase energy levels, helping you to cope with the final weeks of pregnancy and labour.  Some studies suggest it may assist with the initiation of labour, although the evidence is not strong, just like with eating dates.

RAH-Drawings-AcupressureAcupressure:

(Only to be used after 37 weeks to help initiate labour)

Stimulating points on the feet and hands can stimulate other parts of your body ie: uterus and help labour hormones to be released.  Locate the points illustrated in the pictures below, ie SP6 is 4 fingers up from the top of the ankle bone. The points may be tender when you press them. Press firmly with your thumb for about 5 minutes each 1-2 hours. It’s normal that your baby may move during acupressure.  Feeling hot, flushed, teary or experiencing a contraction during the point stimulation is also normal, and will show that the treatment is effective.

Intercourse:

Semen contains prostaglandins, which are hormone-like substances that help soften the cervix, so it may start to dilate. The cervix responds to intercourse only at the end of your pregnancy, and it is generally safe to have sex throughout your pregnancy, unless you have been advised not to.  It is common for many women to find it uncomfortable toward the end of pregnancy, so trying the above alternatives instead may be just as beneficial in terms of preparing for labour.