Giving birth, to the firtst born especially, is often mostly a matter of time and patience. It is a tough, but also a special proces, your child is going to be born! We are here to help and support you. We help you cope with contractions, give tips on posture and are there fro you to answer all your questions. In addition, we of course monitor how you and your child are doing. Indicat what you like, this can be done in advance via a birth plan (link), but is also possible right there and then. We are happy to support in your preferences. If you feel comfortable, it is best to relax, this helps with the contractions and encourages the course of the birth.
How does it start..
With slimy blood loss.
This is called “drawing.” You then lose some blood mixed with mucus. A bit like your period. This does not always mean that you are giving birth right at that time, but it is usually within a week. So: wait. If you do not trust it, you can of course always call to consult us, but in general you can say: normal until a sanitary towel is full, when there is more blood loss you should call us.
A contraction is when the muscles of your uterus tighten up like a fist and then relax. Your belly becomes a hard ball, this lasts for about a minute. Afterwards your belly relaxes and a few minutes later the next one comes. In the days before the birth you can already notice that you occasionally have some light, irregular cramps.
Membranes can rupture at any time: before the contractions begin, during the contractions or when the pushing begins. If the membranes do not rupture on their own, we will do so at some point. Rupture of the membranes, both done spontaneously and by us, is not painful.
If the membranes spontaneously rupture, you sometimes hear a “Snap” and then fluid runs out of you that you cannot stop. Sometimes it is a whole stream in one go, sometimes it also comes in small bits. Try to catch something (in a panty liner that you then put in a buttoned plastic bag or in a sealed clean jar). Sometimes you will not be sure if the amniotic fluid that is coming out of you is because you may have some urine loss or a thin discharge.
Then just wait and see: urine loss is short-term, amniotic fluid continues to drain. If in doubt:
call us to consult.
Amniotic fluid is usually clear, whitish or slightly pink in colour. These are the “good” colours. We would like to know that the membranes are ruptured, so please call us to let us know. If it is at night you can wait until the morning. We will come over during visiting times. If the amniotic fluid is green or brown, the baby may no longer find it as comfortable in your stomach. You have to call us immediately and we will come and see you immediately. Even if the baby has not descended at the end of your pregnancy and your membranes rupture, you must call us immediately: we will immediately come over to see if the baby has descended.
Usually the delivery starts with irregular yet not so powerful contractions. For example, one moment you have 4 contractions in 10 minutes, then again nothing for half an hour. This is the start-up period before the “real” work. At some point, regularity starts to come. If the contractions regularly come within 5 to 10 minutes for a longer period of time, you can be pretty sure that the birth will now continue, but it is good to realize that you are still in the start-up phase of the birth. Hereby mainly “maturation” of the cervix takes place (the softening and effacing of the cervix).
Imagine the womb as a large inflated balloon with a spout that is closed like a cervix. The end of the cervix is usually closed during pregnancy. During the pregnancy the cervix feels like the tip of your tongue when you stick it out and push it against your finger: fairly firm. The cervix is usually centered backwards, but sometimes it is also in the middle or a bit more to the left or right. When the birth starts, the cervix must first become soft, like your tongue when you keep it limp or the inside of your cheek. The cervix must then be placed centrally. This means that the cervix will be placed directly in front of the exit (vagina), so no longer to the rear but in the middle. At the same time the cervix effaces: the cervix shortens. A balloon that is inflated to the limit, so that there is almost no mouthpiece left that you can hold between your fingers. When the cervix has completely effaced, the nozzle has disappeared. Effacing therefore means that the cervix becomes shorter, flattens and eventually disappears.
After the softening, centering and effacing of the cervix, the dilating begins and gradually opens. When your cervix is completely open, you have complete dilation: 10 centimetres. The cervix can no longer be felt. The road is clear and the pushing can begin. With a second or subsequent child, the effacing and dilating are often the same, which means that dilating can proceed faster. There is already some dilation while you can still feel a spout.
The dilating proceeds in two phases: the latent and the active phase
The first part of the dilating is called the latent phase. This can take a long time. In addition to opening the cervix, it must also become more flexible and thinner. It may be that when we come to see it for the first time and establish 2cm dilation during the examination and only 1cm more three hours later, while a lot has actually happened to relax your cervix, but this cannot be measured properly.
If the contractions are coming within 5 minutes with a first child you can generally say that now the dilation is coming. The contractions occur regularly, are painful and last 30-45 seconds. Then the cervix opens slightly to 3 to 4 centimetres. The contractions are usually easy to cope with during this period. Sleeping is often no option anymore, but you can still talk through it and participate in a conversation or talk to us on the phone. You are also well aware of your environment.
