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The Fibromyalgic Pregnancy and Beyond - Different ways you may give birth

Different ways you may give birth

Every birth is unique! There are a multitude of factors that may influence each form of delivery. Vaginal birth is the most common and so will be the topic for this month. To begin with here is a reminder of the differences between early labour (little or no dilating of the cervix occurs during this phase) and established labour (the time when you should come into hospital if all else is well with you and the pregnancy).

Early Labour

  •  No “bloody show.”
  • Contractions irregular and not progressively closer together.
  • Walking, changing activity or positions may relieve or stop the contractions.
  •  No change in cervix.
  • No dilation 

Established Labour

  •  A “bloody show” may be the first sign. It is usually associated with cramp-like pains.
  •  Contractions get stronger, occur more frequently and last longer.
  •  Walking, changing activity or position doesn’t affect intensity or frequency of contractions.
  •  Cervix dilates.
  • Contractions should be regular and happen at least every ten minutes or more
  • Duration of contractions is 30 seconds or more

Induction of labour

Commonly, induction of labour may be recommended if you go more than 10 - 12 days overdue.  The best way for you to be induced is to have your waters broken followed by an oxytocin drip (drug to stimulate contractions) if required. Women with FM may find that the rapid onset of labour is painful as natural labours usually begin more slowly allowing you to build your endorphin levels.  Ways you can lessen your pain is by walking around the labour room and /or changing your position frequently. Your partner can help by following you with your drip stand. If you go overdue you will also be offered a membrane sweep a week or so before your induction to try and get you to go into labour naturally. 

This involves having an internal examination, with one finger being used to sweep the membranes around the neck of your womb (cervix).  Although this only takes a few minutes to do, it feels like a cervical smear but with more pressure and women with FM may find this very uncomfortable.  You may need to take additional pain relief before your appointment and use a hot water after to ease any cramps you may have. Additionally, even though it will likely be the last thing on your mind, you should try the natural induction method at home before any of these procedures.  This involves sexual intercourse in either the spoon or kneeling position and works quite well.

Monitoring in labour

If your labour has been induced by medical methods it will be suggested that your baby be monitored continuously as changes in the heart rate pattern may be the first sign of a problem. The belt that holds the monitor against your belly can be extremely uncomfortable for women with FM and you may need to ask the midwife for 20 minute breaks from the monitor.  If your baby is coping well, the midwife can listen in with a hand held monitor.  If you are induced or need oxytocin during your labour the midwife will want to perform vaginal examinations every 2 hours to make sure the induction or acceleration of the labour is working. 

Vaginal birth

The first stage of labour starts with the beginning of your regular contractions and is completed when your cervix reaches 10 centimetres dilatation. The first stage of labour can take quite a long time, especially with a first baby. It isn’t at all uncommon for the first stage of labour to last 12 or more hours. Your contractions will begin gradually and build up to up 4 every 10 minutes towards the end of the first stage of labour.  Fighting against the contractions can lead to additional strain for muscles already compromised by FM.  If your labour has begun naturally, without medical induction then a birthing pool may be ideal for help in relaxing into your contractions.

It takes active concentration to relax muscles but you may already have experience of doing this when suffering a flare up, in which case you are miles ahead of women in labour who do not have FM. I have found that women with FM, on the whole, have much higher pain thresholds than women without and cope much better with labour, needing much less pain relief than they expected.

 The second stage of labour starts when your cervix is fully dilated and is completed with the birth of your baby. The second stage of labour is much shorter than the first stage, usually between 1 -3 hours. By now your cervix has dilated enough for your baby’s head to pass through and when the head has moved low enough you will begin feeling urges to push.  This stage may make you feel quite shaky as your muscles will be tired from the first stage but you will be surprised at the surge of energy you get with these contractions.  You are much stronger than you realise.  It may feel like your bowels are moving, but don’t worry about this... it is just the pressure of the baby’s head on your back passage.

Each time you have a contraction, the baby moves farther and farther down.. As you bear down, or push, your baby’s head begins to appear. Between contractions it will recede a little but will move further down with each push and finally, your baby is born!  You will be encouraged to gather up your baby into your arms and if you do not feel able to do this, the midwife or your partner will pass you your child.  A new LIFE! A new person in the world! Congratulations, it was probably scary, it probably hurt a lot at some points but the reward in your arms was worth every second.  You’ll feel exhausted and excited; all your great expectations are here, finally. Congratulations to you both, you have already done a most important parenting task, you are already fantastic parents and the most special people in the universe to your child…keep up the good work.

