Birth: from Braxton Hicks to baby’s first breath

The birth of a baby is a deeply personal experience. Every expectant mother experiences this moment in her life differently. And many have mixed feelings about giving birth. A sense of joyful anticipation combined with worries. Will everything go well? Will I be able to bear the contractions? How will the birth go? Will our child be healthy?

A birth preparation course will teach you all about pregnancy, birth, breastfeeding, the postnatal period and your new family life. You will learn special breathing and relaxation techniques to help make your birth easier. You can also talk to experts and other expectant parents about your questions and concerns. If you decide to take a birth preparation course, start from the 28th week of pregnancy. Most courses last six to eight weeks.

Tip: before your due date, visit the clinic where you will give birth. Get familiar with the building and the atmosphere. This will make it less stressful for you when the time comes.

Labour pains are contractions that cause painful cramps in the lower abdomen and/or back. Some women will start to feel Braxton Hicks contractions from the 20th week of pregnancy, particularly if they have had a baby before. They are sometimes called “practice contractions”. These contractions mean the womb is preparing for the birth. From the 32nd week of pregnancy, these contractions will be quite noticeable. They last for about 30 seconds. They happen at most three times an hour and up to 10 times a day.

From the 36th week of pregnancy, the latent labour phase starts; this is also known as “pre-labour” or ‘“false labour”. Your body is getting ready to give birth. Your baby’s head is slowly moving down towards your pelvis. You will usually experience it as cramp-like pains radiating down your back. Your abdomen will feel hard. There might be several hours or even days between contractions.

Labour pains signal the first stage of labour. These contractions are stronger and more painful than pre-labour. They come at regular intervals and more frequently.

Home remedies against pre-labour pains

You can use natural remedies and methods to make contraction pain easier to manage.

• Many expectant mothers use acupuncture or homeopathy. About half of all pregnant women find that homeopathic remedies ease the pain and cramps.
• Heat feels good and relaxes your muscles; for example, place a heat pillow or hot water bottle under your back.
• A warm lavender body wrap will comfort a hard abdomen and promote sleep. To make your own, place five drops of pure lavender oil in a bowl with 37°C warm water and add a little coffee creamer to bind the oil. Soak a muslin cloth in the mixture and place it on your stomach.

Recognise when labour is starting

How do you know whether your pain is Braxton Hicks contractions, pre-labour or actual labour? If your actual labour is starting, the contractions will get stronger, more frequent and more painful. To begin with, the time between individual contractions is 10 to 15 minutes. They will become more and more frequent as your labour progresses, until they are four to five minutes apart. During this stage, each contraction can last 20 to 60 seconds. This signals that you are almost ready to give birth. It’s time for you to call your midwife and go to your chosen place for the baby’s delivery.

A natural birth consists of three stages. The length of each stage varies with every women. That’s why our information about how long birth takes just gives an average. If this is your first baby, it will usually take a bit longer. But do not wait too long to make your way to the clinic.

How to alleviate labour pains

During your birth preparation course, you learn and try out different techniques for managing labour pains.

• Concentrate on your breathing. Through conscious, regular breathing and focusing on your exhale, you reduce the risk of hyperventilating. Do not be shy – when you breathe out, hum a loud A or O sound. Even shouting can have a calming effect.
• Move your pelvis; for example, move it around in circles on a stability ball, or straddle a chair and move your hips back and forth.
• Have a gentle massage. Depending on what you need, focus on your sacrum, lower back or shoulder area.

If these natural methods are not enough, drugs are available to ease the labour pains as a suppository or infusion. Take pain medication only in consultation with your gynaecologist or midwife to avoid any side effects for your baby.

The last resort for relief of intense labour pains is spinal or epidural anaesthesia, known simply as an epidural. This numbs you from your hips down to your feet. You will not feel any pain, but you will experience the birth of your child while fully conscious.

During the birth, your baby’s head may stretch your perineum so much that the tissue between the opening of your vagina and your anus can tear. In many births, the perineum tears only slightly and heals without any complications. A perineal tear is categorised in severity as a first, second, third or fourth-degree tear. A first-degree tear heals without any stitches. A second-degree tear can be stitched straight after the birth with a local anaesthetic. In third and fourth-degree tears, the anal sphincter muscles are also affected, and in a fourth-degree tear the intestinal mucosa is damaged. This type of injury is sewn under partial anaesthesia.

The second option to enlarge the vaginal opening for the baby is to make a small incision. In the past, the perineal incision was standard. Today, experts favour natural perineal tears because they heal better. However, a perineal cut may be necessary if the birth needs to be sped up for medical reasons. If your tissue is more elastic, this can prevent a perineal tear.

Tips for a more elastic perineum:

• From the 34th week of pregnancy, massage the skin around your perineum each day for two to three minutes using a plant oil, such as almond oil, clary sage oil or marjoram massage oil.
• Several times a day, do squats with your knees pointing outwards.
• Or spend a few minutes each day sitting cross-legged.

Water birth

A water birth can greatly ease labour pains, as warm water between 34°C and 36°C eases tension. It also helps give a sense of weightlessness. In the water, a mother in labour can move more freely and it’s easier for her to get into more comfortable positions to ease the pain.

Studies also show that perineal tears are much less common in water births. For the baby, a water birth means less stress.

You cannot have a water birth if your baby is in breech position, if you are giving birth to multiple babies or it is before your 37th week of pregnancy. When deciding whether to have a water birth, you should also consider that if you have any complications, it will be more difficult for the person caring for you to intervene quickly. In a water birth, you will not be able to have pain relief, such as an epidural.

Caesarean section

A caesarean section may be medically necessary or could be a personal preference. Medical reasons can include: changes in the baby’s heart sounds, a prolapsed umbilical cord, the baby is in a breech or transverse position, the placenta is in an unfavourable position, the mother has certain preconditions, the baby is premature, the mother is expecting more than one baby, or it is a stillbirth. An emergency caesarean section during birth can save the mother and child’s lives if there are complications.

Personal reasons for planning a caesarean section can include a negative past experience in childbirth, intense fear of pain or potential injury, or a wish to plan the due date.

Like any operation, a caesarean section comes with risks – including for the baby. The surgery can cause breathing problems, injuries (e.g. cuts), or difficulties bonding with the baby, because the mother does not have direct physical contact with the baby during and straight after the birth. If you have had a caesarean section, try to bond with your baby as much as possible by plenty of skin-to-skin contact.

Discuss your wishes and concerns about childbirth with your nurse or gynaecologist. 

In the first six weeks following the birth, your body will change a lot.

• Your womb will shrink back down. After-birth contractions help your womb to do this.
• Your breasts have to get used to breastfeeding. The tips above can help.
• Your digestive system will need a few days to adapt to your new situation and get back to normal.
• You will have bleeding for four to six weeks after the birth. This bleeding will be heavy at first and then slow down until it is only a white discharge.
• Your pregnancy tummy will probably still be obvious. You should wait eight weeks before you start any abdominal exercises, or ten weeks if you have had a caesarean section. Your midwife or postnatal instructor will show you what exercises you can do after this time.

You will experience these changes and others during your postnatal period. Read about what you can do to ease discomfort.