Dr Rahul Sen ~ Being at the Birth. Dr Rahul Sen explains how committed he is to being at the birth of your baby – from travelling by ferry in the moonlight to driving from the Blue Mountains in the middle of the night to reach the birth on time. Dr Sen also highlights the specialist team of obstetricians he works with who are on-call for you when Dr Sen can’t be.
Timing of Birth
It is generally better for you (and your baby) if your labour starts spontaneously, however if this does not occur then I would normally plan to induce your labour up to 10 days after your due date. The reason for inducing labour, and for most interventions regarding timing of birth, is to minimise the risk of stillbirth. Reassuringly the risk of this is extremely low.
Women with complications in pregnancy, such as high blood pressure or diabetes, may need to be induced earlier. The main disadvantage of inducing labour is that it can make your labour more intense. If we are planning delivery by elective caesarean section I will generally perform this between 39 and 40 weeks, as this time has been shown to be safest for your baby.
Labour can start gradually or all at once. You may experience some “practice” contractions before true labour starts. Contractions become more frequent and more intense as labour establishes.
You will often make better progress in labour in your home environment, however if you need pain relief or feel you may be progressing rapidly then you should ring the Delivery Suite and come into hospital. When you are having regular, painful contractions that are five minutes apart, or your waters have broken, it is time to contact the Delivery Suite at your booked hospital.
It’s important to ring the Delivery Suite at your hospital before you leave and please remember to bring your antenatal card. If you are unsure whether you should go to the hospital please ring the Delivery Suite and one of our midwives will give you advice over the phone.
On arrival at the Delivery Suite a midwife will assess you and your baby and then notify me of your admission and progress. During your labour you and your baby will be assessed regularly. Provided the labour is progressing normally you may not see me until close to the delivery time, however I shall be in close telephone contact with the midwife looking after you, and readily available should I be needed.
If you are having a planned caesarean section and you start to go into labour or your waters break before the planned date, please notify the Delivery Suite immediately. There is no need to panic, but you will need to come into hospital immediately for assessment. Please do not have anything to eat or drink, in case your caesarean needs to be performed urgently.
Not all women want or need pain relief in labour. During labour your body naturally produces Adrenaline and natural forms of Morphine, which allow you to cope with labour pains. Also many women find it very comforting in labour to be under the shower, or immersed in a bath of warm water. Other things that can help are massage, a TENS machine and nitrous oxide gas.
If you do want stronger pain relief then there is a range of options available to you, including injections of Morphine or an epidural anaesthetic. If you want or need an epidural you can have one, and it does not need to be booked in advance, unless you want a specific anaesthetist. There is a consultant anaesthetist on call 24 hours a day in both hospitals. Both hospitals have recently started a patient controlled epidural service, which provides good pain relief with some degree of mobility.
Perineum and Pelvic Floor
The perineum is the area between the anus and the vagina. The pelvic floor is a sling of tissue, mainly muscle, that supports and controls your bladder and bowel function, and through which your baby passes when coming through the birth canal. I usually perform an assessment of your perineum at your first visit and teach you how to perform a pelvic floor squeeze correctly. Once you have learned how to do a pelvic squeeze correctly I recommend that you practise regularly during the pregnancy and post-natally, to reduce the risk of bladder leakage and prolapse in later life.
At the birth one of my priorities is to protect your perineum from avoidable tearing. I do not routinely do an episiotomy (cut with scissors), and a small tear is generally better than a cut, however major tears can leave you with lasting pain and problems with lack of bowel control, so there are times when an episiotomy is better. That is particularly the case when forceps or vacuum is required for delivery. You can reduce the risk of tearing by doing perineal massage or by the use of the Epi-No device.
Cutting the Cord
I usually encourage your partner to cut the cord after I have clamped it. Traditionally the cord is clamped and cut immediately after the birth, however there is now a trend towards delayed clamping. Delayed clamping allows more cord blood to flow to the baby and is thought to be beneficial for pre-term babies (under 37 weeks).
For babies 37 weeks and older the benefit is less clear – it does give them a higher blood count, but it also gives them higher rates of jaundice, requiring phototherapy, and may result in the baby being separated from you for admission to the special care nursery for treatment.
I usually compromise and cut the cord at around 1-3 minutes. This still gives the baby a little extra cord blood, does not appear to be associated with higher levels of jaundice, and still allows me to collect the cord blood, either for donation or for private storage.
About Vitamin K
Vitamin K is a vitamin that naturally occurs in our bodies, which helps to clot the blood. After a baby is born it takes a few months for their liver to make enough Vitamin K to ensure their blood can clot properly. By giving your baby Vitamin K it makes sure they will have enough to clot their blood and can prevent a rare disorder, known as, haemorrhagic disease of the newborn (HDN). HDN can cause bleeding into the brain and could result in brain damage or, in extreme cases, even death.
Vitamin K can be given to your baby by injection or orally. Only one injection is required, however, oral dosage is more complicated. To give your baby Vitamin K orally you will need to make sure your baby has one dose at birth, one dose between three and five days after birth and another one in their fourth week of life. There are a few reasons babies may not be able to have Vitamin K orally, including if they are ill, if they are born prematurely or if you have had medication during your pregnancy for epilepsy, blood clots or tuberculosis.
One Vitamin K injection is enough to last your baby for months. They will only need one injection or one course of oral treatment. Vitamin K has been used in Australia for more than 25 years without any apparent side effects and has eradicated HDN. There was one study that suggested there could be a link between Vitamin K and childhood cancer, but this study has since been discredited.
It is your choice whether or not your baby is given Vitamin K. However, medical experts in Australia agree that babies should be given Vitamin K to prevent the very serious disease of HDN. Your baby will be given a Vitamin K within an hour or two after birth. If you would prefer your baby to have Vitamin K orally, please speak to me, and let your midwife know at the birth.
Maternity bras: Getting it right
Your breasts will grow throughout the pregnancy but mostly in the first 26 weeks and in the last few weeks of your pregnancy. It’s normal for your breasts to increase by at least a cup size so it is important to wear a comfortable (non maternity) bra at this time, sports bras may be an appropriate choice.
Underwire bras are not recommended as they can sometimes make your breasts feel uncomfortable and affect the way the milk ducts form. It is a good idea to get a proper feeding bra fitted professionally around 36 weeks, Your pregnancy bra should generally be bigger than normal, to allow room for breast growth, which will occur after your baby’s birth. Having a few inexpensive breastfeeding crop tops or singlets on hand may get you through the first few weeks after baby’s birth.
Many women have an oversupply of breastmilk that may last up to 6 weeks. Your breasts will then decrease in size yet still containing enough milk for your baby. Your breasts should generally remain that size for the duration of your breastfeeding time. 6-8 weeks postnatally may also be a good time to have a bra professionally fitted, particularly if you are getting upper back or neck pain.
There is increasing evidence that the use of probiotics may help both you and the baby. Benefits for you include reduced a risk of mastitis and improved bowel health, especially if you need antibiotics. There may also benefits for your baby, especially if he or she is born early or if you need antibiotics.
The most promising probiotics for pregnant and breastfeeding women appear to be either Qiara or VSL. Qiara is available from selected pharmacies. VSL is only available online at this stage.