 The third stage of labour begins after the birth of your baby and is completed with the delivery of the placenta. The third stage of labour is the passing of the afterbirth, or placenta. If all went well with your delivery and your blood loss is within normal limits, you can ask your midwife for a natural 3rd stage.  Another option is to have an injection to make your womb clamp down and this shears your placenta off so that your midwife can gently pull it out. Then it’s time for a warm bath, food, and bonding with your new baby. Some hospitals will allow you to pay for a private room so that your partner can stay with you both.  If this is not an option for you, make sure you explain what help you will need and ask for it when you need it!  The staff may not have a thorough understanding of the help you require because of FM and will treat you like the other women on the ward unless you ask for assistance. 

Assisted deliveries

There are two types of instrumentally assisted vaginal birth techniques; the vacuum extraction method and the use of forceps.  These are usually performed by obstetricians although in a few hospitals in England there are some midwives who have been trained to perform these procedures.

 Vacuum extraction is used to assist the birthing of your baby by applying suction to your baby’s head.  This technique may be suggested if you have done most of the work of birthing your baby on your own but have run out of energy just before the end. The vacuum cup will be applied to your baby’s head, the suction started and as you push the doctor will gently angle and pull on your baby’s head at the same time. It should not cause any trauma to you as the cup and hose are soft but your baby’s head may have a blister for several days after wards. 

The paediatrician can prescribe some painkillers for your baby if necessary. If you need help birthing your baby vaginally, have done most of the work yourself and your baby is not distressed, then this is the best method for women with FM.  It should cause no extra physical trauma to you and will speed the end of a long labour that has exhausted you.  Then you can regain your strength as you gaze adoringly at your baby, or while you sleep while your birth partner spends some time gazing adoringly at your baby.

 Forceps are used if the baby or yourself are physically distressed or threatened by your labour continuing and if the baby is at an appropriate depth in your birth canal for this method to be effective.  For this procedure you will need an episiotomy (a cut to your labia) to widen the working area where the doctor will need to insert the forceps and clamp them around either side of your baby’s head.  There may be some damage to your vagina or rectum and you will need stitches to help close the area where you were cut. The operating theatre team will be on standby before the doctor begins a forceps delivery in case the baby’s head does not come down and deliver.  If this is the case then you will need a caesarean section.

 Caesarean section is the third type of assisted birth and involves delivery of your baby through a cut in your abdomen. It is used when a vaginal delivery is not possible or there is an urgent danger to you or your baby during labour. Some women mistakenly believe that this is the most sensible way to birth a baby is by pre planned caesarean section as no labour will be involved.  This is not correct as labour is a natural state for a woman’s body to be in at the end of pregnancy and you will heal much faster from a natural birth than from a surgical birth.

If a caesarean is required then you will need to have an epidural inserted or, for emergency procedures, you will need a general anaesthetic. Caesareans are somewhat more risky because they involve major surgery and some type of anaesthesia and infections, bleeding and wound complications occur more frequently with caesarean births. However, if you have had a caesarean because you or your baby’s health was at risk then the value of this operation far outweighs the risks.

 Vaginal Birth after Caesarean (VBAC). Until very recently, most thought that once a woman had a caesarean birth, any future babies should be delivered by a repeat caesarean. Today, an effort is being made to allow certain women to deliver vaginally after a previous caesarean birth. This option is not appropriate for everyone, but you can and should consider discussing this with your obstetrician.  When compared to another caesarean birth, VBAC is associated with a shorter hospital stay, easier and faster recovery and an earlier resumption of your normal state of health. 

When do I need to choose?
It is sensible to have an idea of what you want to do early in the pregnancy and I would recommend that you discuss your options with the consultant and midwife at your 20 week visit.  A number of things can happen during your pregnancy that may alter your final plans so I suggest that you finalise your delivery choice at about 36 weeks.

Please remember that natural vaginal births are the normal way to have your children and the least physically stressful even with FM. 

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