The advantage of this phase is that you can gradually get used to the contractions. They can usually be well received now, so you have the chance to find the most relaxing way to deal with it.
Certainly with a first delivery this is the first job that needs to be done. The latent phase lasts an average of 7.5 hours with a first child, but can just as well last 12 or even 20 hours. The average duration for a second or subsequent child is 5 to 12 hours. Sometimes the latent phase goes more or less unnoticed during the last weeks or days of the pregnancy. This is often the case when it concerns a second or subsequent child. At a certain point the contractions become a lot more intense, appear every 2 to 3 minutes and are difficult to cope with; you need a lot of concentration. Now you are in the active phase of delivery. This goes a lot faster. You can read more about this here.
Tip: if you are still at the beginning of dilating, try to get some sleep. You will not be able to have a deep sleep, but you will be able to rest a bit between contractions. Also look for some distraction: for example, go water the plants, bake a cake, watch a movie together, play a game or whatever you want.
We speak of the active phase when you are 3 to 4 centimetres dilated. The contractions now come more often, every 2 to 3 minutes, more powerful (so more painful) and can last for a minute. These are the heavy contractions that can cause dilation and for which you have to put all your concentration in place to deal with them. Chatting or participating in a conversation is no longer possible and you often no longer feel like eating. In this phase you can also lose some blood and mucus. Dilating is hard work, especially when it comes to a first child. In between contractions you often have a minute to three minutes of rest until the next contraction. This continues up to 10 centimetres of dilation. then the expulsion phase (pushing) can begin. During the dilation we come by several times, sometimes at intervals, to check how things are going and how far you are. We provide tips for relaxation in between contractions and for taking care of contractions, for example a different position or a hot shower. We listen to the heartbeat of the child, feel your belly and will do internal research. If the dilation is well advanced, or if you need it sooner, we will stay with you or go to the hospital and call the maternity nurse to help us.
Nausea is common during dilation, we often see this between 3 and 7 cm. The most important thing when dilating is your relaxation and to be timeless. A birth does not stick to the clock. Dilating a first child takes on average 12 to 24 hours, but can also take 4 hours or 40 hours. The length does not matter for the final result, as long as you can find your rest and you can keep up.
The last mile is the longest. It is now going quick. The baby now drops considerably in the pelvis, so that you feel more pressure on the anus. That feels like a “press urge” or a “poop feeling.” You often also start losing more mucus and blood. Yet there is still no full dilation and you cannot push just yet. Also in this phase it helps to stand under a warm shower or take a warm bath if the situation permits, we will advise you on this. Changing postures is often nice, for example hanging over a table or lying on your side. Many women find a hard back massage enlightening and it also helps some women to make a noise.
The last 2 centimetres of the dilation, from 8 to 10 centimetres, you often feel restless and you feel that you can no longer sustain it: also called the transition phase. Many women find this final phase the toughest. The contractions are now powerful and painful. They come every 2 minutes on average and last for a minute. Postures (foldable)
During the birth it can help to change positions, to further contractions and to give the child as much space as possible to move forward. Choose a position that makes you feel most comfortable.
We carefully feel with 2 fingers he degree of softening and effacing of the cervix, the dilation, how far the head has descended, whether the membranes are still intact and what the position of the head is.
At a given moment you have complete dilation, this is 10 cm. You usually lose more blood and usually have an untenable urge to push. The pushing takes an average of 1 hour for a first child. Take a position that you find most comfortable (we also have a birth stool if you wish)
We regularly listen to the heartbeat of your child to see if he / she is doing well.
During the expulsion, the head gradually turns further into the pelvis. We sometimes say: with pushing the head decreases 3 steps forward and 2 steps backwards, that is: it goes very gradually. At the first part of the pushing you cannot see anything from the outside, this is normal. After a while you see more and more of the head and you also feel more pressure on the bottom. After the head is delivered, the rest of the body will follow shortly, often during the same contraction.
We place your baby on your abdomen: the big reward for your hard work! If the umbilical cord is beat out, it will be cut by your partner or yourself or by us if you wish. Your child will stay on your abdomen, warmly covered with a cloth and a cap: you can now get to know each other and enjoy each other! We think it is important that your baby lays comfortably with you for an hour on average, this is good for starting breastfeeding and good for getting to know you. If you have other wishes, we will of course respond to this.
Also at the birth of the baby we have extensive experience in supervising childbirth with alternative postures, namely the vertical posture on the birth stool, in the side position, on hands and knees, standing and giving birth in the bath. These postures have many advantages over the supine position. It is therefore important during your birth to discover for yourself which position you like. Of course we also give you advice. For examples of different postures click here.
In addition to various positions, there is also the option of giving birth in the bath. Hot water is relaxing. No wonder that more and more women are opting for a bath birth. It helps to tolerate the pain of contractions better. This allows you to relax better and the delivery is generally smoother and less stressful. Moreover, for the baby it is a more pleasant transition from the warm amniotic fluid to the warm bath water than to the “cold outside air”. For more information about bath deliveries and necessities click here.
After a while you will feel a contraction of your uterus again (a kind of “half contraction”) and the placenta will come loose. Push one more time and the placenta is born, generally without much effort. After the birth of the placenta we will check if you need to be stitched and if you don’t lose too much blood.
For more information about the preparation for the birth, various positions and how to deal with pain look here. Pregnancy courses and information evenings can be found here and for more information about the birth plan look here.
You can always call us when you are worried or have any questions. In addition, there are a few situations where you should call us:
If you are not yet 37 weeks pregnant and there are signs that the birth has begun, call us immediately.
In case of blood loss more than one sanitary towel full. A little bit of bright red with some mucus is normal, in case of doubt or concern you can always call.
When giving birth to a first child with regular contractions every 4 to 5 minutes for 1 hour. The contraction should last for about 1 minute. If you still manage to properly cope with contractions, you can wait until the contractions get closer more smoothly and / or are harder to cope with. – When giving birth to the next child when the contractions occur every 5 minutes and you have to make an effort to catch them.
Rupture of the membranes (breaking the water):
Tip: Are you unsure whether your membranes are ruptured? Try to collect some fluid. If it is possible, in a clean jar with a lid or otherwise keep a panty liner or underwear, if it is nice and wet, in a buttoned plastic bag.
If your pregnancy goes well without problems, you can choose where you want to give birth.
This can be at home or in an outpatient clinic at the ZGT Almelo or MST Enschede.
It is important that you choose a place where you and your partner feel relaxed. Relaxation is important during the delivery, it helps you to cope with the contractions and makes the delivery more successful. Whether you give birth at home or in an outpatient clinic, we are here to support you and you will receive extra help from a maternity nurse. We will discuss your wishes with you during your pregnancy. However, it may be that during the delivery you think differently about it, make sure you indicate this. Then we will look together with you what is the best and most sensible for you.
It is possible that during the delivery there is still a reason to transfer the delivery to the gynaecologist and clinical obstetrician at the hospital. For example if you want pain relief or the baby has pooped in the amniotic fluid. We will ensure that we transfer you well in the hospital.
If you give birth at home, we will come to support you together with a maternity nurse. You give birth in your own bed and after the birth you take a nice shower, while your bed is changed. The advantage of this is that if there are no complications you do not have to relocate and you are in your own environment.
What do you need to prepare at home for a home birth:
The maternity package · A tarpaulin on the mattress, from shoulder to foot end or a mattress cover – 2 buckets, one with a garbage bag in it · Aluminium foil · 10 ironed cotton diapers · A chamber pot (to rent from thuiszorg) · Clumps under the bed (or beer- / soft drink crates) · A roll of toilet paper
Furthermore, ensure a room temperature of approximately 23 degrees (maternity room and baby room) and adequate lighting. You can also fill two hot water bottles with boiling water and put it in the bed, wrapped around baby clothes.
If the room in which you want to give birth is in the attic and / or with a steep or “difficult” staircase or spiral staircase, consult us if this room is a suitable choice.
Tip: switch on an outdoor lamp in the evening so that we can find your house more easily.
If you opt for an outpatient birth then you give birth in the delivery rooms in the hospital. You can see this as a displaced home birth. You will take care of the first contractions at home and you will go to the hospital when the opening up goes quick. We usually drive with you to the delivery room. It can be useful and relaxing to already drive the route to the hospital during the pregnancy. In the hospital, the maternity assistant will assist you and us with the delivery. If everything goes according to plan, you will go home with your baby about two to three hours after the birth.
It is important to know that you have to pay a personal contribution for an outpatient birth.
Consult your health insurance policy for this.
What do you put in your hospital bag:
A shirt to give birth in. – Clean things for yourself, comfortable clothing for after the birth. – Clothing for the baby (2 sets): romper, pants, sweater, socks and a cap. Toiletries, also think of your glasses and things for your lenses, toothbrush, etc. – 2 euros for the wheelchair (if you go to the MST) – giving birth is also a lot of waiting around so bring a book, magazine, IPad etc.- do not forget chargers for your phone, IPad and camera